Tobacco Reduction and the Three Bears:
Becoming Involved in Tobacco Reduction

By Peter Dehnel, M.D., Medical Director, Children’s Physician Network

Congratulations on your decision to consider working to reduce the harm caused by tobacco! Chances are you will never meet many of the people that you help lead healthier – and longer – lives. Be assured that every person who smokes less, is exposed to less secondhand smoke, or who you help to never start using tobacco in the first place will be healthier. There are few other interventions in medicine that will have that kind of guaranteed ef­fectiveness.

With tobacco use and secondhand smoke exposure being the first and third leading causes of prevent­able deaths, you may wonder why more physicians are not publicly engaged in tobacco reduction ef­forts. One way of answering that is by thinking of the analogy of bear wrestling. Most people simply choose not to take on that activity unless their lives are immediately threatened, and most do not see the threat imposed by tobacco as that serious. The likeli­hood of success is also perceived as small, and so why engage in the struggle in the first place. Physi­cians often feel that their energies should be reserved for being excellent at treating the consequences of tobacco use – heart disease, lung cancer, and so on.

The situation with tobacco is actually a little more challenging than just wrestling a single bear. You are not just taking on one bear, but three. By publicly taking on tobacco you will be wrestling simultane­ously with:

Baby Bear—nicotine dependency, and the fear of loss of easy access to a source of nicotine

Mama Bear—misinformation surrounding tobacco, personal rights arguments, freedom of choice issues, tobacco industry philanthropy and tax revenue considerations

Papa Bear—the tobacco industry and anyone else who is involved in raw material supply, manufactur­ing, distribution, sales and marketing of tobacco products

Those physicians who do decide to take a more pub­lic position on tobacco are likely to look on this as a long-term challenge, similar to scaling Mt. Everest, which will have at least some small victories along the way. But then again, I would consider every healthier life a victory.

Steps to Tobacco Reduction Advocacy

Tobacco reduction is a blend of tobacco cessa­tion, secondhand smoke reduction and tobacco use prevention. In order to become an effective public advocate on behalf of your patients and community, you may want to consider the following steps:

Step I: Be convinced of the harm caused by to­bacco: without this, nothing else really matters. You will not have the energy, drive and determination to sustain your efforts to even a partial completion.

Step II: Develop a working knowledge of the three aspects of tobacco reduction – tobacco cessation, secondhand smoke reduction, prevention. By limit­ing your focus to one or two of these will likely limit your overall effectiveness and will prevent you from seeing “the big picture” on behalf of your patients or community.

Step III: Become more of an effective advocate within your clinic with your current patients, col­leagues and office staff. The operative word here is effective, and not obnoxious.

Step IV: Partner locally with a group or mentor that is doing tobacco reduction work to learn more about the challenges and pitfalls that exist. It can be an invaluable experience if you have the opportunity to observe how they go about tobacco reduction advocacy work in a public setting. You may even be able to provide some feedback to them in terms of their presentation.

Step V—Begin to publicly express your views. Letters to the editor, articles for local publications, speaking to community groups and health fairs are all ways to start to establish some experience with presenting your views on tobacco. What you do will depend on your personal preferences, community opportunities and ability to commit time.

Step VI—Write or talk to local city council mem­bers, school board officials and other local gov­ernmental agencies about tobacco-related issues. See where they stand on the role of city and local government in reduction efforts. Offer to meet with them if there is a need for additional education and information.

The next two steps require more of a public pres­ence, and will be a significantly different experience for most physicians than their day to day office prac­tice. Consider some sort of public speaking training if you have not done this type of activity before. Ask for constructive feedback from someone who observed your presentation or interview.

Step VII—Give testimony in city council meeting at those times when public comment is invited on tobacco-related issues.

Step VIII:—Offer to be a media spokesperson and be willing to speak at press conference, news stories, and be available for interviews.

One of the real surprises with any of the above steps, especially STEPS V and after, is that anything can happen. To use the phrase, things will come “flying at you totally unexpectedly out of left field”. To­bacco reduction is going to actively opposed by any number of groups and not all of them are going to “play fair” or stick to the facts. Since the facts about tobacco cannot be denied, one strategy that some pro-tobacco groups will employ is discrediting the messenger. If you are aware of this going in, you will be much better prepared to deal with any misin­formation, if it should appear. Remember, you're wrestling bears, and bears abide by no rules.

 

* Resources are taken from the “Tools for Eliminating Secondhand Smoke in Your Community” Sponsored by Blue Cross and Blue Shield of Minnesota and the Minnesota Medical Association