Latest UCSF Tobacco Policy is the Wrong Approach to Health Promotion

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Medical Center

On September 3, UCSF instated its new 100% Tobacco Free Policy, which requires anyone affiliated with UCSF to refrain from using any tobacco products during their shifts, including break times, on or off university grounds.

The stated goal of the policy is to provide a maximally healthful environment at UCSF, demonstrating a commitment to health promotion for patients and communities. I will argue that proponents of this policy are so focused on the ideals of a tobacco-free environment that they fail to properly consider the unintended consequences of a ban.

During a recent series of Town Hall meetings, UCSF has made it clear that it is proud to be the first medical center and campus in California to use this strategy. Authorities are also quick to point out that the focus of the ban is on education and cessation, and that it is not meant to be punitive.

I believe the very idea, however, is fundamentally flawed. The words “non-punitive ban” can be placed next to one another in a way that seems as if it could make sense, but like the terms “round square” or “separate but equal,” I believe a “non-punitive ban” is something that probably does not exist.

Whenever something is banned, two questions immediately come to mind: “How will it be enforced?” and “What are the consequences of breaking the rules?”

According to the presentation at the aforementioned meetings, security guards are to act as “Tobacco Ambassadors,” reminding tobacco users about the policy and pointing them to available cessation resources.

Managers or other employees are encouraged to utilize gum packs or handouts as conversation starters when approaching people they believe may have been using banned products, the list of which includes chewing tobacco and e-cigarettes (which clearly do not affect other people’s health).

In fairness to UCSF, they have put together a very nice set of resources to help people stop using tobacco. Nicotine replacement gum will be provided at both the Parnassus and Mount Zion campuses, full reimbursement will be given to UCSF employees who complete a four-week tobacco cessation program at the Fontana Tobacco Treatment Center at Mount Zion, and there will be group counseling offered on smoking cessation and relapse prevention (information available at TobaccoFree.ucsf.edu).

But there are no specific guidelines on how to handle violations, and managers have been instructed to address them on a case-to-case basis.

Unless there is a clause that specifically protects employees from being punished, how can we call this policy non-punitive? On the other hand, if there are no plans to exercise punishment, what have we gained by making people feel bad for breaking a rule?

We all agree that smoking is bad and we don’t want people to do it. Instead of a ban, why not call 100% Tobacco Free a goal,  something toward which we set specific milestones to try to achieve together in a step-wise fashion, incentivizing compliance rather than hanging a nebulous threat over people’s heads?

The best way for UCSF to create a healthy environment is to make balanced and thoughtful policies that help an already struggling population of smokers deal with the multiple biologic, social and psychological factors they are facing. At the very least, we need not add fuel to the fire in the hearts of those who might interpret this policy as a justification for hurtful, vigilante-style confrontations.

UCSF wants to focus on positives. Unfortunately, any type of ban clearly focuses on negatives, no matter how much one tries to sugar-coat it.