Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies – more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.

Study: Smoke-free workplace leads to fewer heart attacks

Mayo Clinic researchers have found a 33 percent drop in heart attack rates in a Minnesota county after public smoking bans were enacted. This, while rates of hypertension, diabetes, high cholesterol and obesity remained the same or even increased after the ban was put in place, reports The New York Times. The conclusion: “I think the bottom line is this should turn the page on the chapter discussing whether or not secondhand smoke is a risk factor for heart attacks,” said Dr. Richard D. Hurt, an author of the study and a professor of medicine at the Mayo Clinic in Rochester, Minn.

The study, published in Archives of Internal Medicine, was conducted in Minnesota's Olmstead County where medical records were examined 18 months before the county's 2002 public ban went into effect and 18 months after it extended the ban to all workplaces in 2007. (Read more)

'Cigarette 6' smoked by Hopkinsville paper's editorial

First came the Jackson Five, then the Chicago Seven. Now, straight from Hopkinsville's city council, come the Cigarette Six. So dubbed by the editorial board of the Kentucky New Era, the Six were met with by a incredulous headline on an editorial that addressed the group's attempt to circumvent a drive for an anti-smoking ordinance in most indoor public places: " 'Cigarette 6' on council must think we're stupid."

The editorial takes direct aim on the six members' apparent lack of interest in protecting citizens from secondhand smoke and their approach to a smoking ban that isn't one: a do-it-yourself sort of ban "that requires businesses to declare whether they will be a smoking or a smoke-free establishment." As if that is not what businesses are today without such a pronouncement. The New Era called the Six's stance "an embarrassment to the city." Read the complete New Era editorial here.

Because the 6-5 vote came with a smoking-ban proponent absent, and in the council's committee of the whole, where Mayor Dan Kemp, another proponent, cannot break ties, the council could still vote 7-6 in favor of the originally proposed smoking ban. For a report on the last council meeting, click here.

The editorial comes in the wake of a recent report by the statewide Friedell Committee for Health System Transformation that called for county health boards to "assume responsibility for educating their population about improving their health status," be "highly visible and proactive," and play a leading role "in developing healthy community coalitions and partnerships," and the Christian County health director's vow to take his board in that direction. An item on that report is 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)

Floyd County woman is Kentucky's smoke-free advocate of year

For her work spreading the word about second-hand smoke and founding the coalition that ultimately helped Prestonsburg pass a smoke-free ordinance in 2009, Floyd County's Jean V. Rosenberg was named 2012 advocate of the year at the annual Smoke-Free Policy Conference hosted by the University of Kentucky's Kentucky Center for Smoke-Free Policy. She stands with center Director Dr. Ellen Hahn, left, and Dr. Melissa Walton-Shirley, right, the Glasgow cardiologist who won in 2011.

Rosenberg started her work in 2005 when she began working for the Floyd County Health Department as a program specialist to increase awareness about the dangers of second-hand smoke, reports Ann Blackford reports in a university press release. During that time, she founded the Breathe Easy Floyd County Coalition, which educated people about second-hand smoke and supported local smoke-free initiatives.

On Nov. 1, 2009, the City of Prestonsburg implemented a 100 percent smoke-free ordinance in all workplaces and enclosed public places, with Rosenberg at the helm to propel the effort forward. (Read more)

Mayor will propose smoking ban in Hopkinsville, largest Kentucky city without one

The largest Kentucky city that has not banned smoking in public places may change that.

Hopkinsville Mayor Dan Kemp's proposal "fundamentally resembles Lexington's ban," reports Nick Tabor for the Kentucky New Era. The law would apply to bars and restaurants but not private clubs; retail tobacco stores and tobacco warehouses; and rented rooms in hotels, hospitals and nursing homes. "The best thing would be to have no exemptions," Kemp said, adding that he recognizes the need for compromise. 

An online survey by the Christian County Health Department two years ago indicated strong support for a ban. A recent, scientific survey of 500 Kentuckians shows 59 percent support a statewide ban, the American Cancer Society found. Kemp said he has "received a mostly positive response from local businesses," Tabor reports.

