CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much

Kentucky spends only 7.6 percent of what it should spend on preventing the use of tobacco, the federal Centers for Disease Control and Prevention says in its latest annual report on the subject.

The state spent $4.33 million on tobacco-control programs in 2011, the year covered by the report. The CDC said spending of $57.2 million was called for, since 29 percent of Kentuckians smoked that year. Tobacco-related illnesses are estimated to cost Kentuckians $3.3 billion a year.

South Carolina and Texas, which spent 6.5 percent and 7 percent of the recommended amounts, were also singled out for criticism by the CDC. Nationally, states spend less than 18 percent of what they should, $3.7 billion, in the agency's view. "Only Alaska and North Dakota funded programs at the CDC-recommended levels, $10.7 million and $9.3 million, respectively," Samantha Ehlinger of McClatchy Newspapers reports.

Read more here: http://www.kentucky.com/2015/06/25/3918046/cdc-says-kentucky-isnt-spending.html#storylink=cpy

"States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of smoking has declined faster as spending for tobacco control programs has increased," the CDC report said. "Evidence suggests that funding tobacco prevention and control efforts at the levels recommended . . . could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality."

In contrast to the state spending of $658 million on tobacco control, tobacco companies spent more than 13 times as much on advertising and promotion in 2011: $8.8 billion, or $24 million per day, the report noted.

"During the same period, more than 3,200 youth younger than 18 years of age smoked their first cigarette and another 2,100 youth and young adults who are occasional smokers progressed to become daily smokers," the report said. "If current rates continue, 5.6 million Americans younger than 18 years of age who are alive today are projected to die prematurely from smoking-related disease. However, the tobacco-use epidemic can be markedly reduced by implementing interventions that are known to work."

For the CDC's latest comprehensive report on tobacco use in Kentucky, with data from 2012, click here. For county-by-county figures on adults smoking in Kentucky in 2011-13, click here.

Study outlines historical barriers to tobacco prevention in Kentucky and other tobacco-growing states

A University of Kentucky College of Nursing study published in The Milbank Quarterly has shown that five major tobacco-growing states—Kentucky, North Carolina, Virginia, South Carolina and Tennessee—fall behind the rest of the states in enacting laws to reduce tobacco use.

Tobacco and the diseases it causes affect those five states more than others across the nation, and tobacco is the leading cause of preventable death in the U.S. Those states also have fewer smoke-free laws and lower tobacco taxes, which are two evidence-based policies that help reduce tobacco use, write the authors, Amanda Fallin and Stanton A. Glantz.

The researchers used five case studies chronicling the history of tobacco-control policy "based on public records, key informant interviews, media articles and previously secret internal tobacco industry documents available in the Legacy Tobacco Documents Library," they write.

They found that beginning in the late 1960s, tobacco companies focused on creating a pro-tobacco culture to block tobacco-control policies. However, since 2003, tobacco-growing states have seen passage of more state ad local smoking bans, partly because the alliance between tobacco companies and the tobacco farmers dissolved and hospitality organizations stopped objecting to such bans. National Cancer Institute research projects also built infrastructure that led to tobacco-control coalitions. "Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states," the researchers write.

To continue the progress, health advocates need to teach the public as well as policymakers about "the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced," Fallin and Glantz write. Kentucky once had about 50,000 tobacco farmers; today it has about 5,000, and production is dominated by large farmers. The study is behind a paywall; to read its abstract, click here.

Lake Cumberland District Health Department using polls in an effort to get school boards to make campuses tobacco-free

Countywide smoking bans are unlikely to pass anytime soon in most of rural Kentucky, but more county school districts are making their campuses tobacco-free. Now a multi-county health department is trying to get rural school boards to do that, with public-opinion polls showing that county residents overwhelmingly favor the move.

Department logo has been altered to
show Clinton County in yellow.

The Lake Cumberland District Health Department conducted the poll in Clinton County, and said it found that 86.55 percent were in favor and 7.16 percent were opposed. The rest had no opinion.

Making a campus tobacco-free means that members of the public are not free to smoke at school athletic events, so the poll also asked, “Would you like to see our school become tobacco-free at all events?” The results were virtually the same: 85.3 percent answered yes and 8.7 percent answered no, even though one-fourth to one-fifth of the county's residents smoke and it has a long history of raising tobacco.

"The results are perhaps surprising to some, considering the rate of tobacco usage in the county," reports the Clinton County News. The poll of 749 residents has an error margin of plus or minus 3.6 percentage points.

The department also surveyed 100 teachers in the school system and found that 77 percent would "definitely" support making the schools 100 percent tobacco-free.

The health department presented the survey and other findings to the Clinton County Board of Education June 15, but the board took no action. The department noted that a recent survey found that 28 percent of the county's students in eighth through 12th grades had used smokeless tobacco in the previous 30 days. "That level was the highest in the Lake Cumberland District," the Clinton County News reports.

The Casey County Board of Education adopted a smoke-free policy after a poll by the health department showed 70 percent of the county's residents favored it, the Casey County News reported.

Elementary-school students prompt Middlesboro smoking ban

UPDATE, May 20: The council passed the ban with one member opposing it. Gary Mills said, “I don’t think it’s the government’s right to intrude on businesses owned by individuals. If the public doesn’t like it, they won’t come. . . . This is too intrusive by the government.” Two non-smoking business owners expressed similar sentiments.

The Middlesboro City Council has approved on first reading an ordinance that would ban smoking in public, enclosed spaces. "It remains unclear if the ban would apply to the use of e-cigarettes and vaping products," William Tribell reports for the Middlesboro Daily News.

