9.19.2012

Digest #32: This Month in Smoke-free News

This month's "top story" is a local one for me: Arizona State University, the largest university in the country, is one (big) step closer to becoming a tobacco-free campus. On Monday, September 17, the ASU University Senate approved a motion to ban tobacco on campus next fall. I have personally been working with the ASU Health & Counseling Student Action Committee to continue their longstanding efforts to get a policy passed, and after getting the support of over thousands of students over the past few years (including that of the undergraduate student government), university leaders now seem ready to make the change.

Meanwhile, student leaders at the University of Arizona, ASU's arch-rival, are making progress of their own, so much so that I decided to pose an unofficial online "race" to a tobacco-free campus policy on Facebook. Unless the U of A is able to get a policy passed and effective fall 2013, it appears that ASU will win this race. A new push for a tobacco-free Pima County may help the cause. With that having been said, I would hope that the U of A would not pass a policy without adequate forethought; much planning needs to be done to make any tobacco-restrictive policy work as intended.

Some ASU students are voicing legitimate concerns about moving smoking off of campus property--and onto streets and/or private property. Interestingly, since the University of Oklahoma went smoke-free this year, a street corner nicknamed 'Cancer Corner' has developed into a smoking haven. Even more interesting is that the CEO of the company that owns the property is actually accommodating the smokers, offering to install a bench, trash cans and a smoking urn to help keep the property clean. Still, one student had this to say about his experience smoking on Cancer Corner:
“People look at us like we’re meth heads, but we’re not drug users,” --University of Oklahoma freshman
...Oh, but you are--you just don't realize it.

Regardless, all of this comes at a time when the US Department of Health & Human Services is launching its National Tobacco-free College Campus Initiative, so I am hopeful that, within a couple of years, these collegiate updates will no longer be newsworthy, but rather commonplace.

Other news:

  • A slap in the face of Big Tobacco: A new apartment complex in Richmond, Virginia--home of tobacco giant Philip Morris, will have a smoke-free policy.
  • I ran across what I thought was a catchy campaign to get small communities to adopt tobacco-free parks, pools and playgrounds: Young Lungs at Play. I gather that the program was developed by none other than Penn State...Nobody ever hears about the good news...
  • A Dairy Queen in Indiana, a state that recently passed a highly controversial smoke-free policy, has installed a "no smoking" sign on its drive-thru window. Ignoring the strong possibility that many Dairy Queen drive-thru customers have kids in the car (see recent debate in Utah about smoking with kids in the car), this is still a very interesting topic. While some would say that smokers have the right to smoke in their car, fast food workers can argue that secondhand smoke drifting through the drive-thru window endangers their health. I must I would like to see more of this kind of activity at other fast food chains, nationwide--regardless if local smoking ordinances are in place or not...but I suggest that we don't start in New York City, where sugary drinks over 16 oz. will be banned as soon as March. Let's not anger the customers too much...

8.27.2012

Digest #31: This Week in Smoke-free News

By far the biggest news in tobacco control this week was the US Court of Appeals decision against the proposed FDA graphic warning labels that were originally set to debut on all cigarette packages in September. Again, RJ Reynolds and other tobacco companies won on First Amendment grounds, in that the government's attempt to force tobacco companies to include the warning labels surpasses the limits of commercial speech regulation.

This is such a tough issue for me because, on the one hand, I do believe that the government has a substantial interest--backed by more than a "shred of evidence"--in discouraging the purchase of cigarettes, but on the other hand, I have the utmost respect for the First Amendment and freedom of speech. I've joked about how we somehow need to amend the First Amendment so that regulations such as this one can pass legal scrutiny, but the problem isn't with the way that the First Amendment is worded (i.e., "Congress shall make no law...abridging the freedom of speech, or of the press..."), but rather the precedent for regulating commercial speech that has been developed over the last century or so. Since Central Hudson Gas & Electric Corp. v. Public Service Commission was decided in 1980, the following four questions have generally been asked of cases involving regulation of commercial speech, so I'll attempt to answer them:


  1. Is the expression protected by the First Amendment? Lawful? Misleading? Fraud? The expression is lawful and not misleading. Statements like "Smoking can kill you" are scientifically verifiable.
  2. Is the asserted government interest substantial? You bet it is. Healthcare costs alone make smoking prevention a substantial interest of government.
  3. Does the regulation directly advance the governmental interest asserted? I sure think so. By placing graphic warning labels on the cigarette packages, the FDA is attempting to intercept smokers before they pull out a cigarette.
  4. Is the regulation more extensive than is necessary to serve that interest?  This is where I think the issue lies and the FDA may have gotten ahead of itself. Some of the proposed images depict worst-case scenarios: a man exhaling smoke with a hole in his throat, a pair of the ugliest lungs possible, and a corpse. However, some images, like the child being exposed to secondhand smoke, aren't unreasonable--they merely elicit strong emotion. Perhaps if all of the imagery were illustrated similarly to the one pictured above, the Court would have ruled differently.

For the sake of public health, I hope that the Supreme Court has a different opinion.