As for a smoking ban imposing on a person's right to light up, Kemp said, "I just think it's such an overriding health concern that that trumps the individual rights argument." Kemp hopes the council will vote on the proposal June 5. If they ratify it, the ban could take effect July 1. (Read more)

In 11-1 vote, Somerset passes comprehensive smoking ban

Lighting up in Somerset, once a big tobacco town, will no longer be allowed in all enclosed public places. The city council voted 11-1 Monday evening to pass a smoking-ban ordinance, reports Heather Tomlinson of the Commonwealth Journal. (C-J photo)

The ordinance includes restaurants, bingo halls, gaming facilities, nursing homes and any place of employment. "It's a public health safety issue," said councilor Jerry Girdler, who lost his well-known brother Eddie two weeks ago to throat and lung cancer. "The facts back up that smoking is harmful to the people around them."

The meeting attracted a crowd of more than 50, many of whom voiced their opinions. Business owner Teresa Singleton said, "I am really shocked at the fact that the City of Somerset is considering taking away the rights of businesses to make those decisions on whether we want our place of business to be smoking or non-smoking. For you to take that on your own, I think that's a major step in the wrong direction."

Local podiatrist Pamela Jensen-Stanley disagreed. "I believe the ban is necessary," she said. "I think it's time that Somerset moves up and gets with the program." (Read more)

Hopkinsville newspaper endorses smoking ban

The Kentucky New Era newspaper in Hopkinsville said in a recent editorial that if the state legislature doesn't enact a smoking ban, the city should.

The General Assembly "should not squander the opportunity or delay action on a law that could protect everyone against the health risks associated with exposure to secondhand smoke," the editorial said. "Legislators should not disregard the overwhelming scientific evidence of the effects of secondhand smoke. . . . Opponents of a smoking ban argue that they want to protect the rights of smokers. We believe those rights to not extend to smoking in places where non-smokers work, shop and eat." (Read more)

Corbin City Commission enacts smoking ban

The Corbin City Commission passed an ordinance this week to ban smoking in all enclosed public areas and enclosed public buildings. The ordinance will also require smokers to remain at least 25 feet from building entrances. Areas subject to the ban include bingo parlors, restaurants except for outdoor seating, and motels and hotels, "which may not offer more than 20 percent of rooms as smoking," Dean Manning of The News Journal reported. "Once the ordinance is advertised, it will become law," Becky Kilian of The Times-Tribune reports.

Race for city commission seat puts an end to debate over city's smoking ban, advocate and opponent agree

The Bowling Green City Commission candidate who said he wanted to rewrite the city's smoking ban ran last in the five-way race for an unexpired term on the commission Tuesday, and he and a commissioner in the 3-2 majority that enacted the ban said the result is an indicator of public opinion on the issue.

Candidate Bill Goodwin got only 682 votes, or 8.6 percent of the total. "Commissioner Brian 'Slim' Nash said he believes voters sent a message in Tuesday’s election: Citizens are satisfied with the city’s smoking ban," Andrew Robinson of the Daily News reports. "Goodwin said he spoke to a few citizens who told him the result is a clear sign there’s little support for revisiting the ordinance."

“The people spoke or the people didn’t show up,” Goodwin told the  newspaper. “It’s got to be an issue that’s dead right now. That’s all there is to it.” (Read more)

Light up at school? Face a $150 fine in Jessamine County

If students at the two Jessamine County high schools are found with cigarettes or any kind of tobacco product while on campus, they can face a fine up to $150.

East Jessamine High started issuing tickets a few years ago, and West Jessamine joined the effort last month, reports Jim Warren of the Lexington Herald-Leader. Since it was implemented, the number of students caught with the contraband items has gone down at East, with 120 incidents in 2009-09 and 149 in 2009-10. "Last year, we only had 39," Principal Janet Granada said. "Once the word spreads that there's a fine involved, it seems to lessen smoking greatly."

The idea came from Billy King, a school resource officer at East Jessamine High. "We recognized we had a problem with minors using tobacco," he said. "I felt that it would prevent them from bringing tobacco to school if they knew they could get a fine. But I also knew that they probably didn't think it would happen. Police generally don't cite juveniles for tobacco possession, even though the law has been on the books forever."

