Kentucky spends less than a penny of its tobacco-settlement money on prevention programs; few states do very much

By Molly Burchett
Kentucky Health News

A new report says that 15 years after the 1998 state tobacco settlement, Kentucky ranks 38th in the nation in funding tobacco prevention and cessation programs, only 3.7 percent of the amount recommended by the federal Centers for Disease Control and Prevention.

The CDC recommends that the state spend $57.2 million a year on programs to help people quit smoking, but Kentucky is only planning to spend $2.1 million in 2014 on them, says the new annual report from the Campaign for Tobacco-Free Kids. Last year's report ranked Kentucky 37th as it planned to spend the same amount.

The goal of these programs is to help kids and adults quit smoking. Of the $320.3 million in revenue the state will get from the settlement in the current fiscal year, Kentucky will spend just 0.7 percent of it on tobacco-prevention programs, or less than a penny of every dollar it collects in revenue, the campaign says in a news release and a chart.

Kentucky has the highest smoking rates in the country, a an estimated 28.3 percent of adults and 24.1 percent of high-school students smoke. Each year, tobacco claims 7,800 lives and costs the state $1.5 billion in health care bills, about $487 million of which are covered by the federal-state Medicaid program, and each Kentucky household pays an estimated $582 per year in taxes to cover smoking-caused government expenditures, the release says.

To reduce smoking and its negative consequences, health advocates are calling on Kentucky leaders to pass a comprehensive, statewide ban on smoking in workplaces and enclosed public spaces. Some advocates also call for an increase in the state's tobacco tax. The report says Kentucky has the 40th lowest cigarette tax in the country at 60 cents per pack, 93 cents below the state average. It was doubled a few years ago.

"Tobacco takes a terrible health and economic toll on Kentucky, but state leaders can do something about it by increasing funding for tobacco prevention and passing a comprehensive, statewide smoke-free law," said Matthew L. Myers, president of the campaign. "The evidence is clear that reducing tobacco use not only saves lives, it also saves money by reducing tobacco-related health care costs. It's one of the smartest investments Kentucky can make."

Nationally, the report finds that most states are failing to adequately fund tobacco prevention and cessation programs. States will collect $25 billion from the tobacco settlement and tobacco taxes in 2014, but will spend just 1.9 percent of it on prevention programs.

States are spending only 13 percent of the CDC's recommended $3.7 billion in funding for these prevention programs, and only two states – Alaska and North Dakota – spend the recommended amount.

Green = State spends 50 percent or more than recommended amount; Orange= 25-45 percent of recommended amount; Yellow = 10-24 percent of recommended amount; Gray = less than 10 percent of recommended amount 

"Tobacco use is the number one cause of preventable death in the U.S., killing more than 400,000 people and costing $96 billion in health care bills each year. Nationally, about 18 percent of adults and 18.1 percent of high school students smoke." says the report.

Since the states settled their lawsuits against the tobacco companies in November 1998, the Campaign for Tobacco-Free Kids has issued annual reports to hold states accountable for settlement spending, an amount estimated to be $246 billion over the first 25 years.

The annual report on states' funding of tobacco prevention programs, titled "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 15 Years Later," was released by the campaign, the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights.

Advocates hope push in rural areas will help pass statewide smoking ban, at least in the state House

By Justin Richter

University of Kentucky College of Communication and Information

Kentucky has had a love affair with both growing and smoking tobacco, but supporters of a statewide smoking ban believe that smoke should not be shared with people who don’t smoke.

Rep. Susan Westrom

For the fourth straight year, Democratic State Rep. Susan Westrom of Lexington is filing a bill for a smoking ban in workplaces and enclosed public places. She and her allies are focusing increased attention in the state’s rural areas, where smoking is more prevalent.

This summer Westrom visited several towns, from Owensboro to tiny Sandy Hook, to talk with fellow legislators and their constituents about the bill. “We want to be able to access legislators in the rural areas, meet them on their own turf,” showing them their constituents care about secondhand smoke, Westrom said.

A third of the adults in Eastern Kentucky smoke, and almost a third of those in Western Kentucky do, according to the Behavioral Risk Factor Surveillance System, an ongoing telephone survey by the federal Centers for Disease Control and Prevention.

