Travis County Commissioners Court
December 13, 2011 (Agenda)
Item 17
Speaking of a clear atmosphere, number 17 is to consider and take appropriate action and take appropriate action on proposed amendments to chapter 57, Travis County smoking policy of the Travis County code.
and we indicate here that this matter may be taken into executive session under the consultation with attorney exception.
anyway, our lawyers will be busy this afternoon.
good morning.
>> good morning.
>> good morning, judge, good morning, Commissioners.
dr. Harry dell, director of the Travis County wellness clinic.
we've been working with health and human services on the tobacco-free workplace policy.
and today I've been asked to discuss the health risk of tobacco.
hire with me is josie from the wellness clinic.
tanya who is the research assistant with the grant and (indiscernible) with the grant and don blankenship who is the director of hr.
so I would just like to discuss the health risks of tobacco.
one of the things is that tobacco smoke contains 7,000 chemicals and approximately 17 are known to cause cancer.
according to the surgeon general there is no safe exposure to tobacco smoke.
tobacco is the leading cause of premature deaths in the u.s.
and according to the cdc it causes approximately 1200 deaths a day and this accounts for one in every five deaths each year in the u.s.
in Travis County 11 people die each week because of tobacco.
a person who smokes dies 14 years earlier than a nonsmoker.
tobacco causes more deaths a year than hiv, illegal drug use, alcohol use, motor vehicle accidents and murders combined.
and you may have seen the advertisement on the television which puts that out dramatically: samakiing can actually -- smoking can actually damage the dna and it causes approximately 90% of all lung cancer deaths in males and 80% lung cancer deaths in females.
and it increases the risk of lung cancer 23 times in men and 13 times in women.
in addition to lung cancer, smoking causes other cancers as well that people may not be aware of.
a type of leukemia, bladder cancer, cancer of the cervix, kidney cancer, cancer of the voice box, cancer of the oral cavity, cancer of the pharynx.
stomach cancer.
cancer of the pancreas and uterine cancer.
more than two-thirds of cancer deaths are related to smoking.
the risk of heart disease increases two to four times.
smoking also causes narrowing of the arteries in the arms and legs and weakening and ballooning of the main artery in the body, the aorta, which can burst, resulting in death.
in fact, the united states preventive taskforce recommend that men over 65 who have ever smoked have an ultrasound test to detect this early so they can prevent death.
smoking damages the airways and the small air zachs in the lungs, causing emphysema, bronchitis and chronic airway object construction.
and smoking can cause death by object constructive airway disease.
women can have stillbirth, low birth weight and sudden infant death syndrome.
in postmen pause al women who smoke, they have a lower bone density and increased risk of hip fracture compared to women who have never smoked.
now, the other issue is secondhand or environmental tobacco smoke.
and secondhand smoke also contains 7,000 chemicals and approximately 70 of those can cause cancer.
and again, there is no safe level of exposure to secondhand smoke.
secondhand smoke causes 46,000 premature deaths from heart disease each year in the u.s.
among nonsmokers.
and nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25 to 30%.
even a brief secondhand smoke exposure can damage the lining of the blood vessels and cause inflammation and make the platelets more stickier and these changes can cause a deadly heart attack.
in fact, with cdc they have suggested that people who already have heart disease are at especially high risk of suffering adverse effects from breathing secondhand smoke and should take special precautions even with brief exposures.
nonsmokers exposed to secondhand smoke at home or work increase their risk of developing lung cancer by 20 to 30% and secondhand smoke causes an estimated 3,400 lung cancer deaths among u.s.
nonsmokers each year.
even a brief secondhand smoke exposure can damage the cells in ways that set the cancer process in motion: along with the high level of exposure to secondhand smoke, the greater the risk of develop lung cancer.
it increases the risk of sudden infant -- sudden unexplained death of an infant in the first year of life and it is the leading cause of death in otherwise healthy infants.
secondhand smoke also causes asthma and infections in children.
the workplace is a major source of secondhand smoke exposure for adults and the surgeon general has concluded that smoke-free workplace policies are the only effective way to eliminate secondhand smoke exposure in the workplace, separating smokers from nonsmokers, cleaning the air and ventilating buildings cannot eliminate exposure.
secondhand smoke exposure in the workplace has been linked to an increased risk of heart disease and lung cancer among nonsmokers.
and not only is there health costs to smoking, but there's also a financial burden.
the estimated annual smoking related productivity losses for smokers are $1,372 a year.
and the estimated annual smoking related health care costs for smoker is $2,016, total of $3,388 per year per smoker.
and if we estimate that there's approximately 4,426 employees and approximately 20.2% use tobacco, that gives us 894 employees.
and the estimated total cost per year for those 894 employees would be $3,028,872.
and smoking related health costs and loss productivity costs.
and this is a very conservative estimate because it doesn't include dependents or retirees.
the total annual cost of smoking in the county as a whole, Travis County, is over $460 million each year.
