The American Lung Association released its annual report card last week on how well the nation is doing when it comes to reducing smoking rates, and once again Massachusetts received two failing grades. The state was given an “F’’ for spending only $9.9 million, in state and federal money, on prevention programs – far less than the $90 million recommended by the Centers for Disease Control and Prevention. Massachusetts also got an “F’’ for its coverage of medications and counseling to help smokers quit, investing just $1.26 per smoker compared with the CDC-recommended investment of $10.53.

The state earned an “A’’ for its smoke-free air, thanks to a ban on smoking in restaurants, bars, and other public places, and a “B’’ for its cigarette tax, which is $2.51 per pack of 20.

But the biggest buzz at the ALA press conference was centered around new smokeless tobacco products. The US Food and Drug Administration has not yet decided how to regulate them.

“They’re much easier for kids to hide than a cigarette,’’ said the ALA’s Erika Sward. And the packaging “looks like a cellphone in someone’s pocket,’’ rather than a bulky cigarette pack.

How would you feel if the government told you that you couldn’t smoke in your own car? Perhaps you’d endorse the idea that public health officials were trying to make it harder for people to maintain a habit that increases their risk of developing lung cancer, emphysema, heart disease and a host of other problems. Maybe you’d rejoice that you’d never again be forced to carpool to a meeting with a chain-smoking colleague.

You might even breathe a sigh of relief for all the children of smokers who would be able to ride to school, soccer practice and piano lessons without being forced to inhale clouds of secondhand smoke.

And some of you – smokers or not – might be more than a tad annoyed at the prospect of Big Brother dictating what you can and cannot do in the privacy of your own vehicle.

No law forbidding all smoking in cars is on the horizon in the U.S. (where a good many people get worked up about proposals to encourage healthy eating by imposing so-called fat taxes on soda, fried foods and the like). But drivers in the United Kingdom may be restricted from lighting up behind the wheel – if the country’s doctors have their way.

A report released Wednesday from the British Medical Assn.’s Board of Science calls on governments in the U.K. to impose a ban on smoking in vehicles as part of its overall effort to “achieve a tobacco-free society by 2035.” Over there, it is already against the law to smoke in buses, taxis and other public vehicles. Extending those rules to private vehicles could be done in one of three ways, the BMA suggests:
The ban could apply only to cars carrying children.
The ban could apply to any car with a passenger of any age.
The ban could apply to all vehicles at all times. (This is the option favored by the doctors, in part because it would be simplest to understand and enforce, they say.)
Why do they care? One of the primary reasons is to cut down on people’s exposure to secondhand smoke, which is especially concentrated inside a vehicle. “Tobacco smoke contains 4,000 known chemicals, 69 of which are known or probable carcinogens,” according to the 19-page report. Experts estimate that 23 children and 4,000 adults die in Britain every year because of the health effects of secondhand smoke.

A secondary concern is that fiddling with a cigarette is a dangerous distraction for drivers. Police in Britain are already empowered to write tickets for drivers if smoking is preventing them from driving safely.

Smoking rates in Britain are a little higher than they are in the U.S. (the U.S. Centers for Disease Control and Prevention says that 20.6% of Americans were smokers in 2009). According to the BMA, 21% of adults in England are smokers, along with 23% of adults in Wales, 24% of adults in Scotland and 24% of adults in Ireland. Three out of 10 smokers say they sometimes have a cigarette while driving.

Recent polls show some support for the doctors’ proposal – 88% of people in Ireland and 74% of people in England said they were in favor of a ban on smoking in cars carrying children. In addition, a report out last year from the Royal College of Physicians found that 56% of people in Britain support a blanket prohibition on smoking in vehicles.

An all-out ban would appear to be a first, but other countries do prohibit smoking in vehicles under some circumstances. In South Africa, it’s illegal to smoke in a car if any passengers are under the age of 12; five of Australia’s six states ban smoking in cars carrying children or teens (different states have different age cutoffs). In California, smoking is not allowed if any passengers are younger than 18.

Children are especially vulnerable to secondhand smoke because they take more breaths than adults, their immune systems aren’t fully developed, they’re “more vulnerable to cellular mutations” and they “absorb more pollutants because of their size,” according to the BMA.

The report notes that the Tobacco Manufacturers’ Assn. (which represents the British tobacco industry) is opposed to a complete ban. They prefer that discussion of health risks focus on issues related to distracted driving, not secondhand smoke.

