SECOND-HAND SMOKE AND THE ELDERLY
53,000 DEATHS ANNUALLY: A HEALTH & PUBLIC POLICY ISSUE

• Health Issues
• Public Policy Issues
• Smokefree Public Policies
• Michigan AG Sues Tobacco
• Smokefree Restaurant List
• Health Fair Boycott Gets Smokefree Shopping Mall
• 66 Year Old Stuns Tobacco Jury Awards Victim $750,000

HEALTH ISSUES

Environmental Tobacco Smoke (ETS) is a toxic substance responsible for 53,000 deaths annually in U.S. nonsmokers. ETS, or second-hand smoke, is now officially listed as a Group A carcinogen, which is a classification reserved for those compounds, like asbestos and benzene, which have been shown to cause cancer in humans.

Older Americans and children are especially affected by ETS. Of the 53,000 persons who die yearly from ETS, most are older persons who die from heart disease or cancer, including 3,000 to 5,000 due to lung cancer. As early as 1986, the Surgeon General reported that the effects of smoking on nonsmokers are as severe as the direct effects on smokers.

ETS consists of both smoke emitted by the burning tobacco in cigarettes, cigars and pipes, and smoke exhaled by smokers. ETS is a danger to nonsmokers because, in closed environments, they are forced to involuntarily inhale the smoke. While this "sidestream" smoke is more diluted than the "mainstream" smoke inhaled directly by smokers, it contains essentially the same cancer-causing and other toxic elements.

ETS is a particular concern for older persons, especially those with pre-existing heart or respiratory disease or disorders such as emphysema, asthma, allergies, or coronary artery disease. Exposure to ETS has been found to induce the onset of angina, arrhythmias, and the symptoms of bronchial asthma. In addition, ETS may cause nonsmokers to experience coughing, phlegm production, chest discomfort, and reduced lung function.

ETS is also an intergenerational health concern for older Americans because ETS is a great risk to children--grandchildren. ETS exposure increases the risk of lower respiratory tract infections such as bronchitis and pneumonia--causing an estimated 150,000 to 300,000 cases annually in infants and young children up to 18 months of age, with 7,500 to 15,000 of these babies being hospitalized.

Children--grandchildren--have significantly increased risks of middle ear infections, increased risks of reduced lung function, and increased frequency of asthmatic episodes and severity of symptoms due to ETS. Up to 1 million asthmatic children have their condition significantly worsened annually by ETS.

Tobacco has been called a "pediatric disease" because children are the targets of tobacco industry advertising, and childhood is when 90% of current smokers were addicted. However, tobacco/ETS is also a "geriatric disease" because that is when the disease and death caused by tobacco largely occurs.

PUBLIC POLICY ISSUES

Just as there is no mystery about how dangerous ETS is to nonsmokers, there is no mystery about how to prevent this danger--smokefree public places. Medical authorities have said for years that "tobacco is the most preventable disease in America." And, prevention for older persons is spelled, "Quit Smoking," and "Smokefree Public Places."

Today, increasing numbers of businesses are going smokefree to protect their workers health and to decrease the costs of employee health insurance by reducing illnesses caused by smoking and ETS. Most health care facilities--hospitals, nursing homes, adult day care facilities, etc.--are virtually smokefree, while many public places frequented by elders-- restaurants, malls, stores, libraries, civic centers and arenas, and theaters--are adopting smokefree policies.

This trend reflects the growing health concerns about tobacco use and ETS. However, public policy debates continue about how best to protect against the dangers of tobacco use and ETS. These debates often are inflamed by lobbyists for the tobacco industry. They usually work behind the scenes and attempt to frame the discussion in terms of "personal choice" versus "government control."

The Center for Social Gerontology (TCSG) believes that when one strips away the rhetoric and emotionalism from these debates, legitimate concerns exist about how to balance protecting the health of citizens from the hazards of ETS while protecting personal rights. In TCSG's opinion, the dangers of ETS to citizens' health, particularly elders' and children's health, are so well documented that ETS must be treated as a serious public health issue. As such, public policies are needed which protect the public from ETS, while retaining the right of those who smoke to do so in environments which do not threaten the health of other persons.

