smoke-free policy development in the rural south carol a. riker, msn, rn associate professor...
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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 Accidents
Suicide
AIDS
Homicides
430,000
105,095
53,000
46,30030,906
29,93924,932
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
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
111
177
267
108 87121
172 158
0
100
200
300
400
500
PM2.
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-Law
Federal OUTDOOR standard
PM
2.5
(mic
rog
ram
per
cu
bic
met
er)
Air Pollution Dropped 91% After Lexington’s Smoke-free Law
BEFORE
AFTER0
50
100
150
200
250P
M 2
.5 m
icro
gra
m p
er c
ub
ic m
eter
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
PM
2.5
(mic
rogr
am p
er c
ubic
met
er)
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
hai
r n
ico
tin
e le
vel
After Lexington’s Smoke-free Law, Hair Nicotine Dropped by 56%
0
0.5
1
1.5
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5
Pre-law 3-months post-law
Bar
Restaurant
Geo
met
ric
mea
ns
for
hai
r n
ico
tin
e (n
g/m
g)
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
0
10
20
30
40
50
60
70
80
90
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.org
www.no-smoke.org
www.cdc.gov/tobacco
www.tcsg.org/tobacco.htm
Contact Us! Kentucky Center for Smoke-free Policy
www.kcsp.uky.edu [email protected] [email protected] 859-323-1730
University of Kentucky Tobacco Policy Research Program www.mc.uky.edu/tobaccopolicy [email protected] 859-257-2358