King posted signs around the school warning students of the possibility of a fine. A few weeks later, he started handing out tickets. "The word got around pretty quickly," he said. School resource officers write up the citations, which are referred to juvenile court. Fines are paid to the court, so the schools have no financial incentive to issue the citations.

Though many school districts in Kentucky have adopted tobacco-free policies on their campuses, Lisa Gross, spokeswoman for the Kentucky Department of Education said this is the first she's heard of students being given a fine. (Read more)

Bullitt County health board will appeal judge's ruling against smoking ban, with financial help from Clark County

The Bullitt County Board of Health will appeal a local judge's ruling that it lacks the authority to impose a smoking ban, and it will get some help from the board in Clark County, one of four where bans have been enacted by health boards instead of county fiscal courts.

The $5,000 will come not from tax dollars, but from "money received from the University of Kentucky for consulting services provided by Health Department Director Scott Lockard," Rachel Parsons of The Winchester Sun reports. UK "contracted with the Clark County Health Department so Lockard could work with the university and other local public health directors on smoke-free issues."

If the Bullitt County ruling is upheld, the decision could invalidate regulations enacted by health departments in Clark, Madison, Woodford and Hopkins counties. At the Court of Appeals, “If they uphold the lower court’s ruling, then we will have an injunction against our ruling until it goes to the Supreme Court, so we will suspend the enforcement of it until we get a final determination,” Lockard said. “We fully anticipate that the ruling will be in favor of the boards of health, because this is just a very narrow interpretation.” (Read more)

Bullitt judge strikes down health board's smoking ban; could lead to decision with statewide impact, if appealed

A Bullitt County judge has extinguished a countywide smoking ban that was supposed to go into effect Monday, saying the county health board overstepped its authority. The ruling could lead to a decision with statewide impact, determining whether county health boards have such power; a judge in another county approved a ban there and the ruling was not appealed.

Circuit Judge Rodney Burress called the ban void and unlawful, Charlie White of The Courier-Journal reports. "This court does not believe that type of 'Big Brother' conduct was anticipated by the Kentucky state legislature in its grant of power and authority to boards of health," Burress wrote.

"It's a win for business and a win for choice in Bullitt County," said Harlen Compton, one of the founders of Bullitt County Choice, a group of area business owners and residents.

The ban would have prohibited smoking in bars, restaurants and all public places. But even before the Bullitt County Board of Health passed the ban, the county's eight cities and its Fiscal Court sued the board, White reports.

Swannie Jett, the county's health director, said health officials were "very disappointed" and will decide in the coming weeks if they will appeal the decision.

Burress wrote that Bullitt County residents "are entitled to be governed by their elected representatives and should not be subjected to additional laws enacted by an administrative agency without an express grant of authority."

The health board passed the ban under Kentucky Revised Statute 212.230, which says health boards "shall" adopt, implement and enforce regulations necessary to protect public health. Opponents said such a far-reaching regulation as a smoking ban can only be legally passed by city councils or fiscal courts, White reports.

However, the Bullitt County board is not the first in Kentucky to enact such a ban. Health boards in Woodford, Hopkins, Madison and Clark counties have done likewise. The move in Hopkins County did result in a legal battle, but the judge sided with the health department. (Read more)

Smoke-free campuses are a growing trend; UK volunteers taking action to get compliance with ban enacted nearly two years ago

This summer, Tobacco-free Take Action! volunteers at the University of Kentucky have been circling campus, asking students to put out their cigarettes while on school property. UK is one of about 530 U.S. colleges that have enacted smoke-free policies. (Photo from University of Michigan)

Most of the bans are considered comprehensive, with smoking prohibited on all grounds, including athletic facilities, restaurants and parking lots, reports CNN's Stephanie Steinberg. That is the case at UK, which enacted its ban in November 2009. Then, just 300 college campuses had similar bans in effect. Within the past year, 120 campuses were added to the smoke-free list nationwide. Today, in addition to UK, Bellarmine University, Kentucky Wesleyan College, Morehead State University, Pikeville College, Spalding University, St. Catharine College, Union College and University of Louisville are smoke-free, according to the American Nonsmokers' Rights Foundation.

