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Implementing Tobacco-Free Campus & Smoke-Free Conference Policies

March 5, 2007: Reducing Exposure to Secondhand Smoke

Cathy Backinger, Ph.D., M.P.H., Acting Chief, Tobacco Control Research Branch, NCI

After providing background on the health effects of secondhand smoke and those who are most at risk for this exposure (covered by previous speakers and included in this report), Dr. Backinger described to the Committee the adoption of the NCI's smoke-free meeting policy. In 2005, as a result of the C-Change effort (formerly the National Dialogue on Cancer) to adopt a smoke-free meeting policy, member organizations were challenged to do the same. In July 2006 NCI announced its policy to be implemented January 1, 2007:

"…In order to reduce cancer and other serious health hazards caused by secondhand smoke exposure, all meetings and conferences organized and/or sponsored by NCI shall be held in a town, city, county, or state that is smoke-fee, unless specific circumstances justify an exemption from this policy."

The policy applies to meetings and conferences with 20 or more attendees that are organized or sponsored by NCI. Holding a meeting at a smoke-free facility is not adequate—the building must be in a smoke-free jurisdiction. At this point, the policy does not apply to grantees nor does it apply to NCI-sponsored meetings outside of the United States.

Dr. Backinger concluded her remarks by telling the Committee that the National Institute for Drug Abuse (NIDA) has adopted a similar policy, and that the NCI hoped that its new meeting policy would serve as an exemplar for other health organizations to adopt similar policies and encourage jurisdictions to pass smoke-free policies if they had not yet done so.

Corinne Husten, M.D., M.P.H., Chief, Epidemiology Branch, OSH, CDC

In 2003, based on a request from Julie Gerberding, CDC's Director, the agency began planning for the expansion of its smoke-free building policy to a tobacco-free campus. The policy took two years from planning to implementation and prohibits all forms of tobacco use on campus. The policy applies to employees, contractors and visitors including personally manned vehicles. In anticipation of the policy, CDC started offering cessation counseling and Nicotine Replacement Therapy to employees in November 2005 (and included contractors in 2006) to help smokers who want to quit.

Some of the challenges encountered in the development and implementation of the policy were to develop adequate "buy-in" including union support, negotiating the details of the policy and support as well as developing appropriate enforcement protocols. To address these challenges, CDC formed a broad-based working group that included all major stakeholders who worked closely with unions to hear concerns of employees. Frequent and varied communication challenges were used to notify employees of the available cessation benefits and details of the policy.

Dr. Husten reported that the policy has received better support than expected and there has also been a very strong response to cessation services. Moving forward, CDC would like to expand the policy to all CDC campuses as union contracts are negotiated while continuing the availability of cessation services and support. OSH is developing a Healthier Worksite Initiative toolkit and is available to provide technical assistance to other federal agencies considering the adoption of tobacco-free campus policies. Lessons learned include: be prepared for a long preparation process; get support from top leadership; form a planning committee with wide representation; offer cessation resources prior to policy implementation; work with unions and other stakeholders early in the process; and communicate with leadership and employees.

Following the afternoon panel presentation, Dr. Noonan asked for questions from the Committee.

Kimberly Hamlett-Berry congratulated OSH on the adoption of its smoke-free campus policy and then asked Elizabeth Cotsworth whether parents of children in Head Start were getting cessation support as part of the program. Ms. Cotsworth reported that this was an important element and that the EPA was still in negotiation with Head Start regarding all the elements of the partnership.

Jack Henningfield, Pinney Associates, asked Jonathan Winickoff whether issues relating to "turf" arose with his efforts to provide advice to quit to the parents of pediatric patients. Dr. Winickoff responded by saying that a policy resolution adopted by the AMA states that treatment can be provided to any tobacco user in any context. Dr. Henningfield followed this response by asking about the best way to intervene in these instances without driving the tobacco user away. Dr. Winickoff agreed that this was a concern and said that is was an illustration of why system-wide changes are more effective because they don't "single people out." Dr. Husten added that the majority of tobacco users want to quit and respond well to supportive encouragement rather than confrontational approaches.

Dr. Moritsugu asked Dr. Noonan to comment on what can be done to prepare health care professionals to address tobacco use disparities. Dr. Noonan responded that an important first step is to continue to work on changing the culture so that nonsmoking is a principle of health for all people, including people of color. He also noted that schools of public health can be an effective resource in this area. Dr. Moritsugu asked Dr. Baezconde-Garbanati to comment on the same question. She responded that it was important to continue to move toward smoke-free school and hospital campuses to change the social norms around tobacco use. Dr. Baezconde-Garbanati also noted that the Masters in Public Health program at the University of Southern California included a strong tobacco control component.

