The Journey to Smoke Free

1
The Journey to Smoke Free

• Presented by
• Gayle Harris, MPH, RN
• April 26, 2012

2
Objectives

• Provide a summary of the Durham County experience
• Discuss lessons learned

3
The BeginningAnticipation of a Move
4
an Enclosed Courtyard
5
a Parking Lot with 404 Spaces
6
The Journey

• Concept presented to BOH on July 8, 2010
• Occupancy of new facility to begin in 2011
• Department directors desired smoke-free policy
• Policy to cover county property on two city
  blocks
• Request from Duke University Hospital in
  September 2010

7
a Sidewalk in Front of a Hospital
8
The Journey

• BOH meeting September 2010
• Introduction of request from Duke
• Presentation by Sally Herndon
• HB 2 clause that allows BOH to establish
  stricter rules
• Statewide compliance with HB -2 in bars and
  restaurants
• Services available from Tobacco Prevention and
  Control Branch
• Boards concern regarding authority to take
  smoking rights away from citizens

9
The Journey

• BOH meeting in November 2010
• Introduction of Friedens Health Impact Pyramid

10
(No Transcript)
11
The Journey

• BOH meeting in November 2010
• Friedens Health Impact Pyramid
• Draft Rule
• Regulation of Smoking and the use of Other
  Tobacco Products in Durham County Health
  Department buildings, on Durham County Health
  Department grounds, in The Durham Center, on the
  Durham Center Grounds, in Healthcare Facilities,
  in Veterinary Offices, in Pharmacies, in City or
  County Bus stops and on Abutting Sidewalks
• Discussion and lots of it
• Subcommittee appointed
• Inclusion of other public places

12
The Journey

• BOH meeting January May 2011
• Board discussions to refine the proposed Rule
• Decision to hold a written public comment period

13
The Journey

• May 2011
• Written public comment period (May 16th
  June15th) advertised
• Links to the Rule and CDCs website (How Tobacco
  Smoke Causes Death and Facts about Tobacco
  Smoke and How It Impacts Your Health) posted on
  website.
• Mailing and e-mail addresses posted on website
• Newspaper article (Ban Smoking in Public?) and
  story on blog site (County health department
  proposes outdoor smoking restrictions)

14
The Journey

• BOH meeting in July 2011
• Public comments reviewed
• Subcommittee to reconvene to consider impact of
  comments
• BOH meeting in August 2011
• Subcommittee reports no changes to Rule
• Proposed amended Ordinance presented
• Mock-up of proposed signage and educational
  tools, budget, and Awareness Campaign presented

15
The Journey

• Presentations to Elected Officials
• - November 15th Joint City County Meeting
• - November 22nd City Council Worksession
• - December 5th BOCC Worksession
• Official comments from City staff via City
  Manager
• Agreed to make entire park system and shelters at
  bus stops smoke-free
• Did not agree with authority to address sidewalk
  maintained by the City in State right-of-way
• Recommended an enforcement strategy with
  designated staff rather than involving law
  enforcement

16
The Journey

• BOH Subcommittee reconvened in December 2011 to
  consider feedback received and made adjustments
  to the Rule.
• BOH meeting in January 2012 changes to Rule
  approved.
• Individual meetings held with BOCC members to
  review the changes (January 18th 19th)

17
NC GS 130A-498
Local governments may restrict smoking in public
places. (a)        Except as otherwise provided
in subsection (b1) of this section, and
notwithstanding any other provision of Article 64
of Chapter 143 of the General Statutes to the
contrary, a local government may adopt and
enforce ordinances, board of health rules, and
policies restricting or prohibiting smoking that
are more restrictive than State law and that
apply in local government buildings, on local
government grounds, in local vehicles, or in
public places. A rule or policy adopted on and
after July 1, 2009 pursuant to this subsection by
a local board of health or an entity exercising
the powers of a local board of health must be
approved by an ordinance adopted by the Board of
County Commissioners of the county to which the
rule applies. The definitions set forth in G.S.
130A-492 in Part 1A of this Article apply to this
section and shall apply to any local ordinance,
rule, or law adopted by a local government under
this section.
18
A Last Minute Wrinkle

• (e)        A county ordinance adopted under this
  section is subject to the provisions of G.S.
  153A-122.  (2007-193, ss. 2, 3.1 2007-484, s.
  31.7 2008-95, s. 1 2008-149, s. 4 2009-27, s.
  1.)

19
A New Beginning

• February 13, 2012 BOCC regular meeting
• The Board adopted the Board of Health Smoking
  Rule with an effective date of August 1, 2012

20

• Smokers worlds are shrinking, yet again, and it
  happened in Durham without so much as a raised
  eyebrow. That in and of itself may be a sign that
  we have reached a tipping point in our city in
  the anti-smoking movementWe applaud the County
  Commissioners unanimous support of the
  measureWere glad commissioners have made it a
  smaller world.
• The Herald-Sun
• February 15, 2012

21
(No Transcript)
22
Lessons Learned

• Where you start is just that where you start.
• This is an iterative process.
• Use all available resources.
• Communication and education are key components in
  the process.