Tessa Quinn
Smoking is a prominent issue in Missouri, with the state's tobacco tax being the lowest in the U.S. and nearly one in five adults smoking. Missouri hospitals are working towards a 100% smoke-free policy, which includes the regulation and restriction of tobacco, e-cigarettes, and vaping products. While some U.S. states have laws in place to protect smokers from discrimination, it is not recognized as a protected class under federal law. Missouri is one of the states that permits the non-hiring of smokers, with an emphasis on non-profit organizations where tobacco use could conflict with the entity's purpose. This exemption applies to hospitals, among other organizations.
| Characteristics | Values |
|---|---|
| Smoking discrimination laws | Missouri's 1992 statewide smoking law, the Indoor Clean Air Act, prohibits smoking in all enclosed public places and public meetings, except in designated smoking areas, which may occupy no more than 30% of the place's enclosed area. |
| Hospitals | Hospitals in Missouri are working towards a 100% smoke-free policy, which includes tobacco, e-cigarettes, and vaping products. |
| Discrimination in employment law | Missouri is one of the states that permits the non-hiring of smokers, with some smoker protection policies not applying to non-profit organizations. |
| Discrimination in medical marijuana use | Missouri law provides workplace protections for employees who require medical marijuana to treat a disability or medical condition. It is illegal to fire someone for consuming medical marijuana, and employees can assert their rights with the help of a lawyer. |
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What You'll Learn
Missouri's 1992 Indoor Clean Air Act
Missouri's 1992 statewide smoking law, the Indoor Clean Air Act, prohibits smoking in all enclosed public places, including workplaces and public meetings. Designated smoking areas are allowed, but they can occupy no more than 30% of the enclosed area, and warning signs must be appropriately posted. Local governments in Missouri can prohibit smoking in schools, childcare facilities, school buses, and other public places.
The Act does not include a statewide smoking ban, instead leaving it to local governments to decide. For example, in Ballwin, smoking has been banned in all workplaces, including bars and restaurants, since 2006, with an exemption for private clubs with no employees. In Belton, a public vote in 2009 led to a ban on smoking in all enclosed public places and workplaces, with exemptions for business vehicles where all occupants agree to smoking, private and semi-private rooms in nursing homes, retail tobacco stores, and private clubs.
The Missouri Department of Natural Resources works with federal and local governments to improve the state's air quality for all citizens. The state has adopted federal regulations from the Environmental Protection Agency (EPA), which is charged with administering the federal Clean Air Act. The Clean Air Act, enacted in 1970, regulates air emissions from stationary and mobile sources.
The Missouri Clean Indoor Air Act is available to view online and can be downloaded.
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Hospitals' smoking policies
Smoking is the leading preventable cause of death in the United States, with tobacco use impacting every system or organ in the body. In Missouri, 19.4% of adults smoke, compared to the national smoking rate of 13.7%. Missouri's tobacco tax is the lowest in the country, and tobacco use costs Missourians over $3 billion in healthcare costs annually.
In light of these concerning statistics, many hospitals in Missouri are working towards implementing 100% smoke-free policies. This involves regulating and restricting not only the use of tobacco but also vaping products. The Missouri Hospital Association (MHA) recommends expanding existing hospital tobacco-free or smoke-free policies to include vaping products. This is due to the growing popularity of vaping, especially among high school students, and the associated health risks, including nicotine addiction.
The successful implementation of a smoke-free policy in hospitals requires strong leadership and a visible presence of the policy through signage, social media, and websites. Hospitals that have successfully transitioned to smoke-free campuses instruct their employees to approach smokers with courtesy and respect, adopting a non-confrontational approach to enforcement. Additionally, hospitals can utilize resources such as nicotine replacement therapy, pharmacotherapy, coaching, and employee assistance plans to support individuals in their cessation efforts.
While there is no statewide smoking ban in Missouri, the state's 1992 Indoor Clean Air Act prohibits smoking in all enclosed public places, public meetings, and workplaces, except in designated smoking areas occupying no more than 30% of the enclosed area. Localities within Missouri have also implemented their own smoking bans, with varying exemptions for specific types of establishments. However, it is important to note that smokers are not recognized as a protected class under federal law, and employers are generally permitted to not hire smokers without facing legal repercussions.
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Missouri's tobacco tax
Missouri has the lowest tobacco tax in the US. The state collects a separate tax on cigarettes and other tobacco products sold within the state, in addition to sales tax. The tax is calculated based on mills (1/10 of one cent) per cigarette. For instance, the State School Money Fund receives 9 cents per pack of 20 cigarettes, the Health Initiatives Fund receives 4 cents per pack of 20, and the Fair Share Fund receives 4 cents per pack of 20. Typically, a licensed wholesaler files the reports and pays the tax to the Department of Revenue each month. However, if a retailer or individual purchases tobacco products directly from a manufacturer or non-licensed wholesaler, they must pay the tax to the Department.
