1. Boston’s Tobacco Regulations – Prohibiting the Sale of Tobacco Products by Health Care Institutions Nikysha Harding, Tobacco Control Program Director Margaret Reid, Director, Division of Healthy Homes Timothy J. Harrington, Assistant General Counsel Boston Public Health Commission Donney John, Pharm.D., Assistant Professor of Pharmacy Practice Clinical Pharmacist - South End Community Health Center Massachusetts College of Pharmacy & Health Sciences - Boston

2. The Boston Public Health Commission Health Department for the city of Boston Our mission is to protect, promote, and preserve the health and well-being of all Boston residents, particularly the most vulnerable. First local health department in the nation – Paul Revere on first board of health!

3. Legal Authority of the Commission (1) Timothy J. Harrington, Assistant General Counsel 617-534-9640 The Boston Public Health Commission is an entity created by the Massachusetts Legislature via the Boston Public Health Act of 1995. It was formerly a city agency, but is now a legally distinct entity from the City of Boston with over 1,000 employees. The Commission is governed by a board of seven members. Six members are appointed by the Mayor of Boston subject to the approval of the Boston City Council. The Executive Director also sits as a member of the Board. As a functioning board of health, the Commission has broad regulatory authority under Massachusetts law, M.G.L. c. 111 Section 31.

4. Legal Authority of the Commission (2) Massachusetts Boards of health have wide latitude in enacting regulations affecting the public health. See Brielman v. Commissioner of Public Health of Pittsfield, 310 Mass. 407 (1938). The Commission’s regulatory authority is embedded in its enabling legislation, which grants it the right and power “to proscribe rules, regulations and policies in connection with the performance of its functions and duties.” M.G.L. c. 111 App. § 2-7(a)(1). A health regulation is not required to address all evils and is not made irrational simply because it does not address a particular set of circumstances. See Clements v. Fashing, 457 U.S. 957, 971 (1982).

5. Legal Authority of the Commission (3) It is permissible for legislation affecting the health and safety of the public to be enacted in stages. Williamson v. Lee Optical of Oklahoma, 348 U.S. 483, 489 (1955). This well established jurisprudence in Massachusetts supports the Commission’s authority to ban the sale of tobacco in health care institutions. This was jurisprudence was recently tested in a related case. On March 26, 2009, after a two day trial, a Massachusetts Superior Court judge upheld a different provision of the new tobacco regulations which banned the sale of blunt wraps in the City of Boston. The court found Commission’s ban on blunt wraps was reasonable and supported by reliable evidence that minors were using the blunt wraps to smoke marijuana. The decision may be appealed by the manufacturers.

6. Boston Tobacco Prevention and Control Program Develops, implements and enforces local ordinances that control the sale, use and distribution of tobacco. Supports/leads initiatives which promote smoking cessation, protect residents from second hand smoke and prevent youth from becoming smokers in the City of Boston Monitors data to identify high risk populations

7. *homicides, suicides, motor-vehicle injuries, unintentional, and “undetermined” injuries NOTE: The rates shown are deaths per 100,000 population. DATA SOURCE: Boston resident deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office Leading Causes of Death by Year: Counts and Age-Adjusted Rates, Boston, 2004-2006 2004 Cancer977199.3 Heart Disease879174.2 Stroke24548.4 Injuries*24241.4 Chronic Obstructive Pulmonary Disease17234.7 All causes4,063802.1 2005 Cancer992202.9 Heart Disease828164.0 Stroke21341.8 Injuries*24141.1 Chronic Obstructive Pulmonary Disease17935.8 All causes4,070804.6 2006 Cancer944192.7 Heart Disease751148.4 Injuries*31655.3 Stroke20941.4 Substance Abuse17633.5 All causes3,864763.7

8. Adults Who Are Current Smokers by Age Boston, 2006

11. Enacted by Boston Board of Health December 11, 2008 New Regulation on Sales Prohibit the sale of tobacco products by Health Care Institutions and Educational Institutions Ban the sale of blunt wraps Amendments To Existing Workplace Regulations Expanded definition of the workplace Removed “hotel exemption” from the Smoke-Free Workplace Regulation Banned the issuance of any additional Smoking Bar permits

12. Regulation Restricting the Sale of Tobacco Products in the City of Boston The sale of tobacco products in incompatible with the mission of health care institutions, because it is detrimental to the public health and undermines efforts on the safe and effective use of medication The sale of tobacco products is also incompatible with the mission of educational institutions which educate the younger population about social, environmental and health risks and harms

13. Regulation Enforcement Inspections on implementation day May re-inspect Any violation of this Regulation will result in an initial fine of $200, with a second and third violation within a 24-month period incurring a $700 and $1000 fine, respectively.

14. Provide Free Smoking Cessation Groups and Individual Counseling w/ Patch Distribution Promote the Mass Health Tobacco Benefit Poster Translation and Materials Distribution Technical Assistance for Health Institutions Basic Skills & Tobacco Treatment Specialist Training Collaborate with DPH and UMass Medical School Provided training to @45 health center, hospital and community agency staff Scholarships ongoing BPHC Support for Cessation Efforts

16. Resources for Pharmacies and Pharmacists CME event on regulation sponsored by school of pharmacy Signage addressing regulation Tobacco Treatment Specialist to run cessation groups Scholarships for Staff Training/mentoring Patient/customer brochure including tobacco treatment services (English/Spanish) List of Smoking Cessation resources Materials from Rx for Change – Drug Interactions with Tobacco Smoke – Pharmacologic Product Guide