The BMA report describes the tobacco industry’s position like this: “The proposal to ban smoking in what is a private space is a step too far and an unwarranted intrusion on individual freedeom.” To that, the doctors retort: “It is important to note, however, that this takes no account of the freedom of other individuals to use the roads safely, and for other individuals to be free from the risks posed by distracted drivers.”

It’s nearly back to the drawing board for a model smoking ordinance that got mixed reaction at two public hearings.Augusta’s public services committee voted Monday to send the draft back to General Counsel Andrew MacKenzie to incorporate feedback from the hearings and potentially broaden the ordinance at the request of Commissioner Corey Johnson.

On Monday, Mayor Pro Tem Joe Bowles questioned why the draft ordinance banned e-cigarettes, electronic devices that dispense a chemical vapor, while Johnson asked if the ordinance couldn’t also ban smoking in cars with children.
“If we’re going to address this issue, let’s address it more broadly,” Johnson said.
The draft ordinance bans smoking within 20 feet of all public places and private workplaces in Augusta-Richmond County, excluding the city limits of Hephzibah and Blythe. It prohibits smoking in outdoor ATM lines, in and around public parks and facilities and at outdoor worksites where two or more employees are working.
The ordinance’s ban on smoking in public buildings and parks concerned Recreation, Parks and Facilities Director Tom Beck, who Monday questioned employees’ ability to enforce it outdoors and its impact on city-owned facilities such as Julian Smith Casino. The city-owned facilities generate $500,000 in rental income a year, Beck said.
Johnson said he’d like to see the commission hold “a few more workshops” to get the ordinance right.
A dozen representatives from Augusta’s Fishbowl Lounge, Club Barcelona, The Pub, Cuz’s and the Silver Bullet came to Monday’s meeting to demonstrate opposition. Most said the city should leave the decision to outlaw smoking in nightclubs to bar owners themselves.
Helping coordinate the opposition group was Ronald Wolf, president of the Georgia Licensed Beverage Association. Wolf said Monday that the ordinance infringed on the rights of property owners and had the potential to eliminate jobs.
Commissioner Wayne Guilfoyle said he had also heard from the owners of other businesses, not bars or restaurants, whom the ordinance would prohibit from smoking “in their own business or yard.”
Scarlet Hawk, a consultant working with the American Cancer Society, wasn’t discouraged by the committee’s lack of action Monday.
“It’s great that they’re going to work on it,” Hawk said. “I’m sure that they will be tailoring it perfectly for Augusta.”
Commission committees declined to take action on several other items Monday, referring them to future committee meetings or workshops, including:
• A $511,000 sole-source purchase of two trucks by the city’s Environmental Services department
• How to cut services or generate more revenue to fill a $7.3 million hole in the 2012 budget
• Approving a 15-year contract with Augusta Riverfront LLC to manage the TEE Center parking deck
• Setting a flat water rate for First Tee of Augusta, which pays thousands for water while nearby Forest Hills Golf Course pays a flat $143 monthly to irrigate the 18-hole course. Utilities Director Tom Wiedmeier said Monday that Forest Hills has used $650,000 worth of water since 2004 under an unwritten agreement.

Cal State Long Beach calls itself a smoke-free campus, yet many students and faculty overlook the smoking policy every day. The smoke-free environment policy was adopted in the fall semester of 1989. The policy states that smoking is prohibited inside buildings and courtyards, within 20 feet of building entrances, windows and air intakes, and the perimeter of Brotman Hall. With this policy, CSULB claims to guard against secondhand smoke.

“I usually see people smoking while waiting for class at the CBA building, and there’s clearly a sign posted around the building,” said Daniel Carter, sophomore criminal justice major.
In 2004, Assembly Bill 846 went into effect to increase the smoking distance from five feet to 20 feet from state buildings. AB 846 also mandates that state agencies can further regulate with more severe restrictions.
Although the official policy states 20 feet, the signs posted on the CBA building are written as 25 feet. This rule means 20 or 25 feet from any entry, exit or air vent of any university building.
“Whenever I see someone smoking outside of class or something, I just move away, even though I know they’re the ones who are supposed to [move],” said Kristian Patterson, junior criminal justice major.
Long Beach is a smoke-free city. The same regulations apply to the city, as listed in CSULB’s policy.
As part of the Long Beach Municipal Code 8.68, smoking is prohibited at beaches and near bus stops. Still, there are several bus stops on campus where people can be seen smoking while waiting for their buses.
“I guess everyone just has to look out for themselves since it’s not going to be enforced,” Patterson said.
The policy also prohibits smoking outdoors in areas that are near food service facilities.
“I hate when I’m trying to eat, and I can smell smoke,” Carter said. “It makes me want to get up and leave.”
According to the CSULB’s smoke-free environment policy, “The success of this policy depends upon the thoughtfulness, consideration and cooperation of everyone.”

