Lexington marks 20 smoke-free years, but smoking bans still haven't caught on in most of Ky. despite tobacco's toll on health

Lexington Mayor Linda Gorton led a celebration of the 20th anniversary of the city's ordinance banning smoking in indoor workplaces and public spaces. (WEKU photo by Stu Johnson)

Kentucky Health News

Twenty years ago, Lexington became the first city in the South of Midwest to make indoor smoking in public places illegal. It's had a big impact there and in several other Kentucky cities, but only three in eight Kentuckains live in a place with such an ordinance.

“Lexington’s ordinance has had an enormous impact on the health of Lexington citizens,” said Mayor Linda Gorton said at a celebration of the anniversary. “In terms of public health, it is one of the most important, if not the most important, ordinance we have passed in the last 20 years. It has saved countless lives.”

Tom Latek of Kentucky Today reports, “After the measure took effect, there was a reduction in heart attacks and emergency-department visits for asthma, and the smoking rate in Fayette County declined nearly 32%, resulting in 16,500 fewer smokers for an estimated annual health-care cost savings of $21 million.”

In 2014, electronic cigarettes, "addictive and popular among youth, were added to the ban," Latek notes. "In the 20 years since Lexington’s smoke-free law passed, 57 additional Kentucky municipalities have passed smoke-free laws, protecting 38% of Kentuckians."

"The number of people benefiting is considerably higher, as residents of counties that don’t protect against secondhand smoke travel to cities that do in order to work, shop, do business, dine and have fun," writes Jamie Lucke of Kentucky Lantern.

But despite Kentucky's high smoking rate and tobacco's effect on the state's health, bills to enact a statewide indoor-smoking ban couldn't get through the General Assembly even when the House was conrolled by Democrats, and now that it and the Senate are heavily Republican, advocates have given up on the idea, at least for now. So they concentrate on local ordinances.

Ellen Hahn, Ph.D., R.N.

“Policy change takes time, often decades,” says Ellen Hahn, the University of Kentucky nursing professor who has been the leading advocate of smoke-free ordinances. “Policy change is also a team sport. While a few people can make a difference, I could not stick with it without support from others.

“As a nurse, I am naturally a patient advocate, giving voice to the voiceless, and as a public health nurse, my patient is the community. I am willing to wait for effective change. . . . The payoff for society is definitely worth the wait.”

Hahn told Lucke that she wishes for four things: “A comprehensive smoke-free law that covers every community in the state . . . a strong, hard-hitting media campaign” against heavily promoted tobacco products; higher cigarette taxes, which Lucke notes "deter young people from starting and to motivate adults to quit;" and more smoking-cessation services. "Kentucky spends just 3.5% of what the Centers for Disease Control and Prevention recommends on tobacco control and prevention," Lucke notes.

“It’s really not a shock that we have such high smoking rates,” Hahn told Lucke. “We don’t invest in prevention. And the sad part is we know what works to reduce smoking. We’re just not doing it.”

Ky. Center for Smoke-free Policy recognizes communities, groups and individuals who work to create smoke-free communities

Lori Fulton Brookbank is Smoke-free Advocate of the Year. Image from the Smoke-free Tomorrow Facebook page

The Kentucky Center for Smoke-free Policy honored communities, groups and individuals from across the state who are making progress in creating healthier, smoke-free communities. The awards were presented Nov. 10 at a virtual award ceremony. 

“Kentucky has had an amazing year as we now have 38 communities with comprehensive smoke-free workplace laws, covering 36.2 percent of Kentuckians," said University of Kentucky nursing professor Ellen Hahn, director of the Kentucky Center for Smoke-free Policy. "We have experienced extraordinary momentum and leadership by local elected officials and advocates for smoke-free and tobacco-free protections even during the pandemic. These community heroes are making Kentucky a better place to breathe.” 

This year’s awards include:

The Smoke-free Indoor Air Excellence Award recipients were the cities of Hazard, Perryville, and Hodgenville as well as Perry County (which includes Hazard) for their leadership and collaborative efforts in promoting the health of their citizens by enacting comprehensive smoke-free workplace ordinances.

The Smoke-free Excellence in E-Cigarette Policy Award recipients were the cities of Corbin, Campbellsville, and Williamsburg for their leadership and collaborative efforts in promoting the health of their citizens by strengthening their comprehensive smoke-free ordinance to include e-cigarettes.

The Smoke-free Endeavor in E-cigarette Policy Award recipients were Franklin County, its seat of Frankfort and the City of Hopkinsville for their leadership and collaborative efforts in promoting the health of their citizens by adding e-cigarettes to their partial smoke-free ordinance.

The Lee T. Todd Jr. Smoke-free Hero Award  recipients were Hayley Leach and Sierrah Miley, UK Tobacco-Free Take Action Ambassadors, for their commitment to smoke- and tobacco-free environments in the face of adversity.

The Timothy W. Mullett, MD, Lung Cancer Prevention Award went to Angela Criswell of the Lung Cancer Alliance, and Lindi Campbell of Breath of Hope KY, for their devotion and passion for preventing lung cancer through education, advocacy, or policy change. 

The Lifetime Achievement in Tobacco Control Award recipient was Mary Singler, retired health -promotion manager with the Northern Kentucky District Health Department, for her exceptional career devoted to leadership in tobacco control.

The Tobacco-free Campus Award recipient was Western Kentucky University for its leadership and collaboration in promoting a healthy campus environment by implementing a 100% tobacco-free campus policy.

The Smoke-free Youth Advocate Award recipient was the Mason County High School Family, Career and Community Leaders of America chapter for excellence in promoting secondhand smoke education and smoke-free policy.

The David B. Stevens, MD, Smoke-free Advocate of the Year recipient was Lori Fulton Brookbank, with the Smoke-free Partnership of Mason County, for her excellence in promoting secondhand smoke education and smoke-free policy. 

The other two nominees for the Smoke-free Advocate of the Year award were Shirley Daulton of the Lake Cumberland District Health Department, and Jennifer Osborne of the Lincoln Trail District Health Department.

Smoke-free advocates say the policy can be more palatable if part of a wellness campaign; also say to include smokers at the table

By Melissa Patrick
Kentucky Health News

If you're trying to win passage of smoke-free policies in communities that have been resistant to such efforts, you should focus on the broad issue of improving the health of those communities. That's what one told more than 250 attendees at a conference, saying that efforts to make a community healthier naturally lends itself to policies that minimize exposure to second-hand smoke.

Onjewel Smith of the Southern States Regional Project of
the American Nonsmokers' Rights Foundation discussed
smoke-free campaigns in rural communities at the 2019
Kentucky Tobacco Conference. (Photo by Melissa Patrick)

Onjewel Smith, who works for the American Nonsmokers' Rights Foundation Southern States Regional Project, offered examples of how rural communities in Mississippi and Louisiana have successfully passed smoke-free laws by focusing on "healthy community initiatives." She told the group that these strategies have worked because advocates have framed smoke-free in a way that matters to these communities.

"It's about getting people to think about wellness and not necessarily smoke-free," she said. Later adding, "I don't care what the motivation is. I really don't. At the end of the day we want these policies in place. We want people protected. "

She also reminded the group that getting folks ready for a smoke-free policy requires a whole lot of community engagement to bring awareness to the issue. "We can't ask for change until people understand there is a problem," she said.

