1. SECONDHAND SMOKE, SMOKE-FREE LAWS, AND YOUR COMMUNITY

2. Nothing Kills Like Tobacco Cigarettes Alcohol 2 nd Hand Smoke Car Accidents Suicide AIDS Homicides 430,000 105,095 53,000 46,300 30,906 29,939 24,932 Source: Centers for Disease Control and Prevention (CDC)

3. Is Secondhand Smoke a Mere Annoyance? Secondhand smoke causes approximately 3,000 lung cancer deaths per year in nonsmoking adults. Secondhand smoke causes approximately 46,000 heart disease deaths per year in nonsmoking adults. Secondhand smoke causes approximately 430 SIDS deaths per year in newborns. Source: U.S. Surgeon General, 2006

4. Why is Secondhand Tobacco Smoke so Toxic? Methanol Carbon Monoxide Hydrogen Cyanide Acetone Tar DDT Naphthalene Vinyl Chloride Benzene There is no risk-free level of exposure to firsthand or secondhand tobacco smoke SHS contains at least 250 toxic chemicals Formaldehyde Mercury Lead Arsenic Toluene Cadmium Ammonia Butane Ethanol

5. Heart disease Lung cancer Sudden Infant Death Syndrome (SIDS) Low birth weight Asthma Otitis Media (ear infections) in children Slowing of lung growth in children Bronchitis and pneumonia Breast cancer in pre-menopausal women Increased risk of cervical cancer Cognitive deficits among children even at extremely low levels of exposure How Does It Harm Your Body?

6. Does Even a Little Bit Hurt Your Heart? 5 minutes of exposure stiffens the aorta (harder for the heart to pump blood). 20 minutes of exposure causes excess blood clotting (increasing risk of heart attack and stroke). 30 minutes of exposure limits the ability of the blood to manage LDL ("bad") cholesterol leading to the build up of arterial fat deposits (increasing risk of heart attack and stroke). 2 hours of exposure can speed up the heart rate and lead to abnormal heart rhythms (which may cause death).

7. In April 2004, the Centers for Disease Control and Prevention issued a warning that all patients with heart disease should avoid exposure to secondhand smoke.

8. Why are Some Workers Affected More Than Others? In a single full-time shift (8 hours) in a smoky bar, a worker is exposed to levels of carcinogenic toxins equivalent to smoking 16 cigarettes. Servers have the greatest risk of developing lung cancer and heart disease compared to other occupations.

9. Bar Workers Benefited the Most from Lexington’s Smoke-free Law Median hair nicotine level* Average decrease in hair nicotine, post-law *adjusted for cigarettes smoked per day

10. “No one should have to breathe tobacco smoke to hold a job.” Suzanne H Cocktail Waitress for 14 years Emphysema attributed to secondhand smoke at work

11. What Does the Tobacco Industry Say About the Health Effects? “ “ It is our view that, the scientific evidence is not sufficient to establish that environmental tobacco smoke is a cause of lung cancer, heart disease or other chronic diseases.” Brown & Williamson Tobacco, 2003

12. How Many Kentucky Adults are Exposed to First & Secondhand Smoke? Most (71%) do NOT smoke cigarettes. Yet nearly all (70%) ARE exposed to secondhand smoke.

13. Sign in Chicago where there is a weak, confusing ordinance Sign in Chicago where there is a weak, confusing ordinance

14. What are the Public Health Benefits of Smoke-Free Laws? Nonsmokers protected Nonsmokers protected Fewer children start to smoke Fewer children start to smoke Smokers consume fewer cigarettes Smokers consume fewer cigarettes More smokers quit More smokers quit Fewer heart attacks Fewer heart attacks

15. How did Support for Lexington ’ s Smoke-free Law Change Post-law? Public support for the law increased significantly.

16. What Does the Tobacco Industry Think about Smoke-free Laws? (Bates # 2054893642/3656; Legacy Tobacco Documents Library; 1994. http://legacy.library.ucsf.edu/tid/nyg12a00) “Smoking bans are the biggest challenge we have ever faced. Quit rates go from 5% to 21% when smokers work in non-smoking environments.” (Bates # 2054893642/3656; Legacy Tobacco Documents Library; 1994. http://legacy.library.ucsf.edu/tid/nyg12a00)ttp://legacy.library.ucsf.edu/tid/n

17. Is it Government’s Role to Enact Smoke-free Laws? “Among the police powers of the government, the power to promote and safeguard public health ranks at the top…….. The real issue is whether the public health regulation [Lexington’s smoke-free law] is reasonable….. In this case we must conclude that it is.” Kentucky Supreme Court Decision, April 2004

18. What Difference Do Smoke-free Laws Make?

19. Median hair nicotine level How Do We Know that Smoke-free Laws Protect Workers? Worker hair nicotine dropped 56% post-law

20. The smoking rate in Fayette county declined nearly 32% (from 25.7% before the smoke-free law to 17.5% after), while smoking rates remained stable in other similar Kentucky counties without smoke-free ordinances. The smoking rate in Fayette county declined nearly 32% (from 25.7% before the smoke-free law to 17.5% after), while smoking rates remained stable in other similar Kentucky counties without smoke-free ordinances. Lexington’s law resulted in 16,500 fewer smokers for an estimated annual healthcare cost savings of $21 million. Lexington’s law resulted in 16,500 fewer smokers for an estimated annual healthcare cost savings of $21 million. Source: Preventive Medicine, 2008 Source: Preventive Medicine, 2008 How Do Smoke-Free Laws Affect Adult Smoking

