Secondhand smoke and Smoke-Free Policy

Transcription

1 Secondhand smoke and Smoke-Free Policy Cabinet for Health and Family Services

2 Secondhand smoke and Smoke-free Policy This report was prepared by: University of Kentucky College of Nursing Tobacco Policy Research Program In collaboration with Tobacco Prevention and Cessation Program Kentucky Cabinet for Health and Family Services University of Kentucky Contributing Staff: Ellen J. Hahn, DNS, RN Laura K. Jones Cole, MS, MA Laura Whitten, BA Heather Robertson, MPA Carol Riker, MSN, RN Mary Kay Rayens, PhD Karen Arrowood, MS Kathy Begley, BA Leah Casanave, BA Jon McGee, BFA Sarah Kercsmar, PhD Norah Slone, MS Brenda Vestal, BA Kristian Wagner, MS Monica Warren, MS KDPH Contributing Staff: Irene Centers, BA Please direct requests for additional information to: Ellen J. Hahn, DNS, RN, Professor Director, Tobacco Policy Research Program University of Kentucky College of Nursing 751 Rose Street Lexington, Kentucky (859) office, (859) fax A full copy of this report can also be viewed at: June 2009 (2nd edition) 1

3 Executive Summary Secondhand Smoke and Smoke-free Policy, 2nd ed., 2009 is designed for policymakers and community advocates who want to know more about the health effects of secondhand smoke and the effects of smoke-free laws on communities. New in the second edition are Kentucky Snapshots and quotes from Kentuckians who are experiencing the benefits of smoke-free laws. Since the first edition in 2006, Kentucky has seen an explosion of local smoke-free laws. Several communities have adopted Board of Health regulations. Secondhand smoke is a toxic air contaminant. Secondhand smoke is the third leading cause of preventable death in the United States. There is no risk-free level of secondhand smoke. Secondhand smoke affects nearly every organ of the body, causing heart disease, lung cancer, breast cancer and other cancers, breathing disorders such as emphysema and asthma, and sudden infant death syndrome. Most Kentuckians do not smoke, but at least 70% are regularly exposed to secondhand smoke in workplaces and public places. Secondhand smoke exposure costs $10 billion in direct and indirect medical costs each year in the U.S. Smoke-free laws are a good business decision. Comprehensive smoke-free workplace laws protect smokers and nonsmokers from secondhand smoke in the workplace and public places. Smoke-free laws significantly reduce air pollution and improve the health of workers. Lexington s smoke-free law resulted in a 22% reduction in emergency department visits for asthma. There is no scientific evidence that smoke-free laws harm business and workers are just as likely to stay on the job. Smoke-free laws do not hurt revenues from charitable gaming (e.g., bingo). As of June 1, 2009, 30% of Kentuckians were covered by comprehensive smoke-free workplace laws. Those most at risk are hospitality workers, blue collar workers, and workers in gaming facilities. Some schools and some workplaces have voluntarily adopted policies to reduce exposure to secondhand smoke. About half (52%) of public and private schools in Kentucky prohibit smoking on school grounds. Comprehensive smoke-free laws are the gold standard because they cover all workplaces and enclosed public places and have few to no exceptions. Exemptions create confusion, an uneven playing field for businesses, the potential for legal challenges, enforcement difficulties, and they leave workers unprotected. Statewide smoke-free laws that are put in place before there is widespread support at the local level are often weakened by exemptions and often take control away from local governments to pass stronger laws. 2

