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Purpose of "Tobacco Free Alabama"
To briefly discuss the history of tobacco and tobacco use with an emphasis on anti-smoking efforts in the state of Alabama. It explores specific anti-smoking legislative efforts in Alabama, current anti-smoking bills, economic impacts of tobacco, prevalent tobacco-use related health and social problems, as well as statistics and youth efforts against tobacco use within the state.

History of Tobacco
Tobacco is an agricultural crop defined as a nervous system stimulant that triggers complex biochemical and neurotransmitter disruptions. The psychoactive ingredient is Nicotine, a stimulant present in cigarettes. Initially, tobacco was believed to be a cure-all used for religious and medicinal practices, to dress wounds, as well as a pain-killer. Chewing tobacco was often used to relieve toothache pain and by the 1800s, many people used it in small amounts. Some chewed it while others smoked it occasionally in a pipe. Cigarette smoking became more widespread in 1881, when James Albert Bonsack invented the cigarette-making machine. The popularity of smoking increased and in 1964, the Surgeon General of the U.S wrote a report concerning the dangers of cigarette smoking, which prompted Congress to pass the Cigarette Labeling and Advertising Act of 1965. In 1984, Congress passed another law called the Comprehensive Smoking Education Act, which required cigarette companies to change warning labels on their products every three months. The American public has been aware of the risks of tobacco use, especially cigarette smoking for almost 50 years as its negative health impacts are exaccerbated by excessive consumption, abuse, and exposure.

Overview of State and National Anti-Tobacco Efforts
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and its smoke is tasted or inhaled. Tobacco use is the leading cause of preventable illness and death in the United States. Each year more than 443,000 Americans die from tobacco-related illnesses. In Alabama, approximately 7,500 adults die each year from their own smoking. According to the Center for Disease Control, approximately 88 million nonsmoking Americans continue to be exposed to secondhand smoke in homes, vehicles, workplaces, and public places. In Alabama, approximately 850 adult nonsmokers die each year from exposure to secondhand smoke. The American Lung Association, founded in 1904, to help combat tuberculosis, has worked for more than 100 years to save lives by preventing lung disease and promoting lung health in the fight against illness and death caused by tobacco use. The American Lung Association is a member of the Coalition for a Tobacco-Free Alabama and works to reduce tobacco use in the state by creating smoke-free environments at the state and local level, and increasing tobacco taxes. The American Lung Association supports individuals with lung cancer, and through stronger tobacco control policies seeks to reduce the 157,000 deaths caused by lung cancer each year. The American Lung Association’s "State of Tobacco Control" calls to action national and state elected officials to enact stronger tobacco control laws in their respective areas of representation. According to the United Health Foundation's 20th Annual Report, a factsheet outlaying America's health, Alabama places 48th nationally with smoking and obesity as primary causes of its poor ranking. .

State Legislative Efforts in Alabama
While Alabama does not have a statewide smoking ban, individual localities have passed laws with varying limitations on smoking in counties, cities, restaurants, and bars. Senator Vivian Davis Figures of Mobile proposed a bill in 2008, that would have banned smoking in restaurants and other public places, making an exception only for bars where food sales make up less than 20 percent of their business. The bill died in the Legislature without coming up for a vote in the House on the final day of the 2008, regular session. Alabama attempted to pass a smoking ban again in 2009, that was stalled when its author Senator Vivian Figures (D-Mobile) pulled the bill from Senate consideration after what she believed were attempts to, “gut the bill.” Senator Hank Erwin, a long time supporter of the legislation said that “Figures felt it was better to pull the bill for right now and regroup.”. Recently in March 2011, a new bill was proposed that if passed would create stricter smoking laws in public places as well as punishment for violations.

Statewide Smoking Bans
As of January 2, 2011, according American Nonsmokers’ Rights Foundation all workplaces in these cities and counties in Alabama are smoke-free: Alexander City, Atmore, Bayou La Batre, Centerpoint, Citronelle, Cottonwood, Daphne, Decatur, East Brewton, Fairhope, Flomaton, Foley, Geneva, Gulf Shores, Opelika, Orange Beach, Oxford, Phenix City, Prichard, Robertsdale, Spanish Fort, Talladega, and Tuskeegee.

All restaurants in these cities and counties in Alabama are smoke-free: Alexander City, Atmore, Auburn, Bay Minette, Bayou La Batre, Birmingham, Citronelle, Cottonwood, Daphne, Decatur, East Brewton, Fairfield, Fairhope, Flomaton, Foley, Fort Payne, Gulf Shores, Headland, Homewood, Luverne, Northport, Opelika, Opp, Orange Beach, Oxford, Phenix City, Prichard, Robertsdale, Spanish Fort, Talladega, Tuskegee.

