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Dr. Soffer is editor emeritus of CHEST.
Correspondence to: Alfred Soffer, MD, Master FCCP, 950 Central Rd, Glenview, IL 60025-4476
The report by Denny and associates in this issue of CHEST (see page 692) provides dramatic proof that the majority of the 102 hospitals identified in their communication are neglecting a unique opportunity in health care. The Web site of each of these hospitals was visited; only 30% contained information on smoking cessation. The response to a phone survey of hospital switchboards was even more startling. Only 47% had a smoking cessation program available via phone inquiry.
This relative paucity of a hospital-based effort to assist the smoker in the challenging task of cessation is particularly regrettable, since outpatients and especially inpatients frequently represent an unparalleled group to target for smoking cessation programs. Individuals receiving or seeking medical assistance in a hospital environment are unusually receptive to health education in preventive medicine.
The article, "Hospital Initiatives in Promoting Smoking Cessation," contains a message that should prompt action. Many more hospitals must recognize their potential to aid patients in stopping smoking. The elimination of cigarette smoking continues to be the single most important health measure available for the prevention of disease and premature death in the United States.
It is entirely appropriate that these data should be published in the major scientific periodical of the American College of Chest Physicians (ACCP). Traditionally the pages of CHEST and its precursor Diseases of the Chest have featured seminal reports on the subject of cigarette smoking and the roles of the clinician and hospital staff in combatting this addiction.
Special supplemental issues on a single topic serve as an important educational and research publication device. The first supplement issued by the ACCP appeared in Diseases of the Chest in 1968.1 The subject was office management of smoking problems, and the issue contained the proceedings of a national forum cosponsored by the US Public Health Service and the ACCP. Thus, as early as 1968, the editor could report that "the American College of Chest Physicians has an enviable record in physician education and research related to the effects of cigarette smoking on the respiratory and cardiovascular systems."
Among the many articles published in CHEST on the subject of smoking, there were a number emphasizing the role of the hospital. One article published in 1982 and an article that appeared in 1983 warrant special attention. The report entitled "The Management of Smoking in the Physician’s ‘Workshop’"2 emphasized the teaching potential that can be utilized in hospital centers. The authors noted, "Literature for laymen on preventive health aspects of smoking should be placed in all public areas as well as in the physician and staff lounges." In August 1983, Andrews described a successful hospital-based program in smoking cessation.3 He concluded, "An effective, comprehensive hospital wide policy regarding smoking has reduced smoking by both staff and patients."
Fifty million Americans continue to smoke. The efforts of the smoker to stop may frequently be countered by the implacable efforts of the tobacco industry to encourage cigarette smoking. Against such odds, the medical profession must utilize every conceivable strategy to educate, encourage, and assist our patients as they struggle to eliminate this profound health hazard in their lives.
How determined is our opposition? Consider the fact that in 1998 the tobacco industry spent $6.3 billion on advertising and promotion. The devious strategies used to solicit new smokers and appeal to the already addicted are not new phenomena. In 1926, advertisements for Chesterfield cigarettes pictured a woman encouraging her date to "Blow Some My Way," intimating that she enjoyed the smoke and possibly that her date might offer her a cigarette. Tobacco moguls shrewdly appraised the American woman’s desire to be slim, and in 1928 introduced the slogan "Reach for a Lucky Instead of a Sweet." When early reports of health hazards began to appear in the 1950s, cigarette ads began to hint that some brands were more healthful than others. Camels praised the "T Zone Test" as proof that the nose, mouth, and throat will tell the smoker that Camels are milder. In the 1960s, Virginia Slims equated smoking with the struggle for feminine equality. Their pernicious but brilliant and unfortunately successful slogan was, "You’ve Come a Long Way Baby." These data and many more insights can be found in the Speakers Kit of the CHEST Foundation, available from the ACCP.
Once again, the tobacco industry has enlisted the support of Hollywood in portraying cigarette usage as a much-to-be-desired status symbol. Although in 2002 only 19% of Americans of high economic status smoke, 57% of their counterparts in movies puff away.
Our country has changed dramatically in recent decades, but the snake oil pitch of the purveyors of nicotine remains the same. It has been 49 years since I prepared an editorial entitled "Smoke Gets in Your Eyes—and Ears," and yet a quotation I used then is still fully relevant. I wrote that W. C. Fields was both amused and irritated by the deceptive practices of the tobacco hawkers, as indicated by his biographer, Robert Lewis Taylor4 :
He often tried to ferret meaning out of sentences like "More doctors smoke Cubebs then formally," or "Repeated tests have proven that Corn Silks are not responsible for 67% of bad breath originating in the mouth," or "Your Y zone is safe with Hempies, the middle sized cigarette." He was ever on the alert for additions of valuable new ingredients such as lataka or chloroform, and he marveled that almost every cigarette was far outselling the competitors. In the wind up he realized that the ultimate end of the fight for mildness was no tobacco at all, and he quit smoking in response to advertising of this sort.
References
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