4 Table of Contents Executive Summary 2 Table of Contents 3 Introduction 4 Secondhand Smoke: A Matter of Health 6 What is secondhand smoke? 6 What is in secondhand smoke? 6 How does secondhand smoke affect the heart? 7 How does secondhand smoke affect the lungs? 7 How does secondhand smoke affect the breasts? 7 How does secondhand smoke affect other parts of the body? 7 Smoke-free Laws: A Way to Protect Health 8 What are the benefits of smoke-free laws? 8 Who is protected by smoke-free laws? 8 How do smoke-free laws affect health? 8 How do smoke-free laws affect smokers? 8 How do smoke-free laws affect air quality? 9 How do smoke-free laws affect workers? 9 Smoke-free Laws: No Harm to Business 10 How do smoke-free laws affect business? 10 Do smoke-free laws affect sales revenue? 10 Do smoke-free laws affect employment? 11 Do smoke-free laws affect charitable gaming? 11 What is the bottom line? 11 Smoke-free Laws: What the Opposition Says 12 What does the opposition say about smoke-free laws? 12 Smoke-free Laws: What the Public Thinks 14 Is there public support for smoke-free laws? 14 Does the public change their social practices after smoke-free laws go into effect? 15 Do smokers change their smoking patterns after smoke-free laws go into effect? 15 Smoke-free Policy: Protecting our Most Vulnerable Adults at Work 16 Who is exposed to secondhand smoke at work? 16 What are the costs of smoking in the workplace? 16 Do worksite smoke-free policies help smokers quit? 17 Do workplace smoke-free policies help employers save money? 17 Smoke-free Policy: Protecting our Youth 18 What is the impact of youth smoking in Kentucky? 18 How does secondhand smoke harm youth? 18 Do schools expose students and workers to secondhand smoke? 18 Do smoke-free laws prevent youth smoking? 19 Do tobacco-free school campus policies reduce youth smoking? 19 How strong are Kentucky s school tobacco policies? 19 Smoke-Free Laws or Regulations: Why Good Is Not Enough 20 What are two ways a local community can go smoke-free? 20 What is the gold standard for smoke-free laws and regulations? 20 How do comprehensive smoke-free laws clear the air? 21 How is Kentucky preparing for a statewide law? 21 References

5 Introduction The purpose of this report (2nd edition) is to provide an updated overview of the science on secondhand smoke and smoke-free policy. The intended audience is policymakers and community advocates. The report summarizes the available data on voluntary and public smoke-free policy over time in Kentucky. New in this edition are Kentucky Snapshots, voices from those with firsthand experience with secondhand smoke and smoke-free policy. Also new in the second edition is Smoke-free Laws or Regulations: Why Good is Not Enough. This section outlines the gold standard for protecting all workers as well as how Kentucky is preparing for a statewide smoke-free law. Local smoke-free laws promote public debate and educate the public close to home. Changing policy is one of the most effective public health measures because it changes the cultural norms about tobacco use. Smoke-free laws protect nonsmokers from the dangers of secondhand smoke and change the community climate such that fewer youth start to smoke. An added benefit of smoke-free laws is that smokers tend to smoke fewer cigarettes and some actually quit altogether. Most Kentucky adults do not smoke cigarettes, yet Kentucky is a national leader in cigarette smoking. While only 25% of Kentucky adults smoke cigarettes, 70% of Kentuckians are regularly exposed to secondhand smoke in workplaces and public places. About one-fourth of Kentuckians are regularly exposed to secondhand smoke in the home. Eighteen percent of U.S. adults are current smokers. Public policy is more effective than voluntary policy change. It is estimated that only half of the population is protected when communities leave decisions about smoke-free air up to business owners. Smoke-free laws are popular in other states and locales. As of April 2009, 15 states, 16 countries, and 340 municipalities had passed 100% comprehensive smoke-free workplace laws or regulations covering all workplaces, restaurants, and bars. Twelve Kentucky communities, 8 urban and 4 rural, are on that list. Comprehensive smoke-free workplace laws are the best vaccine against heart disease, cancer, and breathing disorders. Comprehensive smoke-free workplace laws, the gold standard, cover all workers and patrons with very few exceptions. Partial smoke-free laws, like those in Daviess County and Pikeville, protect only some workers. Partial laws have exemptions that create an unlevel playing field and make it difficult and confusing to enforce the law. For example, Daviess County exempts businesses that allow only those over 18 years of age. The most effective smoke-free laws are those that cover all workplaces and public places with very few exceptions. 4

6 Smoke free Policies are a Matter of Public Health, Not Personal or Private Property Rights. The science is clear. There is no longer any debate that secondhand smoke is known to cause cancer, heart disease, emphysema and stroke. There is no constitutional right to smoke. However, everyone has the right to breathe clean air. A free market approach does not protect all workers. Business owners may privately own their business, but by inviting the public in, they are responsible for providing a safe environment for their workers and the public. It is the Manifest Duty of Local Governments and Boards of Health to Protect Public Health. In April 2004, the Kentucky Supreme Court ruled that local governments have the power to promote and safeguard public health including enacting smokefree laws. Fiscal courts, city councils or city commissions can enact smoke-free ordinances. In June 2007, the Madison County Health Department was the first Board of Health in Kentucky to adopt a clean indoor air regulation. Smoke-free Laws Do Not Harm Business. Peer-reviewed, scientific studies consistently find that when communities go smokefree business is not harmed. While the hospitality industry may share stories of economic hardship, objective economic indicators show otherwise in study after study. There is no scientific evidence that smoke-free laws have adverse economic effects on business or gaming revenues. 5

