For several decades, there have been public health initiatives to help people reduce or eliminate the use of tobacco. Smoking rates have declined from 42.4% in 1965 to 20.6% in 2009.[1] At first there were public awareness campaigns about the harmful effects of tobacco use. They had some impact. Then tobacco advertising was prohibited. That had some impact. Eventually tobacco products were taxed to further discourage use. That also had some impact.

In the workplace, state laws have prohibited smoking inside buildings for many years. Although most states have statewide bans on smoking in bars, restaurants and workplaces, there are still a dozen states that don't have such bans. For many of us, we are used to seeing the smokers gathered around the entrances of buildings.

Employers continue to struggle with how to deal with employees who smoke. These employees are less productive and have higher health care costs, costing as much as $10.47 per pack of cigarettes.[2]

At a recent meeting of the Worksite Wellness Council of Massachusetts, employer's approaches to managing employee tobacco use were addressed. Three approaches were presented:

Smoke-Free Campuses - this is becoming much more common amongst employers. This policy prohibits smoking anywhere on the property of the business or organization. Massachusetts hospitals, who employee over 180,000 people, are moving toward this policy. In this case, it applies not just to employees, but also to visitors and patients. The Massachusetts Hospital Association is leading an effort to get all Massachusetts hospitals to be tobacco free.
Health Insurance Surcharge - the surcharge is based on self-disclosing yourself as a tobacco user. A surcharge, in the range of $25 per month, is added as a 'penalty' for smokers. The thinking here is that eventually, smokers will quit because of the added financial burden. We should note that while the life insurance industry has 'rated' or charged a higher premium for smokers since the 1970s, it is not a current practice of health insurers. While most employers still use the self-disclosing approach, some are beginning to do testing. Another trend with this policy is applying it to all adults covered on the health plan, including spouses/domestic partners and adult children.
No-Hire Policy - those organizations that are getting very serious about tobacco policies are moving towards 'no-hire' policies. This approach is not hiring anyone who uses tobacco products. The Cleveland Clinic was a notable leader when they instituted this type of policy in 2007. These employers are typically using cotinine testing for new hires. While testing for drugs is not unusual with many employers, tobacco testing is still relatively limited.

Regardless of the policy selected, all employers provide support to help employees quit smoking or tobacco use. This may include providing access to smoking cessation programs and no-cost nicotine replacement therapies.

Employers are giving more serious consideration to policies such as surcharges and no-hiring because they have found that after years of offering 'carrots', the number of smokers has not diminished. These 'stick' approaches may seem harsher, but they make a clear statement to employees about the importance of good health.

Mari Ryan, MBA, MHP, CWWPC

index.htm Retreived May 22, 2011

[2] Campaign for Tobacco-Free Kids: Toll of Tobacco in the United States of America. Available at: http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf Accessed May 22, 2011