Cigarette smoking is a noxious mess of 200 toxic chemicals that are risk factors for all kinds of diseases, and so it is sure to be a burden on a health care system that in the United States is increasingly being funded by the government, and therefore the 80 percent of people who do not smoke.

Yet it is also an addiction, and so a small one-year longitudinal study based on surveys which suggests that smokers remain unemployed longer than nonsmokers might seem to be a self-correcting problem. Or it might be that health issues are being used for discrimination, with implicit government approval, the exact opposite of what the federal government says they wanted to accomplish with their health initiatives. 

When smokers do find jobs, they earn substantially less than nonsmokers, according to the results in JAMA Internal Medicine.

Previous studies have claimed an association between smoking and unemployment in the United States and Europe, and in an earlier paper, a team led Judith Prochaska, PhD, MPH, associate professor of medicine at Stanford, found that unemployed job-seekers in California were disproportionately more likely to be smokers than were people who had jobs.

Cause or effect of unemployment?

But it has not been clear if smoking is the cause or the result of unemployment. "You don't know if smokers have a harder time finding work or if smokers are more likely to lose their jobs -- or that when nonsmokers lose their jobs, they become stressed and start to smoke," said Prochaska. In a first step toward establishing that smoking may actually prevent people from getting jobs, Prochaska and her team surveyed 131 unemployed smokers and 120 unemployed nonsmokers at the beginning of the study and then at six and 12 months. "We found that smokers had a much harder time finding work than nonsmokers," said Prochaska.

At 12 months, only 27 percent of smokers had found jobs compared with 56 percent of nonsmokers. And among those who had found jobs by 12 months, smokers earned on average $5 less per hour than nonsmokers.

"The health harms of smoking have been established for decades," said Prochaska, "and our study here provides insight into the financial harms of smoking both in terms of lower re-employment success and lower wages."

Prochaska and her colleagues used survey questions and a breath test for carbon monoxide levels to classify job seekers into either daily smokers or nonsmokers. Participants were not randomized, and smokers and nonsmokers differed in a number of important ways besides whether they smoked. For example, smokers were, on average, younger, less-educated and in poorer health than nonsmokers. Such differences might influence job seekers' ability to find work, said Prochaska.

For this reason, the researchers analyzed their data to control for these and other factors, such as duration of unemployment, race and criminal record. "We designed this study's analyses so that the smokers and nonsmokers were as similar as possible in terms of the information we had on their employment records and prospects for employment at baseline," said co-author Michael Baiocchi, PhD, an assistant professor of medicine who oversaw the data analyses.

After controlling for these variables, smokers still remained at a big disadvantage. After 12 months, the re-employment rate of smokers was 24 percent lower than that of nonsmokers.