At the main entrance of the New Orleans Veterans Affairs Medical Center, a large white easel with the words “No Smoking” sits about 50 feet from a long line of benches where several veterans are perched with cigarettes.
Starting October 1, those veterans will be asked to move completely off campus to smoke. A nationwide smoking ban will be implemented at all veteran’s affairs facilities, including the Southeast Louisiana Veterans Health Care System, which includes eight clinics serving 23 parishes. Smoking has not been permitted at the new VA in New Orleans since it opened in 2016, but tighter regulations mean veterans waiting to be picked up will have to take their cigarettes elsewhere.
Will Whitcomb, 55, is one of those veterans. Waiting for a cab on Monday, his raised his eyebrows at the news that smoking wouldn’t be allowed on the benches. After serving in the military for 11 years and touring in Iraq, he said that he wishes he could quit, but smoking offers a reprieve.
“It’s kind of a crutch,” said Whitcomb, who suffers from post-traumatic stress disorder. "It keeps my mind occupied."
The ban represents a culture shift in the VA system, which has allowed for "smoking shelters" where patients could light up inside many hospitals.
“I remember when I started in the VA and they used to sell cigarettes in the retail store,” said Fernando Rivera, the director of Southeast Louisiana Veterans Health Care System, who started working at the VA in the 1980s.
Rivera said the ban is not so much about policing and penalizing veterans and VA employees, but rather changing behavior and culture over time.
“When we stopped selling cigarettes a long time ago there was a tremendous outcry,” he recalled. “Now, there would be an outcry if we sold them.”
According to Sonia Duffy, a professor at Ohio State University's College of Nursing and researcher at the Department of Veterans Affairs Ann Arbor Healthcare System, smoking bans do work.
“It’s a good thing,” she said. “I think veterans will benefit. Every time you institute another layer of a smoking ban, you do see more people quitting.”
While the New Orleans hospital may have an easier time enforcing the ban because the new building has never had the climate-controlled smoking shacks, veterans do smoke directly outside the building and in their cars on the campus. A few have used e-cigarettes in the building.
“We’ll have people who hide cigarettes, who are nervous about coming to the hospital,” said Rivera. “It will require constant vigilance, reporting and educating. But our [ban] will be more of a reminder.”
A history of tobacco promotion
Cigarettes were included with military rations until 1975.
“We used to have a butt can in the barracks,” said Stephen Rizzo, a Vietnam veteran who was drafted in 1967. “There was no such thing as a no-smoking area,” said the 71-year-old as he took a drag from a cigarette outside the VA hospital on Monday.
Rizzo didn’t know about the impending ban. “It’s a good idea,” he said. “That’s their privilege to [enforce] that. But I saw a whole lot of cigarette butts on the ground here, so I thought it was OK,” he said, pointing to a patch of grass outside the VA entrance.
Veterans have a higher incidence of smoking than the general population. Compared to those who have never served in the military, veterans smoke at double the rate—29% compared to 14%, according to the Centers for Disease Control and Prevention.
Smoking has profound effects on health. Over 80% of lung cancer patients are current or former smokers. Lung cancer is the leading cause of cancer deaths in the U.S.
“Smoking just affects you systemically,” said Duffy. “It can give you more hip fractures; it can give you bladder cancer.”
But for people like Rizzo and Whitcomb, the ban highlights the need for a smoking alternative for veterans accustomed to the habit.
Whitcomb, who was also a fireman for 15 years, thinks the ban is the right thing to do. But he and other veterans point to a long history of smoking culture within the military as a roadblock for many patients who are accustomed to being able to walk outside to seek the relief of a cigarette.
Rizzo was a trucker after serving in the military. He would go through two or three packs a day to keep calm. “It’s nerve-wracking driving down the street pulling a forty-foot trailer,” he said. “I can’t do without it.”
The VA offers free smoking cessation programs to veterans and employees, but both Rizzo and Whitcomb said nicotine patches were not a substitute that worked for them. Whitcomb tried an e-cigarette a few months ago, but it didn’t stick.
To change behavior, Rivera said the VA plans on pushing education more than penalizing.
“You can catch more flies with honey,” he said. “My mother smoked three packs per day. I know how difficult it is to change that behavior. But it was the best thing to do for patients and staff.”
The ban covers the grounds, parking lots and visiting cars. It extends to cigars, pipes and e-cigarettes and other vaping devices.
This article originally appeared at the Nola.com website