Dr. Henningfield asked speakers to comment on the promotion of smokeless tobacco as less harmful in the debate about secondhand smoke exposure. Dr. Husten responded that CDC, as the nation's leading health agency, does not promote any form of tobacco use and does not believe that there is sufficient evidence to support the use of smokeless tobacco as an effective intervention to assist in cessation. Dr. Baezconde-Garbanati added that although there are no secondhand smoke concerns with smokeless tobacco, its use has other harmful effects and therefore should not be considered as true harm reduction. Dr. Winickoff stated that the American Academy of Pediatrics believes there is no safe level of tobacco use.

Following the completion of the question and answer period, Dr. Moritsugu asked for public comments.

Aaron Tallent, Media Advocacy Manager with the American Heart Association read a statement on behalf of his organization. This statement encouraged continued research into the health effects of smoke-free policies and additional methodologies to monitor the impact of policies on heart attack rates. Mr. Tallent urged communities without smoke-free policies to review the science supporting their effectiveness and work toward passing such laws.

Following the public comment period, Dr. Moritsugu encouraged member discussion.

Nathaniel Cobb, IHS, urged Committee members to understand that the tobacco use problem in Indian country is not just related to smoking in casinos. In fact, tobacco use among Indians represents a public health crisis which is magnified by the high rates of poverty and crowded conditions that many of this population experience. Unfortunately, there are very limited resources to address this issue and Dr. Cobb appealed to the Committee members for assistance. Dr. Moritsugu asked about the use of tobacco for religious purposes and whether it represents an additional hurdle with this population. Dr. Cobb responded that while it is important to be aware of the ceremonial use of tobacco, there is fairly widespread acceptance that commercial tobacco use is very different than ceremonial use. Jared Jobe, NHLBI, encouraged more research to better understand tobacco use among minority populations and noted that the high use rate of tobacco among Natives provides an opportunity for intervention.

Tanya Pagan Raggio Ashley, HRSA, talked about family day care and the absence of regulations concerning smoking that occurs in the home after daycare hours which disproportionately affects poor children. She encouraged the inclusion of chart tags that remind providers to discuss secondhand smoke harm at every visit.

Cathy Backinger, NCI, cautioned against believing that we have all the science we need in the area of secondhand smoke. More research is needed, and perhaps it would be a good role for this Committee to convene another meeting to move the research agenda forward.

Thomas Schenk, GM, questioned whether the CDC smoke-free campus policy would accelerate smokers' readiness to quit.

He asked Dr. Husten whether the policy included smoking in government vehicles and Dr. Husten said that it included smoking in all parking lots as well as public and private vehicles.

Ernestine Murray, AHRQ, noted that children can often have a powerful influence over their parents' smoking behavior when they bring home messages they have heard at school. She also noted that it is important to involve people in decision-making who are representative of communities disparately affected by tobacco use.

Dana Shelton, OSH, encouraged more research to identify effective interventions for smoke-free homes and vehicles. She suggested the possibility of a follow-up conference call for the Committee to continue to move this issue forward. Barry Portnoy, NIH, agreed that there is a strong need for implementation research.

Jane Roemer, NIOSH, echoed the comments of others focused on the gaps that still exist in those who are covered by smoke-free policies including non-traditional workplaces, offsite work locations, and daycare situations. She also noted that efforts to get employees to do the right thing are more successful when employers are assisting with these efforts.

RADM Moritsugu proposed that a possibility for a next step might be to have a future ICSH meeting focus on this issue or possibly create smaller subcommittees to look at different aspects of the issue.

Jane Moore, Oregon Department of Human Services, emphasized the important role that states play in disseminating information and how the 2006 Surgeon General's Report was critical in helping people understand that there is no safe level of exposure to secondhand smoke.

Jack Henningfield, Pinney Associates, asked whether representatives from the National Institute for Mental Health (NIMH) or the National Institute for Alcohol Abuse and Alcoholism (NIAAA) are included on the ICSH Committee. Given the high prevalence of tobacco use among people with co-morbidities such as drug and mental health problems, these organizations should be involved and more research on the role of co-morbidities is necessary.

Following Committee member discussion, RADM Moritsugu acknowledged that while this meeting was a good first step he suggested that a future meeting of this Committee also focus on this issue to identify concrete next steps. He asked Dr. McKenna if he would like to offer any final comments as well. Dr. McKenna thanked Committee members, speakers, and OSH staff and commented that the paradigm around tobacco use has shifted positively to a focus on policy and environmental change, away from individual behavior change.

The formal Committee meeting adjourned and was followed by the viewing of several public service announcements produced by the Agency for Health Care Quality and Research.

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