As of April 1, 35.5% of Kentuckians are protected by smoke-free laws covering all indoor workplaces and public places.

The 2019 Kentucky Tobacco Conference "Envisioning a Smoke-Free Future" was held April 16 and 17 in Lexington. It was hosted by the Kentucky Center for Smoke-Free Policy, the Kentucky Department for Public Health, the University of Kentucky College of Nursing and the Kentucky Tobacco Prevention and Cessation Program.

Another recurring theme at the conference was to make sure people who would be most affected by a smoke-free policy are included at the table. Speakers at a harm-reduction summit shared a similar message last week, stressing the importance of partnering with drug users to make syringe exchanges truly successful.

For example, the speakers said African Americans, people from the LGBTQ community, people in addiction and recovery, and people from low socioeconomic status, all need to be involved in policy making. These groups were mentioned because they tend to use tobacco products at high rates, largely because they have been targeted by the tobacco industry.

Vivian Lasley-Bibbs, acting director of the Office of Health
Equity at the state Department for Public Health, engaged
with the advocates at the conference. (Photo by Melissa Patrick)

Vivian Lasley-Bibbs, acting director of the Office of Health Equity at the state health department, talked about the importance of looking at tobacco policies from the lens of health equity, which she said requires us to think about how a policy, decision or practice is unfair to one group or another.

She asked, "How many times have you worked around an issue or gone into a community and sat around the table where those who are impacted aren't there?"

Dr. Valerie Yerger, an associate professor of health policy at the University of California, San Franscisco, had a similar message as she spoke about the tobacco issue: "Look around; if you are dealing with an issue that affects marginalized people, make sure that they are there and let them participate. And think in terms of how you can make the work very, very relative to them."

Another hot topic at the conference was use of electronic cigarettes among teenagers, which has increased nearly 80 percent in the last year among high-school students.

Mindy Ickes, an associate professor at UK and the director of several programs that promote tobacco-free college campuses, told the group that Kentucky data shows that e-cigarette use is as high as 75% among students in some Kentucky high schools.

Jelaine Harlow, a Lake Cumberland District Health Department health educator who works with youth in Casey and Adair counties, said they have largely focused on e-cigarette education with teachers and youth this year, adding that they have even had to deal with a first-grader on the school bus with a Juul, which is the most popular e-cigarette device among teens.

"Juuling has consumed us," she said. "Our kids are using them and they are using them tremendously, it's unbelievable."

Awards were also given for work in several categories, including:

The city of Williamstown was one of six Kentucky cities to be
recognized for success in enacting a smoke-free workplace
ordinance. Mayor Rick Skinner (far left) was also the recipient
of the Smoke-free Advocate of the Year award. (UK photo) 

The city of Elizabethtown received the Smoke-free Excellence in E-Cigarette Policy Award for expanding its smoke-free ordinance to include e-cigarettes.

The Lee T. Todd Jr. Smoke-free Hero Award recipient was Liz Burrows, health educator for Oldham County Health Department, for her commitment to smoke and tobacco free environments in the face of adversity.

The Timothy W. Mullett M.D. Lung Cancer Prevention Award recipient was Ashley Gibson, research coordinator for St. Claire Healthcare in Morehead, for her devotion and passion for preventing lung cancer through education, advocacy and policy change.

David Nunery received the Brian Early Mattone Esq. Legal Counsel Smoke-free Support award for outstanding smoke-free legal service.

The Smoke-free Youth Advocate Award recipient was Monroe County CARES Youth Prevention Ambassadors for excellence in promoting secondhand smoke education and smoke-free policy.

The Smoke-free Indoor Air Excellence Award recipients were the cities of La Grange, Martin, Murray, Paducah, Stanford and Williamstown, and Hardin and Oldham counties.

The recipient of the David B. Stevens M.D. Smoke-free Advocate of the Year, for promoting the secondhand smoke education and smoke free policy, was Rick Skinner, mayor of Williamstown.

House sends tobacco-free schools bill to Senate with three days left in session, minimum needed for passage; backers have hope

By Melissa Patrick
Kentucky Health News

A bill to make all Kentucky public schools and events tobacco-free passed the state House overwhelmingly Tuesday, but with just three legislative days left before adjournment, it needs the fastest possible track through the Senate, which passed a similar bill two years ago.

State Rep. Kim Moser
 (Legislative Research Commission photo)

House Bill 11 would ban the use of tobacco and electronic cigarettes on all school-owned properties, including all school events on such property. It does not prohibit the possession of tobacco and e-cigarette products, just use of them. Enforcement rules would be left up to individual school boards. It passed 85-11.

"Its purpose is to eliminate tobacco use during school hours and at after school events in order to help create an environment where tobacco use is not the norm," its sponsor, Rep. Kim Moser, R-Taylor Mill, told the House. Smoking inside schools is already banned.

The bill had lingered on the House calendar for more than a month after unanimously passing the health committee, which Moser chairs. She and Republican leaders indicated that it was short of being supported by a majority of the 61 Republican members, some of whom said it was overreach by the state into a local issue.

The bill got those votes with the help of two floor amendments by Moser. One filed last week would give schools three years to opt out of the ban. An earlier one would allow adults to smoke on field trips or at events off school property events when students are not present.

Opponents of the bill said there are already laws in effect that allow local school boards to decide whether they want to ban tobacco or not, and 42 percent of them had decided to do so.

Moser replied that nearly 60 percent haven't, and noted that 90 percent of adults report that they started using tobacco products when they were teens – and that for the first time in years there has been an uptick in tobacco use, largely driven by e-cigarettes, which can be highly addictive.

"It's just time to stop addiction where it starts and we know that it starts in teen years," she said, adding later, "This would send a strong message that we care about Kentucky youth's health."

Rep. Richard Heath, R-Mayfield, who had been a key opponent of the bill, said he was able to support it with the amendments.

"If the 60 percent of schools that have not adopted a tobacco policy would have done so, we wouldn't be having this discussion today," he said. "It forces the 60 percent who have not taken this stand to come to the table and consciously say we are going to have to do something – we're either going to have to go with it or opt out, and while we're at it, we need to adopt a policy for our schools."

Some members of the Coalition for a Smoke-free Tomorrow, a coalition of 208 organizations, did not support the amendments.

Ellen Hahn, a University of Kentucky nursing professor and the longtime leader in Kentucky tobacco-prevention efforts, noted that cities, counties and schools aren't allowed to opt out of other public health measures. "Opt-out provisions have long been a tobacco industry tactic to derail meaningful and effective tobacco control policies," she said.

Bonnie Hackbarth, vice-president for external affairs with the Foundation for a Healthy Kentucky, called the vote a "major step forward in protecting our youth" and said the foundation would now be able to target its educational efforts to communities that choose to opt out.

That is, if the bill becomes law. It reached the Senate too late Tuesday to get a first reading. Bills need three readings before passage, and there are only three days left in the session, including March 28, the day set for reconsideration of vetoed bills. The "veto session" has often been used to send bills to the governor, who then can veto them without risk of a legislative override.

Sen. Ralph Alvarado, Gov. Matt Bevin's running mate for lieutenant governor and chair of the Senate Health and Welfare Committee, said he hopes to get the bill before his panel for a quick hearing.

"We have three more days," he said. "It took us this long to get it out of the House the way it is . . . so I don't know that we're going to want to make a lot of changes to it. We want to make it as easy as possible for passage."

