Nashville Clean Air for All Protecting children from secondhand smoke Jason Stamm, MSP Robert Taylor, MPH Tobacco Control Program Metro Public Health Department of Nashville/Davidson County

Objectives Provide basic data about tobacco use in Nashville/Davidson County and Tennessee Provide an overview of the “Nashville Clean Air for All Project” Goals and objectives Strategies Lessons learned

Tennessee: Tobacco Country? Tennessee Nonsmoker Protection Act Tobacco tax increase in 2007 $0.62 per pack $1.23 (national average) $0.38 (tobacco growing states) Preemption

Tobacco & Tennessee National average: 20.5% Smoking rates in Tennessee 24.3% total 47th highest smoking rate in the U.S National average: 20.5% *CDC/BRFSS-2007 data

Tobacco Stats: Davidson County 22.4% of Davidson County residents smoke* More males (26.6%) than females (18.5%) smoke* More African-Americans (28%) than whites (21.7%) smoke* 21.3% of adolescents smoke** * 2008 BRFSS ** 2007 Youth Risk Behavior Survey

Tobacco Use During Pregnancy In Tennessee 22% of pregnant women age 15-19 smoke Rates of smoking during pregnancy are at least 12 times higher among women with 9 to 11 years of education (25%) than among women who hold a college degree (2%).

Nashville Clean Air For All How the Smoke-Free Homes/Cars Challenge Works Metro Public Health Department (MPHD) received a grant from the American Legacy Foundation Thru this grant, the MPHD is partnering with daycares, car seat providers, local hospitals and other agencies that work with parents and children to address children’s exposure to secondhand smoke in the home and car.

Answer: “At some point, they begin to crawl.” Question: How do infants protect themselves from exposure to secondhand smoke? Answer: “At some point, they begin to crawl.” -Tobacco Industry Executive, 1996 RJ Reynolds/Nabisco Annual Meeting

Why focus on children?

Why Focus on Children? Children are particularly susceptible to health risks from secondhand smoke Children's exposure is involuntary Most children of smokers are exposed in the home or car

Why Focus on Children? Almost 60% of U.S. children aged 3-11 years—or almost 22 million children—are exposed to secondhand smoke. About 25% of children aged 3-11 years live with at least one smoker, as compared to only about 7% of nonsmoking adults.

Vic Harville, Stephens Media Group

Third-hand smoke?

Third-hand Smoke January issue of Pediatrics MassGeneral Hospital for Children (MGHfC) Tobacco smoke contamination lingers even after a cigarette is extinguished – a phenomenon they define as "third-hand" smoke.

“the toxic brew of gases and particles clinging to smokers’ hair and clothing, not to mention cushions and carpeting, that lingers long after secondhand smoke has cleared from a room.” http://www.nytimes.com/2009/01/03/health/research/03smoke.html

Third-hand Smoke Conclusions More research needed on the issue Increasing awareness of how third-hand smoke harms the health of children may encourage home smoking bans.

Why focus on homes and cars?

Secondhand Smoke & Children Not covered in Tennessee Nonsmoker Protection Act Children are frequently exposed to secondhand smoke (primarily in homes and cars) Estimates range from 1/3 to 1/2 of all children ETS exposure rates increased in: Children who live in poverty Households with low educational levels

Nashville Clean Air For All How the Smoke-Free Homes/Cars Challenge Works MPHD will train partners on the dangers of tobacco and secondhand smoke. MPHD will provide a “packaged program” and technical assistance that can be easily implemented by partners.

Nashville Clean Air For All How the Smoke-Free Homes/Cars Challenge Works Once trained, partners will: Ask clients about their tobacco use Provide information about secondhand smoke Encourage them to take the “Smoke-Free Home and Car Challenge” (ie-sign smoke-free home/car policy cards). Identify tobacco users and provide information about quitting. Refer to the Tennessee Tobacco Quitline via the Fax Referral System.

Nashville Clean Air For All Media Campaign Metro Transit Authority (buses) Website Earned media opportunities Radio Television Newspaper YouTube Facebook World No Tobacco Day (May 31, 2009) Clean Air Day (July 2009)

Goals & Objectives Secondhand Smoke Goal 1: Reduce exposure to secondhand smoke in typically economically disadvantaged families (families at or below 185% of the U.S. Poverty Income Guidelines.) residing within Nashville, TN. Objective 1: By November 30, 2009, receive 500 completed smoke-free policy cards from Nashville residents pledging they will not allow smoking in their cars or homes. Objective 2: By November 30, 2009, provide education regarding the harmful effects of secondhand smoke to 2500 Nashville residents participating in the car seat safety program along with other MPHD programs.

Strategies Secondhand Smoke Partnerships Daycares Metro Action Commission Head Start program Tennessee Comprehensive Cancer Coalition “Daycares of Excellence” program Car seat programs Meharry Medical College Metro Public Health Department Tennessee State University Safe Kids Coalition Hospitals Smoke-Free Nashville (coalition)

Key Messages: Secondhand Smoke Secondhand smoke contains over 4,000 chemicals Children are frequently (involuntarily) exposed to secondhand smoke Exposure to secondhand smoke is especially dangerous to children The Surgeon General stated there is no risk-free level of exposure to secondhand smoke. Bans on smoking in public and private places (such as restaurants, homes and cars) are effective ways to reduce exposure to secondhand smoke

“Quitting smoking is easy. I’ve done it a thousand times” Mark Twain

Goals & Objectives Cessation Goal 2: Promote cessation among smokers who interact with daycare providers and smokers who participate in the partner car seat safety programs. Objective 1: By November 30, 2009, refer 100 smokers to cessation services with at least a six month quit rate of 20%.

Strategies Cessation Tobacco users will be identified through a brief smoking survey (part of policy card) Once identified, quit packs and information about the Tennessee Tobacco Quitline and Legacy’s www.becomeanex.org will be given to tobacco users indicating a desire to quit Fax referral to the quitline Follow-up at 6 months

Keys Messages: Quitting Tobacco Quitting smoking often requires multiple attempts. Using counseling or medication alone increases the chance of a quit attempt being successful. THE COMBINATION OF BOTH IS THE MOST EFFECTIVE METHOD OF QUITTING

Becomeanex.org EX is an interactive website by the American Legacy Foundation to help smokers quit Ex is a nationwide campaign that provides FREE resources designed to help smokers create their own plan to quit smoking 3 steps to re-learn life without cigarettes Re-learn habit Re-learn addiction Re-learn support

Lessons Learned/Barriers Be flexible with training schedules Be aware of internal policies and procedures Collaborate, but always keep moving forward

Sustainability Possible Year 2 Legacy funding Program is easily sustainable Several “untapped” potential partners Minimal cost for continuation (with partner buy-in) Strong departmental support

Take Home Messages for All Choose not to allow anyone, including yourself, to smoke in your home or car. Choose not to smoke if children are present, particularly infants & toddlers. If you must smoke, choose to smoke outside. Quitting is the best way to prevent your child from being exposed to secondhand smoke.

Thank you for your time and attention. Jason Stamm, MSP Jason.stamm@nashville.gov Robert Taylor, MPA Robert.taylor2@nashville.gov Metro Public Health Department 311 23rd Ave North, Suite 313 Nashville, TN 37203 Work: 615-340-0401 Fax: 615-340-2105