Letter to the Editor: UCSF Tobacco-Free is too One Dimensional

Dear Editor,

In response to my article opposing UCSF’s new tobacco policy (September 5), I have received enough reasonable critique to warrant a response.

A short recapitulation of my position is that the new ban on tobacco use by UCSF personnel during breaks, even if they leave the grounds to do so, fails to meet its goal of creating the healthiest overall environment at this institution.

I will list specific concerns people have brought up to me, followed by my responses.

Critique No. 1: My position does not resolve the issue of the damage tobacco can inflict.

We all agree smoking is bad for smokers and people in the vicinity of smokers (secondhand smoke). There is also growing interest in examining the effects on people exposed to environments where settled pollutants from prior smokers may be re-emitted into the air (thirdhand smoke).

In the case of smokeless tobacco, there is a great deal of evidence that it is bad for the person chewing, but really no evidence that Person A’s use is bad for Person B (although the spitting can be unsightly).

As for e-cigarettes, I received a link to an article that has detected aerosolized volatile organic compounds and (ultra)fine particles in a simulation of e-cigarette use, suggesting a likelihood of passive exposure in an indoor air environment.

For these reasons, I have always, and will continue to support the previously existing UCSF policy that does not allow for use on campus.

This is, however, entirely separate from not allowing a person to leave UCSF to use these products, a policy that I believe is far too paternalistic and not at all based in evidence for the increased protection of other people back on campus.

Critique No. 2: The new policy creates the greatest good for the greatest number of people.

Public health decisions should not be based solely on creating the greatest good for the greatest number. While an attractive policy driver on the face of things, this principle breaks down in that it allows for mistreatment of minorities for the benefit of the majority. Instead, policies need to balance the greater good with the protection of the vulnerable.

Critique No. 3: The new policy may be a response to complaints from neighboring residents or businesses.

If smoking is not allowed on UCSF campus, personnel who smoke may walk just to the edge of campus and smoke there, often leaving a mess for the neighbors. UCSF should have a responsibility to its community, and it is important for the institution to encourage or even incentivize cleanliness. However, I believe it is beyond the scope of UCSF’s authority to dictate what someone can do when he or she is away from campus.

Critique No. 4: The ban sets an example for our patients and community about our dedication to tobacco-use cessation.

It’s true that UCSF, as a top institution in health care and research, should try to set an example for successful cessation techniques, but we also need to recognize that behavioral change is a process, often requiring multiple attempts, using multiple methods.

UCSF can be a leader in providing support and resources for its personnel, measuring and reporting usage patterns accurately and the relative success of institution-based methods that help people with change.

In doing so, acknowledging and addressing the multitude of biological, social and behavioral factors that contribute to the difficulties of a person quitting tobacco use, and creating an environment that does not ostracize those struggling to quit, will move us toward the greatest good without sacrificing the vulnerable.

I have a personal connection to cigarette smoking. Although never a smoker myself, I grew up with a father who smoked until he had a heart attack in 2004.

Luckily, he made a good recovery, and had several years of abstinence before cigarettes slowly and (he thought) secretly made their way back into his routine. In the time since I wrote the first article, my father has had another minor heart attack, and I am writing this response from his hospital room. Again, we are lucky that he is doing well.

I want all environments he is in (including his workplace) to give him support in the process of trying to quit smoking, but the mental picture of him being scolded like a child in the principal’s office for breaking the rules doesn’t make his struggle seem any better.

Akshay Govind