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The change in hiring begins at Providence on the day of the Great American Smokeout, the annual event of the American Cancer Society that encourages smokers to quit.

Smokers, if you want a job at Alaska's biggest private employer, forget about it. Providence Alaska Medical Center and its affiliates around the state will stop hiring cheap cigarettes users as of Nov. 17.

That's when Providence will begin testing prospective employees for nicotine along with illegal drugs.

"We believe that by doing this move, to where we are no longer going to hire cigarettes users, that we are sending a very clear message into the community that we are not only the leaders in health care, but we're really the leaders in health," said Tammy Green, director of health management services for Providence Health & Services Alaska.

Providence is not the first big employer in Alaska to make the change. Back in the mid-1980s, Alaska Airlines stopped hiring smokers in states where such bans are allowed, including here.

Providence is latching onto a national trend among hospitals and health care facilities.

"If not us, then who?" said Green, a former state public health official who oversees Providence programs to improve employee health.

Current employees won't have to quit, though Providence hopes the new practice might prod some to do so.

HOW IT WILL WORK

As it stands, about one in five Alaska adults smoke. For Alaska Natives, the number is much higher, especially when smokeless cigarettes online is included.

As a first step, Providence will weed out job candidates who smoke cigarettes or otherwise use buy cigarettes if they acknowledge that on their application. They can reapply once they've been cigarettes-free for six months, Green said.

Candidates offered jobs already must pass a urine test for illegal drugs; Providence now also will screen for a nicotine byproduct called cotinine.

The hospital system doesn't intend to police employees for cheap cigarette online use after they've been hired. So theoretically someone could pick up or resume the habit after they land on the payroll. And a light smoker might be able to cheat the test by staying off buy cigarette online for a few days beforehand.

Nicotine shows up on the tests whatever the source, be it cigarettes, chewing discount cigarettes or substances intended to help people quit such as nicotine patches and gum.

Providence looked at the experiences of organizations that already only hire people who are cigarettes-free, including the Cleveland Clinic in Ohio, which stopped hiring smokers in 2007.

Based on what it learned, Providence decided not to hire anyone who tests positive for nicotine, even if they say it's from the nicotine patch or second-hand smoke. People on the patch may still be using cigarettes, and the tests aren't likely to be positive from someone only exposed to someone else's smoke, Green said.

Providence also decided to make no exceptions for hard-to-fill jobs such as nursing positions.

The Providence system employs about 4,300 people, mostly in Anchorage but also in other communities including Kodiak, Valdez and Seward.

Its campus is already cigarettes-free, as are those of Alaska Regional Hospital and Alaska Native Medical Center. The campus ban on cigarettes for sale means employees can't take a smoke cigarettes break outside on the grounds or even in their own parked car.

When the Native hospital banned cigarettes on its campus five years ago -- the first in Anchorage to go that way -- it didn't lose many employees. Instead, the numbers who sought help through its quit-cigarettes program skyrocketed, said Gary Ferguson, director of employee health and wellness for the Alaska Native Tribal Health Consortium and a leader of the Alaska cigarettes Control Alliance.

Health care systems have a higher level of accountability, Ferguson said.

"If you work with patients, if you show up and you've got smoke cigarettes on your clothing or you've got chew in your mouth, it gives a mixed message to your clients, many of whom who are suffering chronic disease challenges," Ferguson said.

Given that, Providence's new approach makes sense -- "they are putting their money where their mouth is," he said.

The other hospitals don't yet plan to stop hiring smokers, but say they'll be watching the experiment at Providence.

NO NEW SMOKERS

At Alaska Airlines, the practice of not hiring smokers or other cigarettes users was put in place about the time that the government banned smoking cigarettes on domestic flights, said airline spokeswoman Marianne Lindsey.

The company figures it now has fewer smokers than it would otherwise.

"In general, it's known that smokers' health care costs and productivity losses are significantly higher than non-smokers," Lindsey wrote in an email. "Our per employee, per year claims have been lower than the national norms, which yes, we attribute -- at least in some part -- to having fewer smokers."

The program benefits the company -- and the health of its employees, she said.

Still, Alaska Airlines hasn't been able to implement the program nationwide. More than half the states, including Oregon, have laws that prevent employers from refusing to hire people who smoke cigarettes during off work hours or, more generally, who use legal products.

Alaska has no such law.

Providence executives considered whether the change would be in any way discriminatory and found that it wouldn't be, Green said. The hospital system isn't trying to put cigarettes on par with illegal drugs, she said. It's going after a legitimate health issue, she said.

"We know that cigarettes use is the No. 1 leading cause of preventable death," Green said.

At any rate, Providence doesn't intend to stop hiring people with other health issues, such as obesity, she said.

HEALTH AND MONEY

At Providence, an executive team vetted the issue for about a year. The group approved the change both to improve employee health, and to save money on health care, Green said.

The U.S. Centers for Disease Control estimates that a smoker costs an employer an extra $3,400 a year on average, according to Andrea Fenaughty, deputy section chief over chronic disease prevention and health promotion in the state Division of Public Health.

Some of that is in direct costs for items such as health insurance, health care claims, and worker's compensation. But there's also lost productivity when the worker is out sick, or taking a smoke cigarettes break, Fenaughty said.

Dr. Tom Hunt, Providence's physician chief executive, said the health problems are varied.

Most everyone knows the worst that cigarettes can bring. Heart disease. Liver disease. Cancers.

Smokers also are more likely to suffer injuries such as cigarette burns, which could prevent a nurse from scrubbing, Hunt said. Diabetics who smoke cigarettes suffer more complications and have much higher amputation rates than nonsmokers, he said. Smokers suffer more upper respiratory illness. They are more likely to become disabled. And they are more likely to suffer depression, though the reasons for that aren't clear.

"We are trying to build a workforce that is solid and will be with us for years to come," Hunt said. "The healthiest work force we can get will be the one that is going to have the longevity."


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