8.19.2012

Digest #30: This Summer in Smoke-free News

I'm back! I bet you thought that I'd never post again--but here I am. It's been an incredibly busy few months for me in terms of work, my Legacy fellowship, my various volunteer commitments, and my move to a new apartment, so I have a ton of news to share, which means I'll have to keep my commentary to a minimum. Going forward, I intend to blog more frequently with shorter posts, which will probably be easier for me to sustain and for my audience to digest. But for now:
  • The Oregon Zoo went tobacco-free on May 26. Kim Smith, the zoo director, was quoted saying, "Eliminating tobacco and its byproducts, particularly secondhand smoke, will help us provide a healthy, safe environment for visitors, staff and animals." Although I've discussed the need to reduce smoking exposure among children in places like county fairs (great job, San Diego!), I haven't discussed much about how secondhand smoke--and thirdhand smoke, for that matter--impact animals. Many animals have lungs, so they face several of the same risks that humans do. Moral of the story: Don't let anyone smoke around your pets.
  • Contrary to what had been reported soon after the smoking ban in New York City parks went into effect, there is evidence that it is working. The health department observed 68 percent fewer smokers in 13 selected parks in Manhattan and Brooklyn, including Central Park. A comparable reduction in cigarette butts on beaches (where smoking is also banned) was also witnessed. These findings are timely, as Atlanta's City Council recently approved a ban in city parks, and the King County (i.e., Seattle area) Council is considering a similar measure.
  • And now for a topic that pulls my conscience in two opposing directions: smoking bans in apartment buildings. I've said that I'm conflicted between my sense of need to improve the public health at all costs and my more libertarian side, in that I am hesitant to approve of a smoking ban in private spaces. Now, a new study has found that, in many non-smoking apartment buildings, non-smokers are still frequently exposed to secondhand smoke, a small segment of which reported exposure in their own units (presumably through shared ventilation). So, while the bans may not be effective, this begs the question of whether these bans are even enforceable. Back in April, though, NYC Mayor Bloomberg pushed to require owners of residential buildings to adopt smoking policies (whether smoking is permitted or not), which would then have to be disclosed to prospective buyers and tenants. The still doesn't address the enforcement issue, but this seems like the logical first step to me. Interestingly, Santa Monica, CA was going to require that existing apartment tenants who want their units excepted from the new apartment smoking ban to declare so--but reneged upon a second reading of the ordinance. 
  • The U.S. Air Force has cracked down on not only smoking, but all other tobacco use on Air Force property. As of March 26, all Air Force hospitals and clinics are tobacco-free environments Lt. Col. John Oh, chief of health promotion for the Air Force Medical Services Agency, says that, "tobacco use is really a mission-readiness issue...It's associated with decreased productivity, increased absenteeism and decreased endurance." Additionally, tobacco consumption is associated with nearly $2 billion of the Department of Defense's annual health care budget. The new policy restricts all tobacco use to designated tobacco areas, all of which must be at least 50 feet from building entrances and exits, sidewalks and parking lots, as well as 100 feet from playgrounds. I'm sure that my friends at Project Uniform and CYAN are thrilled. 
  • Moronic Quote of the Summer, by perennial West Virginia Republican Senate candidate John Raese: 
"In Monongalia County now, I need to put a huge sticker on my buildings to say that is a ‘Smoke Free Environment.’ This is brought to you by the Government of Monongalia County. Remember, Hitler used to put a Star of David on everybody’s lapel. Remember that? ...Same thing." 
This type of thinking should partially explain why Raese has never won a Senate election.
  • The New Zealand government is considering raising the price of a pack of cigarettes to as high as $100 by the year 2020. I'd be surprised if that actually happens, but I couldn't help but share this.
  • July 1 marked the first day that the Indiana's watered-down indoor smoking ban went into effect. While the law prohibits smoking in public places and workplaces, exceptions include 21+ bars (24/7) and riverboat casinos. On the surface, it's a step forward--but the fact that it took so long to arrive at this particular compromise tells me that the ban won't be expanded any time soon.
  • Mississippi prisons went smoke-free on July 1. This is the second such policy that I've heard of, as it follows Florida's prison smoking ban that I shared in a previous post.
  • Kansas City area casinos are among the latest facilities targeted by smoke-free advocates to adopt smoke-free policies. I actually just returned from the National Conference on Tobacco or Health in Kansas City, and there I was fortunate enough to receive a free t-shirt that reads, "Time to go all in! Bet on smoke-free casinos." I'll be wearing this shirt proudly, especially after my recent visit to a Phoenix-area casino for some late-night bingo...terrible mistake!
  • Collegiate Update:
    • The University of Central Florida is set to go smoke-free tomorrow, August 20. I strongly approve of the systematic cigarette butt counts that will be used to evaluate the efficacy of the smoking ban.
    • The Ohio Board of Regents have strongly encouraged public university leaders to adopt tobacco-free policies, but for whatever reason, the Board can't require a tobacco ban. Hopefully, there will be more news to follow.
    • CSU Fullerton is set to become the first smoke-free California State University campus on August 1, 2013.
    • The entire State University of New York (SUNY) system, comprising of 64 college campuses, will be smoke-free starting in 2014.
    • The University of Maryland announced that all campuses will be smoke-free by June 30, 2013, but students are pushing back, using potential enforcement issues to advocate for designated smoking areas instead of an outright ban.
    • The University of Mississippi is going smoke-free on January 1, 2013.
    • Maricopa Community Colleges (local to me in Arizona), which went tobacco-free on July 1, has what I think is a model informational website for a campus ban.
That's all for now... look for more frequent, more brief updates from me in the near future.

4.25.2012

Digest #29: This Month in Smoke-free News

How Not to Protest a College Smoking Ban
Step 1: Announce that you oppose the college smoking ban on grounds of individual liberty and freedom of choice, but that you don't encourage cigarette smoking.
Step 2: Hand out free cigarettes to students.

Believe it or not, this is what the Students for Liberty at Scottsdale Community College did near my hometown of Phoenix last month. Self-contradiction clearly isn't not going to be successful. But, thank you, Students for Liberty of SCC, for failing miserably in your attempt to protest the impending smoking ban at all Maricopa Community Colleges--and for giving me the opportunity to reference your idiocy for comic relief. Go Fighting Artichokes!