7 Secondhand Smoke: A Matter of Health Secondhand smoke contains more than 4,000 chemicals: 5 regulated hazardous air pollutants 47 regulated hazardous wastes 60 known or suspected cancercausing agents More than 100 chemical poisons What is Secondhand Smoke? A mixture of the smoke given off by the burning end of tobacco products (sidestream smoke) and the smoke exhaled by smokers (mainstream smoke). A Group A Carcinogen known to cause cancer in humans. 1 2 A Toxic Air Contaminant (TAC). 3 There is no risk-free level of secondhand smoke. What is in Secondhand Smoke? Some of the harmful chemicals, gases and poisons 2, 4-6 in secondhand smoke include: Chemical Name Common Use Toluene Gasoline Arsenic Rat poison Geranoil Pesticides Formaldehyde Embalming fluid Cadmium Batteries Carbon Monoxide Car exhaust Acetone Nail polish remover Methanol Anti-freeze Ammonia Toilet cleaner Polonium 210 Radioactive material Creosote Component of tar Benzene Coal/petroleum Nicotine Addictive drug Hydrogen Cyanide Gas chamber poison 6

8 How does Secondhand Smoke Affect the Heart? Secondhand Smoke: A Matter of Health Secondhand smoke exposure causes at least 46,000 coronary heart disease deaths annually among adult nonsmokers in the U.S. 3 Nonsmokers exposed to secondhand smoke on a regular basis at home and/or work have a 20-30% increase in the risk of heart disease. 3 How does Secondhand Smoke Affect the Lungs? Secondhand smoke exposure causes an estimated 3,000 lung cancer deaths annually in the U.S. 1 The increased risk of lung cancer to nonsmokers exposed to secondhand smoke is estimated at 20-30%. 3 Approximately 80-90% of deaths from emphysema are caused by secondhand smoke. 3 How does Secondhand Smoke Affect the Breasts? 2, 7 Of the 50 known cancer-causing agents in cigarettes, 20 specifically target breast tissue and the mammary glands. Regardless of age, women who are exposed to secondhand smoke show a 25% increased risk of developing breast cancer. How does Secondhand Smoke Affect Other Parts of the Body? 3 Secondhand smoke is associated with numerous other cancers including: Bladder Kidney Pancreas Cervix leukemia Stomach Esophagus Mouth Secondhand smoke is a major, sometimes fatal, threat to persons with asthma. Secondhand smoke causes Sudden Infant Death Syndrome (SIDS). 8 5 minutes of exposure to secondhand smoke stiffens the aorta as much as smoking a cigarette. 20 minutes of exposure causes excess blood clotting, increasing the risk of heart attack and stroke. 30 minutes of exposure increases the build-up of fat deposits in blood vessels, increasing the risk of heart attack and stroke. 2 hours of exposure increases the chance of irregular heart beat that can be fatal or trigger a heart attack. 7

9 Smoke-free Laws: A Way to Protect Health 9, 10 What are the Benefits of Smoke-Free Laws? 250 Air pollution in Lexington s hospitality venues before and after the smoke-free law. Non-smokers are protected from the harms of secondhand smoke. Smoking rates decline. Fewer adolescents and young adults start to smoke. 11, 12 Who is Protected by Smoke-Free Laws? 70.2% of Americans are protected by local and state smoke-free laws. Only 39.6% of U.S. workers are covered by comprehensive smoke-free workplace ordinances or regulations. In Kentucky, 30% are protected by comprehensive smoke-free workplace ordinances or regulations. PM 2.5 microgram per cubic meter How do Smoke-Free Laws Affect Health? There was a 22% reduction in asthma-related emergency room visits in the 32 months after Lexington s smoke-free ordinance took effect. 13 On average, there is an immediate 19% decline in hospital admissions for heart attacks after implementation of smoke-free laws. 14 How do Smoke-free Laws Affect Smokers? There were 32% fewer adult smokers in Lexington- Fayette County in the 20 months after the smokefree law took effect. 9 The longer smoke-free laws are in effect, the more likely smokers are to reduce cigarette consumption and quit smoking. 15 Before After 8

