AGENDA ITEM #9

January 22, 2013

Public Hearing

MEMORANDUM

January 18,2013

TO:

FROM:

SUBJECT:

County Council

Amanda Mihill, Legislative Attorney

~~~

Public Hearing:

Bill 33-12, Health and Sanitation - Smoking - County Property

Bill 33-12, Health and Sanitation - Smoking - County Property, sponsored by Councilmembers

Floreen, Navarro, Rice, Riemer, Leventhal, EIrich, and Andrews, was introduced on November

27, 2012. A Health and Human Services Committee worksession is tentatively scheduled for

January 31, 2013 at 10:00 a.m.

Bill 33-12 would prohibit smoking on property owned or leased by the County. The ban would

exclude County rights-of-way. Materials from the chief sponsor, Councilmember Floreen begin

on©4.

This packet contains:

Bill 33-12

Legislative Request Report

Sponsor materials

Fiscal and Economic Impact Statement

F:\LAW\BILLS\1233 Health - Smoking - County PropertyiPublic Hearing,Doc

Circle

#

1

3

4

19



Bill No.

33-12

Concerning: Health and Sanitation ­

Smoking - County Property

Revised:

10/17/2012

Draft No. _1_

Introduced:

November 27,2012

Expires:

May 27.2014

Enacted: _ _ _ _ _ _ _ _ __

Executive: _ _ _ _ _ _ _ __

Effective: _ _ _ _ _ _ _ _ __

Sunset Date: _ _ _ _ _ _ _ __

Ch. _ _, Laws of Mont. Co. _ __

COUNTY COUNCIL

FOR MONTGOMERY COUNTY, MARYLAND

By: Councilmembers Floreen, Navarro, Rice, Riemer, Leventhal, EIrich, and Andrews

AN

ACT to:

(1)

(2)

prohibit smoking on property owned or leased by the County; and

generally amend County law on smoking.

By amending

Montgomery County Code

Chapter 24, Health and Sanitation

Section 24-9

Boldface

Underlining

[Single boldface brackets]

DQuble underlining

[[Double boldface brackets]]

* * *

Heading or defined term.

Added to existing law by original bill.

Deletedfrom existing law by original bill.

Added by amendment.

Deletedfrom existing law or the bill by amendment.

Existing law unaffected by bill.

The County Council for Montgomery County, Maryland approves the following Act:



BILL

No. 33-12

1

2

3

Sec.

1.

Section 24-9 is amended as follows

24-9. Smoking

in

public places.

-

*

(b)

In

*

*

4

5

Smoking prohibited in certain public places. A person must not smoke

or on any:

6

*

(9)

*

*

7

8

Restroom, except a restroom in a private residence; [or]

(10) Enclosed auditorium, concert or lecture haU[.]; or

{ill

property that is owned or leased

Qy

the County, except

£!:

County

9

10

11

12

Approved:

right-of-way.

*

*

*

13

Roger Berliner, President, County Council

Date

14

Approved:

15

Isiah Leggett, County Executive

Date

16

This is a correct copy ofCouncil action.

17

Linda M. Lauer, Clerk of the Council

Date

o

f:\Iaw\bills\1233 health - smoking - county property\bill 1.doc



LEGISLATIVE REQUEST REPORT

Bill 33-12

Health and Sanitation

-

Smoking

-

County Property

DESCRIPTION:

PROBLEM:

Bill 33-12 would prohibit smoking on property ovvned or leased by

the County, excluding County rights-of-way.

Smoking is known to cause cancer and other illnesses. The Centers

for Disease Control state that there is no risk-free level of exposure to

secondhand smoke.

To reduce employees' and visitors' exposure to secondhand smoke.

Health and Human Services

To be requested.

To be requested.

To be requested.

To be researched.

Amanda Mihill, 240-777-7815

To be researched.

GOALS AND

OBJECTIVES:

COORDINATION:

FISCAL IMP ACT:

ECONOMIC

IMPACT:

EVALUATION:

EXPERIENCE

ELSEWHERE:

SOURCE OF

INFORMATION:

APPLICATION

WITHIN

MUNICIPALITIES:

PENALTIES:

Class C

f:\law\bills\1233 health - smoking - county property\legislative request repol



Montgomery

County Council

From the Office ofCouncilmember Nancy Floreen

November 13,2012

CONTACT: Jed Millard 240-777-7959

N

E

Councilmember Floreen Will Introduce Bill

to Ban Smoking on Montgomery Property

On Thursday; Nov.

15,

in Rockville, She Will Host Event

With American Cancer Society to Mark

37

h

Great American

Smokeout and Offer Details on the Legislation

ROCKVILLE, Md., November 13, 2012-Montgomery County Councilmember Nancy

Floreen at

11

:30 a.m. on Thursday, Nov. 15, will hold a news conference in Rockville to

give details on a bill she

will

introduce that would ban smoking on property owned or

leased by Montgomery County. The ban would include all County properties except

W

S

R

E

L

E

public rights of way.

The bill, which is scheduled for introduction on Nov 27, is co-sponsored by Council

Vice President Nancy Navarro and Councilmembers Craig Rice, Hans Riemer, George

Leventhal and Marc EIrich. A public hearing on the bill is tentatively scheduled for Jan.

15.

The news event will be held in the Third Floor Hearing Room of the Council Office

Building, which is located at 100 Maryland Ave. in Rockville. Representatives of the

American Cancer Society

will

be present as the event coincides with the organization's

3ih

Great American Smokeout. The Smokeout is an annual event that urges smokers to

give up their smoking habits.