Big News in Texas
As I anticipated, I am happy to share that the University of Texas, the fifth largest public university in the nation, will soon be smoke-free. UT-Austin passes the University of Florida as the largest university in the country to have a smoking ban. It sounds like all tobacco will be banned in order to comply with the requirements imposed by the Cancer Research Prevention Institute of Texas, which has given the school tens of millions of dollars of research funds. Though the decision to ban tobacco on campus was clearly a result of the threat of losing future funding, it makes me wonder about other foundations that fund university research and whether or not we'll see similar grant-making policy changes.

Meanwhile, the city of Fort Worth is considering an employee tobacco ban. In other words, the city won't hire tobacco users--quite possibly by screening for cotinine in blood samples. One long-time city employee and smoker said, "I feel like the next thing they want to do is take DNA samples to figure out if anybody is going to have any kind of diseases going forward." Although he makes a good point, smoking is a choice at its core, whereas most diseases are rarely the direct outcomes of choices. Still, as I've said before, I'm reluctant to endorse such measures outside of healthcare or educational settings because I actually do value freedom of choice and individual liberty--just not when choices negatively impact others in such a direct way like that of secondhand smoke. But hey, I'm not exactly going to protest them, either.

A Jewish Ban on Tobacco?
Thanks to Google Alerts, I ran across an article that really grabbed my attention. According to The Jewish Weekly, “there is an increasing consensus that Jewish law prohibits smoking.” For those who take the time to read my blog on a somewhat regular basis, you’ll know that I’ve never incorporated religious teachings into my posts—so this may seem a bit out of left field. Nevertheless, since it’s my blog and I was raised Jewish, I’ll proceed to share excerpts of what I’ve read:
“This follows from a Torah commandment to live a healthy life (Deuteronomy 4:15). Even before it was clear that smoking posed great health risks, Rabbi Moshe Feinstein said that smoking was a prohibition based on Numbers 15:39: ‘You shall not stray after your heart and after your eyes’ (Iggerot Moshe, CM 2:76, YD 3:35); and that secondhand smoke is a form of damage upon another (CM 2:18)
“The prohibition on smoking does not only apply to individuals, but also to society. The Rambam taught that ‘Concerning any obstruction that is life-threatening, there is a positive commandment to remove it and protect against it and to be exceedingly careful concerning it’ (Hilkhot Rotzeiah 11:45).” 
“Smokers today should be viewed as ‘cholim’ (sick individuals) who we must heal. One cannot claim that ‘freedom and liberty’ allows them to increase their burden on the health care system or bring harm to family members, coworkers, and strangers.” 
“Due to the injunction to ‘not put a stumbling block before the blind’ (Leviticus 19:14), one must do everything possible to ensure that others are prevented from accessing the lethal object of a cigarette. Rabbi HaLevi argues that it is a chillul Hashem (desecration of God’s Name) to smoke, since the enlightened world knows how harmful it is, and Jews should not be seen doing foolish things (3:18). By this reasoning, it is also a kiddush Hashem (sanctification of G-d’s Name) to be on the front lines of banning cigarettes from society. 
That last part is comforting seeing that I’ve generally lost touch with my Jewish roots since my Bar Mitzvah. Anyway, I don’t know what the smoking rate is among Jews—or any people who abide by religious law for that matter—but I would imagine that it’s relatively low. For as many people there are who write off religion these days for being too romantic and unscientific, it is certainly interesting to learn how practical and logical some of the teachings can be.

Other News
  • Because I like to follow up on topics I’ve written about previously for the sake of “testing” my hypotheses or predictions about the future of smoke-free law and policy, I want to note that there is now data available that shows how the economics of smoke-free housing is playing out. According to a survey conducted by the New York City Coalition for a Smoke-free City, 58% of New Yorkers would paymore to live away from smokers. Of course, now the question becomes, “How much more?” I suspect that we’ll know soon enough.
  • New York will be creating smoke-free zones in state parks and historic sites, most notably around playgrounds and pools. While smoking won’t be entirely banned from these locations, it is interesting that the state has resolved to convert the six state parks within New York City to smoke-free parks—but only for sake of consistency with the city’s park smoking ban. One would think that it might be in the state’s interest to apply a consistent policy throughout, so it will be interesting to hear what criticism, if any, arises from this decision. Nevertheless, it’s a step in the right direction.
  •  Just when I thought that I’ve written about smoke-free policies in every possible venue, I read that fifteen shopping malls across New York and Massachusetts will be tobacco-free, both indoors and outdoors by May 31. What’s key here is that malls are obvious candidates for smoke-free policies, yet this is the first time I’ve heard about a policy like this. So, I’m beginning to see how smoke-free policies are becoming “contagious”—not only in terms of the same type of establishments adopting them (e.g., universities), but also in terms of leaders of other establishments seizing the opportunity to modernize their venues.
  • Good news: According to a study out of Scotland, pregnancies are more successful now that there has been a public smoking ban in place since 2006. Preterm deliveries dropped by over 10%, and the number of infants born disproportionately small dropped by 5%. Much of this is likely due to the drop in the prevalence of pregnant women who smoke—25.4% to 18.8%. However, the key finding, in terms of this blog, is that the reductions in preterm births and small babies occurred in both the smoking-mother population and and the non-smoking-mother population, which suggests that secondhand smoke was contributing to many of these unfortunate incidents.
  • Students at football powerhouse Louisiana State University are collecting signatures in support of a tobacco-free campus. SmokingWords, the organization leading the charge, is appealing to both public health advocates and environmentalists by addressing the hazards of smoking/secondhand smoke as well as the litter problems that campus smoking causes. Great strategy.
  • Although I don’t think I’ve mentioned it, Cal State Fullerton will be smoke-free by August 2013—the first (but certainly not the last) campus in the California State University system that has followed the example set by the University of California. My reason for sharing this news is to emphasize something that I don’t feel I spend enough time on: policy implementation—because getting the policy approved is really only half of the battle. According to this article, the school is taking steps to ensure that students and faculty are fully aware of the new policy, and that smokers have cessation resources available should they decide to quit. Hopefully, I’ll have more specifics to share on this important topic at a later time.
  • On March 20, Indiana became the 38th state to ban smoking in most workplaces, yet Indianapolis already enacted a similar ban of its own.
  •  The state of Maryland is one step closer to banning smoking in vehicles transporting children under 8 years of age--but doesn't 8 seem a bit arbitrary? Why should smoking in a car with a 9-year-old be acceptable? I couldn't imagine a worse birthday present than having my parents suddenly start smoking on the way to school. Since I'm on the topic, I’d like to take this opportunity to plug another Legacy Fellow’s local advocacy project: Project 1200.
  • Finally, here’s something that I thought was bizarre or miscommunicated when I first read it: 65% of students surveyed at Vassar College do not favor a smoking ban. Although, I’m skeptical about these results, I’ve learned not to assume that the majority of students at a given college campus would favor a smoking ban.