"We're going to need a lot more legislative support, and we're pretty much doing that one legislator at a time," Smoke-Free Kentucky Coordinator Betsy James said at last month's meeting of Kentucky Voices for Health, an association of health lobbying groups. "This is sort of a rural-urban issue, so we do need help out in the counties."

Advocates are hoping to build on the passage of smoking bans in 28 Kentucky cities and 10 counties.  “We’ve got 38 different locations that have smoke-free ordinances and we want to meet the standard we have in Louisville and Lexington,” Westrom said in an interview. 

Louisville and Lexington were two of the first cities to ban smoking in enclosed public places.  Each had exemptions, including bars and clubs, but by 2008 both went to comprehensive bans, unlike some other jurisdictions in the state that have large exceptions.

The Hopkins County Board of Health, for example, passed a regulation in 2009 that permits individuals from smoking in workplaces but has large exceptions that allow individuals to smoke in private clubs, privately rented restaurants, as well as hotel and motel rooms that are rented.

Westrom is working with Dr. Ellen Hahn, director of the Tobacco Policy Research Program at the University of Kentucky College of Nursing, who has led the efforts to pass local smoke-free measures.  After working for years on local bans, she is now working on both local and state fronts. 

Work towards smoke-free public enclosed places has gained ground steadily since Hahn started 10 years ago, but most of the state remains unaffected by any smoking ordinances or regulations.

According to a booklet prepared by the College of Nursing and the state Cabinet for Health and Family Services, “70 percent of Kentuckians are regularly exposed to secondhand smoke in the workplaces and public places.”

Smoking is more common in Kentucky than any other state, with 28.3 percent of adults smoking, compared to 19 percent nationwide according to the CDC. Kentucky Youth Advocates recently released a study done that revealed Kentucky has one of the highest rates of smoking during pregnancy in the nation. 

Westrom and Hahn have been working together since 2011, when Westrom first filed a state-wide smoking ban bill. The first bill did not get out of the House Health and Welfare Committee, but the next two bills did. 

Last year, her bill was then sent to the Judiciary Committee, a sign that it was being taken a bit more seriously, because that panel was more skeptical of it and raised issues that if resolved could help the bill pass.

In 2013 the bill was not given a vote on the House floor, presumably because it did not have enough votes to pass.  Westrom is anticipating getting past the House floor and into the Senate this year. “I think we’re really close in the Senate,” she said, noting that almost every Senate district has at least one smoke-free community.

The Kentucky Chamber of Commerce has supported Westrom’s bill since it was introduced three years ago.  “Over 90 percent of respondents expressed support for a smoke-free law in Kentucky in a recent Chamber survey,” said Ashli Watts, the business lobby’s public-affairs manager.

The chamber is advocating a smoke-free workplace largely because of lost worker productivity due to illnesses causes or worsened by smoking. Research by The Ohio State University's College of Public Health found that every U.S. smoker is costing his /her company an extra $6,000 per year.

Democratic Gov. Steve Beshear said he will continue to support a statewide smoking ban, and that it would be a help to business.  House Speaker Greg Stumbo, D-Prestonsburg, said he hopes the House will pass the bill.

Stumbo spoke at a panel discussion held by the Kentucky Hospital Association with Senate President Robert Stivers, R-Manchester.  Stivers said individual businesses should be able to allow smoking, but said that he would not impose his view on the rest of the Senate.

Northern Kentucky health board supports statewide smoking ban

The main health board in Northern Kentucky, where local smoking bans have stirred much controversy. has endorsed the idea of a statewide ban on smoking in all places of employment.

"The 32-member board, which represents Boone, Campbell, Grant and Kenton counties, voted to support the ban at its Sept. 11 meeting after Dr. Lynne Saddler, director of the Northern Kentucky Health Department, presented evidence about the dangers of second-hand smoke," The Kentucky Enquirer reported.

The board also authorized the department to promote Smoke-Free Kentucky, the main group advocating smoking bans, and its work in Northern Kentucky.