155.5 million a year in lost productivity and 305 million from health care costs.
so these are the main health effects of smoking.
>> let me ask a question and thank you for such a great overview.
and here in the statistics, as we've heard today, whether you're a smoker or nonsmoker, but being exposed to smoke itself, having some of the same effects especially with that intrusion of having or having an equal exposure rate, my question is this.
what -- if a person hearing these statistics today decided that, hey, this is bad news.
I don't want to smoke anymore, nor do I want to expose other people to -- around me to such a devastating state of circumstances by being exposed to smoke, if that person was to stop smoking today, what would be the outcome as far as the number of years that it would probably take for that person to kind of maybe regain some of the things that will be taken away from them if they continue to smoke?
in other words, there are some years maybe that a recovery stage can be set up -- in other words, if you stop smoking a process of healing may come underway.
what would that norm be as far as a person or is there any breakdown of I smoked for 15 years -- I quit.
how long would it take the body to rebound from those instances of where it was exposed to smoking for 15 years?
do you follow what I'm trying to get to?
>> absolutely.
so the different-- it takes different times for the body to heal for different conditions.
and some of the things like the excess risk of coronary heart disease is reduced to half of a smoker, if you stop smoking within one year the risk effects is reduced by half for coronary artery disease.
>> by half.
50%?
>> 50%.
so basically the excess risk of coronary heart disease is less than half of a smoker in one year.
so that's one of the risks that's reduced.
and for stroke the risk is reduced to -- your risk of stroke is reduced to a nonsmoker level any time between five and 15 years.
also the risk of lung cancer drops to 50% at 10 years.
>> okay.
thank you.
>> I have two or three questions.
first is I guess some major employers have a smoke-free policy.
and it's too much to ask for -- to expect employees just to come to work the day after the adoption of the policy and not smoke, right?
so do they designate areas that employees can go to to smoke?
>> when I worked at the methodist hospital we rolled out a tobacco-free campus policy.
and we did have a -- after the policy was in effect we did expect people to be tobacco-free while they were at work or when they were on the premises, whether they were employees or whether they were the public coming in to the facility.
however, we did have a good six months ahead of time where we were going through different exercises to get the public aware and also to have the employees aware.
and we had a number of employee support benefits like we do here at the county through the wellness clinic.
we have a number of employee support benefits to help them if they wish to quit their tobacco or reduce the tobacco.
I also would like to say that in the implementation of the formulary come January 1st, one of the benefits we're adding is we will be covering viban and chantix if they want to get a prescription for that through their regular health care provider.
previously did he within allow that.
they had to come to the wellness clinic to get that.
and that's not convenient for all the employees who are not working close to a clinic.
so we are adding that as a benefit come January 1st in order to help them support their initiative if they want to quit tobacco.
however, we're not asking people to give up tobacco.
we're just saying that in this public building where your co-workers have to come and where the public has to come to do their business, we're going to limit their exposure to tobacco.
>> so in that example there is no place provided to smoke on that employer's property.
>> that's correct.
and that was for the guests also coming in.
they were not allowed to smoke on the premises.
>> see, in this building, if you work in this building you typically go to the garage and smoke apparently.
when I compare the memo to the draft policy, the wording of the draft policy really connects to county owned buildings, whereas I think we intend more than that.
and mary etta in her legal analysis has a much broader area.
see, we say in all the public buildings owned, leased or maintained by Travis County, but we really have a much border definition, right?
>> right.
>> so thank the draft policy that we share with others really ought to indicate all of the areas that we plan to cover.
a good legal question for when we take this into executive session is how do we enforce such a policy.
now, do we -- if we adopt this, say, February 1, it would become effective when?
in your case it was six months, so a six-monthly way?
>> I think there's definitely room for education there within a certain time period that we're going to have a grace period to roll this out to make sure people are aware of it.
I think it's important, especially for the employees, to let them know what the policy is like we would any policy.
and then we definitely need to be planning on enforcing the policy.
it's my personal belief that management, when you take a role may management, part of your job is to enforce the policies the court enacts.
it's not up to us to be ugly about t I think we need to be compassionate to smokers because it's the world that's changing, not them.