3.15.2012

Special Report: Surgeon General, CDC Empower Youth Activists

By Nick Fradkin and Tonya Veitch, Legacy Youth Activism Fellows

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The Legacy Youth Activism Fellowship Program is an 18-month leadership & professional development program for young adults committed to tobacco prevention and control designed to offer training and support to advance local and national projects. Currently, there are 11 Fellows representing 10 different states.
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One week ago, we were working at our respective jobs—Nick in Arizona and Tonya in California. A couple of emails and phone calls later, we were both booked to fly to the nation’s capital to attend and cover the press conference announcing the release of the 31st Surgeon General’s report on tobacco control, Preventing Tobacco Use Among Youth and Young Adults. As young anti-tobacco activists, this was a once-in-a-lifetime opportunity to witness and share our government’s latest public declarations about the state of tobacco control.

Getting There

Nick Fradkin, Legacy Youth Activism Fellow
Asked to arrive at 9am, Nick took the Metro red line from Farragut North over to Judiciary Square and headed down to the Newseum on Pennsylvania Avenue, where the press conference would be starting at 10am. Nick went up to the 8th floor, checked in, and learned that he had a reserved seat in the second row (not too bad!). As he was meeting with Legacy staff and getting the run-down on the morning, Nick spotted a familiar face walk into the room. It was Dr. Victor DeNoble, the original tobacco industry whistleblower and subject of the new documentary, Addiction Incorporated, which Nick had just seen at FilmBar in Phoenix two nights before. Nick introduced himself and said he enjoyed the film, so Dr. DeNoble gave Nick his card to stay in touch about an upcoming promotion in Phoenix.

Tonya Veitch, Legacy Youth Activism Fellow
Meanwhile, Tonya, who had just landed at nearby Reagan International Airport after a two-stop, red-eye trip to D.C. from San Jose, California, was quickly making her way to the Newseum. It had been a long night of traveling but Tonya was too excited thinking about the press conference to focus on how tired she was. She rushed off the plane and ran to a taxi, which arrived at the Newseum at about 9:30am. She checked in, put on her complimentary “We Can Be Tobacco-Free” button, and then proceeded into the press conference. Immediately, she was amazed by all the people and countless cameras. As she was about to call Nick so that they could meet up, she looked into the sea of people and saw a friendly face (Nick). After saying their hellos and getting up to speed from Nick and the team from Legacy, the two proceeded to their second row seats! The press conference was minutes away and as Tonya started noticing all the tobacco control activists make their way into the room she gasped to herself, “I’m here.”

Lights, Camera, Action

Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS), opened the press conference with some high-level findings from the report and some brief thoughts about the state of youth tobacco prevention. She applauded the progress that our society has made since the first Surgeon General’s report on tobacco control in 1964, but she said that our progress is “not good enough,” considering that an estimated 443,000 people die per year from cigarette smoking—and, for each smoker’s death, two “replacements” under the age of 26 take up the same habit. Clearly, as the Secretary put it, “we have a lot more work to do,” as “one child picking up a tobacco product is one too many.”

Next to speak was Dr. Howard Koh, Assistant Secretary for Health at HHS, who echoed the Secretary’s words by insisting that youth tobacco use, as a “completely avoidable and completely preventable” phenomenon, is in a state of “heightened urgency.” Dr. Koh shared a number of striking findings with everyone, but perhaps the most memorable moment was when he emphatically said that advertising, movies and media featuring cigarette use cause youth to take up tobacco products. With $10 billion dollars spent per year on advertising, the tobacco industry has made it simple for us to conclude that “youth smoking is not an accident,” as the Assistant Secretary put it. Dr. Koh closed by saying that we need to “give our youth a fighting chance” against the temptation to try tobacco.

