Hiring a smoker could cost business owners nearly $6,000 extra per year.  

That was the finding of a recent study comparing the cost of employees who smoke with nonsmokers, published in the peer reviewed journal Tobacco Control. This cost includes increased health care, pension costs, absenteeism costs, and loss of productivity due to smoke breaks.  

Researchers say one cost associated with smoking is increased absenteeism among workers. The study found that smokers miss more work, with a cost of $517 per year compared to nonsmokers. Health care expenses were $2,056 more per year, on average, for smokers.  

Perhaps most surprising is the cost of smoke breaks, which are estimated at $3,077 in lost productivity each year per smoker. The average smoker takes about five smoke breaks during the work day. Not only do smokers take more breaks, they also begin to experience withdrawal symptoms soon after smoking which may potentially impact productivity between smoke breaks. As soon as 30 minutes after having a cigarette, smokers can begin to experience cravings and mood disturbances, which may impact the person’s ability to focus and work as effectively.

Increased health care expenses are a significant contributor to the financial impact of smokers on the workforce.  The Centers of Disease Control calls tobacco use the “single most preventable cause of disease, disability, and death in the United States.” Smoking tobacco is a leading risk factor for lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, and many other types of cancer. 

According to the CDC and Prevention, about 443,000 people die prematurely each year in the U.S. as a result of smoking tobacco. To put that into perspective, this would be equivalent to the deaths experienced if there were approximately three World Trade Center terrorist attacks each week, every week, in the U.S. year after year. 

That fact actually could save some employers money in the form of employee pensions, as retired smokers likely will die sooner than their nonsmoking counterparts. The study published in Tobacco Control reported that annual pension costs were an average of $296 less for each employee who smoked.

An additional concern is the fact that many of the conditions associated with smoking are chronic and can lead to tremendous health care costs, absenteeism, and lack of productivity over a period of many years.  Smokers also are at increased risk of other illnesses such as the common cold and pneumonia compared with nonsmokers, contributing to absenteeism and reduced productivity of the individual and potentially the surrounding workforce. The short-term and long-term costs to industry are significant.

But could it just be as simple as setting a policy to refuse to hire smokers? Many companies, particularly those in the health care industry, have chosen to do just that. Many hospitals, health clinics, and health-related agencies have restrictive hiring policies in place.  

One of the first private-sector employers to set the precedent of not hiring smokers was Alaska Airlines in the 1980s. Since that time, and as more employers have become aware of the financial impact of hiring smokers, many more businesses have followed suit. Locally, Avista Utilities has had a policy in Washington state since the late 1990s banning hiring smokers. Employees who already smoked were grandfathered in. Potential employees are asked their smoking status during the screening processes and commit to living a smoke-free lifestyle throughout the duration of their employment. Many other local businesses, both small and large, have versions of restrictive policies as well.

Bans on hiring smokers aren’t without controversy. Twenty-nine states have passed legislation preventing employers from discriminating based on smoking status. Some believe that choosing not to hire smokers is unethical, disproportionally targeting already disadvantaged groups, and therefore reducing their ability to have access to employment and essential services, potentially creating a burden on the state. 

 Smoking rates are higher among those who are below the poverty level, those who didn’t graduate from high school, and among “blue collar” workers. Supporters argue that private-sector employers should have the right to make business decisions that are in the best financial interest of the company, as well as to promote a culture of health.

In 2013, the Spokane Regional Health District implemented a tobacco-free campus policy for its employees, as well as a nontobacco use hiring policy. 

Paige McGowan, tobacco, e-cigarette, and marijuana prevention coordinator for the health district, says, “Implementation of the policy began with changing hiring prac-tices to not hire tobacco users. A few months later, the policy became effective for existing employees. Those who were employees before the policy was implemented were ‘grandfathered’ in and can still use tobacco, but must abide by the Tobacco-Free Campus policy and are encouraged and supported to quit smoking.” 

Implementing hiring bans may involve negotiations with labor unions. The SRHD policy implementation involved two rounds with the district’s unions to settle on a workable policy.

McGowan says, “Tobacco policies don’t need to be lengthy to be effective. The policy at SRHD is only a few sentences long. It explains the health district’s philosophy of personal health and well-being and describes that tobacco use is prohibited during paid work time; while wearing any agency identification; and while in or on the agency’s grounds, buildings, and parking lots, with the exception of in employee-owned vehicles.”

The health district includes its Tobacco-Free Campus policy on its employment site, on job applications, and in its employee handbook. Once hired, employees are required to sign a Nontobacco Use for Employment agreement.

Several options exist for employers wishing to reduce the impact of smoking on their bottom line. Some employers choose to increase health care premiums for employees who smoke. 

Other companies, such as Walgreens, provide free nicotine replacement therapy and smoking cessation counseling to employees. 

General Electric put together a program with a combination of incentives amounting to $750 which led to impressive cessation rates, which were found to be three times more effective than education-alone programs.  

With the enactment of the Affordable Care Act, all new health care plans must cover tobacco cessation treatment, although coverage varies widely from plan to plan. 

The ACA requires coverage of all preventive services given an ‘A’ or ‘B’ rating by the U.S. Preventive Services Task Force, including tobacco cessation.

Help is available for those wanting to incorporate smoke-free policies in both small and large worksites. This spring, the Spokane Regional Health District will release a toolkit for employers who want to develop one or more types of tobacco-free policies. 

Employers can decide whether to allow tobacco use in designated worksite areas, to prohibit smoking on the property altogether, or to implement a tobacco-free hiring policy.

Robin Pickering is an associate professor of the health science department at Whitworth University.