Smoke-free Policy Development in the

Rural South

Carol A. Riker, MSN, RNAssociate Professor

University of Kentucky College of Nursing

Ellen J. Hahn, DNS, RNProfessor, 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

Yearly Deaths in the U.S.A.

Cigarettes

Alcohol

2nd Hand Smoke

Car AccidentsSuicide

AIDS

Homicides

430,000105,095

53,00046,300

30,90629,93924,932

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

www.kcsp.uky.edu

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

Existing smoke-free policies

Community climate

Political climate

Resources

Community knowledge about

SHS & existing efforts

Leadership

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

395

111177

267

108 87121

172 158

0

100

200

300

400

500PM

2.5 in

mic

rogr

ams

per c

ubic

met

er

Figure 2. Average Fine Particle Air PollutionIn Kentucky Communities, 2005

Note. Rural communities in black

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

670

293

65

0

100

200

300

400

500

600

700

800 Rural High School Restroom

Lexington Bars Pre-LawFederal OUTDOOR standard

PM2.

5 (m

icro

gram

per

cub

ic m

eter

)

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

BEFORE

AFTER0

50

100

150

200

250PM

2.5

mic

rogr

am p

er c

ubic

met

er

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

740

0

100

200

300

400

500

600

700

800

PM2.

5 (m

icro

gram

per

cub

ic m

eter

)

FederalOutdoorStandard

GeorgetownBingo Hall

LexingtonBars

GeorgetownBingo Hall

LexingtonBars

Before Smokefree Ordinance

After Smokefree Ordinance

740

227

65

0

0.5

1

1.5

2

2.5

3

Pre-law 3 months Post-law

Med

ian

hair

nico

tine

leve

lAfter Lexington’s Smoke-free Law, Hair Nicotine Dropped by 56%

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Pre-law 3-months post-law

BarRestaurant

Geo

met

ric m

eans

for h

air n

icot

ine

(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

0102030405060708090

Cold/ sinus Runny nose/ sneezing

Pre-Law (n = 104)Post-Law (n = 71)

Lexington’s Public Support and Knowledge of Health Risks Before and After the Law

56.764.0

70.274.7

0

20

40

60

80

100

Public Support SHS as Health Risk

Pre-lawPost-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:

www.tobaccoscam.orgwww.no-smoke.org

www.cdc.gov/tobaccowww.tcsg.org/tobacco.htm

Contact Us! Kentucky Center for Smoke-free Policy

www.kcsp.uky.edu kcsp00@lsv.uky.edu HRobertson@uky.edu 859-323-1730

University of Kentucky Tobacco Policy Research Program www.mc.uky.edu/tobaccopolicy ejhahn00@email.uky.edu 859-257-2358