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mind if i sew a scarlet “T” on your chest? the communication and cultural challenges of no-hire tobacco policies

February 15, 2012

in health communication,tobacco cessation

should companies not hire tobacco users? i’ve been wrestling with this question as news continues to spotlight this particular “stick” companies yield in their efforts to improve employees’ health.

if you’re unfamiliar with the no-hire tobacco policy, let me get you caught up. companies like cleveland clinic, humana, geisinger and others have stated they won’t hire tobacco users. some, like geisinger and cleveland, allow job candidates to reapply for a job once they can prove they’ve quit tobacco. geisinger and cleveland clinic won’t hold the job, but if the position’s still open, candidates can put their hat in the ring again. this no-hire tobacco policy is a more aggressive tactic than tobacco surcharges, which 64% of companies apply or plan to apply, according to a 2010 AON hewitt report. there are no stats, that i’m aware of, for what percentage of companies are currently or planning to institute this no-hire policy.

on the one hand, a no-hire tobacco policy stands on solid financial and cultural ground. tobacco users are more expensive. full stop. they run up more health care bills. they lag in productivity. their habit leads to other devastating, expensive illnesses and negatively affects the health of those around them, whether through second-hand or third-hand smoke. they even make cleaning maintenance bills go up. and culturally, public sentiment does not favor tobacco use. nor does tobacco use align with a company’s healthy workplace vision—particularly for health organizations. after all, how can an insurer or hospital system preaching healthy living reconcile unhealthy behaviors within its own workforce? how can a health team advise a patient to quit tobacco when that patient sniffs tobacco residue lingering on a nurse’s uniform?

on the other hand, this policy has some serious shortcomings:

  • tobacco users don’t come by their tobacco use by chance. marketing, education level and a host of other factors affect someone’s “choice” to use tobacco. many were ensnared before they were the wiser, thanks to cigarette manufacturers manipulating the nicotine yield, making cigarettes increasingly addictive.
  • the majority of tobacco users want to quit and have tried to do so. the average tobacco user attempts to quit between 8 and 11 times before he’s successful. that number increases for people with mental or other substance abuse problems—problems that are exacerbated by economic distress, such as being jobless and reviled.
  • tobacco users don’t get the counseling they need when they’re adrift. employees outside of a tobacco-free workplace may continue using tobacco simply because they’re not coming into contact with those who’d provide, or even advise, quitting support and resources. according to the CDC, only 50% to 60% of smokers receive advice about quitting smoking from a health care provider, and only 39% of smokers are offered over-the-counter or prescription medication or counseling to support the quitting process.
  • tobacco users are left outside of a supportive environment. one of the steps in most advocated quitting approaches includes creating a supportive environment, with new habits, cleansed-of-tobacco spaces, and got-your-back co-workers. listening to cleveland clinic talk about their no-hire tobacco policy, i was struck by the fact that they’ve been successful in cutting by half the percentage of their employee population who smoke. wouldn’t it be far more effective to wrap tobacco users in an environment that motivates their quitting rather than spurns it?

there are additional challenges. employees may question their company’s messaging about creating a culture of health. they’d be justified in asking why tobacco users are singled out and not those who threaten their health or others’ via drunk driving, domestic abuse or even too many twinkies. many have raised the point that obesity is a much more expensive and pervasive problem today than tobacco use.

employees might not be the only ones to buck at the no-hire approach. according to the edelman 2011 health barometer, we consumers want to work for, buy from and recommend those companies that make public health a priority. do consumers see a no-hire policy as a company standing up for good health? or do they view it as a quick way to save a buck? chances are if you sell tobacco but won’t hire tobacco users or charge them more for health insurance, your company’s open to derision.

we’ve made great progress helping people quit, thanks to changes in public policy and public perception. but now we may be a little stuck. a 2010 gallup poll found that 22% report smoking cigarettes, a figure unchanged from five years ago. employers can use their exposure to tobacco users and their hefty influence to move the needle—if they choose to offer tobacco cessation resources for free to eliminate financial barriers, ban tobacco use in buildings and other office property, and implement a comprehensive tobacco-prevention communication strategy. or they can sew a scarlet “T” on people’s chest and show them the door.


for assistance with your approach to tobacco at work, review this document from the CDC.