"I have unfortunately spent a lot of time over the past year with people who have

cancer," said Councilmember Floreen, a survivor of breast cancer. "I want to do

everything I can to help prevent this awful disease in all of its fonns, and this is a good

place to start."

A

S

E



2

In Montgomery County, one in 12 adults smoke cigarettes. Nationally, tobacco use is

responsible for one in five deaths, and an annual toll of 443,000 deaths. Smoking

accounts for at least 30 percent of all cancer deaths and is associated with increased risk

for 15 types of cancer. Tobacco use remains the single, largest preventable cause of

disease and premature death in the U.S.

"The Great American Smokeout is about helping people quit, and we know that passing

this bill is critical to helping people in Montgomery County do just that," said Bonita

Pennino, Government Relations Director for the American Cancer Society's Cancer

Action Network. "In addition we know that strong smoke-free laws mean fewer smokers

and reduced health care costs."

####



Montgomery County

Tobacco Use by Adults: 2000-2010

Maryland Department of Health and Mental Hygiene

Tobacco Use Prevention and Cessation Program

-.­

,',',"

CURRENT USE OF TOBACCO PRODUCTS

1

Current Adult (Age 18 and Older) Use ofTobacco Products

Proportion (%), Confidence Interval (CI), and Estimated Number of Adults

TOBACCO PRODUCTS

-

,

' I

2000

Baseline Data

DATA NOT AVAILABLE

FOR 2000

Prevalence (%), CI, and Number Adults

!

2002

DATA NOT AVAILABLE

FOR 2002

2006

DATA NOT AVAILABLE

FOR 2006

I

2008

i

2010

Any Tobacco Product

(All Adult Populations)

DATA NOT AVAILABLE DATA NOT AVAILABLE

FOR 2010

FOR 2008

Any Tobacco Product

(Adult Minority Populations)

DATA NOT AVAILABLE

FOR 2000

DATA NOT AVAILABLE

FOR 2002

DATA NOT AVAILABLE

FOR 2006

DATA NOT AVAILABLE DATA NOT AVAILABLE

FOR 2008

FOR 2010

Cigarette

13.2%±3.1%

82,261

15.8% ± 4.1%

110,320

9.3%±2.4%

70,439

8.0%±2.8%

55,297

8.0%±2.6%

55,245

Cigar

DATA NOT AVAILABLE

FOR 2000

DATA NOT AVAILABLE

FOR 2002

DATA NOT AVAILABLE

FOR 2006

DATA NOT AVAILABLE DATA NOT AVAILABLE

FOR 2008

FOR 2010

Smokeless Tobacco

I

1.1%±0.9%

6,928

DATA NOT AVAILABLE

FOR 2002

DATA NOT AVAILABLE

FOR 2006

DATA NOT AVAILABLE

FOR 2008

1.1%±0.7%

7,281

INITIATION OF TOBACCO USE IN PAST YEAR

Current Adult (Age 18 and Older) Use of Tobacco Products

Proportion (%), Confidence Interval (CI), and Estimated Number of Adults

2

('INITIATION'

Prevalence (%), CI, and Number Adults

2000

Baseline Data

NOT AVAILABLE-

TOO FEW INITIATING

RESPONDENTS

2002

NOT AVAILABLE­

TOO FEW INITIATING

RESPONDENTS

I

2006

I

2008

2010

DATA NOT AVAILABLE

FOR 2010

Adult Population

NOT AVAILABLE­

NOT AVAILABLE­

TOO FEW INITIATING

!

TOO FEW INITIATING

RESPONDENTS

RESPONDENTS

i

CESSA1'ION OF TOBACCO USE IN PAST YEAR

Current Adult (Age 18 and Older) Use of Tobacco Products

Proportion (%), Confidence Interval (CI), and Estimated Number of Adults

3

I

Prevalence (%), CI, and Number Adults

I

CESSATION

i

2000"

Baseline Data

25.2% ± 13.0%

8,174

2002

31.5% ± 17.3%

11,947

I

2006

2008

34.3% ± 13.6%

I

2010

fOR 2010

Adult Population

I

data

on use of cigars or any other tobacco product.

Thus~

I

35.2%

±

16.5%

10,928

I

DATA NOT AVAILABLE

I

12,073

1 Source: Behavioral Risk Factor Surveillance

Survey~

2000, 2002* 2006, 2008, and 201D.

The

Behavioraf Risk Factor Surveillance Survey collectS data on

use

of

cigarettes and smokeless tobacco only_

It

does not collect

estimates

of

these behaviors are unavailable for 2000. 2002. 2ooS, 2008. and 2010. Estimates

for

'USe

of

smokeless tobacco are available for 2000 and 2010 only.

2 Source: Maryland Adult Tobacco

Survey~

2000,2002, 200S, and 2008.

3 Source: Maryland Adult Tobacco Survey, 2000, 2002. 2006, and 2008.

• Estimates of prevalence are stated as a percentage

(%)

of the total relevant population.

• Confidence Intervals

(Yo)

appear immediately following prevalence estimates.

• Statistically significant change between survey years is underlined, between 2000 and 2010 preceded by an asterisk "".

