Likelihood of Unemployed Smokers vs Nonsmokers Attaining Reemployment in a One-Year Observational Study | Lifestyle Behaviors | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.204.227.34. Please contact the publisher to request reinstatement.
1.
Okechukwu  C, Bacic  J, Cheng  KW, Catalano  R.  Smoking among construction workers: the nonlinear influence of the economy, cigarette prices, and antismoking sentiment.  Soc Sci Med. 2012;75(8):1379-1386.PubMedGoogle ScholarCrossref
2.
Prochaska  JJ, Shi  Y, Rogers  A.  Tobacco use among the job-seeking unemployed in California.  Prev Med. 2013;56(5):329-332.PubMedGoogle ScholarCrossref
3.
Khlat  M, Sermet  C, Le Pape  A.  Increased prevalence of depression, smoking, heavy drinking and use of psycho-active drugs among unemployed men in France.  Eur J Epidemiol. 2004;19(5):445-451.PubMedGoogle ScholarCrossref
4.
De Vogli  R, Santinello  M.  Unemployment and smoking: does psychosocial stress matter?  Tob Control. 2005;14(6):389-395.PubMedGoogle ScholarCrossref
5.
Freyer-Adam  J, Gaertner  B, Tobschall  S, John  U.  Health risk factors and self-rated health among job-seekers.  BMC Public Health. 2011;11:659.PubMedGoogle ScholarCrossref
6.
Max  W.  The financial impact of smoking on health-related costs: a review of the literature.  Am J Health Promot. 2001;15(5):321-331.PubMedGoogle ScholarCrossref
7.
Bunn  WB  III, Stave  GM, Downs  KE, Alvir  JM, Dirani  R.  Effect of smoking status on productivity loss.  J Occup Environ Med. 2006;48(10):1099-1108.PubMedGoogle ScholarCrossref
8.
Goetzel  RZ, Carls  GS, Wang  S,  et al.  The relationship between modifiable health risk factors and medical expenditures, absenteeism, short-term disability, and presenteeism among employees at Novartis.  J Occup Environ Med. 2009;51(4):487-499.PubMedGoogle ScholarCrossref
9.
Berman  M, Crane  R, Seiber  E, Munur  M.  Estimating the cost of a smoking employee.  Tob Control. 2014;23(5):428-433.PubMedGoogle ScholarCrossref
10.
Asch  DA, Muller  RW, Volpp  KG.  Conflicts and compromises in not hiring smokers.  N Engl J Med. 2013;368(15):1371-1373.PubMedGoogle ScholarCrossref
11.
Palmer v Liggett & Meyers Co, 825 F2d 620 (1st Cir 1987).
12.
Jones  JW, Novick  WM, Sade  RM.  Should a medical center deny employment to a physician because he smokes tobacco products?  Ann Thorac Surg. 2014;98(3):799-805.PubMedGoogle ScholarCrossref
13.
Brashear v Simms, ea. 138 F Supp 2d 693 (SDCD Md 2001).
14.
Brose  LS, Tombor  I, Shahab  L, West  R.  The effect of reducing the threshold for carbon monoxide validation of smoking abstinence—evidence from the English Stop Smoking Services.  Addict Behav. 2013;38(10):2529-2531.PubMedGoogle ScholarCrossref
15.
Prochaska  JJ, Sung  HY, Max  W, Shi  Y, Ong  M.  Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization.  Int J Methods Psychiatr Res. 2012;21(2):88-97.PubMedGoogle ScholarCrossref
16.
Fagerström  K.  Determinants of tobacco use and renaming the FTND to the Fagerström Test for Cigarette Dependence.  Nicotine Tob Res. 2012;14(1):75-78.PubMedGoogle ScholarCrossref
17.
Prochaska  JO, DiClemente  CC, Norcross  JC.  In search of how people change: applications to addictive behaviors.  Am Psychol. 1992;47(9):1102-1114.PubMedGoogle ScholarCrossref
18.
Fiore  MC, Jaén  CR, Baker  TB,  et al.  Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service; 2008.
19.
Hendricks  PS, Wood  SB, Baker  MR, Delucchi  KL, Hall  SM.  The Smoking Abstinence Questionnaire: measurement of smokers’ abstinence-related expectancies.  Addiction. 2011;106(4):716-728.PubMedGoogle ScholarCrossref
20.
D’Agostino  RB  Jr.  Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.  Stat Med. 1998;17(19):2265-2281.PubMedGoogle ScholarCrossref
21.
Morgan  SL, Winship  C.  Counterfactuals and Causal Inference: Methods and Principles for Social Research. 2nd ed. New York, NY: Cambridge University Press; 2015.
22.
Rosenbaum  PR, Rubin  DB.  The central role of the propensity score in observational studies for causal effects.  Biometrika. 1983;70(1):41-55. doi:10.1093/biomet/70.1.41.Google ScholarCrossref
23.
Rosenbaum  PR.  Observational Studies. 2nd ed. New York, NY: Springer; 2002.
24.
Rosenbaum  PR.  Design of Observational Studies: Springer Series in Statistics. New York, NY: Springer; 2010.
25.
Rubin  DB.  Causal inference using potential outcomes: design, modeling, decisions.  J Am Stat Assoc. 2005;100(469):322-331. doi:10.1198/016214504000001880.Google ScholarCrossref
26.
Crump  RK, Hotz  VJ, Imbens  GW, Mitnik  OA.  Dealing with limited overlap in estimation of average treatment effects.  Biometrika. 2009;96(1):187-199. doi:10.1093/biomet/asn055.Google ScholarCrossref
27.
Cowan  B, Schwab  B.  The incidence of the healthcare costs of smoking.  J Health Econ. 2011;30(5):1094-1102.PubMedGoogle ScholarCrossref
Original Investigation
May 2016