Alvarado said he is hopeful because a stricter tobacco-free-schools bill passed the Senate in 2017, and he thinks a majority of the Republican caucus would support it, but he still needs to make sure that Senate Republican leaders do.

Moser, in her second term in the legislature and her first as a committee chair, said that she was thrilled that HB 11 had finally gotten a floor a vote, and that she was still hopeful it would pass out of the Senate since Alvarado is so committed to getting it passed.

"I'm grateful that I had so much support, not only the support here but in the community," she said. "It's been huge, a real team effort. It's been a lot of fun to see all the advocacy and all the support."

A floor amendment filed by House Speaker David Osborne, to raise to 21 from 18 the legal age to buy tobacco and electronic cigarettes, was not called for a vote. It replicated a Senate bill that failed in committee. That bill was pushed by Altria Group, the top cigarette manufacturer, which is buying a 35 percent stake in Juul Labs, maker of the most popular e-cigarette.

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

Ban on tobacco use in schools still alive; may pass House with measure raising to 21 legal age to buy tobacco and e-cigarettes; question may be 'coming to terms' with agricultural community

By Melissa Patrick and Al Cross
Kentucky Health News

With just three days left to pass bills, lawmakers in the state House are still working on measures that would protect Kentucky's youth from tobacco and electronic cigarettes, efforts that health advocates have said could stop nearly one in three Kentucky students from ever smoking.

House Speaker David Osborne

A bill to ban the use of tobacco at all public schools and their events was finally in line for a House floor vote Thursday, but House Speaker David Osborne said it was delayed by a drafting error in his amendment to raise the legal age to buy tobacco products and e-cigarettes from 18 to 21.

"I will take blame for it; the amendment was overly inclusive and it specified all tobacco products, meaning cessation products as well, and that was not intended to be in there," Osborne said Thursday. "That is not the intent of my amendment. . . . I'm having that amendment re-drafted."

The bill's sponsor, Rep. Kim Moser, R-Taylor Mill, said in an email Friday night that she expects the House to vote on her House Bill 11 Tuesday. "The House has indicated their support for the measure, so I anticipate its passage and being sent on to the Senate," she wrote.

But for the bill to become law, Senate leaders would have to put it on the fastest possible track, giving its first reading on Tuesday, soon after House passage. It takes three days for a bill to get through the House or Senate, and the last legislative day is Thursday -- except March 28, when the legislature will return for one day to reconsider any bills that Gov. Matt Bevin may veto.

Senate President Robert Stivers

A Senate bill to raise the legal age to 21, known as the "tobacco 21" bill, failed in the Senate Agriculture Committee Feb. 25, but Senate President Robert Stivers said Republicans who run the Senate would consider moving the combined "tobacco 21" and tobacco-free schools bill if passed by the House with all "sectors of that community" in agreement on it.

"We had a lot of communications, and we thought there was a consensus on that bill from all sectors of that community -- be it producers, growers, whomever -- and apparently it collapsed," Stivers said of the "tobacco 21" bill. "I told them that they needed to go find a solution and bring it to us from the House perspective. So once they do that, if they can do that, then we'll deal with it when it gets here."

A key player in the process is Altria Group, the leading cigarette manufacturer, which is buying 35 percent of Juul Labs, maker of the electronic cigarette that is by far most popular with young people. Altria pushed the "tobacco 21" bill in what critics said was a public-relations maneuver to show that it isn't targeting minors. Altria gave $100,000 to the state Republican Party building fund in October and is routinely the legislature's biggest-spending lobbying interest.

However, Altria and its allies have had difficulty getting the consensus Stivers called for, since some legislators see the "tobacco 21" bill as an attack on a crop that has relatively few growers but is a big part of the state's economical, cultural and agricultural heritage.

On Thursday, Sen. Julian Carroll, D-Frankfort, in an impassioned floor speech about tobacco and hemp production in Kentucky, said that he voted against the "tobacco 21" bill in committee after hearing several members from rural communities say, "If we move the age to 21, we are finally putting the death knell on tobacco in the Commonwealth of Kentucky."

Sen. Steve Meredith

The "tobacco 21" bill's sponsor, Sen. Steve Meredith, R-Leitchfield, said he took "great issue and umbrage" with Carroll's assertion and didn't want to be "labeled with that mantle" because that was not his intent.

"This was not my bill," Meredith told the Senate. "I was asked to carry it, and I enthusiastically did so, for two reasons. One, because I think it really addresses a crisis issue with vaping products for our young people, same with smoking," he said. "But also I was told that this was going to save the tobacco industry because the FDA was really scrutinizing the situation with regard to teenage smoking and vaping products, saying there was a real possibility that they could take actions that could greatly harm the tobacco industry in Kentucky." He didn't explain how that might happen.

The FDA has called teens' use of electronic cigarettes an epidemic, and cracked down on flavored e-cigs, which teens report is the main reason they start using the products. Recently, it called out major retail chains for wholesale violations of age limits on purchases of such products.

Meredith said he was told that the Burley Tobacco Growers Cooperative Association had endorsed his bill, "so I'm getting some very mixed messages to what the future of tobacco is in Kentucky. And if we're going to visit this issue again in the near future or in the next session, I think we need to come to terms with the agriculture community [over] exactly what do we want to do with tobacco."

The House has had trouble coming to terms, too. Moser's bill passed unanimously out of the House health committee, which she chairs, but has remained on the House calendar since Feb. 11.

House Majority Floor Leader Bam Carney, R-Campbellsville, has told Kentucky Health News several times that the holdup has been a lack of unity among the 61 House Republicans about whether making schools tobacco-free should be determined through a statewide mandate or be decided locally. About 42 percent of the state's school districts ban the use of tobacco.

Several amendments have been filed to the bill to try to appease the concerns of those who say this measure amounts to government overreach. One, by Rep. R. Travis Brenda, R-Cartersville, would allow adults to use tobacco products at schools when students are not present. Another, filed by Moser, would allow local school boards to opt out of the ban. A provision that would expire three years after the law takes effect in 2020.

Asked Thursday if HB 11 was likely dead, Osborne said, "Do you think I would be filing an amendment on a dead bill? I've got a lot of things to do with my time and messing around with dead items is not one of them."

He added, "It is very late, obviously. As of right now, if a bill has had two readings it can be moved in three days so there is certainly still time. We have four days left on the calendar and so time is tight, but we can still do it."

Sponsor of bill to ban tobacco use at all public schools and events files last-ditch amendment to give districts 3 years to opt out of it

This is an updated version of a story that was first published Saturday, March 2.

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- The sponsor of a bill to ban the use of tobacco at public schools and their events has a last-ditch compromise that she hopes will appease lawmakers fearful of government overreach.

The amendment, filed Monday, would allow local school boards to opt out of the ban. That provision would expire three years after the law takes effect in 2020.

"If this will satisfy some of the folks who have an issue with it, I just wanted to allow for those votes," said Rep. Kim Moser, the sponsor of House Bill 11. It passed unanimously out of the House health committee, which she chairs, but has been sitting on the House calendar since Feb. 11.

Rep. Kim Moser

Moser said she hasn't lobbied for the amendment yet, but is hopeful that allowing more local control will get it called up for a vote. "There was an argument that it took the local option away and this gives them that option back," she said. "If they do not want to have this provision in their schools they don't have to."

