Thursday, August 17, 2006

McHenry County College Poised to Ban Tobacco Use Entirely on Campus; From Public Health to Moralizing and Paternalism

The Board of Trustees Policy Committee of McHenry County College (Crystal Lake, IL) has proposed a new non-smoking policy which would completely prohibit the use of tobacco products anywhere on the college campus. This includes both smoking and the use of smokeless tobacco. This would replace the current policy, under which smoking is restricted to outdoor areas on campus.

The proposed policy, which would go into effect in August 2007, reads as follows:

College-owned buildings, grounds, and vehicles shall be a tobacco-free environment for all, including but not limited to employees, students, and visitors. This includes the smoking of any tobacco product and the use of smokeless or "spit" tobacco.

The new policy was developed by a committee which worked closely with a number of anti-smoking groups, including the McHenry County Health Department, the American Cancer Society, the American Heart Association, and the American Lung Association.

The Rest of the Story

Anyone familiar with my research or my career's work knows that I am a strong proponent of indoor and workplace smoking bans and that I have advocated for banning smoking in all indoor areas of college campuses. In brief, I support the policy that McHenry County College currently has in place, which restricts smoking to outdoor areas and protects nonsmokers from any substantial exposure to secondhand smoke and the resulting health effects.

However, I think this proposed policy goes too far.

It is clearly not necessary to ban smoking on the entire college campus in order to protect nonsmokers from substantial exposure to secondhand smoke. Certainly, restricting smoking to designated outdoor areas can be done in a way that prevents nonsmokers from having to breathe in any significant quantity of secondhand smoke. There is no reason why if a student is smoking in their car in a parking lot, for example, nonsmoking students or employees will be unable to avoid exposure to his or her smoke.

You can't tell me that if a student lights up for a few minutes in the remote area of parking lot F, she is going to cause involuntary exposure to secondhand smoke to anyone who wishes to avoid that smoke by not hanging out in that area of the parking lot.

And how about a smoker who crosses Ring Road and lights up during a break over by the soccer fields if no one is around? How exactly does that represent a major public health threat?

The answer is simple. It doesn't. This policy is clearly not intended to protect the health of nonsmokers from the dangers of secondhand smoke. Instead, the policy is intended to impose moral values on a specific health behavior decision. It is a clear example of moralizing and paternalism masquerading as a public health policy.

If the policy were about protecting nonsmokers from tobacco smoke exposure, then there would be no reason to ban smokeless tobacco use from the campus, since that doesn't produce secondhand smoke. Clearly, there is something else going on.

The problem, as being defined by the Board, isn't exposure to secondhand smoke, it's tobacco use itself.

Which is fine - since tobacco use is a public health problem. But the response to that problem is inappropriate. Public health practitioners on college campuses try to use educational and support programs to discourage tobacco use and encourage tobacco users to quit. If we on college campuses are truly concerned about the problem of tobacco use, we will develop smoking cessation programs and incentives to help smokers and smokeless tobacco users quit.

But imposing health behaviors that do not affect others on the college community is not appropriate from a public health perspective. Not to mention how inconsistent this approach is.

If McHenry County College is truly concerned about imposing healthy behaviors on its community members, then probably the first thing it should do is prohibit the consumption of fatty foods on its premises. Obesity and poor nutrition are huge public health problems and are linked with heart disease, hypertension, stroke, and cancer. If the college doesn't want to allow people to risk slowly killing themselves by smoking, then how could the college possibly allow people to risk slowly killing themselves by eating high quantities of fat (quantities which have, by the way, been demonstrated to cause exactly the same kind of endothelial dysfunction caused by smoking)?

Perhaps the first thing to go should be the fried chicken. What business did the MCC Cafeteria have serving a Soul Food menu, with fat-laden fried chicken, to the college community? If MCC is truly concerned about the health of its community members, then that event should certainly be canceled for this year, or else the menu should be changed. And how can MCC justify serving greens, corn bread, fried chicken, and much more at the regular lunch entree prices? Doesn't that simply encourage excessive food intake and contribute to the obesity problem? Shouldn't some greens, a piece of corn bread, and a leg or breast be enough? Why would you need much more to eat than that? And how irresponsible it is of the college to promote that kind of irresponsible diet and unhealthy eating behavior.

And shouldn't the college end its irresponsible and most unhealthy program of providing a free cup of coffee every day as a benefit for those who buy an Alumni Benefits Card? That level of consumption of caffeine is associated, unequivocally, with cardiac arrhythmias, even more serious than those seen with 2 hours of secondhand smoke exposure.

The MCC Conference Center catering menu would certainly have to change. How does serving scrambled eggs with hash browns and sausage, cheese eggs, an omelet with ham or bacon and hash browns, or sausage gravy promote a healthy diet among the campus community? And what about the roast beef and beef sirloin tips entrees? You really can't do much worse than that if you're looking to find a meal with a healthy level of fat. Eat like that for long and you'll be in the same hospital ward as all the smokers who will soon be dodging the traffic on Highway 14 to find a place where they can smoke.

If the Board of Trustees of the College approves this policy, it will be giving a moral value to smoking that it does not give to any other legal health behavior. And that's why, ultimately, I find the proposed policy to be unjustified on public health grounds. There should not be a moral value attached to smoking among adults. Yes, it is a dangerous and risky behavior. But so are many other behaviors that so many of us engage in. What business do we have telling other people that their unhealthy behaviors are not to be tolerated, but our unhealthy behaviors are just fine?

Ultimately, there's a double standard at work here. And so what it comes down to is downright hypocrisy. Maybe it's no surprise that there are anti-smoking groups at least partially behind this proposal. The hypocrisy had to come from somewhere.

Finally, I should add that I don't seriously think that this policy, if imposed, would result in smokers quitting. If anything, I think it will alienate the smokers and solidify their smoking behavior, make them less motivated to quit. This is not health promotion; it's imposition of values on a community in a hypocritical, inconsistent, and intolerant way.

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