Efforts to pass a statewide smoking ban have never come to a floor vote in the legislature, but "23 Kentucky communities have passed comprehensive smoke-free laws, covering 34 percent of Kentuckians," the Enquirer noted. "In Northern Kentucky, only Kenton County has a smoke-free law, and it contains exemptions for bars and restaurants." (Read more)

10 years ago, Lexington's smoking ban started creating a healthier city and a movement among others in Kentucky

A decade ago, Lexington took a bold step by enacted the state's first public smoking ban, in a city that once proudly touted its status as the "World's largest burley tobacco market." As smoke-free supporters and Lexington residents celebrate the ordinance's 10th anniversary Monday, a recent editorial in the Lexington Herald-Leader highlights the dramatic benefits that have followed this historic step.

After the smoking ban took effect in April 2004, the city had 22 percent fewer emergency room visits for asthma in the next 32 months, and the Fayette County smoking rate has dropped from 26 percent to 17.5 percent, the editorial notes. These positive changes have yielded health-care savings of $21 million a year, says the University of Kentucky's Tobacco Policy Research Program.

"There is nothing quite as cost effective as smoke-free policies," the editorial quotes Ellen Hahn, a UK nursing professor and director of the Kentucky Center for Smoke-Free Policy, as saying. "We predict a 32 percent decline in smoking rates if Kentucky were to go smoke-free. That would save billions in health care costs and reduce premature death and suffering from the chronic diseases that plague Kentucky."

The editorial also says Lexington led the way for Louisville and 20 other municipalities to protect citizens from secondhand smoke; a third of the state's population now lives in a smoke-free environment, and many of the initial fears about a smoking ban are now extinguished.

Kentuckians feared economic harm, the shunning of Lexington restaurants and bars and suffering tourism or downtown attraction, but the opposite predictions came true, says the editorial. The scene in downtown Lexington is "far richer than 10 years ago... It once was an article of faith that tobacco would always be king in Kentucky, yet tobacco declined and agriculture has thrived."

Leaders in Mayfield, a town with a rich tobacco heritage, approve smoking ban

UPDATE, July 9: The ban passed 5-4 on second reading. It will take effect in 2014 and "excludes spaces used primarily for sleeping such as hotels, hospices or nursing homes, rooms designated for social functions and separate smoke-proof enclosures with a heating and air conditioning system," WPSD-TV reports.

In a Western Kentucky county speckled with tobacco farms, the only sizeable town may extinguish smoking in public, enclosed spaces. By a 6-4 vote this week, the Mayfield City Council approved first reading of a smoke-free ordinance that would punish violators with fines.

The ordinance has to pass a second reading on July 8 to go into full effect. Mayor Teresa Cantrell said she wants to add her city to the list of cities with bans, even though she would not have agreed with a ban in the past, reports Jason Hibbs of WPSD-TV in Paducah.

"What has changed my mind is the realization of the public-health hazard and mainly as it pertains to the workers in the restaurants," Cantrell said. Many residents think the smoking ban is long overdue, despite Graves County's rich tobacco heritage.

"I have a little one and I don't want her to be around smoking if she doesn't have to be," restaurant customer Britanee Handley told Hibbs. Handlee doesn't smoke, avoids smoky places for her baby's sake and can't wait to see all the ashtrays in the town disappear, reports Hibbs. 

Cantrell told Hibbs that she visited three Mayfield restaurants during lunch hour and their smoking sections were completely empty, and one restaurant manager discussed removing the smoking section from his restaurant because most customers don't want to smoke.

Council members who voted against the ban said business owners should be able to decide smoking policy on their own, reports The Paducah Sun.

Cantrell told Hibbs said the Mayfield ordinance is modeled after a well-received ordinance passed in Paducah in 2006. It requires ashtrays to be stowed away and prohibits smoking within 15 feet of public places, but it does grant exceptions for hotels, nursing homes, rooms designated for private social functions, tobacco retailers and designated indoor smoking areas.

If the ban is passed in July, violators of the ordinance will be assessed a $50 fine for a first violation, $100 for a second and $250 for a third, and after that could face a restraining order or permanent injunction. To read the proposed ordinance, click here.

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

By Molly Burchett

Kentucky Health News

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

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

To read the full report, go here.

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

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

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

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

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

143 groups in state working to improve health, directory lists

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

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

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

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

Rockcastle County school board nixes ban on smoking at schools

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

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

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

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

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

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

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

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

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

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

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

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

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