Smoke-Free Illinois - Capstone Project Example

Smoke Free Illinois Introduction The affects of smoke have long been an object of study, debate, and policymaking in the United States and other countries. Different no-smoking laws and policies have been implemented, and countless studies have been undertaken to scientifically document the medical risks and negative environmental and pollution consequences of smoking. On particular aspect of this rather broad subject is the issue of second hand smoke, or the negative consequences smoke can have on non-smokers who nevertheless breathe in smoke through the air. Numerous states and regions have been addressing this issue and developing policies to protect non-smokers from the negative impact of smoke. This capstone seeks to define the problem of secondhand smoke in terms of health effects, mortality rate, and the ineffectiveness of various solutions; provide a focus-point analysis using Illinois and the Smoke Free Illinois Act to illustrate a possibly more effective solution to the problem and evaluate its success; and finally, present various conclusions and ramifications based on the current study about the remaining difficulties and possible future outcomes. 2. Defining the Problem Different sources provide various definitions for “secondhand smoke,” all more or less the same in essence, varying only in wording. Considering that this capstone will deal primarily with the Smoke Free Illinois Act, it will mainly used the definition offered by the Illinois Department of Public Health, which states: “Secondhand smoke is a mixture of the smoke given off by the burning end of tobacco products and the smoke exhaled from the lungs by smokers that contains a complex mixture of chemicals, many of which are known to cause cancer” (Illinois Department of Public Health). An additional definition that gives a few more specific details pertaining to the source and chemical reality of secondhand smoke, as propagated by the Ontario Campaign for Action on Tobacco (OCAT), states that “Second-hand smoke contains over 4000 chemicals and is a mix of mainstream smoke exhaled by smokers and sidestream smoke emitted from the tips of burning cigarettes” (OCAT). Often, secondhand smoke is also called environmental tobacco smoke (ETS). Secondhand smoke is seen as a hazard and problem requiring attention because of its negative effects on health. For decades, medical research and laws focused on the negative effects smoking has on the health and lungs of the person smoking. While this still holds true, attention in recent decades has turned to the fact that smoking has a negative health effect on everyone exposed to the toxins and chemicals emitted into the air by the smoke. This implies that even nonsmokers are harmed by the smoke, now called secondhand smoke, since it has not been smoked directly, but is received through the air. Anyone who breathes air that has secondhand smoke (carcinogens and other chemicals), is exposed to smoke and therefore at risk of the same health problems as the smokers themselves. This “involuntary smoking” involves the consumption over more than one hundred chemicals that can pose a threat to health (cf. OCAT). Reports show that while nonsmokers breathe in less smoke from secondhand smoke than smokers themselves, there is little difference in the medical outcome. Heart, lung, and other health problems are just as likely. According to OCAT, secondhand smoke causes “heart disease, lung cancer, nasal sinus cancer, sudden infant death syndrome (SIDS), asthma and middle ear infections in children and various other respiratory illnesses” and is “causally associated with stroke, low birthweight, spontaneous abortion, negative effects on the development of cognition and behavior, exacerbation of cystic fibrosis and cervical cancer” (OCAT). The U.S. Department of Health and Human Services reports that nonsmokers who are exposed to secondhand smoke have a 25-30% increased chance of heart disease and a 20-30% increased chance of lung cancer (cf. U.S Department of Health and Human Services). While the health conditions mentioned in this paragraph are not necessarily linked to secondhand smoke, and can happen for unrelated causes, the proven link between secondhand smoke and these health issues makes society responsible for protecting the public from exposure to such toxins, thereby decreasing or eliminating the presence of these health conditions resulting from smoke. Children are at even greater risks than adults when exposed to secondhand smoke. This is largely due to the high speed at which children breathe. In any given amount of time, a child will inhale more than twice and up to three times the amount of smoke as an adult and, as a result, suffer from higher levels of toxins. According to Terry Martin’s article, Secondhand Smoke and Children, in-uterus exposure to secondhand smoke can lead to underweight babies, and increases risk of learning disabilities and other disorders including cerebral palsy and SIDS mortality. Between two hundred thousand and one million children have asthma caused or worsened by exposure. Secondhand