Kirk Voelker, MD, medical director of Sarasota Memorial’s Clinical Research Center and a local pulmonologist who has been a longtime advocate for smoking prevention programs, has been appointed to the State of Florida’s Tobacco Education and Use Prevention Advisory Council.

While advisory in its capacity, the 23-member Council represents a selection of experts in and advocates for tobacco prevention and control from Florida and the nation. According to a Sarasota Memorial press release, the council oversees the direction and goals of Florida’s anti-tobacco activities.

Voelker, whose advocacy stems from years of treating patients with advanced lung disease and lung cancer, was appointed in March by Florida’s Speaker of the House Dean Cannon. His term runs through August 2013.

“I am honored to have the opportunity to have a meaningful impact on such an important area about which I feel so passionate,” Dr. Voelker said.

Florida voters adopted Amendment 4 on Nov. 7, 2006, requiring funding of a Comprehensive Statewide Tobacco Education and Prevention Program. The Amendment resulted in implementing legislation and the creation of several program components, including the Tobacco Education and Use Prevention Advisory Council, SMH press release said.

Anti-smoking advocates are at it again – delivering the right message the wrong way.
No argument on the message:
Smoking is bad for your health.
But government intervention to reduce or stop a person’s tobacco use flies in the face of America’s core value, individual freedom. Monday’s Gazette carried a story about the American Lung Association’s tobacco control report card for North Carolina.

The state scored “F” – no surprise given the importance of tobacco in the economic history of our state. As you also would guess, the lung association’s scoring methodology stacks in favor of government intervention into the personal lives of its citizens.

A lung association spokesperson made no bones about the intent of the report card, saying its real reason is to influence the people who make public policy.

A host of anti-smoking advocates now want to achieve their goals by increasing the tax on cigarettes by $1 or more. They intend to push for the increase in this year’s General Assembly session.

The current cigarette tax in North Carolina is 45 cents, $1 less than the national average.

The Gaston County Board of Health has named reducing tobacco use as one of three priorities for the county. Gaston has a higher smoking rate for adults and more deaths attributable to smoking than North Carolina as a whole. The county has, however, seen considerable improvement in the percentage of adult smokers – from 33.3 percent to 23.7 percent – in the past five years.

To its credit, the health department worked with several Gaston restaurants who volunteered to go smoke-free before the state forced the issue last January. Key word: volunteered. That’s the right way to send this message.

(Interestingly, the health department itself didn’t go totally tobacco-free until Jan. 1 of this year.)

Deciding to be smoke-free — or not — is a choice best left up to restaurant owners who have business to win or lose based on their decisions. But North Carolina lawmakers, influenced by the anti-tobacco advocates, snatched that freedom by forcing restaurants to be smoke-free.

Will legislators once again bow to special interest wishes by attempting to control behavior, this time through taxation?

How much tax would it take to stamp-out smoking? A dollar? Two dollars? More?

Will an out-right ban on tobacco products be next? What will that do? Like illegal drugs do now and illegal whiskey did during Prohibition, it will drive transactions underground where purchases are made in dangerous, often life-threatening, circumstances.

As long as other states have lower prices on tobacco products, there will be a loss of revenue for merchants, particularly in border counties such as Gaston. People will drive across state lines to make their purchases and bring back cheaper goods for others. Don’t believe it? Ask older folks about the way cigarettes flew over the state line as travelers passed through North Carolina when cigarettes here were cheaper than anywhere in the country.

The lung association spokesman made it clear that the tax hike is only one strategy in the assault on smoking. Next up: smoking bans in the workplace, in retail establishments, in private schools.

Already, most of these places have decided on their own to go smoke-free. They made the decisions because they believed it was in their best interest. Had smoking enhanced their business, in a tobacco shop for example, they should be free to decide in that direction, too.

Government has no right to dictate behavior in any private establishment, even in the name of wellness, as anti-smoking advocates now claim. Freedom means people are free to make even bad choices.

We urge our lawmakers to refrain from supporting any attempt to limit the freedom of North Carolina citizens. It’s the wrong way to send even the right message.