Dr. Regina Benjamin, Surgeon General
(Courtesy: Zimbio.com)
Finally, Dr. Regina Benjamin, United States Surgeon General, took the podium. Since 1964 the Surgeon General’s report has highlighted the dangers of tobacco; however, it has been 18 years (the 1994 Surgeon General report) since the report has specifically focused on youth! Dr. Benjamin hit the ground running by stating, “the burden of tobacco burdens all of us.” She followed with the most recent statistics about youth and young adult smoking rates and many were shocking to hear. For example: Did you know that for everyone one tobacco related death, there are two new youth smokers? We didn’t and we were shocked by this finding. Dr. Benjamin stressed that “we need to bring back that commitment to tobacco control that was so effective between 1997-2003.” The Surgeon General expressed that Tobacco Prevention and Education Programs have been effective in reducing youth and young adult smoking rates, so we can’t stop now just because those rates are at an all-time low. Like Secretary Sebelius said, “one child picking up a tobacco product is one too many.”

Lastly, the Surgeon General’s Video Challenge was released. This challenge encourages youth and young adults to share with the world why they choose NOT to buy tobacco (double entendre) in a short English or Spanish video. There will be four grand prize prizes ($1,000) and 12 runner-ups ($500). Dr. Benjamin’s got a jump-start on the competition and actually had a video to share with all of us at the press conference! This PSA will hopefully be coming to a town near you. Tonya is challenging the youth groups that she works with as well as college advocates in Santa Clara County. Will you?

Afterthoughts and Impact

As Legacy Youth Activism Fellows, our efforts epitomize the commitment that the Surgeon General challenged us to revive. 2,500 miles away from Washington, D.C., we plan to use the startling findings from the report in our own local advocacy efforts.

The fact that nearly all adults who smoke daily started smoking before age 26 is critical to Nick’s efforts in advocating for smoke-free universities in Arizona. While 80% of daily smokers started before age 18, Nick wants to make it clear that college administrators have a unique responsibility to address tobacco use in the 18-26 age range by adopting smoke-free or tobacco-free campus policies. Meanwhile, Tonya has been working with youth and young adults for the past two years on tobacco control efforts through a CPPW (Communities Putting Prevention to Work) grant; however, the funding is ending this month. Being at the press conference encouraged Tonya to fight to make tobacco prevention a priority within Santa Clara County. Even though we won’t have the same amount of funding that we’ve had for the past two years doesn’t mean we can’t continue to do amazing things; we just have to be more creative and financially savvy when it comes to opportunities.

We aren’t the only ones who will take this 899-page report and run with it. The nine other Legacy fellows and the other youth advocates who attended the press conference will surely do the same. Nick and Tonya met a great group of anti-tobacco activists from Youth Empowered Solutions from North Carolina. Their passion and dedication to tobacco control was evident and they seemed inspired to bring back what they learned to their hometowns (and they even got a head-start on their video!).

Overall, we had an amazing experience. We even got to meet and take pictures with the Surgeon General, herself. From the bottom of our hearts, we are truly grateful to Legacy for this once-in-a-lifetime opportunity. Being at this press conference has inspired us to take what we’ve learned and share it with our communities. We truly feel that, together, we can end the tobacco epidemic.

From left: David Satcher, M.D., Ph.D.; Director, Satcher Health Leadership Institute; Director, Center of Excellence on Health Disparities; 16th Surgeon General of the U.S. - Tonya Veitch, Legacy Youth Activism Fellow - Nick Fradkin, Legacy Youth Activism Fellow - U.S. Surgeon General Dr. Regina Benjamin, M.D., M.B.A., V.D.M., U.S. Public Health Service
Thank you to Legacy and the CDC for making this possible, and thank you to Kim Homer Vagadori of California Youth Advocacy Network, who (coincidentally) has been a mentor to both of us.

3.01.2012

Digest #28: This Month in Smoke-free News

I am organizing this month's digest by type of news: government, higher education, and other. It seems logical, so I'm going with it.

