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http://www.huffingtonpost.com/2010/02/24/french-oral-sex-antismok_n_474909.html?

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Associated Press reporters Raphael Satter in London and Jan Olsen in
Copenhagen contributed to this report.
French 'Oral Sex' Anti-Smoking Ad Sparks Scandal (PHOTOS) 2010
A provocative anti-smoking ad campaign featuring teens in a subservient sexual position has
sparked a storm of controversy in France, with the country's family minister calling Wednesday
for the advertisements to be banned.
The ad, sponsored by the Association for Nonsmokers' Rights, features a teenage boy who could
be construed to be performing oral sex on a man in a suit, except the teen has a cigarette in his
mouth. A caption reads, "Smoking means being a slave to tobacco." There are two other ads in
the same vein, one featuring an adolescent girl.The leader of the organization behind the
campaign acknowledged the ads were meant to shock and said such provocative campaigns were
the only way to reach young people.
"Traditional advertisements targeting teens don't affect them. Talking about issues of health,
illness or even death, they don't get it," the group's director, Remi Parola, told The Associated
Press in an interview. "However, when we talk about submission and dependence, they listen."
Parola insisted the ads developed pro bono by the BDDP & Fils advertising agency were not
really about sex at all.
"The visuals have a sexual connotation, that I can't deny, but it's really a way to start a discussion
with young people to get them to understand the dangers of smoking."
Family Minister Nadine Morano thinks otherwise. Speaking Wednesday on RMC radio, Morano
added her voice to the growing chorus of those offended by the graphic ads.
"I think this might constitute an affront on public decency, indecent exposure," she said, adding
that she is looking into getting the ads banned. "There are other ways to explain to teenagers that
cigarettes are addictive."
Representatives of pro-family groups have also denounced the ads as ineffective and even
pornographic and called for them to be banned.
The spokeswoman for the Families of France association, Christiane Therry, denounced the ads
as "stupid."

"It makes no sense. An advertisement, even a provocative one must be decipherable and
understandable, it should create a message, transmit a message," she said. This campaign "gives
the impression of being more about sexuality than about anti-smoking. This is what bothers us."
The advertisements have not yet been used in France, but photos of them have accompanied
media stories published since the association announced the launch of the campaign Monday.
Ironically, the ad agency said that it no longer really matters whether the campaigns end up
appearing in magazines, as originally planned.
"What's funny here is that those who are making a flap over the ads, saying they are indecent, are
the ones who are promoting the campaign," the BDDP & Fils agency's vice president, Marco de
la Fuente, told The AP in a telephone interview. "This campaign has made a splash thanks only to
them."
France has long battled teenage smoking. Despite a 2008 ban on smoking in bars, restaurants and
other public places and efforts to crack down on those who sell cigarettes to minors, the habit
remains prevalent among the country's youth. Fully one-third of 17-year-olds here smoke,
according to a recent study by the French Watchdog of Drugs and Addictions.
France is no stranger to grisly or hard-to-watch public interest ad campaigns. Recent road safety
posters featured close-ups of the mangled bodies of accident victims, while a TV spot featured
violent car crashes taking place in real time.
Other provocative anti-smoking campaigns have made waves throughout Europe. Britain's
advertising watchdog received hundreds of complaints after the Department of Health put up
posters showing grimacing smokers with fishhooks piercing their cheeks as part of its 2007 "Get
Unhooked" campaign.
In Denmark, ads showing bleeding brains and body parts drew some criticism, while others
contended the blood-soaked campaign which appeared in newspapers, on TV and the Internet
and in pharmacies was highly effective.
http://www.huffingtonpost.com/entry/adele-quitsmoking_5676e9dae4b0b958f65707a6?utm_hp_ref=smoking
Adele Feared For Her Life After Smoking 25 Cigarettes A Day 2015
Cole Delbyck
Adele has spoken recently about entering a new stage in her life. It turns out that breaking a bad
habit might have been crucial in that process.

The 27-year-old revealed Friday that she quit smoking because she feared it would eventually
kill her.
According to The Mirror, Adele was smoking up to 25 cigarettes a day before she stopped
performing in 2011 and underwent vocal cord surgery to prevent permanent damage to her
voice.
"If Id carried on smoking Id probably have died from a smoking-related illness and I think
thats really bad," she told The Mirror. If I was dying from lung cancer I would have potentially
given it to myself and that wouldnt be something Id be proud of.
In her cover story for Rolling Stone, the Grammy winner credited her new outlook to her 3-yearold son, Angelo.
"I absolutely loved [smoking], but it's not that fucking cool when I'm dying from a smokingrelated illness and my kid is, like, devastated," she revealed.
In a 2011 interview with People, below, the singer described how she noticed a difference in her
voice since she put down the cigarettes.
http://www.huffingtonpost.com/entry/smoking-secondhand-smoke-tied-toinfertility-and-early-menopause_5671c42ae4b0648fe301f465?
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Secondhand Smoke Tied To Infertility And Early Menopause
Andrew M. Seaman 2015
Smoking and exposure to secondhand smoke is tied to infertility in women and early menopause,
according to a new study.
Compared to women who never smoked and those exposed to the least secondhand smoke,
women who smoked or were exposed to the most secondhand smoke were more likely to have
problems getting pregnant and more likely to enter menopause before age 50, researchers found.
Andrew Hyland of the Roswell Park Cancer Institute in Buffalo, New York, who led the
research, said earlier studies had linked smoking to reproductive issues in women, but few had
looked at links between secondhand smoke and infertility and early menopause.
"The literature really wasnt clear particularly with secondhand smoke," Hyland told Reuters
Health.

Hyland and colleagues analyzed data on 88,732 U.S. women who enrolled in the Women's
Health Initiative Observational Study between 1993 and 1998, when they were between the ages
of 50 and 79.
Based on questionnaires the women completed at the start, about 15 percent met the criteria for
infertility, which is the inability to get pregnant for at least a year. About 45 percent also met the
criteria for early menopause, which occurs before age 50.
Compared to women who never smoked, researchers found that those who reported being active
smokers at some point in their lives were 14 percent more likely to have infertility and 26
percent more likely to enter menopause early.
Women who smoked the most reported entering menopause about two years earlier than women
who didn't smoke, the researchers report in the journal Tobacco Control.
Women who never smoked but were exposed to the most secondhand smoke were 18 percent
more likely to have problems getting pregnant and to enter menopause at an early age, compared
to women who never smoked and were exposed to the least amount of secondhand smoke.
While an 18 percent increased risk may seem modest, Hyland said it's large considering
infertility and early menopause are not uncommon.
"There are a lot of events that could be attributed to these exposures," he said.
Hyland cautions that the study can't prove smoking causes these problems. The research team
did, however, adjust the data to account for other factors that would be tied to infertility and early
menopause.
The study also can't say what may underlie the link between smoke exposure and infertility and
early menopause, but Hyland said other research suggests that smoke exposure may affect
hormone levels.
It appears the association is driven by smoke exposure throughout a woman's lifetime, he said.
"As for a recommendation to clinicians, you should advise women of reproductive age to limit
their exposure to minimize these outcomes," said Hyland.
HUD Seeks To Ban Smoking In Public Housing
Jennifer C. Kerr 2015
http://www.huffingtonpost.com/entry/hud-seeks-to-ban-smoking-in-publichousing_5644daa4e4b045bf3dee2fbf?utm_hp_ref=smoking

WASHINGTON (AP) Smoking could soon be banned in the nation's public housing.
The Department of Housing and Urban Development proposed a rule Thursday to require the
more than 3,100 public housing agencies across the country to make their properties smoke-free.
"We have a responsibility to protect public housing residents from the harmful effects of
secondhand smoke, especially the elderly and children who suffer from asthma and other
respiratory diseases," HUD Secretary Julian Castro said in a statement.
Castro says the ban would protect the health of more than 760,000 children and save about $153
million a year in health care costs, repairs and preventable fires.
The rule would ban lit tobacco products in all residences, indoor common areas and
administrative offices. Smoking also would be prohibited outdoors within 25 feet of housing and
administrative buildings.
In 2009, HUD began encouraging public housing agencies nationwide to adopt smoke-free
policies in their buildings and common areas. Currently, there are more than 228,000 public
housing units that are smoke-free. The proposed rule would impact the more than 940,000 units
where smoking is allowed.
The nation's surgeon general says the rule is needed to protect public housing residents from the
dangers of secondhand smoke.
"Everyone no matter where they live deserves a chance to grow up in a healthy, smokefree home," said Vivek Murthy. "There is no safe level of secondhand smoke."
The public has 60 days to comment on the rule. The ban would take effect 18 months after the
rule is finalized.
Lisa Rapaport
Chronic Smoking Makes Breast Cancer Three Times More Deadly

http://www.huffingtonpost.com/entry/chronic-smoking-habits-makes-breast-cancer-three-timesmore-deadly-according-to-new-report_55afca7ce4b0a9b948534a4e?utm_hp_ref=smoking 2015
Long-time smokers may face an increased risk of death if they develop breast cancer, according
to a Japanese study that adds to a growing body of evidence highlighting the lethal effects of

cigarettes.
Among more than 800 women with breast cancer, those who had smoked for more than two
decades had at least triple the odds of dying of any cause, or from breast cancer in particular,
compared with women who never used cigarettes.
Fewer years of smoking were also linked to an increased risk of death from breast cancer, but the
extra risk was so small that it might have been due to chance.
Other studies have explored the connection between smoking and survival among breast cancer
patients, but the current research is among the first to assess the impact of the duration of
smoking on outcomes for women with this type of tumor, said study co-author Dr. Masaaki
Kawai, a breast oncologist at Miyagi Cancer Center Hospital in Japan, in email to Reuters
Health.
Worldwide, breast cancer is the most common malignancy in women. About one in nine women
will eventually develop it, according to the National Institutes of Health. The risk increases with
age, from 1 in 227 at age 30 to 1 in 26 by age 70. Factors such as obesity, inactivity, alcohol use
or early menstruation can increase the risk.
For the current study, Kawai and colleagues followed 848 women who were treated at the
Miyagi Cancer Center Hospital between 1997 and 2007 for newly diagnosed breast cancer.
Women who described themselves as current smokers were typically younger when their breast
cancer was diagnosed, about 49 years old on average, compared with 53 for women who claimed
to be former smokers and 58 for nonsmokers.
The current smokers also tended to weigh less, have more advanced tumors, and have fewer
health complications than the other women in the study.
With half of the women in the study followed for at least seven years, the researchers saw 170
deaths from all causes - including 132 deaths from breast cancer.
Roughly one third of the women hadn't yet gone through menopause when they started the study.
In this subset, those who had smoked for more than about 21 years were three times more likely
to die of any cause, and nearly three and a half times more like to die of their breast cancer, than
those who never used cigarettes.
Researchers also examined exposure to second-hand smoke among women whose husbands
were current or former smokers and found no significant impact on the women's risk of death
from any cause or from breast cancer specifically.

One limitation of the study is its reliance on patients to accurately report information about their
exposure to cigarettes, the researchers acknowledge in the journal Cancer Science. The study
also lacked data on second-hand smoke that didn't come from the women's spouses.
Even so, the findings add to a growing body of research pointing to the specific risks smoking
poses for women with breast cancer, said Peggy Reynolds, a researcher at the Cancer Prevention
Institute of California and Stanford University School of Medicine.
"There are now quite a few studies suggesting that active smokers diagnosed with breast cancer
have poorer survival - not to mention accumulating evidence that smokers may have a greater
risk of developing breast cancer," Reynolds, who wasn't involved in the study, said by email.
This study, however, didn't look at whether smoking causes breast cancer.
Even if not all of the evidence is conclusive, it should still be enough to motivate patients to
abandon cigarettes, said Mia Gaudet, strategic director of breast and gynecologic research at the
American Cancer Society in Atlanta, in an email.
"Regardless of whether or not a woman has breast cancer, quitting smoking is likely to be the
best lifestyle change a woman can make to improve her health," she said.
Lindsay Holmes 2015
http://www.huffingtonpost.com/entry/what-youll-look-like-if-you-dont-quitsmoking_55e99565e4b093be51bb2a06?utm_hp_ref=smoking

Dr. Judson Brewer


http://www.huffingtonpost.com/dr-judson-brewer/smoking-workplace_b_3203906.html
Here's yet another reason to kick that smoking habit for good: Your physical appearance.
In the video above, BuzzFeed and a makeup artist teamed up with Taylor Hays, director of the
Nicotine Dependence Center at the Mayo Clinic, to transform three smokers' faces to show what
they'll look like in the future if they continue the habit. The results are an eye-opening insight
into the damaging effects cigarettes have on the body.

Some of the changes these smokers will experience are deepened wrinkles, particularly around
the mouth, yellowed teeth and saggier face tissue overall, Hays told BuzzFeed.
While the physical aspects are certainly alarming, the scariest byproduct of smoking is the health
risk it imposes internally. The habit is the leading cause of preventable death in the United States,
according to the Centers for Disease Control. Smoking can lead to lung cancer, emphysema and
cardiovascular disease and has the potential to negatively impact every organ in the body. Talk
about a reality check.
"If this is what my outside appearance looks like from smoking cigarettes, I cannot even imagine
what my insides look like," Meredith, one of the smokers, states in the video after her
transformation. "It's not worth it."
We totally agree. Watch the full transformation above and check out these tips to help you quit
smoking ASAP.
http://www.huffingtonpost.com/dr-judson-brewer/smoking-workplace_b_3203906.html 2013
Should We Ban Smokers? Some Companies Are
Dr. Judson Brewer

Over the past decade, we have seen an increase in the number of places where smoking is banned
-- bars, restaurants, clubs and so on. The days when smoking was allowed on airplanes seems
like ancient history. Now we are seeing the trend of "smoke-free workplaces" across the country
-- including here at Yale-New Haven Hospital. And these measures seem to be helping: Studies
in the U.K. showed far-reaching effects of these bans, from improvements in asthma to reducing
hospital admissions due to heart attacks.
If this is so helpful, should we just ban smokers?
This seems a bit extreme, but over the past few years, some companies have taken to policies of
not hiring smokers. That's right: If you smoke, you can't work here. But isn't that discrimination?
Some states think so -- 29 states have instituted laws making these practices illegal. But the rest
of the country hasn't, and large companies such as Alaska Airlines and Union Pacific Railroad
have stopped hiring smokers altogether. Some argue that this has helped cut down on smoking.
The Cleveland Clinic, the largest employer in Cuyohoga County, Ohio, stopped hiring smokers
in 2007. Between 2005 and 2009, the smoking rate in the county dropped from 21 percent to 15
percent, whereas the rate for the state as a whole only dropped from 22 percent to 20 percent.

What isn't known is whether this hiring practice actually led people to quit smoking or just move
out of town because they could no longer get employment.
It has long been known that smoking rates vary greatly between different socio-demographic
groups. For example, 32 percent of adults who haven't graduated from high school smoke,
compared to only 13 percent of college graduates. And as a recent New England Journal of
Medicine article pointed out, the smoking rates for unemployed people are about 45 percent
whereas they are much lower for those with full-time employment (28 percent). Is not hiring
smokers adding insult to injury? The authors of a companion article in the New England Journal
of Medicine have argued that these "tough love" policies, not hiring smokers or even firing
smokers, "may indeed be for their own good." These policies are certainly good for the
employers, as it costs them an estimated $3,000-$4,000 extra per year for employees who smoke
vs. those who don't (mainly due to lost productivity and health-related issues).
Interesting. "You smoke, so I'm not going to hire you. Your obvious next step is to quit
smoking." Or better yet, "You smoke, so I'm going to fire you so you'll stop smoking." Forget the
fact that the stress from getting fired will probably lead you to smoke more.
Smoking is a diagnosable psychiatric disorder. It even has a code in our little book (The
Diagnostic and Statistical Manual, or DSM). This means that, similar to major depressive
disorder, we psychiatrists recognize nicotine dependence as a psychiatric disorder, can treat
patients with it and bill insurance for it. Depression is also expensive for employers. So why
don't we also stop hiring people with depression or fire those who become depressed on the job?
Oh right, we can't discriminate against individuals who have psychiatric disorders!
As the push to reduce health care costs continues, it will be interesting to see how we can find
creative solutions to help contain these costs (and perhaps even help to improve the health of our
society). I am yet to be convinced that policies such as not hiring or going as far as firing
smokers is a better solution than devoting resources to helping them quit (and work).
How about all you smokers out there? Should we fire you so you quit smoking?
For more by Dr. Judson Brewer, click here.
For more on smoking, click here.
References:
Asch, D. A., R. W. Muller and K. G. Volpp (2013). "Conflicts and Compromises in Not Hiring
Smokers." New England Journal of Medicine 368(15): 1371-1373.

Nakajima, M. and M. al'Absi (2012). "Predictors of risk for smoking relapse in men and women:
a prospective examination." Psychol Addict Behav 26(3): 633-637.
Schmidt, H., K. Voigt and E. J. Emanuel (2013). "The Ethics of Not Hiring Smokers." New
England Journal of Medicine 368(15): 1369-1371.
http://usatoday30.usatoday.com/money/industries/health/story/2012-01-03/health-care-jobs-nosmoking/52394782/1
Workplaces ban not only smoking, but smokers themselves 2012
Wendy Koch
More job-seekers are facing an added requirement: no smoking at work or anytime.
As bans on smoking sweep the USA, an increasing number of employers primarily hospitals
are also imposing bans on smokers. They won't hire applicants whose urine tests positive for
nicotine use, whether cigarettes, smokeless tobacco or even patches.
Such tobacco-free hiring policies, designed to promote health and reduce insurance premiums,
took effect this month at the Baylor Health Care System in Texas and will apply at the
Hollywood Casino in Toledo, Ohio, when it opens this year.
"We have to walk the walk if we talk the talk," says Dave Fotsch of Idaho's Central District
Health Department, which voted last month to stop hiring smokers.
Each year, smoking or exposure to secondhand smoke causes 443,000 premature deaths and
costs the nation $193 billion in health bills and lost productivity, according to the Centers for
Disease Control and Prevention. The CDC says 19.3% of U.S. adults smoked last year, down
from 42.4% in 1965.
"We're trying to promote a complete culture of wellness," says Marcy Marshall of the Geisinger
Health System in Danville, Pa., which begins its nicotine-free hiring next month. "We're not
denying smokers their right to tobacco products. We're just choosing not to hire them."
The policies stir outrage, even in the public health community.
"These policies represent employment discrimination. It's a very dangerous precedent," says
Michael Siegel, a professor at Boston University's School of Public Health. He says the
restrictions punish smokers rather than helping them quit.
"What's next? Are you not going to hire overly-caffeinated people?" asks Nate Shelman, a
smoker and Boise's KBOI radio talk show host whose listeners debated the topic last month. "I'm
tired of people seeing smokers as an easy piata."

After several companies, including Alaska Airlines, adopted smoker-hiring bans a couple of
decades ago, the tobacco industry and the American Civil Liberties Union lobbied for smoker
rights. As a result, 29 states and the District of Columbia passed smoker-protection laws.
Some laws exempt non-profit groups and the health care industry, and 21 states have no rules
against nicotine-free hiring.
Federal laws allow nicotine-free hiring because they don't recognize smokers as a protected
class, says Chris Kuzynski with the U.S. Equal Employment Opportunity Commission.
There's no data on how many U.S. businesses won't hire smokers, but the trend appears strongest
with hospitals, says Lewis Maltby, president of the National Workrights Institute, a non-profit
offshoot of the ACLU that opposes the hiring bans.
Many of the new policies expand on smoke-free workplace rules. At Bon Secours Virginia
Health System, more than 300 employees have kicked the habit since its campuses went smokefree in 2009, and one applicant did so since it began nicotine-free hiring Nov. 30, says
administrative director Kim Coleman.
The bottom line will benefit because health care costs for tobacco users are $3,000 to $4,000
more each year than for non-smokers, says Bon Secours' Cindy Stutts. "There's also an impact on
productivity," she says, because smokers take more breaks.
Paul Billings of the American Lung Association says he's seen no data that prove nicotine-free
hiring gets people to quit. He says cessation programs are a better bet. Still, his group won't hire
smokers: "We're non-smoking exemplars."
http://usatoday30.usatoday.com/money/industries/health/2011-06-30-smokers-jobshumana_n.htm 2011
Humana won't hire smokers in Arizona
Ken Alltucker,
If you light up a cigarette, it will snuff out your chances to land a job with health-insurance giant
Humana in Arizona.

