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 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.
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