10 How do Smoke-Free Laws Affect Air Quality? Indoor air pollution in restaurants, bars, and other entertainment businesses dropped 91% after Lexington s law went into effect. 16 In Letcher County, Kentucky, indoor air pollution in restaurants and other venues declined by 75% after their smoke-free law took effect. 17 Indoor air pollution drops immediately when smoke-free laws take effect. In Georgetown, Kentucky, air quality significantly improved within a week after the law took effect. 18 How do Smoke-Free Laws Affect Workers? 19 Smoke-free Laws: A Way to Protect Health Restaurants and bars in smoke-free cities have 82% less indoor air pollution than restaurants and bars in cities without smokefree protection. 20 Hair nicotine levels declined by 56% among smokers and non-smokers working in restaurants and bars after Lexington s smoke-free ordinance took effect. Restaurant and bar workers were less likely to report breathing problems after smoke-free laws took effect, whether or not they smoked. Average Fine Particle Air Pollution in Three Communities PM 2.5 micrograms per cubic meter Letcher Lexington Louisville Outdoor Standard The National Ambient Air Quality Standard of PM 2.5 ug/m 3 24 hours. There is currently no indoor air quality standard. Pre Law Post Law Outdoor Standard 9

11 Smoke-free Laws: No Harm to Business How Do Smoke-free Laws Affect Business? Restaurant employment increased and bar employment was stable after Lexington s smokefree law took effect. Employment data from 64 months prior to the law were compared to data 14 months after the law took effect. 21 Businesses were just as likely to open and close after Lexington s law took effect, regardless of whether or not the business sold alcohol. 21 Workers are just as likely to stay on the job after smoke-free laws take effect. 22 Do Smoke-free Laws Affect Sales Revenue? Restaurant sales tax receipts are not adversely affected by smoke-free laws. Fifteen cities in California and Colorado with smoke-free restaurant ordinances were compared with 15 cities in the same states without ordinances from 1986 to Gross restaurant sales in Flagstaff, Arizona increased 16% one year after a smoke-free ordinance took effect. 24 Restaurant and bar revenues in El Paso, Texas did not change after a smoke-free law took effect. Sales and mixed-beverage tax data were examined 12 years before and one year after the law took effect. 25 Going smoke-free has been great for my business. Jim Sawyer (Owner, Sawyer s Grille, Lexington, Kentucky) 10

12 Do Smoke-free Laws Affect Employment? There was no negative economic impact in Lexington, Kentucky, a tobacco-growing community, after a smoke-free ordinance covering all enclosed buildings open to the public went into effect in April Growth in restaurant employment was three times higher in New York City than the rest of the state from 1993 to 1997 after their citywide smoke-free ordinance. 26 Employment in drinking and eating places increased by 4% after a statewide smoke-free law took effect in Florida. 27 Do Smoke-free Laws Affect Charitable Gaming? There was no reduction in charitable gaming revenues from bingo in Kentucky after local smoke-free legislation took effect, despite the fact that Kentucky is a tobacco-producing state with higher-than-average smoking rates. 28 Delaware s smoke-free law had no effect on gaming revenues. 29 What is the Bottom Line? There is NO scientific evidence that smoke-free laws have adverse economic effects. There are no economic reasons to exempt bars or gaming facilities from smoke-free laws. Smoke-free laws create healthy places for workers and patrons and reduce health care costs from smoking and exposure to secondhand smoke. Smoke-free Laws: No Harm to Business Secondhand smoke exposure costs $10 billion in direct and indirect medical costs each year in the U.S. 30 Good economic studies: measure what actually happened (not just what people feared would happen). use hard numbers (such as actual revenues or employment statistics from an unbiased source). include information for a reasonable time before and after the smoke-free law went into effect. account for underlying business fluctuations. use at least one year of data (usually 4 quarters) to measure the effects of the law. disclose the source of funding for the study. are published in scientific, peerreviewed journals. are financed by groups that have no ties to the tobacco, alcohol or gaming industries. 11

