Kayhan Parsi, JD, PhD
In the first-year clinical skills course at our medical school, we offer a session on tobacco cessation. In this part of our course, we emphasize to our medical students the significant costs tobacco use incurs. The costs to health are now well documented. The financial costs are substantial as well. We teach our students that they can have a positive impact upon their patients’ health by utilizing motivational interviewing techniques and applying the 5 A’s of change (ask, advise, assess, assist, arrange). The students obtain some basic skills counseling patients on smoking cessation. They understand they can play a relevant role in addressing this major public health issue. And, of course, we want our clinicians to be able to influence positive health changes in their patients. But, the reality is that certain public health measures can play an even bigger role in reducing tobacco use.
Take for example the ban on indoor smoking that took place here in the state of Illinois in January of 2008. Before this legislation was passed, it faced vociferous opposition from certain trade groups, particularly the restaurant and casino lobby. The fear was that this kind of legislation would drive smoking patrons away and harm the economic interests of such entities. Smoke Free Illinois has had a dramatic impact, virtually eliminating indoor smoking in this state, and having a positive impact upon the effects of second hand smoke. Indeed, this policy is an example of withdrawing an activity that was once perfectly legal. It’s a more subtle form of withdrawing than what Schmidt is arguing for in this issue of AJOB.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.