As if higher tobacco taxes, steeper health insurance premiums and smoke-free workplaces weren't enough, tobacco users have one more financial incentive to kick the habit - missed job opportunities.
Starting Feb. 1, Memorial Hospital no longer will hire people who use tobacco products, making the hospital one of a small number of employers nationwide that consider smoking status in job applicants.
Under the new rule, which does not affect current Memorial employees, those offered employment at the hospital will be tested for nicotine during their required drug test, a human resources officer said. Even nicotine gum or the patch would make a potential employee ineligible.
The decision not to hire tobacco users isn't based on potential savings in health care costs, but rather is an extension of the hospital's commitment to health, said Brad Pope, vice president of human resources. Like all hospitals in the region, Memorial's entire hospital campus is tobacco-free.
"I understand the concerns people have, but we are here for the health of our community," he said. "Like it or not, what's proven is that tobacco is the most preventable cause of death and disability in the United States. I think the Chattanooga and surrounding communities should expect this from Memorial."
The practice of refusing employment to tobacco users began to crop up a few years ago and isn't yet widespread, a tobacco control researcher said. Particularly in the deep South, and in a tobacco state such as Tennessee, it's a bold move for Memorial, said pulmonologist Dr. Carlos Baleeiro, with Battlefield Pulmonology in Fort Oglethorpe
"It's very brave of them," he said. "I'm quite impressed by Memorial."
On Memorial Hospital's Web site: "To further our mission of building healthier communities, effective February, 1, 2010, Memorial Health Care System will no longer hire individuals who use tobacco or nicotine products in any form. Memorial Health Care System and its affiliates recognize the major importance of associates' health and well being, and the responsibility of maintaining a healthy and safe environment for all associates, volunteers, patients and visitors. Therefore, all individuals who are offered a position with Memorial Health Care System or any of its affiliates, are screened for illegal drug, alcohol, and/or tobacco/nicotine use as part of the post-offer health screening. Individuals whose post-offer health screening results are verified positive for illegal drugs, alcohol, and/or tobacco/nicotine use, and/or whose reference and/or background checks are verified unsatisfactory, will be disqualified from employment, their job offer will be withdrawn, and they may be disqualified from applying for employment for six months from the date of the post-offer health screening."
* Tennessee quit line: 1-800-784-8669
* Georgia quit line: 1-877-270-STOP
A growing number of workplaces now deny employees the right to smoke anywhere on their campus, including outside. Policy prohibiting the hiring of tobacco users may be the future as the country develops a deepening social intolerance of smoking, said Jay Collum, coordinator of tobacco education and control at the Chattanooga-Hamilton County Health Department.
"Especially in a tobacco-growing state in the Southeast, this is a huge change in mindset and positioning, but we're really behind the curve in our area," he said.
For others, this step is a slippery slope. Some are concerned about the potential for hiring restrictions based on other unhealthy - but entirely legal - behaviors.
Tobacco-control researcher Dr. Michael Siegel, a professor at the Boston University School of Public Health, said he's an avid proponent of education on the dangers of tobacco use, but he believes policies about not hiring tobacco users amount to discrimination.
Twenty-six states have laws prohibiting such a policy, according to a report he co-wrote last year in the journal Tobacco Control.
"The same rationale that would support not hiring smokers would also support not hiring people who are obese or people who have young children or people who don't eat nutritious food or people who don't exercise," he said. "What it's basically saying is the private behavior of people in their own homes is somehow relevant to their qualifications to work in a workplace."
Dr. Siegel worries that if many large employers refuse to hire smokers, tobacco users - those arguably in the greatest need of health care - will struggle to gain employment and health insurance.
"WON'T BE THE LAST"
For smoker Mike Sullivan, an ICU nurse at Memorial, the new rule doesn't come as a surprise.
"They're not the first company to do that, and they won't be the last," he said.
Mr. Sullivan has smoked on-and-off for more than 30 years, quitting countless times and always going back to the habit.
Mr. Sullivan, 53, said in less than two years he'll be eligible for retirement, and he'd hoped to come back and work part time at Memorial after retiring. But now, that would mean he'd have to kick the habit for good.
"I really think it would be a good incentive" finally to quit, he said.
This year for the first time, new recruits for the Chattanooga Fire Department can't be smokers, a decision the city hopes will bring both savings in insurance costs and improvement in firefighters' health.
"The main thing is to keep a healthier employee. We get 'em for 25 to 30 years or longer, and we want them to be healthy throughout their life while they're here, as well as when they retire," said Chief Randy Parker.
Costs and productivity consideration have led many employers nationwide, including the Chattanooga Times Free Press, to raise health insurance premiums for employees who use tobacco products and experiment with other programs to encourage wellness and help workers quit using tobacco, said Ron Harr, senior vice president of human resources and public affairs for BlueCross BlueShield of Tennessee.
"There is absolutely an increased interest by our customers in anything they can do that makes their employee group healthier and reduces their insurance risk," he said.
He had not heard of any other employers in the state actually ruling out smokers as job applicants, he said.
The average smoker costs his or her employer $2,500 to $4,000 more each year in health care costs, compared with a nonsmoker, said Cathy Taylor, assistant health commissioner for the Tennessee Department of Health.
Nationally, smoking is responsible for an estimated $96 billion in direct medical costs and $97 billion in lost productivity annually, according to estimates from the U.S. Centers for Disease Control and Prevention.
Some are optimistic that there will be little resistance to heightened restrictions for smokers. When Hutcheson Medical Center's campus went smoke-free last year, Dr. Baleeiro recalled that some were concerned about a negative backlash, but that never happened.
The same is true with Georgia's partial smoking ban that passed in 2005, prohibiting smoking in most public places, he said. Tennessee passed a similar ban in 2007.
"They thought restaurants would go out of business; bars would close, and none of that happened," he said. "I think (Memorial's new rule) is going to be an interesting experiment to see how that's going to be taken in the community."