The Republican from Taylor Mill in Northern Kentucky added, "I still think it is an important message that we send to all school children in Kentucky that schools are tobacco-free. That's really the point of the whole bill."

Several other floor amendments have been filed on the bill. One by Rep. R. Travis Brenda, R-Cartersville, would allow adults to use tobacco products at schools when students are not present.

Brenda said he was uncertain about Moser's amendment, particularly because it would also add electronic cigarettes to the existing law that bans smoking by adults on school property when children are present, unless they do it in a designated smoking room. Brenda said last week that officials in the Rockcastle County Schools, where he teaches, have concerns about enforcing the ban against employees when students aren't present.

Brenda said he does not use tobacco products and has a father with a cancer caused by long-term tobacco use. He said it's important to protect students from tobacco, but it's also important to allow adults, out of the presence of students, to be able to make those decisions for themselves.

Moser has said the main obstacle may be that the bill has more votes among the House's 39 Democrats than among its 61 Republicans, or lacks a majority of the Republicans. House Majority Floor Leader Bam Carney, who calls bills from the calendar, was asked Thursday if he calls them only if they have support from most Republicans.

"I wouldn't say that's a policy, but anytime you want to move a piece of legislation, you would want to have a unified caucus as much as possible and again, on this particular issue, the local control issue is the part that's being discussed," said Carney, R-Campbellsville. He said the five House Republican leaders were still trying "to get some more unity on it in our caucus."

He added, "I think in concept, everybody agrees with it. Some members side with local control, others want it statewide." Only 42 percent of the state's school districts have tobacco-free policies, affecting just over half the state's students.

Tobacco's influence remains strong

At a rally for the bill last week, Moser said getting it passed has been a "heavy lift" even though "at face value" tobacco companies have said they have no intention of marketing their products to children and have been "pretty neutral" on it.

 "We have a lot of tobacco farmers here in Kentucky, and so there is still a lot of misgivings about limiting any sort of tobacco," she said. "We are working on educating folks so hopefully we can get some movement."

Fewer than 4,000 tobacco farmers remain in Kentucky, but the state has a strong tobacco heritage, and that was made loud and clear Feb. 25 at the Senate Agriculture Committee, which voted 4-6 against a bill to raise the legal age to buy tobacco products and e-cigarettes from 18 to 21.

 "Where I come from, tobacco is still king," said Republican Sen. Stan Humphries, a Trigg County tobacco farmer who voted against Senate Bill 249, sponsored by Sen. Steve Meredith, R-Leitchfield. 

Meredith has since filed a version of SB 249, applying only to electronic cigarettes, as a floor amendment to another bill that is pending in the Senate. The committee chair, Sen. Paul Hornback, R-Shelbyville, has filed amendments that would make 21 the legal age for buying any tobacco product, including e-cigarettes.

The amendments were filed to Senate Bill 218, sponsored by Sen. Brandon Smith, R-Hazard, which would create an anonymous hotline or electronic system for students to report concerns about the distribution and use of e-cigarettes or other tobacco products on school property or at school events. It also includes an educational component and guidelines for how to handle the reporting.

UPDATE, March 5: The Senate passed Smith's bill without amendments.

Smith's bill passed unanimously out of the Senate Health and Welfare Committee after a group of students from Johnson County Middle School told lawmakers that the nicotine addiction caused by e-cigarettes is so bad in their school that many students have to go to the bathroom every two hours to vape and that others are bullied for speaking out against it.

One pod for the most popular e-cigarette among teens, made by Juul Labs, has as much nicotine as a pack of cigarettes. After the students spoke, Meredith announced his plan for a floor amendment to ban sales of e-cigs to those under 21. "If you can't get the whole pie I'll settle for half the pie," he said. "This is a good start."

But some health advocates disagree. A press release from the health foundation listed eight organizations that want to revive Meredith's original bill to raise the legal age to purchase all tobacco products to 21. They also seek modifications to the bill, including one to remove the penalties for young buyers, which they say have not proven to be effective in curbing use.

Health advocates look at the hangup with tobacco bills and wonder about the influence of Altria Group, parent of Philip Morris, which sent a vice president to Frankfort to get the "Tobacco 21" bill passed.

 It is unclear what Altria might think of Meredith's amendment to raise the legal age for buying e-cigarettes. Altria is buying a 35 percent of Juul Labs, regularly reports spending more money than any other lobbying interest at the legislature, and in October gave $100,000 to the state Republican Party's building fund.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, told WKU Public Radio, "The tobacco companies have outsized influence in Frankfort still." He told Kentucky Health News that the influence of the tobacco lobby on the tobacco-free school bill remains uncertain.

"We don't know what the tobacco companies are doing and what they are behind," he said. "We think that one of the impediments is that the members don't want to vote for more than one tobacco bill."

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

Tobacco-free schools bill hits a snag; prospects still appear favorable, but floor leader Carney says 'Nothing is certain'

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- The bill to get tobacco out of all Kentucky schools has hit a snag.

House Bill 11 passed unanimously out of the House Health and Family Services Committee Feb. 7 and was put on the consent calendar, for bills to pass without debate. It was moved to the regular orders, a switch that required signatures of three lawmakers.

Rep. Lynn Bechler, R-Marion, said he initiated the effort to move the bill from consent. The other signatures came from Reps. Myron Dossett, R-Pembroke, and Reginald Meeks, D-Louisville.

All three told Kentucky Health News that they signed the petition because they thought it needed to be debated on the House floor before it was voted on, but they differed in the specifics. Meeks said he would support it, but Bechler and Dossett said it would be government overreach, and Dossett spoke up for tobacco.

Rep. Lynn Bechler

Bechler said, "I thought it was important enough to discuss, not just be passed because it came out of committee that way. I also think that the bill goes way too far. I have no problem should an individual school district, as I believe 42 percent have already done so, have instituted the policy. But I think it would be state government overreach if we were to force schools to do that."

Among the state's 173 school districts, 74 have adopted 100 percent tobacco-free policies, covering 740 schools and 58 percent of the state's students. Federal law only prohibits smoking inside schools that receive federal funding.

The bill's sponsor, Rep. Kim Moser, R-Taylor Mill, argued that the bill would allow school boards to set their own rules around implementation and regulation, giving them a sort of "local option."

Bechler added, "I think it is wrong if somebody who chews tobacco can't come out at half-time of a football game and go sit in his or her car at the back of a parking lot and throw in a chew. There is no smoke coming out, none of the kids would be aware of it, it's not presenting a bad example."

The bill would apply to all school properties and events. Rep. Travis Brenda, R-Brodhead, a Rockcastle County teacher, has filed a floor amendment that would allow use of tobacco products on school property if children were not present.

Rep. Myron Dossett

Dossett concurred with Bechler, echoing several of the same points. "A lot of school districts have already voted to do this and I'm a strong believer that this is one of those local issues," he said, adding that it's important for parents to teach their children about the dangers of tobacco.

Dossett also noted that he represents Christian County, a large tobacco producer. It is also home to a large smokeless-tobacco factory.

Bechler nor Dossett said they had  received calls from their constituents, educators or school employees in opposition to the bill.

In support of the bill, Meeks said it was important to pass because it will help to decrease teen smoking rates, which will contribute to a lifetime of better health outcomes for them. "I asked that it be pulled so that we can have that more robust discussion of the bill," he said.