13 Smoke-free Laws: What the Opposition Says What Does the Opposition Say about Smoke-free Laws? The tobacco industry partners with the alcohol, hospitality, and gaming industries, smokers rights and libertarian groups to work against smokefree policy by proposing weak and ineffective laws. Their hope is to convince the public that something is being done about the harm of secondhand smoke, while accommodating smokers. The opposition typically appears shortly after the smoke-free movement goes public or after the law or regulation is passed, and often involves subtle or more blatant intimidation. 1 PROPERTY RIGHTS 2 Myth TRUTH ECONOMICs Myth TRUTH 12 It is the business owner s right to decide whether or not to allow smoking. Smoke-free laws intrude into private property rights. Smokers will act responsibly without government interference. The April 2004 Kentucky Supreme Court ruling 31 on Lexington s smokefree ordinance says: Where public interest is involved it is to be preferred over property interests. the protection of public health is not only a right but a manifest duty. The Right to Breathe Clean Air Trumps Property Rights! Smoke-free ordinances do not restrict smokers from smoking. They simply restrict smoking in places where others breathe the air. If personal responsibility were taken seriously, no one would smoke where others breathe the air. Smoke-free laws respect everyone s basic right to breathe smoke-free air, smokers and non-smokers alike. 2.Businesses will suffer with a smokefree ordinance or regulation. 2. Posting signs or using a rating system gives Did the you consumer know? the choice of whether to enter the business. This Comprehensive is called a red smokefree workplace laws light-green light approach. protect public health and create a level playing field for all businesses. The most effective smoke-free laws: Cover all workplaces and public places. Do not exempt certain businesses like bars or gaming facilities. Spell out a clear, consistent enforcement plan. Business Thrives with Smoke-free Laws! Numerous studies show no negative economic impact of smoke-free 21, 25, 26, 32 laws. Smoke-free laws have no significant 28, 33 effect on gaming revenues. 75% of Kentuckians don t smoke and may avoid businesses where smoking is allowed. 34

14 2. Posting signs or using a rating Posting signs is no different from system gives the consumer the the status quo. choice of whether to enter the Workers are not protected. business. This is called a red light-green light approach. This approach lulls officials 3 into thinkind the problem of VENTILATION 4 secondhand smoke Myth TRUTH In the 1990s, tobacco industry executives testified under oath that nicotine is NOT addictive. Myth Accommodation TRUTH Business owners should have some flexibility in deciding how best to address the preferences of nonsmokers and smokers through separation, separate rooms, and/or high quality ventilation. 35 Ventilation Doesn t Work! Ventilation only eliminates smoke and odor; the fine particles from secondhand smoke remain to cause disease and premature death. Only tornado-force winds inside a building would reduce the deadly 36, 37 particles from secondhand smoke. There is no safe level of exposure to secondhand smoke. 3 Two common pro-tobacco strategies to accommodate smokers: 1). Post signs or use a rating system to give patrons the choice of whether to enter a business that allows smoking 2). Limit smoking to certain hours of operation or to establishments where children are not allowed. Hospitality Workers Deserve to Breathe Clean Air! Under the guise of accommodating smokers, such alternatives put workers at risk. Workers should not have to breathe the equivalent of 16 cigarettes per 8-hour shift to hold a job. 36 Age and hour provisions create loopholes, making enforcement difficult and confusing. Posting signs is no different than the status quo and limit places the public can safely go. These strategies lull officials into thinking they have addressed the problem, but succeed only in discriminating against workers

15 Smoke-free Laws: What the Public Thinks Most Kentuckians (75%) do not smoke cigarettes. 34 Yet 70% of Kentuckians are regularly exposed to secondhand smoke in workplaces and enclosed public places. 11 Is There Public Support for Smoke-free Laws? In Lexington, there was a significant jump in public support for the smoke-free law, from 56% before the law to 63% six months after it took effect in April Most Kentucky residents (60%) living in urban and rural communities favor local smoke-free laws. 40 Less than half (43%) of Kentucky adults believe secondhand smoke is a serious health hazard. 52 Nonsmokers are more likely than smokers to think secondhand smoke is a serious health hazard (57% vs. 12%). 52 Playing in Northern Kentucky bars and clubs is great except for the massive amounts of cigarette smoke that make a thick haze by the end of the night, irritating my eyes and choking me to where I can t even breathe. These bars are my workplace and I shouldn t have to be poisoned to do what I love. Mike Flinchum (Musician) 14

