JHMI’s ‘No Smoking’ Policy

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JHMI’s ‘No Smoking’ policy allows employees and visitors who wish to smoke to do so in designated outside areas exterior to Johns Hopkins Medical Institutes (JHMI) buildings and on public sidewalks on the perimeter of Johns Hopkins buildings, unless prohibited by signage. Patients, employees and visitors at JHMI are frequently smoking in designated smoking and smoke-free areas around the hospital.

The U.S. Surgeon General Report has concluded that there is no risk-free level of exposure to Second Hand Smoke (SHS). Non-smokers, students, small children and sick patients at JHMI are exposed to SHS on a daily basis while waiting or passing through designated outdoor smoking and smoke-free areas. JHMI’s no smoking policy contradicts the mission of the JHMI.

Although the indoor smoking ban made smoking more inconvenient, at least 25% of smokers report smoking while in the hospital with 82-90% of outdoor smoking clustered within 10 meters of building entrances, exposing others to SHS and creating problems with litter, fire risk, and negative role modeling in highly trafficked and visible areas. A study measured air pollution levels at places where people were smoking outdoors found that the level of exposure to SHS outdoors within a few feet of a smoker was comparable to SHS levels measured inside a home or tavern.

Smoke-free hospital grounds are required in Hong Kong, Philippines, by England’s National Health Service and many US hospitals. Hospital officials implemented campus wide smoke free policy reported getting more support from employees, patients, hospital boards, and doctors than expected.
The partial smoking ban in JHMI’s current ‘No Smoking’ policy is not as protective as desired. I would agree for a comprehensive smoke-free policy, banning outdoor smoking, to ensure smoke-free JHMI campus that will be consistent with the mission of JHMI.

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18 Responses to “JHMI’s ‘No Smoking’ Policy”

  1. marbee Says:

    The 2006 surgeon general’s report was based on a 1993 EPA report that was ruled null and void by Judge Oosteen in federal court due to it’s fraudulence! The U.S. Surgeon General managed to avoid testifying under oath to a congressional committee along with the commissioner from the FDA. The surgeon generals report is then also fraudulent. The surgeon general did not have to testify under oath to the validity of his claim. If you tell a lie enough, people will eventually fall for it. If you are so afraid of whiffs of cigarette smoke, you better start banning firefighters to protect them from their jobs!UCLA School of Public Health’s James Enstrom fired from that school because he adheres to academic integrity and the powers that be don’t want him publishing his findings that are contrary to this agenda and PROVE that this is all nonsense! The World Health Organization’s study showing that SHS may even have a protective effect and not the least harmful was withheld because it didn’t promote total control of the population. Need proof? http://web.archive.org/web/20021128202555/http:/www.telegraph.co.uk/htmlContent.jhtml?html=/archive/1998/03/08/wtob08.html
    It is increasingly clear to us that ETS is a political ploy, not scientific.
    In 1998 the American Cancer Society finally retracted their 53,000 statistic, stating in a press release: “The American Cancer Society will no longer use the statistic because we too have been unable to acquire the documentation to support this citation.” In other words, it was a lie.
    Wonder why the figure is still being used? They simply can’t stop lying. Close to 90% of the weight of tobacco smoke is composed of oxygen, nitrogen, carbon dioxide, and plain water (1989 Report of the Surgeon General p. 80). This mix is usually called “fresh air.”
    I may have to bring this subject up of smoker persecution with my
    son when I teach him about the many uses for tar and feathers.

    • bhavmod Says:

      Dear Marbee,
      Second Hand Smoke has been established as a human carcinogen by the U.S. Environmental Protection Agency, National Toxicology Program and the International Agency for Research on Cancer (IARC) and as an occupational carcinogen by the National Institute for Occupational Safety and Health.
      Some carcinogens in secondhand smoke:
      .. Polycyclic aromatic hydrocarbons (PAHs) (e.g. Benzo[a]pyrene)
      .. N-Nitrosamines (e.g. tobacco-specific nitrosamines)
      .. Aromatic amines (e.g. 4-aminobiphenyl)
      .. Formaldehyde
      .. Inorganic compounds (arsenic, beryllium, cadmium, lead, nickel
      and radioactive polonium-210).
      There is causality associated and cofirmation reached about lung cancer, Coronary Health Disease, and other Reproductive effects of Second Hand smoke scientifically (Oberg et al. Lancet 2011;377:139-146).
      The link you have posted seems like unscientific write up without any evidence.