APPENDIX B -

ADULT PREVALENCE, INITIATION,

&

CESSATION

Page

120



CURRENT CIGARETTE SMOKING ­ Pregnant Women

4

Proportion (%) of Selected Populations and Number for Pregnant Women from 100% of Birth Certificates

POPULATIONS

Prevalence (%) and Number Adults

i

Baseline Data

i

2001

8.7%

8,361

2002

8.0%

7,879

2003

7.7%

7,7S9

2004

7.4%

7,508

2005

6.9%

7,001

2006

6.8%

7,267

2007

6.6%

7,152

2008

6.6%

7,113

2009

6.1%

6,593

lVlaryland Statewide

Montgomery County

9.2%

8,842

2.5%

327

2.0%

269

1.3%

168

1.3%

171

1.0%

142

0.9%

120

0.7%

95

0.5%

68

0.6%

80

0.6%

76

ADULT HOUSEHOLDS WITH MINOR CHILDREN

5

Current Adult (Age 18 and Older), Proportion (%), Confidence Interval (CI), and Estimated Number of Adults

POPULATIONS

Prevalence (%) and Number Adults

i

2000

Baseline Data

19.9% ± 4.4%

51,360

2002

19.4%·±4.7%

52,2.78

2006

20.8% ± 4.5%

59,233

2008

14.0%±3.4%

43,342

2010

DATA NOT

AVAILABLE FOR 2010

Proportion •

with Adult Smokers •

MOST IMPORTANT REASON FOR WANTING TO QUIT SMOKING CIGARETIES, 2008

6

(Top 3 Reported as 'Most Important Reason'

by

Former Smokers and Smokers Trying to Quit)

I

I

0%

5%

10%

15%

20%

25%

30%

35%

Health Probl

Smoking.

0%

5%

10%

15%

20%

25%

30%

35

4 SOUtce.: VitalStatistrc.s

S Sou(te: Maryland Adult Tobact"o Survey, 2000, Z002, 2006, and 2008.

6 Source: Maryland Aduh: 1oba{;CD Survey, 2000, 2002. 2006, and 200ft

Page 121

APPENDIX B - ADULT PREVALENCE, INITIATION,

&

CESSATION



Montgomery County

Tobacco Use by Youth: 2000-2010

Maryland Department

of

Health

and

Mental Hygiene

Tobacco Use Prevention and Cessation Program

CURRENT USE OF TOBACCO PRODUCTS

Underage «18) Public Middle and High School Youth (Combined)

Proportion (%) and Estimated Number of Youth

TOBACCO PRODUCTS

Any Tobacco Product

(All Youth Populations)

I

2000

Baseline Data

16.6%±4.1%

10,604

15.9% ± 3.4%

4,507

12.1%±3.4%

7,455

6.6%±1.8%

4,107

2.9%±0.7%

1,853

5.0%±1.6%

3,087

3.4%±0.8%

2,113

2.9%±1.1%

Prevalence (%), CI, and Number Youth :

2002

14.9%±2.7%

10,561

15.0%±2.4%

5,755

9.5%±2.1%

6,474

6.1%±1.3%

4,152

3.7% ± 0.8%

2,545

4.6%±0.9%

3,177

3.1%±0.8%

2,109

2.8%±0.8%

1,870

2006

14.3%±1.7%

10,519

14.5%±1.8%

6,058

9.0%±1.3%

6,414

6.2%±1.0%

4,423

5.0%±0.9%

3,640

5.2%±0.8%

3,801

5.8%±0.9%

4,219

3.3%±0.7%

2,364

2008

11.5%±1.4%

8,348

11.7%±1.6%

4,823

6.9% ± 0.8%

4,971

2010

13.1%±2.3%

9,599

14.5%±2.3%

6,730

*7.1%±1.5%

5,182

7.1%±1.5%

5,153

PIPE SPECIFIC DATA

NOT AVAILABLE FOR

2010

BIDI5PECIFIC DATA

NOT AVAILABLE FOR

2010

KRETEK SPECIFIC DATA

NOT AVAILABLE FOR

2010

2.2% ± 0.6%

1,563

•

Any Tobacco Product

(Minority youth)

Cigarette

Cigar

Pipe

(tobacco)

7.7%

±1.0%

5,529

4.6% ± 0.9%

3,246

3.0%±0.S%

2,136

2.5% ± 0.6%

1,755

2.6% ± 0.6%

1,849

Bidi

Kretek

Smokeless Tobacco

,

....

1,836

INITIATION OF TOBACCO USE IN PAST YEAR

Underage «18) Public Middle and High School Youth Combined, Proportion (%) and Estimated Number of Youth

INITIATION

Prevalence (%), CI, and Number Youth

2000

Baseline Data

15.8%±3.4%

10,100

14.9%±2.7%

4,232

2002

2006

13.1%±

1.7%

9,640

11.8%±1·6%

4,906

2008

11.7%±1.3%

8,497

10.6%±1.1%

2010

15.0%±2.5%

11,0£6

16.3%±2.4%

7,581

All Youth

Minority Youth

I

13.4%±2.8%

9,S46

12.4%±2.5%

4,785

I

4,355

CESSATION OF TOBACCO USE IN PAST YEAR

Underage «18) Public Middle and High School Youth Combined, Proportion (%) and Estimated Number of Youth

prevalenc~7~~~,~JJ~u~ber

Youth

I .'

All Youth

Minority Youth

!

