KY-ASAP REGION 6 TOBACCO/NICOTINE POLICY RECOMMENDATIONS, including Hookah bars and e-cigarettes
Hookah bars are emerging as an important consideration for smokefree air efforts in many communities. As more municipalities in Kentucky go 100% smokefree in workplaces, restaurants, bars, and casinos, establishments seeking to violate the law look for loopholes wherever they can.
In 2005, the World Health Organization (WHO) issued an Advisory Note on Waterpipe Tobacco Smoking. This Advisory Note states:
• “waterpipe smokers and second-hand smokers [are] at risks for the same kinds of disease as are caused by cigarette smoking, including cancer, heart disease, respiratory disease, and adverse effects during pregnancy.”
• And recommends that “waterpipes should be prohibited in public places consistent with bans on cigarette and other forms of tobacco smoking,” and that “education…is urgently needed about the risks of waterpipe smoking, including high potential levels of secondhand exposure.”
Current e-cigarette use among middle and high school students tripled from 2013 to 2014, according to data published by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration’s Center for Tobacco Products (CTP) in today’s Morbidity and Mortality Weekly Report (MMWR). Findings from the 2014 National Youth Tobacco Survey show that current e-cigarette use (use on at least 1 day in the past 30 days) among high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014, rising from approximately 660,000 to 2 million students. Among middle school students, current e-cigarette use more than tripled from 1.1 percent in 2013 to 3.9 percent in 2014—an increase from approximately 120,000 to 450,000 students.
This is the first time since the survey started collecting data on e-cigarettes in 2011 that current e-cigarette use has surpassed current use of every other tobacco product overall, including conventional cigarettes. E-cigarettes were the most used tobacco product for non-Hispanic whites, Hispanics, and non-Hispanic other race while cigars were the most commonly used product among non-Hispanic blacks.
Tobacco Free Schools – Model School Nicotine Use Prevention
A 100% TFS policy prohibits tobacco use, including vapor products and alternative nicotine products, by staff, students and visitors twenty-four hours a day, seven days a week, inside Board-owned buildings or vehicles, on school owned property, and during school-sponsored student trips and activities.
Tobacco use is the leading cause of preventable death in Kentucky. Kentucky also has the highest youth tobacco use in the nation. This is important because 80% of current tobacco users started using tobacco before the age of 18.
A 100% TFS policy provides opportunities for adults and peers to role model tobacco-free lifestyles for students. We cannot send mixed signals in our learning environments. The good news: studies show that schools with 100% TFS policies for three years or more have 40% fewer youth smokers than those in non-TFS districts.
Model Policies for Schools to Reducing Youth Smoking and Other Tobacco/Nicotine Use Should Include:
• Forbid tobacco/nicotine use by students, staff and visitors on all school grounds and at all school sponsored events.
• Provide comprehensive tobacco prevention education.
• Provide program-specific training for teachers.
• Involve parents and families in school efforts to prevent tobacco use.
• Offer interactive tobacco-free projects for students.
• Help tobacco-using students and staff quit.
• Adopt a firm school policy of not accepting any funding, curricula or other materials from any
• tobacco company.
• Evaluate the school’s tobacco-free programs at regular intervals.
Taxes
Tobacco tax increases offer a win-win-win solution for states, especially as they face a severe fiscal crisis and work to balance budgets while preserving essential public services.
Health Win: Tobacco tax increases are one of the most effective ways to reduce smoking and other tobacco use, especially among kids. Every 10 percent increase in cigarette prices reduces youth smoking by about seven percent and total cigarette consumption by about four percent.
Budget Win: Every state that has significantly increased its cigarette tax has enjoyed substantial increases in revenue, even while reducing smoking. Higher tobacco taxes also save money by reducing tobacco-related health care costs, including Medicaid expenses. States can realize even greater health benefits and cost savings by allocating some of the revenue to programs that prevent children from smoking and help smokers quit.
Political Win: National and state polls consistently have found overwhelming public support for tobacco tax increases. Polls also show that, when it comes to balancing budgets, voters prefer raising tobacco taxes to other tax increases or cutting crucial programs such as education and public safety.
