State Tobacco Control Laws

The time for a new round of state tobacco control legislation, based on our understanding of third hand tobacco smoke, is now in the offing. But more easily, we need to build support at the city/county level.

More importantly, the business/profit level can bypass legislation in the four states (Michigan, Missouri, Kentucky, and Mississippi) in which Provision Living operates. In all four states, more restricted control measures at lower levels of government and business are not preempted by the state.

Although states regulate assisted living operations, historically, they have done less to regulate tobacco usage. Successful tobacco control legislation is created by small groups, companies, and cities clearing their air first, which then generate the votes needed at the state level to pass effective legislation.

[“The Missouri Comprehensive Tobacco Control 2016-2021 Strategic Plan” is a 12-page compilation of everything and everyone who can help create a bill that could be a model for any state. It is now 2018. State funding for 2018 is $48,500, plus Federal $2,200,000, or 3% of the $73,000,000 recommended by the CDC. Prior to this, three ineffective attempts failed (fortunately) with the help of tobacco companies’ ingenious deceptions. A 2014 Kentucky tobacco control program has also failed to have an assisted living component implemented.]

The old laws and the understanding they reflect are prior to our current knowledge about how quickly toxic tobacco smoke injures, kills, and addicts (seconds to minutes rather than decades); both users and those around them.

In general, anything that was, or was assigned as, residential was exempt from smoking restricts under the belief that only the smoker was at risk. Restrictions were later applied to protect workers and caregivers rather than the patients, residents or customers. [Protecting workers may protect residents.]

Assisted living residences are best defined by what they are not. Housing for the ill, infirm, and elderly evolved, by about 1980, into three sets of services: Short term, hospital care; and long term, nursing home care, that were heavily regulated and supported by insurance and public funding.

What was left became private pay assisted living. Development was different in each of the four states. The classification of serves is confusing.

The Missouri Residential Association (MRA) formed in 1982 even had to be renamed the Missouri Assisted Living Association (MALA) in 1997 so the association name and Missouri law could use the same term for the same set of services. Other states used a variety of names.

The climate in which third hand tobacco control laws will now be written will be more difficult at the state level than the city/county level. This is indicated by the low support these four states make to prevention and smoking cessation.

The American Lung Association has a “Sample Tobacco-free Workplace Policy” (2013) that updates “Smoke Free” areas to “Tobacco-free” properties. This does not satisfy the problem of nicotine addicted smokers working directly with memory care or other residents, patients, or customers (third hand tobacco smoke exposure).  I will update the policy in the next post.

Each state needs a comprehensive tobacco control law that includes the effects of third hand tobacco smoke. The law should include all classes of people wherever they live. Assisted living should no longer be excluded from full protection. Assisted living needs a voice in this process including votes at all levels of government. 

The Public Health Law Center found no mention of Mississippi laws (2012) protecting residents in assisted living residences or their equivalents.

References:

Missouri Comprehensive Tobacco Control 2016-2021 Strategic Plan https://health.mo.gov/living/wellness/tobacco/smokingandtobacco/pdf/strategicplan.pdf  (or copy and paste) Created but not implemented.

Tobacco-Free Assisted Living Resources (2016)  (January 2016)  http://www.publichealthlawcenter.org/resources/tobacco-free-assisted-living-resources-2016  “State and local tobacco control laws often exempt residential care settings, including assisted living, adult foster care, nursing homes and similar environments, where many of the most vulnerable members of society live and where a disproportionate number of residents (and staff) either use tobacco products or are exposed to secondhand smoke. This collection of resources presents the legal landscape of state regulations and provides the public health rationale for reducing tobacco use and secondhand smoke exposure in assisted living and similar residential care settings.”

U.S. Assisted Living Residence Smoke-free Regulations: A 50-State Review.  (January 2016) http://www.publichealthlawcenter.org/sites/default/files/tclc-guide-ALR-50-state-review-2016.pdf  (or copy and paste) An annotated directory to state smoke-free regulations specific to assisted living residences.

Frequently Asked Questions  May 2016 http://www.publichealthlawcenter.org/sites/default/files/resources/tclc-fs-assisted-living-tobacco-free-FAQ-2016.pdf   Definitions and funding. “Although eleven states include assisted living residences (or adult foster care equivalents) in their smoke-free laws, all but three of them (Massachusetts, Michigan and Montana) allow smoking in designated areas of these residences.

Our Initiatives >Tobacco >Smokefree Environment www.lung.org includes (1) Smokefree Policies in Multi-Unit Housing, (2) Expanding Smokefree Communities, and (3) Workplace Wellness. These all apply to assisted living and memory care.

Support and Community > Corporate Wellness www.lung.org includes an “Improve Indoor Air Quality Tobacco-free” policy that can be edited for Third Hand Smoke Free in memory care.

State of Tobacco Control    www.lung.org/sotc   (January 24, 2018) An annual report on how the process of shutting down the marketing and sales of tobacco products is progressing without creating an extensive bootlegging operation.