Likelihood of Unemployed Smokers vs Nonsmokers Attaining Reemployment in a One-Year Observational Study

Author Affiliations
  • 1Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
  • 2San Francisco Department of Veteran Affairs, San Francisco, California
  • 3Buckelew Programs Residential Support Services, San Rafael, California
JAMA Intern Med. 2016;176(5):662-670. doi:10.1001/jamainternmed.2016.0772
Abstract

Importance  Studies in the United States and Europe have found higher smoking prevalence among unemployed job seekers relative to employed workers. While consistent, the extant epidemiologic investigations of smoking and work status have been cross-sectional, leaving it underdetermined whether tobacco use is a cause or effect of unemployment.

Objective  To examine differences in reemployment by smoking status in a 12-month period.

Design, Setting, and Participants  An observational 2-group study was conducted from September 10, 2013, to August 15, 2015, in employment service settings in the San Francisco Bay Area (California). Participants were 131 daily smokers and 120 nonsmokers, all of whom were unemployed job seekers. Owing to the study’s observational design, a propensity score analysis was conducted using inverse probability weighting with trimmed observations. Including covariates of time out of work, age, education, race/ethnicity, and perceived health status as predictors of smoking status.

Main Outcomes and Measures  Reemployment at 12-month follow-up.

Results  Of the 251 study participants, 165 (65.7) were men, with a mean (SD) age of 48 (11) years; 96 participants were white (38.2%), 90 were black (35.9%), 24 were Hispanic (9.6%), 18 were Asian (7.2%), and 23 were multiracial or other race (9.2%); 78 had a college degree (31.1%), 99 were unstably housed (39.4%), 70 lacked reliable transportation (27.9%), 52 had a criminal history (20.7%), and 72 had received prior treatment for alcohol or drug use (28.7%). Smokers consumed a mean (SD) of 13.5 (8.2) cigarettes per day at baseline. At 12-month follow-up (217 participants retained [86.5%]), 60 of 108 nonsmokers (55.6%) were reemployed compared with 29 of 109 smokers (26.6%) (unadjusted risk difference, 0.29; 95% CI, 0.15-0.42). With 6% of analysis sample observations trimmed, the estimated risk difference indicated that nonsmokers were 30% (95% CI, 12%-48%) more likely on average to be reemployed at 1 year relative to smokers. Results of a sensitivity analysis with additional covariates of sex, stable housing, reliable transportation, criminal history, and prior treatment for alcohol or drug use (25.3% of observations trimmed) reduced the difference in employment attributed to smoking status to 24% (95% CI, 7%-39%), which was still a significant difference. Among those reemployed at 1 year, the average hourly wage for smokers was significantly lower (mean [SD], $15.10 [$4.68]) than for nonsmokers (mean [SD], $20.27 [$10.54]; F(1,86) = 6.50, P = .01).

Conclusions and Relevance  To our knowledge, this is the first study to prospectively track reemployment success by smoking status. Smokers had a lower likelihood of reemployment at 1 year and were paid significantly less than nonsmokers when reemployed. Treatment of tobacco use in unemployment service settings is worth testing for increasing reemployment success and financial well-being.

×