Current average state tobacco tax: $1.54 per pack | Kentucky tobacco tax: $0.60 per pack
Smoke-free multi-unit housing
Secondhand smoke exposure poses serious health threats to children and adults. According to the U.S. Surgeon General, there is no safe level of secondhand smoke exposure. Eliminating indoor smoking is the only way to protect nonsmokers from the harmful effects of tobacco smoke.1 For residents of multi-unit housing (e.g., apartment buildings and condominiums), secondhand smoke can be a major concern given that it can migrate from other units and common areas and travel through doorways, cracks in walls, electrical lines, plumbing, and ventilation systems.
In the last decade, the availability of smokefree multi-unit housing has skyrocketed as a result of greater awareness of the dangers of secondhand smoke, increased consumer demand, state and local advocacy efforts, and recommendations issued by federal authorities including the U.S. Department for Housing and Urban Development (HUD) and Environmental Protection Agency (EPA). Smokefree multi-unit housing policies are beneficial for both residents and property owners. Going smokefree promotes residents’ health by protecting them from secondhand smoke while improving a property manager’s bottom line through reduced turnover costs and decreased fire risks.
Parks/Recreation
To protect residents from drifting secondhand smoke while they enjoy outdoor sports and other activities, city and county governments can create smokefree parks and recreation areas. This fact sheet outlines the benefits of laws and policies to create smokefree parks.
Smokefree parks promote healthy living. People go to parks to play with their kids, to participate in sports, or to relax and enjoy the outdoors. Creating smokefree parks is a way for communities to make outdoor spaces even more conducive to healthy living. By passing a law to create smokefree parks, a city or county can take an important step to encourage healthy behaviors and make parks places where people can expect to be free from secondhand smoke. Smokefree environments help adults model healthy behavior for kids, and can encourage people who smoke to smoke less or even quit.
Smokefree University/College Campuses
The American College Health Association (ACHA) acknowledges and supports the findings of the Surgeon General that tobacco use in any form, active and/or passive, is a significant health hazard. ACHA further recognizes that environmental tobacco smoke has been classified as a Class-A carcinogen and that there is no safe level of exposure to environmental tobacco smoke (ETS), a recognized toxic air contaminant. In light of these health risks, ACHA has adopted a NO TOBACCO USE policy and encourages colleges and universities to be diligent in their efforts to achieve a 100% indoor and outdoor campus-wide tobacco-free environment. This position statement reflects the viewpoint of ACHA and serves only as a guide* to assist colleges and universities with evaluating progress toward becoming or maintaining tobacco-free living and learning environments that support the achievement of personal and academic goals.
Campus-based efforts to promote tobacco-free environments have led to substantial reductions in the number of people who smoke, the amount of tobacco products consumed, and the number of people exposed to environmental tobacco hazards.
Cessation AND Insurance coverage of cessation/NRT
All public and private health insurance plans should cover a comprehensive tobacco cessation benefit for plan members, including all 7 medications and 3 types of counseling recommended by the U.S. Public Health Service.
Tobacco dependence increasingly is recognized as a chronic disease, one that typically requires ongoing assessment and repeated intervention. In addition, the updated Guideline offers the clinician many more effective treatment strategies than were identified in the original Guideline. There now are seven different first-line effective agents in the smoking cessation pharmacopoeia, allowing the clinician and patient many different medication options. In addition, recent evidence provides even stronger support for counseling (both when used alone and with other treatments) as an effective tobacco cessation strategy; counseling adds to the effectiveness of tobacco cessation medications, quitline counseling is an effective intervention with a broad reach, and counseling increases tobacco cessation among adolescent smokers. Finally, there is increasing evidence that the success of any tobacco dependence treatment strategy cannot be divorced from the health care system in which it is embedded. The updated Guideline contains new evidence that health care policies significantly affect the likelihood that smokers will receive effective tobacco dependence treatment and successfully stop tobacco use. For instance, making tobacco dependence treatment a covered benefit of insurance plans increases the likelihood that a tobacco user will receive treatment and quit successfully. Data strongly indicate that effective tobacco interventions require coordinated interventions. Just as the clinician must intervene with his or her patient, so must the health care administrator, insurer, and purchaser foster and support tobacco intervention as an integral element of health care delivery. Health-care administrators and insurers should ensure that clinicians have the training and support to deliver consistent, effective intervention to tobacco users.