SLATI (State Legislated Actions on Tobacco issues) www.lungusa2.org  (2018) A detailed, annotated, easy to use, copy of state tobacco control laws.

Historical Evolution of Assisted Living in the United States, 1979 to the Present  Keren Brown Wilson, PhD The Gerontologist, Volume 47, Issue suppl_1, 1 December 2007, Pages 8-22, https://doi.org/10.1093/geront/47.Supplement_1.8

tobacco.org    www.tobacco.org/tagged/real-estate  The latest news on tobacco control and banning smoking.

Missouri Statewide Comprehensive Tobacco Control Law

Missouri Statewide Comprehensive Tobacco Control Law

19 May 2018

The State of Missouri can now write a final comprehensive statewide tobacco control law. It needs to; or lose millions of dollars. Toxic tobacco smoke is no longer needed to manage nicotine levels. (See references below.)

Toxic tobacco smoke is the leading cause of preventable illness and early death. There is no safe level of tobacco smoke exposure. Nicotine addiction is of such a public health concern that smoking cessation is now free to every smoker.

Individuals at both ends of their life span (newborn, and the ill and infirm) are extra sensitive to toxic tobacco smoke to the extent that it can result in sudden death. Between these two extremes all individuals suffer from the aggravation of a large number of illnesses that can shorten a life by as much as 10 years.

The response time to tobacco smoke exposure is no longer 20-30 years (cancer). It is now known to be as short as 3 minutes (stroke and heart attack); 3 seconds to restrict blood flow and to irritate cell membranes (oxidative stress).

No one living in multi-unit housing (of any kind; memory care, assisted living, independent living, residential housing, condominium, nursing home, etc.) should be subjected to second hand tobacco smoke drifting into their living space; or third hand tobacco smoke carried into their living space on hair, cloths or bodies of caregivers and guests.

Any tobacco free property (combined with the use of nicotine replacements, when on duty), can satisfy the requirement of being free of all tobacco smoke exposure. Having no smokers guarantees clean air.

Low paying, high turnover rate, occupations need active smoking cessation programs in place when nicotine-addicted individuals (smokers who cannot resist adjusting their nicotine levels) are hired. Smokers who are that ill (addicted) must be restricted from working closely with patients, residents and customers.

Missouri needs a law that clears the air where uninformed addicted individuals and corporations fail to use free tools to promote smoking cessation. We need everyone to be aware of successful long term smoking cessation programs.

Educate everyone, restrict tobacco usage, and tax to reduce the known harm from tobacco smoke exposure. Vote YES. Half of any new tobacco tax money must be mandated to support prevention and cessation of smoking or vote NO.

Richard A. Hart, PhD.   www.residentialcarefortwo.blogspot.com     rahart1@outlook.com

Annotated References:

The Internet is loaded with exaggerated, dated, and intentionally misleading information. The same source may post opposing views at different times: consider the use of nicotine lozenges and vaping.

The strict separation of smoking and nicotine lozenges has evolved into using a lozenge to avoid smoking in restricted areas. Vaping has gone from ritualistic clouds of theater smoke (falsely labeled water vapor) to cloudless devices that resemble computer thumb drives leaving the CDC and FDA confused as to how to regulate the devices: smoking cessation and/or nicotine addicting.

Most of the information needed for tobacco smoke exposure control is provided by the best authorities, at the time, based on a review of numerous publications and a consensus with other authorities. They do no always agree: research, medical, marketing, and cult need to be identified and dated. 

           American Lung Association   www.lung.org   

This is a massive website with something for everyone. I have picked out what I found most useful and how to find it again.

Freedom From Smoking^® Self-Help Guide  Self-guided workbook including key activities in an easy-to-follow format. Call 1-800-LUNGUSA to get a copy.

Facilitator Training   Become certified to lead a Freedom From Smoking group clinic and to conduct an in-house smoking cessation program as a part of new-hire training. Eight hours. $350. Clayton, MO, 7745 Carondelet Avenue, Suite 305    314-449-9145

Our Initiatives >Tobacco >Smokefree Environment includes (1) Smokefree Policies in Multi-Unit Housing, (2) Expanding Smokefree Communities, and (3) Workplace Wellness. These all apply to assisted living and memory care.

Our Initiatives > Support and Community > Corporate Wellness that includes an Improve Indoor Air Quality Tobacco-free policy that can be edited for Third Hand Smokefree in memory care.

State of Tobacco Control    www.lung.org/sotc   (January 24, 2018) An annual report on how the process of shutting down the marketing and sales of tobacco products is progressing without creating an extensive bootlegging operation.

SLATI (State Legislated Actions on Tobacco Issues) www.lungusa2.org  (2018) A detailed, annotated, easy to use, copy of state tobacco control laws.

Existentialism and Memory Care

This course by Jack Kultgen (Osher 1) has given me a new framework in which to think about death; the topic for the last of the eight meetings, this week. Death is always close in memory care (two living in adjoining apartments passed last week).