2000

Baseline Data

36.9%±6.9%

1,955

46.7%±12.1%

987

I

I

I

2002

43.7%±3.5%

2,046

49.4%±5.3%

1,218

I

2006

45.0%±6.2%

1,577

47.9% ± 7.9%

995

2008

39.4%±5.6%

1,481

41.6%±6.1%

1,010

I

2010

*50.8%

± 6.4%

1,881

52.3%±6.2%

!

1,452

• Estimates of prevalence are stated as a percentage

(%)

of the total relevant population.

• ConfIdence 1ntervals

C':

%)

appear Immediately follOWing prevalence estimates.

• Statistically significant change from the previous survey year are underlined; change between 2000 and 2010 preceded by an asterisk "".

~

APPENDIX A-YOUTH PREVALENCE, INITIATION,

&

CESSATrON

Page 68



CURRENT CIGARETTE SMOKING - School Type, Gender

&

Minorities

Underage «18) Public Middle and High School Youth

Proportion (%) and Estimated Number of Youth

YOUTH POPULATIONS

..

Prev'alence (%), CI, and Number Youth

2000

Baseline Data

3.7%±1.5%

1,065

3.3%±2.1%

450

3.8%±2.5%

558

4.4%±1.7%

566

19.4%±2.5%

6,389

19.6%±4.4%

3,217

18.8%±3.9%

3,101

2002

3.1%

± 1.0%

981

2.3%±0.9%

346

4.0%±1.8%

635

3.9%±1.2%

685

14.9%±2.0%

5,494

14.1%±2.5%

2,583

15.4%±1.9%

2,836

14.0%±1.9%

2,683

2006

3.0%±1.2%

916

2.1%±1.3%

320

3.6%±1.8%

556

3.3%±1.5%

553

13.4%±1.5%

5,498

12.8%±2.0%

2,573

14.0%±1.9%

2,899

12.9%±1.7%

3,006

2008

1.3%±0.7%

408

1.0%±0.7% .

146

1.7%±1.1%

262

1.8%±0.9%

316

11.1%±1.3%

4,563

8.9%±1.3%

1,823

13.1%±2.0%

2,700

2010

2.7%±1.2%

816

Middle School (MS)

MS Females

MSMaies

MS Minorities

High School (HS)

HS Females

HS Males

HS Minorities

2.3%±

1.6%

362 .

3.1%

± 1.5%

454

3.7%±1.7%

706

*10.4%

± 1.5%

4,366

*8.2%

± 1.7% .

1,798

*12.7%

± 1.9%

2,568

,

15.4%

±2.9%

2,222

11.2%

± 1.3%

2,543

*11.1%

± 1.3%

2,927

Montgomery County - Current Cigarette Smoking

(Underage Middle

&

High School Youth,

by

Grade)

50%

~-------------~

2000

~2002 ~2006 ~2008 ~2010-Maryland20J.uf_--------,

~----------------------------------------~

40%+---------------------------------------------------------------~

30%

+-----------------------------------------------------------------~~------~

20%+-------------------------------------------~_~--------T,-~------_i·_.~~---1

10%+-------------~·~~---_t

~

_______6_t_h_G_r_ad_e_ ____7_t_h_G_ra_d_e_____8_t_h_G_r_ad_e_____

9_t_h_G_r_3d_e_____

l_Ot_h_G_r_ad_e ____

_

l_lt_h_G_r_a_de ____

_

1_2t_h_G_r_ad_e ___

-J~

_

Page: 69

APPENDIX A-YOUTH PREVALENCE, INITIATION,

&

CESSATION



Evolution of Montgomery County smoking laws

1977 Prohibited smoking in elevators, retail stores where more than 8 persons

work at any time, public areas of health care facilities, publlc schools,

County government facilities, and theaters. Exceptions: private enclosed

offices, when facilities are closed to the public, central areas of malls,

barbershops, and beauty shops (Bill 26-76, effective 5-5-77)

1979 Required patient rooms in hospitals to be nonsmoking unless otherwise

requested by all occupants. (Bill 53-79, effective 3-12-80)

1981 Required employers to "consider the needs of nonsmoking employees and

... accommodate their need to the extent possible." (Bill 53-81, effective

11-15-82)

1986 Prohibited smoking in rail transit stations and most County government

workplaces. Exceptions to the workplace prohibition: designated smoking

areas, private enclosed offices. (Bill 27-85, effective 4-28-86)

1987 Required all restaurants with at least 50 seats to have a no-smoking area

covering at least 50% of the total seating area' (Bill 1-87, effective 7-10­

87)

1988 Prohibited smoking in public areas of offices, retail stores, banks,

factories, and other private businesses. Exceptions: mom

&

pop stores

(where no more

than

2 persons work at any time), private functions not

open to the public. Also prohibited smoking in public restrooms and

auditoriums. (Bill 27-87, effective 6-9-88)

1990 Prohibited smoking in shared workplaces, and required employers to post

notices and inform employees. Exceptions: mom

&

pop

businesses, other

businesses when all employees sharing the workplace consent. (Bill 51­

89, effective 5-24-90)

1992 Prohibited sale of tobacco products from vending machines, except in

private clubs. (Bill 5-91, 64-91, effective 5-1-92) County law declared

invalid by Circuit Court 4-19-93; Court of Appeals declared similar laws

from cities of Bowie and Takoma Park preempted by state law later in

1993.

