Smoke-free Policy Development in the Rural South Carol A. Riker, MSN, RN Associate Professor University of Kentucky College of Nursing Ellen J. Hahn, DNS, RN Professor, University of Kentucky College of Nursing and College of Public Health

Primary Purpose To describe a dissemination and implementation model used to promote local smoke-free policies in a rural, tobacco- growing state To evaluate findings from community-based studies related to smoke-free policy development

Nothing Kills Like Tobacco Cigarettes Alcohol 2 nd Hand Smoke Car Accidents Suicide AIDS Homicides 430, ,095 53,000 46,300 30,906 29,939 24,932 Source: Centers for Disease Control and Prevention (CDC)

MOST People Are Exposed to Secondhand Smoke An estimated 3,000 lung cancer and 35,000 heart disease deaths occur annually among adult nonsmokers in the U.S. from exposure to secondhand smoke Approximately 60% of people in the U.S. have biological evidence of exposure.

Secondhand tobacco smoke contains more than 4,000 chemicals 5 regulated hazardous air pollutants 47 regulated hazardous wastes 60 known or suspected cancer-causing agents More than 100 chemical poisons

Short-Term Heart Effects of Secondhand Smoke Exposure 5 minutes of exposure 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.

“I worked as a cocktail waitress in smoky restaurants and bars for 14 years. I have onset emphysema. My doctor says my constant exposure to tobacco smoke contributed significantly to my emphysema. No one should have to breathe tobacco smoke to hold a job.” Suzanne H

Kentucky Center for Smoke-free Policy (KCSP) Provides rural and urban communities across Kentucky with science-based strategies for advancing smoke-free policies on the local level and educating citizens and policymakers about the importance of smoke-free environments. Funded by seed money from The Robert Wood Johnson Foundation to the UK College of Nursing Tobacco Policy Research Program

Public Health Benefits of Smoke-Free Laws Nonsmokers protected Fewer children start to smoke Smokers consume fewer cigarettes More smokers quit

KCSP: Primary Functions Assess readiness Determine stage of readiness Use stage-specific, tailored strategies Assist communities to: Translate and disseminate science Build capacity Build demand

23 Community Partner Counties

Six Readiness Dimensions for Smoke-free Policy Development Knowledge about the negative health effects of smoking/secondhand smoke exposure (SHS) and existing smoke-free policies Existing smoke-free policies Leadership Resources Community climate Political climate

Community’s knowledge about the negative health effects of smoking and SHS exposure and existing smoke-free policies Mortality and morbidity related to smoking and SHS exposure Healthcare related expenses Workplaces, schools, restaurants and bars that are smoke-free

Existing smoke-free policies Voluntary smoke-free restaurants and bars Voluntary smoke-free workplaces Strength of school tobacco policies Youth access ordinances

Community leadership National/state partners - American Lung Association, American Heart Association, American Cancer Society Opinion shapers that support smoke-free policy – hospitals, health-care providers, health departments, religious leaders, business and labor leaders Major political players – both elected officials and non-elected leaders who support smoke-free policy Coalition members’ expertise Coalition leaders’ effectiveness

Community resources Tobacco control coalition Support from the medical community Support from community groups/foundations, youth-oriented, low income, and religious groups Media Money and in-kind donations Volunteers

Community climate Smoking incidence and prevalence rates (adults and youth) Strength of the pro and opposing smoke-free champions Media’s portrayal of smoking, SHS and smoke- free policy efforts Progressive versus conservative environment

Political climate Support of elected officials Pre-emption issue Election year effect Political champions Champion’s accessibility to politicians Issue framing Priority of other local policy issues being discussed

Stage of Readiness Unawareness Vague Awareness Pre-planning Preparation Initiation Endorsement

Effects of Smoke-free Laws on Indoor Air Quality From1991 to 2000, cotinine concentrations in the U.S. dropped to 58% for children, 55% for adolescents, and 75% for adults primarily due to changes in smoke-free policies. If all U.S. workplaces were smoke-free, it is estimated that after one year there would be 1.3 million new quitters and nearly $49 million would be saved in direct medical costs from treating sick smokers.

Average Fine Particle Air Pollution in Kentucky Communities, 2005

Air Pollution in a Rural Kentucky High School Student Restroom is 10 Times the Federal Outdoor Air Quality Standard and Over 2 Times Higher than Lexington’s Bars, Pre-Law PM2.5 (microgram per cubic meter)

Air Pollution Dropped 91% After Lexington’s Smoke-free Law

Indoor air pollution in the Bingo Hall was 11 times higher than the Federal Outdoor Standard after the law

Median hair nicotine level After Lexington’s Smoke-free Law, Hair Nicotine Dropped by 56%

Geometric means for hair nicotine (ng/mg) Geometric means by establishment type and time, adjusted for cigarettes per day The Average Decrease in Hair Nicotine Was Greater in Bar Workers

Respiratory Symptoms among Restaurant and Bar Workers, Pre-law and 3 months Post-law

Lexington’s Public Support and Knowledge of Health Risks Before and After the Law Public support for the law increased significantly.

The Economics of Smoke-free Laws A large number of studies using objective measures show no negative economic impact. Smoke-free measures have been shown to improve business. A few studies using subjective measures show negative economic impact.

Economic Impact of Lexington’s Law on Fayette County Restaurants and Bars 3% increase in restaurant employment Bar employment remained stable No change in payroll withholding taxes in restaurants or bars No change in business openings or closures in alcohol-serving establishments or at non- alcohol serving establishments

“Not since the polio vaccine has this nation had a better opportunity to make a significant impact in public health.” David Satcher, MD, PhD, Former U.S. Surgeon General

For more information about secondhand smoke and smoke-free environments:

Contact Us! Kentucky Center for Smoke-free Policy University of Kentucky Tobacco Policy Research Program