All bars in these cities and counties in Alabama are smoke-free: Atmore, Auburn, Bayou La Batre, Citronelle, Cottonwood, Decatur, East Brewton, Fairfield, Flomaton, Gulf Shores, Headland, Homewood, Luverne, Orange Beach, Oxford, Phenix City, Talladega.

Smoke-free hospitals in Alabama: Atmore Community Hospital (Atmore, AL), Eliza Coffee Memorial Hospital, East and Collins Medical Building (Florence, AL), and Shoals Hospital (Muscle Shoals, AL) , East Alabama Medical Center (Opelika, Alabama) , Andalusia Regional Hospital (Andalusia, AL) , and Alabama mental health facilities (state-wide).

Economic Downside
The State of Tobacco Control 2010 Report grades states on their anti-tobacco efforts; in this report, Alabama received straight “Fs." The report grades states on four categories: 1) their spending on programs to prevent and control tobacco use, 2) their statewide smoking restrictions, 3) the tax they levy on cigarettes, 4) and whether they pay for medications and counselin g for Medicaid patients and state employees who are trying to quit smoking. Alabama ranked right at the bottom in all four categories. For every smoker in Alabama, $993 a year is spent on hospital care as a result of smoking A national study shows that Alabama’s economy suffers $5.6 billion a year in direct costs because of smoking, which also includes more than $1 billion in lost workplace productivity and $1.7 billion in direct medical expenditures.

Problem of Smoking in Alabama
• Alabamians spend $842 million a year on drugs directly as a result of smoking.

• Nearly $125 million a year is spent by Alabamians in nursing homes directly as a result of smoking

• For every smoker in Alabama, $993 a year is spent on hospital care as a result of smoking

• Annual health care costs in Alabama directly caused by smoking: $1.49billion

• Portion covered by the state Medicaid program: $238million

• Residents’ state and federal tax burden from smoking-caused government expenditures: $540

•Smoking-caused productivity losses in Alabama: $2.24billion

Statistics
In Alabama, 22.1% of the adult population (ages 18+), over 783,000 individuals, are current cigarette smokers. Across all states, the prevalence of cigarette smoking among adults ranges from 9.3% to 26.5%. Alabama ranks 42nd among the states. Among youth ages 12–17, 12.0% smoke in Alabama. The range across all states is 6.5% to 15.9%. Alabama ranks 40th among the states.

Among adults age 35+ years, over 7,600 died as a result of tobacco use per year, on average, during 2000–2004. This represents a smoking-attributable mortality rate of 317.5 per 100,000. Alabama's smoking-attributable mortality rate ranks 44th among the states.

How are other states handling the usage of Tobacco?
As of December 2010, twenty-seven states prohibit smoking in bars and thirty-two states prohibit smoking in restaurants. Thirty-three states have 100% smoke-free indoor air laws for worksites. Idaho, Mississippi, and North Carolina prohibit smoking in government worksites but not in private worksites. As of December 31, 2010, twenty-five states including Arizona, Colorado, Delaware, Hawaii, Illinois, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Jersey, New Mexico, New York, Ohio, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington, and Wisconsin and the District of Columbia have 100% smoke-free indoor air laws for bars, restaurants, and worksites. Also, Kansas, Michigan, South Dakota, and Wisconsin are now smoke-free in all three locations, bars, restaurants, and worksites. A new North Carolina law now prohibits smoking in bars and restaurants but still not in all workplaces.

Alabama Bills On Smoking
Specific smoking regulatory bills passed in Alabama include the following:

Summary of Bill: Section 22-15A-4 focuses on issues of smoking in public places. It states Alabama's general prohibition against smoking in public arenas and lists four specific exceptions to this law.

Section 22-15A-4 "Prohibition against smoking in public places; exceptions. (a) No person shall smoke in a public place or at a public meeting except as otherwise provided in this subsection and in Section 22-15A-7. This prohibition does not apply in any of the following places: (1) Bars and lounges. (2) Retail tobacco stores and tobacco businesses. (3) Limousines used under private hire by an individual or corporation. (4) Hotel and motel rooms rented to guests, except for those rooms designated by the hotels and motels as 'no smoking' rooms. (b) Smoking by patients in a chemical dependency treatment program or mental health program may be allowed in a separated well-ventilated area pursuant to a policy established by the administrator of the program that identifies circumstances in which prohibiting smoking would interfere with the treatment of persons recovering from chemical dependency or mental illness." (Act 2003-314, p. 770, §4.)

Summary of Bill: Section 22-15A-6 discusses required designation of smoking areas in public venues. It states forbidden and allowed areas that may be designated, as well as ventilation requirements that must be met in areas where smoking is allowed.

