An increasing number of hospitals and medical businesses are making tobacco use a reason to reject job applicants or fire existing employees, The New York Times reported Feb. 10.

Under the new “tobacco-free” hiring policies, applicants can be turned away for smoking, or if they are caught smoking after hire. Policies differ by company, but some require applicants to take urine tests for nicotine. Health care businesses say they have adopted the new policies because they want to promote health, cut health care costs, and support healthy choices. Opponents say the policies set a troubling precedent for penalizing employees for engaging in legal behavior.

Dr. Michael Siegel, a professor at the Boston University School of Public Health, said that if the policies become mainstream, there could be serious consequences. “Unemployment is also bad for health,” he said. 

It’s not certain how many businesses have adopted tobacco-free policies, but the number of examples are growing, and courts in several states have said the policies are legal. Federal data show that about 20 percent of Americans smoke, and that employees who smoke cost $3,391 more each year in health care costs and lost productivity than non-smoking employees do.

“We felt it was unfair for employees who maintained healthy lifestyles to have to subsidize those who do not,” said Steven C. Bjelich, CEO of St. Francis Medical Center in Cape Girardeau, Mo., which has stopped hiring smokers. “Essentially that’s what happens.”

Lewis Maltby, the president of the National Workrights Institute, argued that refusing to hire smokers opened the door for other bans. “The number of things that we all do privately that have negative impact on our health is endless,” Maltby said. “If it’s not smoking, it’s beer. If it’s not beer, it’s cheeseburgers. And what about your sex life?”

Anti-smoking organizations are split on the issue. Several prominent advocacy organizations — the American Lung Association, the American Cancer Society and the World Health Organization — do not hire smokers because of their mission. The American Legacy Foundation, however, has argued that punishing smokers is likely to discriminate against low-income and comparatively unskilled workers.

“Smokers are not the enemy,” said the organization’s chief counsel, Ellen Vargyas. “We want to be very supportive of smokers, and the best thing we can do is help them quit, not condition employment on whether they quit.”

Mandy Carroll, a nursing student at the University of Kansas, opposed the new policies as discriminatory. She smokes a pack a day, even though she understands the potential health consequences.

“Obviously we know the effects of smoking, we see it every day in the hospital,” she said. “It’s a stupid choice, but it’s a personal choice.”