The ordinance was prompted in part by a March presentation and petition from a group of Middlesboro Elementary School students involved in Destination Imagination, "a volunteer-led, educational nonprofit organization whose purpose is to inspire and equip students to become the next generation of leaders," Tribell writes. "The team was awarded the DaVinci Award for Outstanding Creativity for their efforts and will now compete at the world competition May 20 in Knoxville."

The students drafted the ordinance after researching those in other cities, Tribell reports: "In their presentation to the city council, the team said that 33 percent of Bell County’s population smoke, and they discussed the health effects it has on the community at large."

"The council voted unanimously in favor of the ban ordinance, and it will go up for a second-reading vote at their meeting on May 19," Tribell reports.

Anthem gives $140,000 for 3-county program to cut smoking by pregnant women, still at 21.9% in Ky., among highest in U.S.

Health departments in Christian, Hopkins and Madison counties will start a program called Giving Infants and Families Tobacco Free Starts, with a $140,000 grant to the state health department from the Anthem Foundation.

The GIFTS program was created to help decrease the number of women who smoke during pregnancy and reduce exposure to secondhand smoke for the pregnant woman and her infant, a state news release said. Smoking before and during pregnancy is the single most preventable cause of illness and death among mothers and infants, according to the federal Centers for Disease Control and Prevention.

“Tobacco use is a serious problem in Kentucky, but it is an even more serious issue for women who smoke during pregnancy,” said Dr. Ruth Shepherd, director of the state health department's Division of Maternal and Child Health. “Smoking during pregnancy and infant exposure to secondhand smoke create numerous risks for babies, including pre-maturity and low birth weight, and risks for developing certain conditions like asthma.”

Smoking rates among pregnant Kentucky women dropped from 26.3 percent in 2004 to 21.9 percent in 2013, but that is still among the highest rates in the U.S. In 2013, 13.3 percent of Kentucky births to smoking mothers were premature, compared to 10.2 percent of births to mothers who did not smoke. Even more striking were these numbers: 13.6 percent of babies born to smokers had low birth weight, compared to only 7.5 percent of those born to non-smokers.

The GIFTS program includes a screening tool for assessing tobacco dependence; screening for depression, social support and domestic violence; individualized counseling and support; referral to a service that helps smokers quit; and educational materials, including relapse prevention and the risks of secondhand smoke exposure in the home.

“Reducing the amount of tobacco use and secondhand smoke exposure is not only crucial for improving the health of our state,” state Health Commissioner Stephanie Mayfield said in the news release. “We are thrilled to receive this grant from the Anthem Foundation and look forward to building on the success of GIFTS and working toward reaching our state’s health goals.”

Smokers using electronic cigarettes are less likely to quit smoking than those who don't use the devices, California study finds

The sudden increase in use of electronic cigarettes has prompted questions about whether they actually help people quit smoking. A study published online in the American Journal of Public Health found that individuals who use e-cigarettes are actually less likely to quit smoking than those who do not. In Kentucky, 24 percent of adults and 41 percent of those aged 18 to 29 reported using e-cigarettes, according to a Kentucky Health Issues Poll.

The study, conducted by researchers from the University of California San Diego School of Medicine, discovered that smokers who use e-cigs are 59 percent less likely reduce cigarette use and 59 percent less likely to stop smoking altogether, compared to smokers who have not used e-cigs.

"Based on the idea that smokers use e-cigarettes to quit smoking, we hypothesized that smokers who used these products would be more successful in quitting," said Wael Al-Delaimy, professor and chief of the Division of Global Public Health in UC-San Diego's Department of Family Medicine and Public Health. He said the research showed the hypothesis was false, and more studies are required to find out why these people can't stop smoking. "One hypothesis is that smokers are receiving an increase in nicotine dose by using e-cigarettes," he said.

E-cigs don't contain tobacco, but smoking them releases ultra-fine particles and volatile organic compounds such as heavy metals. The study also found that women and those who smoke daily are more likely to have tried e-cigarettes.

Burgin, in heart of Kentucky, is state's 40th school district to go tobacco-free; ban, won by students, applies to vapor products

Burgin Independent Schools, in the heart of Kentucky, will be the latest 100 percent tobacco-free schools in the state, and the first in Mercer County, which has a strong tobacco heritage.

The Burgin Board of Education voted April 8 to ban all tobacco use, including vapor products, on school grounds and during school-related student trips, Robert Moore reports for The Harrodsburg Herald. The policy becomes effective July 1 and includes any building or vehicle owned or operated by the board and applies to any renters of school property.

Burgin will be the 40th Kentucky school district to become fully tobacco-free. Kentucky has 173 public- school districts, with 1,233 public schools, according to the state Department of Education.

The Kentucky 100 percent Tobacco-Free Schools website says, "Studies show that schools with 100 percent tobacco-free school policies for three years of more have 40 percent fewer smokers than those in non-tobacco free school districts." The 2013 Kentucky Youth Risk Behavior Survey found that 18 percent of Kentucky youth smoke, and 47 percent of them have smoked at least once.

"I’m really proud we’re going to be a tobacco free campus," board member Priscilla Harris told the Herald after the meeting. "We want to set a good example." The independently owned weekly newspaper recently did a three-part series on tobacco in the county, including Burgin students' efforts to get tobacco banned.

Kentucky 100 percent Tobacco Free Schools map, with Burgin added

Warren County school board bans tobacco use on campuses and by students and employees during extracurricular school activities

The Warren County Board of Education voted 4-1 on March 16 to ban the use of tobacco "by students, employees or those on school grounds or during extracurricular school activities" as of July 1, Charles Mason reports for the Bowling Green Daily News.

