The Shame of Cigarette Smoking in the Healthcare System
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On a recent Thursday morning, while some hospital employees smoked cigarettes in Brigham and Women’s safe haven known as the "butt-hut," others crowded the lobby on Frances Street in Boston to check out the American Cancer Society's “The Great American Smoke-Out” event.
Two women sat behind a folding table handing out informational pamphlets on smoking hazards and ways to kick the fatal habit. Several of the women and men who approached the table for information or signed up to get their lung capacity tested were wearing scrubs, a sign that cigarette smoking is still prevalent among health care employees.
“Hospitals, including Dana Farber, are starting to now reimburse employees who enroll in a quit-smoking program. In some cases, they get back almost $ 500 for counseling, patches, and nicotine gum,” said Jennifer Kelly, who runs the smoking cessation program at Brigham and Women’s.
The smoking cessation program is offered to both employees and the public, and provides individual and group counseling, which meets one day a week for eight weeks. Kelly explained that each hour- long session costs $10, however the fee is waived for those with free healthcare benefits or Medicare and all participants of the program receive discounts on nicotine patches and chewing gum. With several Boston area programs designed to rid the habit of the 20% of Massachusetts residence, who smoke and with hospitals practically paying their employees to quit smoking than why are 47 million adults in the U.S. still smoking cigarettes?
Nicotine is one of the most addictive substances today; studies have shown that nicotine is as addictive to people as heroin, cocaine and alcohol. According to a study conducted by the American Cancer Society, in the U.S today, nicotine is the most common form of drug addiction among adults, high school students and middle-school students. While studies preformed by the Center for Disease Control and Prevention have shown that cigarette smoking has declined 40% among adults ages 18 and over, between the years of 1965 and 1999 still today, nearly 26% of men and 22% of women smoke cigarettes.
Dr. Laura Fredenburgh, a soft spoken and attractive woman in a white coat with her name and title embroidered on the pocket, sat at a long table on Thursday morning. She carefully explained to people the results of their free lung capacity tests that were given during the “Smoke-Out.
“Lung cancer is the leading form of death among women. I see more and more younger people being diagnosed with lung cancer,” said Fredenburgh, who works at Brigham and Women’s Hospital.
While hospital employees try to keep their habit from others who frown upon it, there is a refuge at the hospital for doctors and nurses to smoke in “peace.”
“ It’s the ‘butt-hut’ on the roof. You can smoke up there in your scrubs and no one says anything. I see patients up there too, in their robes, sometimes even cancer patients. It’s hard to quit, and these people need somewhere to smoke and not be yelled at,” said a nurses’ assistant at the Brigham, who asked that her name not be used in the story.
Denial is a common theme among healthcare employees who smoke. Many claim that they try not to think about the long -term affects and although they see patients suffering from the affects of cigarette smoke, they don’t apply the consequences to themselves.
“When you take care of other people for a living and you are always the healthy one taking care of the sick, that role sticks in your head. Some nurses may think that because they are working for a hospital it means that they will never be in a hospital bed. Its not true though, it’s a complete misconception,” said Sandy Nelson, 60, a hospice nurse of Brighton.
Misconceptions are a basis in the knowledge of cigarette smoking. A majority of people answered “lung cancer” when asked what they thought happens from the long- term affects of cigarettes; however, several other cancers and illnesses are also caused by smoking. Tobacco smoke contains 43 substances that cause cancer and cigarette smoke is the major cause of cancers of the mouth, pharynx, larynx, esophagus, kidney, bladder, pancreas and uterine cervix. Sadly, American Cancer Society studies have shown that smoking shortens a person’s life by nearly 13 to 14 years in comparison with the life span of someone who has never smoked. Another major affect of cigarette smoking is on pregnant women who smoke and illnesses and death caused to their infants.