The use of tobacco and tobacco-related products is the leading preventable cause of death in Missouri, with 11,000 deaths each year. It costs Missourians over $3 billion in healthcare costs and Missouri Medicaid $644.3 million annually. Missouri high school students smoke at a rate of 10.9%, compared to the national rate of 5.8%.
To address this issue, the Missouri Hospital Association (MHA) has published resources to help hospitals become tobacco-free. They recommend expanding existing smoke-free policies to include vaping products, as vaping among high school students increased by 78% from 2017 to 2018. MHA suggests that hospitals utilize strategies such as nicotine replacement therapy, pharmacotherapy, coaching, and employee assistance plans to assist employees in quitting smoking.
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Missouri's smoking rate
Missouri has the lowest tobacco tax in the US, and tobacco use costs Missourians over $3 billion in healthcare costs and $644.3 million for Missouri Medicaid annually. Tobacco use impacts every system or organ in the body and causes the deaths of 11,000 Missourians each year. Nearly one in five, or 19.4%, of Missouri adults smoke (921,400), compared to a national smoking rate of 13.7%.
Missouri's 1992 statewide smoking law, the Indoor Clean Air Act, prohibits smoking in all enclosed public places (including workplaces) and public meetings, except in designated smoking areas, which may occupy no more than 30% of the place's enclosed area. Warning signs must be appropriately posted. Local governments may prohibit smoking in schools, childcare facilities, and school buses, as well as in public places.
Some localities in Missouri have implemented additional smoking bans, including:
- Ballwin: banned in all workplaces, including bars and restaurants; exempts private clubs with no employees.
- Belton: banned in all enclosed public places and workplaces; exempts business vehicles where all occupants agree to allow smoking, any businesses occupied exclusively by one smoker, private and semi-private rooms in nursing homes, retail tobacco stores, and private clubs.
- Branson: banned in all enclosed public places and workplaces; exempts designated hotel and motel smoking rooms, tobacco shops, and smoking lounges in tobacco-related businesses.
- Independence: banned in all workplaces, including bars and restaurants; exempts private and semi-private rooms in nursing homes occupied exclusively by smokers.
- Jefferson City: banned in all enclosed workplaces, including bars and restaurants.
- Kansas City: banned in all indoor workplaces, except casino gaming floors and establishments receiving more than 80% of their revenue from tobacco.
In addition to the smoking bans, Missouri hospitals are working towards integrating a 100% smoke-free policy. This includes regulating and restricting the use of vaping products, as well as providing resources and support for employees trying to quit smoking.
The high smoking rate in Missouri may be influenced by tobacco advertising, as research has found that kids are twice as sensitive to tobacco advertising as adults and are more likely to be influenced by cigarette marketing than by peer pressure. Additionally, vaping among high school students in Missouri has increased by 78% from 2017 to 2018, with a smoking rate of 10.9% compared to a national rate of 5.8%.
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Smoker protection legislation
In the United States, smoker protection laws are state statutes that prevent employers from discriminating against employees for using tobacco products. Currently, 29 states and the District of Columbia have laws in place that elevate smokers to a protected class. However, the American Lung Association does not support these types of laws.
These laws generally prohibit employers from refusing to hire or firing an employee for using any type of tobacco product during non-working hours and off of the employer's property. While most of these laws were enacted in the late 1980s and early 1990s, several states have implemented them more recently due to the increasing discrimination against smokers in the workplace. For example, some employers have started refusing to hire new employees who smoke, with many of these businesses being in the healthcare industry.
Despite the existence of smoker protection laws, most state laws have exceptions. Employers can still discriminate against smokers if they can establish that compliance is financially and physically unreasonable. Additionally, employers and insurers can require smokers to pay higher health insurance premiums. In New Jersey, employers can discriminate if they have a "rational basis for doing so which is reasonably related to employment duties."
Missouri has a statewide smoking law called the Indoor Clean Air Act, enacted in 1992, which prohibits smoking in all enclosed public places, including workplaces, and public meetings, except in designated smoking areas occupying no more than 30% of the enclosed area. Some localities in Missouri, such as Ballwin, Belton, and Branson, have implemented additional smoking bans that include all bars and restaurants. However, it is unclear if these bans extend to hospitals or if there are any specific exemptions for healthcare facilities.
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Frequently asked questions
No, Missouri hospitals are not exempt from smoking discrimination. In fact, the Missouri Hospital Association (MHA) recommends hospitals implement a 100% smoke-free policy, which includes tobacco, e-cigarettes, and vaping products.
The Missouri Indoor Clean Air Act of 1992 prohibits smoking in all enclosed public places, including workplaces, and public meetings, except in designated smoking areas, which can occupy no more than 30% of the enclosed area.
Yes, the MHA provides resources and tools to support hospitals in their efforts to address tobacco, e-cigarette, and vaping product use. Additionally, hospitals can utilize resources such as insurance coverage of pharmacotherapy and nicotine replacement therapy, and employee assistance programs to help employees quit smoking.
