Smoking and the Hispanic Paradox

In the course of writing last month’s post about U-haul’s no-nicotine policy, I created the following graph:

This visualization didn’t make the final cut, but it’s nonetheless cool. It demonstrates that smoking rates among Hispanics are far less responsive to income than those of other ethnic groups (though even for Hispanics, the relationship between income and smoking rates is statistically significant). I was surprised to find this relationship, but apparently it’s a known factor of the phenomenon called “the Hispanic Paradox” (alternatively known as the “Latino Paradox”).

The paradox is that, on average, American Hispanics live longer than their non-Hispanic white counterparts, even though the former tend to have lower incomes and less education. The causes aren’t entirely understood, but Hispanics’ low smoking rates are thought to be a major contributor.

Source: Center for Disease Control, 2013

Some of the difference in smoking rates can be explained by immigration. Latin American countries tend to have lower smoking rates than the United States. Among those born in the United States, only Mexican-Ameicans seem to retain lower smoking rates and the attendant mortality advantage over non-Hispanic whites. It will be interesting to see if the Paradox ebbs as native-born Hispanics begin to account for more of the Hispanic population.

The Hispanic Paradox illustrates the capricious power of cultural influence on real-world outcomes — and conversely forces us to confront our limited ability to re-engineer the world.

We tend to think of (the physical, policy, social, or economic) environment and choice as the chief determinants of human behavior and outcomes. But we are just as much a product of the commingling of genetics and culture. The paths before us are well-worn by our predecessors, and we would be arrogant to think we can wholly resist their inclinations.

Cigarette Daydreams

Last week, U-Haul announced that beginning February 1 of this year it would no longer hire nicotine users in the 21 states that permit employers to take that information into account when hiring. To be clear, this covers use outside of the workplace, and it could affect former smokers who use nicotine patches or similar delivery systems.

If you didn’t hear about this, you have my envy and my respect, as it probably indicates that you’re employed and/or don’t spend hours on Twitter, where the topic was briefly trending.

From what I can tell, the reaction has mostly been cynicism about U-Haul wanting to cut healthcare expenses. I think that’s probably true; smokers can indeed be charged higher premiums than non-smokers under the Affordable Care Act, and presumably U-Haul will cover at least some of this.

But since I spent a small chunk of last year’s blog posts talking about selection effects and signalling (most notably here, here, and here), I feel obliged to point out that selecting against smokers is also an effective way to screen for other undesirable qualities in employees. As smoking rates have plunged, smoking has become an increasingly good proxy for a bunch of socioeconomic factors.

(Pardon the use of 2013 data in the following charts; I happened to have this version of the BRFSS on my laptop, and went with it for convenience. I don’t think there’s a good reason the general idea should have changed much in the interceding years.)

For example, smokers, and to a lesser extent, former smokers, miss more days due to their physical or mental health than non-smokers:

Smokers miss more days
The examples given in the BRFSS codebook of “usual activities” are work, self-care, or recreation.

They’re also more likely to have less education and to have lower incomes:

Educational attainment by smoking status

Income bracket by smoking status

Notably, U-Haul is pitching this as a step in “fostering a culture of wellness”:

“We are deeply invested in the well-being of our Team Members,” said U-Haul Chief of Staff Jessica Lopez in a press release. “Nicotine products are addictive and pose a variety of serious health risks. This policy is a responsible step in fostering a culture of wellness at U-Haul, with the goal of helping our Team Members on their health journey.”

So here we have a company policy that is ostensibly for the benefit of employees’ health, but the actual consequences of which will be to save money for the employer and disproportionately preclude the candidacies of many low-SES applicants. Mind you, this is for a job at U-Haul during a period of supposedly record-low unemployment.

I think what bugs me most about this is a feeling (which could be wrong but is at least widespread) that there are diminishing opportunities—especially for low-SES Americans—to participate in the productive side of the economy, which by all indication is something that gives people a sense of meaning and self-respect.

I also can’t shake the feeling that a more powerful or organized constituency would be able to generate some public sympathy in a similar situation. If U-Haul made it policy to deny employment to obese people, presumably to similar effect, there would have been a cascade of outraged NYT opinion pieces and an ACLU lawsuit.

Still more hilarious is the contrast with growing corporate, public, and governmental acceptance (or even endorsement) of marijuana use. A new, publicly announced prohibition on employee use of marijuana would come across as horribly retrograde and likely receive more negative attention.

Smokers, alas, are nearly universally reviled, out of the graces of the upper classes and on the wrong side of demographics.