Toward a Tobacco Free Future

Effective July 1, 2013, the University of Pennsylvania Health System will cease hiring tobacco users in our efforts to improve the overall health of our workforce while reducing health care benefit costs.

In addition, during our UPHS annual Open Enrollment, employees will be required to complete an attestation regarding their spouse and/or dependents use of tobacco products if they are participating in the UPHS health care benefit plan. UPHS will continue to provide free smoking cessation counseling and nicotine replacement therapy (NRT) to support our staff and their families in eliminating the use of tobacco products. Plan participants who are not actively enrolled in a smoking cessation program or using NRT can expect to pay a higher premium for their health care benefit.

What is the effective date of the Tobacco Free Hiring policy?

The University of Pennsylvania Health System will cease hiring tobacco users effective July 1, 2013. All applicants with a Start Date on or after July 1 will be required to complete an attestation that they have not used tobacco products for the previous six months.

Does the Tobacco Free Hiring policy apply to all UPHS entities?

Yes, with the exception of clinical practices located in New Jersey. This policy does not apply to candidates who are seeking exclusive employment in New Jersey practices because of state laws that restrict employers from having policies that limit employment opportunities based upon tobacco use. However, most states permit the right of employers to implement a tobacco usage surcharge on health care benefit premium. Regardless of location, employees who are tobacco users can expect to pay a higher premium for their health care benefit.

Will the Tobacco Free Hiring policy impact current UPHS employees?

No. Current employees will be grandfathered---but employees who are tobacco users can expect to pay a higher premium on their health care benefit if they are not actively enrolled in a smoking cessation program or nicotine replacement therapy.

Who does this policy apply to?

This policy applies to all UPHS employees, inclusive of physicians employed by the Health System, who begin employment on or after July 1, 2013. Due to the lengthy recruitment cycle of fellows and residents the effective date for this policy is July 1, 2014-providing a full year notification to applicants. This policy does not apply to faculty and staff employed by the University or UPHS employees working exclusively in New Jersey.

Why the focus on tobacco users?

The health risks and related costs associated with tobacco use have caused UPHS to mobilize action for moving toward a tobacco free future by focusing on the health of its workforce while containing the escalating costs associated with tobacco use. The Center for Disease Control (CDC) provides evidence that smoking or 2nd hand smoke exposure contributes to 443,000 premature deaths annually and results in $193 billion in health care costs and lost productivity.

Over 50 years of research has proven that tobacco use is the leading preventable cause of death and disease in the US, imposing a huge health and financial burden on families and businesses. Employees who smoke cost, on average, $3,391 more a year for health care. In addition, smoke breaks during work may be disruptive and subject patients/colleagues to the unpleasant smell of smoke on employees' scrubs and clothing (Source: Institute of Medicine, Ending the Tobacco Problem: A Blueprint for the Nation, National Academy of Sciences, 2007).

Is there documented evidence that 'banning the hiring of tobacco users' reduces overall health care costs?

There is no longitudinal study that provides demonstrable evidence that employers who cease hiring tobacco users reduce overall health care costs. This is largely due to the fact, that this type of employment practice has only been initiated in the past few years. One of the first to introduce the 'tobacco free hiring' policy was the Cleveland Clinic in 2007-whose practice has contributed to an overall reduction in smoking rates in Cuyahoga County. Many others have followed since then including Geisinger Health Care System, St. Luke's, Baylor Health Care System, Humana, Massachusetts Hospital Association and many others throughout the country.

Inherent in the mission of health care organizations is healing the sick and cultivating healthier communities. So it does make sense that health care organizations would be the first employers to move toward a tobacco free future-ending a habit that leads to disease, disability and premature death.

How are applicants screened for tobacco use?

Applicants for employment on or after July 1, 2013 will be asked to attest that they are non-tobacco users on their employment application. Falsification of information on the employment application is grounds for discipline up to and including termination.

Is the screening for tobacco use legal?

Yes. Users of tobacco are not in a legally protected class. Non-tobacco hiring policies are legal in 21 states including Pennsylvania. In 1987 a federal Appeal Court ruled that smokers are not a "protected class" entitled to special legal protections and that courts need no further rationale than the Surgeon General's warning on cigarette cartons: Cigarette smoking is hazardous to your health. This policy does not apply to UPHS employees or future job candidates for practices located in New Jersey.

If an applicant is a tobacco user, can he/she reapply for employment at UPHS?

Yes. Candidates/applicants may reapply when they can truthfully attest that they have not been a tobacco user for the previous six months.

What if an applicant is hired as a non-tobacco user and then subsequently begins to use tobacco?

UPHS is concerned about improving the overall health of its workforce. Employees will be strongly encouraged to participate in free smoking cessation counseling including free nicotine replacement therapy. Employees can also expect to pay a higher premium on their health care benefit if they are not actively enrolled in these programs and continue to use tobacco products.

If an employee falsifies their non-tobacco attestation, what will be the consequences?

Employees who falsify information on the application or benefit enrollment form may be subject to discipline up to and including termination. We rely on our employees to be truthful in the information submitted for employment or benefit enrollment purposes.

If a current employee terminates employment with UPHS and then re-applies, will they be subject to the new policy?


Will physicians be subject to the tobacco free hiring policy?

All physicians who are employed by UPHS are subject to this policy-inclusive of residents, fellows and most CCA physicians. Faculty and staff who are employed by the University are not subject to this policy. Due to the recruitment cycle of residents and fellows the effective date for policy implementation for this group of employees is July 1, 2014.

Will residents of communities who have higher smoking rates-be adversely impacted by this policy?

Even surrounding communities that have a relatively high usage of tobacco products have far more non-tobacco users than tobacco users. We also are continuing our efforts to increase education on the impact of tobacco use in those communities with higher usage rates. The implementation of this policy does not adversely impact our recruitment efforts.

We are committed to enforcing this policy while ensuring that our hiring rate in these communities does not decrease.

What future bans will UPHS consider next?

The University of Pennsylvania Health System is committed to a safe and healthy work environment and to promoting the health and wellbeing of its employees. Other than requiring future applicants to attest to being a non-tobacco user, there are no specific plans to restrict employment for other conditions.