smoke also causes around 300,000 cases of bronchitis and pneumonia each year, middle ear infections, and levels of cotanine in blood (cf. Martin, Terry). The Mayo Clinic, an organization internationally known and recommended for its medical practice and research, has confirmed the health risks that secondhand smoke causes for both children and adults (cf. Mayo Clinic). The health risks posed by secondhand smoke are confirmed and proven by the number of deaths related to such exposure. The most recent data provided by the Illinois Department of Health shows that 65,000 people die each year in the United States from exposure to secondhand smoke. This statistic only deals with non-smokers who die from exposure to smoke; it does not take into account the number that die from smoking themselves. In the state of Illinois, the yearly toll of non-smokers who die from exposure to secondhand smoke is 2,900 (cf. Illinios Department of Public Health). The common phrase “secondhand smoke kills” is not just an idiom; it can and should be taken literally as well, based on the real effect exposure to smoke has on mortality. Some of the simplest and most basic solutions that have been implemented for decades to decrease exposure to smoke include designating smoking areas, no-smoking areas in public places, air purifiers, and air ventilation systems. While these actions might clean the air of some things, studies have consistently shown that they do not provide adequate protection from secondhand smoke. In fact, the U.S Department of Health and Human Services has gone as far as saying that there is NO RISK FREE LEVEL OF EXPOSURE (cf. U.S Department of Health and Human Services). Therefore, reducing the public smoking area, or employing various filters do not eliminate the health risks posed by exposure to secondhand smoke. Only zero exposure to secondhand smoke can eliminate these risks. While smoke in all areas leads to the same health conditions, and nonsmokers anywhere can be exposed to secondhand smoke, the greatest impact is usually seen in restaurant, bar, and hospitality environments (cf. American Lung Association): places with the smokiest atmospheres. A study providing information about a casino in Illinois illustrates this reality. The Rosewell Park Cancer Institute issued a “Casino Air Monitoring Study” in East St. Louis Illinois, September 2007. The study showed the following results: 1. The average level of fine particle indoor pollution on the gaming floor was 172μg/m3, 16 times higher than outdoor background levels. 2. Employees and patrons of this casino are exposed to “very unhealthy” levels of fine particle air pollution exposure according to the U.S. Environmental Protection Agency (EPA) Air Quality Index. 3. Employees and patrons will exceed USEPA 24-hour standards for PM2.5 exposure after 3 hours and 28 minutes on the gaming floor. (Travers, Mark J., 2007) As a result of this high concentration of pollution and toxin exposure, employees and nonsmokers regularly in a casino, restaurant and bar environment suffer from the greatest health risks of secondhand smoke. 3. The Smoke Free Illinois Act In an effort to respond to the health risks posed by exposure to secondhand smoke, Illinois, following twenty-two other states, implemented a policy against secondhand smoke. The Smoke Free Illinois Act went into effect January 1, 2008. This Act was not a sudden innovation; it followed a series of policies against smoking that were enacted beginning in 2006. These policies all aimed at lessening the health threats of exposure to secondhand smoke. The more radical Smoke Free Illinois Act followed due to the incomplete success of previous measures. The American Lung Associate provides a brief overview of the legislation that led to the Smoke Free Illinois act of 2009. Clean indoor air policies took effective January 1, 2006, as part of a nationwide “trend.” During the same year, the state of Illinois passed thirty-six laws against smoking, the greatest number any state has passed in the duration of a year. The working legislation that would become the Smoke Free Illinois Act was first introduced by Senator John J. Cullerton in 2007. (cf American Lung Association). The Smoke Free Illinois Act, which went into effect January 1, 2008, begins by providing the General Assembly’s findings regarding the existence and dangers of exposure to secondhand smoke. The Assembly addressed the presence of carcinogen, the mortality level due to smoke, and other medical consequences, which are coherent with the ones presented in the first section of this capstone. The Assembly furthermore affirmed the impossibility of risk-free exposure to secondhand smoke, and the failure of ventilations systems to provide protection, also mentioned above in reference to the U.S. Department of Health and Human Services. This section of the act concludes saying that the only way to eliminate the health risks of indoor exposure is to completely eliminate indoor smoking (cf. Smoke Free Illinois Act). Following this establishment of the need to ban indoor smoking, the act proceeds to define various terms