The health insurer said Wednesday that it will no longer hire workers in Arizona who smoke or
use other tobacco products, part of a trend of employers who are cracking down on tobacco use
among workers.

To enforce the tobacco ban that starts Friday, Humana will test new employees for nicotine use
during a pre-employment urine drug screen.
Humana representatives say it makes sense for a company in the health-care field to lead by
example. Smoking's harmful effects on human health are well-documented, and Humana seeks to
promote health and wellness starting with its workers.
"Humana is dedicated to helping our employees take charge of their own health," said Dr.
Charles Cox, Humana vice president and market medical officer for Arizona, Nevada and Utah.
Humana is part of a growing number of employers, many of them in health care, seeking to ban
smoking among new hires. The Cleveland Clinic stopped hiring smokers in 2007, and hospitals
in several states have stopped hiring tobacco-using employees.
No legal protections
Legal experts say nothing under state law prohibits employers from not hiring smokers.
"Being a smoker is not a category that is protected under the law," said Lisa Coulter, an attorney
with Snell and Wilmer in Phoenix.
Coulter said more and more employers are seeking to regulate employees' conduct outside the
workplace. Some examples include guidelines that prohibit what an employee can post on a
social-media websites such as Facebook or Twitter.
Some employers offer financial incentives or penalties to reduce health-care costs by seeking
behavioral changes. Some examples include programs that encourage employees to shed weight,
diet, quit smoking or manage other risk factors that could lead to costly health conditions such as
diabetes or high-blood pressure.
Such "wellness plans" may include tests that can measure things such as whether a person's
body-mass index exceeds recommended standards or if cholesterol levels are dangerously high.
"They are trying to get a handle on the cost of health care and health insurance," said Henry
GrosJean, a broker for GrosJean and Associates, a benefit-advisory firm.
Employees in Maricopa County, Arizona, recently complained about a new health plan that
required them to submit saliva samples to test for nicotine. The employees complained that such
testing represented an invasion of privacy. County employees who agreed to take the test and did
not have tobacco in their system qualify for insurance premiums that are $480 less than what
smokers and those who refused to take the test must pay.

Several Arizona employers have encouraged employees to quit smoking through policies that
adopt a carrot-and-stick approach. Companies often ban smoking at work and offer discounted
health insurance for employees who agree to kick the habit. Some employers have assessed a
benefit surcharge on employees who continue to use tobacco, according to Blue Cross Blue
Shield of Arizona.
Humana representatives said they are merely trying to improve the health of their workers. The
company cited Centers for Disease Control and Prevention statistics that show that smoking
causes about 443,000 deaths each year.
"Cigarette smoking increases the risk of cancer and shorten life spans," Humana spokesman Ross
McLerran said. "We're trying to provide a workplace that is safe and healthy. We do care about
the health of our associates."
Expanding the ban
Humana implemented a tobacco ban for its new employees in Ohio two years ago. The Ohio
program did not test for nicotine use among new hires like the Arizona program will, but the
company said the effort has worked. In Ohio, 78% of Humana's employees report being tobaccofree.
Cox, the Humana vice president, said it selected Arizona to roll out the new program because
state laws allow employers to require tobacco-cessation programs. The state's smoking rate,
13.1%, is also among the lowest in the nation, according to the Arizona Department of Health
Services.
"Our new hiring process is how we are going to lead by example," Cox said.
Humana may expand the smoking ban to employees in other states, but the company has not
publicly announced such plans, he said.
The policy does not apply to employees at the company's headquarters in Louisville, Ky.
Kentucky has declared smokers a "protected class," making it illegal to discriminate against
people because they smoke. Other states have similar laws.
Humana employs about 1,300 full-time workers in metro Phoenix and Tucson, and the company
is hiring 104 full-time employees for its Medicare call center in Phoenix. Those new positions
include telesales specialists and supervisors who will sell Humana products nationwide.
Humana's ban for new hires will apply to all tobacco products, including cigarettes, pipes,
chewing tobacco and cigars. These workers must agree to abstain from tobacco use while
employed by the company. If those new hires start using tobacco, they will be required to self-

report their use and enroll in a free tobacco-cessation program that provides counseling and
nicotine-replacement products.
Secondhand smoke, that which is inhaled passively by someone who is not smoking, might be in
a person's system at the time of the drug test, but the test is sensitive enough to distinguish
whether a person is exposed to nicotine through secondhand smoke or whether the person
actually uses tobacco products, a Humana spokesman said.
Although existing Humana-employed smokers aren't required to halt tobacco use, they will be
encouraged to do so. Those employees will be offered free stop-smoking help, Humana officials
said.
Employees who enroll in the smoking-cessation plans also are offered discounted medical
insurance.
http://knowledge.wharton.upenn.edu/article/refusing-to-hire-workers-who-smoke-an-economicperspective/
Refusing to Hire Workers Who Smoke: An Economic Perspective 2013
Wharton health care management professor Mark Pauly looks at recent reaction to a health
systems decision not to hire new workers who smoke. Much of that discussion centered on the
ethics of such a move. But Pauly, an economist, suggests a different framework for analyzing the
issue. His comments, below, appeared earlier this week in a new blog Voices@LDI started
by Penns Leonard Davis Institute of Health Economics.
The recent debate about the ethics of a health systems decision to refuse to hire new workers
who smoke was understandably couched in the framework of ethics. But hiring a worker
buying labor is an economic transaction that occurs in a market, and so it may be useful to
discuss the economic framework as well.
The very narrow framework presented was of a firm (a hospital, in this case) hiring a given
number of workers in a labor market where more workers are willing to work at the wage-benefit
package it offers than it needs to hire. Thus the ethical issue is framed as whether it is fair to
give one of the jobs in short supply to a non-smoker rather than a smoker. But wages and
demand for labor are determined in markets, both for labor and for products or services.
Considering these market level effects, I argue that that some of the framing of the ethical
problem is factually dubious and that the conclusions about fairness may need to be modified.
Wages, Jobs, Discrimination

In general labor economics, there are two well-known predictions: 1) the total compensation paid
to a given worker in a given job will equal the marginal revenue the firm expects to bring in
because it hired the worker, and 2) at that level of total compensation, labor markets will clear
(all workers who want to work at that level of compensation will find employment and
employers will not be looking to alter either employment or total compensation). How might
smoking affect the equilibrium of total compensation, money wages, and employment levels in a
competitive labor markets?
Smokers are less productive. The empirical evidence that smokers have lower productivity over
working years is fairly strong. They are less productive because they may miss work more
frequently (absenteeism) and because their smoking-related health conditions (shortness of
breath, cardiovascular conditions) may affect their ability to perform certain kinds of jobs
(presenteeism). Even if the firm does not pay sick leave, the disruptive effects of more frequent
absences in jobs that require teamwork (such as hospital nursing) will probably lead initially to
costs on employers. These cost effects may be minimized if wages can be varied for a given job,
or, if wages cannot be varied, by hiring non-smokers.
Smokers have higher medical costs. Smokers have higher average health care costs than nonsmokers, other things being equal. (They may have higher life insurance costs but lower pension
costs, as well.) Almost all job-related insurance in hospitals is experience-rated or self-insured.
Even if employee premiums for health and life insurance are not adjusted for smoking status and
wages are uniform within firms, the fact that medical costs will increase for firms or occupations
with larger shares of smokers means that there will be offsetting reductions in money wages.
Consumers and coworkers may prefer non-smokers. In face-to-face interaction with workers,
buyers may have preferences about behaviors or appearance of workers; attributes that buyers
regard as negative will depress total compensation and wages. In contrast, for occupations and
industries where consumers see only the final product (a manufactured good, a piloted airplane)
there should be no such discriminatory effects. However, if co-workers have similar preferences,
they may require higher money wages to work with smokers.
Labor Outcomes at the Firm and Market Levels
The effects of smoking are easier to predict at the level of overall labor markets. Suppose that,
across local labor markets, smoking rates vary for workers in a particular occupation or industry.
The prediction is that smoking will lower average total compensation in those markets with
larger proportions of smokers; whether compensation packages within markets are lower for
smokers specifically or for all workers in high-smoking communities or occupations depends in
part on what is administratively feasible and/or legal. If wage/premium discrimination is not
possible, the compensation of all workers will be depressed, but aggregate data across markets
will show lower total wages and compensation for smokers since they are more likely to be

present in high-smoking markets. Higher benefits costs for smokers will further depress money
wages unless employee-paid premiums can fully reflect higher benefits costs. Either way, take
home pay will be lower in such markets.
If all firms in a market hire from the same labor pool with its mix of smokers and non-smokers,
these effects will be uniform across firms. However, individual firms may correctly estimate
that, if they increase money wages above the prevailing level but then only hire non-smokers
from the pool of applicants, the firm may lower total labor cost. Note that behaving in such a
discriminatory fashion has a cost to the firm that follows this policy it pays higher total
compensation or hires less qualified workers but its bottom line may still be better off.
This was one of Milton Friedmans most perceptive arguments about discrimination, whether
racial or habit-related: Whatever it does to workers, it costs employers money to discriminate. If
all or most firms in a local market decide to discriminate, either money wages of smokers will
fall (if wages can be discriminatory), or there will be an increase in unemployment among
smokers if wage and/or insurance premium discrimination is not possible.
Ethical Arguments
Now, about those ethical arguments over not hiring smokers
As an economist, I have no expertise in ethical judgments, but I can discuss how this economic
framework might interact with the ethical arguments on both sides.

The employer who discriminates against smokers pays a price for doing so compared to
not doing it just what Friedman said about racial discrimination. The employer may
offset a benefit it expects to get against this price, but it is making a sacrifice;
discrimination is not free, and the worse it is, the more it costs the discriminator.

If all employers of a particular kind of labor (e.g., all hospitals) discriminate in a


particular way against smokers, their wages are likely to fall. This means that, despite the
point in the previous paragraph, employers may paradoxically, after the dust clears, end
up paying little or no cost, though each employer would still lower its labor costs if it
stopped discriminating. It all depends on alternative jobs available to smoking workers
and
whether those jobs discriminate.

Any effects on health insurance costs can be handled with higher premiums for smokers
so that, if such smoker surcharges are in place, higher medical costs are no longer a
reason to refuse to hire smokers; they pay their own way.

Discrimination for reasons other than medical costs will cut smoking workers job
opportunities to a greater extent if wages cannot be varied by smoking status. If wages
can be varied, jobs will still be there (although at lower wages, smokers may not want
them) but both incentives to stop smoking and compensation to the employer for any
distress to consumers will occur. The effect need not be large if smokers seek jobs in
other industries, but it can happen.

The public health argument for discrimination is that increasing the cost to workers of
smoking you wont be able to get a good job in our firm or industry may
cause workers to stop smoking or never start. This societal benefit should be offset
against perceptions of ethical unfairness. Maybe, but this is a slippery slope. Think of
other behaviors that society would like to discourage, such as teenage pregnancy or
committing a felony. Should good jobs be closed to young mothers and felons who
served their time? There is probably some calculus that can rationalize discrimination
here, but it is distinctly unlovely and there must be better and more effective ways
to change behavior than this. Even without accepting the argument that there are kinder
and better ways to get people to stop smoking, the no job for you smokers strategy
seems like (pardon the expression) overkill.

Of course, the argument that discrimination is unethical because it penalizes smokers for an
involuntary addiction also suffers by extension, because taxes on cigarettes do the same thing,
and few would think that taxing smoking or drinking (alcoholic or sugar-sweetened) beverages is
unethical because it discriminates against addicts. Plus, the incontrovertible fact that this
addictive behavior responds to prices shows that it is not perfectly addictive so do we need to
decide how much is addiction and how much something else?
The most fundamental message is one you might expect from an economist: Whatever your
ethical goals, it is better to achieve them by adjusting wages and prices than by rules about who
gets a job. Using financial rewards and penalties can change behavior at least as effectively as
discrimination, without adding excess harm to workers who cannot kick the habit. Like carbon
taxes, these penalties may not seem to some to be sufficient punishment of the guilty or
statement of virtuous behavior by the employer if you are allowed to sin if you pay the price,
arent we being nonserious about sin and letting sinners off too easily? But overall, these
strategies may be better in the sense of being fairer and more effective at discouraging behavior
whose costs outweigh its benefits.
http://www.mlive.com/opinion/grandrapids/index.ssf/2013/12/is_it_ethical_companies_to_ref.html
Can companies ethically refuse to hire smokers? Overeaters? Ethics and
Religion Talk 2013

Whether companies and businesses can ethically refuse to hire smokers, overeaters or others who
engage in unhealthy behavior is the subject of this week's column.
Our panel explores the issue, predicated on a Canadian company's announcement this year that it
would not hire smokers.
By Rabbi David Krishef
This past spring, a Canadian company declared that it would not hire smokers. In the United
States, a number of health care organizations have implemented nicotine testing as part of their
hiring process.
This weeks question is: Is it ethical to refuse to hire a smoker? How about someone who
overeats or engages in other unhealthy behavior?
Sister Mary Timothy Prokes, a member of the Franciscan Sisters of the Eucharist,
responds:
Three major aspects need to be considered when hiring an employee: the place and nature of the
work for which a person is applying; those affected by the work; and the suitability of an
applicant seeking to fill the position. Ethically, discrimination may never be the basis for a
decision regarding a prospective employee. Rather, those hiring ought to exercise prudence in
evaluating a prospective employee.
Circumstances, however, can alter an applicants suitability. For example, smoking is already
legally prohibited in enclosed public areas. Jobs such as nursing or waiting on table which
involve close contact among co-workers or those they serve, may result in a smokers application
being rejected. A smokers clothing may retain an offensive odor, even if the employee would not
light up on the premises. Other jobs in remote open areas might be well-served by a smoker.
The principle of suitability would also apply to those who overeat. Applicants for work, as well
as employers, need to make prudential judgments about their ability to fulfill the positions they
are seeking. Some types of work require agility and the ability to lift and move heavy weights.
Vying for a position as an NFL nose-guard might be feasible for a heavyweight person, but the
same applicant would most likely be passed-over if he sought to become an astronaut.
Sometimes, good judgment on the part of an employer may be misunderstood as discrimination.
At other times, however, discrimination or dislike may actually be the cause of refusal to hire,
but be cloaked under false explanations. Truthfulness is the basic criterion.
Fred Wooden, the senior pastor of Fountain Street Church, responds:

Strictly speaking, the only person over whom I have any moral authority is myself. Following
the advice of the rabbi from Nazareth, I should remove the motes from my own eye before
calling attention to the flecks in someone else's. In deciding whom to hire, the I cannot ethically
refuse to hire someone who is obese any more than I can refuse someone who is black, or
someone who smokes any more than someone who is gay. I can ask that their behavior not
impugn upon anyone else's, as for example smoking. But beyond that, if they can do their job
well and can be a positive part of the workforce, such that the business is better off for their
being there, then I have no ethical reason to decline to hire them.
Aly Mageed, a Shura member (roughly equivalent to an elder or a member of the Board of
Trustees) of the Islamic Mosque and Religious Institute of Grand Rapids, responds:
This question is a good reminder of the conflict that sometimes exists between the limits of
individual accountability and individual freedom. In my opinion it opens up another slippery
slope of where to draw the line. Would we move to having a group who would determine what is
considered acceptable life style and police those who do not conform? Would this someday lead
to the perfect healthy diet that all have to follow or they lose some of their rights or privileges?
How are we even going to police every citizen to confirm compliance? There are many
individual behaviors that would pose a higher risk of some medical condition on the individual
who chooses to follow them. Some examples include drinking and liver cirrhosis, certain sexual
behaviors and particular health risks, many dietary habits and high cholesterol, hypertension,
heart attacks or colon cancer. I also understand that we need to incentivize healthy behaviors. I
believe that these are some situations where education and carrots could be more effective than
sticks.
My view:
Although Jewish law includes a mandate to take care of ones health and prohibits smoking, it
does not provide for communal sanctions against those who engage in unhealthy behaviors. On
the other hand, if it is the case that people with unhealthy habits are more expensive employees,
perhaps an employer should have the right to save money by hiring less costly employees. If we
accept this, we might also argue that employers should have the right to hire only other classes of
healthier employees such as younger people who would cost less in lost productivity and
decreased absenteeism and insurance costs. This, however, would violate the explicit Biblical
mandate to show respect to the aged. It seems to me in this case, the ethical pitfall of allowing
such sanctions on those who engage in unhealthy behavior would inevitably lead to ethically
indefensible hiring sanctions against vulnerable members of society.
Ethics and Religion Talk is compiled and written by David Krishef, rabbi at Congregation
Ahavas Israel in Grand Rapids. Krishef takes questions from readers and shares them with a
panel of clergy, then provides the responses in collaboration with community engagement

specialist Zane McMillin. The views expressed are those of the panelists and do not necessarily
represent the official perspectives of their congregations or denominations. Please submit
questions from your own day-to-day encounters to EthicsAndReligionTalk@gmail.com.
http://www.nejm.org/doi/full/10.1056/NEJMp1301951?query=featured_home&
The Ethics of Not Hiring Smokers 2013
Harald Schmidt, Ph.D., Kristin Voigt, Ph.D., and Ezekiel J. Emanuel, M.D., Ph.D.
Finding employment is becoming increasingly difficult for smokers. Twenty-nine U.S. states
have passed legislation prohibiting employers from refusing to hire job candidates because they
smoke, but 21 states have no such restrictions. Many health care organizations, such as the
Cleveland Clinic and Baylor Health Care System, and some large nonhealth care employers,
including Scotts Miracle-Gro, Union Pacific Railroad, and Alaska Airlines, now have a policy of
not hiring smokers a practice opposed by 65% of Americans, according to a 2012 poll by
Harris International. We agree with those polled, believing that categorically refusing to hire
smokers is unethical: it results in a failure to care for people, places an additional burden on
already-disadvantaged populations, and preempts interventions that more effectively promote
smoking cessation.
One justification for not employing smokers, used primarily by health care organizations, is
symbolic. When the World Health Organization introduced a nonsmoker-only hiring policy in
2008, it cited its commitment to tobacco control and the importance of denormalizing tobacco
use. Health care organizations with similar policies have argued that their employees must serve
as role models for patients and that only nonsmokers can do so.
A second, more general, argument is that employees must take personal responsibility for actions
that impose financial or other burdens on employers or fellow employees. Accordingly, smokers
should be responsible for the consequences of their smoking, such as higher costs for health
insurance claims, higher rates of absenteeism, and lower productivity. These costs amount to an
estimated additional $4,000 annually for each smoking employee.
Yet it seems paradoxical for health care organizations that exist to care for the sick to refuse to
employ smokers. Many patients are treated for illnesses to which their behavior has contributed,
including chronic obstructive pulmonary disease, heart failure, diabetes, and infections spread
through unprotected sex or other voluntary activities. It is callous and contradictory for
health care institutions devoted to caring for patients regardless of the causes of their illness to
refuse to employ smokers. Just as they should treat people regardless of their degree of
responsibility for their own ill health, they should not discriminate against qualified job
candidates on the basis of health-related behavior.

