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.