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Where There’s Smoke There’s…Reduced Productivity in the Workplace

By June 28, 2018No Comments

By Harold C. Urschel III, MD, MMA, Enterhealth Chief Medical Strategist

Cigarette smoking has been identified as the single most preventable cause of both disease and premature death in the United States, accounting for more than 480,000 deaths every year, or about 1 in 5 deaths.1

In 2018, nearly 14 of every 100 U.S. adults aged 18 years or older (13.7%) – or about 34.2 million adults – currently smoke cigarettes. More than 16 million Americans live with smoking-related diseases such as lung cancer, emphysema, chronic obstructive pulmonary disease (COPD), asthma, and the list goes on.1

The number of current smokers has declined from 20.9% (nearly 21 of every 100 adults) in 2005 to 13.7% (more than 14 of every 100 adults) in 2018, however, current smoking prevalence did not change significantly during 2015-2018.1

Smoking and its Impact on the Workplace

The U.S. Centers for Disease Control and Prevention (CDC) estimates that smoking costs American companies approximately $300 billion in health expenses and lost productivity. This means that, on average, smokers cost their employers nearly $6,000 a year more than staff who don’t smoke, according to a recent study in the journal Tobacco Control.

There are two types of costs that employers need to consider:

  • Direct Costs. By this we mean dollars spent on health services. Direct costs include things like money the company spends on healthcare benefits, disability, and workers’ compensation.
  • Indirect Costs. The indirect costs refer to expenses that aren’t immediately related to treating disease. This includes things like lost wages, lost workdays, costs related to using replacement workers, overtime expenditures, productivity losses related to absenteeism, and productivity losses of workers on the job.

When it comes to direct costs, many studies have shown that smokers cost the healthcare system and health insurers more. And because many companies self-insure – meaning they pay for healthcare costs even if a health insurance company manages the benefits for them – that means smokers cost employers more in the long run than non-smokers. For an employer, insuring someone who smokes costs $2,000 more every year than compared to a non-smoker, and a typical smoker will rack up an additional $16,000 in lifetime medical bills.

Additionally, allowing smoking on the work property increases the risk of fires and accidental injuries, which impacts the employer’s insurance costs. Some smoke-free businesses pay 25-30% lower fire and property insurance premiums and even reduce their cleaning or maintenance costs.

Besides the increase in medical costs which can be attributed to smoking, there are the indirect costs as well. These include impacts on workplace absenteeism and productivity. For example, A number of studies have shown that employees who smoke report considerably higher rates of absenteeism, accidents and injuries than employees who don’t smoke. Absenteeism, however, is just a small piece of the indirect burden that smoking employees represent for companies. In addition to the time lost as a result of illness or injury, there is a growing body of evidence to suggest that smokers are also less productive while they’re on the job.

Another cost to employers from smoking employees is ‘presenteeism’— lower on-the-job productivity that results from nicotine addiction. While almost all employees are unproductive some of the time in one way or another, research shows that cigarette smoking negatively impacts productivity separately and apart from lost work time due to things like taking smoking breaks and other forms of absenteeism while they’re technically on the clock.

That’s because nicotine is a powerfully addictive drug, and although a cigarette may satisfy a smoker’s need for nicotine, the effect wears off quickly. Within 30 minutes of finishing off a cigarette, the smoker may already begin to feel the symptoms of both physical and psychological withdrawal. Indeed, much of what a smoker perceives to be the calming and elucidating effect of smoking is actually relief from their acute withdrawal symptoms.

The evidence paints a clear picture of smoking’s effect on workplace productivity. One study of more than 14,000 workers in Sweden found smokers took an average of 11 more sick days than nonsmokers. Additionally, research published in the prestigious British Medical Journal confirmed that workplace productivity increases and absenteeism decreases among former smokers as compared to current smokers. A national survey of over 29,000 workers in the U.S. found that tobacco use caused more loss of productivity than alcohol abuse or family emergencies.

Since tobacco use is the number one preventable health issue in the U.S., encouraging workers to quit gives companies the opportunity to improve employees’ health, decrease health insurance costs and increase productivity. The good news is that with the right motivation, quitting smoking is easier than most people assume.

The Easiest Addiction to Treat

Getting smokers to quit may not be as daunting a task as it seems when looking at the numbers. Studies have shown that as smokers are presented with more opportunities and resources to help them quit, they are much more likely to utilize these resources to kick the habit.

In fact, many smokers will admit that they want to quit, but doing so can be quite difficult. The reality is that most cigarette smokers who try to quit on their own take, on average, six to nine attempts before they are successful. It’s for these reasons and more that Enterhealth, a Dallas-based drug and alcohol addiction treatment company, has been offering the latest smoking cessation treatments as a part of their standard rehabilitation regimen for over 10 years. These effective treatment techniques are found in both our inpatient facility, Enterhealth Ranch (located in Van Alstyne), as well as our Outpatient Center of Excellence (located in the Park Cities neighborhood of Dallas).

Now, in an effort to extend their reach beyond just patients who come for drug and alcohol addiction treatment services, Enterhealth is also offering these services to individuals and, importantly, companies that want to give employees an extra resource to help them finally kick the habit.

The treatment, which involves a 12-week program, is typically conducted over Enterhealth’s secure online telehealth portal, Enterhealth Connect (although in-person sessions can be arranged). These teleservices sessions (using online video) start with medical interviews and assessments with board-certified M.D.s and addiction-trained therapists who then tailor the smoking cessation program to each individual in order to reduce the cravings, anxiety, depression and weight gain which often accompany quitting smoking. By conducting the initial assessment, both a doctor and therapist are able to first determine if there are any underlying physical or psychological issues, then they are able to select the right science-based medications and therapies to make it as easy as possible for that patient to stop smoking. Patients who have used the online service find it not only very effective but also very convenient, as they can participate in all of the sessions from a location of their choosing without have to use any of their time for transportation to and from the session.

Successful Smoking Cessation Helps More Than Just the Individual

It’s no surprise that quitting smoking can improve your health in myriad ways. The obvious benefits are the decreased risks for heart disease, lung disease, diabetes and cancer. But there are less obvious ones as well. People who quit smoking report that their sense of smell and taste “return” after quitting, and it can also clear up blemishes and halt damage to your skin (especially the face). Quitting smoking can also lower the chances of men developing erectile dysfunction and improve the chances of having a healthy sex life.

The benefits don’t stop there, and the advantages for companies are also substantial. The aforementioned study in the journal Tobacco Control provides several tangible benefits that are attractive to companies, including: fewer instances of sick leave, reduced absenteeism, increased productivity, and, most importantly, higher levels of satisfaction with life (i.e., happier employees!).  

If you or a loved one would like to quit smoking, don’t wait, reach out and contact the experts at Enterhealth today. You can call us at (800) 388-4601 any time, or you can visit our website at to learn more about how we can help.


  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2018 June 20].
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