In its most recent incarnation, the Food and Drug Administration’s (FDA) war on tobacco has expanded its regulations to include the labels and advertisements of cigarettes. The new initiative seeks to scare potential smokers away from a pack with sharp messages and poignant depictions of the negative effects of cigarette smoke. The warnings are as unwavering as the staunch opponents of tobacco, including grim messages such as: “WARNING: Smoking can kill you.”

According to the U.S. Department of Health and Human Services (HHS), the FDA has recently issued a proposal entitled “Required Warnings for Cigarette Packages and Advertisements.” This measure would require tobacco companies to put bolder warning labels and graphic images on cigarette packaging and advertising.
For many, the proposed act would signify a great victory for health in America.
“Today, (the) FDA takes a crucial step toward reducing the tremendous toll of illness and death caused by tobacco use by proposing to dramatically change how cigarette packages and advertising look in this country,” said Margaret A. Hamburg, M.D., Commissioner of the FDA, according to The New York Times. “When the rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes.”
This initiative is a part of the HHS tobacco control strategy and is an extension of the Family Smoking Prevention and Tobacco Control Act. Previous restrictions have focused on preventing the sale, distribution, and general access of cigarettes to people under the age of 18. According to the FDA, the proposal will push regulations into unprecedented territory: to expand preventative measures to include blunt warnings about the repercussions of habitual cigarette smoking.
The FDA will choose nine different warning labels and images explaining the negative health effects of tobacco use. The labels include warnings such as “WARNING: Cigarettes cause fatal lung disease,” and “WARNING: Smoking during pregnancy can harm your baby.”
Of course, a picture says a thousand words.
The images chosen by the FDA are forthright, full color, and range from illustrations of a person dying in a hospital bed to a picture contrasting healthy and cancerous lungs. The bottom line of their message: cigarette smoke kills — in horrible ways.
“Every day, almost 4,000 youths try a cigarette for the first time and 1,000 youths become regular, daily smokers,” said Kathleen Sebelius, secretary for the U.S. Department of HHS. “Today marks an important milestone in protecting our children and the health of the American public.”
The new anti-smoking initiative is one of deterrence, prevention and education. It is directed at the young, attempting to mold a smoke-free generation by depicting the harsh reality of cigarette-related illnesses.
According to HHS, tobacco use is the leading cause of premature and preventable death in the U.S., responsible for 443,000 deaths each year. According to the Centers for Disease Control, the prevalence of smoking among U.S. adults (18 years or older) has declined from 24.7 percent in 1997 to 20.6 percent in 2009. However, tobacco use is still particularly high among low-income groups and those with limited social mobility.
People will indeed smoke, despite the risk or the cost of a pack.
“I don’t think it’s really going to make a difference,” said first-year Alice Gushue. “I think people are aware of the dangers of smoking and still choose to smoke.”
Some feel that the new law will result in further alienation and stigmatization of smokers. When cigarettes are portrayed as a purely reckless and self-deprecating endeavor, the smokers themselves are labeled as such.
“Smoking is often a habit picked up at an early age,” senior Zack Pinsky said. “Although it has a vice connected to it, nicotine is a serious addiction. One would not berate a heroin user for being addicted. It is a matter of addiction, which is a serous issue, not something to be mocked or looked down upon.”
The topic of tobacco use and control is a controversial issue for Americans. It is coming to the forefront of health issues in our generation and the government is seeking input from the nation, as it begins to take new legislative steps.
The FDA is looking for opinions and feedback on the labels and images being chosen for the proposed rule. According to HHS, these opinions can be submitted by mail or online between Nov. 12 and Jan. 11, 2011. The final regulations will be issued on June 22, 2011, and will take effect no later than 15 months after the requirements are set.
When they do take effect, these labels will be loaded with meaning. For some, it will be a triumph over corporation and a commitment to a cleaner, healthier America. For others, it will be a slight loss in profit. Undeniably, it will act as a glaring reminder of the health risks and social stigma of smoking cigarettes for smokers everywhere in the nation.

The Great American Smokeout passed rather quietly last week, but a national report issued on the day of the event caught our eye, and not just because Alabama is near the bottom of another list. The annual report on states’ funding of tobacco prevention programs shows that most states don’t do a good job with tobacco prevention and cessation programs.