Government News:
  • On February 6, Oklahoma's governor ordered the elimination of smoking and tobacco use on all state property. Leading a state with one of the highest smoking rates in the country at 23.7%, Governor Mary Fallin has made a bold, yet (in my mind) inevitable move to ban smoking. As with any good policy change, an educational campaign is planned to inform the thousands of state employees who smoke about quitting options. The best part? The smoking room in the capitol building will be converted into a fitness center.
  • Rhode Island parks and beaches may soon be smoke-free. After visiting a couple of friends up there in October and walking along perhaps some of the most underrated beaches in the country (where I do recall stepping on a few discarded cigarette butts), I certainly hope that state legislators get the job done.
  • In the wake of a poll suggesting that a majority of Kentucky residents favor a state indoor smoking ban, Representative Susan Westrom says that it's time for Kentucky to go smoke-free. She says that it's "so typical for Kentucky to be so behind." Apparently, Rep. Westrom saw the state's failing grade for the American Lung Association's annual State of Tobacco Control report and saw the opportunity to get her state ahead. With the highest smoking rate in the country at 29%, Rep. Westrom certainly has her work cut out for her. In related news, a Valentine's Day rally was planned to occur at the state capitol, where smoking ban advocates were going to wear red and raise awareness of the link between secondhand smoke and heart disease.
  • After five years of failure, the Indiana Senate has finally passed a statewide indoor smoking ban. However, it wasn't without serious compromise; bars will be exempt from the ban, and so will bingo halls...and mental health facilities...and nursing homes. And the minimum distance from doorways to smoke-free facilities where people are permitted to smoke is actually being reduced from 12 feet to 8 feet (really, FOUR feet? That's 48 inches, people). Anyway, I'd normally emphasize big news like a new state smoking ban a bit more, but this truly is a "watered down" ban. That having been said, it is better than nothing at all, and perhaps this is just a first in a series of intermediary steps toward a more comprehensive ban.
  • On June 5, California voters will decide on a measure to increase the state's cigarette tax by $1 per pack. It's called the California Cancer Research Act, and researchers at the University of California, San Francisco have estimated that this would generate an extra $855M per year to fund smoking education, cessation and research, as well as create 12,000 new jobs--not to mention that it would save approximately 100,000 lives from smoking-related deaths. I'm all for it; tax 'em 'til they quit.
  • recent poll in Mississippi suggests that 68% of state residents are in favor of a statewide indoor smoking ban. Although this statistic is itself comforting, I find it especially important to note that the same percentage of registered Democrats and Republicans support such a ban--which is a great reminder about bipartisanship in tobacco control. Rarely, in our society, do we encounter a circumstance in which a vast majority of each party agree about a highly controversial issue. Shouldn't this phenomenon tell us that something is truly special--and pressing--about the anti-smoking cause?
  • I found it interesting how a brief article (and video) explains why some Wisconsin bar owners and bar-goers' defiance of the state smoking ban has led to virtually no consequence and no increased enforcement. One bar owner completely disregards the ban, and he hasn't necessarily made a big deal out of the two citations and hundreds of dollars he's paid for them because he knows that, by self-enforcing the smoking ban, he will lose up to 20% of his business. I think that other states and jurisdictions can learn from this simple economic problem; the violation fine needs to be high enough and the risk of getting cited imminent enough for bars to meet or exceed the risk of losing business by enforcing the ban.
  • Back in November, I mentioned how a US District Court judge placed an injunction on the FDA's efforts to implement graphic cigarette warning labels by September 2012. As expected, the government appealed the ruling, but now--to most public health advocates' dismay--the court has upheld the original ruling. Again, the tobacco industry claimed that the graphic warning labels violate freedom of speech clause in the First Amendment because they aren't purely factual, and instead aim to prevent people from purchasing the products. In his 19-page opinion, Judge Richard Leon wrote, "The graphic images here were neither designed to protect the consumer from confusion or deception, nor to increase consumer awareness of smoking risks...Rather they were crafted to evoke a strong emotional response calculated to provoke the viewer to quit or never start smoking." As much as I despise Big Tobacco, I certainly understand their argument and feel that it is strong, given the incredibly graphic nature of the proposed warning labels. Even as a non-smoker, my first impression of the labels was shock--mostly because the labels portray the worst-case scenario for cigarette consumers. So, I am not surprised that these won't be showing up on cigarette packs this fall. While I am disappointed about this, I am optimistic that the FDA can rebound from this failure and come up with modified labels that are both effective and in substantial compliance with the First Amendment.
  • The Surgeon General's latest report on tobacco control is set to release on March 8, and, as a very lucky American Legacy Foundation Youth Activism Fellow, I will be fortunate enough to be at the press conference, which I plan to summarize and comment on by means of this blog next week. Stay tuned for a special post!
Higher Education News:
  • I really enjoyed the closing line of an op-ed about the UC system going tobacco-free written by a San Diego State University student. It reads: "...if eliminating secondhand smoke on campus and perhaps even discouraging incoming freshmen from picking up the habit are possible outcomes of this decision [by the UC President to make all campuses tobacco-free], then opposing the ban for the sake of your mid-break cigarette is even more disgusting than the habit itself." Hundreds of miles away, an article in the Marquette University student newspaper also featured last month's big news that the University of California is going tobacco-free. Long story, short: the UC news has created a ripple effect around the nation (Go Bears).
  • Facing the possibility of losing millions upon millions of dollars in research funding, another large state university system has come close to going tobacco-free. The University of Texas has been receiving funding from the Cancer Prevention and Research Institute of Texas (CPRIT), which recently gave the UT an ultimatum to go tobacco-free by March 1, or risk losing a chance at $100M+. That's one way to enact policy change! Some down in Texas thought it was going to happen, but that doesn't appear to be the case. A smoke-free UT system, in combination with the already-decided smoke-free policies at the University of California, the University of Michigan and the University of Florida, should really put pressure on other leading public institutions to quickly follow suit. I'll hopefully be referring back to this mention next month with good news... 
  • Speaking of the University of Michigan, the Wolverines' rival school, Michigan State University, is exploring the possibility of a smoke-free campus. I'll give it six months, at most, to come to fruition.
  • Harvard University allegedly has a smoke-free proposal on the table, and the editorial board of the student newspaper has officially denounced it...Who ever said that Harvard students are smart?
Other News:
  • Just as I was getting convinced that e-cigarettes may, indeed, be the future of smoking in America, an e-cigarette blows up in someone's mouth. The North Bay, Florida fire department compared the incident to the detonation a bottle rocket in the victim's mouth, which was left with fewer teeth and less of a tongue. Apparently, the battery in the e-cigarette was faulty. This news has surely stalled sales of the device and left the tobacco industry smiling.
  • Researchers at the University of Southern California have found a positive correlation between middle-schoolers' involvement in sports and their propensity to reject cigarette smoking. To me, it's no surprise--but for health-conscious parents, it's a reminder to get their kids involved in youth athletics...ASAP.
  • Quote of the Month: "There is no public health issue that is more important than preventing our youth from becoming addicted to tobacco." -Dr. James Crucetti, in response to the new smoke-free playgrounds ordinance in Albany, NY.
  • The CDC recently had research published that demonstrates how approximately 20% of teens and pre-teens are exposed to secondhand smoke in cars. The tight confines of cars undeniably augment the risk of even the smallest amounts of secondhand exposure emitted within them, and four states--Arkansas, California, Louisiana and Maine--have laws prohibiting smoking in cars with children aged 16 or younger inside. Other than California, these are some unlikely suspects; why aren't other states catching on?
  • Last, but certainly not least is some surprising research out of the UK: Public smoking bans do not necessarily lead to increased smoking in private spaces. In fact, the data suggests that anti-smoking legislation in Ireland, France, Germany and the Netherlands may have spurred an increase in "home smoking bans." In other words, decreased smoking in homes was correlated with the public smoking bans. To me, this finding has incredible implications. If this is true (and consistent in the United States), public smoking bans could actually decrease the amount of private smoking; it suggests that government may not have to take paternalistic measures (e.g., illegalization of cigarettes) to achieve a virtually smoke-free society. For more on my stance on public vs. private smoking, please see one of my first posts (nearly two years ago!).

