Not too many years ago some cigarette ads featured what appeared to be "medical doctors" in their ads. Advertisements were carefully worded to suggest the product(s) were "safe" and "healthy" and the "MDs" in the ads were obviously smoking. Contrast that approach with the present medical response. The U.S. surgeon general, C. Everett Koop, has called for a "total package of motivation, education, and training efforts" to achieve a "smokeless society by 2000." Koop suggests greater than 90 percent of physicians are nonsmokers and urges physicians do more than just admonish the patients they see to quit--he wants active intervention by physicians and other health care providers to

Provide specific cessation and maintenance strategies from doctors' offices. 
Refer patients to smoking cessation programs. 
Encourage abstinence with advice and direct service. 
Clarify the reduction of risk that will occur when their patients stop smoking. 
Provide information to their patients clarifying the risks associated with smoking. 

Industrial hygienists, among others, have joined in this call for activism--the chairperson of the American Industrial Hygiene Association's occupational medicine committee said "Hygienists have the right, and obligation, to help in the fight to restrict employees' smoking on the job." It was reported that "passive smokers" (those who breathe the smoke expelled into the air by smokers) have the following problems:

Although an increased incidence of lung cancer in passive smokers has not been indisputably established, thirteen of fifteen studies indicated a positive correlation for increased risk for the spouses of smokers. 

In adults, there is universal acknowledgment of the irritation factor associated with sidestream smoke--tearing of the eyes, tickling of the throat, headaches, and other effects. 

At the workplace, workers exposed to sidestream smoke forty hours a week have effects similar to smoking several cigarettes a day. 

Nonsmokers can experience a measurable decline in lung function when exposed to others' smoke. 

Children reared in homes with smoking parents are more likely to be hospitalized with pneumonia or bronchitis in their first year of life. The lungs of infants exposed to tobacco smoke don't mature normally. 

Patients with established heart or lung problems may experience symptoms sooner in a smoke-filled atmostphere than they otherwise would. For instance, smoke will trigger pain in people who have angina pectoris (heart pain related to partially blocked blood vessels). Those who have pulmonary problems will experience shortness of breath or cough sooner.

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