The broader claim that it is fair to exclude smokers because they are responsible for raising
health care costs is too simplistic. It ignores the fact that smoking is addictive and therefore not
completely voluntary. Among adult daily smokers, 88% began smoking by the time they were
18,1 before society would consider them fully responsible for their actions. Much of this early
smoking is subtly and not so subtly encouraged by cigarette companies. As many as 69% of
smokers want to quit,2 but the addictive properties of tobacco make that exceedingly difficult:
only 3 to 5% of unaided cessation attempts succeed.3 It is therefore wrong to treat smoking as
something fully under an individual's control.
In addition, all other diseases and many healthful behaviors also result in additional health
care costs. People with cancer burden their fellow workers through higher health care costs and
absenteeism. People who engage in risky sports may have accidents or experience trauma
routinely and burden coworkers with additional costs. Having babies increases premiums for
fellow employees who have none. Many of these costs result from seemingly innocent, everyday
lifestyle choices; some choices, such as those regarding diet and exercise, may affect cancer
incidence as well as rates of diabetes and heart disease.
We as a society have rejected the notion that individuals should be fully responsible for their own
health care costs. In instituting health insurance, we acknowledge the fragility of health and the
costliness of restoring it, and we minimize catastrophic consequences. The United States has
chosen to pool risk predominantly through employers rather than the government. Consequently,
U.S. law requires firms with more than 50 employees to provide risk-pooled insurance.
Finally, although less than one fifth of Americans currently smoke, rates of tobacco use vary
markedly among sociodemographic groups, with higher rates in poorer and less-educated
populations. Some 42% of American Indian or Alaska Native adults smoke, but only 8% of
Asian women do. Among adults with less than a high school education, 32% are smokers; among
college graduates, smoking rates are just over 13%. More than 36% of Americans living below
the federal poverty line are smokers, as compared with 22.5% of those with incomes above that
level. Crucially, policies against hiring smokers result in a double whammy for many
unemployed people, among whom smoking rates are nearly 45% (as compared with 28% among
Americans with full-time employment).4 These policies therefore disproportionately and unfairly
affect groups that are already burdened by high unemployment rates, poor job prospects, and job
insecurity.
So what should employers do? We believe that offering support for healthful behaviors is the
best approach. Central in this regard is assisting employees by providing evidence-based
smoking-cessation programs, removing cost barriers, facilitating access, and providing necessary
psychological counseling and other support. For example, many employers, such as Walgreens,
provide free nicotine-replacement therapy and smoking-cessation counseling to employees.

Recent research also indicates that financial incentives can effectively promote smoking
cessation. For example, a randomized, controlled trial involving employees of General Electric
showed that a combination of incentives amounting to $750 led to cessation rates three times
those achieved through information-only approaches (14.7% vs. 5.0%).5
But General Electric's experience also reflects the political challenges of instituting policies
regarding smokers. When the company decided to provide the program to all employees,
nonsmokers objected to losing out on what would effectively be lower insurance premiums for
their smoker colleagues. In response, the company replaced the $750 reduction with a $625
surcharge for smokers.5
Just like policies of not hiring smokers, penalties imposed on smokers raise serious ethical and
policy concerns. The Department of Labor is considering whether to permit employers to
penalize smokers with a surcharge of up to 50% of the cost of their health insurance coverage
(typically more than $2,000 per employee per year). Yet even rewards for quitting are hard to sell
to nonsmokers, who might also object to free smoking-cessation programs that they subsidize
indirectly through their insurance premiums. Underlying such opposition is a distorted notion of
personal responsibility and deservedness, according to which refraining from smoking results
from willpower and active choice alone. Although some employees may be nonsmokers through
such efforts, most should have the humility to recognize that there but for the grace of God go
they.
Given nonsmokers' resistance, it would be helpful if employers providing smoking-cessation
support engaged in early outreach emphasizing that helping smokers to quit adheres to the
principle of risk pooling underlying health insurance. Successful cessation programs could lead
to higher productivity and lower insurance contributions for nonsmokers, thereby benefiting all
employees.
The goal of reducing smoking rates is important. Although smoking rates among U.S. adults
have decreased from 42% in 1965 to 19% today,5 more remains to be done, particularly for lowincome and unemployed populations. Promoting public health is a shared responsibility, and
employers have a social obligation to contribute to the public health mission outlined by the
Institute of Medicine: fulfill[ing] society's interest in assuring conditions in which people can be
healthy. By cherry-picking low-risk employees and denying employment to smokers,
employers neglect this obligation, risk hurting vulnerable groups, and behave unethically. The
same goes for imposing high penalties on smokers under the guise of providing wellness
incentives.
We believe that employers should consider more constructive approaches than punishing
smokers. In hiring decisions, they should focus on whether candidates meet the job requirements;
then they should provide genuine support to employees who wish to quit smoking. And health

care organizations in particular should show compassion for their workers. This approach may
even be a winwin economic solution, since employees who feel supported will probably be
more productive than will those who live in fear of penalties.
http://www.nejm.org/doi/full/10.1056/NEJMp1303632?query=featured_home&
Conflicts and Compromises in Not Hiring Smokers 2013
David A. Asch, M.D., M.B.A., Ralph W. Muller, M.A., and Kevin G. Volpp, M.D., Ph.D.
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
combined1 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 might justify such hiring
policies in many ways arguing, for instance, that they're taking a stand against a habit that
causes death and disability, that they're sending an important message to young people and others
within their communities about the harms of smoking, or that they're reducing their future costs,
given that smokers, on average, cost employers several thousand dollars more each year than
nonsmokers in health care expenses and lost productivity.
These policies engender controversy, and we recognize that they risk creating or perpetuating
injustices. One set of concerns arises from the fact that tobacco use is more concentrated in
groups with lower socioeconomic status. Hospitals do better than most institutions at creating
employment and advancement opportunities for disadvantaged populations. So even though most
members of lower socioeconomic groups do not use tobacco, and even though anti-tobacco
hiring policies are not intended to reduce jobs for these populations, they are likely to do so
inadvertently, at least somewhat.
However, these policies may also save lives, directly and through their potential effects on social
norms, and these same disadvantaged populations are at greatest risk for smoking-related harms
and ensuing disparities in health. Many Americans see it as perfectly acceptable that most
workplaces are smoke-free and that smoking is prohibited in many bars and restaurants. We are
reminded of how far we have come in our tolerance for restricting this activity only on visits to
other countries, where public smoking is much less restricted, or when we recall the time when
airplanes had smoking sections a notion that seems absurd today.
To be sure, many of the restrictive policies we now take for granted were justified not by their
effects on smokers but by the harm inflicted on nonsmokers by secondhand smoke. These

policies also increased the stigma against smoking, so although there's debate over whether
stigma can be used as a tool for good,2 ultimately these policies almost certainly contributed to
the decrease in the prevalence of smoking, not just the limits on where it occurs. For example,
the Cleveland Clinic moved to a smoke-free campus in 2005 and stopped hiring smokers in
2007. Reportedly, smoking rates decreased in Cuyahoga County (where the Cleveland Clinic is
located) from 20.7% in 2005 to 15% in 2009, whereas the overall rate in the state decreased only
from 22.4% to 20.3%.3
Similarly, policies against hiring smokers shift the debate from the question of where one smokes
to that of whether one smokes. Are these policies aimed at tobacco, which is harmful and
destructive, or at people who are addicted to tobacco, who may be seen as victims? Do the
policies target legally available products or people who make a personal choice that contributes
to a social burden and could conceivably choose otherwise? Are the rules designed to reduce
smoking, which is a population health goal, or to fence out smokers, which may be an
institutional financial goal? How, exactly, should we look at these policies?
We believe we should see them as one product of a growing recognition that changing behaviors
is hard, that combating addiction is harder, and that behaviors that were once seen as exclusively
private often have profound societal effects. As a result, many stakeholders are trying to change
unhealthy behaviors through mechanisms as varied as legislative requirements for calorie
labeling in some restaurants, bans on the sale of large servings of sugar-sweetened beverages,
and Affordable Care Act provisions allowing employers to provide rewards or penalties worth up
to 50% of employees' health insurance premiums on the basis of health assessments, including
smoking status. Those policies would have seemed like hard paternalism back when no one
questioned passengers' right to smoke on airplanes, but they might be seen as considerably softer
now in light of social trends, and perhaps in the future we won't consider them paternalistic at all.
The Nuffield Council on Bioethics in the United Kingdom has proposed a conceptual ladder of
progressively higher levels of interventions aimed at improving health-related behaviors.4
Finding the ladder useful in the context of smoking, we have laid out an anti-tobacco
intervention ladder that ranges from simply monitoring behavior, to guiding people's choices
through increasingly aggressive means, and ultimately to eliminating choice (see figure

Proposed Ladder of Interventions to Reduce Tobacco Use.). An important


justification for climbing the ladder is that the gentler interventions that make up the lower rungs
haven't resulted in adequate smoking-cessation rates, given tobacco's harms.

For example, we conducted a randomized trial comparing the use of employer-provided financial
incentives for smoking cessation, aided by counseling, with an approach in which the same sorts
of counseling programs were made available to employees but no incentives were given
effectively comparing enabling choice (rung 3) with guiding choice through incentives (rung 5).
In one sense, the results were dramatic: during 12 to 18 months of follow-up, employees in the
incentive group had a quit rate that was approximately three times that in the comparison group.5
But in absolute terms, even the incentive group had an 18-month quit rate of only about 9%
meaning that even with an aggressive system of rewards, 91% of employees who wanted to quit
could not. We believe that the severe harms of smoking justify moving higher up on the ladder
when lower-rung interventions don't achieve essential public health goals.
Not everyone will see a given approach as achieving the same balance between social goals and
effects on individuals. Is it fair to penalize smokers even though the highly addictive nature of
nicotine makes their behavior less than entirely voluntary? In many surveys, about 70% of
smokers say they want to quit, but only 2 to 3% succeed each year. One reason for this huge gap
is that smoking cessation has immediate costs in the form of nicotine withdrawal (i.e., the
symptoms of withdrawal and the costs of antismoking treatments), but its benefits in terms of
improved health are considerably delayed. Thus, although some people may see anti-tobacco
hiring policies as adding economic injury to physical injury, we would argue that such policies
also make the benefits of smoking cessation more immediate and so help to counterbalance the
immediate costs of quitting.
Do hospitals' anti-tobacco hiring policies send a signal to their patients? Many patients dislike
the smell of smoke clinging to a health worker's clothing as he or she leans over them or at
least may see that odor as inconsistent with the values and goals hospitals are supposed to
represent. Do hospitals' anti-tobacco hiring policies denormalize smoking and help communities
escape tobacco's burden? Critics may argue that these claims are disingenuous, akin to a human
resource director's saying to tobacco-using applicants, Believe me, it's for your own good that
I'm not hiring you. But in the long run, such policies may indeed be for their own good.
We recognize that these hiring practices are controversial, reflecting a mix of intentions and
offering a set of outcomes that may blend the bad with the good. We know that many companies
will want merely to continue their current level of anti-tobacco efforts, but given the threats that
tobacco presents to our communities and institutions, we believe it's time to climb another rung
on the ladder.
http://www.eremedia.com/ere/the-case-against-hiring-smokers/
The Case Against Hiring Smokers
Jim Roddy 2015

Im going to tick off nearly every smoker who visits this website and delight most every nonsmoker by detailing why its a good rule of thumb to not hire smokers. (A Rule of Thumb is a
principle whose broad application is not intended to be strictly accurate or reliable in every
situation. It is an easily learned and easily applied procedure for approximating a determination.)
The catalyst for this column is an email I received a couple weeks ago from a small business
owner:
Jim,
My father and I own a small business and we are having problems with hiring smokers. The last
few hires have been smokers and we seem to have more lost productivity due to smoke breaks.
How do weed those candidates out without infringing upon any labor laws? Are there any
questions that we can use?
Thank you,
A.J.
Following is my reply:
Hi A.J.,
Thanks for the note. Below is a passage and a couple questions from my book (Hire Like You
Just Beat Cancer) related to smoking. The first step before moving forward on pre-employment
questions would be to ask a competent employment attorney if smokers are a protected class in
your locale. They could also tell you if the questions I list below and your company adopting a
no-smoking agreement are legal where you do business.
Dont hire smokers. (Note: This rule of thumb might not be legal in some states especially
those along Tobacco Road.) This is another rule of thumb that raises eyebrows, but every nonsmoker with whom Ive talked it through sees the wisdom in it. The only folks who disagree are,
predictably, some smokers. It is almost a certainty that a regular tobacco habit will diminish
smokers productivity, depreciate your real estate, annoy their non-smoking co-workers, and
damage employee-manager relationships. Plus, managing this issue adds an unnecessary level of
grief and liability to your business.
My first summer job was in the employee services department at the Erie Zoological Gardens.
(You might think everybody who works at a zoo shovels elephant poop all day long, but thats
not the case. I worked in the concession stands, ticket booth, carousel, and other areas where

employees interacted with visitors. I smelled lots of elephant poop but never touched the stuff.)
My last year on the job was the summer after my freshman year in college. A new hiring
manager had brought in a wave of new high schoolers, some of them smokers. The previous
hiring manager never hired smokers, so this was my first exposure to nicotine-addicted team
members. I learned firsthand that their habit will harm:

Their productivity: After wed served a flurry of customers on busy days, the concession
stand needed all hands on deck to wipe the counters, refill the ketchup dispensers, and fill
the napkin holders before the next wave hit. But the smokers needed a quick hit. So
theyd leave the concession stand to smoke in the employee break room, which meant the
size of the clean-up crew was cut in half.

Your real estate: Our break room was already crummier than the monkey cages, but the
smokers made it intolerable. When I punched out for lunch, Id have to walk through a
smoke-filled hallway. When the smokers werent taking a(nother) break, the room was a
mess because they tossed their cigarette butts on the floor.

The attitude of non-smoking co-workers: Based on what youve just read, how do you
think I felt about my smoking teammates? When we needed helping hands, they werent
there. They trashed the break room. And they were belligerent when asked to change their
behavior. Its a habit, was their excuse. I told them playing basketball was my habit. So
would they mind if I took a break during a rush of customers to dribble around the giraffe
exhibit? They argued that their habit was excusable because it was an addiction. Im sure
my employer enjoyed paying us for having these conversations.

Employee-manager relationships: The veteran employees tasked with training the newhire smokers resented the extra grief they had to endure. Wheres Steph? Shes been
gone for 20 minutes now. You just had your hands near your mouth. Wash your hands
before touching the food. Youve already taken three breaks today. Do you really need
another?

Hiring casual smokers is acceptable, but there are very few true casual smokers. Candidates often
smoke more than they claim they do. Ive listed a bunch of reasons not to tolerate smoking and
the associated grief it creates in your workplace, but heres the biggest one: Smoking causes
cancer.
These pre-employment questions may be illegal in some states where smokers are a protected
class.
1. Do you smoke?

2. Everyone who works here signs a no-smoking agreement. Smoking is not permitted on
company premises in the building or on the parking lot at any time of day or night,
including weekends, at lunchtime even if you leave the premises, at any company
function anywhere, or at trade shows at any time. Would you sign that no-smoking
agreement?
I hope this information is helpful. If you have more questions or would like to discuss, please let
me know.
Thanks & Happy Hiring!
Jim
If its legal where you live, I recommend adopting a no-smoking agreement and discussing
smoking in your pre-employment process. Some companies go as far as urine testing for nicotine
prior to making a job offer.
Review your HR and hiring practices at least annually to see if they need updated. HR law and
your organization change frequently. For example, would you now apply this rule of thumb to
employees who work 100 percent from home?
http://labor-employment-law.lawyers.com/employment-discrimination/can-your-employer-stopyou-from-smoking.html
This article was verified by:
Neil H. Deutsch, Esq. 2015

Can Your Employer Stop You from Smoking?


The government protects citizens against workplace discrimination over certain characteristics
that are beyond their control. Under federal discrimination law, smokers are not a "protected
class." Some state laws, however, prohibit employers from discriminating against smokers.

Employers Can Control Their Workplaces


Most states allow employers to ban smoking in their workplaces. Employers have the right to
control all employees' exposure to second-hand smoke and fire hazards. It is not discrimination
to require that employees go outside to smoke or smoke only when off-duty. Some laws, in fact,
completely forbid smoking in any workplace.

Some Employers Can Control Who They Hire


In some states, employers can refuse to hire smokers. Employees are screened as part of the
application process, testing them for nicotine. If the prospective employee's results are positive,
the company won't offer the applicant a job.
Federal law says this practice is allowed - there's no prohibition against it. Once a person has
been hired, most states forbid firing the person for being a smoker or taking up smoking.
What You Do on Your Own Time
The American Civil Liberties Union argues that refusing to hire a smoker is a form of
discrimination, because employers are excluding applicants because of actions they take on their
own time. Most employers say that they're not telling employees what to do when they're not on
the clock. They're just not hiring them, which is their right. Federal law doesn't address this issue.
Most States Favor Smokers' Rights
Even though federal law doesn't protect smokers from workplace discrimination, more than half
of all states have enacted laws to do so. In these jurisdictions, smokers have no right to light up
while working, but they can do so after hours.
Their employers can't fire them or deny them jobs because of it. In these states, smokers are
considered a protected class or group. Their own state will protect them, even if the federal
government doesn't. Of the remaining states, most have no legislation that addresses smokers'
rights in the workplace at all. They're "silent," meaning they neither allow discrimination nor do
anything to protect against it.
An Employment Lawyer Can Help
The law surrounding discrimination against employees who smoke is complicated and evolving.
Plus, the facts of each case are unique. This article provides a brief, general introduction to the
topic. For more detailed, specific information, please contact an employment lawyer.
Tagged as: Labor and Employment , Employment Discrimination

https://en.wikipedia.org/wiki/Smoker_Protection_Law 2015
Smoker Protection Law
In the United States Smoker Protection Laws are state statutes that prevent employers from
discriminating against employees for using tobacco products. Currently twenty-nine states and
the District of Columbia have such laws. Although laws vary from state to state, employers are
generally prohibited from either refusing to hire or firing an employee for using any type of

tobacco product during non-working hours and off of the employer's property. In two states
(Colorado and New York) there is no specific law related to employee tobacco use but smokers
are protected under broader state statutes that prohibit employers from discriminating against any
employee who engages in a lawful activity. California also has a law that protects employees
who engage in lawful activity, but it has been interpreted by the courts as not creating any new
substantive rights but instead set forth a process to pursue claims for violation of existing Labor
Code protections before the state Division of Labor Standards Enforcement.
Most of these laws were first enacted in the late 1980s and early 1990s. However, as
discrimination against smokers in the workplace has become more widespread in recent years,
several states have enacted such laws more recently. In states without smoker protection laws
some employers have adopted policies where they are refusing to hire new employees who
smoke, forcing current employees to quit smoking. While many of these employers are using the
honor system to enforce these policies, a few of them are requiring that employees be tested for
nicotine.[1] Many of the businesses with these policies are in the healthcare industry, but some
county and municipal governments have also enacted such policies.[2] [3]
Arizona previously had a smoker protection law but it was repealed 2007.
http://www.healthline.com/health-news/policy-employers-should-not-discriminate-againstsmokers-041013
Not Hiring Smokers Is Unethical, Doctors Say
Brian Krans 2013
Doctors argue that arbitrarily excluding smokers does little to solve the problem, and that this
type of healthcare discrimination could spread to other unhealthy groups.