16 Does the Public Change Their Social Practices After Smoke-free Laws Go Into Effect? Smoke-free Laws: What the Public Thinks Dining and entertainment practices did not change in Lexington, Kentucky after the smoke-free law went into effect. 39 There was no significant decline in the number of persons who reported going to a restaurant at least once a week after Lexington s law took effect. 39 There was a significant increase in the percentage of people who reported visiting bars or nightclubs in Lexington at least once a week after the law took effect (from 15% to 18%). 39 Do Smokers Change Their Smoking Patterns After Smoke-free Laws Go Into Effect? Adult smoking dropped from 25.7% to 17.5% in Lexington-Fayette County after the smoke-free law took effect, representing 16,500 fewer smokers. 9 When public places and private workplaces restrict smoking, fewer cigarettes are smoked, and more 15, 50, 51 smokers try to quit. The debate is over. The science is clear. Secondhand smoke is a serious health hazard that causes premature death in children and nonsmokers. 3 Anti-health groups conduct misinformation campaigns in an attempt to mislead the public about the dangers of secondhand smoke. The Opposition manipulates science by taking information out of context and using old studies, flawed science, anecdotal information, and opinions. 15

17 Smoke-free Policy: Protecting Our Most Vulnerable Adults at Work Who is Exposed to Secondhand Smoke at Work? Over one-fourth (27%) of Kentucky s blue collar workers are exposed to secondhand smoke every time they go to work. 53 Of the over 6.6 million food preparation and service workers in the United States, only 43% are protected by smoke-free laws. 54 Workers in gaming facilities are exposed to high levels of secondhand smoke despite the fact that casino patrons smoke at rates similar to the U.S adult population. 55 What are the Costs of Smoking in the Workplace? More than 126 million nonsmoking Americans are exposed to secondhand smoke in the home and workplace the two primary locations for secondhand smoke exposure. Nonsmoking employees exposed to secondhand smoke are more likely to take time off for illness than those not exposed. 58 Smoking costs an estimated $193 billion in direct health care costs and productivity losses in the U.S. every year. 34 Smoking and secondhand smoke exposure account for 5.1 million years of potential life lost annually. 59 Workers Covered by Comprehensive Smoke-free 11, 12, 57 Workplace Laws in Kentucky and the U.S. Percent Kentucky U.S. 16

18 Do Worksite Smoke-free Policies Help Smokers Quit? Smoke-free policy in the workplace reduces smoking among employees by 3.8% and daily cigarette consumption by 3.1 cigarettes. 60 Smoke-free workplaces are associated with a 29% drop in cigarette consumption. 60 Smokers are 25% more likely to make serious quit attempts and quit using tobacco if they work in a smokefree workplace. 61 Do Workplace Smoke-free Policies Help Employers Save Money? Employee turnover does not increase as a result of smoke-free laws. 62 Smokers are absent from work 2.9 days per year more than nonsmokers. 63 Smoke-free Policy: Protecting Our Most Vulnerable Adults at Work 40% of hospital campuses in Kentucky are completely tobacco-free inside and out. 68 Blue collar workers are more likely to be exposed to secondhand smoke 65, work in a business that allows smoking 66, and smoke cigarettes. 67 The EPA estimates that $4 to $8 billion in building operations and maintenance costs would be saved if smoke-free workplace policies were adopted nationwide. 64 Healthcare insurance and workers compensation costs decrease in smoke-free workplaces. 64 Kentucky Workers at High Risk for Secondhand Smoke Exposure 56 Employment Occupation, Kentucky % 9% Hospitality Workers Manufacturing Other Occupations 81% 17