Rep. Kim Moser

Moser said she was working hard to make sure all of the House members were educated on the intent of the bill. Further, she said this year's version of the bill does not include possession of tobacco products, but only tobacco use.

"We want to get it right and I think it will pass," she said. "We've got a lot of support -- outside of the questions here, statewide -- it is so supported."

Moser has said the bill has the support of the Kentucky School Boards Association, the Kentucky Association of School Superintendents, the tobacco industry and the Juul Labs, maker of the most popular electronic cigarette. The idea had the support of 87 percent of Kentucky adults in the Kentucky Health Issues Poll and the lobbying support of the Coalition for a Smoke-free Tomorrow, about 180 groups across the state.

The coalition said in a prepared statement Thursday, "A strong tobacco-free schools policy is essential to protect our youth from tobacco. Prohibiting tobacco use 24/7 creates an environment where tobacco use is not the norm, reduces adolescent and teen tobacco use, protects youth from secondhand smoke, aerosol and residue, and provides positive adult role modeling. . . . The proposed amendment to allow some to use tobacco on school property is unnecessary, and would result in a weak, ineffective bill."

Rep. Bam Carney

House Majority Floor Leader Bam Carney, R-Campbellsville, said he thought the bill had enough votes to pass and that he expects that he would call it up for a vote at some point, but added, "Nothing is certain."

Carney, an educator, added, "It is an issue that a lot of our caucus members, particularly in the rural areas of the state, not that they are opposed to it, but I think it is a fundamental question again about local control, letting locals make that call, which 42 percent have already done that. So I think that's the fundamental question is to whether or not locals should be able to do that."

Speaker David Osborne of Prospect said he and other leaders of the House's Republican majority had not taken an official position on the bill, but "I'm personally for it and it would be our intent to move it."

Sen. Ralph Alvarado, R-Winchester, who has filed a companion bill in the Senate, said he was "optimistic" that the House version of the bill would be passed in the Senate if they could just get it through the House. "That'll be the toughest part," he said.

The Senate passed a bill similar to Moser's in 2017, but it died in the House and such bills weren't even heard in the House and Senate education committees last year.

McCreary and Wayne counties win Health Policy Champion award from Foundation for a Healthy Ky. for being 'bright spots'

Foundation for a Healthy Kentucky CEO Ben Chandler announced the award as nominees listened.

By Al Cross
Kentucky Health News

Wayne and McCreary counties won the first overall Health Policy Champion award presented by the Foundation for a Healthy Kentucky, for being "bright spots" of progress on health issues in Appalachian Kentucky.

"We have a tie," Foundation President and CEO Ben Chandler said as he announced the award at the foundation's annual Howard L. Bost Memorial Health Policy Forum in Lexington on Monday.

The adjoining counties on the Tennessee border were two of eight nominees for the award, which spotlights "those folks who are advocating the policy changes that will make Kentucky healthier," Chandler said. The $5,000 award was divided equally between the McCreary County Health Coalition and the Wayne County Health Council.

"They show us there' s always somewhere to start when it comes to working to improve health," Chandler said.

The two counties were among nine in Kentucky and 42 in Appalachia that the Appalachian Regional Commission and the Robert Wood Johnson Foundation named "bright spots" because they had better than expected health outcomes given their resources and health indicators.

McCreary and Wayne were among 10 counties in a case study that took a deeper dive into what they were doing to improve the health of their citizens, despite their many challenges.

The Lake Cumberland district, with Wayne and
McCreary outlined. Taylor is not in Appalachia.

The other "bright spots" in Kentucky were Green, Adair, Russell, Wayne, McCreary, Pulaski and Lincoln counties, like McCreary and Wayne part of the Lake Cumberland District Health Department, and Lewis and Morgan counties.

The other Health Policy Champion award nominees were Dr. Van Breeding of Whitesburg, for fighting substance abuse; and Murray Mayor Jack Rose, Paducah cardiologist Pat Withrow, Paducah Mayor Brandi Harless, the Casey County Youth Coalition and, jointly, Lexington Mayor Jim Gray and Lexington Legends owner Andy Shea, all for efforts against tobacco use.

Murray City Council passes a smoking ban on 8-2 vote, but the mayor, who pledged to pass it, says it could still be 'tweaked'

Murray City Council members voted 8-2 on June 14 to prohibit smoking in all public places and places of employment within the city limits, but John Wright reports for the Murray Ledger & Times that it may not be a "done deal." After about an hour of debate, Mayor Jack Rose suggested that the council pass the ban, but leave the issue open. (Wright's story is behind a paywall.)

Sperling's Best Places map

“I think we need to go ahead and pass it tonight, then come back and tweak it if need be,” Rose said. “I’m interested in listening if someone has an idea to make this the best situation we can find. If we see that there’s an element of difficulty with it, then we can look at it later.”

The ordinance, which is set to take effect in September, prohibits the smoking of cigarettes, as well as electronic cigarettes and vapor devices, in parking lots and areas within 15 feet of entrances, windows and ventilation systems. In restaurants and bars there must be a 15-foot buffer between outdoor seating and serving areas, and the rules also apply for numerous outdoor areas, Taylor Inman reports for WKMS-FM.

"Heartfelt congratulations to Mayor Jack Rose," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "He committed to getting it done before he retired. And, by gosh, he has done that! Even better, the ordinance that he was able to shepherd through to passage follows all the guidelines for truly making a difference in the health of those who live, play and work in Murray."

Local restaurant owners voiced opposition to the ban. Ron Gladden, owner of the Big Apple Cafe, one of only six restaurants in Murray that still permits smoking, told the council that smokers often outnumber non-smokers in his restaurant, and non-smokers had 62 non-smoking restaurants in the area to choose from.

“The citizens of Murray and Calloway [County] essentially vote every day on where they want to eat," Gladden said, adding that at the Big Apple, "the vote" is pretty clear. “I don’t believe it is the city council’s right to make decisions on smoking. It should be the business owners and the citizens of Murray, Kentucky," he said.

Robin Floyd, a longtime radiologist at the local hospital and also the owner of Tap 216, a restaurant that allows smoking, acknowledged that smoking is unhealthy, but said he thought restaurants that had created ways to separate the smokers from the non-smokers should be allowed to "opt-out" of the ordinance.

Supporters of the ordinance also spoke out. Local hospital CEO Jerry Penner said he had worked to strengthen smoke-free rules at the facility over the past two years, and though he recognized how hard these rules are for smokers, he said, "I think we have to err or the side of health here."

Penner also pointed out that far Western Kentucky, including Murray, ranks first in the state for lung cancer cases and deaths from it. “I’m tired of burying people," he said.

Rose, citing studies proving the danger of secondhand smoke, said the ordinance is needed to improve health in the city, Kentucky's 20th largest. “Let’s just say they get all kinds of secondhand smoke and are lucky and don’t get cancer or some other kind of disease because of that,” Rose said. They’re still more comfortable, so we’re making a comfort level.” Here is a video report from Paducah's WPSD-TV.

Elizabethtown expands smoking ban to e-cigarettes

The Elizabethtown City Council has expanded its 12-year-old ban ban on smoking in public places to include electronic cigarettes, at the request of the Lincoln Trail District Health Department.

“We approached the council about banning e-cigs because they still contain toxic gases and tiny particles that irritate the eyes and lungs,” health department spokesman Donny Gill said. “Also, the vapor does contain nicotine and is addictive and contributes to cardiovascular problems.”

