title: Likelihood of Unemployed Smokers vs Nonsmokers Attaining Reemployment in a One-Year Observational Study.
abstract: Studies in the United States and Europe have found higher smoking prevalence among unemployed job seekers relative to employed workers. While consistent, the extant epidemiologic investigations of smoking and work status have been cross-sectional, leaving it underdetermined whether tobacco use is a cause or effect of unemployment.
  
  
  
  To examine differences in reemployment by smoking status in a 12-month period.
  
  
  
  An observational 2-group study was conducted from September 10, 2013, to August 15, 2015, in employment service settings in the San Francisco Bay Area (California). Participants were 131 daily smokers and 120 nonsmokers, all of whom were unemployed job seekers. Owing to the study's observational design, a propensity score analysis was conducted using inverse probability weighting with trimmed observations. Including covariates of time out of work, age, education, race/ethnicity, and perceived health status as predictors of smoking status.
  
  
  
  Reemployment at 12-month follow-up.
  
  
  
  Of the 251 study participants, 165 (65.7) were men, with a mean (SD) age of 48 (11) years; 96 participants were white (38.2%), 90 were black (35.9%), 24 were Hispanic (9.6%), 18 were Asian (7.2%), and 23 were multiracial or other race (9.2%); 78 had a college degree (31.1%), 99 were unstably housed (39.4%), 70 lacked reliable transportation (27.9%), 52 had a criminal history (20.7%), and 72 had received prior treatment for alcohol or drug use (28.7%). Smokers consumed a mean (SD) of 13.5 (8.2) cigarettes per day at baseline. At 12-month follow-up (217 participants retained [86.5%]), 60 of 108 nonsmokers (55.6%) were reemployed compared with 29 of 109 smokers (26.6%) (unadjusted risk difference, 0.29; 95% CI, 0.15-0.42). With 6% of analysis sample observations trimmed, the estimated risk difference indicated that nonsmokers were 30% (95% CI, 12%-48%) more likely on average to be reemployed at 1 year relative to smokers. Results of a sensitivity analysis with additional covariates of sex, stable housing, reliable transportation, criminal history, and prior treatment for alcohol or drug use (25.3% of observations trimmed) reduced the difference in employment attributed to smoking status to 24% (95% CI, 7%-39%), which was still a significant difference. Among those reemployed at 1 year, the average hourly wage for smokers was significantly lower (mean [SD], $15.10 [$4.68]) than for nonsmokers (mean [SD], $20.27 [$10.54]; F(1,86) = 6.50, P = .01).
  
  
  
  To our knowledge, this is the first study to prospectively track reemployment success by smoking status. Smokers had a lower likelihood of reemployment at 1 year and were paid significantly less than nonsmokers when reemployed. Treatment of tobacco use in unemployment service settings is worth testing for increasing reemployment success and financial well-being.
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Prochaska
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Michalek
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Catherine
authors.initials: C
authors.lastname: Brown-Johnson
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Daza
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Baiocchi
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Nicole
authors.initials: N
authors.lastname: Anzai
authors.affiliation: San Francisco Department of Veteran Affairs, San Francisco, California.
authors.forename: Amy
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Buckelew Programs Residential Support Services, San Rafael, California.
authors.forename: Mia
authors.initials: M
authors.lastname: Grigg
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Amy
authors.initials: A
authors.lastname: Chieng
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007586:Job Application; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012307:Risk Factors; D012456:Salaries and Fringe Benefits / Q000706:statistics & numerical data; D012495:San Francisco / Q000453:epidemiology; D012907:Smoking / Q000208:ethnology*; D014478:Unemployment / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*