Two recent events regarding tobacco in Jefferson County are being celebrated by public health officials. One was the release of survey results showing a decrease in the percentage of adults smoking tobacco products in Jefferson County. The other was an increase in the county’s population protected by strong smoke-free policies. Tobacco is still arguably Public Health Enemy Number One; it continues to be the leading cause of preventable death in the United States. While we are making progress, much remains to be done to continue that progress and avoid losing ground.
In November, data made available from the Alabama Department of Public Health indicated that the percentage of Jefferson County residents who self-reported cigarette smoking declined from 22.3 percent in 2013 to 15.8 percent in 2014. That is a remarkable 29 percent, although it should be viewed with caution since there is a wide margin of error due to the sample size. Additional years of data will be needed to verify a significant trend, but it is encouraging. These data are generated from the Behavioral Risk Factor Surveillance System (BRFSS), a nationwide phone survey of adults conducted by the Centers for Disease Control.
Also in November, the city of Homewood joined five other Jefferson County municipalities (Birmingham, Clay, Fultondale, Midfield and Vestavia Hills) in passing a strong smoke-free ordinance that increases protections from secondhand smoke. Improvements over Homewood’s previous ordinance include smoke-free public patios, a 20-foot smoke-free zone from open doors and windows of public places, and the incorporation of electronic cigarettes into the ordinance.
Additionally, all hotels in Homewood will be smoke-free in all indoor areas; smoking rooms will be a thing of the past. This is significant, because even when smoking rooms are confined to certain parts of a building, spread of tobacco smoke to other areas cannot be completely prevented. Non-smoking guests will be guaranteed cleaner air to breathe, and hotel workers will now be protected from secondhand and “thirdhand” smoke (residual toxins emitted from carpets and other fabrics in rooms).
When the Homewood City Council heard public comments on the proposed ordinance, there was overwhelming support among Homewood residents who attended. The main dissenters were advocates for e-cigarettes or “vaping,” mainly because the original proposal disallowed vaping in vape shops. Vaping inside vape shops was ultimately allowed in the final ordinance that was passed. There was less argument against prohibiting electronic cigarette use in other public places.
There remains quite a bit of controversy around e-cigarettes. Some smokers report using them as a way to get off cigarettes, but there are good reasons for including these in the smoke-free ordinance. The first reason is that the aerosol emitted from e-cigarettes is not harmless; it contains a variety of toxic chemicals, including nicotine and some carcinogens and that can be inhaled secondhand.
The second — and perhaps more compelling — reason is to avoid public modeling of e-cigarette use to young people as a social norm to be imitated. E-cigarettes are already produced in several flavors that are appealing to youth, and there is a false perception among many youth that they are harmless. Nicotine is a highly addictive substance, no matter how it is delivered, and the National Youth Tobacco Survey shows that e-cigarette use among youth is on the rise. This has real potential to cause us to lose ground in public health, since electronic cigarette use among teens is associated with a greater likelihood of progressing on to regular tobacco use. In October of this year, the American Academy of Pediatrics issued a strong policy statement urging greater regulation of e-cigarettes, including a recommendation that smoke-free laws include e-cigarettes. The AAP press release can be viewed here: bit.ly/1lggLpd
Some have expressed concern that smoke-free ordinances hurt business, but on the experience of the city of Birmingham and countless other cities across the country, smoke-free ordinances on the whole have not harmed business revenues, including those of bars and hotels. In some places they have been associated with an increase in revenues.
A study of nine states (including Alabama) published in the CDC’s journal Preventing Chronic Disease in 2013 looked at data from 216 smoke-free cities and counties and found no evidence of an adverse economic impact of smoke-free laws on restaurants or bars in any of these states. In one of the states studied, smoke-free ordinances were associated with a positive economic outcome. Other studies have corroborated these findings, and there have been studies with similar findings for smoke-free hotels. Tom Frieden, M.D., director of the Center for Disease Control, commented, “Smoke-free laws make good business sense – they improve health, save lives, increase productivity, and reduce health care costs.”
With the addition of Homewood, 43 percent of Jefferson County’s population now enjoys the health benefits of very strong or comprehensive smoke-free ordinances. Other municipalities, including the city of Hoover with a population of approximately 84,000, need to join in improving protections for all of their residents, workers and visitors. Better yet, the Alabama legislature needs to pass a statewide comprehensive smoke-free law.
There are other policy changes that have real, evidence-based promise to further reduce the number of tobacco users over time, and substantially improve health and curb health care costs in Alabama. One is to further raise the legal age to purchase tobacco products and e-cigarettes to 21. The other is to raise the tobacco tax substantially higher than the current level; the latest increase by 25 cents may have helped Alabama’s general fund budget, but it did little to discourage young people from picking up the nicotine habit.
Smokers and other tobacco users should know that it is never too late to reap the benefits of quitting. The Alabama Tobacco Quitline, at 1-800-QUIT-NOW (784-8669) or online at QuitNowAlabama.com, provides free assistance from trained smoking cessation counselors for any Alabamian who wants to quit.