The Centers for Disease Control and Prevention reports about 46 million Americans age 18 and older smoke cigarettes. A 2010 American College Health Association report found 4.4. percent of the more than 30,000 students surveyed had smoked every day in the past 30 days. In Kentucky, about 26 percent of adult Kentuckians smoke.

Since UK enacted its ban in 2009, a growing number of people have gotten help to quit smoking at the university. "After the policy's first year, enrollment rose to 146 people," up from 33 the year before, Steinberg reports. "The number of nicotine replacement coupons redeemed by students and faculty also increased from 124 to 470 in the same period."

One of the keys to changing mindsets is to avoid being too heavy-handed, Steinberg reports. "We certainly don't have smoking police," said Ellen Hahn, director of UK's Tobacco Policy Research Program. Instead student volunteers gently remind others of the policy while offering smoking cessation information.

Ty Patterson, former vice president of student affairs at Ozarks Technical Community College in Missouri, predicts that in 10 years almost all college campuses in the country will be smoke-free. "We've gone from pushing smoking out of the building . . . to now trying to push smoking totally off campus," said Laura Talbott Forbes, chairwoman of the 2010 American College Health Association's Alcohol, Tobacco and Other Drugs Coalition. (Read more)

Retiring Boyle County health director has played important roles in the community; many of his counterparts do likewise

The man behind Danville's smoke-free ordinance is stepping down from his position as Boyle County's public health director. "I've got a 100-acre farm and I plan to pursue those interests and do some extensive traveling," Roger Trent told The Advocate-Messenger's Mandy Simpson. (Advocate-Messenger photo)

Trent has been at the helm of the health department for 12 years. During his tenure, he "successfully lobbied the Danville City Commission to pass an ordinance banning smoking in all enclosed public places of employment," Simpson reports. He also started smoking cessation classes at the health department, collected food for families in need, and headed efforts during the 2009 ice storm. "He will certainly be missed, and I hope we can find somebody equivalent," said David C. Liebschutz, chairman of the Boyle County Board of Health.

Al Cross, director of the Institute for Rural Journalism and Community Issues and publisher of Kentucky Health News, commented on Trent's impact on his community: "County health directors rarely get noticed except when they create controversy or retire," he said. "They play, or should play, a more important role in the community than local news media might suggest." (Read more)

E-cig, hookah ban takes effect Monday in Madison County

Electronic cigarettes and water pipes known as hookahs will be banned in enclosed public places in Madison County beginning Monday under an amendment to the county's existing smoking ban.

The ban, which has been in effect since 2007, was amended in April by the Madison County Board of Health. In addition to adding the e-cig and hookah regulations, the amendment also prohibits smoking in retail tobacco stores, reports the Lexington Herald-Leader's Greg Kocher.

Madison County is not the first jurisdiction to ban e-cigs and hookahs. Bardstown and Glasgow prohibit the use of e-cigarettes in their smoking bans. The Bullitt County Board of Health also approved a ban, which takes effects in September, that prohibits them. Effective July 1, a campus-wide tobacco-free policy that includes e-cigarettes and hookahs takes effect at St. Catharine College in Washington County. Lexington's smoking ban does not include e-cigarettes. (Read more)

Bowling Green American Legion post tests smoking ban, is fined

An American Legion post in Bowling Green has been fined $25 for violating the city's no-smoking ordinance. The Bowling Green Code Enforcement Board decided unanimously Tuesday to uphold the citation that Post 23 received April 28 after two plainclothed police officers went into the facility during bingo night and found people smoking inside, Justin Story of the Bowling Green Daily News reports.

Officers Tammy Britt and Rebecca Robins testified they bought two sheets of bingo cards and a soda at the facility. They said they were not asked at any point if they were members of the Post. The city's smoking ordinance "defines private organizations as establishments that are exempt from federal income taxes, are not profit-oriented, maintain a selective membership that operates the organization and does not sell food, drinks, entertainment or lodging to anyone who is not a member or a member's guest," Story reports.