It is our concern for others while we are alive that matters. We will no longer be conscious after our own death; unless we build a framework in another dimension.

Existentialism starts with no external framework beyond one’s own existence.  We are only conscious of what we experience. Humans, dogs and cats seem programmed to seek new experiences, as extroverts and introverts (Osher 2).

Last year I ran onto “The Origin of Consciousness in the Break Down of the Bicameral Mind” by Julian Jaynes” (Book 4). This provides an evolutionary explanation for the development of consciousness, hypnosis and religion; in many ways around the world, at about the same time.

Some 20 years later Marcel Kuijsten, a rabbi, published “Gods, Voices and the Bicameral Mind, the Theories of Julian Jaynes” (Book 5) which supports the origins of God voices, and also hypnosis, as a natural development of the human mind we have today“.

In old Testament times, it is theorized, the left brain perceived messages from the right brain as voices from God. Commands were carried out without question. This worked until living groups, small cities, became too large; and little was known about how the dynamic continuing creation works as we do today.

Having now dismissed the two above books totaling 803 pages in three short paragraphs, I will try now to do the same for Margaret and me in memory care.

Death was once a natural event. It happened. Life was a time to enjoy, one day at a time. Memory care can extent life several years with a remarkable ability to maintain near normal consciousness to within hours to a few days of passing. However expected, death always seems to be a surprise to everyone.

Some 3,000 years of religious developments have created a variety of after-lives not shared with milkweeds and Monarch butterflies. Most of the great religions seem to have descended from the voices of the Gods often experienced in dreams and visions. This can be replaced by guided meditation, self-hypnosis, today.

Maggie will live and die as a Baptist, with Jesus Christ as Savior of her soul. This belief has served her, and her generation, well during her lifetime, and after she passes.

All of the great religions are interested in saving souls; but in their unique and combative way. This view is changing. Not saving souls from Hell and the Devil but saving mankind by saving the earth for the living, is now in.

The old Christen denominations that sing hymens are being replaced with community mega-churches that sing praises. Be thankful for having been given a life.

When you pass, your body dies like a milkweed or a Monarch butterfly. We are all part of the same miraculous creation. Celebrating the life lived, is in; grieving the death, is out.

Develop and use your God given talents for the betterment of everyone. Our calling now is to continue the creation at a higher level of consciousness, or pay the price of blind evolution: extinction. Save the earth.

This view of life causes our two years in Hawaii to haunt me. To control overpopulation, some years ago, each newborn that could sleep overnight without feeding was taken to a temple ground on a cliff over the ocean. If the baby was still there in the morning, all was well. If the baby was gone it was either in the ocean or selected for the royal family to raise. The mother would never know.

The great religions promote peace, charity, and love. The USA constitution promotes peace, prosperity, and the pursuit of happiness (create wealth as well as share wealth). [Earning wealth is more dependable, and acceptable, than finding wealth.]

Humans are the product of a violent turbulent past (geographically, biologically, and socially) that has left, remnants of each level of development, access to the most advanced level, for good and evil. Quit violating other people with your tobacco smoke, for example.

Education or extermination, modified by effective communication (and miscommunication), will drive the future of what we now call mankind: savage, civilized, robot, warm chip implant, cold solid state being.

Dreams of the future, as dreams in the past, help make sense of what we are doing now for individuals, beliefs, and nations. We must dream it to achieve it, or as a non-existentialist, just act or follow and not think about consequences (Osher 2).

Do what can be done, and persist until the times are right for success (Osher 3).

References:

Osher Lifelong Learning Institute at the University of Missouri, Spring 2018.

Osher 1: John Kultgen, Life Choices from Existential Perspectives: Kierkegaard and Sartre.

Osher 2: Cindy Claycomb, Understanding Behavior and Change Through Trans-State Induction Theory. [grounded in existentialism]

Osher 3: Michael Connelly, Before and After "How a Bill Becomes a Law:" The "How, What, Why and Why Not?" for Regular People.

Book 4: Julian Jaynes, 1976 & 1990. The Origin of Consciousness in the Break Down of the Bicameral Mind, 491 pages. ISBN: 0-618-05707-2  My posts: 
https://residentialcarefortwo.blogspot.com/2017/11/the-cost-in-lives-of-learning-to-use.html introspective minds. [Larry Brown, Faith in the Face of Tyranny. Osher Fall 2017]
https://residentialcarefortwo.blogspot.com/2017/10/who-we-are.html
https://residentialcarefortwo.blogspot.com/2017/06/mythos-and-logos.html

Book 5: Marcel Kuijsten, 2016. Gods, Voices and the Bicameral Mind: The Theories of Julian Jaynes, 312 pages. ISBN: 978-0-9790744-3-1  LCCN: 2016904044  My post: https://residentialcarefortwo.blogspot.com/2017/12/words-from-god-and-man.html