1. Paul Hunting, MPH Health Education Specialist Centers for Disease Control and Prevention Office on Smoking and Health TM So You Passed a SHS Law: Now What? Session #: POLI - 40 National Conference on Tobacco or Health Minneapolis, MN October 24, 2007 3:30 – 5:00 pm The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.

2. TM So Who IS Smoke-free? (as of October 2007) Arizona*California*Colorado Connecticut*DelawareDistrict of Columbia FloridaHawaiiIdaho* IllinoisLouisianaMaine* Maryland* Montana New Jersey North Dakota* Puerto Rico* Utah Massachusetts Nevada New Mexico* Ohio Rhode Island Vermont* Minnesota* New Hampshire* New York Oregon* South Dakota* Washington Source * : ANR Foundation Fact Sheet: Summary of 100% Smokefree State Laws; October, 2007 Source: CDC/OSH, STATE System

3. TM So Who IS Smoke-free? (as of October 2007) 58.6% of the US population is covered by SHS Protections! Source: ANR Foundation Fact Sheet: Summary of 100% Smokefree State Laws; October 1, 2007 Workplaces and/or Restaurants and/or Bars

4. TM SHS, Health, and the OSH Goal Areas Reducing exposure to SHS has positive health impacts well beyond just clearing the air…

5. TM Health Effects in a Sound Bite “The debate is over. The science is clear: Secondhand smoke is not a mere annoyance, but a serious health hazard” - U.S. Surgeon General Richard Carmona Source: Press Conference on The Health Consequences of Involuntary Exposure to Tobacco Smoke : a Report of the Surgeon General. – U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, [2006]

6. TM Exposure  “Median cotinine level in nonsmokers had decreased across the life stages: by 68 percent in children, 69 percent in adolescents, and 75 percent in adults,” (as compared to samples collected in the early 90’s)  “It is clear that banning smoking from the workplace is the only effective way to ensure that exposures are not occurring.”  “The home remains the most serious venue for secondhand smoke exposure.” Source: The Health Consequences of Involuntary Exposure to Tobacco Smoke : a Report of the Surgeon General. – U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, [2006]

7. TM Exposure Reduction PM2.5 in Micrograms per cubic meter Source: Indoor Air Quality in Hospitality Venues Before and After Implementation of a Clean Indoor Air Law --- Western New York, 2003, MMWR, November 12, 2004 / 53(44);1038-1041

8. TM SHS is a Toxic Air Contaminant  Forced or involuntary inhalation of tobacco smoke (TTS) is a Toxic Air Contaminant (TAC).  TTS is a mixture of compounds including benzene, 1,3 butadiene and arsenic.  TTS releases into the air: –40 tons of nicotine, –365 tons of respirable particulate matter, and –1900 tons of carbon monoxide in California alone. Source: California EPA: Office of Environmental Health Hazard Assessment, February 2006

9. TM Effects Causally Associated with SHS Exposure  Developmental Effects: Low birth-weight; SIDS; and Pre-term delivery  Respiratory Effects: Acute lower respiratory tract infections in children; Asthma induction and exacerbation; Chronic respiratory symptoms in children; Eye and nasal irritation in adults; and Middle ear infections in children  Carcinogenic Effects: Lung cancer; Nasal sinus cancer; and Breast cancer in younger, primarily pre-menopausal women  Cardiovascular Effects: Heart disease mortality; Acute and chronic coronary heart disease morbidity; and Altered vascular properties Source: California EPA: Office of Environmental Health Hazard Assessment, February 2006

10. TM Estimated Annual Morbidity & Mortality in Non-Smokers from SHS Exposure in California Select Data  Asthma: New cases in kids: 31,000  4,021 Deaths (Heart Disease; Lung Cancer; and SIDS)  Breast Cancer Risk –Approximate 68-120% increased risk Source: California EPA: Office of Environmental Health Hazard Assessment, February 2006

11. TM SHS and Youth Initiation Students exposed to SHS in places other than the home were 1.3 to 1.8 times more likely to be susceptible (to becoming regular smokers).” Source: “Exposure to Secondhand Smoke Among Students Aged 13–15 Years Worldwide, 2000-2007”—MMWR, 25 May 2007 / Vol. 56 / No. 20.

12. TM SHS and Cessation/Consumption A 2002 review of 26 studies concluded that a complete smoking ban in the workplace reduces smoking prevalence among employees by 3.8% and daily cigarette consumption by 3.1 cigarettes among employees who continue to smoke. –Fichtenberg CM, Glantz SA., British Medical Journal. 2002;325:188 Source: Centers for Disease Control and Prevention, Office on Smoking and Health: Fact Sheet, Smoke-Free Policies Reduce Smoking, (October 2006)

13. TM Health IT GETS BETTER!!!  In Laramie, WY, The median post-bar visitation cotinine levels for the 13 participants dropped by 89% after enactment of the smoking ban.  Had the law not been put in place, the study also estimates SHS exposure would have caused 37 SHS- related deaths per 1000 career bar workers in Laramie. Source: J.L. Repace, LARAMIE, WYOMING BAR PATRON COTININE STUDY, September 2005

14. TM New OSH Opportunity!  OSH is now offering a limited number of state- specific SHS training opportunities for states that pass statewide SHS laws. –½ to a full day in length –Offered at your convenience and in-state –Agendas are customizable to meet state-specific priorities –Content experts attend in-person or over the phone –Offered at no cost to the states  Work with your state Program Manager to determine eligibility and set up your state training soon.

15. TM Resources  The Health Consequences of Involuntary Exposure to Tobacco Smoke – US – DHHS, 2006  Model Ordinance – Americans for Nonsmokers’ Rights; 2/2007; http://www.no-smoke.org/document.php?id=229 http://www.no-smoke.org/document.php?id=229  Save Lives, Save Money: Make Your Business Smoke Free – CDC/OSH, 2007  Bar Patron Cotinine Study – Laramie Wyoming, 2005  A Toolkit for Implementing and Defending Smoke-Free Ordinances - ClearWay Minnesota, 2007  TCP Clean Indoor Air Law Implementation Tool Kit – New York, 2003  The Smoke-Free New Mexico Website: http://www.smokefreenm.com – New Mexico, 2007  Eliminating Smoking in Bars, Taverns and Gaming Clubs – California, 2001

16. TM Take Aways…  Be prepared;  You are not alone, call on the experiences of others;  SHS work impacts all aspects of your comprehensive program;  SHS is more hazardous than most people realize so you need to make the realize it. Danger = Hazard + Outrage

17. Paul Hunting, MPH Centers for Disease Control and Prevention Office on Smoking and Health 4770 Buford Hwy., NE, MS K-50 (mailing) 3005 Chamblee-Tucker Rd., 2nd floor (delivery) Atlanta, GA 30341 Ph: 770-488-1165 Fx: 770-488-1220 PHunting@cdc.gov www.cdc.gov/tobacco TM CS113350 Implementing State Laws: A Shared Experience