Opinion: University Smoking Bans are Justified by the Overwhelming Evidence of its Adverse Health Effects

by

October 1, 2017

North American culture has had a long history of promoting smoking and it was widespread in the film industry, advertisements, and in many communities. However, as a society we have diverted away from this position after extensive research on the negative effects of smoking.

McMaster University in Hamilton is taking an even stronger approach — banning smoking on campus property effective January 1, 2018. McMaster will ban the use of tobacco and all smoking products on all McMaster campus buildings including those in Waterloo, Niagara, and Burlington. In addition, smoking will not be permitted in vehicles parked on campus or in private campus residences.

This move, supported by various Hamilton organizations (Hamilton Health Sciences, Hamilton Public Health Services, McMaster Students Union, and McMaster Graduate Students Association) reflects McMaster’s signing of the Okanagan Charter, which focuses on making health and well-being a priority in all activities at educational institutions.

The objective is not to discriminate against smokers, per say, but to create a healthier environment for faculty, staff, and students. In addition, McMaster University has increased the availability and accessibility of cessation programs starting September 1, 2017. These programs are freely accessible to members of the McMaster community.

“We understand too that you can’t just say no smoking, you have to support people in dealing with that new situation and we are putting a number of measures in place that would help members of our community conform in a gradual way to the new order on smoking here,” said Patrick Deane, president of McMaster University, in a video statement.

The University of Toronto has similar plans to ban smoking on all campus property but has not yet released a finalized plan of action. In this context, the University needs to consider how a ban on smoking would affect privately owned campus buildings, public roadways that go through the campus, and the challenges associated with enforcing a ban in a metropolitan area of downtown Toronto.

The banning of smoking on McMaster University campus property comes with many concerns and considerations.

  1. Religious and Cultural Reasons – McMaster University allows smoking on campus for certain religions and cultures on a case-by-case basis.
  2. Disciplinary Action – In the first months, the objective is not to use disciplinary action, but to support students, faculty, and staff and direct them to resources on campus.
  3. Vehicles and Private Residences – These qualify under the new rules at McMaster University despite being private property. Smokers will have to drive off of campus property in order to smoke.
  4. Increase in Smoking in the Surrounding Areas – McMaster University intends to closely observe the levels of smoking in the surrounding residential area.
  5. Accessibility of Cessation Programs – McMaster University is making their cessation programs and resources freely accessible and available to all community members.

One of the overarching concerns arising from the issue of banning smoking on McMaster University property is the freedom to choose.

On one hand, for the smokers, the freedom to choose represents what they smoke, when they smoke, and where they smoke. They should be free to answer these questions themselves. On the other hand, for non-smokers, the freedom to choose means the freedom to live in clean, unadulterated air without significant physical health risks.

Some institutions have designated smoking areas whereas other institutions have not. Even if designated areas exist, there is no compulsion for smokers to remain within those boundaries because these rules are not legally binding.

I have encountered many smokers either at a bus stop, garden, or elsewhere. In such circumstances, I hold my breath for about 30 seconds, speed up my walking, and desperately reach out for air, gasping in despair. I hold my breath because I understand the deleterious effects of second-hand smoking that hundreds of studies have documented.

As a research methodologist, I have spent a significant part of my life learning about how we conduct research, how it is reported and how we interpret the findings and apply them to practice and policy. The majority of people seldom understand the meaning of causation.

Let me be clear here, making the conclusion that one factor causes the other is extremely difficult. There is no magical statistical formula that allows you to conclude causation. There are some criteria we can use to indicate causation but these are just guides and not definitive rules. If a research study hypothesizes that something causes something else, this is only a hypothesis and not an absolute assertion that should turn our world upside down as it seems to be the case in many instances where the media chooses to report on research findings.

There is an exception, however.

When we learn about causation formally, we use smoking as the best example because there is no question in the scientific community that smoking causes deleterious effects. A recent review of papers, for example, found that smoking cigarettes can cause asthma, pulmonary fibrosis and recurrent tuberculosis in the short-term, and advanced, fatal cancer, low bone health and eye disease in the long-term not only for smokers themselves but also for second-hand smokers. Another report reviewed the evidence from 1964 that showed that second-hand smoking causes lung cancer and other adverse outcomes. The Surgeon General in the United States has a long and extensive report on the health consequences associated with involuntary exposure to smoking.

The evidence linking smoking to adverse health outcomes is unequivocal.

The effects of smoking tend to be compounded, long-term and based on exposure. The higher the exposure, the higher the likelihood of cancer, heart disease, lung disease, etc. If someone is exposed to smoke regularly, their risk for cancer and disease increases significantly regardless of whether or not they smoke themselves. In this situation, for non-smokers, the right to live in clean, risk-free air is violated because of smokers’ rights to smoke whatever, whenever and wherever they want.

The issue, I think, is not about the right to smoke, but the right to smoke freely and the right to live in a clean environment without significant health risks. Both of these may be negotiated with inclusive policies that govern behaviour and protect the health of those who have never smoked in their lives.

Though McMaster University’s stance may seem aggressive to some and revolutionary to others, they hold a unique position as being a world leader in health and clinical research. Allowing health risks on campus property is discordant with McMaster’s values and beliefs.

Yes, there are definitely hundreds and thousands of other exposures that may cause significant health risks such as alcohol, processed foods, and binge-watching TV. But the majority of these factors do not have the level of evidence to support its link to adverse outcomes more than smoking does. Research is still growing in these areas, and when the findings become unequivocal, as it did for smoking, then practice and policy should change to support the health of all community members.