The goal of health for all by the year 2000 ("The Meaning of," 1978) is congruent with the Swedish concept, originated in the early 1970s, of the first smoke-free generation (Canadian Initiatives, 1983; Roemer, 1982). In the United States and Canada, educational programs are aiming for a generation of nonsmokers by the year 2000 (Break Free, 1987; "Drug Abuse," 1991; "State Coalitions," 1990; Wynder, 1988). Expectations for the year 2000 are high, and nonsmoking may become the norm. How will social work have contributed to the development of a smoke-free society?
The question arises because social work's alliance with health restoration, maintenance, and promotion is well established (Shannon, 1989; Weick, 1986). Yet social work's participation in the creation of a smoke-free North American society is virtually unknown, and a social work literature on smoking does not exist. Social workers have undoubtedly counseled individuals about their smoking practices, offered smoking cessation programs (Bultz, Scott, & Taenzer, 1988), and participated in the development of organizational and governmental policies related to tobacco. Nonetheless, the lack of any public proclamation by social work of interest in this major health issue warrants exploration. This article considers the factors that may account for social work's low profile and proposes activities ranging from direct services to policy development and legislation. It provides social workers with information about the harm caused by cigarette smoking and offers a rationale for social work involvement in the creation of a smoke-free society. The rationale is based on an examination of the extensive literature on smoking.
Trends in Smoking Behavior
The history of the tobacco industry in North America; its promulgation by advertising; the emergence of antismoking forces; and the ensuing battle over recruitment of children, adolescents, and young women into smoking are well documented (Diehl, 1969; Sobel, 1978; Wynder, 1988). However, changes in smoking behavior since 1965 indicate that smoking may become the exception by the year 2000 (Active Health Report on Alcohol, 1989). According to Grise (cited in "Smoking at 47-Year Low," 1989), current American per capita consumption of cigarettes is the lowest since 1942. The Centers for Disease Control and Prevention reported that in 1987, 25.2 percent of those surveyed smoked (cited in Sperling, 1989). In Canada the percentage of regular smokers has declined from 43 percent in 1966 to 28 percent in 1990 ("Canadians Butting," 1989; Stephens & Craig, 1990). With the demise of the tobacco industry (Glover, 1987), tobacco companies have set their sights on developing countries, where governments are eager for the revenues derived from tobacco production and use and the citizenry are ill informed about the health hazards of smoking (Fielding, 1985).
Cigarette smoking is currently almost as common among women as it is among men, and in the 15-to-24 age group women surpass men in smoking rates (Active Health Report on Alcohol, 1989; Stephens & Craig, 1990). In Canada, 40 percent of women 15 to 19 are smokers ("Girls Buck," 1990). The trend toward lower rates of smoking is more pronounced among men than among women ("Canadians Butting," 1989; Wynder, 1988), and women in every social group have lower rates of stopping than do men (Jacobson, 1981a). The women's movement has done little to identify smoking as an indicator of women's oppressed social condition. However, Jacobson (1981b) indicated that the lower one's status, income, and educational achievements, the more likely one is to smoke. One reason may be that the women's movement has benefited from the tobacco industry's financing of women's sports events and women's magazines through advertising.
The proportion of reported smokers declines with age (Active Health Report on Seniors, 1989); smoking is most frequent among adults ages 25 to 34, with nearly 40 percent reporting that they smoke (Active Health Report on Alcohol, 1989). …