"Board Chairman Kerry Young dissented," Mason reports. "He said he wanted the district to establish designated smoking areas. Young said tobacco is legal for adults, and is a traditional cash crop for Kentuckians."

However, "Board Member Don Basham said it was in the best interest of the district to promote a tobacco-free environment," and the other three members agreed. 

About 40 of Kentucky's school districts have banned tobacco. "Warren will join Simpson County as the only two school districts in south-central Kentucky deemed 100 percent tobacco-free under state guidelines, Mason reports.

Kenton County Schools ban use of tobacco

The Kenton County Board of Education voted unanimously March 2 to approve a smoke-free policy immediately prohibiting the use of tobacco on school property, in board-owned vehicles and on school-related trips.

“We have a responsibility to model healthy behavior for students,” Supt. Terri Cox-Cruey told the Community Press and Recorder. "Jess Dykes, director of public relations and community engagement, said the request for the district to become smoke-free came from Gov. Steve Beshear," reporter Melissa Stewart writes. "The governor has requested all school districts to consider the policy change."

Dykes said Kenton County joins six other Northern Kentucky school districts with a smoking ban: Grant County, Beechwood, Dayton, Carroll County, Gallatin County and Williamstown.

Casey County High School, which will be smoke-free next year, curbs smoking by locking the restrooms most used by smokers

For two weeks in February, Casey County High School students who wanted to smoke in one of the restrooms were unable to do so because they were locked, Editor Larry Rowell reports for the Casey County News. Principal Josh Blevins said he locked restrooms "most frequented by the students who chose to smoke."

In September, the Casey County School Board passed a prospective tobacco-free rule, so students and staff will not be allowed to smoke in school buildings next year. Locking the restrooms was a way of sending a message. "That was not my long-term plan," Blevins said. "I was using this as a launch pad saying it [smoking] wouldn't be tolerated."

Blevins started a policy requiring students to ask permission and use a sign-out sheet to use the bathroom during class. The restrooms located near the administrative offices are never locked. he said students have the option of reporting to class and asking to use the restroom.

At least one parent did not agree with the new rules. Ellena Hussey, whose daughter attends the school, told Rowell that the students should have bathroom access between classes. She said her daughter has received 10 tardy slips because she had to wait in line to use the only unlocked restroom. Blevins said he had not heard from any parents who had a problem with his actions.

Local building contractor Kenneth Blevins said one restroom with four stalls is enough for the 200 students who attend the school. "The building code says you have to have one facility for the first 49 people and an additional one for every 50 you have," he said.

Breathitt County High School employed another method to curb student smoking. "We open all bathrooms at break time between classes," Supt. Larry Hammond told the Casey County News. "They are locked during class, and they can go to the bathroom between classes, before school, during lunch and after school. They are supervised by teachers." Students who need to use the bathroom during class get a pass and use the restroom in the principal's office.

"It at least controls the smell of smoke in the school building," Hammond said. "You don't smell it down the hallway." (Read more)

Harrodsburg Herald, a weekly newspaper, does three-part series on tobacco issues in Mercer County and statewide

In a state where more than one of every four adults smoke, tobacco is an issue in every county, but it's rare for weekly newspapers to take a detailed look at the issue. The Harrodsburg Herald did that recently, in a three-part series by Robert Moore.

Moore explored why Mercer County and the state have relatively little money for tobacco prevention, writing, "Kentucky doesn't seem all that interested in fighting tobacco. In 2014 the state will receive $158.7 million in tobacco settlement money and spend only $2.5 million to help smokers quit and prevent kids from starting, according to the Kentucky Center for Smoke-free Policy."

The states' lawsuit against cigarette manufacturers, and the Master Settlement Agreement that followed, was ostensibly to recover their costs for treating illnesses due to smoking. However, most of the money has gone to general purposes, and in Kentucky half the money was dedicated to improving the agricultural economy — but the legislature steered some of that money elsewhere, mainly for rural water lines, Moore noted.

"The largest single use of tobacco funds now is debt service," he wrote. "Every year, $28 million of the MSA payment goes to pay interest on $434,883,200 in outstanding municipal bonds. The bonds financed various construction projects over the last decade—$20 million for construction of the UK Veterinary Diagnostic Center in Lexington and $2 million for renovations to the FFA Leadership Training Center in Hardinsburg, both in 2008."

Another story explored the growing phenomenon of electronic cigarettes, and the other looked at efforts to curb smoking, statewide and locally. Moore looked at lobbying and campaign-finance reports from Altria Group, the leading cigarette manufacturer, and wrote about efforts by the Burgin High School chapter of Teens Against Tobacco Use to have smoking banned on their campus.

In a more recent story, Moore updated the Burgin issue, concluding, "Until something changes in the state legislature, schools like Burgin will be the most important battlegrounds in the fight against tobacco-related deaths."

Smoking-ban bills get unfavorable committee assignment in state Senate, but supporters say they'll keep trying to get votes

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The state Senate's Republican leaders have assigned both the Republican and Democratic smoking-ban bills to a committee that appears unlikely to send them to the full Senate.

The Veterans, Military Affairs and Public Protection Committee got House Bill 145, which the House had passed 51-46, and Senate Bill 189, filed by Sen. Julie Raque Adams, R-Louisville.

Adams is chair of the Health and Welfare Committee, and smoke-free advocates had hoped the bills would go there, improving its chances in a Senate that doesn't appear disposed to pass it.

