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Despite the awareness of health hazards and economic costs, the official policies of leading hospital associations toward smoking were virtually non-existent (1964-1974) to weak (1975-1993) [T]he American Hospital Association Board of Directors endorsed the Surgeon Generals report of 1964 but took no further action, leaving the matter to be decided at the local level

Most importantly, histomorphological alterations of testes, significantly increased abnormalities in epidydimal spermatozoa and sperm DNA damage have been observed in rats exposed to cigarette smoke [41, 42]

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DOI: 10.1001/archpsyc.1994.03950110058008 Umhau JC, Schwandt ML, Usala J, et al