November 20, 2017

Clearing the smoke at Kaiser Permanente

“Once you made it inconvenient, I finally took steps to quit.”

— Former smoker, employee at Kaiser Permanente, 1980s.

Medical professional at Kaiser Permanente smoking a pipe and inspecting an X-ray, circa 1960

It wasn’t that long ago that cigarettes were an accepted part of the cultural landscape. It’s well-known that tobacco companies used to promote endorsements from physicians (although none from Permanente Medical Group doctors), and smoking in hospitals was typical, Kaiser Permanente facilities included.

A 1960s brochure from the Kaiser Permanente hospital in Fontana, Calif., cautioned patients that “Bedding can burn. Be careful with cigarettes and matches.” Staff housekeepers in many offices complained that one of their most common problems was fires in waste cans, because people would dump cigarette butts that weren't completely put out. As medical evidence about tobacco’s harm piled up, however, it became clear that the smoking habit should not be part of the environment in health care facilities.

Kaiser Permanente first drove smoking out of its facilities in the 1980s. At first, the offices were smoke-free, then whole buildings. On January 1, 1987, a no-smoking policy went into effect in all Kaiser Permanente facilities throughout the Northwest Region. But people still went outside to smoke.

Anxious prospective fathers’ ashtray, “Dream Hospital” newsreel, 1953

California passed AB-13 prohibiting smoking in places of employment in 1997. On January 1, 2000, Southern California Kaiser Permanente banned smoking anywhere on campus property (including outdoor areas like parking lots, which were not included in prior local or state laws) making it the first major health care organization in the country to adopt such a sweeping policy.

There's good evidence that the harder you make it for people to smoke, the more likely they are to quit.

One example comes from a Kaiser Permanente office building in the Portland area in the mid-1980s. A designated smoking shelter had been set up outside of an office building to keep smokers out the rain. But to make a point, a large crane was brought in and removed the structure for a photo opportunity. They unbolted it and lifted it off, a clear message that a haven for smokers was really gone, and they were not going to be able to light up there any longer.

Kaiser Permanente Fontana hospital patient caution regarding smoking in hospital room, circa 1960

Grudgingly, the smokers moved out to the curbs. One employee commented, “You know, I might have still been smoking, but once you made it inconvenient, I finally took steps to quit. What am I doing walking out in the rain to do this, this is ridiculous.”

Current practices to discourage smoking, beyond signage, include features at facilities that encourage healthy activities such as walking paths and outdoor exercise stations.

Now, smoking cessation has new targets – for example, dealing with e-cigarettes and vaping – but the goal remains the same. E.W. Emanuel, MD, of Mid-Atlantic Permanente Medical Group, sums it up well in his March 2017 blog that these new vehicles for tobacco delivery are still considered harmful to adolescents' health. E-cigarettes contain nicotine and other potentially toxic chemicals, and teens who use them may be more likely to start smoking tobacco. Kaiser Permanente offers advice and programs for those wishing to break the tobacco habit.