1. Smoke-free Air Policies to Reduce Smoking
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2. 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):

3. 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).
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. 
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4. 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.

5. 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).  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
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Picture is from Dr. Lee Buenconsejo-Lum

6. 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.

7. 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.
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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.

8. 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).

9. 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

10. 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

11. 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.

12. 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.

13. 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 feet).

14. 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 feet).

15. 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 feet).

16. 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 : 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

17. 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

18. 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

19. 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 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

20. Who to contact?
James Rarick Technical Officer, Tobacco Free Initiative
WHO Western Pacific Regional Office
Manila, Philippines  