19 Smoke-Free Policy: Protecting OUR YOUTH What is the Impact of Youth Smoking in Kentucky? Kentucky United States Smoking Prevalence, Grades 9-12 Youth Projected to Start Smoking 71 Youth Projected to Die Prematurely from Smoking-related Illness 27% 69 20% ,000 19,943, , , ,382, ,407, PM 2.5 micrograms per cubic meter Levels of Fine Particulate Air Pollution in a Rural Kentucky High School 76 Air pollution in a rural Kentucky high school student restroom was 10 times the Federal Outdoor Air Quality Standard and over 2 times higher than Lexington s bars (pre-law) Rural High School Restrooms Lexington Bars (Pre-Law) Federal OUTDOOR Standard How does Secondhand Smoke Harm Youth? Youth exposed to secondhand smoke are more likely to have: 3»» respiratory illness such as bronchitis and pneumonia. 3»» ear infections. 3»» learning problems. 3»» more frequent and severe asthma attacks. 73»» absenteeism from breathing problems. 2, 74, 75»» breast cancer at a young age. Do Schools Expose Students and Workers to Secondhand Do Schools Smoke? Expose Students and Workers to Secondhand Smoke? Smoke in some high school bathrooms is worse than in Smoke bars. in some high school bathrooms is worse than in bars. One rural Kentucky high school restroom had One secondhand rural Kentucky smoke high levels school over twice restroom that had in Lexington secondhand smoke bars before levels the over smoke-free twice that law. in Lexington 76 bars before the smoke-free law

20 Do Smoke-free Laws Prevent Youth Smoking? Smoke-free laws may reduce the number of youth who start smoking by changing how they view smoking and its social acceptability. 77 Youth living in towns with comprehensive smokefree regulations may experiment but are less likely to become established smokers. 77 Do Tobacco-free School Campus Policies Reduce Youth Smoking? Students on smoke-free campuses are less influenced to smoke by teachers, staff and other students who 78, smoke. When tobacco-free school policies are strongly enforced, fewer youth smoke on campus, 81 especially yearolds. 80 Youth who experiment with tobacco quickly become addicted to nicotine. 82 Smoke-Free Policy: Protecting OUR YOUTH The Pro-Children Act of 2001 prohibits smoking in schools and other indoor facilities used to provide children s services to minors if the services are federally funded. Violators may be liable for a civil penalty not to exceed $1000 for each violation or 50% of their federal funding. 84 How Strong are Kentucky s School Tobacco Policies? 83 About half (52%) of public and private schools prohibit smoking on school grounds. Many schools (73%) post signs prohibiting tobacco use, but very few (13%) post them near restrooms. 19

21 SMOKE-FREE LAWs OR REGULATIONs: WHY GOOD IS NOT ENOUGH What are Two Ways a Local Community Can Go Smoke-free? Ordinance Enacted by Fiscal Court or City Commission or Council Among the police powers of the government, the power to promote and safeguard public health ranks at the top. 31 Regulation Adopted by Single County or District Board of Health Boards of Health have the legal responsibility to, adopt administrative regulations necessary to protect the health of the people. KRS Exemptions create confusion, an uneven playing field for businesses, and the potential for legal challenges. They can make enforcement difficult, and leave workers 85, 86 unprotected. What is the Gold Standard for Smoke-free Laws and Regulations? A comprehensive smoke-free law or regulation that covers all workplaces and enclosed public places. No or very few exemptions. Protects all workers from secondhand smoke exposure. Having a partial law in Louisville was a nightmare to enforce. It caused confusion, led to lawsuits, and did not protect all workers. Dr. Adewale Troutman, MD, MA, MPH (Director, Louisville Metro Department of Public Health and Wellness) 20

22 How Do Comprehensive Smoke-free Laws Clear the Air? Laws with exemptions may have no effect on indoor air quality or even lead to an increase in air pollution. After Louisville revised their law and passed a comprehensive one, air quality improved by nearly 97%. 87 Indoor air quality does not improve overall when laws have exemptions. Indoor Air Pollution in Louisville Public Venues Before and After a Comprehensive Law PM 2.5 micrograms per cubic meter No Law Law with Exemptions Comprehensive Law Federal Outdoor Standard SMOKE-FREE LAWs OR REGULATIONs: WHY GOOD IS NOT ENOUGH State smoke-free laws that are put in place before there is widespread support at the local level are often weakened by exemptions and often take control away from local governments to pass stronger laws. How is Kentucky Preparing for a Statewide Law? Building awareness, support, and demand for smokefree laws, one community at a time. Educating local communities and policymakers on secondhand smoke and smoke-free policy. Local education and debate produces meaningful policy changes and better enforcement. As of June 2009, 30% of Kentuckians were covered by local comprehensive smoke-free workplace laws or regulations

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26 An Equal Opportunity University Kentucky Center for Smoke-free Policy University of Kentucky College of Nursing 751 Rose Street Lexington, Kentucky Tobacco Prevention and Cessation Program Department for Public Health Cabinet for Health and Family Services 275 E Main Street, Frankfort, KY