What's the problem?
I’m sympathetic to smokers. Honestly. I was one myself after all. In some ways I miss smoking. I quit not because of health concerns - I can be hopeless at looking after myself - but because the spiralling cost of cigarettes was eating too large a hole in my wallet.
Looking back though, it’s clear the evidence was in even then. Who doesn’t know that smoking is bad for your health? And if you are person living with HIV, it’s doubly so. Research suggests that it's the biggest predictor of early death for people living with HIV, knocking no less than seven years off an average life span. . Then there is the made-in-Ontario research which points to the prospect of increased hospitalization and reduced quality of life poz smokers can expect.
It’s hard too not to notice that smoking is an increasingly frowned upon (think stigmatized) habit. Who needs extra stigma?
Nevertheless smoking rates in people living with HIV, while on the way down, are approximately twice the national average. There are many, and complex, reasons for why that is, but that’s the reality.
Time to give those who want to quit a helping hand? The Positive Quitting Project, which I’ve talked about here before (led by the Ontario HIV Treatment Network, PositiveLite.com and a consortium of community representatives and smoking cessation specialists), thinks so.
The project is focussed on people living with HIV who smoke cigarettes. But what about the people who serve and support them, those with whom they interact in AIDS Service Organizations (ASOs) who themselves may be smokers? That piece raises tricky issues like:
- Does existing legislation which governs smoking in the workplace protect ASO staff and clients enough?
- Should the role of ASO staffers be to model behaviors that are not harmful to the health and wellbeing of their clients? (Or alternatively, is their merit in staffers being seen to be struggling with the same issues that clients themselves are facing?)
- Should ASO staffers be allowed to smoke at all during work hours?
- What about smoking right outside the workplace, or at agency functions?
- If an ASO worker visits a client’s home to provide support services, should the staffer be protected from the impact of second hand smoke by only accessing smoke free environments?
- Should we be looking at providing a smoke free environment right outside ASO entrances and exits?
- What policies need to be put in place at the ASO to protect the interests of staffers and clients alike?
The law says what?
What’s covered by existing legislation? Right now in Ontario smoking in the workspace – any workplace - is strictly prohibited. The Smoke-Free Ontario Act came into force in May 2006. The Act prohibits smoking in enclosed workplaces and enclosed public places in Ontario in order to protect workers and the public from the hazards of second-hand smoke.
Looking further in to what is the law, the provincial legislative requirement regarding smoking outside healthcare buildings is also addressed in the act. For example, the act prohibits smoking outdoors within nine metres of entrances and exits of health care facilities. The Act establishes a minimum standard that applies across the province. The legislation also provides sufficient flexibility for municipalities to adopt local bylaws that go beyond its requirements.
The reach of such legislation is expanding. In January of this year Ontario added other areas where smoking is not allowed - on and around children’s playgrounds and publicly owned sport fields and surfaces (e.g., areas for basketball, baseball, soccer or beach volleyball, ice rinks, tennis courts, splash pads and swimming pools that are owned by a municipality, the province or a postsecondary education institution).
More locally, Toronto bylaws additionally cover municipal buildings (e.g. City Hall, civic centres, recreation and community centres, libraries, arenas and administrative offices), shopping malls, stores, offices and institutional buildings, multi-residential buildings (e.g., condos and apartments) restaurants, bars, cafes and outdoor patios
Notice the embargo on smoking within the vicinity of healthcare facilities contained in the Ontario legislation. One could ask why similar concerns might not apply to the health of those entering and exiting ASO premises. Yet to date, as far as I’m aware, none has taken the step of imposing a nine metre smoke free zone outside an agency entrance.
Smokers tend to congregate. It’s a social thing. Even as a smoker I worried about the message sent by a gaggle of smokers like myself outside an ASO or HIV conference doors. True, those huddled groups were great for networking; I still miss that opportunity to chat and share stories during breaks. But now, and while the numbers indulging seems less, the sight gives pause for thought
Some ASOs are starting to look at their own policies, to see to what extent staff smoking is at all in conflict with their core values of promoting the health and wellness of staff and clients alike; second hand smoke is a bothersome issue, after all.
One such Ontario example is Positive Living Niagara that has recently adopted a set of policies governing staff smoking. An extract is shown below. (A second set of policies covers client smoking issues.)
I asked the agency’s Executive Director Glen Walker what prompted the agency to draw up these policies. Explained Walker “These policy documents came out of presentations at the (Ontario) Gay Men’s Sexual Health Alliance Summit session on smoking and the realization that as an organization we were supporting a dangerous and unhealthy practice that was jeopardizing the health of the people we support who have HIV. It was also clear that we had developed a culture within the agency which did not fit within current health and safety legislation as well. Since we operate from a harm reduction model of intervention it was important to pass on the information on the harmful effects of smoking and ensure we were keeping our employees safe in accordance with legislation. We wanted to do this while still creating a supportive environment that would allow the people we support and staff to modify their smoking habits when they saw fit.”
But what is their role in all this? Does Walker feel it’s the implied function of staff to be role models or model behaviours that promote the health and wellbeing of the agency’s clients?
Walker says this: “We believe that staff should promote good health and model health behaviours as much as possible. In particular we should not be conducting our business of promoting healthy living with our clients while we are smoking with them and effectively endangering their health while we are doing this. “
The reaction to all this? Walker says that many clients and staff have been supportive of this initiative and feel it reflects the healthy life-style the agency promotes. “A few clients believe it is their right to smoke in the presence of our staff in their homes” he says. “When we talk about our reasons for the policies, and our legal obligations, everyone has been understanding and cooperative. In fact we have been able to support one of our clients to attend a smoking cessation program at our local health clinic.”
Positive Living Niagara’s newsletter article on the topic has also sparked discussions with clients and provided information which many were not aware of, he says. “So many of us were not aware of the significant impacts smoking has on people living with HIV and this initiative has been an eye opener for many of us.”
The way of the future? Other ASOs are contemplating policies of their own and support for individuals who need help to quit. Stay tuned for news as this story develops.
Information on crafting workplace smoking policies can be found here: