Background Information - Smoking

1. Begin a discussion among the class by asking some questions:

 How many people smoke?
 How many people smoke and live with others that smoke?
 How many people don’t smoke but live with those that do?
 How many people are former smokers
 For the smokers, how old were you when you began?
 What influenced you to begin smoking?
 What are some of the health concerns you have about smoking?
 What are some of the dangers you are aware of associated with smoking?
 Have you ever tried to quit? If so, what methods did you use and what was the outcome? Why?

2. Introduce material /information regarding smoking

Fact Sheet
Adult Cigarette Smoking in the United States: Current Estimates
(updated November 2007)
Cigarette smoking remains the leading preventable cause of death in the United States,1 accounting for
approximately 1 of every 5 deaths (438,000 people) each year.2,3

National Estimates

 An estimated, 20.8% of all adults (45.3 million people) smoke cigarettes in the United States.4

 Cigarette smoking estimates by age are as follows: 18–24 years (23.9%), 25–44 years (23.5%), 45–64
years (21.8%), and 65 years or older (10.2%).4

 Cigarette smoking is more common among men (23.9%) than women (18.0%).4

 Prevalence of cigarette smoking is highest among American Indians/Alaska Natives (32.4%), followed by
African Americans (23.0%), whites (21.9%), , Hispanics (15.2%), and Asians [excluding Native Hawaiians
and other Pacific Islanders] (10.4%).4

 Cigarette smoking estimates are highest for adults with a General Education Development (GED) diploma
(46.0%) or 9–11 years of education (35.4%), and lowest for adults with an undergraduate college degree
(9.6%) or a graduate college degree (6.6%).4

 Cigarette smoking is more common among adults who live below the poverty level (30.6%) than among
those living at or above the poverty level (20.4%).4

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/adult_cig_smoking.htm

Fact Sheet
Health Effects of Cigarette Smoking
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(updated January 2008)
Smoking harms nearly every organ of the body; causing many diseases and reducing the health of smokers in
general.1 The adverse health effects from cigarette smoking account for an estimated 438,000 deaths, or nearly 1 of
every 5 deaths, each year in the United States.2,3 More deaths are caused each year by tobacco use than by all
deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and
murders combined.2,4

Cancer

 Cancer is the second leading cause of death and was among the first diseases causually linked to smoking.1

 Smoking causes about 90% of lung cancer deaths in men and almost 80% of lung cancer deaths in women.
The risk of dying from lung cancer is more than 23 times higher among men who smoke cigarettes, and
about 13 times higher among women who smoke cigarettes compared with never smokers.1

 Smoking causes cancers of the bladder, oral cavity, pharynx, larynx (voice box), esophagus, cervix, kidney,
lung, pancreas, and stomach, and causes acute myeloid leukemia.1

 Rates of cancers related to cigarette smoking vary widely among members of racial/ethnic groups, but are
generally highest in African-American men.5

Cardiovascular Disease (Heart and Circulatory System)

 Smoking causes coronary heart disease, the leading cause of death in the United States.1 Cigarette
smokers are 2–4 times more likely to develop coronary heart disease than nonsmokers.6

 Cigarette smoking approximately doubles a person's risk for stroke.7,8

 Cigarette smoking causes reduced circulation by narrowing the blood vessels (arteries). Smokers are more
than 10 times as likely as nonsmokers to develop peripheral vascular disease.9

 Smoking causes abdominal aortic aneurysm.1

Respiratory Disease and Other Effects

 Cigarette smoking is associated with a tenfold increase in the risk of dying from chronic obstructive lung
disease.7 About 90% of all deaths from chronic obstructive lung diseases are attributable to cigarette
smoking.1

 Cigarette smoking has many adverse reproductive and early childhood effects, including an increased risk
for infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS).1

 Postmenopausal women who smoke have lower bone density than women who never smoked. Women who
smoke have an increased risk for hip fracture than never smokers.10

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/health_effects.htm

Fact Sheet

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Secondhand Smoke
(updated September 2006)

Definition of Secondhand Smoke

 Secondhand smoke, also known as environmental tobacco smoke, is a complex mixture of gases and
particles that includes smoke from the burning cigarette, cigar, or pipe tip (sidestream smoke) and exhaled
mainstream smoke.1

 Secondhand smoke contains at least 250 chemicals known to be toxic, including more than 50 that can
cause cancer.1

Health Effects of Secondhand Smoke Exposure

 Secondhand smoke exposure causes heart disease and lung cancer in nonsmoking adults.2

 Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by
25–30% and their lung cancer risk by 20–30%.2

 Breathing secondhand smoke has immediate harmful effects on the cardiovascular system that can increase
the risk of heart attack. People who already have heart disease are at especially high risk.2

 Secondhand smoke exposure causes respiratory symptoms in children and slows their lung growth.2

 Secondhand smoke causes sudden infant death syndrome (SIDS), acute respiratory infections, ear
problems, and more frequent and severe asthma attacks in children.2

 There is no risk-free level of secondhand smoke exposure. Even brief exposure can be dangerous.2

Current Estimates of Secondhand Smoke Exposure

 Exposure to nicotine and secondhand smoke is measured by testing the saliva, urine, or blood for the
presence of a chemical called cotinine. Cotinine is a byproduct of nicotine metabolization, and tobacco is the
only source of this marker.2

 From 1988–91 to 2001–02, the proportion of nonsmokers with detectable levels cotinine was halved (from
88% to 43%).3

 Over that same time period, cotinine levels in those who were exposed to secondhand smoke fell by 70%.3

 More than 126 million nonsmoking Americans continue to be exposed to secondhand smoke in homes,
vehicles, workplaces, and public places.2

 Most exposure to tobacco smoke occurs in homes and workplaces.2

 Almost 60% of U.S. children aged 3–11 years—or almost 22 million children—are exposed to secondhand
smoke.2

 About 25% of children aged 3–11 years live with at least one smoker, compared to only about 7% of
nonsmoking adults.2

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  The California Environmental Protection Agency estimates that secondhand smoke exposure causes
approximately 3,400 lung cancer deaths and 22,700–69,600 heart disease deaths annually among adult
nonsmokers in the United States.4

 Each year in the United States, secondhand smoke exposure is responsible for 150,000–300,000 new
cases of bronchitis and pneumonia in children aged less than 18 months. This results in 7,500–15,000
hospitalizations, annually.5
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/secondhandsmoke.htm

The Health Consequences of Involuntary Exposure to Tobacco Smoke:

A Report of the Surgeon General, U.S. Department of Health and
Human Services
6 Major Conclusions of the Surgeon General Report

Smoking is the single greatest avoidable cause of disease and death. In this report, The Health
Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, the
Surgeon General has concluded that:

1. Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and
workplaces despite substantial progress in tobacco control.

Supporting Evidence

o Levels of a chemical called cotinine, a biomarker of secondhand smoke exposure, fell by 70 percent from
1988-91 to 2001-02. In national surveys, however, 43 percent of U.S. nonsmokers still have detectable levels
of cotinine.
o Almost 60 percent of U.S. children aged 3-11 years—or almost 22 million children—are exposed to
secondhand smoke.
o Approximately 30 percent of indoor workers in the United States are not covered by smoke-free workplace
policies.
2. Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke.

Supporting Evidence

o Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic (cancer-causing),

including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide.
o Secondhand smoke has been designated as a known human carcinogen (cancer-causing agent) by the U.S.
Environmental Protection Agency, National Toxicology Program and the International Agency for Research on
Cancer (IARC). The National Institute for Occupational Safety and Health has concluded that secondhand
smoke is an occupational carcinogen.
3. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute
respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and
slows lung growth in their children.

Supporting Evidence

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 o Children who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances
and poisons as smokers. Because their bodies are developing, infants and young children are especially
vulnerable to the poisons in secondhand smoke.
o Both babies whose mothers smoke while pregnant and babies who are exposed to secondhand smoke after
birth are more likely to die from sudden infant death syndrome (SIDS) than babies who are not exposed to
cigarette smoke.
o Babies whose mothers smoke while pregnant or who are exposed to secondhand smoke after birth have
weaker lungs than unexposed babies, which increases the risk for many health problems.
o Among infants and children, secondhand smoke cause bronchitis and pneumonia, and increases the risk of
ear infections.
o Secondhand smoke exposure can cause children who already have asthma to experience more frequent and
severe attacks.
4. Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes
coronary heart disease and lung cancer.

Supporting Evidence

o Concentrations of many cancer-causing and toxic chemicals are higher in secondhand smoke than in the
smoke inhaled by smokers.
o Breathing secondhand smoke for even a short time can have immediate adverse effects on the
cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems
in ways that increase the risk of a heart attack.
o Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing
heart disease by 25 - 30 percent.
o Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing
lung cancer by 20 - 30 percent.
5. The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.