Alabama ranks 44th in funding such programs, spending only $860,000 a year. That sounds like a huge amount of money until you consider that the state will collect $242 million from the 1998 tobacco settlement and tobacco taxes. Do the math and you’ll see that $860,000 is less than half of 1 percent of the money the state receives. The tobacco companies spend $261.6 million a year to market their products in Alabama, according to the report. That’s 304 times when the state spends on prevention.

“A Broken Promise to Our Children: The 1998 State Tobacco Settlement 12 Years Later” is backed by some heavy hitters — the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association and the Robert Wood Johnson Foundation.

Alabama is not alone. Only 2 percent of the money states collect from the tobacco settlement and taxes will be spent on prevention programs. That’s a paltry $517.9 million out of $25.3 billion collected nationally.

Why are prevention programs important, especially in tight economic times? Each year in Alabama, tobacco claims 7,500 lives and costs the state $1.49 billion in health care bills. Nationally, more than 400,000 people die each year from tobacco-related diseases and the health care tab is $96 billion.

In Alabama, a little more than one in five high school students smoke — 20.8 percent compared to 19.6 percent nationally. Each year, some 10,700 young Alabamians become regular smokers.

I am confused. Currently in America, cigarette smoking is discouraged. It is vilified, regulated and even banned from many public places. At the same time, marijuana smoking is being viewed more favorably than ever. A recent Gallup poll found that 46 percent of Americans favor the legalizing of cannabis. Let me repeat, I am confused. One type of smoking — cigarette — is almost university frowned upon, while another type of puffing — marijuana — apparently is being embraced like never before.

It seems self-evident to me that the presence of smoke — any kind of smoke — in a person’s lungs is not helpful or healthy. I have two brothers who were career firefighters. At some point during their careers, each was hospitalized for smoke inhalation. It is clear that smoke + lungs = bad.

It took decades of education for a majority of Americans to grasp the reality that cigarette smoke is not healthy. And yet now, it seems that many believe that somehow marijuana smoke is going to be different. They naively believe that when it come to cannabis, smoke + lungs = good.

Those embracing marijuana are wrong. Not only is marijuana smoke unhealthy, it is worse, much worse than cigarettes.

The very least a cigarette smoker can expect to experience is a diminished lung capacity. The worst, however, is a variety of respiratory disorders and lung cancer. None of which are pleasant.

Second-hand cigarette smoke is also a health issue. People exposed to a smoker’s puffing are also put at a greater risk for lung-related problems. As already stated, smoke + lungs = bad.

Just like cigarette smokers, marijuana users expose themselves to diminished lung capacity as well as respiratory illnesses. The jury is still out as to whether or not lung cancer can be linked to the smoking of cannabis; however I will not be surprised when it is.

Unlike cigarettes, marijuana smokers experience intoxication. In slang terms it is referred to as “being stoned” or “getting high.” Whatever you call it, the user is impaired somewhat like a person who is drunk on alcohol.

As an experiment, two California journalists recently attempted to navigate a car over a closed road course after smoking marijuana. The pair conducted the test in light of the Golden State’s Proposition 19, an initiative on Tuesday’s ballot seeking to make recreational marijuana smoking legal in the state.

Peter Tilden, radio talk show host for a radio station in Los Angeles and Steve Lopez, columnist for the Los Angeles Times both smoked a small amount of marijuana and then attempted to drive a car. The California Highway Patrol provided oversight for the experiment.

According to reports, Tilden and Lopez did not fare very well. Tilden attempted to parallel park and thought he had done fine. However, he learned that he had parked six feet from the curb.

“The experiment showed how impaired I was on pot,” Tilden told reporters. He went on to explain that driving the course was made more difficult because of the marijuana and that he did not do any better on the driving portion than he did trying to park.

Lopez also struggled on the driving portion of the test and, according to reports, when he tried to change lanes he drove straight for a ditch.

Anyone that has ever smoked marijuana has experienced the intoxication that results. If fact, it is the main reason for inhaling the smoke. Marijuana produces a “high” that impairs a person in much the same way alcohol does. That, in turn, can impact the public’s safety.

Second-hand smoke is also an issue when it comes to marijuana. However, it is not only respiratory issues that are at stake. It is possible for a person to experience, to a lesser degree, some of the same intoxicating effects as the person smoking the marijuana.

Marijuana has some of the same health implications as tobacco cigarettes, with the added issue of intoxication. That said, cigarettes are viewed by most Americans as unhealthy. Marijuana, on the other hand, has never been more popular. I confess I am confused. After all, smoke + lungs = bad.