Senate President Robert Stivers defended the assignment, saying the bills relate to public protection. Last year, a smoking-ban bill sponsored by the previous Health and Welfare chair, Republican Julie Denton of Louisville, was sent to the Judiciary Committee and never heard.

Stivers was asked if Adams' bill was sent elsewhere because of her support for it. He acknowledged that it could have been considered a health issue, and "It was a choice." Pushed to answer, he said, "I don't recall anything being made, because we put a lot of bills in chairman's committees that they support whether leadership supports it or not."

Adams did not respond to requests for comment, but Amy Barkley, chair of the Smoke-free Kentucky Coalition, said she had hoped the bill would go to Health and Welfare because it addresses a health issue.

"We hope it gets a hearing in the Senate," Barkley said. "We are hoping that even if those individuals in leadership are not supportive, that they will at least let the bill have a fair hearing and hopefully a vote – and they can vote no if they are not supportive, but we think it deserves to have a vote so we know where people stand."

Sen. Morgan McGarvey, of Louisville, a Democratic co-sponsor of the Senate bill, said he understood how a smoking ban could be perceived as a public-protection matter, but used the assignment as an argument for the legislation.

"There is no bill we can pass this session that would save the state more money than a comprehensive statewide smoking ban," he said. "It will make Kentuckians healthier; it will save the state money."

Advocates' job will be to persuade Republicans, whose policy is not to allow bills to reach the full Senate unless they are favored by a majority of the 26 Republican senators.

The chairman of the Public Protection Committee, Sen. Albert Robinson, R-London, said through his assistant that he wasn't ready to talk about the bills because they had just been assigned to his committee. He told the Lexington Herald-Leader, "I don't know if there is support for it in my committee." He told The Courier-Journal that he opposes the bill.

The legislation has been debated in the legislature for five years. Senate Bill 189 is identical to the original House bill, which was amended. Both bills would prohibit smoking in workplaces and indoor places, and within 15 feet of their entrances, to protect others from secondhand smoke, which is estimated to kill 950 Kentuckians annually.

House Bill 145 passed with three changes: an exemption for cigar bars, cigar clubs, tobacco stores, private clubs and market-research facilities; significantly lower fines for violation; and preservation of any weaker or stronger local bans in effect when the bill would become law, in late June.

The fundamental conflict about the bill, largely along party lines, is whether individual liberties or public health take priority.

Stivers reiterated his stance, siding with those who support individual liberties.

"I do not like smoking. I don't patronize places that smoke. I have allergies," he said. "It costs you money to take your suits to the cleaners and things of that nature, but I just don't think it is the role of government to start telling private businesses what they can and can't do from that perspective."

He suggested that his opposition wasn't decisive. "I am one of 38 [senators] and if you go back and look at respective bills, there have been bills that I haven't voted on that have made it to the floor because they have the support of the body. Actually, I think we voted on one this week or maybe late last week that I did not vote for, but there was support in this chamber for that issue."

Stivers noted that more Republican senators support the ban than last session, mentioning Adams and Sen. Ralph Alvarado, a Winchester physician. Both were elected to the Senate last fall.

Alvarado explained why he values health over liberty on this issue. He said we all have the right to swing punches at another person, but at the point of contact, that person's rights have been violated. "My individual rights to do something ends when it affects the rights of another individual is my perspective, and secondhand smoke is just that," he said.

Alvarado said he continues to talk to senators about why they should support a statewide smoking ban, saying," It would cost nothing to implement and the benefit from a fiscal perspective and lives saved . . . would be tremendous."

As a rookie public official, Alvarado said he still has a "romantic idea" that it is possible to persuade senators to change their positions and "find at least some type of compromise to get more people covered and to reduce (secondhand smoke) exposure."

Sen. Perry Clark of Louisville, a libertarian-oriented Democrat on the Public Protection Committee, said it was too early to say how he might vote on the issue because the bill might be amended. It has been suggested that the bill could pass if local governments could opt out of the ban, but Barkley told The Courier-Journal that would fatally weaken it.

Besides Clark and Robinson, other members of the committee are Republicans C.B. Embry of Beaver Dam, Carroll Gibson of Leitchfield, Ernie Harris of Prospect, Stan Humphries of Cadiz, Chris McDaniel of Taylor Mill, Dan Seum of Louisville, Whitney Westerfield of Hopkinsville, Mike Wilson of Bowling Green and Max Wise of Campbellsville; and Democrats Julian Carroll of Frankfort and Dennis Parrett of Vine Grove.

Opinion: Toward a healthier Kentucky, with a smoke-free law

By the Friedell Committee for Health System Transformation 

It is no secret that Kentucky is among the unhealthiest states in our country. 

Kentucky is No. 7 in cardiovascular deaths, No. 1 in cancer deaths, No. 1 in lung cancer, and No. 13 in asthma prevalence. And Kentucky leads the nation in smoking with 26.5 percent of its adult population.

Even non-smokers are at risk of diseases caused by tobacco. Exposure to secondhand smoke increases the risk of coronary heart disease by 25 to 30 percent among nonsmokers.  It increases the risk of lung cancer in nonsmokers by 20 to 30 percent. 

This means that waitresses and bartenders (most of whom do not smoke) in workplaces that allow smoking risk their lives just to earn a paycheck.  Sadly, 68 percent of Kentuckians are currently exposed to secondhand smoke in public places.  At this rate it is no wonder that Kentuckians suffer serious and deadly consequences.

