"I DO Mind If You Smoke!"

AMERICA IN THE 1960's and 1970's has witnessed two minor revolutions. One is the recognition of the rights of many minority groups. Another is the recognition that tobacco-smoking is a serious health hazard to all who are unfortunate enough to be habituated. Moreover, it is now abundantly clear that those nonsmokers who find themselves in proximity to smokers must unwillingly suffer, in good part, the same adverse health consequences.

The smoke rising from the burning tip of a cigarette (called the sidestream smoke, as opposed to the mainstream smoke that the smoker inhales) enters the room air to be breathed by all. Sidestream smoke contains three times the tar and nicotine, four times the benzopyrene (a carcinogen), five times the carbon monoxide, and fifty times the ammonia of the mainstream smoke. Cadmium, which may be related etiologically to emphysema, also exists in greater concentration insidestream smoke. Non-smokers in the same room with smokers suffer smoke-related rises in blood pressure and pulse rate, have rises in blood carbon monoxide (which aggravates angina), and, if they belong to that group of two million Americans who are sensitive to tobacco smoke, they may have an acute asthmatic attack. Respiratory illness and school absenteeism in children from homes where there are smokers is twice as common as among children from smoke-free homes.

Progress has been made in this fight against smoking, which with alcohol must rank as the most important public health hazard facing Americans. In the last ten years, the yearly per capita cigarette consumption has declined from approximately 4,400 cigarettes to 4,100. Seventy percent of all cigarettes sold today are filter-type, and due to changes in tobacco breeding and cigarette manufacture, the average cigarette of today delivers about 50 percent less tar and nicotine than it did ten or fifteen years ago. But these numbers are sterile testimony. A better way to realize the changes that have been accomplished is to try to "Remember When?"

---remember when a carton of cigarettes was an ideal Christmas gift?

---remember when there were nothing but cigarette jingles on the radio, and TV screenfuls of young lovers romping through the great outdoors in a cloud of cigarette smoke?

---remember when people thought non-smokers were "square" and "goody-goodies"?

---remember when airlines passed out free cigarettes to please their passengers?

---remember when almost every one on TV and in movies smoked? Remember Edward R. Murrow and Humphrey Bogart? (Both died of lung cancer.)

---remember when a doctor might have offered patients a cigarette to help them calm their nerves?

---remember when cigarette ads talked about rich, full flavor in stead of low tar and nicotine levels?

remember when children were not upset if their parents smoked?

Yes, times and attitudes are changing. A few hospitals in our area have already removed cigarette vending machines from their premises and restricted smoking to areas where nonsmokers will be minimally affected. The Central Massachusetts Lung Association and Radio Station WSRS-FM are broadcasting re quests to smokers to stop smoking or at least to respect the sensibilities of the non-smoker. State Representative Lois Pines of New ton has introduced legislation to limit smoking in many public places. Airlines segregate smokers and non-smokers.

Health care professionals should be leaders, not followers. It is now high time for us to assert the leadership that the communities we serve expect and deserve, both in dramatizing the need for education of all members of our society about the consequences of tobacco usage, and in protecting the rights of the sizable majority of people who are non-smokers. What can we do? As one example, the Medical Staff of the Memorial Hospital voted unanimously on the eve of the tenth anniversary of the Surgeon General's Report on the Health Consequences of Smoking to recommend to their Board of Trustees the consideration of the following measures:

1. Remove cigarette machines from hospital property.

2. Prohibit smoking in all patient waiting areas such as Emergency Ward, Out-Patient Department, Radiology, and Admitting.

3. Prohibit smoking in patient areas.

4. Prohibit smoking in all conference rooms.

5. Reserve specific areas of the dining room and cafeteria for smokers, and screen those areas off to protect the nonsmokers.

6. Post "No Smoking" signs in elevators and corridors, as well as other areas mentioned above.

7. Request visitors to non-smoking patients not to smoke by means of posted signs or in person by nursing personnel.

8. Observe common sense fire safety rules and prohibit smoking by bed-ridden patients, drowsy patients, or patients taking medications which might make them drowsy.

9. Most important, patients admitted to a hospital people who are ill should not be forced to breathe air which will make them more ill. Therefore, the Admitting Office should try to group smoking patients separately from non-smoking patients.

Remember the Surgeon General's words: "Non-smokers have as much right to clean air and wholesome air as smokers have to their so-called right to smoke, which I would redefine as a so-called right to pollute. It is high time to ban smoking from all confined places such as restaurants, theaters, airplanes, trains, and buses. It is time that we interpret the Bill of Rights for the nonsmoker as well as the smoker."

We urge that all hospitals adopt smoking control regulations, that each individual physician encourage legislation to adopt regulations and statutes protecting the nonsmoker in public places, and that every non-smoker rise up with a resounding "Yes, I do mind if you smoke."