NORTHAMPTON — A half-dozen cigarettes burn inside an outdoor “smoke shack” at the hilltop Veterans Affairs Medical Center, filling the bare-bones shelter with thick, swirling, eye-watering smoke that has largely disappeared outside this 12-by-20-foot space.
“It’s my way of relaxing, and I’m addicted to it,” said Rocky Lavalette, a 70-year-old Vietnam veteran whose white mustache is stained by nicotine. “I’ve tried stopping about 88 times. I’ve tried everything.”
Lavalette presumably will have to try again. The VA is rolling out a nationwide smoking ban at all its hospitals and medical centers beginning Oct. 1, a blanket prohibition that covers the grounds, parking lots, visiting cars, and even the designated “smoke shacks” where veterans congregate.
But where VA officials see a long-needed ban for health reasons, many veterans — particularly older ones — see a hastily implemented change that will compound their stress, interfere with camaraderie, and be difficult to enforce.
“I don’t need this aggravation,” said Lavalette, who has smoking-related lung disease. “It’ll be something else to worry about. It’ll make me want to smoke more.”
In addition to cigarettes, the ban will include cigars, pipes, and e-cigarettes, including vaping devices that have not been approved by the US Food and Drug Administration. Union employees at the VA will be allowed to smoke until January under an agreement reached with the American Federation of Government Employees, which had filed a grievance against the move.
VA administrators acknowledge that the ban presents problems in implementation and for veterans culture, considering that cigarettes once were included in military rations. Veterans smoke at double the rate of people who have never served in the military — 29 percent to 14 percent, respectively, according to the US Centers for Disease Control and Prevention.
“It will be very challenging at first,” said Andrew McMahon, associate director of the VA Central Western Massachusetts Healthcare System, a group of eight sites that include the Northampton facility. “We’re going to approach them in a very friendly manner with the resources that we can provide.”
McMahon also said Oct. 1 will not bring overnight enforcement by VA police, adding that the VA will ease the transition to a smoke-free environment for the 7,000 veterans who receive care at Northampton.
“I don’t want to tie our hands and say we’re not going to enforce anything, but we really want to take an outreach approach,” McMahon said. “We’re not going to be issuing any monetary tickets or anything that has any real consequences for the foreseeable future.’
The same go-slow approach appears likely to be repeated at the VA’s Boston facilities in Jamaica Plain and West Roxbury. John D’Adamo, who co-chairs the VA’s smoke-free implementation team in Boston, said the initial focus will be spreading awareness of the policy and encouraging smokers to take advantage of VA wellness programs.
“We’re really embracing this as an opportunity to encourage and promote a healthy and safe environment,” D’Adamo said.
The Boston VA offers a smoking-cessation program, as well as alternative therapies such as stress management, yoga, Tai Chi, and meditation, D’Adamo said.
But in the smoke shack at Northampton, one of four shelters on campus, a half-dozen veterans said they had not learned of the ban until recently. McMahon said information about the changes was rolled out according to national guidance from the VA.
“There should have been a bigger push,” said John Morris, a 34-year-old veteran of the Army’s 82d Airborne Division. “I take it kind of personally that they just dropped this on us.”
VA posters about the ban have been up for weeks, but many veterans were not aware of the prohibition until a mailing less than two weeks ago, when they received information about the plan along with their VA appointment cards, said Matt Stenson, a clinical case manager for the nonprofit organization Soldier On.
The group provides transitional housing and support services for veterans and leases VA buildings at Northampton. Jack Downing, president of Soldier On, said that the VA should have begun informing veterans months ago, and that the ban should have been part of a broader health program.
“This is insanity,” Downing said. “It’s not a bad thing, but it’s how you implement it.”
Downing also questioned whether the ban can ever be effective.
“You would need a force of 100 VA police to enforce this. I don’t know how you would do it,” he said. “We’ll have contraband coming on the campus.”
In Boston, D’Adamo said, the VA will try to persuade smokers by linking the ban with the health of nonsmoking veterans, who can be affected by second- and even third-hand smoke embedded in clothing and residue.
That conversation must be respectful, D’Adamo said.
“This is something we talk about all the time. They’ve put their lives on the line,” D’Adamo said. “There’s no one size fits all.”
In Northampton, however, the smoking veterans showed no desire to stop — ban or no ban.
One veteran said he has lung cancer and already has picked a place to smoke in the woods. Lavalette said he will rip up any citation a VA police officer gives him. Others predicted that cigarette butts will start showing up all over campus, instead of being relegated to the metal buckets where they’re dropped in the shacks.
“Where are people going to smoke? They’re going to smoke wherever they want,” said Steve Howland, a 63-year-old Air Force veteran from Foxborough.
Morris is no fan of the ban, but the 82d Airborne veteran said he understands the reasoning behind the move. Hospitals all over the country have long been smoke-free, he said.
Still, the cravings endure.
“When I was in the service, I looked forward to that cigarette when I was on the gun range,” Morris said. “We just wanted that moment where we could get away.”
But two weeks ago, Morris said, he began using an FDA-approved device to wean him from traditional smoking.
So far, so good.
“It’s working,” he said amid a haze of second-hand smoke. “I don't have any cigarettes on me.”