Thank you for not smoking Featured

8:00pm EDT October 26, 2008

Even though the smoking rate among adults in the United States has dropped from 42 percent in 1965 to 21 percent in 2006, tobacco use continues to kill 440,000 Americans a year. What may be more astounding is that secondhand smoke kills an estimated 53,000 persons each year. It is estimated that exposure to secondhand smoke in the workplace kills more people than any other occupational hazard.

Secondhand smoke is a Class A carcinogen. State and federal governments have strict laws to protect workers from all other powerful carcinogens, but employers are given much more leeway in protecting their workers from secondhand smoke.

“Helping employees quit smoking has evolved from a generous outreach effort to a health and business imperative,” says Michael O’Donnell, Ph.D., MBA, MPH.

Smart Business talked with O’Donnell about how smoking cessation programs can be instituted in the workplace.

What are the costs of employee smoking to an employer?

In addition to the health problems caused by smoking, the increase in medical costs is estimated at $1,600 per year per smoker. On top of that, employees who take three 10-minute smoking breaks a day are spending 15 eight-hour days of paid company time a year away from the job to smoke.

What smoking-restriction policies are available to employers?

There are three options:

  • Restrict smoking to designated areas. This is a good start for companies that have no restrictions, but it is very difficult to keep the smoke in the smoking areas. Also, smoke in confined smoking areas is so concentrated that it puts people who are forced to work in these areas at double risk.

  • Establish smoke-free buildings. Not only are you providing clean air in all indoor work locations, you are also forcing smokers to go outside to smoke, which is enough to convince some to quit and most to smoke less. However, the main drawback is that smokers tend to congregate by the doors, which means that other workers, customers and visitors have to walk through the smoke.

  • Implement an entire campus as smoke-free. When employers create smoke-free work environments, the benefit to workers who were previously exposed to secondhand smoke is immediate. All workers now have access to clean air to breathe and do not have to worry about risking their health just coming to work.

Is altering hiring practices appropriate?

A growing number of employers have decided not to hire smokers, including the American Cancer Society and the Union Pacific Railroad. Not hiring smokers does not directly benefit smokers, but it has clear direct benefits in terms of worker productivity and medical costs. A small number of companies have fired employees who smoke. This has attracted much visibility and numerous legal challenges.

How can you make these policies succeed?

Any new smoking policy should include support, such as smoking cessation programs to help smokers quit. Implementing a smoke-free workplace will increase the number of people who try to quit. The key to success is an approach that combines expert advice and medication.

Regardless of the policy an employer chooses, there are four factors that contribute to success. One, the leadership team should have a unified message regarding the policy and announce it to employees. Two, employees, including smokers and nonsmokers, should be engaged to determine how to best implement the policy. Three, communication efforts should focus on the importance of protecting the health of all workers by providing clean air to breathe. And, fourth, clear protocols should be in place to enforce the policy.

What are the benefits to an employer of instituting a smoking cessation program?

Worker productivity should increase as soon as a smoker quits because he or she is able to spend more time at work. However, much of this productivity gain will be offset by the struggles of overcoming the physical addiction to nicotine.

Many smokers who quit have very real physical withdrawal symptoms, including irritability, fatigue, insomnia, headache, cough or sore throat. These symptoms can make it difficult for some workers to focus on work, so productivity may actually drop for a few days. Showing compassion for quitters during this time will go a long way.

Smokers have higher medical costs because they are sick more often and more severely. Smokers who quit because of an acute health problem may actually see their medical costs increase in the first year or two because of the disease, not because they quit smoking. It will take time for former smokers to recover, and their costs will drop as they heal. In fact, these costs will drop to the costs of non-smokers over a period of five years for former smokers who do not have chronic diseases and 10 years for those who have chronic diseases.

MICHAEL O’DONNELL is a Ph.D., MBA, MPH. For more information, contact William Modoono, senior writer, UPMC Health Plan at or (412) 454-7781.