Lack of statewide smoking ban represents one part of Kentucky's struggle to deal with tobacco use and the health issues it creates

By Molly Burchett

Kentucky Health News

As the bill for a statewide smoking ban lies on its deathbed in the General Assembly, new federal data show Kentucky still has the highest percentage of smokers (29 percent) of any state, leads the nation in the share of smoking high school students (24 percent) and spends only a minuscule portion of their tobacco revenues to fight tobacco use. Those figures come from the federal Centers for Disease Control and Prevention's Tobacco Control State Highlights 2012 report. (For county-by-county figures, click here.)

The lack of a statewide smoking ban, which nevertheless has become popular among Kentuckians, represents only a small part of the struggle to address Kentuckians' tobacco use and resulting health problems. Kentucky's program to discourage tobacco use has been severely underfunded for years, contributing to the state's lack of or slow progress in reducing its smoking and tobacco use rates and subsequent health problems, said Dr. Ellen Hahn, director of the Kentucky Center for Smoke-Free Policy at the University of Kentucky.

State tobacco revenue (left bar) and spending (right bar)

The CDC says Kentucky should spend $57.2 million a year to have an effective, comprehensive tobacco-prevention program, but the state allocates only $2.1 million a year to such programs -- 3.7 percent of the recommended amount.

By another measure, the amount is only 0.6 percent of the estimated $381 million the state gets from tobacco taxes and the 1998 national settlement with cigarette manufacturers, according to a tobacco settlement report.



Meanwhile, Kentucky's health-care costs attributable to smoking add up to about $1.5 billion a year, and smoking-caused productivity losses total $2.3 billion a year. These amounts do not include health costs caused by exposure to secondhand smoke, smoking-caused fires, smokeless tobacco use or cigar and pipe smoking.

Despite the known health risks that tobacco use poses, smoking in Kentucky remains a part of everyday life in most places. But that is increasingly less so around the country, so there is an increasing gap between heavy-smoking and low-smoking states; smoking in Kentucky is about twice as prevalent as in Utah and California, reports Steven Reinberg of HealthDay. Click here for an interactive map of states' tobacco prevention efforts.

There are proven, multi-pronged strategies to curb smoking. They include combinations of higher tobacco taxes, smoke-free laws, media campaigns, and restricted access to tobacco products. However, Kentucky continues to lag behind other states due to "stagnant policies" and a lack of funding, said Hahn.

Many other factors contribute to Kentucky's lack of tobacco-prevention progress. By failing to substantially reduce adult smoking, the state misses opportunities to encourage younger adults and children not to smoke, Hahn said. Kentucky needs to employ strategies that communicate the success and affordability of tobacco cessation programs, she said; people often lack the encouragement to quit smoking because they don't know how or they don't believe it is possible.

The latest tobacco report is a timely reminder that tobacco use remains a huge public health problem for Kentucky and there are proven strategies that, if implemented, could help Kentuckians live a healthier, tobacco-free life.

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

Tobacco use higher in rural areas; several factors include tobacco companies' targeting of rural youth, Lung Assn. says

Tobacco use is higher among rural communities than in suburban and urban areas, and smokeless tobacco use is twice as common. According to the American Lung Association, rural youth are more likely to use tobacco and to start earlier than urban youth, perpetuating the cycle of tobacco addiction, death and disease.

In its latest health disparity report, “Cutting Tobacco’s Rural Roots: Tobacco Use in Rural Communities,” ALA says the increased tobacco use is associated with lower education levels and lower incomes, which are both common in rural areas where there may be fewer opportunities for educational and economic advancement.

The exposure to secondhand smoke is also likely to be higher, since rural communities are less likely to have smoke-free air laws in place, and that probably makes residents less likely to ask individuals not to smoke in their homes or other indoor places they control.

The report also pointed out that the tobacco industry "spends millions of dollars targeting rural youth," and "these young people are less likely to be exposed to tobacco counter-marketing campaigns. Rural tobacco users are also less likely to have access to tobacco-cessation programs and services to get the help they need to quit. Promotion of the availability of state counseling services by phone and online resources also lags in rural communities."

To read the full report, go here.

Hopkinsville council, absent a proponent, narrowly replaces smoking ban idea with plan to require posted smoking policies

The effort to pass a smoking ban in the largest Kentucky town without one may have hit a roadblock Thursday night. The Hopkinsville City Council forwarded a smoking ordinance that would merely require businesses to decide whether to allow smoking and post signs at every entrance announcing its policy. The council's vote as a committee of the whole was 6-5, and the one absent council member favors a typical smoking ban.

