Prevention Matters

A person’s decision to light up can have serious consequences for their health, but also for the health of those around them. Secondhand smoke is known to cause heart disease and lung cancer in nonsmoking adults but also to cause sudden infant death syndrome, acute respiratory infections, middle ear disease, exacerbated asthma, respiratory symptoms, and decreased lung function in children. Given these health hazards, how effective are our nation’s safeguards at preventing this secondhand exposure?

This week’s Morbidity and Mortality Weekly Report (MMWR), “Vital Signs: Nonsmokers’ Exposure to Secondhand Smoke – United States, 1999-2008,” provides the answer to this question by determining the proportion of the nonsmoking population who are exposed to secondhand smoke and by analyzing past trends in secondhand smoke exposure as determined by the 1999 to 2008 National Health and Nutrition Examination Surveys. Study results showed that the prevalence of secondhand smoke exposure among nonsmokers declined from 52.5% during the 1999-2000 survey to 40.1% during the 2007-2008 survey.

Despite this significant decrease in secondhand smoke exposure, this decline was only present for nonsmokers who did not live with a smoker in their home and also was not significant for non-Hispanic whites. This decline has also been shown to fluctuate from year to year and to be quite inconsistent. Furthermore, disparities among secondhand exposure still exists and study results have shown that exposure during every survey cycle is greater among men than among women; among non-Hispanic blacks than among non-Hispanic whites and Mexican-Americans; among children and youth than among adults; and among those below the federal poverty line than among those at or above the federal poverty line. What is most impressive, however, is that despite this decline in secondhand smoke exposure, 88 million nonsmokers who are above the age of three were still exposed to secondhand smoke during 2007-2008 and among these 88 million, 32 million were America’s children and youth (ages 3-19 years).

The results reported in this MMWR have major implications for public health practice and policies. Partnership for Prevention advocates for increases in state, local, and voluntary smoke-free policies in order to make this decline in secondhand exposure consistent and to eliminate existing disparities, especially among youth and children. Currently only twenty-four states and the District of Columbia have comprehensive smoke-free laws covering workplaces, restaurants, and bars. Complete state-wide bans are needed in order to reduce secondhand smoke exposure and protect the American public.

Homes were also shown to be a major source of secondhand smoke exposure, especially for children. Following the American Academy of Pediatrics and the U.S. Public Health Service’s recommendation, Partnership for Prevention supports efforts to increase clinician interventions for those parents who smoke. It is recommended that these parents not only get help in quitting smoking, but are also educated about the harms of secondhand smoke.

The Healthy People 2010 goal of reducing secondhand smoke exposure among the nonsmoking population to less than 56% has been accomplished. However, there are still a vast number of Americans who are exposed to the potential dangers of secondhand smoke. With more smoke-free policies and a greater emphasis on preventing at-home exposure, we can do a better job of safeguarding America’s nonsmokers.


Katie Burggraf
Tobacco Control Team
Partnership for Prevention

A recent USA Today/Gallup poll found that opinions on smoking in public places are drastically changing and not to the benefit of tobacco users. Since Gallup’s first poll in 1987 on restricting smoking in public places, respondents have become increasingly opposed to smoking in restaurants, hotels, and in workplaces. The percentage of those in support of banning smoking in restaurants and hotels has more than tripled since the first Gallop poll, and has more than doubled for the percentage of those in favor of workplace smoking bans.

The 2010 Gallup poll found that 59 percent of respondents believed that smoking should be banned in restaurants, an increase when compared to the 54 percent who wanted smoking restrictions in restaurants during the 2007 Gallup poll. Partnership for Prevention is pleased that smoking bans in public places are becoming more and more popular and the risks of secondhand smoke are also becoming increasingly evident. However, only 31 percent of poll respondents favored, in bars. In fact, 23 percent of respondents actually favored having no restrictions in bars and 43 percent believed that designated areas should be set aside for smokers in bars. In addition, while only 36 percent of participants felt that smokers should be accommodated in restaurants, the majority thought that smokers should be accommodated in workplaces and hotels/motels (52% and 58% respectively).

Why this change in opinion all of a sudden?

One possible reason is that the percentage of current cigarette smokers has declined from 30 percent in 1987 to the current prevalence of 22 percent. Gallup polls have consistently shown that nonsmokers are more likely to support smoking bans compared to smokers. Thus, this decline in smoking trends could offer some explanation as to why public smoking is being favored less and less.

Another possible reason is that the public is becoming increasingly aware of the dangers of secondhand smoke, especially after the US Surgeon General’s 2006 report, The Health Consequences of Involuntary Exposure to Tobacco Smoke. The percentage of people who perceive that exposure to secondhand smoke poses a serious threat to a nonsmoker’s health has also increased dramatically from 36 percent in 1994 to 55 percent in 2010.

