Exemptions to Arkansas' clean indoor air law of 2006 and evidence of an unjustified hazard at Arkansas' racinos.

In spring of 2006 the Arkansas Legislature passed a very weak clean indoor air law protecting many from the hazards of secondhand smoke (SHS). Notable exemptions to the health and safety standards mandated by the legislature were given to the gaming floors of any franchisee of the Arkansas Gaming Commission at Oaklawn and Southland Parks. SHS was then, and still is, the third leading cause of preventable death in Arkansas.  By autumn of 2006 the California EPA had classified SHS as a Toxic Air Contaminant and a federal court had convicted the tobacco industry of racketeering and fraud for, among several things, 5 decades of deceit and manipulation of public opinion about the hazards of smoking and SHS.

The Journal of the Arkansas Medical Society (JAMS) published in November a paper documenting research I did on the air quality at Oaklawn and Southland during spring of 2014.  Sampling of fine particulates in interior areas at both venues greatly exceeded the Environmental Protection Agency’s standard for daily exposure for outside air.  Workers and visitors to Southland endure up to 800% of the EPA’s safe daily standard.  Levels at Oaklawn were up to 400% of the threshold for safety.  Oaklawn is the only business in the state that exposes children to SHS.  A video documenting this research is linked here.  The JAMS article is linked here.

Special thanks are due to the Arkansas Cancer Coalition, the Arkansas Department of Health Tobacco Prevention and Education Branch, and a litany of sophisticated and knowledgable co-authors.

Primary to rectifying the many flaws in the 2006 law is addressing the failure to protect all individuals from SHS. We do not lose the right to breathe at 21. The data from this pilot study should be disseminated widely. It is well time for policy makers to recognize their responsibility to the public health. The risk of death from cancer or heart disease should never be a condition of employment or patronage. 

As the Worm Turns...

Life was so simple when the only thing tobacco free advocates had to deal with were the petty interpersonal politics of unqualified bureaucrats and ill educated political sycophants accidentally undermining challenges to the tobacco industry. This was infuriating when we imagined we were all on the same side.  Over a decade of advocacy makes me a novice compared to many.  But what sincere tobacco free advocates are dealing with today in Arkansas is completely new.  We were alarmed that tea bagger conservatives had taken over the ledge in the last session.  But, and I count myself among the naive, we had no idea what having a pro tobacco executive could do to evidence based tobacco prevention. 

We see what little regard this legislative and executive body has for human rights re education, race, women's rights, and LGBT issues.  Why did we imagine that tobacco control might actually fly under the radar?  Hell, I was just hoping.

Thus far the damage has been minimal but what I hear from the periphery of tobacco free advocacy near the Arkansas Department of Health is that actual tobacco free policy change is strictly verboten within the bureaucratic and financial arms of this administration’s Arkansas Department of Health. If you smell something rotten in Denmark, he said being sophomoric and cute, it is tobacco smoke.

I had great hopes that Mr. Hutchinson’s pro tobacco tenure would be tempered by his defeat in the Senate race years ago.  As if the accusations of being big tobacco’s pawn would humble or at least slow down pro tobacco advocacy as Governor today.  Apparently that was just wrong as shit.  I say this watching the obviously tobacco industry bill (SB978) dealing with Electronic Nicotine Delivery Systems sailing through the bowels of the legislature.  Egregious as the language is in the bill, the most offensive note is an amendment by Central Arkansas’ Douglas House that preempts any local control for stronger pubic health efforts.  Challenging preemption is Tobacco Free 101.

And if that wasn’t bad enough, the Arkansas Department of Health’s Tobacco Prevention Cessation Program is cricket silent about a bill that can detract from decades of tobacco free efforts and hinder decades more. The few people  that will actually talk to me tell me that ADH not only does not oppose the bill they ask that TPCP grantees essentially shut the fuck up. Just pretend we are all back in Kansas. Of course, that’s a bad analogy too.

I do not know many more people in tobacco prevention that I respect more than TPCP’s medical authority, Dr. Gary Wheeler. And I know this gentleman must be grappling with his conscience now. The potential bargains pressed upon sincere public health advocates to surrender tobacco free challenges scare the hell out of me for things to come. 

The visigoths are upon the gates. Save your sword for one last self inflicted wound.

SB978 was written by the nicotine industry. If I’m not around,  please someone document these crimes. Thanks.

Personal Ambition, Tobacco Prevention in Arkansas

A little knowledge is a dangerous thing.  I started trying to find out WTF was going on within Arkansas Department of Health TPCP issues.  Long time advocates were being edged out.  Given the revolving door for ADH employees and community grantees the institutional memory of tobacco prevention was being put at serious risk.

Snot the first time.  

Years ago functionaries within the Arkansas Cancer Society and the Arkansas Heart Association did their royal best to wrest ADH funding from the Coalition for a Tobacco Free Arkansas.  I recall former CTFA Chair, Dr.Caesar Compadre, laughingly talk about his first issue w CTFA was a motion to dissolve the coalition. Fortunately this bizarre coup was thwarted.

