Editor's choice

Smoke free journal?

Kamran Abbasi, deputy editor. 

Doctors smoking in the mess, patients puffing away in corridors, cigarette stubs discarded in waiting rooms and outpatients. Images that are immediately identified with hospital culture in the United Kingdom. Daily experiences that health workers rarely give a second thought to. But in an attempt to create a smoke free world we cannot bring you a smoke free journal.

What we should be campaigning for, at least, is smoke free hospitals, as Martin McKee and colleagues explain (p 941). This is another area where UK health care lags behind its equivalents in the United States, where over 90% of hospitals were smoke free by the mid-1990s and over 40% had exceeded national recommendations. Meanwhile, a hospital nearing completion this year in Northern Ireland is including seven smoking rooms for patients and staff at a cost of half a million pounds. There is growing evidence about the effectiveness of workplace bans in reducing smoking, including a systematic review published in the BMJ last year that found that the effect of a total workplace ban would be equal to that achievable by almost doubling the price of cigarettes. McKee and colleagues argue that money set aside for hospital smoking rooms would be better spent implementing smoking bans and expanding smoking cessation activities. But these themselves can flounder, as researchers in the Australian Smoking Cessation Consortium discovered (p 952). Funded by GlaxoSmithKline, makers of smoking cessation treatment bupropion, this consortium recently lost many of its researchers. They resigned in protest at the company's decision to take legal action to block new government controls on bupropion, which is most effective if people complete the full course of treatment and receive counselling and support. The problem is that the prevalence of smoking in Australia has not changed since the introduction of bupropion, despite 10% of smokers being prescribed the drug. One study has shown that only 20% of people prescribed bupropion complete the full course of treatment, and less than half receive counselling.

After prevention and cessation, this week's BMJ also attempts to understand influences on smoking behaviour. Judith Bush and her team explore smoking culture in British Asian communities, where smoking prevalence is high in Bangladeshi men but low in all Asian women (p 962). There are some specific influences of sex and religion, but the culture of smoking also bears strong similarities to that of white smokers, particularly among younger adults. Bush's team recommends culturally sensitive smoking cessation interventions for Asian adults, a group ignored by current national guidelines.

And for those who enjoy recreational cannabis and may have convinced themselves that cannabis is less harmful than tobacco, the current evidence, although not as robust as that for tobacco smoke, is that smoking cannabis is a comparable public health hazard (p 942).

Footnotes

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