Wednesday, February 15, 2006

Does the Existence of Individuals with Extreme Smoke-Sensitivity Justify Policies to Preclude Smokers from the Workplace?

One of the responses I have received to my posts arguing against policies that fire smokers or refuse to hire smokers solely on the basis of off-the-job smoking is that off-the-job smoking does in fact affect co-workers at the worksite because smoke residues on the smoker and/or exhaled smoke long after the smoker smoked the last cigarette could cause low levels of exposure to tobacco smoke, which could harm people who are highly sensitive to secondhand smoke.

For example, one commenter suggested that: "smokers stink like an ashtray because smoke remains on their hair and clothing (which can offend coworkers and customers), - smokers continue exhaling tobacco smoke pollutants for more than an hour after they've smoked their last cigarette (which creates tobacco smoke pollution in smokefree workplaces)."

Two other commenters have pointed out that they are extremely sensitive to tobacco smoke, and that an asthmatic reaction can be triggered by even small amounts of secondhand smoke exposure.

This argument has been used by some to justify policies that would preclude smokers from the workplace (by firing existing smokers and refusing to hire smokers as new employees).

In this post, I address the issue of individuals who are extremely sensitive to tobacco smoke and the argument that this justifies such policies.

The Rest of the Story

First of all, let me say that I do not doubt that there are a small number of individuals who are super-sensitive to secondhand smoke such that even very low exposure can trigger adverse health effects, such as an asthmatic reaction. So I am not going to contest the contention that in rare circumstances, exhaled smoke from a smoker who is not currently smoking may be detrimental to the health of a co-worker.

But two points are worth mentioning. First, it is certainly a small number of individuals, so far as we can tell. I have not seen any scientific literature documenting this as a commonly-seen problem in medicine. There is no evidence that this is more than a problem under rare circumstances.

Second, it is a problem that is not unique to tobacco smoke exposure. In fact, respiratory sensitivity to chemicals is much more common with other substances; in particular, allergens. There are a number of people with severe allergies or severe asthma, so severe that even small amounts of cat hair on a co-worker could trigger an allergic or asthmatic reaction. I have myself treated a fair number of individuals with multiple chemical sensitivity, a disorder in which the individual is super-sensitive to a wide range or possible environmental chemical exposures.

And many of us are familiar with children who are so allergic to peanuts that even transmitting a small amount of peanut butter from the hand of another child may cause an allergic reaction. There are also some individuals with respiratory disease who are very sensitive to the smell of perfumes and perfume exposure can trigger an adverse reaction in these individuals.

So it is entirely a fair question to ask how to appropriately handle these situations. And I think that the most appropriate method is to tackle them on a case-by-case basis. In other words, where we have an identified individual who is highly sensitive, appropriate accommodations need to be made to protect that person from the insulting exposure and to allow them to function as normally as possible.

In the workplace, we actually have a law that requires employers to accommodate employees who have extreme sensitivity to particular chemical exposures. As long as they are deemed medically disabled (which something like multiple chemical sensitivity or extreme sensitivity to tobacco smoke or cat hair or perfume would represent), they are entitled (under the Americans with Disabilities Act) to a reasonable accommodation from their employer.

But it is important to note that a reasonable accommodation would unlikely necessitate the firing of all smokers in the workplace, all people who wear perfume in the workplace, or all people who own cats in the workplace.

Similarly, most schools do not deal with the problem of peanut allergies by banning all students from eating peanut butter or refusing to allow students who consume peanut butter. Most schools deal with the problem either by: (1) banning students from bringing peanut-containing products to school; or (2) setting up peanut-free zones to accommodate the children who are allergic to peanuts.

It seems to me that presence of individuals who are extremely sensitive to tobacco smoke or to a number of other chemical and allergenic exposures does not justify a widespread policy of precluding from all workplaces all people who might present the risk of any exposure to the list of agents to which some individuals are sensitive.

There is no question that these individuals deserve and require accommodation. But the problem does not in any way justify policies to cleanse all workplaces of all smokers, all cat owners, all peanut butter eaters, and all perfume wearers.

While I completely understand and respect the opinions of those who are themselves extremely sensitive to tobacco smoke (while I still disagree with the argument that this problem in any way justifies precluding smokers from the workplace), I have to honestly question the motivation of others who are advancing this argument to promote workplace smoker bans.

It seems to me that this argument is so far off the mark that there may be something more fundamental driving the use of this as a justification for smoker bans. Perhaps it is anger at, and/or a desire to punish smokers. But whatever the reason, I just don't buy the argument.

The rest of the story is that the existence of individuals with extreme smoke-sensitivity does not in any way justify policies that ban smokers from workplaces.

If we, as tobacco control practitioners, want to advance policies that eliminate the smoke, fine. But eliminating the smokers from the job market is promoting no public health interest, and no interest at all, other than perhaps hate, intolerance, and bigotry.

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