THE FACT that cigarette smoking is widespread in hospitals is a paradox. Smoking, voluntary and involuntary, is a major risk factor associated with respiratory and cardiovascular disease, a growing list of malignancies, adverse outcomes of pregnancy, and impaired healing of peptic ulcers. This has been documented in the past two decades by several US Surgeon General's reports, and some 30,000 articles.1 As quoted in a recent editorial in The Journal,2 the 350,000 premature deaths per year attributable to smoking in the United States exceeds the number of American lives lost in all the wars this country has fought in the 20th century. Medical care expenditures and productivity loss cost Americans at least $49 billion a year.3 Worldwide, the annual toll of over 1 million tobacco-related early deaths is expected to rise as a result of aggressive cigarette promotion in the Third World.4 Briefly stated, the tremendous
H AM. Reducing Smoking in Hospitals: A Time for Action. JAMA. 1985;253(20):2999–3000. doi:10.1001/jama.1985.03350440077036
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