pertaining to smoking and the ban thereof that are used in the act. Words like “bar,” “employee,” “enclosed area,” “gaming facility,” “public place,” and “smoking,” among many others, are defined. The primary ban is found in section fifteen of the Smoke Free Illinois Act, and reads as follows: Smoking in public places, places of employment, and governmental vehicles prohibited. No person shall smoke in a public place or in any place of employment or within 15 feet of any entrance to a public place or place of employment. No person may smoke in any vehicle owned, leased, or operated by the State or a political subdivision of the State. Smoking is prohibited in indoor public places and workplaces unless specifically exempted by Section 35 of this Act. (Smoke Free Illinois Act) The act continues to address mechanisms of implementation, such as posting signs and removing ashtrays, specifies further no smoking areas, such as dormitories, and defines the exemptions provided for, including private residences (with a few exceptions), retail tobacco stores, private hotel rooms and private or “semi-private” rooms in nursing homes. The Act also puts forth a provision enabling employers, owners, or other people in control of a public area to designate even non-enclosed areas as no smoking (cf Smoke Free Illinois Act, Section 30). Section forty of the Act sets for the consequences – levels of fines – of violations. The remaining sections of the Act deal with further details regarding the application and implementation of the indoor public smoking ban. 4. An Analysis: Success Level of the Smoke Free Act A poll was administered six months following the implementation of the Smoke Free Illinois Act, to determine the success of the ban based on statewide public opinion. According to a public press release following the survey, “Illinois voters overwhelmingly support the law making public places smoke-free by prohibiting smoking inside all workplaces, including restaurants, bars, and casinos. The poll also finds that voters would reject attempts to exempt casinos from the new law” (Gitlin, Naomi). The survey itself asked questions about the general direction taken in Illinois, and then focused specifically on the smoke-free law and the positive or negative impact it had in daily life and activities. The poll results themselves show 73% in favor of the law, with 25% opposing and 3% remaining indifferent; 84% consider a smoke free workplace environment to be very important, with 15% considering it not important and 1% indifferent. The poll also reported 68% as saying that their experience in restaurants and bars had been more enjoyable since the ban went into effect; 12% found it less enjoyable. These statistics and other related responses were published as the results of Greenberg Quinlan Rosner Research (cf. Greenberg Quinlan Rosner Research). While the poll demonstrated popular support and improvement, it does not provide medical or environmental evidence of the ban’s success. Little statistical data regarding the impact the law has had in Illinois as far as lowering the mortality level based on smoke exposure or decreasing health risks has been released, due to the short period of time that has passed since the act went into effect. A period of five years or more is usually used to determine a change in statistical trends, including health tendencies and death rates. Considering, however, that Illinois was the twenty-third state in implement such a ban, it is reasonable to assume that the medical and environmental effect in Illinois will be similar to the changes noted in other states with the same policies. A study using Pueblo, Colorado as an example, showed the number of people hospitalized for heart attacks during the year and a half preceding the smoking ban, and contrasted it with the number afterwards. According to the CNN report on that study, three years after the ban went into effect, the study showed a 41% decline in the number of people hospitalized for heart attacks after the ban (cf. CNN Health.com). An Atlanta study reported by the Associated Press shows that bans such as the one just implemented in Illinois have had a strong impact on the smoking environment since the 1990s, bringing the number of adult smokers to under 20% (cf. Associated Press). The study shows that the number of nonsmokers with nicotine in their blood has dropped from 84% in the 1990s to 46% in 2004. The study also shows that the decline in exposure to secondhand smoke is higher in white Americans and Mexican Americans than it is in black Americans. The decline has also been higher in adults than in children. Thomas Glynn from the American Cancer Society and CDC representatives explain that the exposure is still higher for children because the smoking ban does not apply to private homes, cars, etc., which is where children may be most exposed to secondhand smoke from their parents (cf. Associated Press). From the economic perspective, many business owners of restaurant, bars, and casinos balked at the idea of the ban, and have continued to fight it on the basis that it is bad for their