Rarely in the medical field will anyone defend smokers, but three doctors recently published a
perspective paper in the New England Journal of Medicine in defense of smokers who are
arbitrarily screened out of jobs.
The authorsHarald Schmidt, Ph.D., Kristin Voigt, Ph.D., and Ezekiel J. Emanuel, M.D., Ph.D.
stated that while the move is both symbolic and an effort to lower health insurance costs for
non-smokers, it is hypocritical for healthcare organizations to care for the sick while limiting
their hiring practices based on a single risk factor.
Many patients are treated for illnesses to which their behavior has contributed, including
chronic obstructive pulmonary disease (COPD), heart failure, diabetes, and infections spread

through unprotected sex or other voluntary activities, they wrote. "It is callousand
contradictoryfor health care institutions devoted to caring for patients regardless of the causes
of their illness to refuse to employ smokers.
Twenty-one states allow businesses to arbitrarily deny employment to smokers, while the other
29 have legislation preventing it. Many healthcare organizationsincluding the Cleveland Clinic
and Baylor Health Care Systemand businesses like Alaska Airlines, Scotts Miracle-Gro, and
Union Pacific Railroad, have polices about not hiring smokers. The World Health Organization
stopped hiring smokers in 2008.
Canadian tech company Momentous Corp. gained some attention recently for its unwillingness
to hire smokers and its stated policy, We drink. We swear. We dont f---ing smoke.
Delray Beach, Fla., stopped hiring smokers for municipal work, citing an annual savings of
$12,000 per year in insurance for each non-smoking employee hired.
The U.S. Centers for Disease Control and Prevention (CDC) states that cigarette smoking costs
$193 billion per year$97 billion in lost productivity and $96 billion in healthcare costs.
Second-hand smoke costs an additional $10 billion.
However, if healthcare costs are the only consideration, why aren't other groups also singled out
for their unhealthy behavior?
Who Else Should Be Screened Out by Employers?
While no company can be faulted for wanting to protect the health of their employees and
discourage damaging behavior, if they begin screening applicants based solely on healthcare
costs, applications from members of these groups are also headed straight for the shredder.
People Who Are Fat
Unlike a persons smoking habits, a persons weight is a taboo subject for discussion, but obesity
increases a persons risk of developing heart disease, type 2 diabetes, cancer, high cholesterol,
high blood pressure, osteoarthritis, and more. The CDC estimates that obesity costs the country
$147 billion annually.
People Who Drink Soda
Sugar-laden sodas contribute to diabetes and obesity so much that the American Heart
Association claims that soda kills 180,000 people per year. Thats nothing compared to the 5
million deaths smoking causes each year, but you dont have to die from obesity and diabetes in
order to accrue high healthcare costs.

People Who Drink Alcohol


Sorry, Momentous, but excessive alcohol consumption causes 80,000 deaths per year and more
than 1.2 million hospital visits, and it costs more than $223 billion annually. Better make sure no
one at the company has more than five drinks on any one occasion (four for women).
People Who Drive Cars
Car exhaust pollutes the air, and recent research from UCLA shows that children who are
exposed to high levels of traffic pollution in the womb are at a higher risk of developing rare
pediatric cancers. That, and traffic pollution is as harmful for kids as second-hand smoke. Not to
mention the fact that auto accidents cost the country $164.2 billion a year.
People Who Sit at a Desk
Unfortunately for office employees, the Mayo Clinic says that sitting for more than four hours a
day increases a persons risk of deathfrom any causeby 50 percent and increases the risk of
cardiovascular disease by 125 percent. Hopefully, no one at these companies sits at a desk.
A CEO would be lambasted in the press for deliberately not hiring people from these other
categories, but there is no similar public sympathy for smokers.
Assistance: the Logical Approach to Company Policy
Smoking is highly addictive, though public health campaigns have reduced smoking rates from
42 percent of U.S. adults in 1965 to 19 percent today.
The NEJM authors say considering that 69 percent of smokers want to quit but only three to five
percent succeed without help, it is therefore wrong to treat smoking as something fully under an
individual's control.
Assistance programs to help employees quit have been proven effective at protecting not only the
health of the individual employee, but also the financial health of the corporation.
We believe that employers should consider more constructive approaches than punishing
smokers, the doctors wrote. In hiring decisions, they should focus on whether candidates meet
the job requirements; then they should provide genuine support to employees who wish to quit
smoking.
http://www.hrmorning.com/ban-hiring-smokers/
A ban on hiring smokers? Its not that simple
Dan Wisniewski 2013

More companies than ever wont hire people who smoke. But is that legal and is it worth it
for employers?
The University of Pennsylvania Medical System is the latest employer to announce it will no
longer hire smokers.
The firm joins a number of companies whove closed their doors to tobacco user, as Molly
DiBianca of the Delaware Employment Law Blog pointed out in a recent post.
But just because these organizations have decided not to hire smokers doesnt automatically
mean that you can.
Banning smokers is it legal?
First, you and your supervisors should understand theres no federal law that protects smokers or
entitles them to equal protections when it comes to hiring, promotions, etc. Thats because the
Equal Employment Opportunity Commission doesnt recognize smokers as a protected class.
That said, there are 29 states (along with the District of Columbia) that do offer protections for
smokers.
If your company is in one of those states, you cant refuse to hire people just because they smoke
(although you can turn them down for other, legitimate reasons).
Heres the list of states that provide employment protections to smokers, according to the
American Lung Association:

California

New Jersey

Colorado

New Mexico

Connecticut

New York

District of Columbia

North Carolina

Illinois

North Dakota

Indiana

Oklahoma

Kentucky

Oregon

Louisiana

Rhode Island

Maine

South Carolina

Minnesota

South Dakota

Mississippi

Tennessee

Missouri

Virginia

Montana

West Virginia

Nevada

Wisconsin

New Hampshire

Wyoming

Is it worth it?
If youre not located in one of those states, youre likely permitted to enact a smoke-free hiring
policy and keep people who smoke out of your workplace.
But is a ban on hiring smokers really the right way to go? Opinions differ.
On the one hand, a 2009 study by the Journal of Tobacco Policy & Research did find that
smokers take more sick days than their non-smoking co-workers.
It also found that even if a smoker is in relatively good health (isnt obese, doesnt have chronic
health conditions like diabetes, etc.), theres a good chance he or she will still have higher
medical costs than a comparable non-smoker over a three-year period.
But a smoking ban is worthwhile only if smokers quit for good. If the prohibition causes people
to quit until theyre hired and then they take up smoking again as soon as they pass the
nicotine test its not an effective cost-cutting tactic.
The results point to a need for constant testing to ensure former smokers dont fall back into the
habit after theyre hired which can get expensive.
Cons of a ban on hiring smokers
Another study from anti-smoking journal Tobacco Control found that a tobacco-free hiring
policy might not be a good idea. Heres why:

Its a slippery slope. If the decision were based on health-related costs, couldnt a case be
made for banning people with with weight-related problems, such as high cholesterol or
diabetes? And wouldnt that raise discrimination concerns?

Would you be turning away good talent because of a smoking addiction an addiction
that could be licked with some help?
Sure, when unemployment is high and lots of people are job hunting, you can be choosy.
But do you really want to lose that top salesperson or IT manager to a competitor because
of smoking?
And what about when the employment market turns around, and you find yourself
scrambling for good people?

Researchers at Tobacco Control instead say employers should push hard to get employees into
smoking-cessation programs, especially ones sponsored at work.
Every analysis of such programs shows theyre cost-effective in improving absentee rates and
time lost because of smoking-related illnesses.
http://www.nbcwashington.com/news/local/Md-Hospital-Refuses-to-Hire-Smokers315145661.html

Nicotine Test: Md. Hospital Refuses to Hire Smokers


By Chris Gordon and Andrea Swalec 2015
Smokers need not apply.
A hospital in Annapolis, Maryland has a new hiring policy that eliminates job candidates who
smoke or use other tobacco products.
Anne Arundel Medical Center has run a smoke-free campus for years, and as of July 1 the
facility rejects prospective hires who test positive for nicotine, just like it screens out drug users.
"Cigarette smoking is the largest preventable cause of death and poor health, so we know this is
one is a clear association," Dr. Stephen Cattaneo said. "[The policy] makes sense and fits with
the mission and the values of the hospital."
Candidates rejected because of the smoking ban are offered resources to help them quit and are
eligible to reapply for jobs in six months if they then pass a nicotine test.

Neighbor Dennis McClearn Jr. said he thought the practice put people struggling with a medical
issue at a disadvantage.
"It's unfair to discriminate against people and refuse them jobs just because of an addiction," he
said.
The hospital is within the law, employment attorney Mindy Farber said.
"I think it's going to surprise people, particularly people who smoke, but I think [nicotine testing]
is the next step after testing people for alcohol and testing people for drugs," she said.
http://usatoday30.usatoday.com/money/industries/health/story/2012-01-03/health-care-jobs-nosmoking/52394782/1
Workplaces ban not only smoking, but smokers themselves
By Wendy Koch, USA TODAY 2012
More job-seekers are facing an added requirement: no smoking at work or anytime.

As bans on smoking sweep the USA, an increasing number of employers primarily hospitals
are also imposing bans on smokers. They won't hire applicants whose urine tests positive for
nicotine use, whether cigarettes, smokeless tobacco or even patches.
Such tobacco-free hiring policies, designed to promote health and reduce insurance premiums,
took effect this month at the Baylor Health Care System in Texas and will apply at the
Hollywood Casino in Toledo, Ohio, when it opens this year.

STORY: Humana won't hire smokers in Arizona

"We have to walk the walk if we talk the talk," says Dave Fotsch of Idaho's Central District
Health Department, which voted last month to stop hiring smokers.
Each year, smoking or exposure to secondhand smoke causes 443,000 premature deaths and
costs the nation $193 billion in health bills and lost productivity, according to the Centers for
Disease Control and Prevention. The CDC says 19.3% of U.S. adults smoked last year, down
from 42.4% in 1965.
"We're trying to promote a complete culture of wellness," says Marcy Marshall of the Geisinger
Health System in Danville, Pa., which begins its nicotine-free hiring next month. "We're not
denying smokers their right to tobacco products. We're just choosing not to hire them."

The policies stir outrage, even in the public health community.


"These policies represent employment discrimination. It's a very dangerous precedent," says
Michael Siegel, a professor at Boston University's School of Public Health. He says the
restrictions punish smokers rather than helping them quit.
"What's next? Are you not going to hire overly-caffeinated people?" asks Nate Shelman, a
smoker and Boise's KBOI radio talk show host whose listeners debated the topic last month. "I'm
tired of people seeing smokers as an easy piata."
After several companies, including Alaska Airlines, adopted smoker-hiring bans a couple of
decades ago, the tobacco industry and the American Civil Liberties Union lobbied for smoker
rights. As a result, 29 states and the District of Columbia passed smoker-protection laws.
Some laws exempt non-profit groups and the health care industry, and 21 states have no rules
against nicotine-free hiring.
Federal laws allow nicotine-free hiring because they don't recognize smokers as a protected
class, says Chris Kuzynski with the U.S. Equal Employment Opportunity Commission.
There's no data on how many U.S. businesses won't hire smokers, but the trend appears strongest
with hospitals, says Lewis Maltby, president of the National Workrights Institute, a non-profit
offshoot of the ACLU that opposes the hiring bans.
Many of the new policies expand on smoke-free workplace rules. At Bon Secours Virginia
Health System, more than 300 employees have kicked the habit since its campuses went smokefree in 2009, and one applicant did so since it began nicotine-free hiring Nov. 30, says
administrative director Kim Coleman.
The bottom line will benefit because health care costs for tobacco users are $3,000 to $4,000
more each year than for non-smokers, says Bon Secours' Cindy Stutts. "There's also an impact on
productivity," she says, because smokers take more breaks.
Paul Billings of the American Lung Association says he's seen no data that prove nicotine-free
hiring gets people to quit. He says cessation programs are a better bet. Still, his group won't hire
smokers: "We're non-smoking exemplars."
http://www.worketiquette.co.uk/uk-smoking-rules-out-office.html

UK Smoking Rules in and Out of the Office

Garry Crystal 2015

Smoking in the office and in any UK workplace has been against the law since 2007. But some
employers are laying down rules on smoking far beyond the requirements of the smoking ban.
Is Smoking Completely Prohibited in Workplaces?
Smoking is prohibited in the workplace in public areas that are enclosed. This can include whole
enclosed and substantially enclosed areas. For example, smoking in public bars is prohibited but
there may be outdoor areas such as partially enclosed outdoor balconies or gardens where
smoking is permitted. But where private businesses are concerned the decision whether or not to
permit smoking in partially enclosed outdoor areas will come under the discretion of the
employer.
What Happens if an Employee is Caught Smoking at Work?
There are different steps an employee can take if an employee is caught smoking at work. The
first step could simply be a reminder that they are breaking the law. The second step could be
disciplinary procedure such as a warning with the offence noted in the employees file. The
employer could be fined if they allow anyone to smoke on smoke free business premises. There
have been actual cases where employers have dismissed people who have smoked on business
premises and broken the smoking ban.
Who Enforces the Smoking Ban on Business Premises?
The employer should be the person who enforces the smoking ban. If there is suspicion of
smoking on business premises with the permission of the employer then Environmental health
officers can be called in to investigate. Fines for smoking in smoke free business premises can
range from between 200 and 2500.
What Other Smoking Rules can Employers Implement?
It is becoming more common for employers to place certain restrictions on employees who do
smoke. Some major businesses will not allow employees to smoke when they are wearing a
business uniform. This also includes after or before work hours if employees are in uniform.
Employers can also stipulate how far away from business premises employees must be before
they can smoke. Employees have been disciplined and dismissed for breaking these stipulations.
Can Employees Refuse to Hire Smokers?
Although it does sound like discrimination it is not against the law for employers to refuse to hire
smokers. Even if the employee claims they will not smoke during work hours the employer can
still refuse to hire them. One employee in the UK was dismissed 15 minutes after being hired
after employers found out that she smoked. This may seem like discrimination but employers are
perfectly within their rights not to hire smokers.

Are the Smoking Rules Being Taken too Far by Employers?


Smoking has become a hot topic health issue in the UK. The consequences for breaking the
smoking ban can be severe, especially for employers. Two luxury hotels in Scotland recently
applied a rule that threatened employees with dismissal if they arrived at work and smelt of
smoke. This rule applies to the hotels hundreds of members of staff and the rule does go well
beyond the actual requirements of the smoking ban.
Are Business Vehicles Included in the Smoking Ban?
Smoking is also prohibited on public transport, taxis and business vehicles. Many employers
have laid down rules that include no smoking in business vans outside of working hours. British
Telecom have stipulated that 100,000 of their employees both in and outside of the UK are
banned from smoking in any vehicle bearing the BT logo. Denbigshire council in Wales has
implemented a smoking rule that bans all employees from smoking within working hours, even
if they are smoking in their own cars.
Is a Complete Ban in and Out of Work Hours the Right Answer?
Banning employees with extreme measures such as no smoking in uniforms outside of working
hours does seem extreme. Although many employers are in favour of these extreme measure this
type of blanket ban is causing stress in the workplace. It has been found that this type of stress
has actually led to a decrease in efficiency and productivity in the workplace. Workplace
smoking policy should be set out after rational decisions are made. The ideal scenario is that
employers would consult employees to formulate a workplace smoking policy that actually
works.
What Sort of Workplace Smoking Policy Could Work?
A blanket ban on smoking during work hours, outside of the business premises is not ideal. Many
employees have been smoking for decades and are addicted. There is nothing to stop employers
from identifying outdoor smoking areas and setting designated smoking breaks. Blanket bans
should be considered as a last resort not the first option.

http://www.daytondailynews.com/news/news/local/not-hiring-smokers-is-discriminatory-saygroups/nM9PK/
Not hiring smokers is discriminatory, say groups
Jim DeBrosse 2010

Smokers rights groups and civil liberties advocates say the trend toward not hiring smokers in
Ohio is discriminatory and could lead to bans against hiring others at risk of missing work.

What about women of childbearing age? Will they be next? said Pam Parker, co-founder of
Opponents of Ohio Bans. If tobacco were illegal, I would be totally behind what these
companies are doing, but its not.
Parkers group and others are backing a bill to be introduced soon into the Ohio legislature by
State Rep. Stephen Dyer, D-Green, that would make it illegal to refuse to hire people who use
tobacco products outside the workplace.
While I applaud the idea of a drug-free workplace, a ban on tobacco redefines the concept,
Dyer said.
Thirty states and the District of Columbia have made it illegal for employers to make
employment decisions based on off-duty smoking. Two states California and Connecticut
prohibit discrimination on the basis of all legal behavior.
While the American Civil Liberties Union is opposed to nicotine-free hiring policies, Ohios
employment at will laws prevent the organization from doing anything about it, said Mike
Brickner, a spokesman for the ACLU in Ohio.
We have always taken the position that employers should not have the right to regulate outsideemployment activities, but Ohio employers have such huge leeway under the law its no use
fighting it in court, he said.
Premier Health Partners, the parent of Miami Valley and Good Samaritan Hospitals, has taken
the toughest stand against tobacco thus far in the Dayton area. This year, it began assessing an
annual $520 surcharge on health care benefits for employees who admit to smoking or chewing
tobacco, lighting up cigars, or living in a household where others smoke.
Premier does not test employees for tobacco use.
At Kettering Health Network facilities, including Kettering and Grandview medical centers,
employees are not permitted to smoke during breaks, even if theyre off campus, because theyll
return to work smelling of tobacco, said Leslie Grooms, Ketterings network director of
compensation and benefits.
The no-smoking, no-smell policy is for the safety and comfort of their patients, she said. Just the
smell of cigarette smoke could cause a negative reaction in asthma patients and others with
lung conditions, she said. And, certainly, its not something you want around newborns.
Smoking has been on the decline in Ohio since 1995, according to the Centers for Disease
Control. Back then, about one in four Ohio adults were smokers (26 percent). Today, the
proportion is fewer than one in five (18 percent).

With health insurance costs continuing to climb when employers are also being squeezed by a
recession, smokers may be just the first targets of insurance-driven hiring policies, said Mary
White, a professor of ethics at Wright States Boonshoft School of Medicine.
Similar policies based on aging, on weight, on whatever criteria they choose (to lower their
insurance costs) might be considered, she said.
If were content to deny health care coverage to one of every six people in this country, well
just let it keep going to ever larger categories of people, she said.
Cost of smokers vs. nonsmokers
A study by the Health Policy Institute of Ohio in 2006 found that:
Businesses lose $3,400 per year for every employee who smokes.
Smokers average 6.16 missed days of work per year due to illness compared to 3.86 days for
nonsmokers.
Employees who smoke have almost twice as much lost production time per week as nonsmokers.
Businesses average $2,189 in workers compensation costs for smokers compared to $176 for
nonsmoking employees.
Employees who smoke cost more to insure.
http://www.forbes.com/sites/alicegwalton/2013/03/28/should-companies-have-the-right-torefuse-to-hire-smokers/
Should Companies Have The Right To Refuse To Hire Smokers?

Alice G. Walton 2013

Theres been a lot of hubbub in recent years about how to get people to quit smoking. The
smoking bans in bars and restaurants in the last decade created some initial backlash, but
ultimately in many cities, the bans are now seen just as a matter of fact. Now though, as some
businesses and hospitals have begun to refuse smokers hire, a new set of ethical issues has
emerged. And while some of these policies have been in place for several years, people are still
arguing about the best courses of action to solve the smoking problem, which is estimated to
be responsible for about 440,000 deaths per year.

