Puff or No Puff?

I’ve been thinking a lot about smoking lately. My hometown of Boise, ID just joined, although late to the party, the ranks of many other cities around the nation by banning smoking in bars. As a patron, I appreciate the smoking ban and remember the days when I would wear clothes that already needing washing given the presence of smoke stench after an evening out. Sort of brings me back to my college days at The Corner Club in Moscow, ID.  I’ll admit I was a smoker for a brief period my sophomore and junior years and please don’t tell my mother.

However what really has me thinking about smoking as it relates to Healthcare and the workplace is a news story from Geisinger Health System in Danville, PA that just recently banned smoking for their employees (a quick thanks to Mr. HISTalk for the lead on the story). The article states that beginning on February 1st of this year; applicants for jobs will be screened for nicotine and those that test positive are declined, offered resources for quitting and can re-apply after six months. Overall, the program is intended to create a culture of wellness for the organization as well as reduce healthcare costs. As a pseudo-Economist, I always tend to think raising quality and decreasing costs is a good thing.

“That’s discrimination!” No, it’s not. Under federal laws including the Civil Rights Act and American with Disabilities Act, smokers are not a protected class such as race, national origin, or age (40 and over). The program mentioned above is modeled after the Cleveland Clinic who also bans smoking as well as large employer Alaska Airlines. A Google search for “companies that ban employee nicotine use” returns 961,000 results! The adage when I was growing up was: do not let your peers pressure you into smoking. After reading this article from The New York Times, it looks like business and hospital peers are pressuring each other into banning smoking.

Does this infringe on our personal rights? As a non-smoker or a smoker, I am not sure and am eager to hear what our readership has to say about this issue. The New York Times article above incited 590 reader comments. What if it was alcohol that was banned and causes many health problems as well like liver problems? If I am a drinker or a smoker, should my healthcare premiums by higher? As a beer aficionado and pseudo-married to a home brewer, I would have a real problem finding work if employers banned personal alcohol consumption.

Thinking about smoking, or not smoking, is not a fad and many employers are doing it. I suspect we’ll continue to see this trend. What do you think readers? Is this a good thing, bad thing, outrageous? Let me know and I will follow up more on this issue.

About the author


Cassie Sturdevant

Cassie Sturdevant is a Senior Recruiter for Impact Advisors, a healthcare IT strategic and implementation services consulting firm just named 2013 Best in KLAS for Overall Services. She specializes in humor and follow up.


  • Great post Cassie and you hit a HUGE nerve for me!

    My father and 2 uncles died as a result of complications from emphysema which means that I am at HUGE risk for doing the same. The last 10 years of each of their lives were spent in total suffering where each morning the would cough and cough and cough in the hopes that eventually they would free up as much as 10% of their lung capacity for the day even when assisted by their Oxygen machines. Additionally, each had “other complications” like heart attacks and lung cancer that made their lives that much more challenging. My father and uncles grew up in a time where everyone smoked and where it was not cool if you did not smoke – the climate is much different today.

    For those of you that smoke, when I walk by you I picture you lying on the floor gasping for air like my father and his brothers did their last 10 years AND I get VERY ANGRY at you for putting second hand smoke in my lungs that could put me in that same situation.

    So, Cassie to your question about infringing on the rights of the smoker, what about my rights to live in an environment that won’t put me in danger of contracting emphysema? I say “Bravo” to Geisinger and I hope more organizations follow suit. And yes, insurance premiums should be higher for those that smoke! (as well as those that engage in other unhealthy lifestyles)

  • Joe,

    Thank you very much for your comment! I just love when we here at HealthcareITToday.com (yourself included) drum up some passion in our readers.

    First, I am very sorry to hear that your father and uncles had such a tough time at the end of their lives. That’s terrible to hear and your anger at smokers for exposing you to second-hand smoke is definitely justified! I surmise that you are stating that you feel your rights to clean air are being infringed upon by smokers. That’s very interesting because both sides of this debate are making nearly the same argument i.e. “We have the right to smoke OR clean air.” Are these rights equal? Or are your rights more important because you are making the scientifically proven healthier choice?

    Glad to hear that you are applauding the hospitals and companies out there that are outlawing smoking. How about this one on for size – what if companies banned overweight people such as with a BMI threshold? Just think about it. The obesity epidemic and the consequences of obesity are also making our healthcare costs skyrocket i.e. chronic diseases like diabetes and CAD. So what if that happened . . . ???

  • Great article Cassie. Very insightful and a great conversation starter.

    I am currently an employee of a company who is self-insured and has always been an advocate (since the founder was still alive) of a tobacco free life style. Back when the founder was alive, he would literally troll the smoking hut outside of the building and offer people a $100 bill on the spot if they promised him they would quit smoking. Of course, he had no way to prove that they were actually doing so after he handed them a $100 bill but you can bet that if he caught you smoking again, it would have an adverse effect on your professional career.

    His character and his desire for a tobacco free environment carried over to the companies culture and we currently offer a reduction in your health plan premiums if you are, and stay, tobacco free. The company unfortunately doesn’t have a mechanism in place to prove or disprove an employee’s use of tobacco, but if you are caught your benefits become forfeit with the company. A steep price to pay. It’s nice to hear that other companies are following suit with tobacco and other high risk health measures to ensure that premium prices stay as low as possible.

    As an aside, think about what smoking bans and, really, bans of any kind does to industry and taxation in general. I’m certainly no advocate for tobacco use, but from an economic stand point, it will be interesting to see what the ramifications are when these multibillion dollar business start to fall away and those retail sales aren’t keeping up like they were. In turn, this will reduce state and federal taxes taken from tobacco purchases as well as create unemployment and a litany of other business and industry issues.

  • Jarett,

    Thank you for your post and your example of your employer. I think my favorite part of this story is that your company engages in consequence management i.e. if you are caught smoking after accepting the healthy employee discount, you forfeit your benefits on the spot. I have a deep respect for companies that practice what they preach.

    And of course, as a fan of Economics myself, I certainly appreciate your bringing to light taxation. I am a former and future resident of Chicago, IL where we have loads of Sin Taxes – alcohol, cigarettes, sugar, gasoline and bottled water are all taxed. Chicago sees cigarettes as a filthy revenue-generating habit. You pay to play. Maybe in addition to lessened healthcare premiums, you should also receive a tax voucher if you quit smoking . . . I don’t really see that happening in my favorite city though. Would be interesting if city government banned smoking to their employees to save on healthcare costs though. haha that just made my chuckle.

  • Hello All – I thought I would post here a discussion that I had with my friend Kristy Mayer over Facebook about this topic. Enjoy!

    Kristy: The hospital where my mother-in-law works just introduced higher premiums for smokers, those with high blood pressure, high cholesterol and obesity who are not currently seeking treatment. I think it’s a fantastic concept, and see it happening with more employers, even here in BFE.

    Cassie: That is very interesting stuff! Where does she work? I like the idea of making obese people pay higher premiums and just mentioned that at the link above as well. Over-weight related Diabetes and CAD make healthcare costs skyrocket. Quick question – how do they measure someone “seeking treatment”?

    Kristy: She works at St. Joe’s hospital in Lewiston. I believe some of the measures are: Do they participate in a smoking cessation program? Are they taking prescribed blood pressure/cholesterol meds? Not sure on the obesity one, but I do know they offer Weight Watchers at the hospital, and there are incentives to get half or all of your money back per session based on the amount of weight you lose.

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