Cities across Texas are going smoke-free, and physicians stand at the forefront of the movement. More than 20 cities have passed smoking ordinances, many since 2006. Texas Medical Association (TMA) physicians have led successful efforts to pass public smoking bans in Victoria, Abilene, Tyler, and Temple. Amarillo citizens are set to vote on a similar referendum this spring. Doctors involved in these efforts see championing the cause as a way to improve the health of their community.

"It's a health issue, it's always been a health issue, it's never been anything but a health issue," explains Leon Gilner, MD, about his involvement in the passage of Victoria's smoking ordinance in 2006. "Secondhand smoke is as fatal as firsthand smoke," adds Dr. Gilner, a neurosurgeon and a TMA physician leader. "As a neurosurgeon, I see the worst problems associated with smoking: Cancers in the spine and lung disease that prevent patients from getting even the simplest operation to help them."

Cigarette smoke carries thousands of chemicals, many of which cause cancer or are toxic when inhaled. Inhaling tobacco smoke causes short-term acute effects, like asthma attacks in children. It also causes long-term chronic diseases like lung cancer - the No. 1 killer in men and women.

Seeking to limit people's exposure to those dangers, the Victoria city council held a public vote to ban smoking in restaurants and other public places. Dr. Gilner decided to speak out in support and start his own grassroots campaign because no other ordinance supporters seemed to emerge. He designed a Web site, Smoke Free Victoria, and made buttons to pass out to voters. He feels it is his responsibility to act on behalf of public health. "As a physician I heal the sick, but even more, I should improve the health of our citizens," adds Dr. Gilner.

Ralph McCleskey, MD, an Abilene cardiovascular specialist, believes the same. He was equally active in his hometown's no-smoking movement. "As a physician, I had instant credibility. I could stand up and say that science has proven time and time again that secondhand smoke is harmful, and is at least as dangerous as firsthand smoke," TMA physician leader Dr. McCleskey says. "I've been telling my patients this for 30 years." Dr. McCleskey helped to create Smoke Free Abilene in 2006 in support of his town's proposed ordinance. The group included other local physician leaders plus people from various other professions. "I used my medical experience and joined with other people to have a much larger impact on the community than I ever could as an individual."

Though he credits the entire group for the local movement's success, Dr. McCleskey became the face and voice of the cause. He appeared in television ads and recorded a phone message that went to every Abilene voter. "It said something like, 'Hello, this is Dr. Ralph McCleskey. I've been practicing medicine in Abilene for the past 30 years, and I have seen firsthand the dangers of secondhand smoke and the harm that it can cause my patients,'" he recalls. In Abilene, 69 percent of voters passed the comprehensive smoking ban. "It really makes me feel good knowing that the community in general can pretty much go wherever they want and not be exposed to tobacco smoke," he says.

Dr. Gilner experienced a similar victory, as 70 percent of Victorians passed their measure in 2006. "I became the first [Victoria] physician to champion the cause in such a way that people could respond to it," he notes. "If I weren't a doctor, no one would have listened to me. People rallied, so in my 59 years, this is probably the thing I am most proud of."

Proponents of a statewide smoking ban were unsuccessful in their efforts to pass legislation in 2007. At the time, Joel Dunnington, MD, told legislators, "One of the easiest, simplest, and fastest public health interventions Texas can implement is to make Texas smoke-free." Dr. Dunnington, a TMA physician leader and radiologist at the M.D. Anderson Cancer Center in Houston, also told legislators that secondhand tobacco smoke causes around 50,000 deaths in the United States every year.

To date, 19 states have smoke-free restaurants and 13 states have smoke-free bars, while numerous cities have similar ordinances. Yet opponents of smoking bans cite infringement of smokers' rights, potential negative financial impact on affected businesses, and dislike of government intervention overall as reasons to oppose.

Dr. Dunnington notes that economic surveys show either there is no economic downturn in the community, or there is improvement after workplaces go smoke free. He also notes tourism in California and New York are booming following enactment of smoke-free legislation.

Dr. Gilner says Victoria restaurants and other businesses are booming with families enjoying smoke-free outings. "Even the smallest change can have big effects," he says. He hopes to see fewer heart attacks, less cancer, less hypertension, and less emphysema suffered in his community as a result.

Times are good in Abilene too, according to Dr. McCleskey, who points to a bowler friend who laments the effects of the new ordinance. "He said, 'I used to get a lane easily. Now since there's no smoking, there's all these families with kids running around and the bowling alley's full; so I can hardly get a lane!" he recalls.

"Physicians and citizens have to take an active role in public health; neither side is capable of making this happen without the other side's support," says Dr. Gilner. Not only do Victorians face less secondhand smoke but also some patients have told Dr. Gilner they quit smoking altogether as a result of the ban. "It became such a pain in the 'tuchis' to have to try and find a place to smoke, they said it wasn't worth it."

TMA is the largest state medical society in the nation, representing more than 43,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. Organized in 1853, TMA's key objective is to improve the health of all Texans.

Texas Medical Association

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