Smoke-free Air Policies to Reduce Smoking Picture is from: http://www.no-smoke.org/learnmore.php?id=669 Picture is from: http://www.cdc.gov/nccdphp/dch/programs/CommunitiesPuttingPreventiontoWork/communities/profiles/tobacco-al_mobile-county.htm

Background Misuse and Abuse of Tobacco Increase rates of cancer Lung cancer Heart disease Poor circulation asthma High blood pressure Source: Morbidity and Mortality Weekly Report, November 14, 2008; 57(48): 1226-1228. http://www.cdc.gov/mmwr/PDF/wk/mm5745.pdf

Key Facts on Tobacco Use It is estimated that two people die each minute from tobacco-related disease in the Western Pacific. On the average, smokers die 10 years earlier than non-smokers. Source: World Health Organization Tobacco Fact Sheet (July 2013). http://www.who.int/mediacentre/factsheets/fs339/en/ Source: Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R.N., McAfee, T., & Peto, R. (2013) 21st Century Hazards of Smoking and Benefits of Cessation in the United States.  New England Journal of Medicine, 368:341–50.  Picture from: http://www.hivehealthmedia.com/sunshine-state-big-tobacco/

Secondhand Smoke -Smoke inhaled by people who are near the person who is smoking -There are over 7,000 known chemicals found in secondhand smoke and 250 are known to be toxic. Source: U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

Designate Smoke-Free Evidence has shown that there is no safe level of exposure to secondhand smoke. Separate or ventilated smoking areas do not protect nonsmokers from secondhand smoke. Only 100% smoke free places improve overall air quality. Guide to Community Preventive Services. Reducing tobacco use and secondhand smoke exposure: smoke-free policies (abbreviated).  www.thecommunityguide.org/tobacco/smokefreepolicies.html. Last updated: 11/2012. Studies have shown that effective smoke-free policies: -reduce exposure to secondhand smoke -reduce the prevalence of tobacco use -increase the number of tobacco users to quit -reduce the number of youth tobacco users -reduce tobacco-related deaths Picture is from: http://healthoutloud.areavoices.com/2011/02/01/freedom-to-breathe-under-attack/ Picture is from Dr. Lee Buenconsejo-Lum

Pregnancy and Tobacco Smoke Risk of stillbirth Babies with birth defects cleft palate heart problems Low birth weight baby Chemicals from secondhand smoke affect the brain and interferes with the infants breathing Source: U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

Youth and Tobacco Studies have shown that children whose parents smoke are sick more often. Get more frequent and severe asthma attacks Lung problems, like bronchitis and pneumonia Ear infections We must protect our youth from tobacco! Source: U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. Picture is from: http://www.globosapiens.net/travel-information/Palikir-1884.html Exposure to secondhand smoke can cause new cases of asthma in children who have not previously shown symptoms. Exposure to secondhand smoke can trigger asthma attacks and make asthma symptoms more severe. Bronchitis, which is a serious medical condition, can narrow the airways in the lungs, which result in coughing and phlegm. Pneumonia is an infection of the lower area of the lungs. The infection in the air sacs, can fill up with fluid and cause coughing with phlegm, fevers, chills and breathing problems. The infectious bacteria can go to other parts of the body and potentially be a more serious disease. Ear infection is caused by build up of fluid behind the eardrum. Children will become fussy, cry, have trouble sleeping, fever, problems with balance and trouble hearing.

Picture from: http://www. euro. who It is estimated that two people die each minute from tobacco-related disease in the Western Pacific Region. -World Health Organization Tobacco Fact Sheet (July 2013). http://www.who.int/mediacentre/factsheets/fs339/en/ www.euro.who.int

WHO Framework Convention on Tobacco Control Identifies key policy interventions critical to combat tobacco To stop the NCD epidemic, leaders at all levels must commit to fully enacting the provisions outlined in the Framework Convention WHO Framework Convention on Tobacco Control

Article 8: Protection from exposure to tobacco smoke total elimination of smoking and tobacco smoke in a particular space or environment in order to create a 100% smoke free environment indoor workplaces indoor public places public transport public outdoor places: entry ways, outdoor venues WHO Framework Convention on Tobacco Control

Important Considerations Smoke-free laws benefit overall conditions such as air quality, environment, health, and reduces smoking. Smoke-free air acts have been enforced in indoor workplaces, public transportation, beaches, and parks. Smoke-free air acts reduce smoking by 3.8% in Canada, United States, Australia and Germany in 2002, which is about 3.1 fewer cigarettes smoked per day per smoker. Source: Fichtenberg, C.M. & Glantz, S.A. (2002). “Effect of smoke-free workplaces on smoking behavior: systematic review,” British Medical Journal, 325(7357):188.