Supporting Evidence

o Short exposures to secondhand smoke can cause blood platelets to become stickier, damage the lining of
blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially
increasing the risk of a heart attack.
o Secondhand smoke contains many chemicals that can quickly irritate and damage the lining of the airways.
Even brief exposure can result in upper airway changes in healthy persons and can lead to more frequent
and more asthma attacks in children who already have asthma.
6. Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating
smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to
secondhand smoke.

Supporting Evidence

o Conventional air cleaning systems can remove large particles, but not the smaller particles or the gases
found in secondhand smoke.
o Routine operation of a heating, ventilating, and air conditioning system can distribute secondhand smoke
throughout a building.
o The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), the preeminent
U.S. body on ventilation issues, has concluded that ventilation technology cannot be relied on to control
health risks from secondhand smoke exposure.

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon
General was prepared by the Office on Smoking and Health, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC).
The Report was written by 22 national experts who were selected as primary authors. The Report
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chapters were reviewed by 40 peer reviewers, and the entire Report was reviewed by 30
independent scientists and by lead scientists within the Centers for Disease Control and
Prevention and the Department of Health and Human Services. Throughout the review process,
the Report was revised to address reviewers’ comments.

Citation
U.S. Department of Health and Human Services. The Health Consequences of Involuntary
Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

For more information, please refer to the Resources page. Additional highlight sheets are also
available at www.cdc.gov/tobacco.

Last revised: January 4, 2007

Erie County's New Smoking Law

Quick Reference

SMOKING TO BE PROHIBITED IN:

 Elevators;
 Buses, taxicabs, and other means of public transportation, and ticket, boarding and
waiting areas of public depots;
 Public restrooms;
 Service Lines;
 Retail Stores;
 All areas available to and used by the general public in all businesses and not-for-
profit entities patronized by the public, including, but not limited to, professional and
other offices, banks, laundromats, hotels, and motels;
 Aquariums, galleries, libraries, and museums;
 Facilities used for exhibiting any motion picture, stage, drama, lecture, musical
recital, or other similar performance, except or performers when smoking is part of
the production;
 All rooms, chambers, meeting places or places of public assembly, including but not
limited to, school buildings, under the control of any board, council, commission,
committee, including joint committees, or agencies of the County of Erie or any
political subdivision thereof;
 Hospitals, clinics, physical therapy facilities, doctors' offices, dentists' offices, and
any other health care facility;
 Lobbies, hallways, and other common areas in apartment buildings, condominiums,
retirement facilities, nursing homes, and other multiple unit residential facilities;
 Lobbies, hallways, and other common areas in multiple unit commercial facilities;
 Government and municipal buildings, facilities, and vehicles;
 Polling places;
 Places of worship.

RESTAURANTS (sale of food is not incidental to the operation of the business - sale
of food comprises more that 40% of total annual gross sales).
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WITH A BAR:
 As of January 1, 1997, must limit seating of smoking patrons to 20% of total
seating;
 As of January 1, 1998, all dining areas, restrooms, and waiting areas must be smoke
free;
 Smoking may be allowed in the bar area of restaurants, provided the bar area is not
the sole patron waiting area, is not the sole means of entrance or exit to the facility
or to its restrooms, and is separated from the seated dining area by a floor-to-ceiling
partition or is separated by at least a four foot space.

WITHOUT A BAR:
 As of January 1, 1997, must limit seating of smoking patrons to 20% of total
seating;
 As of January 1, 1998, all dining areas, restrooms, and waiting areas must be smoke
free.

BARS/TAVERNS: (Sale of food is incidental to operation of business, and comprises

less than 40% of total annual gross sales).

 Smoking may be permitted

BOWLING CENTERS
EFFECTIVE JANUARY 1, 1998:

 No smoking in "settee" area.

 Smoking in dining areas of bowling centers consistent with provisions governing
Restaurants with or without bars;
 Smoking may be permitted in concourse area of bowling center, provided that:
← Area consists solely of adults in league or other tournament play;
← If open bowling is allowed in remaining portion of bowling center, open
bowling must be engaged in exclusively by adults, and adult league patrons
must be separated from open bowling patrons by a space of no less than four
(4) bowling lanes;
← If a minor is present on the premises, no smoking may be allowed in the
bowling center, unless a designated smoke free enclosed area is provided for
minors;
← Regardless of the activities, state law still stipulates that 25% of concourse be
designated non-smoking.

