Policy Options to Promote Smokefree Environments for Children and Adolescents Karla S. Bartholomew, PhD, JD, MPH, PA

Foreword: Policy Options to Promote Smokefree Environments for Children and Adolescents In this issue, Dr. Karla Bartholomew provides a comprehensive summary of policy options to promote smokefree environments for children and adolescents.1

An important policy option that has been implemented in many places is the smokefree air law. Figure 1 shows the 100% smokefree air laws in the United States as of April 2015.2 Although

Fig. 1

Curr Probl PediatrAdolesc Health Care, June 2015

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significant progress has been made in protecting individuals in workplaces, bars, and restaurants, many children and adolescents are still exposed to secondhand smoke in other places including their homes, cars, and public venues. In addition to secondhand cigarette smoke, children and adolescents may be exposed to the vapor from electronic cigarettes (e-cigarettes). Most local and state smokefree laws were enacted before e-cigarettes were sold, so often, they do not explicitly mention e-cigarettes. Another of the many important policy options that can reduce children’s exposure to secondhand smoke is smokefree policies in subsidized and public housing. In 2014, scientists at the Centers for Disease Control and Prevention estimated that the total cost savings nationally that

could result from implementing smokefree policies in subsidized and public housing in the United States could reach approximately $500 million annually, including $310 million in related health care expenses, $133 million in renovation costs, and $53 million in fire losses.3 When examined by state, cost savings ranged from $0.58 million in Wyoming to $124.68 million in New York. Prohibiting smoking in public housing alone would yield cost savings of $152.91 million; by state, total cost savings ranged from $0.13 million in Wyoming to $57.77 million in New York. As of April 2015, at least 306 local housing authorities in 27 states had adopted smokefree policies in private units of multi-unit housing.4 Actions have also been taken by 5 state housing authorities to adopt smokefree policies. The

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Curr Probl Pediatr Adolesc Health Care, June 2015

Delaware State Housing Authority prohibits smoking in all units of all buildings it owns and manages as of October 1, 2013. MaineHousing, the State Housing Authority, prohibits smoking in all units of all buildings built and financed by the state’s Low Income Housing Tax Credit program as of 2013. Hawaii prohibits smoking in all units of all buildings under the jurisdiction of the Hawaii Public Housing Authority as of June 16, 2014. The North Carolina Housing Finance Agency requires buildings that receive tax credits through their program have a smokefree policy as of 2015. The Montana Board of Housing will require that buildings funded through their state housing finance agency have a smokefree policy as of 2016. As the use of e-cigarettes has risen, some states have enacted laws specifically restricting the use of e-cigarettes in smokefree venues. Figure 2 shows state and local laws in the United States regulating the use of e-cigarettes.5 As of April 2015, state laws restricting e-cigarette use in 100% smokefree venues were currently in effect in 3 states. State laws restricting e-cigarette use in other venues were currently in effect in 18 states. Local laws restricting e-cigarette use in 100% smokefree venues were

Curr Probl PediatrAdolesc Health Care, June 2015

currently in effect in 354 localities. In addition, 186 local laws restricted e-cigarette use in other venues. Many other states are planning further actions to protect children and adolescents from e-cigarettes. Dr. Bartholomew offers excellent guidance for consideration by both pediatric providers and policymakers interested in primary prevention.

References 1. Bartholomew KJ. Policy options to promote smokefree environments for children and adolescents. Curr Probl Pediatr Adolesc Health Care 2015;45(7):170–205. 2. U.S. 100% smokefree air laws. Berkeley, CA: Americans for Nonsmokers Rights Foundation; 2015. http://www.no-smoke. org/pdf/100map.pdf. 3. King BA, Peck RM, Babb SD. National and state cost savings associated with prohibiting smoking in subsidized and public housing in the United States. Prev Chronic Dis 2014;11: 140222, http://dx.doi.org/10.5888/pcd11.140222. 4. US local laws and policies restricting or prohibiting smoking in private units of multi-unit housing. Berkeley, CA: Americans for Nonsmokers Rights Foundation; 2015. http://www.no-smoke. org/pdf/smokefreemuh.pdf. 5. U.S. State and Local Laws Regulating Use of Electronic Cigarettes. Berkeley, CA: Americans for Nonsmokers Rights Foundation; 2015. http://www.no-smoke.org/pdf/ecigslaws.pdf.

Ruth A. Etzel, MD, PhD Associate Editor

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Foreword: Policy Options to Promote Smokefree Environments for Children and Adolescents.

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