Wednesday, January 17, 2018

Cultural Smoker Rescue

I need a webpage to hold easy to find information for this blog. The following draft pages have been prepared. Your comments will be appreciated. I now have something worthwhile to do in winter when I cannot work out on the Monarch Butterfly Sanctuary.
1.    New Website.
2.    Tobacco Free Pledge
3.    Definitions
4.    Together We Can
5.    Terminology
Two years at Provision Living at Columbia show a need to rescue smokers and residents from tobacco smoke. Nicotine addiction is not a private matter using cigarettes.
Cultural norms over the past 50 years have changed from ancient customs of ceremonial use to a society becoming fully aware of the health consequences of cigarettes designed for maximum addiction that thus yield maximum profit.
The new norm is no exposure. Instant elimination of exposure is now legally available from nicotine sources other than smoke.
The long term approach is culturally imbedded. It took 30 years for hospitals to discover they were health care facilities. And longer for airlines to be smoke free because it was more profitable. And 50 years for MU Health Care to be smoker free.
The general public is now smoking less, but 75% of smokers still want to quit. Many do all by themselves. A pack-a-day smoker can save the equivalent of a $1/hr raise. But most smokers need a close knit support group: church, club, job site.
I think the following homework allows me to make a valid comparison between tobacco free (if it exists) residential care in San Antonio and a plan to develop such here if we remain in Columbia.
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1. New Website            13Jan18
Three years ago I started www.residentialcarefortwo.blogspot to record our search for a place for my wife and me. We have now lived for two years in Provision Living at Columbia, MO, in assisted living and in memory care.
Our family situation has changed. We are looking again. Columbia, MO, is not a tobacco smoke free city. Employees can smoke on the job in designated areas. San Antonio, TX, is a tobacco smoke free city. Many workplaces are smoke free.
This time we would like to find a site that is free from third hand tobacco smoke. Tobacco smoke: first hand, second hand, and now third hand, has been found to be equally damaging to health, in comparable amounts (with the exception of triggering my allergies). Tobacco smoke has no place in health care facilities including assisted living and memory care.
Unfortunately, big money still controls tobacco use at the federal and stage level. Current smokers finance the infamous tobacco settlement that pays states for 25 years for damages to health and to promote non-smoking. That money, however, is not used to promote non-smoking but put into the state general fund.
The tobacco tax is also seen as an important revenue source for states; when governors worry about a loss in the tobacco tax as the price of cigarettes is increased to reduce sales to minors. Missouri collects about $20,000 per 20 cases of cigarettes. Most states collect about $180,000 for 20 cases. That is the value of one life lost from tobacco.
Protection of the general public then falls to the general public, and to the advantage, companies see in declaring; first, smoke free, then tobacco free, and finally, totally, smoker free (first hand, second hand, and third hand smoke).
Provision Living at Columbia is a good [candidate]. It was constructed with no tobacco use in the building. It is just two years old. It has a skilled, experienced work force that includes many former smokers. It has only one resident smoker who diligently goes outside, come whatever weather, each morning.
This is a college town. This helps promote a high turnover rate. The opportunity exists to expose a large number of people to an effective smoke secession program as new hires are welcomed into productive [groups] (or rejected).
Now to explore the status of tobacco in residential health care facilities near Columbia, and not waste the effort, by posting what we find on this [website]. We may move to San Antonio, for a year or two, or work at clearing the air here.
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--DRAFT--                           2. Tobacco Free Pledge                              --DRAFT--
Your residential health care facility will be tobacco free soon, if it has not already been established as tobacco free. Also help the 75% of smokers who want to quite, to quite. This is easier to do in a model Smoke-Free City.
San Antonio City Ordinance: 2010-08-19-0697, Chapter 36: (Bold my emphasis.)
WHEREAS, numerous studies have found that tobacco smoke is a major contributor to indoor air pollution, and that breathing secondhand smoke is a cause of disease in healthy nonsmokers, including heart disease, stroke, respiratory disease and lung cancer; and
WHEREAS, secondhand smoke is particularly hazardous to elderly people, individuals with cardiovascular disease, and individuals with impaired respiratory function, including asthmatics and those with obstructive airway disease; and
WHEREAS, the United States Surgeon General has stated that there is no risk-free level of exposure to second-hand smoke (U.S. Surgeon General’s Report – 2006, The Health Consequences of Involuntary Exposure to Tobacco Smoke);
Company: _____________________________________
          Independent Living    Assisted Living    Memory Care    Skilled Nursing
Beds:            _____                    _____                _____                 _____
Date to be tobacco smoke free: _____________

Date to be a tobacco free site:   _____________

Date to be a smoker free site:   _____________

Date to be a clean air site:        _____________
Address: _________________________________________________________
Phone: __________________ 
Email: __________________________________
Name: __________________________________  Date: ___________________
Comments:

Post to: [www.residentialcarefortwo.org] (near Columbia, MO, and San Antonio, TX)
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3. Definitions
As detailed as these three definitions are, they still do no state clearly current situations. This leaves the code open to interpretation.
Is a residential care facility such as Provision Living ranked as a health care facility?
The tobacco free status of the MU campus includes the medical center and all outdoor areas, including parking lots and sidewalks.
Health care facility means an office or institution providing care or treatment of diseases, whether physical, mental, or emotional, or other medical, physiological, or psychological conditions, including but not limited to, hospitals, rehabilitation hospitals or other clinics, weight control clinics, nursing homes, homes for the aging or chronically ill, laboratories, and offices of surgeons, chiropractors, physical therapists, physicians, dentists, and all specialists within these professions. This definition shall include all waiting rooms, hallways, private rooms, semiprivate rooms, and wards within health care facilities.
Place of employment means an area under the control of a public or private employer that employees normally frequent during the course of employment, including, but not limited to, work areas, employee lounges, restrooms, conference rooms, meeting rooms, classrooms, employee cafeterias, hallways, and vehicles. A private residence is not a “place of employment” unless is is used as a child care, adult day care, or health care facility.
Public place means an enclosed area to which the public is invited or in which the public is permitted, including but not limited to, banks, bars, bingo facilities, educational facilities, gaming facilities, health care facilities, hotels and motels, laundromats, public transportation facilities, reception areas, restaurants, retail food production and marketing establishments, retail service establishments, retail stores, shopping malls, sports arenas, theaters, and waiting rooms. A private residence is not a “public place” unless it is used as a child care, adult day care, or health care facility.
Smoking means inhaling, exhaling, burning, or carrying any lighted or heated cigar, cigarette, pipe, or any other lighted or heated tobacco or plant product intended for inhalation.
The code does include exhaling tobacco smoke; which may include third hand smoke: out-gassing from body, hair, and clothing.
My one-week trip to San Antonio, nest week, should provide some answers. What is said and what actually happens can be very different. The following provides no protection from third hand tobacco smoke; only tobacco free does that.
“As for the smoking free environment. Yes, we are smoke free and nobody can smoke in the building. The only place that associates can smoke outside is in designated area outside.”
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--DRAFT--                        4. Together We Can                                       --DRAFT--
Employers and employees have an obligation to assist fellow employees and new hires to gain control of their addiction to nicotine. It gives a pack a day smoker about a $1/hr raise at little cost to the employer.


A. Set the terms for employees to be free from nicotine addiction (as is, all other drug addictions are illegal and/or grounds for dismissal).

There is no, risk-free, level of tobacco smoke.
Nonsmokers enjoy better health and more productive time.
Employer support includes nicotine management supplies and services.
All new hires must take an active part in a support team.




B. Organize employees to support one another and recognize progress.

Organize employee support teams by job locations.
Try to include a former smoker in each team.
Award periodic prizes for progress.
Make provision for new hires.
Recognize arrival at smoke free and tobacco free site rankings.
Celebrate success when smoker free (except for new hires).
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5. Terminology
Tobacco use has been a part of our culture for centuries. Life was short. Baseball players spit tobacco. Cowboys smoked Marlboro. In the past century they lived long enough to develop mouth cancer and lung cancer.
In 1964 the United States Surgeon General declared that tobacco was the greatest cause of preventable illness and death in the country. Our cultural assumption was it only involved tobacco users.
In 1994 seven tobacco company executives lied to congress, “I do not believe that cigarettes are addictive,” and lost their jobs but avoided jail time. Our culture learned that tobacco use is not a habit but a means of delivering a powerful addictive drug. The cigarette is optimized to addict and therefore to kill.
By 2006 the United States Surgeon General had determined that there is no risk-free level of exposure to second hand smoke. Our cultural response was to increase the isolation of addicted smokers and to declare tobacco free areas.
A cultural response is needed today to assist tobacco addicts to regain control of their own behavior. Tobacco companies and federal regulations are of little help to addicts. The task of becoming tobacco free falls to communities and work groups. I have experienced five levels of concern in the past two years:
*Unregulated: San Antonio, TX, lives on top of its water supply. Cigarette buts can contaminate that water.
*Smoke Free: No active smoking in the area (indoors and outdoors). Dividing a room into smoking and nonsmoking was a political maneuver. Addicts are temporarily provided an isolated smoking area (indoors or outdoors) with self-extinguishing butt collectors.
*Tobacco Free: No tobacco products allowed on the area. No butt collectors. Active therapy provided for addicts by health care services, employers and employee support groups.
*Smoker Free: No smokers!! End of air quality problem? NO.
*Clean Air: The continuous injection of air contaminates that mask or alter odder in residential care space without the consent or knowledge of the occupants is not only unethical but a health hazard. It is one more stress on people in poor health (our laundry can be marked: no softeners). The marketing pitch is they increase sales in boutiques by about 10%. They may have a clean air or fresh air effect for some people but I know of none in use that actually clean or refresh air.



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