Kentucky Insurance Cessation Overview
Icon Legend:
• = Covered
• = Coverage Varies
• = Not Covered
Medicaid Coverage
The Kentucky Medicaid program covers:
• NRT Gum
• NRT Patch
• NRT Nasal Spray
• NRT Lozenge
• NRT Inhaler
• Varenicline (Chantix)
• Bupropion (Zyban)
• Group Counseling
• Individual Counseling
• Quitline
Each health plan covers some medications and some form of counseling. Medicaid members should contact their health plan to find out what is covered for them.
Note: the Affordable Care Act requires all Medicaid programs cover all tobacco cessation medications beginning January 1, 2014. If a medication is marked here as not being covered, there is not yet evidence that Medicaid has complied with this requirement. Patients should call their Medicaid program and ask how to receive these medications. Also note: the coverage information above applies to traditional Medicaid. Coverage information for the Medicaid expansion population is still to be determined.
Because the smoking prevalence among Medicaid patients is 39% higher than that of the general U.S. population (Lethbridge-Cejku, Rose, & Vickerie, 2006), a more comprehensive coverage of tobacco dependence treatments is likely to impact a significant proportion of the smoking population. Nicotine Replacement Therapy (NRT), including nicotine patches, lozenges and gum, is over-the-counter, therefore, Medicare Plan D will not cover it.
Health Insurance Marketplace Coverage
All plans in the Health Insurance Marketplace are required to cover tobacco cessation treatment. Specific coverage varies by plan. Check with your insurance plan to find out what is covered.
State Employee Health Plan Coverage
The Kentucky Employees Health Plan covers:
• NRT Gum
• NRT Patch
• NRT Nasal Spray
• NRT Lozenge
• NRT Inhaler
• Varenicline (Chantix)
• Bupropion (Zyban)
• Group Counseling
• Individual Counseling
• Phone Counseling
• No Tobacco Surcharge
Members are eligible for the Smoking Cessation Program once per year. If enrolled in the Cooper Clayton program or the Kentucky Tobacco Quitline Program, members can receive and receive 3 months of over-the-counter nicotine replacement every two weeks for $5 each. This co-payment will be dropped on January 1, 2014. Copays for other drugs will still apply. Members can also receive bupropion or varenicline for 3 months once a year by obtaining a prescription from their doctor and prior authorization from their plan. Copays range from $10-25. Counseling coverage is limited to 13 one-hour sessions. State employees who are tobacco users are charged $16.80/month in extra health insurance premiums for individual coverage and $33.60/month for family coverage.
Private Insurance Coverage
This state does not require private health insurance plans to cover cessation treatments. Cessation coverage in private health insurance plans varies by employer and/or plan. Smokers with this type of health insurance should contact their insurance plan for information on cessation benefits.
This state does not mandate cessation coverage for private insurance plans.
Quitline
Contact Information: 1-800-QUIT-NOW; http://www.quitnowkentucky.org
Hours: 8 AM – 1 AM Monday-Sunday
Eligibility to recieve counseling: A resident of Kentucky age 15 and older wanting to quit tobacco use within the next 30 days.
Medications provided: NONE
No-smoking in cars with kids
As the public becomes more aware that there is no safe level of exposure to secondhand smoke, both individuals and legislators are taking action to reduce exposure in vehicles.
Since 2006, several communities, seven states (AK, CA, LA, ME, OR, UT, VT) and Puerto Rico have enacted laws to prevent smoking in cars when children are present.
Exposing passengers, both children and adults, to secondhand smoke in the confined space of a car is extremely hazardous. Everyone should be encouraged not to smoke in vehicles.
When someone smokes in the small enclosed space of a car, people are exposed to toxic air that is many times higher than what the EPA considers hazardous air quality, even when a window is down. Additionally, the gaseous and particulate components of tobacco smoke absorb into the upholstery and other surfaces inside a car, and then off-gas back into the air over the course of many days, exposing passengers to toxins long after anyone actually smoked in the car.
Because a law, by itself, is unlikely to eliminate secondhand smoke exposure in cars, we recommend that any smokefree car campaign be accompanied by a strong education effort, stressing the health hazards of smoke-filled vehicles. Campaigns for smokefree car laws can serve as a tool to educate the public about the health hazards of secondhand smoke exposure and improve decision making about smoking in ways that harm other people.