More members started to smoke after Jim Manley, the Post's chief finance officer, told the crowd they were free to do so. "He said that if a citation were issued it would be to (the post) and not the individual, and after that more people started smoking," Britt said. The citation indicates the facility violated three provisions of the ordinance: allowing smoking in a building/enclosed area; failure to remove ashtrays; and failure of owner or person in control to ensure compliance.

Malcolm Cherry, an officer of Post 23, "said that he wanted it to be cited by allowing smoking during charitable gaming on April 28 in an effort to prove it was exempt," Story reports. "Our whole intention was for the officers to be there and have the citation issue to us personally," Cherry said. City Attorney Gene Harmon argued the post does not meet all the criteria to be considered a private club, in part because it sells bingo cards and refreshments during bingo night. The board agreed. (Read more)

State health commissioner encourages smoke-free ordinances

Kentucky's public health commissioner said communities are moving in the right direction by enacting smoke-free ordinances and hopes Kentucky can become a smoke-free state. "We have communities in Letcher County, as well as areas in far Eastern Kentucky, Western Kentucky and Northern Kentucky implementing second-hand smoke ordinances because it's dangerous for people who are non-smokers," Dr. William Hacker said.

Hacker, who spoke at the Breathing Clean Air Summit in Owensboro Thursday, said 25 percent of Kentuckians smoke, the highest percentage in the country, reports Jasmin Embers of WFIE-TV in Evansville. "We're ranked number one in lung cancer deaths, so if you're number one in smoking, you can expect to be number one in lung cancer deaths," Hacker said.

Hacker encouraged communities that already have smoke-free efforts or laws to go farther. Change can be seen at Owensboro Medical Health System, which now has four smoking huts on its campus. Those will be eliminated by the end of the year, a move that was decided after employees responded to a smoking survey. "Half of the respondents said they felt that smoking on OMHS grounds contradicted our mission statement to heal the sick and improve health of our community," wellness committee member Gordon Wilkeron said. (Read more)

Kenton Co. smoking ban yields 15 complaints; citations next?

There have been 15 complaints to the Northern Kentucky Health Department since Kenton County's smoking ban took effect nearly two weeks ago. Because enforcement does not take effect until next week, no one has been cited yet, Cindy Schroeder of the Kentucky Enquirer reports.

The ban went into effect after the outgoing Kenton Fiscal Court approved the ordinance in December. It bans smoking in most workplaces, including "restaurants, churches, factories, offices, bingo halls, bowling alleys and stores," Schroeder reports. It does allow exemptions for bar and private clubs. So far, 65 drinking establishments and five private clubs have applied for exemptions, 62 of which have been approved.

The biggest the challenge to the health department so far has been to inform owners what they need to do to comply with exemption requirements. "Those include having a separate enclosed smoking section with its own air system and its own entrance," Shroeder wrote. "Also, no one under 18 can be employed or admitted." (Read more)

Kenton County goes it alone with smoking ban in Northern Ky.

Kenton County's smoking ban took effect today, making it the first county in Northern Kentucky "to ban smoking in most public places," Cindy Schroeder reports for The Kentucky Enquirer. "The controversial ordinance approved by the outgoing Kenton Fiscal Court in December requires offices and public establishments such as restaurants, churches, bowling alleys, bingo halls and retail stores to go smoke-free. Private clubs and 'drinking establishments' that meet certain requirements can apply for an exemption." (Enquirer photo by Patrick Reddy: Richard Gordon of Florence, in Boone County, lights up at the Super Bowl in Erlanger, in Kenton County.)

The urban counties on either side of Kenton have no smoking bans. Advocates of a ban tried to get all three counties to adopt the same legislationm, but Boone County rejected the idea, and a newly elected fiscal court in Campbell County repealed a ban that was enacted by the former court last year and had not gone into effect. Now Kenton County businesses fear the sole ban in the region will drive customers to other counties, and "Both opponents and supporters of smoke-free legislation agree that Kenton County's partial ban allowing exemptions for some, but not all public places, is confusing and will be difficult to enforce," Schroeder writes. Still, "People on both sides of the issue say it's only a matter of time, however, before all of Kentucky goes smoke-free, just as Ohio and 22 other states have done." (Read more)