This week, dueling commentaries in the New England Journal of Medicine by two groups of
ethicists and behavioral economists offer strikingly opposing views about how to address it. One
group, which includes Ralph W. Muller, CEO of the University of Pennsylvania Health
System, argues that its high time to amp up our efforts to help people quit even if new policies
bring short-term unhappiness, they will certainly bring long-term health benefits. The other set of
authors, which includes former White House health advisor Ezekiel J. Emanuel, says that even
though everyone agrees that smokers should be encouraged to quit, its fundamentally unethical
for businesses, and even hospitals, to refuse people jobs because they smoke.
The Its for Their Own Good Argument
The first group argues that even though the policies against hiring smokers like those adopted
by the Cleveland Clinic, the University of Pennsylvania Health Care System, Union Pacific
Railroad, and Alaska Airlines may seem unjust in the early days, particularly since smokers are
more often of lower socioeconomic status, it will more than make up for this issue by saving
those lives over the long term. It may also create a bit more stigma against smokers, but this is
ok, they say, since ultimately this will recalibrate social norms.
The process may take time the effects certainly wont be felt for a number of years but it will
be well worth it in the long-run, as society will shift for the better:
We believe we should see [the new policies] as one product of a growing recognition that
changing behaviors is hard, that combating addiction is harder, and that behaviors that were once
seen as exclusively private often have profound societal effects. As a result, many stakeholders
are trying to change unhealthy behaviors through mechanisms as varied as legislative
requirements for calorie labeling in some restaurants, bans on the sale of large servings of sugarsweetened beverages, and Affordable Care Act provisions allowing employers to provide
rewards or penalties worth up to 50% of employees health insurance premiums on the basis of
health assessments, including smoking status.
These policies, the add, would have been considered hard paternalism back in the day when
people thought nothing of smoking on airplanes and in the office, but nowadays theyre generally
considered softer and acceptable. In the future, theyll just been seen as a matter of course.
This group also points out that stepping up our efforts to help people quit is especially necessary
since even company measures that go as far as offering financial incentives for employees to quit
only lead to very low quit rates (about 9% are still quit after 18 months). And of the 70% of all
smokers who say they want to quit, only about 2-3% are actually successful at quitting. In
hospitals, they say, not allowing employees to smoke is a no-brainer, since patients dont want to
smell cigarette smoke on their healthcare providers clothes.

Anticipating the arguments of the other side, the authors say, Critics may argue that these claims
are disingenuous, akin to a human resource directors saying to tobacco-using applicants,
Believe me, its for your own good that Im not hiring you. But in the long run, such policies
may indeed be for their own good.
The Unethical Argument:
It may be for employees own good, say the other group of writers, but if you pick apart the
policies and the effects theyll have across the socioeconomic strata, policies against hiring
smokers cant be considered ethical. Implementing a no-hire policy for smokers results in a
failure to care for people, places an additional burden on already-disadvantaged populations, and
preempts interventions that more effectively promote smoking cessation.
They argue that hospitals, of all places, cannot in good conscious refuse to hire smokers since
they treat people whose behaviors have often contributed to their health problems. It would be
paradoxical to create policies against employees who do the same:
It is callous and contradictory for health care institutions devoted to caring for patients
regardless of the causes of their illness to refuse to employ smokers. Just as they should treat
people regardless of their degree of responsibility for their own ill health, they should not
discriminate against qualified job candidates on the basis of health-related behavior.
The second issue, they say, is that smoking is not a totally voluntary behavior, since it involves
addiction and you cant discriminate against people for at least partially involuntary behaviors.
And there are health costs associated with a range of unhealthy behaviors, not to mention healthy
ones. People who engage in risky sports may have accidents or experience trauma routinely and
burden coworkers with additional costs. Having babies increases premiums for fellow employees
who have none. So to deny smokers jobs would not be a reasonable course of action.
Finally, the economic impact it could have on people of lower socioeconomic status is
significant, since smoking is unevenly distributed. More than 36% of Americans living below
the federal poverty line are smokers, as compared with 22.5% of those with incomes above that
level. And since about 45% of unemployed people smoke, no-hire policies would create a
double-whammy among this group. These policies therefore disproportionately and unfairly
affect groups that are already burdened by high unemployment rates, poor job prospects, and job
insecurityBy cherry-picking low-risk employees and denying employment to smokers,
employers neglect this obligation, risk hurting vulnerable groups, and behave unethically.
This group of authors suggests that a better way would be to hire the best person for the job, and
to support employees efforts to quit in more productive ways than to punish smokers by not
hiring them, or even by imposing financial penalties on current employees. Successful cessation

programs could lead to higher productivity and lower insurance contributions for nonsmokers,
thereby benefiting all employees.This approach, they conclude, may even be a winwin
economic solution, since employees who feel supported will probably be more productive than
will those who live in fear of penalties.
Its not entirely clear which side has the stronger argument, or what will come of this debate,
which is published in one of the most prestigious medical journals in the world. Certainly both
sides make valid cases. Which side will wavering CEOs favor? Which will undecided politicians
embrace? What are your thoughts?
http://tobaccoanalysis.blogspot.com/2014/02/employment-discrimination-against.html
The Rest of the Story: Tobacco News Analysis and Commentary
Michael Siegel 2014
Employment Discrimination Against Smokers Spreads to Obese Persons, As Predicted
For several years, the Rest of the Story has been arguing against policies by which employers
refuse to hire smokers. My main argument is that this is a form of employment discrimination
and is therefore unwarranted. Further, I have suggested that refusing to hire smokers opens the
door to discriminating against other groups, such as obese persons.
Today, I report that the open door has been entered: Citizens Medical Center in Victoria, Texas
has adopted a policy by which it will not hire anyone who is obese. Obesity is defined in the
policy as a body mass index (BMI) greater than 35.
According to an article in the Texas Tribune: "A Victoria hospital already embroiled in a
discrimination lawsuit filed by doctors of Indian descent has instituted a highly unusual hiring
policy: It bans job applicants from employment for being too overweight. The Citizens Medical
Center policy, instituted a little more than a year ago, requires potential employees to have a
body mass index of less than 35 which is 210 pounds for someone who is 5-foot-5, and 245
pounds for someone who is 5-foot-10. It states that an employees physique should fit with a
representational image or specific mental projection of the job of a healthcare professional,
including an appearance free from distraction for hospital patients."
"The majority of our patients are over 65, and they have expectations that cannot be ignored in
terms of personal appearance, hospital chief executive David Brown said in an interview. We
have the ability as an employer to characterize our process and to have a policy that says whats
best for our business and for our patients. Employment lawyers say Citizens Medical Centers
hiring policy isnt against the law. Only the state of Michigan and six U.S. cities including
San Francisco and Washington, D.C. ban discrimination against the overweight in hiring."

The Rest of the Story


This is blatant employment discrimination, and it is ugly. However, what readers should realize
is that it is no more ugly than policies that refuse to hire smokers. My hope is that the obvious
inappropriateness of this policy will open employers' eyes to the equal inappropriateness of
refusing to hire smokers. Discriminatory hiring practices are simply wrong, and it is time that
public health advocates starting standing up for justice for workers.
What makes the Citizens Medical Center policy particularly ugly is that they justify it by arguing
that their patients don't want to see obese people people it doesn't fit with their "mental
projection" of a healthcare professional. That is simply disgusting. The same thing could have
been said years ago (or maybe today) about certain other groups, such as black health care
workers, LGBT workers, or Jewish workers.
And importantly, the same thing is being said today, in some hospitals, about smokers. A number
of hospitals refuse to hire smokers not merely to reduce health care costs, but because they don't
want their patients to have to even "see" a smoker.
The only bright side to this story is that perhaps it will open the eyes of the public, the media,
and employers to the fact that employment discrimination is indeed ugly and has no place in
America. And that holds even if the group being discriminated against is smokers.

http://www.thestar.com/business/personal_finance/2014/03/18/can_a_company_refuse_to_hire_a
_smoker.html
Sheryl Smolkin 2014
Can a company refuse to hire a smoker?
Ontario bans smoking at work, but no legislation clearly says employer can refuse to hire
smoker. Conference Board of Canada says smoking costs companies
Ontario law prohibits smoking at work and in enclosed public spaces, but there is no legislation
that clearly says an employer can refuse to hire someone who chooses to smoke on his own time.
The only provincial or federal laws are human rights codes that prohibit employers from
discriminating based on a disability. But the legislation does not identify smokers or people with
any other medical conditions as disabled. And to date the Ontario Human Rights Tribunal has not
ruled on whether smoking is a disability.

Last October, the Conference Board of Canada reported that on average a smoker costs a
company about $4,200 a year more than non-smokers. They based this on $3,800 in lost
productivity due to unsanctioned smoking breaks and another $400 in lost productivity due to
absenteeism.
A recent internet search of job postings turned up five Canadian organizations with job ads that
say non-smokers only or non-smokers preferred. They include the Canadian Cancer Society
and Ottawa-based Momentous Corp, owner of the mail-order movie rental company Zip.ca.
These companies have gone a step further than most employers, says Arleen Huggins an
employment lawyer with Torontos Koskie Minsky LLP. They give preference to prospective
employees who also do not smoke outside working hours.
In an interview with CTV in March 2013, Momentous President Robert Hall said: Im not
saying [job applicants] dont have a choice to smoke, Im just saying they dont have the choice
to work at Momentous if they do smoke.
He also said that the companys health benefit costs have been dramatically slashed and
employee productivity has increased as a result of the policy.
In response to a request for an interview, a Momentous spokesperson said Hall is still very proud
of the companys non-smoking policy but he no longer gives interviews on this topic.
Huggins says companies refusing to hire smokers may want to operate under the radar to avoid
provoking possible human rights complaints. She says different factors likely come into play for
organizations like the Canadian Cancer Society.
As a non-smoking advocacy group, they may be able to argue that hiring only non-smokers is a
bona fide occupational requirement.
There have been no definitive Ontario decisions, but Huggins says a British Columbia labour
arbitration from 2000 between miner Cominco Ltd. and the United Steelworkers of America
sheds some light on how the issue might be addressed by a court or tribunal in this province.
In 1998, Cominco adopted a non-smoking policy at its Trail, B.C. smelter. The policy meant that
smokers could not smoke for a full eight hour or 12 hour shift.
The arbitrator agreed with the union that the policy discriminated on the basis of disability
because addicted, heavy smokers typically experience withdrawal symptoms if they are unable to
smoke for more than a few hours. He also noted that the majority of frequent smokers find it
difficult to quit.

The arbitrator clarified that the B.C. Human Rights Code does not protect the right to smoke.
However, the case does recognize that an addicted smoker may have a physical and mental
disability that employers must accommodate to the point of undue hardship.
In spite of the lack of clear decisions in Ontario linking smoking and disability Huggins says
employment lawyers generally advise their clients to err on the side of caution.
If a human rights tribunal finds an addicted smoker is disabled, refusing to hire that person is
just as bad as posting a sign that no pregnant women are allowed, she says.
http://jobs.aol.com/articles/2014/04/15/employer-discrimination-against-smokers/
Can An Employer Discriminate Against Me Because I Smoke?
Donna Ballman 2014

An AOL Jobs reader asks:


I am wondering what your opinion is on employers refusing to accept applications and/or offer of
employment for a smoker. Smoking might be a health risk as is obesity or disability. I live in a
state with many counties and one of them is going to start a "smoking ban" for new hires the
previous county i lived in also did that...is this all "fair"? Where are our rights going?
The employers claim it has to do with insurance issues but where I live now no employer gives
employees insurance as most of the jobs are either part time or seasonal and not even part time
when they give employees 10 hrs. per week. Where is the justification for this type of issue?
Where is the justification indeed? Employers are butting into employees' personal lives in ways
we never contemplated when I started practicing law 27 years ago. The short answer is yes,
employers can refuse to hire you or fire you because you're a smoker . . . unless you live in one
of the 30 lucky states where this is illegal.
What excuses do employers use to invade your privacy this drastically? You're right, that the
main excuse is that smokers have higher health insurance costs. However, the ACLU says this
about the health cost excuse for discrimination against smokers:
[T]he Bureau of National Affairs reported in 1987 that 95 percent of companies that banned
smoking reported no financial savings. Furthermore, even if there were significant savings, the
price would be too high. To permit such discrimination allows, in effect, the banning of perfectly
capable workers from any type of employment -- thus, denying them the opportunity to earn a

living for themselves and their families. Permitting employers to act as "health police" will not
solve our nation's health care crisis; it will only destroy the private lives of working Americans.

In the case reported by this reader, the employer doesn't even provide health insurance. So what's
the excuse? It sounds like pure invasion of privacy, doesn't it? Yet it's legal in many states.
Here are the state laws that protect tobacco users from discrimination by employers:

Tobacco-only laws: Eighteen states prohibit discrimination against tobacco users. These
states are Connecticut, District of Columbia, Indiana, Kentucky, Louisiana, Maine,
Mississippi, New Hampshire, New Jersey, New Mexico, Oklahoma, Oregon, Rhode
Island, South Carolina, South Dakota, Virginia, West Virginia, and Wyoming.

Lawful consumable products laws: Eight states protect employees from discrimination
if they use lawful consumable products, which would include tobacco. These states
include Illinois, Minnesota, Missouri, Montana, Nevada, North Carolina, Tennessee, and
Wisconsin.

Lawful outside activities laws: Four states say employers can't discriminate against
employees who engage in lawful activities outside of work. Those states are California,
Colorado, New York, and North Dakota

It should be noted that, even if employers can't discriminate against you for smoking on your
own time, many of these state laws don't require employers to provide smoking breaks, smoking
areas or any accommodations for smokers.
SHRM, the Society of Human Resources Management, has a terrific updated list of workplace
smoking laws in every state, including laws banning smoking in workplaces and the various laws
banning discrimination against smokers.
If your state is one of the 21 states that has zero protection for smoking and other legal off-duty
activities, it's time to talk to your legislators and state governor about making a change. Unless
employees fight for their privacy, we'll lose more and more ground to employers who think they
have the right to poke their noses into our private business.
http://jama.jamanetwork.com/article.aspx?articleid=193305
2000
Smoking and Mental IllnessA Population-Based Prevalence Study

Karen Lasser, MD; J. Wesley Boyd, MD, PhD; Steffie Woolhandler, MD, MPH; David U.
Himmelstein, MD; Danny McCormick, MD, MPH; David H. Bor, MD

Context Studies of selected groups of persons with mental illness, such as those who are
institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than
in persons without mental illness. However, recent population-based, nationally representative
data are lacking.
Objective To assess rates of smoking and tobacco cessation in adults, with and without mental
illness.
Design, Setting, and Participants Analysis of data on 4411 respondents aged 15 to 54 years
from the National Comorbidity Survey, a nationally representative multistage probability survey
conducted from 1991 to 1992.
Main Outcome Measures Rates of smoking and tobacco cessation according to the number and
type of psychiatric diagnoses, assessed by a modified version of the Composite International
Diagnostic Interview.
Results Current smoking rates for respondents with no mental illness, lifetime mental illness,
and past-month mental illness were 22.5%, 34.8%, and 41.0%, respectively. Lifetime smoking
rates were 39.1%, 55.3%, and 59.0%, respectively (P<.001 for all comparisons). Smokers with
any history of mental illness had a self-reported quit rate of 37.1% (P = .04), and smokers with
past-month mental illness had a self-reported quit rate of 30.5% (P<.001) compared with
smokers without mental illness (42.5%). Odds ratios for current and lifetime smoking in
respondents with mental illness in the past month vs respondents without mental illness, adjusted
for age, sex, and region of the country, were 2.7 (95% confidence interval [CI], 2.3-3.1) and 2.7
(95% CI, 2.4-3.2), respectively. Persons with a mental disorder in the past month consumed
approximately 44.3% of cigarettes smoked by this nationally representative sample.
Conclusions Persons with mental illness are about twice as likely to smoke as other persons but
have substantial quit rates.
Smoking is the leading preventable cause of death in the United States.1 In an effort to target
public health interventions, recent studies have focused on smoking in distinct populations, such
as pregnant women2 and adolescents.3 We believe those with mental illness are another group
that merits special attention.
Previous studies have found high smoking rates among selected populations of persons with
mental illness, such as psychiatric outpatients4 and patients in a state mental hospital.5 Others

have found elevated smoking rates among patients with specific diagnoses, such as bipolar
illness, depression, schizophrenia, and panic disorder.6- 11 Persons with mental illness may
encounter greater difficulty with tobacco cessation.4,12,13 However, no recent study has analyzed
rates of smoking and quit rates across the spectrum of psychiatric diagnoses in a nationally
representative sample. We hypothesized that persons with mental illness smoke at higher rates
than persons without mental illness, have lower quit rates, and comprise a large proportion of the
US tobacco market.
We used population-based data from the National Comorbidity Survey14 (NCS) to examine the
association between type and severity of mental illness and the likelihood of smoking and
subsequent cessation. The NCS differed from previous studies because it was the first to
administer a structured psychiatric interview to a nationally representative sample.15
Furthermore, the NCS was specifically designed to examine both substance-use and
nonsubstance-use psychiatric disorders.
Data Sources
The NCS was a congressionally mandated study of the prevalence of psychiatric disorders in the
United States.15 Administered between September 1990 and February 1992, the survey used a
stratified, multistage probability sample of persons aged 15 to 54 years in the
noninstitutionalized civilian population. The data were released for public use in 1998. The study
design allowed for estimation of the national prevalence of mental illness as defined by the
Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R).16
The NCS surveyed 8098 persons. Questions regarding tobacco use were asked of the 4411
respondents interviewed during the latter half of the survey (1991-1992). Specially trained staff
from the Survey Research Center at the University of Michigan administered a modified version
of the Composite International Diagnostic Interview (CIDI).17 The CIDI is a well-validated,
structured diagnostic interview based on the Diagnostic Interview Schedule (DIS), which was
used in the Epidemiologic Catchment Area Study.18 In the NCS, the overall response rate was
82.4%; nonrespondents resembled respondents in age and sex, which are the only demographic
variables available for all nonrespondents. A supplemental survey was administered to a random
sample of nonrespondents, who were found to have elevated rates of both lifetime and current
psychiatric disorders. The data were weighted to account for sample design (ie, probabilities of
selection among households) and for nonresponse using information from the supplemental
survey. An additional weight was used to extrapolate the data to the national population by age,
sex, race or ethnicity, marital status, educational level, living arrangements, region, and
urbanicity
Definitions of Mental Illness and Tobacco Use
We defined respondents as lifetime smokers if they answered affirmatively to the question,
"Have you ever smoked daily for a month or more?" We defined current smokers as those who

responded, "in the past month" when they were asked, "When was the last time you smoked
fairly regularlyin the past month, past six months, past year, or more than a year ago?" We
defined the quit rate as the proportion of lifetime smokers who were not current smokers.
Because this definition of quit rate differs from that used in other studies, we also analyzed the
data with a more conservative definition of quit rate: the proportion of lifetime smokers who had
stopped smoking for more than a year. This analysis did not significantly change our findings;
hence, we used the former definition of quit rate. The NCS did not ascertain the total lifetime
consumption of tobacco or the current number of cigarettes smoked. However, respondents were
asked, "How many cigarettes did you smoke per day during the period when you were smoking
most?" We defined this number as peak consumption. We considered persons whose peak
consumption exceeded 24 cigarettes per day to be heavy smokers. We defined moderate and light
smokers as those whose peak consumption was 24 cigarettes per day or less. We did not analyze
cigar or pipe smoking.
We defined mental illness as major depression, bipolar disorder, dysthymia, panic disorder,
agoraphobia, social phobia, simple phobia, generalized anxiety disorder, alcohol abuse, alcohol
dependence, drug abuse, drug dependence, antisocial personality, conduct disorder, or
nonaffective psychosis. The latter includes schizophrenia, schizophreniform disorder,
schizoaffective disorder, delusional disorder, and atypical psychosis.
We analyzed persons with and without any mental illness at any time in their lives (lifetime
mental illness), persons with active mental illness in the past month (whom we define as "the
mentally ill"), and persons with each of the individual DSM-III-R diagnoses and with multiple
DSM-III-R diagnoses. In addition, we compared smoking rates in respondents with current
alcohol and drug use to those of respondents who had been abstinent for at least 1 year.
We also estimated the proportion of all cigarettes smoked in the United States that were
consumed by persons with mental illness via the following calculation: (M) (C1) / {(N) (C2) +
(M) (C1)}, where M = the number of current smokers with mental illness in the past month; C1=
the mean peak consumption of cigarettes per day by current smokers with mental illness in the
past month; N = the number of current smokers without mental illness in the past month, which
includes persons with and without lifetime mental illness; and C2= the mean peak consumption
of cigarettes per day by current smokers without mental illness in the past month. For both
persons with and without mental illness, we assumed that the peak number of cigarettes
consumed correlated with the current number of cigarettes consumed.
Statistical Methods
We used the SAS computer statistical package (Version 7; SAS Institute, Cary, NC). We used the
2 test to compare differences between groups in the proportion of persons who smoked, and the
Mantel Haenszel 2 test for trend to compare smoking rates with the number of lifetime DSM-III-

R diagnoses. We used logistic regression to analyze mental illness as a predictor of smoking,


while controlling for sex, age, and region of the United States.
The demographic characteristics of persons with a lifetime history of mental illness and persons
with mental illness in the past month are shown in Table 1. The population prevalence of current
smoking was 28.5%, while the lifetime prevalence was 47.1%. Forty-one percent of persons who
reported having mental illness in the past month were current smokers and represented 40.6% of
all current smokers in the United States. Respondents with a history of mental illness had
elevated smoking rates, and smoking rates increased further in respondents with mental illness in
the past month (Table 2). Current smokers without mental illness in the past month (n = 746) had
a mean peak consumption of 22.6 cigarettes per day vs 26.2 in those with mental illness in the
past month (n = 511). We estimated that persons with mental illness comprised 44.3% of the US
tobacco market.

