According to an article posted by a local FOX news affiliate, Atlantic Beach (Florida) has joined the growing list of employers who refuse to hire smokers in an effort to reduce health care costs.
According to the article, "anyone that applies for a job with Atlantic Beach will be tested for nicotine. There's even a chance that you won'’t be hired if you test positive due to second hand smoke. Employees will also have to sign a statement promising they have not smoked in the last year and will not smoke while they are employed by the city."
When asked whether the city would similarly refuse to hire obese people to save health care costs, the Atlantic Beach city manager apparently replied: "“We've not had any decision on that sort of thing - it's just an issue of smoking."”
The Rest of the Story
Yes - it is just an issue of smoking. It is not, I believe, truly an issue of health care costs, public health, or workplace health promotion. It is clear that what is going on is an attempt to dictate the lifestyle choices of individuals in the privacy of their own homes. It is, as the ACLU appropriately calls it, "lifestyle discrimination." And apparently, the city detests the smoker's lifestyle choices and so it is picking on smokers as scapegoats for its supposed concern over health care costs.
If it were truly an issue of health care costs, then Atlantic Beach would surely want to discard applications from obese individuals, since they incur greatly increased health care costs.
If it were truly an issue of public health or workplace health promotion, then Atlantic Beach would offer cessation programs and services to smokers, not throw their job applications in the garbage.
This policy is particularly intrusive of individual privacy, because it apparently involves not just a questionnaire assessment of smoking status, but a biologic sample for nicotine (probably cotinine) testing. Presumably, this will involve a urine or saliva test.
The policy raises an interesting question: is the policy fair to nonsmokers who are exposed to high levels of secondhand smoke and therefore have cotinine levels that make it appear that they may smoke? Can one assume that they have lied on their job application if they declare that they don't smoke but they have cotinine levels above the cutoff used to determine smoking status?
And similarly, what about smokers whose cotinine levels fall below the cutoff? Are their applications thrown in the trash or are they eligible for jobs with the city?
It is important to recognize that cotinine is not a perfectly accurate measure of smoking status. For example, one of the largest studies of the reliability of this test for determining smoking status found that: "among self-reported smokers, 7.5% (95% confidence interval: 6.3, 8.7) had a serum cotinine level less than or equal to 15.0 ng/ml, the selected cutoff point for identifying nonsmokers." And "among self-reported nonsmokers, 1.4% (95% confidence interval: 1.1, 1.7) had a serum cotinine level greater than 15.0 ng/ml, the selected cutoff point for identifying smokers.
This means that the cotinine test is going to miss a fair proportion of smokers and that it may result in the unfair denial of employment to some individuals who do not smoke, but are exposed to secondhand smoke.
But by Atlantic Beach's reasoning, why not deny employment to passive smokers? After all, there is evidence that secondhand smoke is associated with respiratory and cardiovascular morbidity and that it increases health care costs. So if you are concerned about health care costs, why not ask people about their secondhand smoke exposure and throw their applications in the trash if they say they are exposed? Health care costs would be substantially lower if you only employed non-exposed nonsmokers.
A number of studies (some even conducted by the author of this blog) have demonstrated that health care costs are higher among exposed nonsmokers compared to non-exposed nonsmokers.
Even more troubling is the pledge that employees must take, in which they promise not to smoke while employed by the city.
OK - so what happens if they smoke a single cigarette in their home one evening? Must they call their employer and notify him that they won't be at work the next day? What if they use some chewing tobacco? How about a victory cigar after Florida wins the NCAA Basketball tournament?
Who is going to police this? Will there be random, unannounced testing in which employees must pee in a cup to see if they have been true to their pledge?
It should be readily apparent that this level of intrusion into the privacy of individuals' personal lifestyle and behavior choices is completely unwarranted and should have no place in the workplace.
Believe me - we don't want to go there.
And if you're a smoker, you probably don't want to go to Atlantic Beach.
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