1994 Prohibited smoking in

all

County government workplaces, with no

designated smoking areas. (Bill'42-93, effective 5-2-94)

1998 Prohibited a person in the business of selling or distributing tobacco

products for commercial purposes to distribute any tobacco product,

@



cigarette rolling paper, or tobacco product couponst'b a minor

(Bill

13-98;

also adopted as Board of Health regulation(Council Resolution 13-1410))

1999 Conformed County law to state workplace smoking regulations by

dropping references to workplaces in County law, thus focusing County

law on public places

(Bill

3-99, effective 6-29-99)

1999 Prohibited smoking in all restaurants (Council Resolution 14-70, adopting

Board of Health regulation). Regulation declared invalid because of

improper adoption by Maryland Court of Appeals 5-2-03

2000

Required retail sellers to display or store tobacco products in a place that is

not accessible to l?uyers without the intervention of the seller (Bill 23-00,

effective February 19, 2001)

Prohibited smoking in all restaurants except certain private clubs with

liquor licenses (Bill 15-03, effective October 9, 2003)

Prohibited smoking in indoor common areas of multi-family residential

units and playgrounds (Council Resolution 17-210, adopting Board of

Health regulation, effective August 12,2011)

2003

2011

F:\LAW\TOPICS\Smoking\History Of Smoking Laws Updated.DOC



Tobacco Use - Fact Sheet

American Cancer Society Great American Smokeout® 2012

• Tobacco use remains the single largest preventable cause of disease and premature

death in the United States.

i

• For every person who dies from a

smokin~-related

disease, 20 more people suffer with

at least one serious illness from smoking.

II

• In the US, tobacco use is responsible for nearly 1 in 5 deaths, or about 443,000

premature deaths each year.

I

• On average, smokers die 13 to 14 years earlier than nonsmokers.

iii

• The risk of developing lung cancer is about 23 times higher in male smokers and 13

times higher in female smokers, compared to lifelong nonsmokers.

i

• Tobacco use increases the risk of myeloid leukemia and cancers of the lung, mouth,

.nasal cavities, larynx, throat, esophagus, stomach, colorectum, liver, pancreas, kidney,

bladder, uterine cervix, and ovaries.

i

• Tobacco use accounts for at least 30% of all cancer deaths and 80% of lung cancer

deaths.i

• Thousands of young people begin smoking every day.iv

o Each day, more than 3,800 people younger than 18 smoke their first cigarette.

o Each day, about 1,000 people younger than 18 begin smoking on a daily basis.

• Cigars contain many of'the same carcinogens that are found in cigarettes. Cigar

smoking increases the risk of cancers of the lung, mouth, throat, larynx, esophagus, and'

probably the pancreas.

i

• Sales of little cigars increased by 240% from 1993 to 2007.

i

• Smokeless tobacco products are a major source of cancer-causing nitrosamines

(chemical compounds) and a known cause of human cancer. They increase the risk of

developing cancer of the mouth and throat, esophagus, and pancreas.

i

• Sales of smokeless tobacco products are growing at a more rapid pace than cigarettes.

While sales of cigarettes declined by 42% between 1990 and 2006, per capita sales of

smokeless products in the US nearly doubled.

i

Global Tobacco Use

•

In 2011, tobacco use killed almost 6 million people, with 80% of these deaths occurring

in low- and middle-income countries,i and current trends show that tobacco use will

cause more than 8 million deaths annually by

203g.

v

vi

• 43 trillion cigarettes have been smoked in the last decade.



• Smoking rates are increasing among women, particularly young women, in many

countries. Women and children account for 75% of the deaths caused by secondhand

smoke. vi

Costs and Expenditures

• Cigarette smoking costs the United States more than $193 billion (Le., $97 billion in lost

productivity plus $96 billion in health care expenditures). vii

• Secondhand smoke costs United States more than $10 billion (i.e., health care

expenditures, morbidity, and mortality).Viii

• The tobacco industry receives annual profits of almost $6,000 per death caused by

tobacco. vi

Smoking Cessation

• People who quit, at any age, live longer than people who continue to smoke.

i

• Smokers who quit before age 50 cut their risk of dying in the next 15 years in half,

compared to those who continue to smoke. i

• Large disparities in smoking prevalence and cessation continue to exist. Smokers with

an undergraduate or graduate degree are more likely to quit than those with less formal

education.i

• Many adult smokers want to quit smoking.

o Approximately 69% of smokers want to quit completely.

o Approximately 52% of smokers attempted to quit in 2010.

ix

Secondhand Smoke

• Secondhand smoke contains more than 7,000 chemicals, at least 69 of which cause

cancer.i

• Each year, about 3,400 nonsmoking adults die of lung cancer as a result of breathing

secondhand smoke.

i

• Secondhand smoke may cause coughing, wheezing, chest tightness, and reduced lung

function in adult nonsmokers.

i

i

American Cancer Society.

Cancer Facts

&

Figures 2012.

Atlanta: American Cancer Society; 2012.

ii

Centers for Disease Control and Prevention. Cigarette Smoking-Attributable Morbidity-United States, 2000. Morbidity and

Mortality Weekly Report 2003;52(35):842-4 [accessed 2012 Jun 7]).

iii

Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and

Productivity Losses-United States, 1995-1999. Morbidity and Mortality Weekly Report 2002;51(14):300--3 [accessed 2012 Jun

7].

iv

Substance Abuse and Mental Health Administration. Results from the 2010 National Survey on Drug Use and

r.:;)

Health: National Findings Rockville (MD): Office of Applied Studies [accessed 2012 Jun 7].

©



v

World Health Organization. WHO Report on the Global Tobacco Epidemic, 2009. Geneva: World Health Organization, 2008

[accessed 2012 Jun 7].

