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Smoking Rates in Northern Kentucky Continue to Be Concern for Health Officials

Northern Kentucky streets and sidewalks are consistently littered with discarded cigarette butts. The volume of smokers in Kentucky ranks the state as third in the nation, and Northern Kentucky contributes heavily to that.

27 percent of Kenton County residents use cigarettes, including high school and middle school students.

“We have a long rich history of growing tobacco in Kentucky. Even though that's not the number-one crop in Kentucky, the historical knowledge and influence that it has had is still very prevalent for us today,” said Stephanie Vogle, Director of Population Health for the Northern Kentucky Health Department. “We hear about people being sent to college from their parents growing tobacco. They may still have plots of tobacco. You have that particular piece that plays quite a bit into why we in this region smoke more.”

Campaigns against smoking, citing the serious health risks associated with cigarettes, are ubiquitous. Here, the Northern Kentucky Health Department has teamed up with other like-minded organizations to form the Tobacco Prevention Coalition of Northern Kentucky.

Health risks can also affect those who don't smoke if they inhale second-hand smoke. Children, senior citizens, and even pets can be adversely affected when living in smoking households. Children who live in households where adults smoke see their chances of becoming smokers, too, increase.

Smoking is a lethal habit, killing 8,900 adults in Kentucky each year. That number is higher than deaths from alcohol, AIDS, illegal drugs, murder, and suicides combined. The financial impact of smoking is also high. The Northern Kentucky Health Departments reports that annual health care costs in Kentucky directly caused by smoking is nearly $2 billion.

Locally, there have been efforts to enforce smoking bans with varying degrees of success.

In 2011, the Kenton County Fiscal Court adopted an ordinance prohibiting smoking in public places and places of employment where people under 18 are permitted. Campbell County adopted a similar law in 2010 but it was rescinded a few months later following push-back from activists there.

“Businesses regulate that themselves based on the needs of their customers. The Health Department doesn't need to do this. You don't need a statewide smoking ban, it's pretty much taking care of itself,” said Campbell County resident Kevin Gordon who was part of the group that rallied to have the smoking ban there repealed and later became known as the Independent Business Association of Northern Kentucky (IBANK). “If they would put as much effort toward the heroin issue as the smoking issue, maybe heroin wouldn't be so bad. To me it's a bunch of misplaced priorities.”

However, according to an NKYHealth.org poll conducted in 2014, 70 percent of Campbell County voters polled said they favor smoke-free environments, and 60 percent said that smoking should never be allowed in workplaces.

“One of the reasons you see smoking more in Kentucky than Ohio is because in Ohio they have a smoke-free workplace. In Kentucky, we don't have a comprehensive smoke-free workplace law for this state. So when you're out at venues, you're more likely to see it here than you are in Ohio, because their state is covered with a smoke-free workplace law,” Vogel said. “In Kenton County we have what we call a partial law, so there is a law but there are significant exemptions. There are about 70 locations with exemptions.”

The Health Department regularly advocates for a statewide smoke-free workplace law every year in Frankfort.

“Our board passed a resolution that supported the statewide smoke-free workplace law, and so we have been working over the past several years to educate our elected officials and our community about the harmful effects of second-hand smoke and the importance of smoke-free workplace policy,” Vogel said. “We've been doing that and we have been in Frankfort on days to talk with our elected officials and talk with other people around the state that are doing the same work we are in other parts.”

Gordon suspects, however, that there are other motives at work for the strong advocacy of a state smoking ban.

“You're talking about a legal product and the largest profiteer of that product are state and local taxing authorities that take the money for tobacco. I think it's a waste of their time, it's a waste of their energy and if you really get down to the brass tacks of it, it is because the Health Department is getting so much money from the special-interest groups that are asking them to do this, to put this forward,” he said. “Nothing else makes any sense. The Robert Woods Johnson Foundation that gives them grants, they make a lot of money off the smoking-cessation medication. Of course, they're going to be pushing for the issue. The bottom line is how much of a real serious problem is it?”

He says that the problem is taking care of itself because the only places that most people encounter second-hand smoke in a public place is at bars and private clubs.

“So what's the big deal? Nobody is smoking in county offices, nobody is smoking in real estate offices. Where is anybody smoking anymore?,” he said. “A lot of the people that work at the bars smoke themselves. It's an industry that is notorious for high turnover. It's not like you have someone that works there for 25 to 30 years at the same place, and if it's a place where smoking is that much of a concentration, there are plenty of other places they can go and work.”

But, proponents of a ban argue, children and teenagers are effected in different ways by the state's high smoking rate.

A recent poll conducted by the Foundation of a Healthy Kentucky showed that 60 percent of Kentuckians polled said they would favor raising the minimum age for those allowed to purchase cigarettes from 18 to 21. Of those polled in Northern Kentucky, 54 percent favored the age increase. Kentucky has the highest rate of teenage smokers in the United States at nearly 18 percent.