The relationship between smoking and mental illness persisted when we controlled for age, sex,
and geographic region using logistic regression (details available on request). Compared with
respondents without mental illness, those with any history of mental illness were significantly
more likely to be lifetime smokers (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.9-2.4)
or current smokers (OR, 1.9; 95% CI, 1.7-2.2). This relationship was stronger among
respondents with mental illness in the past month (OR, 2.7; 95% CI, 2.3-3.1 for current smokers;
OR, 2.7; 95% CI, 2.4-3.2 for lifetime smokers).
Persons with multiple lifetime psychiatric diagnoses had higher rates of smoking and smoked
more heavily than persons with only 1 DSM-III-R diagnosis (P<.001, Figure 1). Heavy smoking
was rare in persons with no history of mental illness; only 10% of such persons were heavy
smokers. We observed a dose-response relationship between the number of lifetime psychiatric
diagnoses and smoking rates. Quit rates were lower in smokers with mental illness in the past
month (30.5%, P<.0001) and in smokers with any lifetime history of mental illness (37.1%, P = .
04) compared with smokers without mental illness (42.5%).
Table 3 and Table 4 show smoking rates according to psychiatric diagnosis (lifetime and in the
past month), as well as the corresponding quit rates. The quit rates of respondents who were
abstinent from alcohol (41.5%) or drugs (39.0%) were similar to the quit rate of persons with no
mental illness history (42.5%). Due to small numbers in some diagnostic categories, differences
between individual diagnoses should be interpreted cautiously.

We found that persons with mental illness are about twice as likely to smoke as other persons, a
finding consistent with previous studies.4,6,19,20 Population-based data collected in the early 1980s

by the Epidemiologic Catchment Area Study showed that persons with major depression,
dysthymia, agoraphobia, and alcoholism were 1.6 to 4.7 times more likely to have ever smoked
than subjects without mental illness.6 However, we observed that more than a third of patients
with a history of mental illness had quit smoking by the time of the survey. The quit rate in the
Epidemiologic Catchment Area Study was lower than this and was only determined for persons
with major depression. Our finding that persons abstinent from alcohol had quit rates equal to
those of persons without mental illness confirms previous findings.21 However, our finding that
persons abstinent from drugs also had quit rates equal to those of persons without mental illness
is a novel one.
Our study is based on data collected from 1991 to 1992 and released for public use in 1998, the
most recent national data available on mental illness and smoking. Given the minimal decline in
the prevalence of smoking in the United States over the past decade, from 26.5% in 1992 to
24.7% in 1997,22 our findings are still pertinent. Similarly, we doubt that the prevalence of
mental illness has decreased dramatically since 1992. In the NCS, almost half of the respondents
had experienced a DSM-III-Rdefined mental illness in their lifetime, and 28% had experienced
mental illness in the past month. These numbers appear high because the definition of mental
illness in the NCS (the standard definition used by most psychiatrists in the United States)
encompassed a broad spectrum of severity, from simple phobia to schizophrenia.
Mentally-ill cigarette smokers, like other smokers, are at high risk of smoking-related deaths.
Persons with major depression, alcohol disorders, and schizophrenia have high mortality rates
from vascular disease and cancer.23 Smoking also complicates the treatment of some mental
disorders by decreasing blood levels of neuroleptics.24 Thus, smokers may require larger doses to
achieve therapeutic effect, and thereby run an increased risk of adverse effects.13,25,26 Some26,27 but
not all28,29 studies have found that smokers experience more tardive dyskinesia than nonsmokers.
Why do the mentally ill smoke more? Some have suggested that such persons use cigarettes as a
means of self-medication of psychiatric symptoms.13,30 This theory implicitly assumes that mental
illness causes smoking. However, recent findings9,10,31 raise questions about the direction of
causality. In a study of childhood and adolescent depression,31 antecedent smoking was
associated with an increased risk of depression, but not vice-versa. Similarly, current smokers
have an elevated risk of first-time occurrence of panic attacks relative to nonsmokers or former
smokers,10 and smoking may increase the risk of certain anxiety disorders during late
adolescence and early adulthood.32 Lastly, a recent study9 found that smoking preceded the onset
of schizophrenia in the majority of persons with schizophrenia who smoked.
Internal documents from the tobacco industry suggest that the industry has identified
psychologically vulnerable persons as a part of their tobacco market. In the 1981 Segmentation
Study,33 market researchers at R. J. Reynolds Tobacco Co described smokers who smoked for
"mood enhancement" and "positive stimulation." This marketing study implied that smokers used

nicotine for depressive symptoms, stating that smoking "helps perk you up" and "helps you think
out problems." The authors also identified the role of smoking in "anxiety relief," stating that
smoking helped people "gain self-control," "calm down," and "cope with stress." While studies
have shown that cigarette advertising and promotion influence smoking in adolescents,34 no
studies have examined the effect of cigarette advertising on the mentally ill.
Extrapolating our results to the US population, we estimate that persons with a diagnosable
mental disorder in the past month consume nearly half of all cigarettes smoked in the United
States. Our findings emphasize the importance of focusing smoking prevention and cessation
efforts on the mentally ill. Individual clinicians' efforts in this regard need to be coupled with
broader public policy interventions. Increases in tobacco taxes and antismoking media
campaigns have been shown to reduce cigarette sales and consumption,35- 38 particularly in lowerincome smokers.37 While data are not available on the impact of tobacco taxation on the
subpopulation of smokers with mental illness, we believe that taxation might be an effective
smoking deterrent in this group, which tends to be at a low-income level. Tax revenues could
then be used to fund smoking cessation and other programs for persons with mental illness and to
support counter-advertising campaigns.
Mental illness carries a unique burden of sufferingan "inexplicable agony"according to one
eloquent victim.39 The mentally ill also carry the burden of nearly half of all US tobacco
consumption. However, the fact that smokers with mental illness are able to quit should offer
hope.
http://blogs.findlaw.com/law_and_life/2011/07/can-employers-discriminate-againstsmokers.html
Stephanie Rabiner, 2011
Can Employers Discriminate Against Smokers?
In a recent story out of Arizona, health care insurer Humana has decided to internalize a policy of
smoker discrimination, announcing that it will screen new employees for nicotine, and no longer
hire those that test positive.
Humana is not the first company to refuse to hire smokers. With businesses trying to cut
insurance costs by cutting back on employees who raise health concerns, smokers have come
under fire in recent years.
Is such smoker discrimination legal?

Federal employment law does not protect against smoker discrimination, instead only opting to
prohibit those employment activities that discriminate on the basis of race, color, religion, sex,
national origin, age, disability, and genetics.
However, in addition to federal laws, states are free to protect workers from discrimination based
on a variety of other classifications, such as marital status, income, familial status, political
affiliation, sexual orientation, and even use of tobacco products.
Twenty-nine states and the District of Columbia currently have laws that protect workers from
smoker discrimination, prohibiting employers from refusing to hire smokers and from banning
them from smoking outside of the workplace.
However, many states also have laws that ban, or allow employers to ban, smoking inside the
workplace or on an employer's property. Even in states that don't have this exception, employers
can ban smoking on the premises if another employee requests a reasonable accommodation
under the American with Disabilities Act.
In the end, whether smoker discrimination in a given situation comes down to the state you live
in, as well as how and where an employer is trying to regulate smoking.

https://www.workplacefairness.org/smoking-rights-workplace

Your Rights Smoking and the Workplace 2015


This page provides answers to the following questions:
1. Do I have the right to smoke at work?
2. Do I have the right to a workplace free from secondhand smoke?
3. Is being around coworkers who smoke hazardous to my health?
4. Does workplace smoking violate health and safety laws such as OSHA which regulate
exposure to hazardous substances?
5. I have a health condition which is aggravated by smoking. Is my employer required to
accommodate me by preventing others from smoking?

6. Is it legal for an employer to only hire non-smokers?


7. Tobacco is a legal substance. Can I be fired for smoking away from work?
8. Is it legal for my employer to charge me more for my health insurance because I am a
smoker?
9. Can I smoke from an electronic cigarette or vapor device at work?
10. I work for a government agency that provides hazard pay, am I entitled to hazard pay
when I have to work around secondhand smoke?
11. I have been injured by secondhand smoke, could I get compensation?
12. I believe that my employer's smoking policy violates my rights. What do I do?
13. Where can I get more information on nonsmokers rights in the workplace?
1. Do I have the right to smoke at work?
Most states regulate smoking in the workplace to some degree. There is no federal law that
governs smoking at work, so smoking regulations vary significantly from state to state. Some
states prohibit smoking in indoor areas of the workplace. Some states prohibit smoking in
workplaces, but allow employers to designate a smoking area.. Other states ban smoking
altogether in the workplace. And a few states have NO laws restricting smoking at work. As for
smoking outside the workplace, there are some states that permit smoking only in certain
establishments, like bars, and other states that permit smoking everywhere, except in certain
places, like hospitals and restaurants.
In addition to state laws, local city or county laws may impose stricter regulations on smoking at
work. Even if there is not an applicable law, employers can have their own workplace smoking
policies that prohibit smoking entirely or limit it to certain areas, like a break room, or outside
area. While these laws have been challenged in court, they are generally upheld. To find out what
the smoking laws are in your state, see our page on State Smoking Laws.
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2. Do I have the right to a workplace free from secondhand smoke?
Some states have passed laws either requiring that the workplace be smoke free, or giving
employers the right to declare their workplace smoke free. Other states have laws allowing
employers to designate a specific "smoking area" that is separated from the workplace so
employees may easily avoid exposure to second-hand smoke. However, if your state does not

have a law, and your employer does not have a policy, then you may not be protected if your
coworkers choose to smoke.
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3. Is being around coworkers who smoke hazardous to my health?
Secondhand smoke leads to thousands of nonsmoker deaths per year from lung cancer and heart
disease. Being around coworkers while they are smoking can be hazardous to your health,
especially if you are breathing in tobacco smoke every day at work. The CDC reports that most
exposure to secondhand smoke occurs in homes and workplaces.
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4. Does workplace smoking violate health and safety laws like OSHA, which regulates
exposure to hazardous substances?
OSHA, short for the Occupational Safety and Health Act, gives you, as an employee, the right to
have a safe and hazard-free workplace. OSHA does have indoor air quality standards, but
tobacco smoke almost never exceeds theses limits. In rare and extreme circumstances -- for
example, when tobacco smoke combines with another airborne contaminant in the workplace -the OSHA standards may be exceeded and OSHA will require the employer to remedy the
situation. In general, exposure to tobacco smoke will be regulated solely by state laws, not
OSHA or other federal laws. For more information about OSHA see our site's workplace health
and safety page.
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5. I have a health condition that is aggravated by smoking. Is my employer required to
accommodate me by preventing others from smoking?
An employee that has a legitimate health condition, which goes beyond mere annoyance, may
require their employer to prevent harms from secondhand smoke. If you have a health condition
that is aggravated by secondhand smoke, you should inform your supervisor of your condition
and ask for an accommodation to prevent additional harm. Many state laws explicitly require
employers to provide certain accommodations to non-smokers.
Examples of accommodations include segregation of smokers and non-smokers, restricting the
areas where employees can smoke, and providing improved ventilation systems. If your
employer does not reasonably accommodate you, you may be able to pursue a claim with your
state's health department or under the Americans with Disabilities Act (ADA). Courts are
especially interested if the condition caused the employee to seek medical care, take time off
from work, or change their daily activities. For more information on filing an ADA claim, see
our site's disability discrimination page.

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6. Is it legal for an employer to only hire non-smokers?
With some restrictions, employers are free to hire whomever they want. Federal and state laws
prohibit discriminating against people for a variety of reasons (for example, race, sex, and
national origin). Existing anti-discrimination laws do not prohibit employers from discriminating
based on whether or not the person is a smoker.
In some, it is legal for an employer to ask you whether you are a smoker, and to hire, or not hire
you based on that answer. However, 29 states and the District of Columbia do prohibit
discrimination based on legal activities outside the workplace, which includes smoking tobacco.
In these states, it is illegal for an employer not to hire you simply because you are a smoker.
Employers may be able to get around anti-discrimination laws in certain states if being a nonsmoker is an important part of a specific job's qualifications. For example, an anti-smoking
advocacy group, like the American Lung Association, could choose not to hire smokers, and not
be in violation of the applicable anti-discrimination laws.
The following states prohibit employers from refusing to hire smokers, unless being a smoker
goes against a specific job qualification:

California

Colorado

Connecticut

District of Columbia

Illinois

Indiana

Kentucky

Louisiana

Maine

Minnesota

Mississippi

Missouri

Montana

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Oklahoma

Oregon

Rhode Island

South Carolina

South Dakota

Tennessee

Virginia

West Virginia

Wisconsin

Wyoming

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7. Tobacco is a legal substance. Can I be fired for smoking away from work?
This depends on the state you live in. Twenty-nine states have "smoker protection laws" which
make it illegal to discriminate against an employee for the use of "lawful products outside the
workplace," (understood to refer to cigarettes) or for smoking in particular. In these states, you
cannot be fired for legally using tobacco. However, many states do not have these laws, so
employers are free to fire smokers, even if their tobacco use is solely outside the workplace. As
with hiring, employers may terminate employment due to an employees smoking habit, if
smoking infringes on a valid job requirement.
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8. Is it legal for my employer to charge me more for my health insurance because I am a
smoker?
Yes, in most cases. With health insurance costs raising dramatically in recent years, especially for
smokers, many employers have started charging smokers higher premiums. Employers hope that
increased premiums to smokers will encourage them to quit smoking, saving money and future
health problems. The Patient Protection and Affordable Care Act (ACA), which eliminates
discrimination for many health conditions, still permits employers and insurers to increase
premiums for smokers while reducing premiums for non-smokers. Even the state laws that
protect smokers from being fired for smoking contain exceptions that allow employers to charge
smokers higher insurance premiums.
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9. Can I smoke from an electronic cigarette or vapor device at work?
Many state laws do not specifically mention electronic cigarette usage in the workplace. Some
newer laws, like in Minnesota and South Dakota, specifically ban electronic cigarettes in
workplaces. On the other hand, in Kansas, according to the Attorney General, e-cigarettes do not
violate the States Clean Air Act of 2010, and there is no prohibition on smoking in workplaces.
Due to the uncertainty in many states, employees should ask their employer what the company
policy regarding e-cigarettes is.
While many state governments have not answered this question yet, some localities have
attempted to ban e-cigarettes. You can find a list of localities that have banned e-cigarettes, as of
April 2, 2015, at No-Smoke.org.
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10. I work for a government agency that provides hazard pay, am I entitled to hazard pay
when I have to work around secondhand smoke?
Probably not. Hazard pay is usually given when the employee perform tasks that are risker than
usual. So, hazard pay depends on the risk associated with the job. Jobs that provide hazard pay

usually have a requirement that the action has a much higher than usual probability to harm the
employee. Federal courts have determined that for certain jobs, like prison guards, secondhand
smoke exposer is not enough of a risk to give hazard pay. To see if secondhand smoke exposer
qualifies an employee for hazard pay, the employee should determine how risky their job
typically is, and how much risk secondhand smoke will add.
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11. I have been injured by secondhand smoke, could I get compensation?
When an employee is injured at work they may qualify for Workers Compensation. In some
states workers compensation commissioners have granted compensation if secondhand smoke
exposure injured the employee while at work. But the standards may be high. Typically, the
injury must be caused by regular and long-standing exposure to secondhand smoke, and the
employee must have attempted to avoid smoke from other sources while not at work. If this
occurs the commissioner may grant an employee past and future medical expenses and
temporary disability benefits.
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12. I believe that my employer's smoking policy violates my rights. What do I do?
The first thing you should do is voice your concerns to your employer. Your employer may be
unaware that its policy is illegal or harmful to you. If your employer is unresponsive to your
concerns, contact your state's labor or health department, or a lawyer in your state. This is the
best way to get more detailed information about the particular laws of your state, and what legal
options are available to you.
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13. Where can I get more information on nonsmokers rights in the workplace?
For more information, visit the Americans for Nonsmokers' Rights website at www.nosmoke.org.
http://www.gallup.com/poll/174035/hiring-discrimination-smokers-obese-rejected.aspx
2014
Hiring Discrimination for Smokers, Obese Rejected in U.S.
by Rebecca Riffkin

Americans say higher health insurance rates for smokers are justified
WASHINGTON, D.C. -- Fewer than one in eight Americans, 12%, say companies should be
allowed to refuse to hire people because they are significantly overweight. Similarly, 14% of
Americans say companies should be allowed to refuse to hire smokers.

While Americans are just as likely now to say that companies should be able to refuse to hire
smokers as when Gallup first asked the question in 2005, they are slightly less likely to say that
companies should be able to refuse to hire those who are significantly overweight. The 12% of
Americans who say companies should be able to refuse to hire those who are significantly
overweight is down slightly from 16% in 2005 and 17% in 2008.
These results come from Gallup's July 7-10 Consumption Habits survey, in which 21% of
Americans reported having at least one cigarette in the week prior to being interviewed, near the
historical low. Furthermore, in the same poll, 40% of Americans said they consider themselves to
be "very" or "somewhat" overweight.
Majority Agree With Higher Health Insurance Rates for Smokers
While Americans overwhelmingly reject the idea of hiring discrimination against smokers and
those who are significantly overweight, they are more amenable to the idea of charging these
individuals more for health insurance. In fact, a majority of Americans, 58%, say that it would be

justified to set higher health insurance rates for smokers. Fewer Americans -- but still a
substantial minority, at 39% -- say higher rates would be justified for those who are significantly
overweight.

These figures are both slightly lower than in 2003, when Gallup first asked these questions. At
that time, 65% of Americans said that smokers should pay higher health insurance rates, and
43% said the same about those who are significantly overweight.
Smokers, Overweight Adults More Opposed Than Other Americans
Smokers are much more likely than nonsmokers to oppose hiring discrimination and higher
insurance rates for those who smoke. While a quarter of smokers say that higher insurance rates
are justified, only 3% say companies should be allowed to refuse to hire smokers. Former
smokers' views are similar to those of nonsmokers in general, indicating that current smoking
status is a larger determinant of views on these issues than is past history of smoking.

