Nursing, Our Public Deaths, and the Tobacco Industry

What made this particular set of events so shocking, I think, was so much death and suffering all at once in one place, a circumstance that created widespread public anguish and generated policy changes aimed at prevention, preparations for comprehensive responses on many levels, and unprecedented political unanimity. Such situations suddenly disrupt our ability to cope with the sheer, irrevocable power of death to stop us—every one of us—in our tracks. If we could watch all this from afar, as one watches ants when their numbers are decimated suddenly by the swipe of a sponge or a heavy footfall across their trail, we might better understand an enduring mystery: why our society’s response to death—and to its proximate causes—is so different when it is slow and widely distributed rather than fast and localized. Every week, 52 weeks a year, some 8000 people in this country die from tobacco-related diseases, their lives ended prematurely by an aggressive tobacco industry and the addictive properties of nicotine. They, too, have done nothing to “deserve” death— nothing except to succumb, typically as adolescents or very young adults, to sophisticated marketing and promotion that falsely equate smoking with adult privilege, glamour, independence, emancipation, toughness, naturalness, authenticity, social success, and other desirable attributes, in messages selectively delivered for maximum impact. The total: more than 400 000 premature deaths yearly in the United States and 3 million worldwide. Among the dead will be many nurses, providing evidence that mere knowledge—even firsthand knowledge—about tobacco’s harmful effects on health is not enough to prevent them. Although most nurses are nonsmokers and there is evidence that many nurses have quit during the past 2 decades, smoking rates among nurses (18.3% for registered nurses, 27.2% for licensed practical nurses) are still far higher than those for physicians (3.3%), and nurses’ rates of quitting are lower than physicians’ rates. 2 Some evidence indicates that smoking may be more common among nurses in critical care specialty areas and psychiatry than among nurses in women’s health, pediatric, and general practice areas. 3