How Employers Can Counter Social Determinants of Health and Tobacco Use

How Employers Can Counter Social Determinants of Health and Tobacco Use

Social determinants of health and tobacco use are unfortunate bedfellows, but you might not know this.

With laws limiting where people can smoke, it might seem like tobacco use is fast becoming a relic of the past, along with smoky restaurants and office ashtrays.

But that’s far from the case.

Today, 49 million Americans use some form of tobacco, which includes 34 million smokers. That represents 19.7% of all adults.

Among many of these Americans, the associations between tobacco use and low income, lack of education, and lack of healthcare are strong. To counter them, we need deliberate and thoughtful approaches.

Though employers cannot be expected to solve societal-level issues around income and education disparities, they CAN and SHOULD step up to address tobacco use as one of the major correlates of these disparities.


First and foremost, because it’s the right thing to do. Especially for socially responsible companies, helping employees quit tobacco is a major step toward fostering a sustainably healthier life. It’s also a wise business decision given that employers take a particularly big hit from lost productivity, absenteeism, and higher rates of injury, illness, and chronic disease due to employee tobacco use.

The Link between Social Determinants of Health and Tobacco Use

By understanding the biggest social factors associated with tobacco use, employers can better identify who’s still at risk and tailor their cessation efforts in meaningful, effective ways.


Ironically, and unfortunately, individuals under the greatest financial pressure bear the heaviest costs as they continue to support the tobacco industry. According to the Centers for Disease Control and Prevention, 21% of adults with annual household income less than $35,000 smoke. Smoking drains low-income families of their resources that can perpetuate a cycle of disadvantage through multiple generations.


One of the biggest social determinants of health is education, which can have a significant impact on financial and medical literacy, as well as employment options, income, and access to healthcare. Depending on their education level, tobacco use rates for adults with less than a college education are 3 to 16 percentage points higher than the national average of 19.7%.

The reasons that education is so strongly related to tobacco use are multiple and complex, but it’s clear that individuals with less than a college degree need effective, appealing, and easily accessible tobacco cessation treatment.

Access to affordable health insurance

Employers often rely on health plans to offer tobacco cessation, but these programs may not be reaching the people who need them the most.

A benchmark employer survey from Kaiser Family Foundation found that many low-income workers are still unable to afford health coverage even when the employer offers it. Among firms offering coverage, employers with many lower-wage workers (earning $25,000 or less a year) offer health benefits to a smaller share of their workforce and require workers to pay a higher share of premiums than other employers.

Relieving vs. Exacerbating Social Determinants

There are many employees who deal with all 3 of these factors. As they struggle to make ends meet, they’re hindered by these social determinants of health, and some employers are taking approaches that can exacerbate their struggles instead of relieving them.

For example, employers in 21 states can legally discriminate against smokers, making it harder for them to be hired and to receive access to benefits that can help them quit. Despite wanting to quit—nearly 70% report they’d like to stop—they simply don’t have the resources to make it happen.

How to Lead the Way

A growing number of large employers are doing more to address the physical, mental, and financial wellbeing of workers. This could have a positive impact on tobacco use because it’s a step toward taking a more holistic, thoughtful approach when it comes to offering treatment resources.

See more insights into populations at higher risk for tobacco use in our blogs Why Your Plans for Diversity and Social Justice Must Address Tobacco and How Removing Menthol Cigarettes Could Help Black Communities.

Amanda Graham, Ph.D.

Chief Health Officer

Dr. Amanda Graham leads the Innovations Center within Truth Initiative. The Innovations Center is dedicated to designing and building leading digital products for tobacco cessation, including the EX Program. She is internationally recognized as a thought leader in web and mobile quit-smoking interventions and online social networks and has been awarded over $15 million in research funding. She has published over 115 peer-reviewed manuscripts and serves on National Institutes of Health study sections and numerous journal editorial boards. Graham is Professor of Medicine (adjunct) at the Mayo Clinic College of Medicine and Science.

Human Resources Today