Fortunately, we have scientific evidence that a smoke-free law will reduce disease rates in areas where such a law is in effect. Communities that pass comprehensive smoke-free workplace laws have experienced a 15 percent drop in emergency-room visits for heart attacks.  ER visits for asthma dropped by 22 percent in Lexington after the smoke-free law was enacted. 

Also, adult smoking rates declined by 32 percent in Lexington, saving $21 million per year in health care costs! While a decrease in smoking rates is not the primary reason for secondhand smoke-free laws, many people express an interest in stopping, and the laws make quitting easier.

Our poor health is a problem that affects us all.  It affects our health-care costs, our community health, and a national perception of us as being an unhealthy place to invest in and live.  That problem can be addressed by smoke-free local ordinances, a state law, and/or local boards of health regulations. 

The Affordable Care Act presents a unique opportunity to look at health differently.  We need to start emphasizing prevention of diseases rather than relying only on treatment.  Smoke-free policy is one effective type of prevention. We know that prevention will save lives and reduce health care costs borne by individuals, private business and the government. 

The Saving Our Appalachian Region effort in Eastern Kentucky reminds us that Kentucky can do better.  Going smoke-free is one way. Imagine a Kentucky where no one is exposed to smoke in the workplace and where fewer people actually smoke.  Lives would be saved, diseases would be prevented, and health care costs would decrease.

Thankfully, most Kentuckians agree. Statewide polls show that 66 percent of likely voters are in favor of a smoke-free law.  This makes sense since most Kentuckians do not smoke.  It is time for the state legislature to implement a policy that will improve our health, save lives and reduce health costs.

The Friedell Committee for Health SystemTransformation is an organization of community leaders across the state that knows that Kentucky is not a healthy state but that working together we can do something about it.

Statewide smoking ban passes Kentucky's Democratic House, but its chances don't look good in the Republican Senate

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A statewide smoking ban passed the Democrat-controlled state House Friday for the first time, but its chances appear grim in the Republican-controlled Senate though a clear majority of Kentuckians support the bill.

House Bill 145, which would prohibit smoking in workplaces and indoor places, passed 51-46 after the narrow defeat of two amendments opposed by its advocates and three changes that may have put it over the top. Nine of the 44 Republicans joined 42 of the 56 Democrats to pass it.

Amendments to the bill added exemptions for cigar bars, cigar clubs, tobacco stores, private clubs and market-research facilities; significantly reduced the fine for violation, to $25 for individuals and $50 for businesses; and would preserve any weaker or stronger local bans that are in effect when the bill would become law, in late June.

House Speaker Greg Stumbo told Tom Loftus of The Courier-Journal that the latter amendment was key to the bill's passage. Rep. Tanya Pullin, D-Greenup, told the House that it won her vote because it creates a "window of opportunity" for localities to enact their own bans. It was proposed by Democratic Caucus Chair Johnny Bell of Glasgow.

The defeated amendments would have exempted electronic cigarettes and well-ventilated adult establishments prominently displaying a "Smoking Establishment" sign. The e-cig amendment, proposed by Republican Caucus Chair Stan Lee, lost 46-49; the other one, offered by freshman Rep. Jim DuPlessis, R-Elizabethtown, lost 44-45. For the roll calls, click here.

"A couple of the amendments are problematic," Amy Barkley, chair of the Smoke-free Kentucky Coalition, said in a phone interview. "The existing laws in these communities may not protect all workers," she said. "And localities can pass weak laws (before this bill becomes law) and have that forever."

Nevertheless, Barkley said, "This is really a historic moment."

More compromise may be necessary to get the bill through the Senate, where Republican Sen. Julie Raque Adams of Louisville filed a similar bill as the House measure was coming up for a vote.

Senate President Robert Stivers told Bruce Schreiner of The Associated Press, "I am personally not a fan of smoking, but I just don't believe it is the government's role to tell [a business] that you cannot have a facility that smoking takes place in — be it a pool hall a bar or restaurant." He added, "I don't see there being that type of support in the Senate to pass a bill like that."

Barkley disagrees. "There is a lot of support in the Senate," she said.

The sponsor of HB 145, Rep. Susan Westrom, D-Lexington, said "I cannot predict what will happen in the Senate. Stivers has said from the beginning that he wouldn't let it have a hearing."

Barkley said advocates are asking Senate leaders to "let your members have the vote and go on record with their position." The next clue to the leaders' attitude will be where they send the bill. If it doesn't go to the Health and Welfare Committee, which Adams chairs, that would be a bad sign for it.

Westrom repeately said that the bill does not ban smoking. "This bill just requests that a smoker step outside 15 feet," she said. "Fifteen feet is not too far to walk to know that 950 people in this state won't die from secondhand smoke related illness." That is the estimated number of deaths each year in Kentucky from secondhand smoke.

Westrom said afterward that she had hoped for a larger margin than five votes, but "I couldn't be happier. This is a historic moment and there is lots to be proud of," referring to the many people and organizations that committed themselves to the cause.

The Kentucky Health Issues Poll last fall found that 66 percent of Kentucky adults favored the ban. It won 57 percent support in last year's Bluegrass Poll for news organizations.

During the House debate, opponents of the bill spoke mainly of private-property rights and individual liberty.

I deplore smoking," said Rep. Brian Linder, R-Dry Ridge, "but my love for liberty is greater than my hate, therefore I vote no."

Earlier, Westrom said, "Our freedoms only extend until they begin to affect others."

Democratic Gov. Steve Beshear hailed the House vote as "an extremely important and significant event," adding, "It sends a very strong statement ... that it is time to move in this direction. It is just such a health problem and health issue in the commonwealth; so many of our chronic conditions relate directly back to smoking."