21. How Do Smoke-free Laws Affect Heart Attacks The number of admissions from heart attacks declined on average 19% after smoke-free laws took effect in Helena, Montana, Pueblo, Colorado, New York and several European countries (Preventive Medicine, 2008). The number of admissions from heart attacks declined on average 19% after smoke-free laws took effect in Helena, Montana, Pueblo, Colorado, New York and several European countries (Preventive Medicine, 2008). Overall, hospital admissions for heart attacks in Scotland decreased 17% after their smoke-free law compared with a 4% decrease in England (no smoke-free law) during the same time (New England Journal of Medicine, July 31, 2008). Overall, hospital admissions for heart attacks in Scotland decreased 17% after their smoke-free law compared with a 4% decrease in England (no smoke-free law) during the same time (New England Journal of Medicine, July 31, 2008).

22. How Do Smoke-free Laws Affect Asthma? There was a 22% decline in emergency department visits for asthma in Lexington- Fayette County after the smoke-free ordinance. Rayens, M.K., Burkhart, P.V., Zhang, M., Lee, S., Moser, D.K., Mannino, D., Hahn, E.J. (2008). Reduction in asthma- related emergency department visits after implementation of a smoke-free law. Journal of Allergy and Clinical Immunology. Doi 10.1016/j.jaci.2008.06.029. Rayens, M.K., Burkhart, P.V., Zhang, M., Lee, S., Moser, D.K., Mannino, D., Hahn, E.J. (2008). Reduction in asthma- related emergency department visits after implementation of a smoke-free law. Journal of Allergy and Clinical Immunology. Doi 10.1016/j.jaci.2008.06.029.

23. Ventilation Does Not Work Heating, ventilation, and air conditioning systems distribute secondhand smoke throughout a building. Conventional air cleaning systems remove large particles, but not the smaller particles or gases in secondhand smoke. Simple separation AND ventilation do NOT work!

24. Enclosed Smoking Rooms Do Not Work

25. The Truth about Indoor Smoking Areas

26. What Does the Tobacco Industry Say About Ventilation? Philip Morris, 2002 “Business owners should have some flexibility in deciding how best to address the preferences of non-smokers and smokers through separation, separate rooms and/or high quality ventilation.” Philip Morris, 2002

27. How Do Smoke-free Laws Affect Business? Numerous scientific studies show business improves or remains the same. The only reports showing a downturn in business have been funded by the tobacco, alcohol, and/or gaming industries.

28. How Did Lexington’s Smoke-free Law Impact Business? An average of 400 additional restaurant employees per month (3% of total restaurant employment) An average of 400 additional restaurant employees per month (3% of total restaurant employment) Bar employment stable Bar employment stable No change in business openings or closings No change in business openings or closings

29. Why Does the Tobacco Industry Fight Smoke-free Laws? “Financial impact of smoking bans will be tremendous – 3 to 5 fewer cigarettes per day per smoker will reduce annual manufacturer profits a billion dollars plus per year.” A Smoker’s Alliance, Phillip Morris, 8/1/93

30. What are the Costs of Exposure to Secondhand Smoke? Over $5 billion in direct medical costs per year in the U.S. Over $5 billion in indirect costs per year in the U.S.

31. “Bars need to be exempted.” “Bars need to be exempted.” “Business owners should have the right to decide.” “Business owners should have the right to decide.” “Why regulate a legal product?” “Why regulate a legal product?” The bottom line is: All workers deserve to breathe clean air. You might hear…

32. Are We Making Progress? There has been a 70% reduction in secondhand smoke exposure in U.S. nonsmokers since 1988, due in large part to smoke-free laws. Unfortunately, millions of Kentuckians (70%) are still exposed to secondhand smoke in public places and workplaces. Source: U.S. Surgeon General, 2006

33. The debate is over, the science is clear – secondhand smoke is a cause of premature death and a significant threat to public health. The debate is over, the science is clear – secondhand smoke is a cause of premature death and a significant threat to public health. Workers should not have to choose between their lives and their livelihoods. Workers should not have to choose between their lives and their livelihoods. Smoke-free laws improve health and do not hurt business. Smoke-free laws improve health and do not hurt business. Summary

34. For More Information Kentucky Center for Smoke-free Policy Kentucky Center for Smoke-free Policy www.kcsp.uky.edu www.kcsp.uky.edu kcsp00@lsv.uky.edu kcsp00@lsv.uky.edu kcsp00@lsv.uky.edu 859-323-4587 859-323-4587 University of Kentucky Tobacco Policy Research Program University of Kentucky Tobacco Policy Research Program www.mc.uky.edu/tobaccopolicy www.mc.uky.edu/tobaccopolicy www.mc.uky.edu/tobaccopolicy ejhahn00@email.uky.edu ejhahn00@email.uky.edu ejhahn00@email.uky.edu 859-257-2358 859-257-2358