1. Public Health Nursing Practice: Finding Evidence to Apply to Environmental Health Issues Searching for Smoke-Free Air

2. Secondhand Smoke (SHS) Definition: A combination of “sidestream” smoke given off by smoldering cigarettes, cigars and pipes, as well as “mainstream” smoke exhaled by smokers.

3. Also known as... Environmental Tobacco Smoke (ETS) Passive Smoking Involuntary Smoking

4. Some of the Poisons Found in Secondhand Smoke Acetone Ammonia Arsenic Asbestos Benzene Carbon Monoxide Chromium VI DDT Formaldehyde Hydrogen Cyanide Lead Nicotine

5. Secondhand Smoke = Cigarette Smoking Two hours in smoky bar Two hours in a nonsmoking section of restaurant 24 hours living with a pack-a-day smoker = = = Source: JAMA, July 28, 1993 – Vol. 270, No. 4, pp. 490-493

6. Health Effects on Adults 3 rd leading cause of preventable death in the US Causes 40,000 – 60,000 deaths a year in the US 30% increased risk of coronary heart disease in non-smokers Aggravates cystic fibrosis, asthma, and other lung conditions

7. Smoke-Free Laws Decrease Heart Attack Deaths Study conducted in Helena, Montana – a remote community served by one hospital Compared heart attack admissions before, during and after the law was in effect Findings: After the law went into effect, hospital admissions for heart attacks fell by 40%; when the law was suspended, admission rates rebounded

8. Health Effects on Children Estimated 2,300 SIDS fatalities a year Bronchitis & pneumonia in infants & toddlers – 150,000 - 300,000 cases – 7,500 - 15,000 hospitalizations – 136 - 212 deaths Estimated 17,000 children develop asthma Up to 1,000,000 asthma attacks

9. Exposure to Secondhand Smoke in WI BRFSS Behavioral Risk Factor Surveillance System YTS Youth Tobacco Survey

10. BRFSS 2006 65.5% said yes to being exposed to other people’s tobacco smoke while in public places

11. YTS 2006 40% of youth report living in homes where others smoke 60.7% report being in the same room as other who smoke during the week

12. Wisconsin Department of Health and Family Services 2006 Behavioral Risk Factor Surveillance System (BRFSS)

13. Smoking Rates vs ER Visits for Asthma by County

14. Deaths Related to Smoking in Wisconsin 7,215 Wisconsin Residents die annually from illnesses directly related to smoking 853 Wisconsin Residents die annually from illnesses and fires indirectly related to smoking

15. Economic Impact of Smoking in Wisconsin In 2003 an estimated $2.2 billion in health care costs Wisconsin lost $1.6 billion in productivity costs in 2001 In 2004 Wisconsin residents spent $1.5 billion on over 384 million packs of cigarettes

16. WI Tobacco Prevention and Control Program CDC Guidance Priorities – Smoke-Free Air – Youth Prevention – Treating Tobacco Dependence – Reducing Disparities

17. Local Tobacco Control Coalitions 42 Local Tobacco Control Coalitions Local Public Health Departments – Primary Partners Lead Role for Local Tobacco Control Efforts – Coalition Coordinators

18. Local Tobacco Control Coalitions Coalition Building Community Mobilization Diverse & Representative Membership State Partnerships

19. Local Tobacco Control Coalitions Strategies – System Level Initiatives – Policy Change – Media Advocacy – Education & Advocacy at the Local and State Levels

20. Local Tobacco Control Coalitions Smoke-Free Air – Eliminate exposure to secondhand smoke – 100% Workplace Policies/Advocate for Smoke-Free Homes

21. Smoke-Free Communities in Wisconsin Appleton, Eau Claire, Madison, Marshfield, Shorewood and Shorewood Hills have enacted 100% smoke-free workplace ordinances (includes restaurants and bars). A total of 28 Wisconsin communities have smoke-free ordinances in place which are not 100% comprehensive.

22. States with Smoke-Free Laws That Cover All Restaurants and Bars

23. By 1994, most of the communities in Dane County enacted smoke-free restaurant ordinances. By 1997 revenue grew 24% vs a 19% increase in the rest of the State. The demand for liquor licenses in the City of Appleton grew from 112 (before their smoke-free ordinance) to 122 in 2007. Economic Impact in Wisconsin

24. The Impact of a Smoke-Free Ordinance on the Health and Attitudes of Bartenders A significant reduction in upper respiratory symptoms among bartenders following the establishment of smoke-free workplace ordinances in Madison and Appleton was demonstrated especially among non- smokers.

25. Searching for Smoke Free Air Keywords Tobacco, cigarettes, Smoking Tobacco Smoke Pollution Secondhand Smoke Tobacco Control Passive smoking Smoke Free Workplace Smoke Free Legislation Environmental Tobacco Smoke Smoke Free Air Tobacco Exposure Nonsmokers, Nonsmokers Rights Clean Indoor Air Smoking Regulations, Bans, Policies Ventilation