vi

Eriksen M, Mackay J, Ross H. The Tobacco Atlas. Fourth Ed. Atlanta, GA: American Cancer Society; New York, NY: World

Lung Foundation; 2012. Also available at www.TobaccoAtlas.org.

vii

Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity

Losses-United States, 2000-2004. Morbidity and Mortality Weekly Report 2008;57(45):1226-8 [accessed 2012 Jun 7].

Behan DF, Eriksen NIP, Lin Y. Economic Effects of Environmental Tobacco Smoke Report !§ISchaumburg, IL: Society of

Actuaries; 2005 [accessed 2012 Jun 7].

viii

ix

Centers for Disease Control and Prevention. Quitting Smoking Among Adults-United States, 2001-2010.

Morbidity and Mortality Weekly Report [serial online] 2011 ;60(44):1513-19 [accessed 2012 Jun 7].



CDC - Fact Sheet - Health Effects of Secondhand Smoke - Smoking ...

http://w.vw.cdc. gov Ito baccoldata_statistics/fact_sheets/secondhand_ ...

Centers for Disease Control and Prevention

CDC 24/7: Soving

Lives_ Protectfing

Peopte.""

---.--.----­

--"'--"-'--­

Health Effects of Secondhand Smoke

------,-----,---_._----_.­

•

•

•

•

OverviewC#overview)

Secondhand Smoke Causes Heart Disease (#heart)

Secondhand Smoke Causes Lung Cancer C#lung)

Secondhand Smoke Causes SIDS (#sids)

•

•

•

Secondhand Smoke and Children (#children)

References (#ref)

For Further Information C#info)

Overview

Secondhand smoke is the combination of smoke from the burning end of a cigarette and the

smoke breathed out by smokers. Secondhand smoke contains more than 7000 chemicals.

Hundreds are toxic and about 70 can cause cancer. 1

,2

There is no risk-free level of exposure to secondhand smoke.

Secondhand smoke

causes numerous health problems in infants and children, including severe asthma attacks,

respiratory infections, ear infections, and sudden infant death syndrome (SIDS).1 Some of the

health conditions caused by secondhand smoke in adults include heart disease and lung cancer.1

Secondhand Smoke Causes Heart Disease

Exposure to secondhand smoke has immediate adverse effects on the

cardiovascular system and can cause coronary heart disease.

1

,3

• Secondhand smoke causes an estimated 46,000 premature deaths from heart disease each

year in the United States among nonsmokers.4

• Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of

developing heart disease by 25-30%.1

@

10f5

,11114/20123:37 P,ry



DC - Fact Sheet - Health Effects of Secondhand Smoke - Smoking ...

http://www.cdc,gov/tobacco/data_statistics/fact_sheets/secondhand

_".!

Breathing secondhand smoke can have immediate adverse effects on your blood

and blood vessels, increasing the risk of having a heart

attac~.1,2

• Breathing secondhand smoke interferes with the normal functioning of the heart, blood, and

vascular systems in ways that increase the risk of having a heart attack.

• Even brief secondhand smoke exposure can damage the lining of blood vessels and cause

your blood platelets to become stickier. These changes can cause a deadly heart attack.

People who already have heart disease are at especially high risk of suffering

adverse effects from breathing secondhand smoke and should take special

precautions to avoid even brief exposures. 1

Secondhand Smoke Causes Lung Cancer

Secondhand smoke causes lung cancer in adults who themselves have never

smoked.1

• Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of

developing lung cancer by

20-30%.1

,

• Secondhand smoke causes an estimated

3,400

lung cancer deaths among U.S. nonsmokers

each year.

4,5

Nonsmokers who are exposed to secondhand smoke are inhaling many of the same

cancer-causing substances and poisons as smokers. 1,2

• Secondhand smoke contains about

70

cancer-causing chemicals.

• Even brief secondhand smoke exposure can damage cells in ways that set the cancer process

in motion.

• As

with active smoking, the longer the duration and the higher the level of exposure to

secondhand smoke, the greater the risk of developing lung cancer.

Secondhand Smoke Causes SIDS

SIDS is the sudden, unexplained, unexpected death of an infant in the first year of

life. SIDS is the leading cause of death in otherwise healthy infants.6 Secondhand

smoke increases the risk for SIDS.1

• Smoking by women during pregnancy increases the risk for SIDS.7

• Infants who are exposed to secondhand smoke after birth are also at greater risk for SIDS'b

• Chemicals in secondhand smoke appear to affect the brain in ways that interfere with its

~

regulation of infants' breathing.

1

• Infants who die from SIDS have higher concentrations of nicotine in their lungs and higher

of5

11/14/20123:37 PM



CDC - Fact Sheet - Health Effects of Secondhand Smoke - Smoking ...

http://www.cdc

.gov

Ito

baccoldata_ statistics/fact_

sheetsl

secondhand_...

levels of cotinine (a biological marker for secondhand smoke exposure) than infants who die

from other causes.

1

Parents can help protect their babies from SIDS by taking the following three

actions:

8

• Do not smoke when pregnant.

• Do not smoke in the home or around the baby.

• Put the baby down to sleep on its back.

Secondhand Smoke and Children

Secondhand smoke can cause serious health problems in children.

9

• Studies show that older children whose parents smoke get sick more often. Their

lun~s

grow

less than children who do not breathe secondhand smoke, and they get more bronchItis and

pneumonia.

• Wheezing and coughing are more common in children who breathe secondhand smoke.

• Secondhand smoke can trigger an asthma attack in a child. Children with asthma who are

around secondhand smoke have more severe and frequent asthma attacks. A severe asthma

attack can put a child's life in danger.

• Children whose parents smoke around them get more ear infections. They also have fluid in

their ears more often and have more operations to put in ear tubes for drainage.