I think a grace period to make sure people are aware of it and know what acceptable alternatives there are is a good idea.
certainly they can leave at lunch, leave the premises at lunch and smoke if that's what they choose to do, but to make sure they know what's expected of them.
and employees can do it.
this isn't anything new.
this happened in school districts on school property 20 years ago where it used to be smoking was just a-okay and then it became not okay on the premises.
so employees do understand that policies change, but we do need to be compassionate with them.
>> my question went really more to legal authority, marietta.
>> I do think that the committee that's been studying this should recommend an appropriate grace period.
now, the -- the facts you gave regarding secondhand smoke were provided by the center for disease control?
>> yes.
>> can we get that in a one or two pager?
>> yes.
>> I think employees, if we know you smoke, we ought to make sure you get a copy of it.
and if we don't know you smoke or not, get everybody one or email it to them, because the facts really are devastating.
if I didn't smoke, I certainly wouldn't start after hearing that's facts, but if I've been smoking 20 years or so it may be difficult to quit.
>> what are the statistics with regard to the comparative ease of cigarette smoking?
I've heard all kinds of startling probabilities.
>> it varies.
some individuals can just stop cold turkey and some individuals it takes a lot longer.
and it really depends where you are in the readiness to change.
there is a model of health behavior, stages of change.
if you are ready to change, then you're more likely to be successful.
and some are genetics and how easy it is to give up smoking.
>> do inconvenient circumstances increase the readiness to change?
>> absolutely.
>> we don't apply the policy to the jails.
is there a legal reason for that?
>> I believe they already have one.
the sheriff implemented a tobacco-free workplace.
because that's when we started seeing a lot of those employees wanting to quit smoking.
but yeah, they literally have to go, like, off the campus.
>> and we might want to check that first just for -- because I think if it's a residential facility there are some different obligations.
of course our employees would not be a residential facility.
>> well, this -- so where did this language come from?
>> what language?
>> rephrase your question?
>> I'm looking at the draft policy and the last couple of lines.
this prohibition shall not be effective in actual jail cells or holding areas used for the confinement of county jail inmates.
it may be to keep corrections officers on duty.
>> I think it's actually because they're residential areas.
>> anyway, the question would be where it came from.
second, why?
>> are you reading from the smoking policy that was adopted in 1986?
>> yeah, with the gray area there for the new language.
we would leave the -- the gray area, the new language was added.
the other language we just leave in place because it's part of the existing policy, right?
>> I don't think I have the document that you're looking at with the gray areas, new language.
>> 57.001, and this is subsection f.
so you can just see it later.
>> okay.
>> the gray area is new.
>>
>> [ inaudible ].
>> that's -- what I have is in color.
that's what was actually adopted in 1986 as the current policy.
>> so I shouldn't have this.
>> for reference that's the current policy.
and then you should have a draft for the new proposed policy.
>> so the multi-page document provided by legal --
>> the one that I sent you is the one -- the legal draft or proposals and questions.
there's a one page draft policy that is being proposed by the committee.
>> and the draft policy ought to be consistent with the legal document.
>> well, that's where there's some decisions to be made and some questions to be answered.
before we come up with -- the one page is the proposed policy.
the multi-page were comments from legal and proposed changes and questions to be answered.
>> okay.
and then that other one was the current policy that's on the books.
>>
>> okay.
>> the one page proposed, how was that distributed?
because I didn't end up with it?
>> that should be in your backup.
>> it was e-mailed.
I believe sherri fleming e-mailed it to everybody.
last Tuesday.
>> it didn't come through the regular -- I had the same issue.
it didn't come through the regular channels.
it was e-mailed on the sixth.
>> I thought what I had was what sherri sent me.
for backup.
>>
>> [inaudible - no mic].
and again, in terms of effective date, it's the will of the court to be able to put whatever effective date that y'all deem appropriate.
>> seems to me, though, that the county staff who have been working on this issue should recommend an appropriate time.
ultimately it's our authority whether to adopt that recommendation or to impose one of our own.
but it seems to me that imposing one of our own would be pretty close to absolutely arbitrary.
whereas y'all possess the necessary expertise to make a reasonable recommendation to us.
>> yes, they do.
>> but if you can't make a recommendation, we're bold enough to impose the date.
I don't know that -- at some point -- we did say a public hearing on this last week, right?
two or three weeks before the public hearing I think employees who are interested in ascertaining the new provisions should be handed a draft policy.
and that draft policy ought to include whatever legal principles we have to employ.
by law.
that's why the question of enforceability and what we can and cannot do are important.
okay?
anything else, committee members?
>> [one moment, please, for change in captioners]
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