business. If they run public places that deliberately appeal to people’s desire to smoke, and are no longer able to let their customers smoke, how many customers will they have? In spite of the complaints and worries from this group of stakeholders, actual economic data supports the smoking ban. According the a local Illinois health department – Lake County Health Department – the sales tax revenue in state of Illinois and in Lake County have increased, not only from 1.3% to 2.6% in all tax revenue, but also from 5.2% to 6.7% in revenue from eating and drinking alone (cf. Gazebo News). This shows that while some individual owners may have suffered from the smoking ban, the industry as a whole has not. This shows that while there has been improvement, there is still much to be desired. The level of exposure to smoke still has a negative effect on nonsmokers. Furthermore, this effect is affecting children most of all, who are most susceptible to health problems resulting from exposure to smoke because of their rate of breathing. While the Smoke Free Illinois Act, and similar measures in other states are helping, they cannot eliminate the environment and health consequences of secondhand smoke. 5. Conclusions It can be expected that over the next few years, area specific studies in Illinois will show the same health improvement trends as the Atlanta and Colorado studies. This will mean a decrease in the number of patients who are ill, particularly with heart and lung diseases, due to secondhand smoke exposure. It will also drastically reduce the amount of air pollution and toxin particles in casinos, restaurants, bars, and other previously smoke filled environments, and will not have a remarkably negative impact on the economy or industry field. The support and positive responses to this decision have far outweighed the negative, apprehensive, or fearful ones. Furthermore, the benefit of improved health, as already seen in the drastically reduced number of patients with heart attacks due to smoke exposure in Colorado, outweighs the inconvenience of the no smoking rule in bars, casinos, and other similar environments. The desire to smoke in such atmospheres is a matter of pleasure; the ban is a matter of health. One fundamental problem remains. In spite of the decreased exposure to secondhand smoke brought about by the Smoke Free Illinois Act, exposure continues. As far as health is concerned, this exposure continues to affect a large number of nonsmokers as well as smokers, and is particularly hazardous for children. In terms of the environment, pollution continues as long as there is still smoke. A ban on smoking in indoor public places is not sufficient to eliminate the health risks. In fact, as the U.S. Department of Health and Human Services has already established that there is no risk free level of exposure (cf. U.S. Department of Health and Human Services), the only solution that will eliminate the health risks and environmental threat of pollution is an environment with absolutely no exposure, implying a complete ban on smoking in all areas, public and private, indoors and outdoors. While less of the population considers the danger of outdoor smoking in addition to indoor smoking, it still poses a threat, and must therefore be addressed if a state or society has a risk free environment as its goal. Even outside, where there is more air and atmosphere to absorb the smoke, the fumes, toxins and chemicals enter the air. They rise to a certain height, but then, due to the forces of wind and gravity, settle again in the lower levels of the atmosphere, thus becoming pollution and saturating the air. The most obvious result is the pollution of the air in and around outdoor smoking areas. The actual affects, however, go further as spread by wind, fog and other forms of precipitation. One way to help lessen the smoke is to provide more support and means for people to stop smoking. Programs that help people overcome what may have become an addiction to smoke should be more widespread and encouraged to reduce the number of voluntary smokers and, as a result, the amount of secondhand smoke. Massive health awareness campaigns and training should also be implemented to ensure that all smokers have been properly educated regarding the health hazards smoking brings to them and others. In all likelihood, however, a more fundamental question must be solved before a further solution can be implemented. There are two clear sides to the debate regarding smoking. Smokers consider smoking to be a personal action, and therefore a personal choice. It can be seen as being inherently linked to their personal freedom. Just as each person is free to choose what he/she eats and drinks, and where he/she walks, so each person should be able to choose for themselves whether or not they will smoke. The number of smokers in the United States has significantly decreased in recent decades following the release of medical studies showing the clear relationship between smoking and poor health. This implies that the individuals who continue smoking in spite of the threat it poses for their own health, do