"Gill said studies also have shown secondhand e-cigarette vapor is dangerous," Mary Alford reports for The News-Enterprise. "He said the vapor contains gases that contribute to heart and lung disease. Gill said children exposed to the vapor over time can develop asthma, colds and eczema."

Gill said, “The majority of the research has indicated that e-cigs are harmful to both the user and the bystander. So, when people use these devices to get around the existing smoking laws, they are still putting the health of others at risk. E-cigs and vape devices are not a safer alternative to traditional smoking. Also, they are not approved as a method to quit smoking. The vast majority of e-cig users also still use traditional cigarettes.”

Oldham County adds e-cigarettes to smoking ban, partly at the behest of students, and drops exemptions, including break rooms

Oldham County has expanded its anti-smoking ordinance that it passed in 2006, the second jurisdiction to do so this month.

The Oldham County Fiscal Court voted 7 to 1 on April 17 to add electronic cigarettes to the ban and to remove exemptions that had left some workers unprotected from second-hand smoke, Kentucky Youth Advocates reports. On April 10, Paducah expanded its ban to electronic cigarettes and private places of employment.

The county's new ordinance removed exemptions to independently ventilated rooms in hospitals, hospice or nursing homes, facilities operated by private organizations, designated hotel and motel rooms, retail tobacco stores and designated indoor smoking areas.

The change was prompted partly by Youth Linking Oldham County, "a new collective of high-schoolers advocating for healthier lifestyles and a shift in social norms," Oldham Era Editor Amanda Manning reported in March, when the ordinance had first reading. "They said that the JUUL, a vaping device that looks similar to a flash drive, is popular among students."

Smoke-shop manager Cathleen McCarthy demonstrates the

JUUL device. (Photo by Suzanne Kreiter, The Boston Globe)

“It’s becoming a really big thing in our high school,” student Ava Schumacher said. “They were originally made to get people to stop smoking, but kids our age find them appealing because they come in different flavors.”

"The new ordinance also removes an exemption that allowed for smoking breakrooms in the workplace," Manning reports. Liz Burrows, health educator at the Oldham County Health Department, told the Fiscal Court, “We know based on science that those break rooms are not effective.”

The statewide Coalition for a Smoke-Free Tomorrow praised the Fiscal Court, health department and advocates who led the effort for the stronger protections.

"Strengthening this law -- by removing exemptions that left some workers unprotected and by including e-cigarettes -- recognizes that everyone has the right to breathe clean air," the coalition said in a statement. "Doing so recognizes that comprehensive smoke-free workplace ordinances improve health, and save health care dollars.And it recognizes that no one should have to choose between their lives, and their livelihood.

"Including e-cigarettes among the tobacco products that must be taken outside will keep the air in indoor public spaces and enclosed workplaces free of the toxic aerosol and pollution emitted by these devices. Oldham County is one of 21 Kentucky jurisdictions that has protected workers from these emissions, which can cause lung cancer and contribute to heart disease."

Oldham County is the fifth county in the state to pass a comprehensive smoke-free ordinance, the Oldham Era reports.

The coalition comprises more than 155 groups who support efforts to decrease smoking in the state. Kentucky's smoking rate is second only to West Virginia's, and tobacco is the broadest cause of Kentucky's most serious health problems.

Lexington bans tobacco, including smokeless, at city ballfields

By Melissa Patrick
Kentucky Health News

Lexington's 56 city-run baseball parks, including Whitaker Bank Ballpark where the Lexington Legends play, are now tobacco-free. The city prohibits use of cigarettes and smokeless tobacco products at city fields, including dugouts, bleachers, spectator areas, concession areas and restrooms.

Andy Shea, president and CEO of the Lexington Legends;
Ben Chandler, Foundation for a Healthy Ky. president;
and Lexington Mayor Jim Gray. Shea and Gray received
the foundation's Healthy Kentucky Policy Champion award.

"This important move will create a healthier and safer place for the thousands of Legends fans who come to the park each season," Mayor Jim Gray said at the announcement.

Gray noted that Lexington passed Kentucky's first city-wide smoking ban nearly 15 years ago and saw "almost immediate results," including fewer asthma-related emergency room visits and a "big" drop in the smoking rate.

"For the kids and families coming to the parks, we are taking the next step as a city," he said.

This effort is part of a nationwide movement to break the longstanding connection between baseball and smokeless tobacco, often used by baseball players.

The latest Youth Risk Behavior Survey found that 10.6 percent of Kentucky high schoolers used smokeless tobacco in 2017, compared to 5.8 percent nationally in 2016. Many more boys than girls use the product in Kentucky, 17.2 percent versus 3.1 percent.

It's a habit that comes with serious health risk, including oral, pancreatic and esophageal cancer. It can also lead to nicotine addiction, increased risk for death from heart disease and stroke, and diseases of the mouth.

Amy Barkley, regional director,
Campaign for Tobacco-Free Kids

"We applaud the Lexington Legends for taking a strong stand against tobacco and for kids, by making Whitaker Bank Ballpark 100 percent tobacco-free,"said Amy Barkley, regional director of the Campaign for Tobacco-Free Kids. "By taking tobacco use completely out of the game here in Lexington, it sends a strong message to kids that our national pastime should be about promoting a healthy and active lifestyle, not a deadly and addictive product."

The Campaign for Tobacco-Free Kids' "Knock Tobacco Out of the Park" program has been working with professional baseball for several years to "take tobacco out of the game of baseball for good," Barkley said.

Chewing tobacco has been banned among players in minor league baseball at ballparks and during team travel since 1993, but so far only 14 out of 30 Major League teams have similar policies, said Barkley. She added that the last collective bargaining agreement prohibits any new player in Major League ball from using tobacco.

Andy Shea, president and CEO of the Lexington Legends, said in a news release, "We are very proud to be one of the first Minor League Baseball facilities in the country to go tobacco-free."

Foundation for a Healthy Kentucky CEO Ben Chandler Chandler gave Shea and Gray a Health Policy Champions award from the foundation. He called the announcement "an important signal that we're sending here in the commonwealth of Kentucky to everybody about the need to curb our use of tobacco here in Kentucky."

With nearly nine in 10 Kentucky adults wanting schools to be tobacco-free, will this be the year for a statewide law?

By Melissa Patrick
Kentucky Health News

Most Kentucky adults, by far, want schools to be tobacco-free -- and bills to do just that have been introduced in the Senate and the House.

The latest Kentucky Health Issues Poll, taken Oct. 24 to Dec. 2, found that 87 percent of Kentucky adults favor tobacco-free campuses. Support was strong across party lines, with 89 percent of Democrats, 87 percent of Republicans and 82 percent of independents. The poll also found strong support among those with and without children in their homes: 90 percent and 85 percent, respectively.

The poll has shown consistent support for tobacco-free school policies since 2013, but only 39 percent of the state's school districts (with 55 percent of the state's total students) are covered by comprehensive tobacco-free school policies, according to the state Department for Public Health's Tobacco Prevention and Cessation Program.

Smoke-free school policies are decided by local school boards, but that would change with enactment of Senate Bill 51 or House Bill 318, which would prohibit tobacco products on school properties and at school events. Both bills are still in each chamber's education committee.

