Wednesday, April 27, 2005

New Navy Study Shows Attrition Higher Among Smokers

A study conducted by researchers at the Naval Post Graduate School in Monterey, California and released earlier this week reported that Navy recruits who smoke are more likely to leave the service without completing their enlistment than nonsmokers. Examining first term attrition among 6,950 Navy recruits, the researchers reported attrition rates of 50% for heavy smokers (one pack per day or more), 37% for light smokers, and 27% for nonsmokers.

The study found that smokers were more likely to also have a history of other "misbehavior," including truancy, suspensions, legal problems, and dropping out of school. While the study concludes that a policy of not recruiting smokers would lower attrition, it points out that a more effective policy would be refusing to recruit anyone who smoked heavily as a youth even if they subsequently quit, because the factors associated with smoking initiation appear to be the ones that are predictive of increased attrition, not the actual smoking behavior at the time of enlistment.

The Rest of the Story

Some tobacco control advocates may read the results of this study as providing additional rationale for smokefree hiring policies, since it provides evidence that smokers have higher attrition rates. However, we should not be hasty here.

What the study actually demonstrates is that it is possible to identify a series of factors related to youth behavior that quite accurately predict rates of attrition, at least in terms of military enlistment within the first year of service. And while active smoking is one such predictor, it is probably not the best one. Even better would be a history of having smoked heavily as a youth, regardless of whether or not one smokes at the present time. And better yet might be the age of onset of smoking experimentation. Other excellent predictors suggested by the study authors include the age at which a person wears tattoos or undergoes body piercings.

The bottom line here is that smoking is simply a proxy for a constellation of rebellious behaviors that probably reflect the degree to which a youth rejects adult authority. And it is most likely that propensity to reject authority that ultimately explains the relationship between smoking and attrition, not the smoking behavior itself.

This study highlights the profound dangers of tobacco control advocates promoting policies in which employers refuse to hire smokers for reasons other than a direct negative impact of smoking itself on job performance or a conflict of interest between that behavior and the mission of an employer. First, if smoking is serving only as a proxy for other factors that are truly related to employee retention, then such a policy is unfair to many smokers who may not in fact share those factors and therefore be individually not at high risk for job attrition.

Second, because smoking is just one of many factors that may influence attrition and because its relationship with attrition may not be causal, but spurious, it would be unfair to pre-judge smokers based on this one characteristic without examining the other characteristics that are actually related in a causal manner with attrition.

Third, such a policy is problematic because it demands an answer to the question, "where do we draw the line?" Do we promote policies to not hire anyone who started to smoke at a young age, even if they do not smoke now? Do we promote policies to not hire anyone who started smoking as a teenager, but not anyone who started smoking as an adult? Do we promote policies to not hire anyone with a history of having missed more than 10 days of school per year? How about refusing to hire anyone who ever wore a tattoo or engaged in body piercing? Each of these policies could probably be justified on the basis of a strong relationship with attrition rates.

Finally, perhaps the greatest danger of this type of thinking is that it is really the beginning of the creation of a sub-class of citizens, who, by virtue of a disadvantaged childhood and adolescence, are deemed ineligible to be a part of the employed in our society. Do we as public health practitioners really want to promote policies that significantly limit the jobs available to what is generally a poorer and less-educated segment of our population? Do we really want to contribute to making it harder, not easier, for these individuals to obtain employment and make a living to support themselves and their families and to give themselves an opportunity to pull themselves out of the lower class?

While employers may, at least in some states, legally make hiring decisions based solely on smoking status (absent a direct effect on job performance or a direct conflict of interest with employer mission), I do not think that we as public health practitioners can responsibly promote such policies. In fact, I think it should be our role to seriously question (i.e., oppose) them.

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