not see health as a sufficient reason to stop smoking. If their own health is not a good enough reason, how many of them consider the health of others to be a reason? The fact discussed earlier that children are at greatest risk due to continued exposure at home and in cars shows that many parents do not see even the good health of their children to be a sufficient reason to stop smoking. It is quite possible that such individuals do not take the medical studies and link between secondhand smoke and health problems seriously. In either case, an argument based on health has not presently caused them to stop smoking, and is unlikely to in the future. Smoking is seen as a personal choice and a right. At the same time, the affects of smoke do not just affect the smokers themselves; they also affect nonsmokers. The nonsmokers, for their part, could consider it their right for their health to be protected, as part of the right to quality of life. Why should a nonsmoker suffer and possibly die as a result of exposure to secondhand smoke when they aren’t smoking and don’t want to be exposed to it? What is more important: public health and the protection of the health of nonsmokers, or the freedom of each individual to choose whether or not to smoke? Both considerations are valid. As a result of this dilemma, some foundational principles must be defined before further action can be effectively taken. If smoking is to be banned completely, the action must be publically defined and grouped with other illegal practices, such as drugs and crime, on the basis of injustice or physical, mental, and/or psychological harm. For this to happen, the severity of the influence smoking has on one’s personal health and the health of others must be great. If this is the case, smoking should be clearly illegal, not based on where it is done, but simply based on the fact that it is done, because no matter where it happens, it will have a negative effect on one’s own health, the health of those around them, and the environment. Such a step must be accompanied with due consequences for violators, and a realistic plan of implementation that can be carried out and followed up on. If, on the other hand, smoking is determined to fall within the freedom, or right to liberty of every person, it cannot be completely banned. This option implies that there will always be some exposure, health and environmental consequences of smoke. If this is the case, the focus must be on keeping exposure to a minimum, while accepting that no solution will produce perfect elimination. Considering that the main injustice of poor health due to secondhand smoke it project on the nonsmokers who suffer for it, the focus should be on establishing rules and regulations that best protect the nonsmokers, and especially children. Such laws might, for example, designate certain places set apart for smoking purposes and require smokers to restrict their habit to those locations and refrain from smoking even in their homes to protect the safety of their children. Regardless of the final result, any future policy toward a complete ban on smoking or toward keeping the standard as it is must be thoroughly researched and study due to the serious implications in both directions. If smokers are to be asked to give up their freedom or right to smoke, it must be thoroughly established that the health risks involved are severe enough and widespread enough to merit such abolition. If, on the other hand, nonsmokers are to continue suffering from air pollution and health issues against their own will, as a result of the actions of others, the importance and value of smoking as a personal right that holds equal weight to public health must be explained and justified. Works Cited American Lung Association. Smoke Free Illinois Act. Web. 6 Mar. 2010. Associated Press. Public Bans Credited for Decline in Secondhand Smoke, CDC Study Finds. 10 July, 2008. Web. 10 Mar. 2010. CNN Health.com. Study: Smoke Free Laws May Cut Heart Attack Hospitalizations. 1 Jan 2009. Web. 8 Mar. 2010. Gazebo News. Clearing the Air on Smoking Ban. 26 Dec. 2008. Web. 10 Mar. 2010. Gitlin, Naomi. New Survey: 73 percent of Illinois voters support smoke-free law. 26 June 2008. Web. 10 Mar. 2010. Greenberg Quinlan Rosner Research. Survey of Illinois Voters Frequency Questionnaire. 1 June 2008. Web. 10 Mar. 2010. Illinois Department of Public Health. Smoke Free Illinois. 2008. Web. 6 Mar. 2010 Martin, Terry. About.com: Secondhand Smoke and Children. June 30, 2008. Web. 10 Mar. 2010. Mayo Clinic. Secondhand Smoke: Avoid Dangers in the Air. 2009. Web. 10 Mar. 2010. OCAT (Ontario Campaign for Action on Tobacco). Second-Hand Smoke. 2003. Web. 8 Mar. 2010. Smoke Free Illinois Act. 2008. Web. 6 Mar. 2010. Smoke Free Illinois. Survey of Illinois Voters. 2008. Web. 6 Mar. 2010. Travers, Mark J. Roswell Park Cancer Institute. Casino Air Monitoring Study East St. Louis, Illinois. Sep 2007. Web. 10 Mar. 2010. U.S. Department of Health and Human Services. News Release: New Surgeon General’s Report Focuses on the Effects of Second Hand Smoking. 27 June 2006. Web. 8 Mar. 2010. Read More