Many local health directors unsure of authority to curtail smoking

Local health department directors across North Carolina are confused about state laws covering whether their facilities can be made smoke-free, but still strongly support such policies, according to a new University of North Carolina at Chapel Hill study.

The UNC schools of medicine and public health research showed that a majority of the directors were unsure or did not think they could enact tobacco-free policies on health department grounds.

In response to the confusion, North Carolina's Association of Local Health Directors worked with the N.C. General Assembly to amend state law this year enabling local health departments to implement more stringent policies, including eliminating smoking outside health department buildings.

Such policies are important since studies have proven that secondhand smoke can increase the likelihood of lung cancer, asthma attacks, heart disease and numerous other serious illnesses, scientists say.

"Almost a third of states operate under a tobacco industry standard limiting local governments from passing comprehensive smoke-free laws," said Dr. Adam O. Goldstein, associate professor of family medicine. "North Carolina has such 'preemptive' legislation, but exceptions exist, including local health departments, which can and should take the lead in setting a good example about making the workplace healthier.

"Our study showed that that extensive confusion existed among local health department directors about this exception, with 37 percent believing they were prohibited from enacting a 100 percent smoke-free policy on health department grounds," Goldstein said. "Another 20 percent did not know whether they were prohibited."

While smoking was forbidden in almost all indoor environments, it was allowed in more than 20 per cent of local health department vehicles, at more than 57 percent of departmental social events, at more than 74 percent of outdoor walkways and loading docks and more than 78 percent of entrances and exits, the physician said. Only one local health department was completely tobacco-free. A report on the study appears in the July 8 issue of the Morbidity and Mortality Weekly Report, a publication of the U.S. Centers for Disease Control and Prevention.

Other authors are staff members Caroline Gray and Annie Butzen and Dr. Kurt M. Ribisl, assistant professor of health education and health behavior.

The study involved surveying by telephone 76 of North Carolina's 85 local health directors in the summer of 2003. Questions related to their knowledge and opinions about the effects of exposure to secondhand smoke; state legislation about smoking in public places; tobacco-use policies, enforcement provisions and availability of smoking-cessation support services for employees; health department employee-support for a 100 percent smoke-free policy and other issues.

Visitors to the departments ranged from 3,000 per year to 400,000 and averaged 20,000.

The survey also showed that local N.C. health department directors said more than 85 percent of their employees would support totally tobacco-free worksites.

"The time is right now for renewed public health leadership across North Carolina and the rest of the country to take full advantage of exceptions to preemptive 'clean air' laws," Goldstein said. "To protect public health, states should repeal bad tobacco industry sponsored clean air bills, should expand exceptions to such laws and should ensure that public health advocates take full advantage of all exceptions."