Advocates of smoking ban, including victims of secondhand smoke, rally at Capitol

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Over 500 Smoke-Free Kentucky advocates spent Wednesday, Feb. 11, asking their lawmakers to pass a statewide smoking ban, wrapping up their day with a rally and news conference in the Capitol rotunda, featuring leaders of the effort and people who said they were victims of secondhand smoke.

"Our efforts are paying off; there is going to be a vote very soon," James Sharp of the American Cancer Society's Cancer Action Network said to a cheering crowd. "Keep up the good work, keep up the pressure, keep sharing those personal stories. We will get a smoke-free Kentucky because everyone deserves the right to breathe clean, smoke-free air in this state."

Lt. Gov. Crit Luallen, a colon-cancer survivor, said Kentucky "has some of the worst health statistics in the nation" and conditions like heart disease, lung disease and cancer are all linked to smoking. "If we truly care about our children, and our families and the future health of the commonwealth, it is time to pass House Bill 145 and create a statewide smoke-free law," she said.

"I don't know how any public leader today can sleep at night if they are not committed to help reforms like a statewide smoke-free law," Luallen said to a cheering room. "I don't know how they sleep at night knowing we have more Kentuckians dying of cancer than any other state in America."

"This should not be politically risky," Luallen said after the rally. Saying that many rural towns or businesses will not do this voluntarily and statistics support the correctness of this decision, so "Those legislators who are facing a difficult vote have to look at what is the right thing to do."

Health Commissioner Stephanie Mayfield, who has taken a strong stance against smoking and tobacco since she took office, said the law would be a strong, quick advancement toward better health. "Secondhand smoke can kill you,": she said. "The science is clear, The debate is over."

Joe Geraci, a volunteer for the cancer society and a lung cancer survivor, said he was there to represent those with cancer "who did not make it." He said that he attributed his lung cancer to the smoke-filled capitol building that he worked in as a lobbyist for 10 years.

Geraci said many of the legislators told him that they were getting more calls from people to vote against the bill than to vote for it, so he encouraged calls to the legislature's message line, 800-372-7181.

Denny Nafus of Northern Kentucky said his nonsmoking parents, who volunteered at church bingo for decades, died of lung disease, and Kentucky spends $1.92 billion a year on health care and loses $2.3 billion worth of production because of smoking and secondhand smoke.

Roger Cline of Olive Hill said he was there as a "secondhand smoke victim" because he lost his nonsmoking wife to lung cancer from exposure to smoke at her workplace.

Dr. Erin Frazier of Louisville, a breast-cancer survivor, said that she had no other contributing factors for the cancer other than waiting on tables in smoky bars and restaurants between the ages of 16 and 22. She said wait staff have the highest prevalence of exposure to secondhand smoke of any occupation.

"Young, pre-menopausal women who are exposed to secondhand smoke have a 70 percent greater risk of getting breast cancer than those exposed later in life," she said. "and regardless of the age, women who are exposed to secondhand smoke have a 25 percent increased risk of getting breast cancer."

Sandra Castle described herself as a nurse who loved to sing to her patients. She said she worked for 18 years around secondhand smoke, and blamed it for two different cancers, which caused her to lose a vocal cord and undergo spinal surgery. She said she had lost two of the greatest joys of her life, singing and the ability to lift her grandchildren.

Laura Tarakam said secondhand smoke is a trigger for asthma attacks, and a son died from an attack caused by an unknown trigger. Secondhand smoke is a known trigger for asthma attacks, so this puts her living son, an asthmatic, and others with this condition constantly at risk.

Rep. Susan Westrom, five-year sponsor of the bill, thanked the smoke-free advocates for the work they do and encouraged them to be persistent" saying that as lawmakers became more educated, they better realize their responsibility for improving the health of all Kentuckians, not just in the workplace.

Westrom, D-Lexington, also thanked Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, for its support of the bill. Adkisson said "92 percent of business leaders support this legislation" not only because "smoking is killing us as a health matter, but it is bankrupting us as a financial one."

Asked after the rally about the bill's chances in the Senate, Westrom said "our numbers are so positive" in the Republican-controlled chamber, and better than they have ever been. She said there aren't enough votes yet to get the bill to the floor, but it was "very, very close." Senate President Robert Stivers has said he plans to follow his policy of not allowing bills to the floor unless they are supported by a majority of the Republican caucus, which has 26 members of the 38-member Senate.

Sponsor of local opt-out amendment says smoking-ban bill needs it to pass; sponsor and House leaders don't care for it

By Melissa Patrick
Kentucky Health News

UPDATE: The House didn't vote on this amendment, but Sen. Jimmy Higdon, R-Lebanon, says it or something like it would give the bill a better chance of passing the Republican-controlled Senate.

FRANKFORT, Ky. – Rep. Steve Riggs of Louisville has proposed an amendment to the statewide smoking ban bill that would allow cities and counties to opt out of the ban every two years, saying he wants to improve the bill's chances of becoming law.

Riggs

“This amendment would negate a lot of concern about taking away local rights,” Riggs, a Democrat who supports the ban, said in a press release.

His Floor Amendment 9 to House Bill 145 proposes that local governments be able to opt out of the ban, but would be required to take another vote every two years to prevent the ban from taking effect in their jurisdiction.

Rep. Susan Westrom, five-year sponsor of the ban, first said she welcomes amendments because that is "how we edit our legislation," but still needed to talk to Riggs – and when asked if she thought this amendment was a good idea, she said it "goes against the intent of the bill."