Parents can help protect their children from secondhand smoke by taking the

. following actions:

9

• Do not allow anyone to smoke near your child.

• Do not smoke or allow others to smoke in your home or car. Opening a window does not

protect your children from smoke.

.

• Use a smoke-free day care center.

• Do not take your child to restaurants or other indoor public places that allow smoking.

• Teach children to stay away from secondhand smoke.

References

1.

u.s.

Department of Health and Human Services.

The Health Consequences of

Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General

(/tobacco{data statistics/sgrfsgr 2oo6/index.htm).

Atlanta: U.S. Department of Health

and Human Services, Centers for Disease Control and Prevention, Coordinating Center for

Health Promotion, National Center for Chronic Disease Prevention and Health Promotion,

Office on Smoking and Health,

2006

[accessed

2011

Mar

11].

!'fl\

2.

U.S. Department of Health and Human Services.

A Report ofthe Surgeon General:

How Tobacco Smoke Causes Disease: What

It

Means to You Utobacco

{data statistics/sgrI201o/consumer booklet/index.htm).

Atlanta: U.S. Department of

v

30f5

11114/2012

3:37

p~



DC - Fact Sheet - Health Effects of Secondhand Smoke - Smoking ...

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_ ... ;

Health and Human Services, Centers for Disease Control and Prevention, National Center

for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010

[accessed 2011 Mar 11].

3. Institute of Medicine.

Secondhand Smoke Exposure and Cardiovascular Effects:

Making Sense of the Evidence

(http://www.iom.edu/-/media/Files/Report%2oFiles

/2oo9/Secondhand-Smoke-Exposure-and-Cardiovascular-Effects-Making-Sel

e­

~4! .1.~ "Uy"':..I~-~"!/Secondhand%2oSmoke%2o%2oReport%2oBrief%203.pdf)

@

(PDF-707.47 KB).

Washington: National Academy of Sciences, Institute of Medicine, 2009

[accessed 2011 Mar 11].

4. Centers for Disease Control and Prevention.

Smoking-Attributable Mortality, Years

of Potential Life Lost, and Productivity Losses-United States,

2000-2004

(http://www.cdc.gov/mmwrLPreview/mmwrhtmlbnlIl574sa3.htm) .

Morbidity and

Mortality Weekly Report 2008;57(45):1226-8 [accessed 2011 Mar 11].

5. American Cancer Society.

Cancer Facts and Figures

2009

(http://www.,

1~~

...

/groups/contentl@nho/documentsldocument/500809webpdf.pdf)@.

(PDF-l·7

MB)

Atlanta: American Cancer Society, 2009 [cited 2011 Mar 11].

6. American Academy of Pediatrics, Task Force on Sudden Infant Death Syndrome.

The

Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding

Shifts; Controversies Regarding the Sleeping Environment; and New Variables

to Consider in Reducing Risk.

Pediatrics 2005;116(5):1245-55 [cited 2011 Mar 11].

7. U.S. Department of Health and Human Services.

The Health Consequences of

Smoking: A Report of the Surgeon General

(/tobacco/data statistics

Isgr/sgr 2oo4/index.htm).

Atlanta: 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, 2004 [accessed 2011

Maru].

,

8. National Institutes of Health.

Safe Sleep for Your Baby: Ten Ways to Reduce the

Risk of Sudden Infant Death Syndrome (SIDS)

Orttp:/lwww.nichd.nih.gov

lpublicationsLPubs/safe sleep gen.cfml@.

Rockville (MD): National Institutes of

Health, National Institute of Child Health and Human Development, 2003 [accessed 2011

Mar 11].

. 9. U.S. Department of Health and Human Services.

The Health Consequences of

Involuntary Ex;posure to Tobacco Smoke: A Report of the Surgeon General:

Secondhand Smoke: What

It

Means To You.

(http "

~eneral.gov

llibrary/secondhandsmoke/secondhandsmoke.pdf)

@.

(PDF-l1.05 MB)

Atlanta: 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 [accessed 2011 Mar 11].

For Further Information

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Office on Smoking and Health

E-mail: tobaccoinfo@cdc.gov

Crnailto:tobaccoinfo@cdc.gov)

Phone: 1-800-CDC-INFO

Media Inquiries: Contact CDC's Office on Smoking and Health press line at 770-488-5493.

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11114/20123:37

PM



OFFICE OF MANAGEMENT AND BUDGET

lsiah Leggett

County Executive

Jennifer

A.

Hughes

Director

MEMORANDUM

December 13,2012

TO:

FROM:

Nancy Navarro, President County Council

1ennifer

A.

Office of Manage

Joseph F.

Beach~:eHrector,

Department of Finance

HUgh.~ector)

....:::.::;;;.j-...:r;.___..

\

SUBJECT:

Council Bill 33-12, Health and Sanitation - Smoking-County

Please find attached the fiscal and economic impact statements for the above-referenced

legislation,

1AH:a2a

c: Kathleen Boucher, Assistant Chief Administrative Officer

Lisa Austin, Offices of the County Executive

Joy Nurmi, Special Assistant to the County Executive

Patrick Lacefield, Director, Public hlformation Office

Joseph F. Beach, Director, Department of Finance

Michael Coveyou, Department of Finance

David Platt, Department of Finance

Vma Ahluwalia, Director, Department of Health and Human Services

Clark Beil, Department of Health and Human Services

Pat Brennan, Department ofHealth and Human Services

Lisa Stafford, Department of Health and Human Services

Pofen Salem, Office of Management 'and Budget

Ayo Apollon, Office of Mallagement and Budget

Office ofthe Director

101 Monroe Street. 14th Floor • Rockville. Maryland 20850 • 240-777-2800

www.montgomerycountymd.gov

mon...