1.28.2012

Digest #27: The 2012 Mega-Digest

THE UNIVERSITY OF CALIFORNIA IS GOING SMOKE-FREE!
If you know me at all, or have at least followed my blog, you could have predicted the excitement that I felt in typing the above headline. My lofty goal for the last two semesters of my undergraduate studies at UC Berkeley was to convince campus administration to pass a smoke-free policy, and although I can hardly claim any credit for the recent news, I am incredibly proud to say that not only will UC Berkeley be going smoke-free within the next two years, but UCLA, UC Davis, UC San Diego, UC Santa Barbara, UC Santa Cruz, UC Irvine, UC Riverside, and UC Merced will also be joining the ranks of the 600+ college campuses around the nation that have (or will soon have) smoke-free policies.

I first heard about the news from an email chain originating from a fellow UC Berkeley public health advocate, who attached a letter from University of California President Mark Yudof that called upon each campus chancellor to assemble a campus task force to determine the best way to go about implementing and enforcing a tobacco-free policy (more on this below). I then notified my friends at The Daily Californian of the news, and they managed to find a link to the actual policy proposal that was submitted to Yudof on October 25.

The proposal is actually very simple: It’s broken out into three sections, not including references and appendices. Section 1 summarizes the scientific rationale for policy change, current smoking policies at each of the UC campuses, case studies of other campuses, and support for a smoke-free policy. At the end of Section 1, the authors stealthily indicate that all tobacco products should be banned on each campus:
“The University of California has the potential to be a leader in implementing a system-wide smoke-free policy. We respectfully recommend the University of California become a smoke-free university system. We further recommend this policy eliminate smoking of tobacco products and unregulated nicotine devices (e-cigarettes); use of smokeless tobacco products; and prohibit the advertising and sale of tobacco products on any UC property.” – The Smoking Policy Subcommittee of the Occupational Wellness Forum, University of California
Personally, I don’t feel strongly about banning tobacco products in addition to cigarettes and other smoking products. As I’ve said time and time again, secondhand smoke is what really gets me; smoking products emit secondhand smoke, while smokeless products clearly do not. However, this is not to say that I do not support the all-out tobacco ban, as I think it does make sense to tackle the tobacco issue all at once and leave it in the past. As the top public university system in the nation, we must be leaders in promoting students’ and campus patrons’ health—even if that means overriding law that otherwise permits freedom of choice in using tobacco products that are well-known to foster unhealthy—and often deadly—habits.

Section 2 of the policy proposal goes on to make recommendations for addressing enforcement and student safety, as well as recommendations for an implementation plan, a timeline, and costs. Finally, Section 3 provides example policy language. I think that the inclusion of these recommendations was both strategic and critical in making the proposal comprehensive because the recommendations illustrate how campus administration could potentially address each sub-issue, rather than leaving everything up to them to start from scratch. In other words, the recommendations made for an easier decision to go tobacco-free.

I will be following the progress of the University of California—of UC Berkeley, in particular—over the next several months. Stay tuned.

Smoke-free versus Smoker-free Workplaces
I have previously endorsed measures taken by hospital systems that identify and filter out smokers in their job applicant pools, on the basis that it is both a dangerous and hypocritical practice to allow traces of secondhand and thirdhand smoke anywhere near ill patients. However, thanks to two prominent leaders in tobacco control, I would like to share how my opinion has been challenged.

This past Friday, I had the distinct privilege of listening to two American Legacy Foundation executives, Dr. Cheryl Healton – President & CEO, and Ellen Vargyas – General Counsel, speak about the Master Settlement Agreement (which gave rise to the organization), and their decade-long battle against Big Tobacco. Dr. Healton spoke to a group of eleven newly-selected Youth Activism Fellows, including myself, about how tobacco control is truly an issue of social justice. Although I was aware that people in lower socioeconomic classes are more likely to take up smoking, I previously did not recognize how aggressively the tobacco industry targets these groups in its advertising. Ms. Vargyas’ presentation touched on some of the same issues, but it was this except of her recent article published on Drugfree.org that made me realize how my previous stance was too harsh:
“Smoker free workplace policies disproportionately burden people at lower income and education levels. These days, smoking rates are highest among adults with incomes below the poverty level and among those with a GED diploma or a 9th to 11th grade education. Rates are lowest for adults with graduate degrees. Most of the ad men in “Mad Men” aren’t smoking anymore and haven’t for years. When a hospital decides that it won’t hire smokers, the most likely person to lose out is the orderly or nurse’s aide or janitor. It’s very unlikely to be the highly paid administrator or surgeon– even leaving aside the fact that doctors are typically not even hospital employees and wouldn’t be subject to these policies in the first place.” – Ellen Vargyas – General Counsel, American Legacy Foundation
…How can I argue with that? Nevertheless, given the growing body of evidence demonstrating the harms of thirdhand smoke, I can’t help but hold on to my conviction that hospital administrators should do everything they can to mitigate any and all exposure to environmental tobacco smoke. However, with regard to all workplaces other than hospitals (and perhaps schools), I certainly agree with Ms. Vargyas’ point that employers should be providing smoking cessation resources and enacting smoke-free workplaces, rather than denying jobs to smokers altogether.

