While it has become routine for employers to restrict smoking at the workplace, testing employees to determine their smoking status is getting more attention from Wisconsin companies. As health costs continue to rise, employers are focusing on the role of tobacco in health care spending.
The Centers for Disease Control (CDC) estimates that each smoker costs the economy $1,623 annually in increased medical expenditures and another $1,760 in lost productivity. The American Lung Association of Wisconsin reports economic costs related to smoking in the state are in excess of $3 billion dollars per year; and 20.8 percent of adults, 19.9 percent of high school students and 5.8 percent of middle school students smoke.
On average, smokers die 10 years earlier than non-smokers.
Workplace smoking policies hit the national headlines in 2005 when Weyco Inc., a Michigan medical benefits administration company, adopted a smoking policy that covered its workers on and off the job. Weyco, whose business is helping other companies save money and improve employee health through innovative benefit plans, decided that, as of Jan. 1, 2005, they would no longer employ smokers. Employees and potential new hires are subject to random, reasonable suspicion, and pre-employment smoke tests. The test requires a breath sample and uses a carbon monoxide monitor for analysis. The policy was phased in over 15 months and included supportive efforts like smoking-cessation classes, medication, and acupuncture.
Weyco’s method of screening is not the only option. Breathalyzer tests, although effective, only identify smoke inhalation, and will not detect the use of snuff or chewing tobacco. Other options include testing for cotinine, a chemical in the body that can only be produced by nicotine. Cotinine can be detected in the blood, urine or saliva, through a simple lab test. Specific levels of cotinine provide information about the amount of nicotine present. A drawback to this method of screening is that people who do not smoke but are exposed to secondhand smoke may test positive. People on nicotine patches or gum will also test positive and need to indicate their nicotine status in the screening process. Additionally, the internet is deluged with content about how to “beat the system” in drug and nicotine testing.
Legal liabilities
Weyco’s policy would be unlawful in Wisconsin, where we have a “smoker protection” law. This law specifically prohibits employers from refusing to hire, discipline or discharge employees because they use tobacco or other lawful consumable products outside the workplace. The law does not prohibit employers from offering a life, health or disability insurance policy under which the type or price of coverage varies based on the use of tobacco when the policy meets certain conditions.
Interpretation of smoking policies as they relate to premium-based incentives were clarified in 2006 when the final HIPAA rules on wellness programs classified smoking as a health condition. It is illegal to discriminate health insurance eligibility or premiums based on a health condition. However, you can “reward” individuals who are not smokers or who complete a smoking cessation program within a qualified wellness program.
If they complete the program, they are eligible for the “reward,” even if they continue to smoke. Before using the nicotine testing results to determine premium discounts or other rewards, you may want to pursue expert legal and benefit design consultation. Considerations include: How will you use the results from the testing? How do you implement a policy without violating personal rights? How do you enforce a policy once you have established it? Do you treat everyone with suspicion and randomly subject all employees to testing? Do you incorporate nicotine testing into your yearly health risk appraisal?
Carrot or stick
Some wellness practitioners question if nicotine testing is worth the expenses. Are there more effective ways to address the smoking issue?
A good place to start may be to ask a more important question: What it is that you hope to accomplish? For most businesses, banning smoking is not just about saving money. It’s also about building a healthier workforce. Some feel that mandatory testing may build a wall of fear and resentment, which makes healthy transitions more difficult.
If you want to know if employees smoke, why not just ask them? Experience in wellness programming tells us that most people who smoke want to quit. Although self-reporting has definite shortcomings, the greatest one being honesty, it may be far more effective in building a healthy wellness culture. It is not as invasive as the testing, and may produce the same or better end results.
The data shows that individual assessment, when combined with behavioral interventions such as smoking cessation programs, support groups, wellness coaching and cost coverage for nicotine replacement and pharmacological therapy have high success rates. This positive approach, which shifts the accountability to the employee without the emotionality of judgment, has been shown to help employees successfully change unwanted behavior in the long term.