The Kentucky School Boards Association told Kentucky Health News in November that it would support any legislation that proposes a statewide tobacco-free school law in the 2018 legislative session, because 81 percent of their members support it.

Last year, the Senate bill's main sponsor, Republican Sen. Ralph Alvarado of Winchester, introduced a bill that passed the Senate but died in the House Education Committee.

Alvarado said Senate leaders have told him that the bill needs to pass out of the House first this year, and if it does, he said he thinks it will pass in the Senate.

"My question is, who are the 13 percent who don't support this?" he asked."That's what it comes down to."

Rep. Kim Moser, R-Taylor Mill, who is sponsoring the House version of the bill, said in an e-mail that she has asked Education Committee Chair Rep. John "Bam" Carney, R-Campbellsville, if she can get HB 318 heard, but hasn't heard back from him.

According to the 2017 Youth Risk Behavior Survey, 26 percent of Kentucky high school students regularly (defined as at least one day during the past 30 days) use either cigarettes, electronic cigarettes, cigars or smokeless tobacco, with about 14 percent each using using cigarettes and e-cigs. The numbers are much higher, 40.5 and 44.5 percent, respectively, when students are asked if they have "ever" used e-cigs or cigarettes. The survey found that 45.8 percent of Kentucky high-school students who used any kind of tobacco product, including e-cigarettes, said they had tried to quit. Research shows that strong tobacco-free school policies can discourage youth from smoking and can also help those who want to quit.

Recent studies also show that e-cigarette use among youth can lead to smoking cigarettes.

"We were making great headway in reducing youth smoking until e-cigarettes made tobacco use somewhat socially acceptable again," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. "It is imperative that we send the message to Kentucky's youth that using tobacco of any kind is dangerous. We can reinforce that message by ensuring that students don't see their peers, teachers and role models smoking and using tobacco on school grounds."

The poll, co-sponsored by Cincinnati's Interact for Health, interviewed 1,692 Kentucky adults by landlines and cell phones. The margin of error for each result is plus or minus 2.4 percentage points.

71% of Kentucky adults continue to support smoking ban

Seventy-one percent of Kentucky adults support a comprehensive statewide smoke-free law, the same percentage as the last time the Kentucky Health Issues Poll asked the question, in 2016. Opposition to a smoking ban rose to 27 percent from 25 percent, a change that was within the poll's error margin of plus or minus 2.4 percentage points for each number.

The poll, taken Oct. 24 to Dec. 2, found that a statewide ban still has strong bipartisan support, with 79 percent of Democrats and 68 percent of Republicans saying they favored it. Support among Democrats rose by 3 percentage points from the previous poll, but dropped by 10 points among independents, to 62 percent from 72 percent.

Most adults in every region of the state favor a statewide smoke-free law. Support increased in the Louisville area to 80 percent in the most recent poll, from 74 percent in 2016 and support dropped in the Lexington area to 74 percent, from 82 percent in 2016. Those changes are within the larger error margins for subsamples. Other regions showed even less change.

Kentuckians who say they have never smoked continue to voice the greatest support for a statewide smoking ban, at 83 percent; 74 percent of former smokers favor it. Even among smokers, 44 percent say they favor such a law.

The annual poll, which is co-sponsored by the Foundation for a Healthy Kentucky and Cincinnati foundation Interact for Health, found that nearly a third of Kentucky adults said they were exposed to secondhand smoke at their workplace in the week before they were surveyed.

In a news release about the poll, Ben Chandler, president and CEO of the foundation, listed a few of the many dangers of secondhand smoke, including cancer, heart disease and stroke and called on Kentuckians to pass a comprehensive workplace smoke-free law.

"The single most effective thing we can do to improve Kentucky's health is to reduce our smoking rates," Chandler said. "And one of the most successful tools for doing that is to enact smoke-free laws, which also protect nonsmokers from tobacco smoke."

Chandler is also the chairman of the newly formed Coalition for a Smoke-free Tomorrow which has over 140 members. One of the immediate efforts of the coalition is to help counties pass local smoke-free laws, with a statewide ban part of a longer-term goal.

The Kentucky Center for Smoke-free Policy reports that only 33 percent of Kentuckians are protected from exposure to secondhand smoke by local smoke-free ordinances. Nationally, 27 states and the District of Columbia have enacted smoke-free laws, says the release. Almost 25 percent of Kentucky adults are smokers.

The state House passed a statewide smoking ban in 2015, but it was not called up for a vote in the Senate. Republican Gov. Matt Bevin, who took office in December 2015, has said this should be a local decision so it's not likely such a bill will pass while he is in office.

Marijuana, tobacco and opioids will get different types of debate than in previous legislative sessions, lawmakers indicate

Legislators will debate what to do with drugs of several types when the General Assembly opens in Frankfort Tuesday, Jan. 2. And the debates may be different than in past sessions, if the discussion on the Dec. 18 "Kentucky Tonight" on KET is indicative.

The four lawmakers, including the two health committee chairs, indicated that the use of marijuana will be debated more openly than before, and even for recreational purposes, and that more action will be taken against the opioid epidemic.

"I think we’re gonna see a little bit of everything introduced," said Louisville Republican Julie Raque Adams, chair of the Senate Health and Welfare Committee. "I think we’re gonna see a recreational bill," in addition to legislation for medical marijuana.

"A lot of people across the state of Kentucky have told me they’re tired of talk" and want to see some votes on the issue, Adams said. "We’re gonna see a lot of testimony."

When host Renee Shaw asked if efforts to legalize marijuana would have trouble because some see it as gateway drug, or if there might be less resistance because it is seen as less harmful than opioids, Democratic Rep. Chris Harris of Pike County indicated the latter.

"I think the time is coming in Kentucky for medical marijuana," he said, adding that he has an "open mind" on the issue.

L-R: Reps. Angie Hatton, Chris Harris, Addia Wuchner; host Renee Shaw; Sen. Julie Raque Adams

Rep. Angie Hatton, D-Whitesburg, said "My constituents want to talk about it more than almost any other issue," and it offers the possibility of tax revenue. "We have to talk about it."

Rep. Addia Wuchner, R-Florence, chair of the House Health and Human Services Committee, was skeptical of medical marijuana. A registered nurse and former hospital administrator, she said more research is needed.

Harris said, "There is some track record in other states," and added, "It could help a certain group of people."

Wuchner said legislators are trying for a comprehensive approach to the opioid epidemic, and Adams said they need to discuss a holistic approach with alternative approaches to drugs as the first option for pain relief.

Adams said Kentuckians should expect to see some criminal-justice reforms aimed at steering violators into recovery rather than putting them behind bars. "The trend lines for incarceration are all going in the wrong direction," she said. "We have to be creative about this opioid problem."

Adams said she will introduce a bill to keep the state from pre-empting local smoking ordinances, which are now a focus of anti-smoking advocates because Republican Gov. Matt Bevin opposes a statewide smoking ban. The bill would ban any state limits on local smoking laws.

Adams, who favors a statewide ban, said proposals for it prompted calls for local control, and "We listened. This is a creative way for us to say, 'Hey, start doing it.'" She noted that a Senate-passed bill to ban tobacco at all Kentucky schools got nowhere in the House.

Hatton said tobacco control "needs to be local decision" because it is "a personal freedom issue for a lot of people." Harris agreed, saying smoking bans should be "a step-by-step process. We need to walk before we can run."