You may be asking yourself, “But how does this affect his argument about discrimination against smokers?” …I still don’t think this is logically possible. Smoking is still technically a choice, and historically, the term ‘discrimination’ has been used in contexts in which the discriminators have acted unreasonably and without scientific evidence of two groups’ inherent differences—differences that perhaps make one group more dangerous than the other. In this case, our society “discriminates” (for lack of a better word) against people who use a product, the emissions of which we can conclusively say are dangerous to others in close proximity to the user—even after the product has been used. A circumstance like a hospital smoker-free workplace isn’t an instance of discrimination, but rather an educated quarantine.

Other News:
  • Emory University, a top private university in Georgia, has just implemented a tobacco-free policy that not only bans tobacco use on campus, but also bans smoking in cars parked on campus. This is the first car-specific smoking ban I’ve heard of, and I’d like to see more of these, especially on public roads.
  • The smoking and tobacco ban at the two University of Arizona Medical Center campuses (effective January 1) seems to have spurred more talk of a university-wide smoking ban. Coincidentally, I have targeted the U of A, as well as Arizona State University and Northern Arizona University as smoke-free campus candidates, and I plan to work with campus leaders in the coming months to help them get ahead of the curve. More on that to come…
  • As of March 1, Chicago’s seven city colleges, which collectively enroll over 120,000 students, will be tobacco-free. Prior to conducting an official vote on the measure, the school system surveyed students, faculty and staff, finding that 85% of respondents supported a tobacco-free policy.
  • An expansion of the Indianapolis smoking ban has advanced to a full city council vote that will take place on January 30, which, if approved, may not leave enough time to implement the ban in the bars, bowling alleys and hotels that would be affected before the city hosts Super Bowl XLVI. Meanwhile, a larger-scale statewide ban is making similar progress.
  • The capital city of Texas, Austin, officially has a smoking ban in effect for its parks, preserves and pools.
  • There is hope for Kentucky, the state with the highest smoking prevalence (at 29%): 54% of respondents to a recent poll indicated that they would favor a statewide smoking ban. If Kentucky could somehow pull this off relatively quickly, other state legislatures won't have much of an excuse for dragging their feet.
  • A beach city in Florida has considered issuing fines of up to $500 for leaving a cigarette butt in the beach sand. Not only do I think this would be a deterrent to butt littering, but I think it would also be a deterrent to smoking, in general. I get the impression that many frequent smokers are so accustomed to littering elsewhere, that if they are warned about such a hefty fine, some wouldn’t even trust themselves to not make a mistake in disposing a butt on the beach. Overall, it’s a very intriguing approach.
  • New York City is sporting some recent findings that the average life expectancy of its residents has risen to 80.6 years, or 2.4 years above the national average. The attributed cause (or strong correlation)? Smoke-free policies. No surprise there! Meanwhile, The New York Times ran an article about the widespread increase in smoke-free public housing, which--despite the complaints voiced in the article--suggests that NYC may be heading in that direction.
  • Following the example recently set by Carnival and Norwegian cruise lines, Princess Cruises has banned smoking from all staterooms and stateroom balconies, leaving a cigar lounge, a handful of indoor areas, and open decks as the only areas where people can smoke on the ships. However, e-cigarette use is still permitted in staterooms. Holland America has also banned smoking in all staterooms.
  • Because the 2009 Family Smoking Prevention and Tobacco Control Act did not include cigar regulation, a group of Democratic senators is hoping to get the Food & Drug Administration to extend the existing ban on cigarettes with "candy-like flavoring" to cigars with similar tastes. Seeing that I have had friends who would smoke these flavored cigars and eventually "graduate" to cigarettes, I feel that this is absolutely necessary, and don't know how this prohibition was excluded from the original 2009 legislation.
  • Disturbing news: A New Jersey school bus driver was caught smoking a cigarette in his empty bus.
  • A new book entitled, Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition, by Robert Proctor, explores an idea that many of us anti-smoking advocates dream of, but don't necessarily endorse: an international ban on cigarette sales. Peter Singer ponders this in a recent column posted on CNN.com: "As Proctor says, cigarettes, not guns or bombs, are the deadliest artifacts in the history of civilization. If we want to save lives and improve health, nothing else that is readily achievable would be as effective as an international ban on the sale of cigarettes."
  • Personal anecdote: A few weeks ago, I was driving home from work when I noticed a smoking cigarette peek out of the driver's side window of the car in front of me--nothing out of the ordinary, right? Then, I noticed the 'Donate Life' bumper sticker on the same car...Wow--if I ever need an organ transplant, I sure hope my match doesn't come from that person.
One final thought: Are e-cigarettes the future of smoking in America? An article in The New York Times does a good job of convincing me that they are—for the most part. Considering how the products cause negligible health effects to the user and no secondhand effects to others, e-cigarettes seem to be the answer. However, many antismoking advocates, like myself, maintain that e-cigarettes can easily be confused with traditional cigarettes and can serve as a sort of ‘gateway’ product to traditional cigarettes, so allowing e-cigarette use in smoke-free areas could be counterproductive. However, if the federal government can, one day, ban traditional cigarette manufacturing (as it currently does with marijuana cigarettes) and effectively replace this market void with e-cigarettes, while enabling tobacco companies (which would only be legally permitted to produce smokeless tobacco products) to earn patent royalties from e-cigarette sales, then this—at least in theory—would solve the secondhand smoke problem. The aggressive advertising practices that tobacco companies conduct to sell their addictive products would still be highly questionable, in my opinion—but this issue is somewhat outside the scope of this blog.