"It is a little bit too late for this amendment," the Lexington Democrat said. "We have made too much progress."

House Speaker Greg Stumbo, who says he supports the bill but has clashed with Westrom about its handling, agreed. "I think if you started from day one with that as the idea," he said, "it might have been more palatable."

Stumbo and Republican Leader Jeff Hoover said the amendment would defeat the bill's purpose.

Hoover

Hoover noted, "Advocates have said for many years that we have to have a state-wide smoking ban because of the health concerns all across Kentucky."

Riggs said in an interview that the legislation hasn't had the votes for the past five years and it is time to do something different.

"If you keep swinging at the ball and missing time after time, you probably ought to change your stance," he said. "And that is what they need to do. They need to make a change to get more votes so it will pass."

Westrom said, "We have the votes." But House leaders told her Friday, Feb. 6, that she would need to have commitments from 55 of the 100 House members before they would bring her bill up for a vote.

"What it really says is, it takes 51 votes to pass, but we want 55 commitments because we can't trust everybody," Hoover said. "It's not about having a cushion; it's about they can't trust their own members when they say they are going to vote for something." He said Democratic leaders "should have the discipline to keep amendments, such as this one, from being filed."

Riggs said as chair of the House Local Government Committee, he is sensitive to the needs of cities and counties, and "If we give those people an option to opt out of it, we might be able to get some votes up here to pass the bill."

He said his amendment would allow the bill's advocates to get 90 to 95 percent of what they want to accomplish. "Most people consider that an A, excellent," he said. "This bill might bring in another 10 votes, because people feel if they have the option to opt out, that is liberty and freedom."

Riggs also said the idea might improve the bill's poor chances for passage in the Senate because some senators showed interest in the approach last year.

This is the right thing to do because they don't have enough votes to pass the bill in the House and the Senate," Riggs said.

He said smoke-free advocates don't want any changes to this bill and have not been willing to compromise for the past five years, and asked, "How much illness can we put at their feet because they won't change their swing?"

James Sharp of the American Cancer Society's lobbying arm, the Cancer Action Network, declined to comment.

Hoover, one of the relatively few Republicans for the bill, said he is mindful of opponents' arguments about personal property rights, but also of the "associated health risk with smoking and second hand smoke and the cost that this state is incurring in treating those folks who have diseases related to smoke and second hand smoke."

He concluded, "When I do the balancing test for me personally, I come down on the side that this is a step in the right direction to reduce health care cost and save lives."

With 55 votes needed instead of the usual 51, it just got harder to pass a smoke-free workplace law in the House

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A bill to ban smoking in public places and places of employment will require the commitment of a supermajority to get a vote on the House floor, making it more difficult to pass.

Rep. Susan Westrom, D-Lexington, said in a telephone interview that when she told leaders of the House's Democratic majority yesterday that her bill had 49 votes, two short of a majority, Democratic Floor Leader Rocky Adkins of Sandy Hook told her she would need 55 votes for him to bring the bill before the House.

Asked why she thought there had been a change from the usual 51 votes needed for a floor vote, Westrom said the only reason she could imagine was "There are some members of leadership that don't want to make anyone uncomfortable . . . don't want to ask them to take a vote."

Last year, House leaders declined to bring the legislation to a vote, and Speaker Greg Stumbo of Prestonsburg said many members didn't want to vote on it during an election year.

Adkins said yesterday that a supermajority requirement is not unusual for any bill that is a "high priority" or "one that has been discussed a lot." He said the rule applied to Stumbo's House Bill 2, to raise the state minimum wage. It passed in the House Tuesday, 56-43.

Democratic Rep. Tom Burch of Louisville, the longest-serving member of the legislature and chairman of the committee that approved the bill, said requiring 55 votes to get a floor vote happens from time to time. He said this will "provide a cushion" because "some of these guys will crawfish," or will back off when they see there are 51 votes.

Offering an example of why it it is best to go into a vote with a cushion, Burch recalled 1980, when new Gov. John Y. Brown Jr. took his gas-tax bill to a vote, thinking he had 51. But someone who had committed to vote for it reneged during the vote, leaving Brown one vote short. Burch said he cast the 51st vote at the request of House leaders, who had told him that his vote wouldnt be needed.

"We need a cushion," Burch said.

Westrom said the request from Adkins for 55 votes "comes as no surprise to me."

"We must roll with the punches and keep moving forward," she said. "I am making connections with those in the middle, providing them with information to help them with their comfort zone."

She said that she and other advocates had been educating her colleagues for five years about the importance and need for a smoking ban, but some were just not receptive.

"There are some freshman legislators from rural areas who get it, and seasoned legislators that still don't," she said.

When House Bill 145 passed the Health and Welfare Committee 11-4 last week, Westrom said, "I feel very confident we will get a floor vote." But at that time, she was aiming for 51.

The bill has never gotten out of committee in the Senate and chances in the Senate this year continues to remain doubtful.

James Sharp, lobbyist for the American Cancer Society's Cancer Action Network, said that with 66 percent of Kentuckians statewide supporting the bill, it is time for state leaders to make "the health and economic viability of our commonwealth" a priority by passing this bill.

"We need our leaders in either chamber, in either party, to step up and lead on this issue," Sharp said. "Bring this bill for a vote. Get it passed for the health of all Kentuckians, sooner than later."

Adkins, asked if leaders are doing enough, said they were listening to and working with their caucuses. "So, I think we are working our way through the process," he said. He commended Westrom and advocacy groups for "an outstanding job of really educating people on this piece of legislation, educating Kentuckians."

