IN MY VIEW: Suggesting that Smoking is Offensive is Not the Direction This Program Should Go

In listing its reasons for encouraging cities and towns to ban smoking on streets and sidewalks, Action on Smoking and Health (ASH) stated:

"Activities and images which might be inappropriate for young children and/or which might lead them into bad habits are often prohibited in public places, even if they pose no health risk and might even be appropriate in areas visited voluntarily only by adults. For example, virtually all municipalities have long prohibited consumption of alcoholic beverages in public places like parks and beaches. ... Similarly, prohibiting smoking in outdoor places frequented by the public --– like parks, playgrounds, beaches, etc. --– shields young children from seeing smoking as a common adult behavior to be emulated, even if some may observe smoking by the parents and other adults in private homes. Other examples where activities are prohibited in public places because of their possible impact on children include sexually suggestive movements (permitted on dance floors but prohibited in parks and on sidewalks), gambling (permitted in casinos and tracks but not in public places), displays of pictorial nudity (permitted in art galleries but not on sidewalks), etc."

I have already criticized this argument for banning smoking on streets and sidewalks by noting that it suggests that what we are really doing is trying to make smokers social outcasts who are not even worthy of being observed publicly, that they are no better than, and just as offensive as anyone who is publicly naked or intoxicated. I also noted that this argument leads to a slippery slope as well. What should we ban next? People eating french fries on the street corner?

Here, I focus on my perception that ASH is suggesting that public smoking is offensive and that children need to be protected from seeing this behavior because it is offensive and an affront to public morals.

The Rest of the Story

It is my perception that ASH is suggesting that public smoking is offensive and that children need to be shielded from it because it is an affront to public morals.

Why do I say this? Because the argument that we need to protect children from seeing behaviors that might be unhealthy to them in public places just doesn't hold.

Do we prohibit children from seeing movies in which people are drinking or smoking? Do we prohibit people from eating fatty foods in public? Do we prohibit parents from serving french fries and tater tots to their children's friends? How about Hostess Twinkies (one of my favorites as a kid)? Do we prohibit adults from drinking alcohol in restaurants, where children are present, and where children are obviously going to see the behavior and probably emulate it?

We don't. The reason why some behaviors are regulated in public is not that we are afraid children might emulate them, but because we view these behaviors as being publicly offensive and an affront to the public morals. This is ostensibly the reason why many communities do not allow alcohol use, nudity, sex or sexually suggestive movements, or scanty clothing in public places.

It's simple - these things are viewed as an affront to public morals, and as publicly offensive.

So what I think ASH is really suggesting is that smoking should be added to the list of highly offensive behaviors that represent an affront to public morals when conducted in certain public places.

As a physician and public health practitioner, I have to soundly reject this notion. I did ever view the lawful, unhealthy behaviors of my patients as offensive or as a moral affront. I am not particularly attracted by the idea of a person who gets no exercise, sits around watching television all day, and eats nothing but fast food; but neither do I find that offensive.

Smokers are our public constituents and (for physicians and other health care providers) our patients, and our responsibility is to have compassion for these individuals and do what we can to help them. We also need to be cognizant of the fact that smoking is an addictive behavior and that the overwhelming majority of smokers begin smoking as youths. Who are we to blame them and attack them as being offensive when it is we ourselves who argue that they are "victims" of the tobacco industry's marketing and the addictive manipulation of tobacco products, and that they were kids when they chose to start smoking?

This is a road that we don't want to go down. We just don't do this type of thing in public health.