These poll results suggest that we may be going further than the majority of Americans would prefer with some restrictions on public smoking, but more importantly that we may not be going far enough with other restrictions. Currently only half of all states in the U.S. have broad smoking bans that restrict smoking in public places.

The question remains however: How far should we go?

Certainly we need to protect nonsmokers from the dangers of secondhand smoke, but at what point do we have to stop ignoring public opinion? Perhaps the problem is not simply overriding the public’s opinion on smoking bans, but rather working towards educating the public and helping to change the public’s opinion on smoking restrictions in public places.

For more information please visit: http://www.gallup.com/poll/141809/americans-smoking-off-menu-restaurants.aspx


Katie Burggraf
Tobacco Control Team
Partnership for Prevention

A study showing that children benefit from laws that regulate locations where smoking is allowed was named the “Best Prevention Idea of the Week,” while a study that found that loose infection practices are contributing to problems with infection control at same-day surgery centers was named the “Worst Prevention Idea of the Week."

BEST

Smoke-Free Laws Benefit Kids, Too

Kids benefit from laws that regulate locations where smoking is allowed, a new study shows.

Smoke-free-air laws have already been shown to reduce exposure to secondhand smoke among adults. Now a study shows that such laws benefit children and adolescents, too, as long as they don't live with a smoker.

Researchers analyzed data from the 1999-2006 National Health and Nutrition Examination Survey and found that youngsters who live in a county with extensive smoke-free-air laws had a 39% lower prevalence of cotinine in their blood. Cotinine, an alkaloid found in tobacco, is a major metabolite of nicotine and a common biomarker of secondhand smoke exposure. It is detectable in blood for a minimum of several days after exposure to tobacco smoke.

WORST

Poor infection control at many surgery centers


A new federal study finds many same-day surgery centers — where patients get such things as foot operations and pain injections — have serious problems with infection control. Failure to wash hands, wear gloves and clean blood glucose meters were among the reported breaches. Clinics reused devices meant for one person or dipped into single-dose medicine vials for multiple patients. The findings, appearing in last Wednesday's Journal of the American Medical Association, suggest lax infection practices may pervade the nation's more than 5,000 outpatient centers, experts said.

The United States is continuing to make great strides toward the elimination of tobacco smoke in the country’s air. According to the Americans for Nonsmokers’ Rights Foundation, as of April 1, 2010, 32 states, along with Puerto Rico, the Northern Mariana Islands, and the District of Columbia have strong state/commonwealth laws in effect that qualify for at least one of the 100% smokefree list categories (workplaces, restaurants, and/or bars). A total of 38 states and the District of Columbia now have 100% smokefree air laws in effect at the local level. Adding to this growing list, by July 5, 2010, Michigan, Kansas and Wisconsin will all be 100% smokefree. More specifically, 57.2% of the U.S. population now lives in cities or states with smokefree non-hospitality workplaces; 68.1% in areas with smokefree restaurants; and 57.1% in areas with smokefree freestanding bars. Forty-one percent of the population is currently protected in all three categories.

For more smokefree lists, maps and reports visit Americans for Nonsmokers' Rights.

Alex Einhorn
Policy and Program Intern

The New York Times reports that tobacco manufacturer Altria apparently hopes to navigate around indoor smoking ban laws by persuading the Food and Drug and Administration to let them market smokeless tobacco as far less harmful than cigarettes. 

"While public health doctors agree that the smokeless products are far less hazardous to individuals than cigarettes, they still have concerns because all tobacco products contain nicotine and carcinogens," write the Times' Duff Wilson and Julie Creswell.. "They also contend that promoting smokeless products — some in tiny packages in the shape of cigarette packs — would attract new, perhaps younger customers and maintain the addiction for smokers who might otherwise quit. They note that Altria is adding flavorings to its smokeless products that have long been used in candy.Furthermore, critics say, "

Heart attack rates fall 17% within a year after smoking bans take effect, according to two recent analyses of laws in the USA, Canada and Europe. One analysis, which included 13 studies, appears in Circulation: Journal of the American Heart Association. A second analysis, which considered 11 studies, appears in the Journal of the American College of Cardiology.

Congrats to the University of Louisville!

On November 19, 2009, the University of Louisville will begin its transition toward becoming a smoke-free campus. While some smoking areas will be designated temporarily, the campus will go entirely smoke free in June, 2010. Congratulations to president, Dr. James Ramsey, and the university leadership for making what must have been a difficult decision. Bucking the powerful tobacco industry and facing down disgruntled smoking student and university workers are no easy tasks. You did the right thing!