Some of the push back that the Health Department faces when advocating for a statewide smoke-free workplace law is from the big tobacco companies and their lobbyists.

“There was a point in time when we had a lot of tobacco companies in Kentucky. That visibility is not here as much as it was ten years ago but that was a big push. They would pump lots of money into the economy and do lots of advertising, so we had a pretty rich history of advertising. It may not have been the advertising you think of as recently on television, but they would do other things like product placement in stores and other items that they could do,” Vogel said.

The newest challenge in controlling tobacco use in Kentucky is the recent introduction of e-cigarettes to the market. Less is known about the effects that e-cigarettes have on those who use them, but there are already concerns raised by the Health Department that come with the new product.

“Most of the major tobacco companies own an e-cigarette brand, so that's their new thing,” said health educator Laura Richardson of the Health Department's Tobacco Prevention Program. “Every time I go into a gas station it seems like there is someone there handing out a coupon and it's where the tobacco companies are relaunching their advertising and they don't have as many restrictions as they do on traditional products. The technology has evolved faster than the policies and the research about health effects, so they don't have as many restrictions of what they can do.”

Richardson and Vogel said that already there are reports of children overdosing on nicotine when using the e-cigarettes and that many adults are lured to use them in order to help them quit traditional cigarettes, even though it is not a proven method of cessation. They said that many times, smokers end up using both the e-cigarette and tobacco cigarettes in what they call dual use. 

“The devices that deliver the vapor or the liquid to the body are also being used for other purposes, not just what was intended, so we have folks being creative with ways to use them,” Vogel said. “There are many FDA approved medications to help people quit smoking and until we hear otherwise, that's really what we're promoting people to when they're trying to quit smoking.”

In addition to the sensitivity toward minors smoking, there are other groups of people who are more likely to be negatively effected by cigarettes.

“We definitely have populations that are disproportionately effected and income level is one of those. Folks with lower income levels tend to have higher rates of smoking. Education level is another, and we have high rates of pregnant women and smoking too,” Vogel said. “Most people know that smoking is not good and that second-hand smoke is harmful. We have pretty widespread knowledge of that at this point.”

Gordon agrees that lower-income populations are more prone to smoking, but says that the high tax put on cigarettes mostly hurts those with the least money.

“It penalizes them more than anything else,” he said. “Again with the sin taxes, it's just a revenue grab and more profiteering on the part of the state and the county in order to make more money off of a product. Back in 1996 as part of that huge law suit against the tobacco companies where they had the tobacco settlement, all of these states have been getting money from that. Where has that money gone? It hasn't gone to the education to the people to get them to stop smoking. They take that money and put it into the general fund and spend it on everything other than the education.”

Now there is more information being learned about what is called third-hand smoke which is the chemical residues in materials from places exposed to cigarette smoke that could be harmful to children when they come into contact with furniture, curtains and drapes, and even clothing from longtime smokers.

“The research is still emerging, but we're learning more about it,” Richardson said. “We refer to that as third-hand smoke. It's the smoke that gets into the fabric, or into the walls. In Lexington, they're doing a lot of work with their childcare centers of third-hand smoke, because they were having some in-home childcare where the babies were getting sick. They're definitely the experts in the state right now and we're always learning as much as we can about it and it's an interesting way that we may be going in the future.”

Opponents like Gordon, though, don't see the evidence in any danger of third, or even second-hand smoke.

“If all of that information is true, there isn't a baby boomer that would be alive today because so many of our parents smoked,” he said. “They smoked in the house, both of my parents smoked, they smoked in the car when they were driving us to and from school and none of us got cancer.”

Gordon isn't opposed to all regulations when it comes to businesses that allow smoking in their facility.

“If they want to do something to have bars put up signs to say that it's allowed to smoke in there, have them do it,” he said, “but the issue is taking care of itself. I don't know why there is a need for the government to get involved in yet one more thing. It's really frustrating seeing where their efforts are and identifying what they're serious about.”

The Health Department recently received grant money from a state tobacco settlement program to help implement a cessation program that is targeted towards teens at three Kenton County high schools: Dixie Heights, Scott, and Simon Kenton. There are also many staff members on the Health Department that sit on substance abuse prevention coalitions throughout the region, where strategies are devised that directly impact tobacco use and other harmful substances they are likely to be offered at some point.

“When you're working in prevention, some of the work that you do around messaging and helping folks understand that work is not just giving information about tobacco, but it's all the other skills, like decision-making skills, refusal skills, how to be assertive and understanding other things, and those will be widespread among all drugs, not just tobacco,” Vogel said. “That's going to help when it comes to alcohol use, and for other forms of drug use. We work on those coalitions because it's important for us to give the tobacco message, but also so we can be more broad reaching.”

Written by Bryan Burke, associate editor

Photo: Cigarettes (creator)