Mayor Dan Kemp, who can vote to break council ties and does not sit on the committee of the whole, "said after the meeting that he could not support the proposal because it leaves the current law unchanged," Carla Jimenez reports for the Kentucky New Era. The alternative ordinance is scheduled for first reading Sept. 18; a tie vote would block it, and a tie vote in favor of a smoking ban could be broken by Kemp to pass it.

As first presented to the committee, the ordinance would ban smoking in public places, with exemptions for private clubs, age-restricted establishments and businesses with 12 employees or fewer. The small-business exemption was removed on a vote of 10-1. "That left the ordinance as it originally came before the council for its first reading in June," Jimenez reports. But then the committee voted 6-5 for the alternative ordinance, proposed by Councilman Paul Henson, who argued, “We’re not abusing anybody’s rights. We’re not the bad guy, and yet we have the smoking ban, a smoking ordinance, on the books.”

Councilwoman Peggy Rogers-Everett disagreed, saying smoking is a hazard to everyone, and “Murder is illegal.” Henson and Councilwoman Ann Cherry and Henson laughed, and "Everett was not amused," Jimenez reports. Everett said, “I don’t find that funny. I don’t take that lightly.” (Read more)

143 groups in state working to improve health, directory lists

A directory that lists all the local groups working on health-related issues in the state has been released by the Foundation for a Healthy Kentucky. It identifies 143 groups — at least one impacting each county — and lists the primary contact person at each location.

"These are local residents working on solutions to health issues in their cities and towns," said Susan Zepeda, CEO of the foundation. "As these groups work to make their community a healthier place to live, work, study and play, they are improving the overall health of our state."

Whether in the form of coalitions, collectives, consortia, associations or networks, the groups are working to improve the health of their communities. Some are looking at ways to increase access to healthy food and physical activity, others are planning screenings and education for people with chronic diseases like diabetes, and others are working toward getting smoke-free ordinances passed.

The directory can be viewed by clicking here. It will be updated periodically.

Rockcastle County school board nixes ban on smoking at schools

While more than 30 Kentucky communities have banned smoking in enclosed public places, and about as many school districts have imposed a total ban, many districts remain resistant to the idea. This month the Rockcastle County Board of Education turned down a smoking ban that would have allowed designated smoking areas at athletic events but no smoke breaks for employees.

"Four of the five board members expressed opposition to the ban, including Mike Burdette, who said he didn't feel it was right to tell an adult they cannot use a legal product on grounds their taxes pay for," reported  the Mount Vernon Signal. Other board members said they didn't like the fact that the proposal from the administration did not include smoke breaks since employees "can't leave school during the day except for designated reasons."

The Signal reported that Superintendent Larry Hammond "put forth the argument that research has shown that second- and even third-hand smoke can be harmful to students," but only Board Chairman Martin Vanzant supported the proposal. To a member who suggested that the ban be delayed for two or three years, he said that would be "postponing the inevitable." (Read more)

In Kentucky, "All 174 school systems have restrictions of some sort on the use of tobacco products on their campuses, and any that allow staff smoking have designated areas," Brad Hughes of the Kentucky School Boards Association told Kentucky health News. "About 30 have a total ban."

Some employers stop hiring smokers in effort to 'walk the walk'

As smoking bans become more common nationwide, employers are taking it one step further and refusing to hire people who smoke. Primarily in hospitals, employers "won't hire applicants whose urine tests positive for nicotine use, whether cigarettes, smokeless tobacco or even patches," reports Wendy Koch of USA Today.

"We have to walk the walk if we talk the talk," said David Fotsch of Idaho's Central District Health Department, whose board agreed to stop hiring smokers last month.

"We're trying to promote a complete culture of wellness," said Mary Marshall of the Geisinger Health System in Danville, Pa., which likewise stopped hiring smokers. "We're not denying smokers their right to tobacco products. We're just choosing not to hire them."

As for how many U.S. businesses are opting not to hire smokers, there is no data but "the trend appears strongest with hospitals," Koch reports.

Critics say the practice is the equivalent of employment discrimination. "It's a very dangerous precedent," said Michael Siegel, a professor at Boston University's School of Public Health.

"What's next? Are you not going to hire overly-caffeinated people," said Nate Shelman, Boise's KBOI radio talk show host. "I'm tired of people seeing smokers as an easy piñata."

But federal laws do not view the move as discrimination because smokers are not recognized as a protected class. Still, 29 states, including Kentucky, as well as the District of Columbia, have passed smoker-protection laws.

Paul Billings of the American Lung Association said he is not convinced that refusing to hire people who smoke will help them quit — smoking cessation programs probably are more effective, he thinks — but the ALA nevertheless opts not to hire them. "We're non-smoking exemplars," he said. (Read more)