me""~U"_d,goV/311.

@

240-773-.... TTY



Fiscal Impact Statement

Council Bill 33-12, Health and Sanitation - Smoking-County

1. Legislative Summary.

This bill would prohibit smoking on property owned or leased by the County,

excluding County rights-of-way, thus reducing employees' and visitors' exposure to

second hand smoke.

2. An estimate of changes in County revenues and expenditures regardless of whether the

revenues or expenditures are assumed

in

the recommended or approved budget. Includes

source of information, assumptions, and methodologies used.

No increase in revenues due to the difficulty of enforcing immediate violations of the

law.

Expenditures are difficult to estimate due to the unknown number of

complaints that might be received. Due to the large number of County properties

affected by this legislation there could be initially a large number of complaints.

Both County Police and HHS have authority to investigate complaints and to issue

citations for violations of Section 24-9 and 24-9Aof the County Code. Under current

regulation, violations by county employees are reported to immediate supervisors.

Continued violations are reported to L&R, anell then forwarded to appropriate

Department director and CAO.

It

is

unclear bow violations by visitors to County

facilities

will

be managed.

Licensure and Regulatory Services estimates three complaints per week for the Urst

year of enforcement. Estimating one hour of investigation and enforcement labor

for each complaint at $50.00 per hour the Urst year expenditure for public health

labor would be $7,800. Employee training and education is estimated at $3,450 (see

item 6). Total expenditures are estimated to be approximately $11,250 for the first

year. There maybe additional cost associated with public outreach and signage at

all County leased and owned properties. However these expenditures would depend

on later budget decisions.

3. Revenue and expenditure estimates covering at least the next 6 fiscal years.

As observed with other smoking regulations that have been passed, the Urst year of

enforcement tends to be the most labor intensive. Subsequent years are difficult to

anticipate but estimated to be

%

of the initial year expenditure or $1,950 per year.

4. An actuarial analysis through the enth'e amortization period for each bill that would affect

retiree pension or group insurance costs.

N/A



5. Later actions that may affect future revenue and expenditures if the bill authorizes future

spending.

N/A

6.

An

estimate of the stafftime needed to implement the bill.

It

is difficult to accurately estimate the staff training, education and development of

inspection procedures. This office estimates 3 hours training and public outreach

for each employee at $50 per hour for 23 employees is $3,450.

7.

An

explanation of how the addition of new staff responsibilities would affect other duties.

Investigation of complaints at County properties during normal work hours will

reduce the number of other state mandated inspections that would be completed.

Currently L&R is only able to complete approximately 75% of total mandated

inspections. That percentage will drop further-perhaps by 1-2%--given increased

enforcements duties assigned to L&R in recent legislation-e.g., defibrillators at

community pools, smoking bans in multi-unit buildings and playgrounds. In

addition staff may be required to flex time off during normal work hours to avoid

overtime if after hours or weekend investigations are required, further reducing the

ability to fulfi11 regular inspection duties.

8.

An

estimate of costs when an additional appropriation is needed.

N/A

9. A description of any variable that could affect revenue and cost estimates.

The number of complaints and the time required to investigate and enforce is highly

unpredictable.

10. Ranges ofrevenue or expenditures that are uncertain or difficult to project.

Labor costs associated with implementation and enforcement

is

difficult to

project.

11. If a bill is likely to have no fiscal impact, why that is the case.

N/A

12. Other fiscal impacts or comments.

N/A

13. The following contributed to and concurred with this analysis: (Enter name and

departm.ent).

Clark Beil, Department of Health & Human Services (DHHS)

Pat Brennan, DHHS

Lisa Stafford, DHHS



Economic Impact Statement

Council Bill 33-12, Health and Sanitation - Smoking - County Property

Background:

Bill 33-12 prohibits smoking on or in property owned or leased by the County-it

excepts County right of way from this prohibition.

1. The sources of information, assumptions, and methodologies used.

"The Economic Impact of Michigan's Dr. Ron Davis Smoke Free Air Law: A Report to

the Michigan Department of Community Health;" Helen Levy, PhD, Institute for Social

Research at the University of Michigan, August 6, 2012.

Federal Reserve Bank of St. Louis Regional Economic Development, VoL 2 Number 2,

2006: "On the Economic Analysis of Smoking Bans" by Michael R. Pakko (St. Louis

Fed)

"Review of Economic Studies on Smoking Bans

in

Bars and Restaurants" Information

Brief for the Minnesota House of Representatives, by the MHOR's Research

Department (March 2006)

2. A description of any variable that could affect economic impact statements.

See #3 below.

3. The bill's positive or negative effect, if any on employment, spending, saving,

investment, incomes, and property value in the County.

This bill has no measurable economic impact. The most recent study is from the Institute

for Social Research at the University of Michigan which conducted a study of the two

year old smoking ban enacted by the State of Michigan and found "no significant

negative effect of the ban on aggregate bar and restaurant sales or on cigarette sales."

(The ban was on smoking in the workplace, not just at bars and restaurants). The study

concludes that "the evidence is consistent with the results of studies from other state and

localities that have found no significant negative economic effects associated with

smoking bans.

4.

If

a bill is likely to have no economic impact, why is that the case?

See #3 above.



Economic]mpact Statement

Council Bill 33-12, Health and Sanitation - Smoking - County Property

5. The following contributed to and concurred

with

this analysis: David Platt and Mike

Coveyou, Finance.

. Beach,

Director

~rumment

of Finance

Date

r'-foz,/Iz­

I