      Best,

  2. History Buff Says:

    Tobacco is in the same food group as potato,tomato, cauliflower, egg plant, chili’s, green pepper and other foods. They ALL contain nicotine. As the pharmaceutical industry (that funds with grants state and other smoking) finds their own substitutes, expect the newest marketing scams. … Watch your vitamins a they are after those too.

  3. Kemi Fawole Says:

    I agree the partial smoking ban in JHMI’s current ‘No Smoking’ policy is not as protective as desired especially for non-smokers. There is no doubt smoking is a choice, however an individual’s freedom must be weighed against the health of the public. Several scientific evidence points to the fact that Secondhand smoke contains thousands of toxic chemicals which includes benzene, carbon monoxide, chromium, cyanide, formaldehyde, lead, nickel and polonium. These dangerous particles in secondhand smoke can linger in the air for hours. Secondhand smoke contributes to various health problems, from cardiovascular disease to cancer. Advocacy is very important to make sure people understand what is in secondhand smoke, and consider ways to get protected. And the JHMI/JHSPH should be at the frontline of this advocacy doing much more than they are presently doing.
    http://www.mayoclinic.com/health/secondhand-smoke/CC00023
    http://www.ncbi.nlm.nih.gov/pubmed/21730825
    http://www.ncbi.nlm.nih.gov/pubmed/21742575

  4. ylicoyote10 Says:

    Public health protection versus individual rights – this is a common theme in many of the issues that we deal with in public health. As a resident physician working in hospitals that have a very similar situation as the one described at JHMI, am also a full supporter of a complete ban of smoking in or around medical facilities. In our society, it is very difficult to argue against the freedom of an adult to make choices – smoking included. But what often goes less mentioned it seems, is the freedom of a non-smoker to choose not to be exposed to second hand smoke. By allowing a smoker to smoke outside the main doors of a hospital in ‘designated’ smoking areas, you have ALSO made a decision for every non-smoker that passes through this area. You made the decision and forced the non-smokers to be exposed to a known toxic chemical, a known carcinogen. Every time I walk through the doors of the hospital I work at to get to work, I have to hold my breathe to prevent myself from coughing at the smell of smoke. I have my rights too. As an employee I should have the right to a safe work environment. What about these rights? What about the rights of every non-smoking child that goes into a hospital? What about our society’s unifying principle of protecting our children? Proponents of a complete ban on smoking in these hospital grounds have got to stop focusing on the numbers and the science behind how bad smoking is. We already know that. We need to start battling proponents for individual rights with our very own individual rights argument. Only through these arguments are we arguing on an even playing field. The numbers and science just don’t have the same effect anymore.

  5. Sheila Says:

    Send me money! I’ll tell whatever lies you want about second hand smoke if it gets me some of those lucrative grants! And I’ll do it with a straight face!

    You know how you tell when people are lying about smoking? When thay are not advocating to ban the selling of tobacco products!

    Second hand smoke was invented by the company that sells all the patches and gums. See Johnson and Johnson and Robert Wood JOhnson Foundation, and who they are funding to lobby for this.

  6. mfmonn Says:

    It amazes me the double standards that we set and how easy it is to compromise, thereby preventing true success at reaching public health aims. With all the research done at Hopkins, Hopkins should certainly be among the leaders in banning smoking on hospital grounds.

    Another “double standard” that we often set is the presence of fast food restaurants in hospitals, especially children’s hospitals. A study found that 59 of 200 hospitals with pediatric residencies had a fast food restaurant within (http://pediatrics.aappublications.org/content/118/6/2290 ). With the sheer number of hospital admissions related to childhood obesity, one would hope that hospitals would take a stand and decrease availability of fast food on their premises ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377242/ While the study was performed in Ireland, it certainly applies here as well).

    Hospitals should take a much stronger stand on promoting the health of their patients, whether through tobacco or food regulations.