Two decades of data show Kentucky communities with strong smoke-free laws have 8 percent fewer cases of lung cancer

By Melissa Patrick
Kentucky Health News

Kentucky communities with strong laws against smoking in workplaces have fewer cases of lung cancer, according to a University of Kentucky study that says it's the first to show such findings.

Researchers found that residents of counties with comprehensive smoke-free laws, including those with city-only smoking bans, were 8 percent less likely to be diagnosed with lung cancer than those living in communities without smoke-free laws.

There was no difference in lung-cancer rates between places that don't have smoking bans and those that have moderate or weak laws. The study considered laws to be comprehensive if they covered all workplaces, including restaurants and bars; moderate if they covered indoor public places, but not all workplaces; and weak if they allowed for major exemptions.

The researchers say the findings could encourage more localities to pass smoking bans. Only a third of Kentuckians are covered by such ordinances.

"Local government can play a critical role in preventing lung cancer," Ellen Hahn, the lead author of the study, said in a UK news release. "Elected officials can ensure that all workers and the public are protected from secondhand smoke by passing strong smoke-free laws with few or no exceptions."

Hahn is a UK nursing professor and director of the Bridging Research Efforts and Advocacy Toward Healthy Environments initiative at UK.

The BREATHE researchers looked at 20 years of lung-cancer data for more than 80,000 Kentuckians 50 and older. (Few Kentuckians under 50 have lung cancer.) The state has more cases of lung cancer than any other state, and its death rate from the disease is 50 percent higher than the national average. And not surprisingly, at 25 percent, Kentucky leads the nation in adult smoking.

Jim Waters, president and CEO of the Bluegrass Institute for Public Policy Solutions, a libertarian, free-market think tank, said that while lower rates of lung cancer are "wonderful," correlation does not equal causation and therefore public policy should not be built around it. "You can't attribute deaths directly to a single cause such as smoking," he said, "since many factors usually are involved: hereditary issues, poor diet, lack of exercise and education."

Hahn said the study did take other causes of lung cancer into account. "We used a sound, well-known statistical method to consider the other factors that may have affected new cases of lung cancer, in addition to smoke-free laws," she said. "Even after taking sex, age, smoking rate, and income into account, comprehensive smoke-free laws were associated with fewer new cases of lung cancer."

Hahn said factors that protect Kentuckians from lung cancer were being female, being younger, and living in a county with a lower smoking rate or higher median household income in the county.

Waters said his institute supports education efforts to encourage people not to smoke "without the punitive action of denying individuals the right to participate in a legal practice on private property. . . . Where does that end? We don't believe such reasoning will end with anti-smoking policies."

Hahn replied, "Research shows that simply educating the public not to smoke does not work to lower smoking rates or to reduce disease from tobacco smoke exposure. Smoke-free laws are known to reduce disease," heart attacks and hospital visits for emphysema and asthma, as BREATHE summarizes. "Just as we have laws to prohibit drunk driving (alcohol is legal), smoke-free laws prohibit smoking (legal) indoors where the second-hand smoke can harm workers and the public."

Ben Chandler, CEO of the Foundation for a Healthy Kentucky and chair of the recently launched Coalition for a Smoke-Free Tomorrow, called on Kentuckians to use this research to pass more smoke-free laws.

"We know that the Kentucky communities with smoke-free laws covering every workplace and public building are protecting the freedom of their residents and visitors to breath air untainted by dangerous secondhand smoke," Chandler said. "We know that a secondary benefit of these laws is that they help reduce smoking. But here's solid evidence from more than 20 years of data showing a significant decline in lung cancer."

The latest Kentucky Health Issues Poll on the issue found that 71 percent supported a statewide law to ban smoking in public places and the workplace. The state House passed such a ban in 2014, when it was controlled by Democrats, but the bill died in the Republican-controlled Senate, and Republican Gov. Matt Bevin, who took office in 2015, says smoking bans should be a local issue.

The study was published in Cancer, a journal of the American Cancer Society. An editorial in the journal said the "unique and important" study "has shared an incredibly valuable insight into the impact of smoke-free ordinances on lung cancer mortality" and emphasizes "the need for statewide, not municipal, enforcement for maximum efficacy."

Casey County High School students win award for their smoke-free efforts; 17 percent of Kentucky's youth are smokers

The Casey Youth Coalition won the health foundation's first
Healthy Policy Champion Award for its smoke-free efforts.

A group of 19 Casey County High School students are the first recipients of the Foundation for a Healthy Kentucky's Healthy Kentucky Policy Champion award for their work to change the smoking culture at their school.

"The Casey Youth Coalition has been working for two years to boost adherence to the district's 2015 tobacco-free campus policy, and this award recognizes their unrelenting efforts to change social norms about tobacco use," Ben Chandler, president and CEO of the foundation, said in a news release.

The students' campaign has contributed to a 10 percent decrease in 30-day tobacco use among its 10th graders in 2016, the release said.

"All of us are extremely proud of all we have accomplished because the school's environment has changed," Delaney Sowders, vice president of the coalition, said in the release. "There's no tobacco smell when you enter our school. That has been a long-time problem. It took a lot of our time, commitment, ideas from a diverse group of students, support from our champions and funding, to accomplish this. We still need to work on the community's tobacco use on our campus."

Below is a video created by the Casey County Youth Coalition to instruct other school districts about passing and implementing a 100 percent smoke-free policy in their schools.

Casey County is one of the state's 68 (out of 173) school districts with a 100 percent tobacco-free school policy. As of November 2017, 39 percent of districts have such policies and 55 percent of the state's students are protected from second-hand smoke.

Schools get this distinction if they don't allow tobacco products, including vapor products and alternative nicotine products, by staff, students and visitors at any time on school owned property and during school sponsored events. The 100 percent tobacco-free school website notes that some of the schools need to update their policies to meet the new vapor product standards.

A bill in the 2016 legislative session would have required all Kentucky schools to be 100 percent tobacco-free. It passed quickly out of the Senate, but couldn't garner enough support in the House to bring it to a floor vote. Sen. Ralph Alvarado of Winchester told Kentucky Health News in September that he plans to sponsor the bill again in the upcoming session, and anticipates a similar one to be introduced in the House, where his fellow Republicans gained control this year.

Elizabeth Anderson-Hoagland, a youth tobacco specialist with the state Department for Public Health, said she encourages local school districts to pass 100 percent tobacco-free school policies, despite what happens at the state level.

"It is really beneficial for local communities to take the steps to pass a local tobacco-free district policy," she said in an e-mail. "The process engages students, parents, personnel and community in a discussion about tobacco use and how the community can best protect their young people."

Most Kentuckians support such policies. According to the foundation's 2015 Kentucky Health Issues Poll, 85 percent of Kentucky adults favor tobacco-free schools.

Almost 17 percent of Kentucky's high-school students are smokers and 23 percent of them report using electronic cigarettes, according to the 2015 Youth Risk Behavior Survey. The 2016 national rate for smoking is 8 percent and 11.3 percent for electronic cigarettes, according to the federal Centers for Disease Control and Prevention.

The Casey Youth Coalition is now eligible for the Healthy Kentucky Policy Champion of the Year award, which comes with a $5,000 grant from the foundation given to a Kentucky-based nonprofit of the winner's choice. The winner of that award will be announced next fall. Nominations for the Healthy Kentucky Policy Champion award are accepted at any time. Click here for details.