Burch said, "I am voting for this bill because it is the right thing to do" and encouraged lawmakers to listen to their constituents.

"If these people would listen to what their districts thought, they would be for this bill 100 percent," he said. "Because 75 percent of Kentuckians don't smoke and don't want somebody blowing smoke in their face and they don't want the results of second-hand smoke."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Newport school board's smoking ban, which includes e-cigarettes, would be 38th among 173 Kentucky school districts

The Newport Independent Board of Education passed the first reading of a proposed smoking ban Wednesday, Jan. 28 after adding electronic cigarettes to the ban.

The ban would prohibit smoking on any school campus, including parking lots, cars and the bus garage, and no smoking will be permitted by any groups who rent or meet on any school properties.

The second reading of the ban will be in February and if passed will go into effect July 1, Patricia A. Scheyer reports for The River City News.

"I do expect that it will pass," Superintendent Kelly Middleton told Scheyer. "I haven't had anyone say anything against passing it, and in fact, I have had a couple of comments in favor of it."

If passed, the "Newport school district will be the 38th school district out of Kentucky's 173 districts to become smoke free, joining Beechwood and Dayton Independent schools locally," Scheyer reports.

Low-income smokers have a harder time quitting, which helps explain why Kentucky leads the nation in smoking

Lower-income smokers have a harder time quitting than health-conscious middle- and upper-class Americans, Keith Humphreys reports for The Washington Post.

The numbers suggest one reason why Kentuckians lead the nation in smoking. Kentucky ranks 48th among the states and the District of Columbia in median household income in 2011-13, according to the Census Bureau; it ranked 45th in per-capita personal income in 2013, according to the Bureau of Economic Analysis.

The pol'ls margin of error was plus or minus 1 percentage point.

A 2008 Gallup poll of more than 75,000 Americans showed that the rate of smoking among people making less than $24,000 a year was more than double that of those making $90,000 or more. The higher the income category, the lower the smoking rate, except those making less than $6,000 per year, which was skewed because many in this bracket are students, Rob Goszkowski writes for Gallup.

Once health warnings about cigarettes became widely known, better-off Americans were more likely to quit smoking. "High-income families decreased their smoking by 62 percent from 1965 to 1999, versus only 9 percent for low-income families," Humphreys reports. Education may also be a factor; income and education are usually closely related.

Humphreys list three reasons poorer smokers have a hard time quitting:
1. They inhale more deeply on each draw from a cigarette, creating stronger addiction and making it harder to quit.
2. They don't have the same social support from their colleagues and friends as wealthier smokers. For example, a doctor is likely to be encouraged to quit smoking or get social disapproval if he or she is the last of their peers to stop; a person who works at roadside cleanup might "face precisely the reverse social incentives from his smoking coworkers," Humphreys writes.
3. They are likely to have less access to effective smoking-cessation programs and less access to address behavioral health issues, like depression, that make quitting more difficult. Kentucky has addressed those problems recently by having Medicaid cover smoking cessation and behavioral-health care by any licensed provider.

Some suggest that because lower income smokers have a harder time quitting, using higher tobacco taxes as an incentive for them to quit should be re-evaluated. Humphreys writes, "Deeply addicted, low-income smokers may face the choice between spending much-needed income on tobacco or venturing into the black market for untaxed cigarettes, which carries significant risks of its own."

Kentucky's cigarette tax of 60 cents a pack is lower than all but 10 states. New York ranks first at $4.35 per pack, which pushes the price of cigarettes to $10-$15 a pack, according to the Campaign for Tobacco-Free Kids website.

UK cancer-center director urges lawmakers to raise cigarette tax and pass a statewide smoking ban to reduce cancer deaths

The Markey Cancer Center at the University of Kentucky supports a statewide smoking ban and an increase in the state cigarette tax to significantly reduce cancer deaths in the state, the center's director told a legislative committee Sept. 3.

“We are highly supportive, and we hope that you will be supportive as well, of (these) initiatives that we think will improve the overall health of Kentuckians,” Dr. B. Mark Evers told the state legislative Tobacco Settlement Agreement Fund Oversight Committee.

A news release from the Legislative Research Commission said Evers presented the numbers to back up his advice: Kentucky is first nationally in percentage of people who get cancer, and in overall cancer mortality. Lung cancer alone accounts for about 35 percent of Kentucky cancer deaths; nationally, lung cancer's share is 28 percent.

Twenty-eight percent of adult Kentuckians smoke, with approximately 8,000 deaths each year from smoking-related illnesses. The greatest incidence of tobacco-related cancers is in Eastern Kentucky.

That is the highest percentage in the U.S., Evers notes, adding that there is an indirect relationship between cigarette taxes and smoking rates. Kentucky has the 12th lowest cigarette tax among the states.

"Raising the cost of cigarettes and a statewide smoking ban could help cut Kentucky cancer deaths by 50 percent," Evers said. That is the Markey Cancer Center's goal over the next five years.

The center has a new strategic plan, "Conquering Cancer in the Commonwealth," that focuses on the state's "major cancer killers" -- lung, head and neck, colorectal, breast, and cervical cancer.

In response to a question about how to decrease the number of smokers in Kentucky, Evers pointed to local smoke-free policies and increased efforts in Appalachia toward smoking cessation.

When asked what it will take to lower the percentage of Kentucky smokers to less than 10 percent, Evers recommended three things: increasing the cigarette excise tax, a statewide smoking ban, and instituting lung-cancer screening projects like those in place at UK and the University of Louisville.

“Those three things are really going to help drive down those numbers,” he said.