While similar differences exist between Americans who say they are overweight and those who
say they are "about right," they are not as pronounced. Thirty-two percent of overweight
Americans say higher health insurance rates for those who are overweight are justified,
compared with 44% of Americans who say their weight is about right. Overweight Americans
are just as likely as those who say their weight is about right to say that companies should be
allowed to refuse to hire overweight Americans.

Implications
Most Americans oppose hiring policies that would allow companies to refuse to hire smokers or
those who are significantly overweight. It is unclear if those views are because Americans do not
think smoking and obesity negatively affect workplace performance or they simply reject
discrimination of any kind in hiring. Some workplaces, many of which are hospitals, justify
policies of not hiring smokers by saying they increase productivity and cut down on healthcare
costs. A Texas hospital began extending this policy to those who are obese for similar reasons,
but later reversed the decision.

While higher health insurance rates are acceptable to more Americans, particularly for smokers,
it is still a controversial idea, even though smokers have long had to pay higher life insurance
rates. However, smoking and being overweight are associated with higher healthcare costs. The
Affordable Care Act allows for higher insurance premiums for smokers, and while the majority
of Americans say this type of policy is acceptable, nearly four in 10 say it is not.
Advocates for both of these ideas -- allowing companies to refuse to hire smokers and those who
are overweight, and charging these individuals higher health insurance rates -- say the tactics
would help encourage people to live healthier lives. So far, however, Americans are only on
board with charging smokers higher insurance premiums.
Survey Methods
Results for this Gallup poll are based on telephone interviews conducted July 7-10, 2014, with a
random sample of 1,013 adults, aged 18 and older, living in all 50 U.S. states and the District of
Columbia.
For results based on the total sample of national adults, the margin of sampling error is 4
percentage points at the 95% confidence level.
For results based on the sample of 176 smokers, the margin of sampling error is 9 percentage
points.
For results based on the sample of 837 nonsmokers, the margin of sampling error is 4
percentage points.
For results based on the sample of 249 former smokers, the margin of sampling error is 8
percentage points.
Interviews are conducted with respondents on landline telephones and cellular phones, with
interviews conducted in Spanish for respondents who are primarily Spanish-speaking. Each
sample of national adults includes a minimum quota of 50% cellphone respondents and 50%
landline respondents, with additional minimum quotas by time zone within region. Landline and
cellular telephone numbers are selected using random-digit-dial methods. Landline respondents
are chosen at random within each household on the basis of which member had the most recent
birthday.
Samples are weighted to correct for unequal selection probability, nonresponse, and double
coverage of landline and cell users in the two sampling frames. They are also weighted to match
the national demographics of gender, age, race, Hispanic ethnicity, education, region, population
density, and phone status (cellphone only/landline only/both, and cellphone mostly).
Demographic weighting targets are based on the most recent Current Population Survey figures

for the aged 18 and older U.S. population. Phone status targets are based on the most recent
National Health Interview Survey. Population density targets are based on the most recent U.S.
census. All reported margins of sampling error include the computed design effects for
weighting.
In addition to sampling error, question wording and practical difficulties in conducting surveys
can introduce error or bias into the findings of public opinion polls.
http://www.forbes.com/sites/jaysondemers/2014/07/30/can-you-fire-employees-who-smoke/
Can You Fire Employees Who Smoke?
Jayson DeMers , 2014
Despite data showing that each smoker costs their employer nearly $6,000 in lost productivity
and higher medical costs, employers are still bound by laws when it comes to smoker
discrimination. In many states, its illegal to discriminate against smokers, with worker rights
advocates stating that employers have no jurisdiction over what an employee does after work
hours.
Some companies have begun to find ways to work around the law, including refusing to hire
anyone with traces of nicotine in their urine during routine drug testing. Other companies,
fearing the legalities of such hiring practices, have taken trickier measures to get around the law,
such as banning smoking while within a certain number of feet of the building, even if the
employee is in their car. But whatever issues a business faces involving its smokers, its
important to be aware of a businesss rights when it comes to hiring, firing, and disciplining
nicotine-addicted workers.
The Drug-Testing Question
Employers now regularly exercise their right to require a drug test prior to hiring a candidate,
eliminating candidates who are unable to pass. The presence of illegal drugs in an applicants
urine or blood is a reasonable excuse to pass on an employee, with courts having routinely
upheld the rights of employers to use the results of these tests in their hiring decisions.
However, when nicotine is found in the candidates screening results, an employers options are
limited. Nicotine is still a legal substance, so the courts arent as quick to rule in favor of the
employer in these cases. While there are no federal laws protecting smokers against preemployment discrimination, 29 states currently prohibit it. If you arent located in one of those
29 states, you may be able to decline to hire smokers as part of a smoke-free workplace,
although you may still find yourself the subject of litigation. Its important to carefully research
your local laws to ensure you would win such a case.

Firing Smokers
In many cases, employers have no idea whether an employee smokes until that employee is on
staff. Once an employee has been identified as a smoker, firing that employee can be tricky. In
some cases, courts have upheld employers decisions to dismiss employees for smoking, even
when the activities are taking place after hours. The argument in many of these cases centers on
health insurance premiums, which can be higher for all employees, even if only some employees
smoke.
Instead of firing employees, some workplaces are finding it far more valuable to implement
smoking cessation programs. These programs support workers in their attempts to quit smoking
by offering seminars, counseling, and substantial discounts for cessation aids like prescription
medications and patches. Workplaces have also found that tying their wellness programs into
their insurance plans allows them to reward those workers who take measures to get healthy with
lower premiums, rather than punishing the employees who smoke.
Dealing with Complaints
In addition to health concerns and disrupted workflow, a boss must also cope with complaints
from non-smoking workers. Smokers are known to take more breaks than non-smokers, since
they must indulge their habits. To be fair, many workplaces institute strict break policies, such as
15 minutes in the morning and afternoon in addition to the designated period for lunch. However,
more frequent smokers may sneak outside for a quick cigarette in addition to those breaks. Most
employers dont have time to monitor these behaviors all day, so these employees could slip
beneath the radar until an official complaint is filed.
Non-smokers may also take issue with the secondhand smoke as they pass workers in the
designated smoking areas. Employers are often caught between trying to be fair to smokers
without infringing on the rights of non-smokers. For this to be effective, designated smoking
areas should be situated away from walkways and entrances. Some businesses have also found
that by not providing a comfortable, sheltered area with tables and chairs, theyre able to shorten
employee break times and offset the estimated financial loss.
Its important to note that there have been cases where employees have filed workers
compensation claims based on the health effects they suffer as a result of secondhand smoke.
This shows the importance of safeguarding non-smoking workers and taking their complaints
seriously. Employers are responsible for ensuring that reasonable accommodations are made to
keep employees healthy and safe.
Policies and Disciplinary Action

As with any employee behavior, strong policies and regular feedback are the best methods for
maintaining a productive workplace environment. When written policies are in place, an
employer has much more leverage when those policies need to be enforced. Its important to
focus on making the rules fair for everyone. Employers should outline all allowed breaks and
make clear that the breaks can be revoked by supervisors if the workload mandates it. This
covers employers in the event a smoking employee continuously leaves to smoke while the team
is working hard to meet a deadline.
When it becomes necessary to discipline a smokers behavior, employers should focus on actions
that violate company policies rather than the smoking habit itself. While laws in many states
protect smokers against discrimination, those laws dont include allowing smokers to take breaks
each half hour or smoke in undesignated areas. If an employee consistently violates the rules
despite verbal or written warnings, employers can legitimately initiate disciplinary action based
on these misbehaviors.
http://www.eremedia.com/tlnt/heres-why-you-should-never-ever-hire-people-who-smoke/
Heres Why You Should Never, Ever Hire People Who Smoke
By Jim Roddy 2015
Im going to tick off nearly every smoker who visits this website and delight most every nonsmoker by detailing why its a good rule of thumb to not hire smokers.
A Rule of Thumb is a principle whose broad application is not intended to be strictly accurate or
reliable in every situation. It is an easily learned and easily applied procedure for approximating
a determination.
The catalyst for this article is an email I received a couple weeks ago from a small business
owner:
Jim,
My father and I own a small business and we are having problems with hiring smokers. The last
few hires have been smokers and we seem to have more lost productivity due to smoke breaks.
How do weed those candidates out without infringing upon any labor laws? Are there any
questions that we can use?
Thank you,
A.J.
Following is my reply:

Hi A.J.,
Thanks for the note. Below is a passage and a couple questions from my book (Hire Like You
Just Beat Cancer) related to smoking. The first step before moving forward on pre-employment
questions would be to ask a competent employment attorney if smokers are a protected class in
your locale. They could also tell you if the questions I list below and your company adopting a
no-smoking agreement are legal where you do business.
Diminished productivity on the job
Dont hire smokers. (Note: This rule of thumb might not be legal in some states especially
those along Tobacco Road.) This is another rule of thumb that raises eyebrows, but every nonsmoker with whom Ive talked it through sees the wisdom in it.
The only folks who disagree are, predictably, some smokers.
It is almost a certainty that a regular tobacco habit will diminish smokers productivity,
depreciate your real estate, annoy their non-smoking co-workers, and damage employee-manager
relationships. Plus, managing this issue adds an unnecessary level of grief and liability to your
business.
My first summer job was in the employee services department at the Erie Zoological Gardens.
(You might think everybody who works at a zoo shovels elephant poop all day long, but thats
not the case. I worked in the concession stands, ticket booth, carousel, and other areas where
employees interacted with visitors. I smelled lots of elephant poop but never touched the stuff.)
What my first job taught me about smokers
My last year on the job was the summer after my freshman year in college. A new hiring
manager had brought in a wave of new high schoolers, some of them smokers. The previous
hiring manager never hired smokers, so this was my first exposure to nicotine-addicted team
members. I learned firsthand that their habit will harm:

Their productivity After wed served a flurry of customers on busy days, the
concession stand needed all hands on deck to wipe the counters, refill the ketchup
dispensers, and fill the napkin holders before the next wave hit. But the smokers needed a
quick hit. So theyd leave the concession stand to smoke in the employee break room,
which meant the size of the clean-up crew was cut in half.

Your real estate Our break room was already crummier than the monkey cages, but
the smokers made it intolerable. When I punched out for lunch, Id have to walk through
a smoke-filled hallway. When the smokers werent taking a(nother) break, the room was
a mess because they tossed their cigarette butts on the floor.

The attitude of non-smoking co-workers Based on what youve just read, how do
you think I felt about my smoking teammates? When we needed helping hands, they
werent there. They trashed the break room. And they were belligerent when asked to
change their behavior. Its a habit, was their excuse. I told them playing basketball was
my habit. So would they mind if I took a break during a rush of customers to dribble
around the giraffe exhibit? They argued that their habit was excusable because it was an
addiction. Im sure my employer enjoyed paying us for having these conversations.

Employee-manager relationships The veteran employees tasked with training the


new-hire smokers resented the extra grief they had to endure. Wheres Steph? Shes been
gone for 20 minutes now. You just had your hands near your mouth. Wash your hands
before touching the food. Youve already taken three breaks today. Do you really need
another?

Pre-employment questions you can ask (where legal)


Hiring casual smokers is acceptable, but there are very few true casual smokers. Candidates often
smoke more than they claim they do.
Ive listed a bunch of reasons not to tolerate smoking and the associated grief it creates in your
workplace, but heres the biggest one: Smoking causes cancer.
Note: These pre-employment questions may be illegal in some states where smokers are a
protected class.
1. Do you smoke?
2. Would you sign a no-smoking agreement? Everyone who works here signs a nosmoking agreement. Smoking is not permitted on company premises in the building or
on the parking lot at any time of day or night, including weekends, at lunchtime even
if you leave the premises, at any company function anywhere, or at trade shows at any
time. Would you sign that no-smoking agreement?
If its legal where you live, I recommend adopting a no-smoking agreement and discussing
smoking in your pre-employment process. Some companies go as far as urine testing for nicotine
prior to making a job offer.
Review your HR and hiring practices at least annually to see if they need updated. HR law and
your organization change frequently. For example, would you now apply this rule of thumb to
employees who work 100 percent from home?

http://www.bloomberg.com/bw/magazine/companies-get-tougher-with-employees-who-smoke07012011.html
Companies Get Tougher with Employees Who Smoke
By Pat Wechsler 2011
Many companies use quiet incentives to encourage desired employee behavior, such as losing
weight. Not Macys (M). Beginning on July 1, workers at the department store chain who admit
to using tobacco will be surcharged $35 a month, or $420 a year, for health coverage. The extra
cost will be deferred only if smokers enroll in a free quit-smoking class. Their progress will then
be reviewed after six months.
Instead of using carrots to encourage smokers to kick the habit, businesses increasingly are
wielding sticks. At PepsiCo (PEP), smokers pay an annual $600 insurance surcharge, while
publisher Gannett (GCI) charges $60 a month. Some go even further: Union Pacific (UNP) and
Scotts Miracle-Gro (SMG) refuse to hire smokers.
Between medical spending and productivity losses, smoking costs the U.S. more than
$193 billion a year, says the U.S. Centers for Disease Control and Prevention. Tobacco use is
responsible for one in five U.S. deaths. For employers, a smoker is 18 percent more expensive
than a nonsmoker, says Cathy Tripp, a consultant at Aon Hewitt (AON).
That cost gap likely will widen beginning in 2018 when, under a provision of health reform
legislation passed last year, companies with health plans that spend way more than average will
have to pay an additional federal tax. That may push some to reduce employee coverage.
Employers have two choices: cut benefits or cut the trend of rising medical costs to avoid the
levy, Tripp says. It has made all of them a lot bossier when it comes to employee lifestyle
choices.
Businesses also are looking at how they can get workers to keep closer tabs on their health.
Scotts Miracle-Gro cuts insurance rates up to $60 monthly for workers and spouses who get their
weight, cholesterol, and blood pressure checked regularly. Union Pacific offers free fitness club
access.
Michael Wood, a benefits consultant at Towers Watson, says smoking is employers most
effective wellness target since smoking cessation programs have a relatively high 25 percent
success rate. Employers see wellness as one of the last levers they can pull to try to control
health-care spending, Wood says. You have to get to the root causes of the spending if you
want to cut the trend from the 7 or 8 percent [increases] many employers see annually to
something closer to the 2 to 3 percent inflation in consumer spending.

The tough tactics can have an impact: Scotts Miracle-Gro says its health premiums have risen at
about half the U.S. average since implementing the smoker hiring ban. The strategy can also
ruffle feathers. Some people like the carrot, and some like the stick, says Ken Bordieri,
president of Local 1-S of the Retail, Wholesale and Department Store Union that represents
Macys employees in New York-area stores. I wish Macys had stuck with carrots.
Policies that block employment to smokers or charge extra for insurance discriminate against
low-income and less-educated workers, says Dr. Cheryl Healton, head of the American Legacy
Foundation, the health advocacy group created as part of the civil settlement between cigarette
makers and 46 state attorneys general in 1998. The smoking rate is four times higher among
teens not bound for college than for those pursuing higher education, and lower-income and lesseducated adults also are more likely to smoke, she says.
The Society for Human Resource Management estimated that 59 percent of companies offered
wellness programs in 2010; 28 percent paid bonuses for quitting smoking, losing weight, or
achieving health goals; and a 10th provided insurance discounts for not smoking, getting a health
risk assessment, or joining a weight-loss program.
Health-care companies have been among the most active at tackling smoking. The Cleveland
Clinic banned the use of tobacco in 2005 and stopped hiring smokers two years later. Job
candidates, including doctors, must have their blood tested for nicotine. Says Toby Cosgrove,
chief executive officer of the clinic network: If we want to be a model of health care, then we as
an organization need to show our patients what a healthy lifestyle means.
http://employment.findlaw.com/workplace-safety/smoking-tobacco-in-the-workplace.html

Smoking Tobacco in the Workplace 2015

Because federal law does not regulate smoking in the workplace, most states have laws that
control workplace smoking. Administrative regulations and local ordinances may also apply. The
intent behind these laws is to protect the health of workers. Recent studies have indicated that the
exposure of nonsmokers to tobacco smoke can cause serious health conditions like lung cancer
and heart disease.
Protection of Nonsmokers in the Workplace
Most states do have regulations that protect workers from tobacco smoke. Some laws directly
regulate smoking in the workplace. In Florida, for example, the law prohibits smoking in all
enclosed indoor workplaces (except private residences and bars). A few states limit or ban

smoking in not just workplaces but in public places as well. Other state laws, however, only
protect nonsmoking workers through smoking laws that apply to public places or private places.
If a law limits smoking at work, it will often allow smoking in a designated area. In California,
workplaces with five or more employees must prohibit smoking in enclosed work areas, but may
provide a smoking breakroom as long as nonsmokers have enough breakrooms.
Even when state laws regulate workplace smoking, exceptions may apply in:

Workplaces that typically host private functions

Private offices where only smokers work

Workplaces where the employer can establish that compliance is financially and
physically unreasonable

Protection of Nonsmokers under the Americans With Disabilities Act


Workers that have a serious medical condition that is affected or caused by tobacco smoke may
be protected under the Americans With Disabilities Act (ADA). The ADA prohibits employers,
with at least 15 employees, from discriminating against workers with physical or mental
disabilities. Under the Act, an employee may be able to assert a successful claim if established
that they have a physical impairment that substantially limits one or more major life activity. In a
circumstance involving tobacco smoke, the worker must show that smoking in the workplace has
severely limited the major life activity of breathing.
A worker defined as disabled under the ADA can request the employer provide a reasonable
accommodation. In a circumstance involving tobacco smoke, the worker may request a smokefree workplace. If the employer can establish that prohibiting smoking will cause an "undue
hardship," the employer may not have to accommodate the nonsmoker.
Protection of Smokers in the Workplace
Because the law does not protect the right to smoke in the workplace, an employer may ban
workplace smoking. However, many state laws do protect smokers from discrimination in the
workplace. In some states, laws prohibit employers from banning employees from smoking
outside of the workplace. For instance, in Nevada, an employer may not restrict an applicant or
an employee from smoking tobacco during nonworking hours as a condition of employment.
Other states bar employers from conditioning employment on whether a worker or an applicant
smokes. In North Dakota, an employer may not discriminate, refuse to hire, or discharge a
worker because the worker smokes during nonworking hours, unless it conflicts with the
interests of the business.

- See more at: http://employment.findlaw.com/workplace-safety/smoking-tobacco-in-theworkplace.html#sthash.NpDZhp8m.dpuf

http://chicagoemploymentattorneysblog.com/2010/04/do-you-smoke-state-law-protects-youfrom-termination.html
Do You Smoke? State Law Protects You From Termination
By Steven Tanner 2010
The American Lung Association maintains a list of the 29 states (plus the District of Columbia)
that protect workers from being terminated just because they smoke. Illinois is one of those
states, which enacted the Right to Privacy in the Workplace Act in 1987.
It's a more far-reaching law, essentially prohibiting discrimination against the use of lawful
products. Whether it's Jack Daniels whiskey, Krispy Kreme doughnuts, or Marlboro cigarettes,
any Illinois employment lawyer will tell you that employers may not fire you just because you
enjoy one or more of these vices after work hours.
The American Lung Association makes it clear it doesn't support such legislation, which it
believes puts smokers in a protected class along with minorities and women. But aren't we all
protected from discrimination against personal, legal choices that don't impact our job
performance?
While that's not the case for illicit drugs; which can cost you your job even if they aren't used
during work hours and don't affect performance. Some employers in states without such
protections contend that smokers negatively impact the cost of group insurance plans.
A column in the Ball State Daily News explains how a Pennsylvania hospital plans to start
excluding job applicants who smoke by requiring a nicotine screen as part of a preemployment
drug test. Writer and BSU student Frank Hood, an admitted smoker himself, questions this tact:
"I can understand an employer's wish to reduce health care costs. But is refusing to hire smokers,
or firing employees who are smokers, the best way to do this?"
The Illinois law actually addresses this concern in the workplace privacy law by carving out an
exception with respect to employer-sponsored insurance. That means Illinois smokers may not be
fired, but they may be asked to pay higher health, disability and/or life insurance premiums than
their non-smoking counterparts.