  7. Oscar Minoso y de Cal Says:

    The difference to me between tobacco smoking and the consumption of virtually any other product is the possibility of “passive” consumption. You are forced to consume/inhale the noxious fumes of a smoker each time you are exposed to smoking. This is unlike the case of a Whopper. If someone eats it I am not forced to eat it also. In the case of designating areas of the street for smoking the problem continues. Anyone passing that area is obligated to either hold their breath or inhale the smoke. In part, this is the special nature of tobacco use. The smoker’s right to smoke ends where a non-smoker’s nose begins. If Hopkins wants to designate a room for smokers to “do their thing” then that obviates the problem of passive smoking. I believe that the non-smoker’s right to breath trumps the smoker’s right to smoke. How do you accommodate both sides? Practically, there is only one thing I can think of to accomplish this–ALL common/public areas should be non-smoking unless and until the time comes when there is a way tro keep the smoke in the smoker’s personal space or from entering the non-smoker’s personal space.

    • mfmonn Says:

      I absolutely agree that there is a significant difference. My response was more a point that hospitals have many other ways to impact public health outside of smoking policies, which seems to be the policy most often focused upon. I would make the argument, however, that when fast food is the only option, or the only affordable one, it becomes less an issue of choice for people who have family in that hospital.

  8. Oscar Minoso y de Cal Says:

    If I eat or not affects me alone. If someone smokes it affects the smoker as well as the non-smoker. The smokers “problem” is now mine. There is no commonality between the “fast food restaurant” in the hospital and the smoker in and outside of the hospital.

  9. amilam3 Says:

    It is troubling that staff and patients are able to smoke on hospital grounds. Sick patients, students, and visitors have to pass through clouds of smoke to enter the hospital. Last year the Baltimore City Council submitted a bill to make all hospitals grounds smoke-free but the bill failed to get enough votes.

  10. mateo8480 Says:

    I have worked at two research Universities with a strong medical school/hospital and both have implemented smoke-free policies. At Duke University which is a urban campus smokers were required to go off campus to smoke, usually across the street from the campus. However, it was sad when I would drive by and I would see patents smoking hooked up to a portable IV drip. I also worked at Vanderbilt University which like Johns Hopkins is a city campus in which smokers would still be seen smoking even in the smoke-free zones. Vanderbilt even tried to have “smoke police” where people would get citations for smoking, however in the end this was not that effective. Establishing smoke-free zones for city campus poses a problem compared to urban campuses since the area population walks through the campus which may or may not be part of the campus or hospital population. In order to really have an effective smoke-free policy, it needs to be enforceable with consequences for not following these policies. How this is done remains a significant issue.

  11. mjberley Says:

    I have spent the majority of my life living in the southeast which has never been known for its progressive healthcare rules and regs, however every healthcare facility, health department, or medical school I have been associated with in this region has a smoking ban on the campus. So you can imagine my shock when I walked out the door of the number one public health school in the nation to be greeted by a huge puff of smoke. In fact during orientation it was an ongoing joke how the walk from one building to another was taking years off of our life due to the massive amount of smoking. It’s fascinating to me that facilities such as Cleveland Clinic have begun hiring based on smoking status, yet Hopkins allows it to go on right outside of the doors. I would be very interested to know their reasoning behind this lack luster policy.

  12. catherineallen11 Says:

    The decision of the smoker to buy a pack of cigarette and smoke away did not require any special consultation. However, he should realise that he spent his hard earned money in making this purchase hence he should not share any part of it with the people around him.

  13. riwunze Says:

    LOL. Those blue lines on the side walks of JH are a joke. Where does it start, where does it end, is it even enforceable, is it being enforced? I have never seen it enforced.

    The most amusing thing I saw one day was a patient that walked out of the JHH ER to the sidewalk within the blue line, connected to an IV pole and portable oxygen, a cheetos like snack balanced on the oxygen tank, and him holding a cigarette. It was all so wrong. He was wrong, I was wrong for not saying anything because what he was about to do was dangerous (oxygen tank and cigarette).

    If the area around JHMI and/or sidewalks are considered private property then the no smoking policy should be enforceable with security taking action by giving warnings, telling smokers where it is not okay to smoke, and possible citations by police or some other authority.

    I don’t want to inhale anybody’s cigarette smoke but unfortunately tobacco and smoking tobacco is legal. How do the carcinogens in outdoor second hand smoke compare (type, concentration, dose, dose response and effect, etc) to the carcinogens in the air in busy high traffic area like JHMI in Baltimore city? This is a potentially important question, however, for me it does not matter. I know that cigarette smoke is full of unhealthy combustion products, inorganic metals and compounds, benzene and many other chemicals that are not good for my health and my future offspring. In my short career I have taken care of enough cancer and COPD patients to know that I do not want to share your cigarette smoke.

    Precautionary principle.

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