While few persons would suggest restricting an individual's right to smoke in his/her own home, this "right" becomes much less clear when shared living settings are involved, such as long-term care facilities, in which a number of older persons share common areas, e.g., dining areas and recreational rooms, and have private or semi-private rooms. Often, these issues have been resolved by requiring smokefree common areas while allowing resident's to smoke in their own rooms and arranging for smokers to share semi-private rooms.

Currently, other facilities serving the elderly, e.g., Senior Centers, meals sites, common areas in elderly housing facilities, etc. appear to have varying policies, with some being completely smokefree, some partially smokefree and others allowing smoking. Given the health hazards of ETS, this is an area that should receive much more scrutiny by the program staff and elders utilizing these programs.

In addition to facilities serving the elderly, older persons have a special interest in the smokefree policies of public places such as restaurants, malls, stores, theaters, civic centers and arenas, municipal buildings, bingo facilities, etc. The trend nationwide is for these facilities to adopt smokefree policies or allow smoking only in sections which are separately ventilated and separated by floor-to-ceiling barriers (walls, doors, etc.) from non-smoking areas.

Elders and aging organizations have a special interest in prodding businesses to adopt voluntary smokefree policies and in promoting the enactment of ordinances or regulations requiring smokefree public places. TCSG and the Tobacco-Free Michigan Action Coalition (TFMAC) are available to assist elders and aging organizations in this effort.

SMOKEFREE PUBLIC POLICIES

Across the nation, communities are adopting health regulations and ordinances which require smokefree public places, including malls, restaurants, stores, beauty parlors, bowling alleys, bingo establishments, workplaces, theaters, civic centers and arenas, municipal and state buildings, bars and other places open to the general public.

These laws usually require such public places to be smokefree or to have smoking areas separated completely from non-smoking areas, with separate ventilation systems, as well. As the cartoon in this Notes indicates, smoking areas that are not fully separated from non-smoking areas don't work; just as there is no such thing as the non-chlorinated end of the swimming pool.

MICHIGAN AG SUES TOBACCO

On August 21, 1996, Michigan Attorney General Frank Kelley filed suit against the major tobacco companies and wholesale tobacco distributors, seeking $14 billion in damages for medical costs incurred under the Medicaid program due to tobacco-related diseases suffered by persons on Medicaid, many of whom are older Michiganians.

SMOKEFREE RESTAURANT LIST

The Michigan Guide to Smokefree Restaurants lists over 1,400 restaurants throughout Michigan which are 100% smokefree. Free copies are available from the Health Promotion Hotline at 1-800-537-5666.

All Michigan restaurants which have more than 50 seats must reserve at least 50% of their seating for nonsmoking patrons--however those seats can be directly next to smoking areas, with no barriers separating smoking from nonsmoking, thereby, often, making the whole place smoke-filled.

Recently, the Shore Mall in Egg Harbor, N.J planned a health fair for senior adults--a common mall event. The result surprised everyone.

Atlantic Prevention Resources (APR), a local substance abuse prevention agency, publicly announced that APR would boycott the health fair because it had an agency policy of not participating in any health fairs in places that permit smoking, since tobacco is a major form of substance abuse. Upon seeing an article in the Atlantic City Press describing the boycott, the owners of Shore Mall decided to make the mall smokefree, phasing in the new policy over a one month period. Clearly, this was a policy that the mall owners felt made sense--they just needed a little push. It could also work elsewhere.

Many Michigan malls have already adopted 100% smokefree policies. With some urging, many more are likely to do so. Few malls now believe smokefree policies hurt business. Also, many malls encourage older persons to come "speed walk" in the morning before most of the stores open--elders could make a strong case that smoke fumes in the mall are not healthy, either during walking time or anytime.

Grady Carter, a 66 year old lung cancer victim who had smoked Lucky Strike and Tareyton cigarettes for 43 years, stunned the tobacco industry on August 9, 1996 when a Florida jury awarded he and his wife $750,000. This is the largest verdict ever returned against the $45 billion tobacco industry. It is also only the second such damage award ever against the tobacco industry--in the other, 57 year old lung cancer victim Rose Cipollone won a jury verdict, but it was overturned on appeal.

Brown & Williamson, the makers of the cigarettes Mr. Carter had smoked, had argued that Mr. Carter knew smoking was harmful, but then argued that the perils of smoking haven't been proved. Jury foreman Samuel Gaskins, a retiree himself, said: "To me, it boiled down to two words, crass hypocrisy. They can't have it both ways."