Section 22-15A-6 "Designation of smoking areas; requirements; nonsmoking policies.(a) Pursuant to this section, the person in charge of a public place may designate an area for the use of smokers. Notwithstanding the foregoing, a smoking area may not be designated and no person may smoke in any of the following unless the area is enclosed and well ventilated: (1) Child care facilities.(2) Hospitals, health care clinics, doctors' offices, physical therapy facilities, and dentists' offices. (3) Elevators. (4) Buses, taxicabs, and other means of public conveyance. (5) Government buildings, except private offices. (6) Restrooms.(7) Service lines. (8) Public areas of aquariums, galleries, libraries, and museums. (9) Lobbies, hallways, and other common areas in apartment buildings, senior citizen residences, nursing homes, and other multiple-unit residential facilities. (10) Polling places.(11) Schools or other school facilities or enclosed school sponsored events for grades K-12. (12) Retail establishments, excluding restaurants, except areas in retail establishments not open to the public. (13) Lobbies, hallways, and other common areas in multiple-unit commercial facilities. (b) If a smoking area is designated, existing physical barriers and ventilation systems shall be used to minimize the toxic effect of smoke, and no more than one-fourth of the total square footage in any public place within a single enclosed area shall be reserved and designated for smokers unless clientele dictates otherwise. No area designated as a smoking area shall contain common facilities which are expected to be used by the public. (c) Nothing in this section shall be construed to prevent any owner, operator, manager, or other person who controls any establishment or facility from declaring and enforcing a nonsmoking policy in the entire establishment or facility. (d) Notwithstanding any other provision of this section or this chapter, if any restaurant is deemed by its owner as being too small to have a designated smoking area, it shall be left up to the discretion of the owner if the facility will be a 'smoking' or a 'nonsmoking' facility." (Act 2003-314, p. 770, §6.)

Summary of Bill: Section 22-15A-7 explores the technical aspect of non-smoking zones by discussing "No Smoking" signs, describing the "No Smoking" diagram, emphasizing the importance of proper placement of signs, and outlining repercussions of non-smoking zone violations.

Section 22-15A-7 "Posting of 'No Smoking' and 'Smoking Area' signs; violations of chapter.(a) A 'No Smoking' sign or signs, or the international 'No Smoking' symbol, which consists of a pictorial representation of a burning cigarette enclosed in a circle with a bar across, shall be prominently posted and properly maintained where smoking is prohibited by this chapter, by the owner, operator, manager, or other person in charge of the facility. 'Smoking Area' signs shall also be posted as appropriate in public places. (b) The person(s) in charge of a public place who observes a person in possession of a lighted tobacco product in apparent violation of this chapter shall inform that person that smoking is not permitted in that area by law." (Act 2003-314, p. 770, §7.)

Summary of Bill: Section 22-15A-10 states that chapter smoking laws will not restrict or supercede county, city, town, or village laws as long as minimum standards are met.

Section 22-15A-10 "Local laws, ordinances, or regulations. Nothing in this chapter shall be construed to restrict the power of any county, city, town, or village to adopt and enforce local laws, ordinances, or regulations that comply with at least the minimum applicable standards set forth in this chapter." (Act 2003-314, p. 770, §11.)

Tobacco and Alabama's Youth
While the number of high school smokers is at an all time low, 22.1 percent or 12,400 children under 18 still become new smokers each year. It is estimated that 174,000 kids who are now under the age of 18 and alive in Alabama will ultimately die prematurely from smoking. Furthermore, offsetting the positive trend of reduced smoking rates in youth is an increase in the use of smokeless tobacco products such as snuff, dip, and chew.

A new product called “Snus,” described as a smokeless, spitless, less detectable way to use tobacco is marketed to young users. With higher levels of nicotine than other snuff products, it contains some of the same carcinogens and is more addictive.

On the 2009 Auburn City School’s Pride Student Survey, 10 percent of 10th graders and one out of seven seniors reported using smokeless tobacco products in the last year. This is a dangerous trend since smokeless tobacco products are not safer, and a user’s chance of getting oral cancer is 50 times greater than a non-user.

Anti Tobacco Use Youth Initiatives
In 2008, a student group called Students Working Against Tobacco (SWAT) received $28,000 from the Alabama Department of Public Health to spread their message. SWAT operates out of Bryant, LeFlore and Murphy high schools and Phillips Preparatory middle school.

The Youth Empowerment Program is a peer-teaching model that provides anti-tobacco messages to more than 58,000 teens according to Alabama's state health officer Don Williamson. The state funds community groups to educate people about the dangers of second-hand smoke and to encourage young people to reject tobacco use. The State Health Department also has a new teen cessation project that uses advertising on television and radio, as well as a MySpace page.

The Auburn CARES Coalition and the Alabama Department of Public Health encourage young people to make healthy tobacco-free choices and for those using chewing tobacco to quit. ADPH offers a free support and counseling service to help users successfully quit.