We speak with Judith Prochaska, author of the study ”Likelihood of Unemployed Smokers vs Nonsmokers Attaining Reemployment in a One-Year Observational Study“ that came out April 11 in JAMA internal medicine.

ResearchGate: In your recent study you found that smokers have a harder time getting jobs. How did you come to this conclusion? What were your methods?

Judith Prochaska: We conducted a study of 251 jobseekers with interviews out to 12-months follow-up. About half were daily smokers and half were nonsmokers. We found that the smokers were at a serious disadvantage for finding work and among those who did, they earned, on average, $5 less per hour. Our methods were self-report surveys with bioconfirmation of recent smoking using breath samples to test for carbon monoxide.

RG: Smokers are on average less educated, poorer, and more likely to come from a minority background. All of these factors would make it harder for them to get a job. How did you rule them out?

Prochaska: You are correct about the general profile of smokers, and we saw this pattern in our sample. To account for these factors, Drs. Michael Baiocchi and Eric Daza on our team ran sophisticated data analyses to account for the observational design and the pre-existing differences found in the groups.

Specifically, using propensity score analysis we sought to equate the groups on key factors—i.e., duration of time out of work, age, education, race/ethnicity, and perceived health status in the first model and then added in access to transportation, criminal history, prior alcohol/drug treatment, sex, and housing stability.

Further, we trimmed the data to remove extreme cases—i.e., smokers who were so different on these variables from nonsmokers that there was no overlap in the distributions, and similarly nonsmokers who appeared to be so characteristically different from smokers. You can think of this as a mathematically precise way of “comparing apples to apples.”

The groups we compared weren’t smokers in general versus non-smokers in general. We compared smokers who looked nearly identical to nonsmokers before the training.

The challenge with observational studies is that, while we can account for variables we have in our data set, we have to be cautious because we know there are possibly other variables we do not have in our data set.

What we found is that the magnitude of effect in job seeking success by smoking status was significant both in our unadjusted and propensity score analyses with absolute differences of 24 percent to 30 percent in re-employment.

RG: Why do you think smokers have a harder time finding work?

Prochaska: Why the smokers had a harder time finding work was not directly addressed by our study here.

One thing we found, however, was that smokers in our sample tended to place a greater prioritization with regard to their discretionary spending on cigarettes than on aspects that would aid in their job-search, such as costs for transportation, mobile phone, new clothing, and grooming care.

There also is literature reporting on greater sick days and greater problems with presenteeism among employees who smoke. Presenteeism is the phenomenon of being physically at work but distracted, for example by nicotine craving and withdrawal effects.

RG: Did you notice any geographic differences in the likelihood of smokers finding a job (rural vs. urban)?

Prochaska: For smokers and nonsmokers, we did not find a geographic difference in the likelihood of finding a job (rural vs. urban). That is, smokers were challenged in both urban and rural areas.

RG: How do you think employers think about smokers? Are they right?

Prochaska: Employers are a diverse group. We have a sister study in process to examine implicit and explicit bias toward smokers among hiring managers. Anecdotally, from talking with hiring managers in practice, jobseekers who smell of tobacco place themselves at a great disadvantage for securing employment, though the extent to which this is a factor likely varies by job sector or industry.

RG: Do you think it was also harder to find work as a smoker 30 years ago? What changed?

Prochaska: There have been a number of cross-sectional studies conducted in the United States and Europe with the data going back multiple decades that have documented higher prevalence of smoking among the unemployed, we just do not know the cause/effect relationship.

Our study here is unique in being longitudinal in examining re-employment rates over 12-months time among smokers and nonsmokers. That is, testing whether smoking status is predictive of future re-employment success, and we found smokers to be at a serious disadvantage for securing re-employment.

In terms of what is known about employment policy trends, over the last decade, employers in a variety of sectors (e.g., health care, academia, athletics) have been adopting policies to refuse employment to smokers and to prohibit smoking at the worksite and in the workforce.

I have not seen research that has quantified the extent of adoption of these policies, though our group has proposals under review.

RG: What’s your advice for smoking job seekers? What’s your advice for employers?

Prochaska: My advice to job seeking smokers is that quitting smoking is essential for their health and financial well-being.

My advice for employment development departments (EDD) is that smoking is relevant to job seeking success and attention to jobseekers’ smoking status is warranted.

We are now testing, in a randomized controlled trial, the efficacy of a quit smoking program tailored for jobseekers and offered in EDD settings.

My advice for employers—offer coverage for cessation services, which has been shown to have a strong return on investment.

RG: You’re now studying the effects of an intervention to quit smoking on job seeker’s success. What do you think will happen?

Prochaska: We hypothesize that the tailored quit smoking intervention will result in greater rates of quitting smoking and greater success with re-employment relative to the comparison condition of brief advice. It is still early in the study. We have enrolled just over 60 participants to date with a goal of recruiting 360 individuals.

RG: What’s your best advice to quit?

Prochaska: My advice is to 1) believe in yourself, 2) not give up (it often takes multiple quit attempts before one is successful in the long-term), and 3) seek support and evidence-based treatments. There are a number of medications available for quitting smoking to address nicotine withdrawal and craving.

Support is available through the national toll-free quit-line (1-800-QUIT-NOW) and online (SmokeFree.gov). Ask your health care provider for assistance with quitting smoking.

This article was originally published on ResearchGate.