That sounds fair, doesn't it? If you have any questions about your rights in the workplace, you
may want to consult a Chicago employment lawyer.
How do you reference a web page that lists no author?
When there is no author for a web page, the title moves to the first position of the reference
entry:
Example:
All 33 Chile miners freed in flawless rescue. (2010, October 13). Retrieved from
http://www.msnbc.msn.com/id/39625809/ns/world_news-americas/
Cite in text the first few words of the reference list entry (usually the title) and the year. Use
double quotation marks around the title or abbreviated title.: ("All 33 Chile Miners," 2010).
Note: Use the full title of the web page if it is short for the parenthetical citation. Articles found
on the web, like the example above, are not italicized in the reference entry and are not italicized
but enclosed in quotations in the in-text citation, just like a newspaper or magazine article.
Reports found on the web would be italicized in the reference list, as in Publication Manual (6th
ed.) Examples 31, 32, and 33 on pp. 205206. They would also be italicized in the in-text
citation, just like a book.
How to Cite Something You Found on a Website in APA Style

by Chelsea Lee
Perhaps the most common question we get about APA Style is How do I cite a website? or
How do I cite something I found on a website?
First, to cite a website in general, but not a specific document on that website, see this FAQ.
Once youre at the level of citing a particular page or document, the key to writing the reference
list entry is to determine what kind of content the page has. The Publication Manual reference
examples in Chapter 7 are sorted by the type of content (e.g., journal article, e-book, newspaper
story, blog post), not by the location of that content in a library or on the Internet. The Manual
shows both print- and web-based references for the different types of content.
What seems to flummox our readers is what to do when the content doesnt fall into an easily
defined area. Sometimes the most you can say is that you're looking at information on a page

some kind of article, but not a journal article. To explore this idea, imagine the Internet as a fried
egg. The yolk contains easier to categorize content like journal articles and e-books. In that
runny, nebulous white youll find the harder to define content, like blog posts, lecture notes, or
maps. To wit, the egg:

Content in that egg white area may seem confusing to cite, but the template for references from
this area is actually very simple, with only four pieces (author, date, title, and source):
Author, A. (date). Title of document [Format description]. Retrieved from
http://URL
That format description in brackets is used only when the format is something out of the
ordinary, such as a blog post or lecture notes; otherwise, it's not necessary. Some other example
format descriptions are listed on page 186 of the Publication Manual.

Examples of Online References


Heres an example (a blog post) in which we have all four necessary pieces of information (also
see Manual example #76):

Freakonomics. (2010, October 29). E-ZPass is a life-saver (literally) [Blog post].


Retrieved from http://freakonomics.blogs.nytimes.com/2010/10/29/e-zpass-isa-life-saver-literally/
Sometimes, however, one or more of these four pieces is missing, such as when there is no
identifiable author or no date. You can download a pdf version of the chart here that lists all the
permutations of information that might occur with an online reference and shows how to adapt
the reference.
Heres an example where no author is identified in this online news article:
All 33 Chile miners freed in flawless rescue. (2010, October 13). Retrieved from
http://www.msnbc.msn.com/id/39625809/ns/world_news-americas/
And heres an example for a webpage where no date is identified:
The College of William and Mary. (n.d.). College mission statement. Retrieved
from http://www.wm.edu/about/administration/provost/mission/index.php
We have also covered example references for tweets and Facebook updates, press releases,
interviews, wikipedia articles, and artwork in other blog posts. Thanks for reading!
This post is part of an ongoing series about how references work.
When you need a reference citation but nothing in the Publication Manual seems to fit, it helps
to understand the generic template that all APA Style references follow. As discussed previously,
the generic reference answers four interrogative questions: Who? When? What? and Where?
This post addresses the who or author element. Upcoming posts discuss the "when," "what,"
and "where" questions, as well as give advice on adding supplementary information in brackets
and on mixing and matching elements of example references when what you need isnt in the
manual.
Who Is Responsible for This Content?
To determine authorship, ask yourself, who is responsible for this content? Most often, the
who will be one person, or several people, who have served as authors or editors. But keep in
mind that entities (governments, associations, agencies, companies, etc.) can also function as
authors or editors. See pp. 196197 of the Publication Manual for an index of the author
variation examples available.
No Author: Are You Sure?

Oftentimes when it appears there is no author, a company or organization of some sort is actually
responsible for the content. For example, if you are reporting on H1N1/swine flu pandemic of
2009, one of your sources might be a CDC brief like the one cited below, which was authored by
an entity (the CDC) rather than a specific person:
Centers for Disease Control and Prevention. (2009). CDC recommendations
for the amount of time persons with influenza-like illness should
be away from others. Retrieved from
http://www.cdc.gov/h1n1flu/guidance/exclusion.htm
In other cases, there might be no author explicitly stated but you can be reasonably certain who it
is. Example 67 in the manual shows an author name in square brackets to show that the author is
reasonably certain but not stated on the document (p. 214). This is a new style guideline for
APA, so we dont have much practice in using it, but its available to you.
No Author: For Sure
In some cases, there truly is no way to pin down who the author is. We treat this as no
author. In reference citations, we handle this by moving the contents title into the author
position (with no quotation marks around it). This most commonly occurs for wiki entries,
dictionary entries, and unattributed website content. In the in-text citation, the title (put inside
double quotation marks) likewise takes the place of the authors name.
Other Resources on Authorship in References
Pages 196197 in the 6th ed. of the Publication Manual list the author variations in the reference
examples.
These FAQs and blogs address how to cite when there is no author:
How to cite....
How do you cite website material that has no author, no year, and no page numbers?
Because the material does not include page numbers, you can include any of the following in the
text to cite the quotation (from pp. 170171 of the Publication Manual):

A paragraph number, if provided; alternatively, you could count paragraphs down from
the beginning of the document.

An overarching heading plus a paragraph number within that section.

A short title in quotation marks, in cases in which the heading is too unwieldy to cite in
full.

Because there is no date and no author, your text citation would include the title (or short title)
"n.d." for no date, and paragraph number (e.g., "Heuristic," n.d., para. 1). The entry in the
reference list might look something like this:
Heuristic. (n.d.). In Merriam-Websters online dictionary (11th ed.). Retrieved from
http://www.m-w.com/dictionary/heuristic
http://www.google.com.ph/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0ahUKEwj-8q7T2rzJAhUPmMKHZUGCloQFgghMAE&url=http%3A%2F%2Fpatientprivacyrights.org%2Fwpcontent%2Fuploads%2F2013%2F03%2FThe-Ethics-of-Not-HiringSmokers.pdf&usg=AFQjCNHdZp5_jGCf8QLKB9djmq29Vnc1tw

http://www.forbes.com/sites/alicegwalton/2013/03/28/should-companies-have-theright-to-refuse-to-hire-smokers/

Should Companies Have The Right To Refuse


To Hire Smokers?
Alice G. Walton
Theres been a lot of hubbub in recent years about how to get people to quit smoking. The
smoking bans in bars and restaurants in the last decade created some initial backlash, but
ultimately in many cities, the bans are now seen just as a matter of fact. Now though, as some
businesses and hospitals have begun to refuse smokers hire, a new set of ethical issues has
emerged. And while some of these policies have been in place for several years, people are still
arguing about the best courses of action to solve the smoking problem, which is estimated to
be responsible for about 440,000 deaths per year.
This week, dueling commentaries in the New England Journal of Medicine by two groups of
ethicists and behavioral economists offer strikingly opposing views about how to address it. One
group, which includes Ralph W. Muller, CEO of the University of Pennsylvania Health
System, argues that its high time to amp up our efforts to help people quit even if new policies
bring short-term unhappiness, they will certainly bring long-term health benefits. The other set of
authors, which includes former White House health advisor Ezekiel J. Emanuel, says that even

though everyone agrees that smokers should be encouraged to quit, its fundamentally unethical
for businesses, and even hospitals, to refuse people jobs because they smoke.
The Its for Their Own Good Argument
The first group argues that even though the policies against hiring smokers like those adopted
by the Cleveland Clinic, the University of Pennsylvania Health Care System, Union Pacific
Railroad, and Alaska Airlines may seem unjust in the early days, particularly since smokers are
more often of lower socioeconomic status, it will more than make up for this issue by saving
those lives over the long term. It may also create a bit more stigma against smokers, but this is
ok, they say, since ultimately this will recalibrate social norms.
The process may take time the effects certainly wont be felt for a number of years but it will
be well worth it in the long-run, as society will shift for the better:
We believe we should see [the new policies] as one product of a growing recognition that
changing behaviors is hard, that combating addiction is harder, and that behaviors that were once
seen as exclusively private often have profound societal effects. As a result, many stakeholders
are trying to change unhealthy behaviors through mechanisms as varied as legislative
requirements for calorie labeling in some restaurants, bans on the sale of large servings of sugarsweetened beverages, and Affordable Care Act provisions allowing employers to provide
rewards or penalties worth up to 50% of employees health insurance premiums on the basis of
health assessments, including smoking status.
These policies, the add, would have been considered hard paternalism back in the day when
people thought nothing of smoking on airplanes and in the office, but nowadays theyre generally
considered softer and acceptable. In the future, theyll just been seen as a matter of course.
This group also points out that stepping up our efforts to help people quit is especially necessary
since even company measures that go as far as offering financial incentives for employees to quit
only lead to very low quit rates (about 9% are still quit after 18 months). And of the 70% of all
smokers who say they want to quit, only about 2-3% are actually successful at quitting. In
hospitals, they say, not allowing employees to smoke is a no-brainer, since patients dont want to
smell cigarette smoke on their healthcare providers clothes.
Anticipating the arguments of the other side, the authors say, Critics may argue that these claims
are disingenuous, akin to a human resource directors saying to tobacco-using applicants,
Believe me, its for your own good that Im not hiring you. But in the long run, such policies
may indeed be for their own good.
The Unethical Argument:

It may be for employees own good, say the other group of writers, but if you pick apart the
policies and the effects theyll have across the socioeconomic strata, policies against hiring
smokers cant be considered ethical. Implementing a no-hire policy for smokers results in a
failure to care for people, places an additional burden on already-disadvantaged populations, and
preempts interventions that more effectively promote smoking cessation.
They argue that hospitals, of all places, cannot in good conscious refuse to hire smokers since
they treat people whose behaviors have often contributed to their health problems. It would be
paradoxical to create policies against employees who do the same:
It is callous and contradictory for health care institutions devoted to caring for patients
regardless of the causes of their illness to refuse to employ smokers. Just as they should treat
people regardless of their degree of responsibility for their own ill health, they should not
discriminate against qualified job candidates on the basis of health-related behavior.
The second issue, they say, is that smoking is not a totally voluntary behavior, since it involves
addiction and you cant discriminate against people for at least partially involuntary behaviors.
And there are health costs associated with a range of unhealthy behaviors, not to mention healthy
ones. People who engage in risky sports may have accidents or experience trauma routinely and
burden coworkers with additional costs. Having babies increases premiums for fellow employees
who have none. So to deny smokers jobs would not be a reasonable course of action.
Finally, the economic impact it could have on people of lower socioeconomic status is
significant, since smoking is unevenly distributed. More than 36% of Americans living below
the federal poverty line are smokers, as compared with 22.5% of those with incomes above that
level. And since about 45% of unemployed people smoke, no-hire policies would create a
double-whammy among this group. These policies therefore disproportionately and unfairly
affect groups that are already burdened by high unemployment rates, poor job prospects, and job
insecurityBy cherry-picking low-risk employees and denying employment to smokers,
employers neglect this obligation, risk hurting vulnerable groups, and behave unethically.
This group of authors suggests that a better way would be to hire the best person for the job, and
to support employees efforts to quit in more productive ways than to punish smokers by not
hiring them, or even by imposing financial penalties on current employees. Successful cessation
programs could lead to higher productivity and lower insurance contributions for nonsmokers,
thereby benefiting all employees.This approach, they conclude, may even be a winwin
economic solution, since employees who feel supported will probably be more productive than
will those who live in fear of penalties.
Its not entirely clear which side has the stronger argument, or what will come of this debate,
which is published in one of the most prestigious medical journals in the world. Certainly both

sides make valid cases. Which side will wavering CEOs favor? Which will undecided politicians
embrace? What are your thoughts?

http://www.hrmorning.com/update-the-pros-and-cons-of-refusing-to-hire-smokers/
Tim Gould
The pros and cons of refusing to hire smokers

Now that Obamacare has kicked in, more and more companies are refusing to hire people who
smoke. But some legal dangers do remain.
As we pointed out in a post in February 2013, theres no federal law that protects smokers or
entitles them to equal protections when it comes to hiring, promotions, etc. Thats because the
Equal Employment Opportunity Commission doesnt recognize smokers as a protected class.
And Fisher & Phillips attorney Kytle Frye, writing on the Beckers Hospital Review website,
points out that the Patient Protection and Affordable Health Care Act actually recognizes the
increased healthcare costs associated with smoking employees by allowing insurers to raise
smokers insurance premiums up to 50 percent over those paid by non-smokers.
Theres certainly no lack of evidence that smoking adversely affects employee health and
productivity. Frye offers a sampling of the grim evidence, gathered by various research groups
over the past several years:

smokers miss an average of about 6.16 days of work per year, as opposed to
3.86 days missed by non-smokers

a smoker taking four 10-minute smoke breaks per day actually works one
month less per year than non-smokers

for each smoking employee, an employer shoulders an additional $3,391 per


year in costs including $1,760 in lost productivity and $1,623 in excess
medical expenses, and

in a years time, smokers make more hospital visits per 1,000 employees
(124 vs. 76), have a longer average length of stay (6.5 vs. 5 days) and make
six more visits to healthcare facilities than non-smokers.

The cons
OK, so those are the reasons why refusing to hire smokers seems like a good idea.
But its not a step to take without knowing what youre getting into.

First, 29 states and the District of Columbia have laws in effect elevating smokers to a protected
class. Heres the list, from the American Lung Association:

California

New Jersey

Colorado

New Mexico

Connecticut

New York

District of Columbia

North Carolina

Illinois

North Dakota

Indiana

Oklahoma

Kentucky

Oregon

Louisiana

Rhode Island

Maine

South Carolina

Minnesota

South Dakota

Mississippi

Tennessee

Missouri

Virginia

Montana

West Virginia

Nevada

Wisconsin

New Hampshire

Wyoming

And other possible legal snares? Heres Fryes analysis, in part:


As with almost any decision affecting employees, implementing premium differentials [for
smokers] involves some risk, and the decision to do so should involve due concern for those
risks. For one, the Health Insurance Portability and Accountability Act prohibits employees in a
group health insurance plan from being charged more for coverage because of a health factor,
which includes health status, medical condition and claims experience, among other things.
Although lifestyle choices such as smoking are not named as health factors, medical opinion
exists identifying nicotine addiction as a medical condition. HIPAA does, however, allow
employers some leeway to maintain a premium differential as long as they establish a non-

smoking program as part of a wellness program providing a reward for participation in the
form of a reduced premium for not smoking.
Another potential legal problem arises from the Americans with Disabilities Acts prohibition
against discriminating in benefits with respect to qualified individuals with disabilities. Although
smoking has yet to be identified as, itself, a disability, it often does involve attendant health
issues that are disabilities, and there is always a possibility that a court would accept a claim on
the theory that a smoker was regarded as being disabled. Still, it also is likely that having an
acceptable wellness program would provide some insulation from such outcomes.
Proponents for smokers also have argued that, as the less affluent, less educated are much more
likely to smoke and to fail to participate in wellness and smoke cessation programs, imposing a
premium cost for those choices has a disproportionate adverse impact on such people, which
may amount to racial or national origin discrimination.
The idea here is that minorities and certain ethnicities are much more likely to be smokers. A
related argument is that smoking is often not so much a matter of choice, but an addiction that
began earlier in life.
Finally, a couple of thought-provoking arguments from from the anti-smoking journal Tobacco
Control:

Its a slippery slope. If the decision were based on health-related costs,


couldnt a case be made for banning people with with weight-related
problems, such as high cholesterol or diabetes? And wouldnt that raise
discrimination concerns?

Would you be turning away good talent because of a smoking


addiction an addiction that could be licked with some help? Sure,
when unemployment is high and lots of people are job hunting, you can be
choosy. But do you really want to lose that top salesperson or IT manager to a
competitor because of smoking?

https://www.thinkabel.com/in-the-news-the-pros-and-cons-of-refusing-to-hiresmokers
Lianne Dane
In recent years, a number of companies particularly those within the
healthcare industry have enacted policies under which they refuse to hire tobacco

smokers. HR Morning News recently profiles an article by Kytle Frye for the Beckers
Hospital Review website that examined whether such policies which are designed to
reduce healthcare costs are actually detrimental to companies.

The Pros:
Citing various studies conducted over the past few years, Frye notes that:
smokers miss an average of 6.16 days of work per year, as opposed to 3.86 days
missed by non-smokers
a smoker taking four 10-minute smoke breaks per day works one month less per
year than non-smokers
for each smoking employee, an employer takes on an additional $3,391 per year in
costs, which includes $1,760 in lost productivity and $1,623 in excess medical
expenses
Smokers make more hospital visits per 1,000 employees at 124 per year vs. 76 per
year for non-smokers, and stay an average of 6.5 days versus 5 days for nonsmokers. In addition, smokers make six more visits to healthcare facilities than nonsmokers each year.

However, it should be noted that the Equal Employment Opportunity Commission doesnt
recognize smokers as a protected class. However, 29 states and the District of Columbia
have laws in effect elevating smokers to a protected class. To see the full list, please visit
the American Lung Association.

Cons:
Now the cons largely in the form of legal issues come in, in part, when you factor in
Obamacare, which recognizes the increased healthcare costs associated with smoking
employees by allowing insurers to raise smokers insurance premiums up to 50 percent over
those paid by non-smokers. However, implementing premium differentials for smokers can
involve some risk:
The Health Insurance Portability and Accountability Act (HIPPA) law prohibits
employees enrolled in a group health insurance plan from being charged more for
coverage because of a health factor, which includes health status, medical
condition and claims experience, among other things. Although smoking isnt named
as a health factor, Frye notes that medical opinion exists identifying nicotine
addiction as a medical condition. However, HIPAA does allow employers to
maintain a premium differential as long as they establish a non-smoking program as
part of a wellness initiative that provides a reward for participation in the form of
a reduced premium for not smoking.
A second legal problem that can arise stems from the Americans with Disabilities
Acts prohibition against discriminating in benefits with respect to qualified

individuals with disabilities. Although smoking has yet to be identified as a


disability, it often does involve attendant health issues that are disabilities, and there
is always a possibility that a court would accept a claim on the theory that a smoker
was regarded as being disabled. Again, Frye notes that again, having an
acceptable wellness program would likely provide some insulation from such
outcomes.
Frye further notes that imposing a premium cost for smokers who are said to be
less affluent, less educated and more likely to be minorities or certain ethnicities
has a disproportionate adverse impact on such people, which may amount to racial
or national origin discrimination.
In addition, the anti-smoking journal Tobacco Control questions whether you really
want to lose that top salesperson or IT manager to a competitor because of
smoking? Especially when smoking is an addiction that could be licked with some
help.
Further, if the decision was based on healthcare costs alone, couldnt you then make a case
for declining to hire people with weight-related problems, chronic disease or other
expensive medical conditions? It then becomes a very slippery slope and could open even
the most well-meaning company up to expensive litigation.

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