Conflicts and Compromises in Not Hiring Smokers

From the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center (D.A.A., K.G.V.), and the Perelman School of Medicine (D.A.A., K.G.V.), the Wharton School (D.A.A., K.G.V.), the Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics (D.A.A., R.W.M., K.G.V.), and the University of Pennsylvania Health System (R.W.M.), University of Pennsylvania - all in Philadelphia.
New England Journal of Medicine (Impact Factor: 55.87). 03/2013; 368(15). DOI: 10.1056/NEJMp1303632
Source: PubMed


Tobacco use is responsible for approximately 440,000 deaths in the United States each year - about one death out of every five. This number is more than the annual number of deaths caused by HIV infection, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined(1) and more than the number of American servicemen who died during World War II. A small but increasing number of employers - including health care systems such as the Cleveland Clinic, Geisinger, Baylor, and the University of Pennsylvania Health System - have established policies of no longer hiring tobacco users. These employers . . .

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    • "Approaches include smoke free air laws (Tynan et al., 2011), media campaigns (Wakefield et al., 2010), and pictorial health warnings on tobacco products (Cameron et al., 2015; Hammond, 2011; Monarrez-Espino et al., 2014). In addition, some organizations have instituted antismoking policies such as prohibiting the hiring of smokers (Asch et al., 2013) or requiring higher health insurance premiums for smokers (Madison et al., 2013). Alongside changes in social attitudes , these policies could contribute to the stigmatization of smokers (Bayer, 2008; Bell et al., 2010a). "
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    ABSTRACT: Objective: Little is known about the consequences of tobacco smoking stigma on smokers and how smokers may internalize smoking-related stigma. This review summarizes existing literature on tobacco smoking self-stigma, investigating to what extent smokers are aware of negative stereotypes, agree with them and apply them to themselves. Methods: We carried out a systematic search of Pubmed/Web of Science/PsycInfo databases for articles related to smoking self-stigma through June 2013. Reference lists and citations of included studies were also checked and experts were contacted. After screening articles for inclusion/exclusion criteria we performed a quality assessment and summarized findings according to the stages of self-stigma as conceptualized in Corrigan's progressive model of self-stigma (aware, agree, apply and harm). Initial searches yielded 570 articles. Results: Thirty of these articles (18 qualitative and 12 quantitative studies) met criteria for our review. Awareness of smoking stigma was virtually universal across studies. Coping strategies for smoking stigma and the degree to which individuals who smoke internalized this stigma varied both within and across studies. There was considerable variation in positive, negative, and non-significant consequences associated with smoking self-stigma. Limited evidence was found for subgroup differences in smoking-related stigma. Conclusion: While there is some evidence that smoking self-stigma leads to reductions in smoking, this review also identified significant negative consequences of smoking self-stigma. Future research should assess the factors related to differences in how individuals respond to smoking stigma. Public health strategies which limit the stigmatization of smokers may be warranted.
    Social Science [?] Medicine 09/2015; 145. DOI:10.1016/j.socscimed.2015.09.026 · 2.89 Impact Factor
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    ABSTRACT: Objective We attempted to estimate the excess annual costs that a US private employer may attribute to employing an individual who smokes tobacco as compared to a non-smoking employee. Design Reviewing and synthesising previous literature estimating certain discrete costs associated with smoking employees, we developed a cost estimation approach that approximates the total of such costs for US employers. We examined absenteeism, presenteesim, smoking breaks, healthcare costs and pension benefits for smokers. Results Our best estimate of the annual excess cost to employ a smoker is $5816. This estimate should be taken as a general indicator of the extent of excess costs, not as a predictive point value. Conclusions Employees who smoke impose significant excess costs on private employers. The results of this study may help inform employer decisions about tobacco-related policies.
    Tobacco control 06/2013; 23(5). DOI:10.1136/tobaccocontrol-2012-050888 · 5.93 Impact Factor
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    ABSTRACT: In many countries around the world, including Iran, obesity is reaching epidemic proportions. Doctors have recently taken, or expressed support for, an extreme 'personal responsibility for health' policy against obesity: refusing services to obese patients. This policy may initially seem to improve patients' incentives to fight obesity. But turning access to medical services into a benefit dependent on health improvement is bad policy. It conditions the very aid that patients need in order to become healthier on success in becoming healthier. Whatever else we may think of personal responsibility for health policies, this particular one is absurd. Unfortunately, quite a few personal responsibility for health policies use similar absurd conditioning. They mistakenly use as 'carrots' or 'sticks' for adherence the basic means to the same health outcomes that they seek to promote. This perspective proposes the following rule of thumb: any conditional incentive for healthy choice should be in a currency other than the basic means to that healthy choice.
    International Journal of Health Policy and Management (IJHPM) 08/2013; 1(2):107-10. DOI:10.15171/ijhpm.2013.18
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