Katie* is a nurse at a major Boston hospital. She is five months pregnant and while she is attempting to give up her habit during her pregnancy, she has been unable to completely stop and still smokes between two and three cigarettes a day. Katie’s chief
attempt to quit smoking was to stop buying cigarettes all together. However, she works with several other nurses who smoke and therefore “bums” cigarettes from them throughout her work day.
“My pregnancy was a surprise and I’m not making excuses, but all of the sudden it was like I needed to immediately quit without any game plan. It’s so damn hard and I feel guilty every time I smoke a butt. I mean look at me, I’m pregnant and a nurse, something isn’t right here. It’s done though, I’m not going to smoke anymore,” said Katie, holding back tears.
Katie is seriously endangering her baby by continuing to smoke. According to the Massachusetts Tobacco Control Program, women who smoke during their pregnancy are more likely to have miscarriages and others have good chances of giving birth to premature babies or stillborns. Smoking after the baby is born is harmful as well due to the fact that nicotine is passed through breast milk. Women who smoke just after they give birth are advised not to breast feed their child.
In 1966, the US Surgeon General ordered that all cigarettes packs contain a message warning people of the harmful affects of smoking and in 1987 all smokeless tobacco products were required to carry these messages as well. In 1971 Congress banned smoking advertisements, where cigarette smoking was made to look glamorous and cool from all TV and radio. In the early ‘90s, there was an influx of federal funded programs that were instituted nationwide to educate youth on the fatal affects of cigarette smoking.
According to Abigail Ortiz, a health educator at Southern Jamaica Plain Health Center, now that cigarette smoking has decreased among young people, many programs have lost money from the government to continue educating.
“Where has all the money gone? It’s so typical of the government, once they see results then that is good enough, but it is not good enough. This country needs to take preventative measures to cause people to stop smoking. We’ve lost money in order to run our quit-smoking programs for adults too. Cigarette smoking is an epidemic and it needs to be focused on,” said Ortiz.
Ortiz formulates a curriculum for those who come to her for counseling when they want to quit their smoking habits. While she counsels people individually, she finds that a group setting is more beneficial.
“Group counseling works better in all cases of addiction, because it uses the power of that old saying ‘misery loves company’” said Ortiz.
Ortiz, who wears pig-tail braids and jean skirts, isn’t afraid to admit she was a smoker for 10 years and is passionate about her cause. Her honesty, forthrightness, and bubbly nature make her easy to talk to, she is just as you might imagine a good counselor to be.
" It’s just as hard for a healthcare worker to quit smoking as it is for someone who doesn’t work in a hospital. It’s easy to talk about change, but it’s a lot harder to do it. No one person is more strong willed than another and there is a stigma of shame in healthcare employees who smoke so it may be harder for them to get help,” said Ortiz.
“I know I work with people who smoke and they hide it. I wish they wouldn’t, I wish they would come talk to me, but they won’t,” Ortiz added.
Ortiz talks about the extreme addictiveness of nicotine and compares it to heroin.
“ I think it’s [cigarette smoke] unbelievably addictive but it’s still socially legal, its not heroin which in fact, you can be addicted to your whole life and still die of natural causes. Cigarette smoke which can cause ten kinds of cancers is still very accepted,” said Ortiz.
Ortiz realizes her plight for the ban of cigarettes is small and she knows that not everyone she counsels, successfully quits cigarettes, yet she hopes that her work brings awareness to people. Ortiz, who not only counsels adults on quitting smoking but also teaches sexual awareness to teens, handed out pamphlets at the “Great American Smoke-Out” and encouraged everyone who came by the table to get their lung capacity tested.
The lung capacity test is a quick procedure, which monitors the pattern of one’s breathing over a period of six seconds. The person’s age, height, weight and number of cigarettes smoked per day are recorded in order to compare the data to an average of people with the same statistics. The technician performing the procedure, Mark Anderson, claimed that not very many hospital employees took part in the procedure.
“It a little harder to come to terms with being a smoker when you work in this environment and are around sick people all the time. Those who do smoke are secretive about it,” said Anderson.