Leave a Comment

{ 8 comments… read them below or add one }

Frank Roche February 15, 2012 at 8:28 am

I’ve really wrestled with this one. As an employer of creatives…well, they smoke. I’m not crazy about it…and they have tried to quit. It ain’t easy.

I’ve been majorly anti-smoking my whole life. Both of my parents died of smoking-related illness. (One lung cancer; one emphysema.) And I never once even tried smoking. Hate the look of it. The smell. The health effects. But I sympathize with people who get hooked and then can’t get off that addiction stick. I do think it’s a lot of marketing that gets them to start…

So…my take…companies are out of bounds with no-hire tobacco policies. Maybe they should have a Top 10 Risk Factors list: Gun owners, motorcycle riders, Twinkies eaters, seatbelt avoiders, porn addicts, reality TV fans, anger management candidates, prescription users, diabetes patients, and guys named Frank.


fran February 16, 2012 at 2:37 pm

i do look out for those guys named frank. i hear they’re changeable.

the fact that tobacco use is so highly addictive and has been manipulated to be so is one of the reasons i prefer a hire-and-quit policy instead, as greg talks about below.



Paul Hebert February 15, 2012 at 9:27 am

I think companies have the right to do a lot of things. If they are private companies – hey… still America right?

But it is a slippery slope on some of this stuff – tanning beds? They can increase cancer risk so should we only hire very, very pale people (then you get the whole vampire vibe going tho.)

Connecticut has highest incidence of breast cancer per 1000 – don’t hire people from Connecticut?

Behavior-based risk factors = higher premiums – that’s fair in my opinion. But if someone is doing something that is riskier shouldn’t stop them from working.


fran February 16, 2012 at 2:39 pm

right now we have inconsistent laws protecting tobacco users from these sorts of hiring policies. it’ll be interesting to see what push back results from more companies implementing them.

what do you think of behavior-based risk factors = get thyself into a quit program = same premiums as usual?



Neil Goldfarb February 15, 2012 at 3:31 pm

Great piece. Given how much we know about the adverse health effects and costs of smoking we need to make smoking as inconvenient and socially unacceptable as possible. However, for the reasons you mention, we also should be doing everything possible to increase access to evidence-based smoking cessation programs and therapies.

One concern you didn’t raise is policing these policies. How will smokers be identified during the recruitment process, how will continued abstinence be monitored, what will happen to current employees who take up smoking, and, my favorite, will whistle blowers be allowed to rat out smoke blowers?


fran February 16, 2012 at 2:41 pm

neil, thanks for reading and commenting. you raise some great questions. i have clients who use only self-reporting about tobacco habits because the cost of nicotine testing is too high. as for whistle blowers, i hope not! i wrote before of a growing fat stigmatization. ratting out, bullying or stigmatizing any group isn’t great for individual or company health.



Greg Matthews February 15, 2012 at 4:11 pm

You sure know how to push my buttons, Fran. I guess I’ve been married to the same approach here for the last few years, but I’ll be the first to acknowledge that it’s not without flaws.

Here’s my take: I fully support companies who decide to go with tobacco no-hire processes. BUT – and this is a big one – I think that two things have to caveat that kind of policy:

1. The rule needs to be, “if you smoke, you need to commit to completing this (specific) smoking cessation course during your first year of employment.”
2. If you can’t quit in that first year, you have to commit to taking that smoking cessation class EVERY year until you do.
3. Reporting is voluntary, and left to the honor system. EXPECT employees to be honest and give them the benefit of the doubt.
4. The only grounds for termination or a no-hire decision are a REFUSAL to go through the smoking cessation course.

This leaves no doubt about the position of the company. But it also recognizes that quitting is HARD, and it might take twenty attempts to quit. That’s my two cents, anyway. Thanks for tackling the toughies!


fran February 16, 2012 at 2:42 pm

where would we be if i couldn’t push your buttons?!
i like your rules. would you make quit programs and products free for as long as someone was committed to quitting?



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