BINGO HALLS
 Must post signs indicating that non-smoking bingo is available;
 Effective January 1, 1998, separate rooms must be provided which meet this criteria:
 Floor-to-ceiling partitions separating rooms;
 Each room is separated, enclosed, and separately ventilated to the outdoors;

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  Smoke free seating is in an amount sufficient to meet customer demand, or to a
level of 50% of total seating, whichever is greater;
 Smoking room may not be the sole means of entrance or exit to the facility or to its
restrooms;
 Minors may not be allowed within separate smoking room.

SPORTING/RECREATIONAL AREAS & FACILITIES

(in excess of 5,000 capacity)

 Indoor facilities - smoke free;

 Outdoor facilities - indoor and outdoor areas - smoke free;
 Owners/operators may construct separate smoking room meeting conditions on page
5 of local law;

OUTDOOR FACILITIES AND PARKS

(below 5,000 seating capacity)

 Smoking permitted in out of doors;

 Indoor areas of these facilities - smoke free.

WORKPLACES
 All workplaces, public and private, with exception of restaurants, taverns, bowling
centers, and other exceptions listed above, are to become smoke free;
 90 days after passage of this Local Law, employers must adopt, implement, make
known, and maintain a written smoking policy containing the following requirements:
 Smoking shall be prohibited in all enclosed areas within a place of employment. In
addition, smoking shall be prohibited in all work areas including, but not limited to,
common work areas, auditoriums, classrooms, conference and meeting rooms,
private offices, elevators, hallways, lobbies, medical facilities, cafeterias, employee
lounges, stairs, restrooms, business vehicles, and all other enclosed areas.
 Smoking policy must be communicated to employees at least 3 weeks prior to
implementation;
 This policy would still allow business to construct separate smoking rooms, if they so
choose;

WHERE SMOKING IS NOT REGULATED

 Private residences, except when used for business purposes;
 Private vehicles, except when used for business purposes;
 Establishments whose primary business is the selling of tobacco and tobacco-related
products;
 Any indoor area where private social functions are being held and when the seating
arrangements are under the control of the sponsor of such function and not the
owner, operator, manager, or person in charge of such indoor area.

WAIVER PROVISIONS

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  Commissioner of Health may grant waiver for particular location/establishment if
compliance is considered unreasonable;
 Legislature may also grant waiver through resolution approved by 2/3 vote.

POSTING OF SIGNS
 Signs must be posted in non-smoking areas of all buildings and other facilities where
smoking is regulated by this local law.

ENFORCEMENT
 Enforcement officers are local policing agencies and County Department of Health;
 Aforementioned are authorized to issue appearance tickets to violators;
 Hearings to adjudicate the same are to be held by the Commissioner of Health or his
or her designee.

VIOLATIONS/PENALTIES
 It is a violation for any person who owns, manages, operates, or otherwise controls
the use of any premises subject to this Local Law to fail to request compliance with
its provisions;
 It is a violation for any person to smoke in any area where smoking is prohibited in
this Local Law;
 Violations are punishable by a civil penalty not to exceed $500.

RULES AND REGULATIONS

 Commissioner of Health is to determine rules and regulations necessary to carrying-
out this Local Law;
 The Legislature may disapprove any such regulation promulgated by the
Commissioner, but must do so within 60 days of the Commissioner's written notice
to the Legislature.

GENERAL EXCEPTION
 Any establishment may provide for its patrons a Separate Smoking Room, provided
said room:
← Is clearly designated as a separate smoking area;
← Is separate, enclosed, and separately ventilated to the outdoors;
← Contains adequate means of extinguishing fires;
← Doors are equipped with self closing devices so as to remain closed except for
the purposes of entry and exit from the room;
← Is not the sole means of entry or exit from the facility or its restrooms;
← Is not the sole waiting area for the facility;
← Has signs posted relative to the fact that smoking is permitted in the
establishment, and within designated areas only;
← In restaurants with or without bars, may be used for full-service dining, but
may not comprise more than 20% of total seating capacity of restaurant.

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EFFECTIVE DATE
 Unless otherwise stated, the provisions of this Local Law shall be effective January 1,
1997.

REVIEW COMMITTEE
 No later than January 1, 1999, the Chairman of the Legislature shall appoint and
convene a Review Committee to evaluate this Local Law;
 Membership shall represent a cross-section of the community;
 Committee must report findings and/or recommendations to Legislature within 6
months after its formation.

http://www.erie.gov/depts/government/leg_press.phtml

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