…….Job seekers who smoke are less likely to find employment
Unemployed smokers have a harder time finding work than job seekers who don’t smoke, and they earn less than nonsmokers when the do become employed, researchers reported.
Nonsmokers who were not employed when they entered the study were 30% more likely than unemployed smokers to have found jobs a year later, in one of the first prospective, observational examinations of the economic burden of smoking on employment.
Smokers who did find work earned an average of $5 less an hour than the nonsmokers who were reemployed during the study: $15.10 per hour compared with $20.27, wrote researcher Judith Prochaska, PhD, of Stanford University, California, in JAMA Internal Medicine, published online April 11.
The researchers followed 251 job seekers in San Francisco for a year, recruited at two employment development centers, in an effort to determine if their smoking status impacted the likelihood that they would find work.
Even after controlling for multiple variables that might influence reemployment, such as education, health status, and age, smokers were 24% less likely to find jobs over the 12-month period than nonsmokers.
“Our findings suggest that unemployed people may be an important group to target with regard to (smoking cessation) efforts,” Prochaska told MedPage Today. “We have known for some time that tobacco is very bad for smokers’ physical health, and this shows an important impact on financial well being as well.”
Earlier studies from Prochaska and colleagues and others conducted in the U.S. and Europe have consistently shown higher rates of unemployment among smokers, compared with nonsmokers, but most of these studies have been cross-sectional, “leaving it undetermined as to whether smoking is a cause or effect of unemployment,” the researchers wrote.
The latest study included 131 current smokers and 120 nonsmokers who were all unemployed and looking for work in the San Francisco Bay Area between mid-September of 2013 and mid-August of 2015.
“Owing to the study’s observational design, a propensity score analysis was conducted using inverse probability weighting with trimmed observations,” the researchers wrote.
Close to 66% of the study participants were men, with a mean (SD) age of 48 years (11), and 38% of the participants were white, 36% were black, 9.6% were Hispanic, and 7.2% were Asian.
Just under a third (31.1%) had college degrees, 39.4% were unstably housed, 27.9% lacked reliable transportation, 20.7% had a criminal history, and 28.7% had received prior treatment for alcohol or drug abuse.
A year after enrollment, 55.6% of nonsmokers were reemployed, compared with 26.6% of the smokers (adjusted risk difference, 0.20; 95% CI 0.15-0.42).
“We conducted an inverse probability weight (IPW) analysis with trimmed observations, where the weight was the inverse (i.e., reciprocal) of the PS: The smoking and nonsmoking groups were weighted so as to be similar (on average) to each other in baseline characteristics,” the researchers wrote.
With 6% of the analysis sample observations trimmed, the researchers estimated that nonsmokers were 30% (95% CI 12%-48%) more likely than smokers, on average, to be reemployed a year after enrollment.
“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) reduce the difference in employment attributed to smoking status to 24% (95% CI 7%-39%), which was still a significant difference,” the researchers wrote.
They cited as study limitations the exclusion criteria and sample size, which “while powered for the main outcome, did not allow for tests of association within career clusters.” The study location — in a city where there is very low smoking prevalence and a probable high stigma related to smoking — may also have limited the generalizability of the findings.
In an editorial published with the study, JAMA Internal Medicine deputy editor Mitchell Katz, MD, of the Los Angeles County Department of Health Services, also cited the study location as a potential limitation, but he added the researchers’ estimate, after rigorous adjustment, of a 24% increase in employment associated with smoking cessation has important implications.
“Support for smoking cessation, including referral for cessation medications, should be a standard part of employment counseling,” he wrote. “For smokers seeking employment, we can add another motivation for quitting to all the health and longevity benefits of cessation: increased likelihood of finding a job.”
In her interview with MedPage Today, Prochaska agreed that the identification of employment counseling centers as potentially valuable partners in smoking cessation efforts is a major study finding.
Funding for this research was provided by the State of California Tobacco-Related Disease Research Program, the National Heart, Lung, and Blood Institute, and the Agency for Healthcare Research and Quality.
Prochaska reported consulting with Pfizer on smoking cessation medications and providing expert witness testimony in litigation against tobacco companies.
Katz declared no relevant relationships with industry.