What can churches do? Encourage youth to involve themselves in church activities Educate your community about the harmful effects of tobacco and secondhand smoke Support those who are struggling with tobacco use, including betel nut Ban tobacco use at church related events Declaration of establishment as non-smoking.

What can schools do? Educate your youth about the harmful effects of tobacco and the problems it can have on their health Enforce rules about smoking at school Promote school activities or a week of awareness to discuss the problems associated with tobacco use and their harmful effects Ban smoking at school events and other school activities Declaration of establishment as non-smoking. Prohibit smoking in outdoor areas, such as outside of entrances and windows, and within a reasonable distance (no less than 15-20 feet).

What can communities do? Form or join a coalition to strategize for a smoke-free campaign Work together to help prohibit smoking in public places Educate your community about the harmful effects of tobacco and secondhand smoke Initiate smoke-free community events and activities Strictly enforce smoke-free laws Prohibit smoking in indoor workplaces and public places, including health care facilities, government buildings, restaurants, bars and gambling facilities. Declaration of establishment as non-smoking. Prohibit smoking in outdoor areas, such as outside of entrances and windows, and within a reasonable distance (no less than 15-20 feet).

What can I do? Talk to people that you know are interested in taking action in your community Find out where your community stands about secondhand smoke and smoke-free laws. Reach out to people in the public health sector to address this concern Put together a project with a team/working group who can help you speak at community meetings to help prohibit smoking in public places Prohibit smoking in indoor workplaces and public places, including health care facilities, churches, government buildings, restaurants, bars and gambling facilities. Prohibit smoking in enclosed residential facilities, including hotels/motels. Declaration of establishment as non-smoking. Prohibit smoking in outdoor areas, such as outside of entrances and windows, and within a reasonable distance (no less than 15-20 feet).

Pass and enforce model comprehensive smoke-free air acts Chuuk’s Example Target Population: National/ Catholic Church Members Summary: Indoor Clean Air Act of 2011  After Chuuk’s Legislative building was completely destroyed from a fire in 2011, a lot of the state policies had to be recreated and rewritten Chuuk State Law No. 191-08: Smoking Act of 1991 was repealed and changed it into a more comprehensive tobacco policy, the “Indoor Clean Air Act” of 2011 Indoor Clean Air Act of 2011: -indoor smoking, selling single tobaccos and tobacco products to minors became illegal Domino Effect: Catholic Churches in Chuuk started to prohibit their church members from smoking in church grounds and prohibited all Catholic Church officials from smoking and chewing Currently: NCD Coalition recognizes the need for policy evaluation and is looking towards incorporating policy assessments in NCD Action Plan for years 4 and 5 of the NCD grant cycle

Pass and enforce model comprehensive smoke-free air acts American Samoa’s Example Target Population: all Department of Health employees Summary: American Samoa Department of Health (DOH) Employee Wellness Policy #13-01 October 2013: DOH implemented a policy for all DOH employees relating to proper nutrition, physical activity and tobacco smoking Enforced Smoke-free Worksite became an extension of the Smoke-Free Environment Act of 2010 Prohibition of smoking and tobacco use in all DOH owned and/or leased locations/premises, including but not limited to all internal and external areas, parking lots and building entrances, as well as all DOH owned and/or leased vehicles

Pass and enforce model comprehensive smoke-free air acts Yap’s Example Target Population: Yap State Summary: 2010 State Law 7-75 Anti-smoking Act  A partnership with Yap’s Tobacco Program, Substance Abuse Program, Diabetes Program, Ministry of Health (MOH) and other community organizations and Yap’s NCD Program Educated political leaders on the harmful effects of second-hand smoking and looked at successful policies in other regions such as Hawaii’s anti-smoking laws In 2010, the anti-smoking law in public areas and workplaces was implemented Yap modified Hawaii’s 20 feet no smoking zone and made it into a 50 feet no smoking zones in building entrances

Pass and enforce model comprehensive smoke-free air acts Guam’s Example Target Population: National Summary: PL32-60: Ban of Electronic Cigarette Sales to Minors May 2014: Public Law 32-60 banned the sale of electronic cigarettes to minors Triggered by the increasing popularity of “vaping” or the use of electronic cigarettes among middle school and high school, in addition to the increasing propaganda selling electronic cigarettes as a safe alternative to tobacco smoking Guam’s Department of Public Health and Social Services (DPHSS) took the prohibition of using electronic cigarettes to include all DPHSS staff within all PHSS facilities Currently, the Guam Non Communicable Disease (NCD) Coalition is working on learning more about the contents of electronic cigarettes to better educate the public, especially the youth, on the harmful effects of these products

Who to contact? James Rarick Technical Officer, Tobacco Free Initiative WHO Western Pacific Regional Office Manila, Philippines E-mail:  rarickj@wpro.who.int