Tobacco use costs our nation more than $150 billion annually. Smoking is the leading cause of preventable death. Yet, there is hope – if tobacco users quit by age 30, their life expectancy is comparable to that of non-smokers. And, stopping tobacco use at any age can bring improved health.

Along with instituting a smoking ban, I encourage the University to make comprehensive cessation counseling, quitlines and medications available to all employees and students. Smoking cessation treatment is one of the highest ranked preventive health services – very positive health impact and cost effective.

I’m very proud of my alma mater and encourage all campuses throughout the United States to become smoke-free.

Diane M. Canova, JD
Managing Senior Fellow
& Senior Program Officer

The governor of the nation's largest tobacco-producing state has signed into law a statewide ban on smoking in bars and restaurants. The North Carolina ban doesn’t take effect until Jan. 2, 2010. The bill's chief backer in the legislature left open the possibility that he would try in the future to broaden the new smoking ban in order to cover businesses beyond restaurants and bars.

A new study suggests that comprehensive clean indoor air policies do not lead to a reduction in hospitality jobs, and that exempting bars from community smoking bans makes no economic difference in terms of preserving bar employment.

The research, published in the June issue of the journal Prevention Science, this is the first analysis to compare the economic effects of different levels of clean indoor air policies in multiple cities. The study, led by Elizabeth Klein, assistant professor of health behavior and health promotion at Ohio State University, examined employment trends over three years in eight Minnesota cities with different types of clean indoor air policies and two cities with no laws restricting smoking.

Kudos to Wisconsin and North Carolina for becoming the latest states to act to protect their citizens from the dangers of secondhand smoke. On May 13, both state legislatures gave final approval to bills calling for smoke-free workplaces, restaurants and bars.

As one might expect, Wisconsin’s law is much stronger – calls for 100 percent smoke free workplaces, restaurants, bars and hotel rooms. As with most state laws, certain exemptions are provided – in this case, for cigar bars and tobacco retail shops. And, as often is the case, some preemption language “slipped in.” The state allows certain businesses to designate outdoor smoking areas on privately-owned property – local municipalities are preempted from passing stronger laws affecting private property, like bar or restaurant patios. However, local communities CAN pass stronger indoor and outdoor restrictions on publicly-owned property. The governor is expected to sign the bill early next week.

Now for North Carolina – a big applause for bucking the odds and passing a statewide law. Remember, this is the state that gave us Winston and Salem cigarette brands and still feels significant pressure from “big tobacco.” While all workers won’t be protected from dangerous secondhand smoke, an important group – restaurant and bar employees, as well as their patrons, will be able to breathe easier. Governor Beverly Perdue is expected to sign the bill, which would go into effect January 2, 2010. We appreciate the efforts of the North Carolina Alliance for Health and NC Prevention Partners who pressed for stronger protections and who will continue to fight for the health of all North Carolinians.


Diane M. Canova
Managing Senior Fellow
& Senior Program Officer

An Ohio program to train beauticians about cancer screening was named Partnership for Prevention's Best Prevention Idea of the Week, while a recent vote by the Nevada Senate to soften a statewide smoking ban was named the Worst Prevention Idea of the week.

The Best/Worst Idea awards are a regular feature of Prevention Matters, the blog of Partnership for Prevention. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week's news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org .


BEST

Beauticians learning cancer prevention

The Cleveland Clinic is training local beauticians about cancer screenings and research information. The program is targeted to African-American women. Salon employees were educated on how to give encouragement and guidance for clients who need mammograms and breast health information


WORST

Nevada Senators Vote to Ease the State’s Ban on Smoking

The Nevada Senate voted 16 to 5 on Friday to advance a measure that would soften a statewide smoking ban, putting the state on track to become the first in the nation to ease restrictions it had imposed on cigarette use in public spaces. The Nevada Clean Indoor Air Act, which took effect in 2007, bans smoking in any indoor space where minors may be present and where food is served. The new bill, which now moves to the Assembly for consideration, would allow taverns that offer food to permit smoking if they bar people under 21 from entry.

Only two states passed comprehensive smokefree laws in 2008, while only three states and the District of Columbia raised their tobacco taxes, according to a new report from the American Lung Association.

Stephen J. Nolan, American Lung Association National Board Chairsaid the results indicated that "the significant momentum previously achieved with the passage of smokefree workplace laws stalled during 2008."

To date, 24 states and the District have passed comprehensive smokefree laws as part of the American Lung Association's Smokefree Air challenge.