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At More U.S. Workplaces, Smokers Need Not Apply
Date:1/16/2012

By Mary Brophy Marcus
HealthDay Reporter

FRIDAY, Jan. 13 (HealthDay News) -- Following the lead of the Cleveland Clinic and a growing number of other hospitals, Pennsylvania's Geisinger Health System will turn away job applicants who smoke starting next month.

"This is quite a trend. Hospital systems throughout the country are doing this increasingly," said Dr. Michael Siegel, a professor of community health sciences at Boston University School of Public Health.

The move further flames a debate between workers' rights organizations and health advocates over whether denying jobs based on tobacco use is just. Some argue it's a form of employment discrimination, while organizations that adopt such standards, including Geisinger, say that turning away smokers reduces health care costs and absenteeism, and sets a healthy example.

Non-nicotine hiring policies are legal in many states, including Pennsylvania. Only 29 states have laws that prohibit making employment decisions based on smoking or tobacco use, said Paul Billings, vice president of national policy and advocacy at the American Lung Association.

All of Geisinger's facilities have been tobacco-free since 2007, said Marcy Marshall, the organization's director of clinical enterprise communications. "This new policy was just the next step in creating a tobacco-free environment," she said.

"Users of nicotine in Pennsylvania are not a legally protected class. We're well within our rights according to Pennsylvania law to do this," Marshall said. Geisinger employs more than 14,400 workers, and Marshall said those who already use tobacco won't risk losing their jobs when the new hiring measure goes into effect on Feb. 1.

"We have a responsibility, being a health care organization, to encourage people to take good care of themselves. Certainly using any nicotine products is harmful to your body -- it's been scientifically proven," Marshall said.

More than 392,000 people in the United States die each year from tobacco-caused disease, making it the leading reason of preventable death, according to the American Lung Association. Another 50,000 people die from exposure to secondhand smoke.

It's another way to get the message across that smoking is bad for your health, said pulmonologist Dr. Aditi Satti, director of the smoking cessation program at Temple University Hospital, in Philadelphia. But it's complicated, she said. "I think a pretty fine line runs between public health and personal liberties. Whether or not this is going to be an incentive, time will tell."

To ensure an applicant is tobacco-free, Geisinger will require anyone who is extended a job offer to take a nicotine screen, a urine test that detects cigarette, smokeless tobacco, snuff, nicotine patch, nicotine gum and cigar use, Marshall explained.

"It will be part of the routine drug screening," she said.

If the candidate fails the screening, Marshall said Geisinger's doors aren't closed forever. "They'll be welcome to apply for jobs again in six months," she said.

Some experts aren't confident that blocking smokers from jobs will motivate them to kick their habit.

"Tobacco use is a very powerful addiction. We don't support making smokers a protected class, but we also have great concerns about these punitive approaches," Billings said. "There's not a lot of data that shows this is an effective mechanism."

Siegel is against no-smoker hiring rules. "Despite being a pretty strong anti-smoking advocate and working in the health care field, I'm really opposed to these policies. It's a form of employment discrimination. Making decisions about hiring based on a group to which someone belongs rather than on their actual qualifications for the job, as a principle, is wrong," he said.

Siegel said once a company makes the argument not to hire a person in a particular group because it will cost the organization more money for health care, it justifies not hiring people for other health reasons. "Why not not hire anyone over 50, or fat people, or people with diabetes?" he asked. He said research suggests there is also a link between smoking and lower education levels, so in theory, the policy also becomes an issue of class discrimination.

"It's also an invasion of privacy," Siegel said. "I think what someone does in the privacy of their own home is really no business of the employer. It's basically saying it's perfectly okay for an employer to delve into any aspect of your personal life they want to. Once they go down this road, why not ask about their sexual practices, how many partners do you have -- it starts getting ridiculous."

Temple's Satti said the key to really help smokers quit is to make programs and medications easily available to them. "Why not hire the person as long as they promise to do the program?" she said. "Instead of punishing them, give them additional reasons to help them quit smoking."

More information

Visit the U.S. Centers for Disease Control and Prevention to learn about tobacco-free workplaces.

SOURCES: Michael Siegel, M.D., M.P.H., professor, community health sciences, Boston University School of Public Health; Paul Billings, vice president, national policy and advocacy, American Lung Association; Marcy Marshall, director, clinical enterprise communications, Geisinger Health System, Danville, Pa.; Aditi Satti, M.D. director, smoking cessation program, Temple University Hospital, Philadelphia


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