Unfortunately, the pettiness of some individuals involved, at w least tobacco, still seems the take away. Recently the bureaucracy within ADH has gone out of their way to alienate and de-fund the two statewide coalitions, the Coalition for a Tobacco Free Arkansas and the Youth Extinguishing Smoking Teams.  Both CTFA and the fiduciary for YES teams have declined to re-apply for restrictive and micro managed grant opportunities. Couple this w an ADH request for proposals for a statewide coalition that both CTFA and the YES people have been encouraged to ignore and one can see a very focused attack on the two most effective coalitions, and individuals, in the state.

A sincere tobacco free advocate has to ask, “Why?”

In 2003 the very first real lesson tobacco free advocates in Arkansas learned was that there must be a distinct separation between the tobacco free lobbyist and the tobacco free advocate.  At one level this is a matter of simple semantics. At another it is bureaucratic and ineffectual neurosis.

There is bullshit going on within the Arkansas Department of Health and those ostensibly working as public health advocates that truly stinks of pettiness, ambition, and personal gratification. Unfortunately, this comes at an inopportune time for  tobacco free advocates. We should not be fighting among ourselves now. We should be educating policy makers up and down a legislature dominated by right wing de-regulation anti public health zealots.

Funny how long time tobacco (free) lobbyists do so little of that.

I am always open for queries and conversation.

Project Prevent, My Reason to Write

How many years has the Arkansas Department of Health spent toiling away to find easy to swallow cessation and youth education campaigns?  Neither of which will have the impact that evidence based efforts to de-normalize tobacco use have.  And most recently the Tobacco Prevention and Cessation Program has announced the latest winners for their Project Prevent essay contest. Well, let loose the under inflated balloons. 

Of all the winners of all the age groups none mentioned the tobacco industry.  Only one made reference to the manufacturers of cigarettes boosting nicotine.  A short look at the web page clearly indicates that marketing strategies targeting youth were clearly emphasized.  Well, where was that emphasis rewarded by recognition and awards?

The kids that wrote these essays aren’t gonna be smokers.  They can spell and their syntax is fairly cogent. They pay attention in class.  The young people who are at risk are on the scholastic periphery and an essay contest is maybe one of the most ineffective means of affecting their behavior. The sorts of things that are evidence based to reduce youth initiation are policy changes that challenge the tobacco industry; policies that denormalize tobacco use, taxes, tobacco free space, marketing reform. And here’s the rub. Unless you recruit young people to advocate for these policies their involvement is wasted.  Every science class they’ve taken tells them that tobacco is gonna kill them. But until they are savvied to the fact that someone is playing them for a mark, efforts miss the mark. And unless they become politically involved in policy change they are also misled and disenfranchised in any effort at reducing tobacco prevalence. 

So what we have here with Project Prevent is an activity that not only does not prevent tobacco use it wastes the effort of those youth who might well be engaged in evidence based effective prevention. Local grantees get to say, Woo Hoo! We got the local kid in the paper.  ADH gets to say, Look, a kid in the paper!  But at no point does anyone get to say that this is making a difference in itself.  Good press is good press, but unless there is advocacy for underlying policy change you’re just spending the money. And for far too long TPCP and too many grantees have hoisted a Mission Accomplished banner when the money gets spent. 

Sincere tobacco free advocates need to demand that Settlement funds be spent efficiently to reduce prevalence.  Easy tripe like youth essays have limited value in this endeavor.

Maybe there's a reason ADH has tobacco prevention in the basement.

I really don’t keep up w too much of ADH politics for a couple of reasons.  One is because I no longer volunteer for a local community tobacco prevention coalition.  The other is because it fairly typically makes me ill.

Such is the case learning that the 2015 RFPs for tobacco prevention have tweaked themselves to not only demand ownership of all work product and materials, (That really grates on an unpaid media volunteer) but also has dismissed the Coalition for a Tobacco Free Arkansas and the youth YES teams to find some party they can control as one entity. 

First, for as long as I have had any understanding of the MSA funding for which pittance is still left for actual tobacco prevention there has been a need for a distinct legal separation between lobbying and advocacy. It has always been the tactic, in Arkansas since ethics complaints in Fayetteville in 2004, for pro- tobacco forces to claim state funds were used to lobby for policy change.  Since then tobacco free challenges have made great effort to distance advocacy from lobbying.  I was there in Fayetteville when Dr. David Bourne suggested that advocates abridge their freedom to speak when Huckabee was threatening to pull ADH funding for tobacco prevention. This is the point of having a statewide coalition keeping accounting that distinguish lobbying efforts from any ADH funding. That degree of separation is integral to making policy change efforts immune to industry, and significantly legislative complaints, that public money was used to lobby. Policy change is essential to actual population based measured tobacco free change.

Like I said, I dunno what is going on within TPCP but it does not portend much tobacco free success and has the potential of discarding years of sincere educated and sophisticated advocacy protecting Arkansas’ dedication of MSA dollars. Micro managing organizations that have worked hand in glove with previous TPCP bureacrats neglects a tremendous learning curve that the tobacco industry depends on.

We expect more from the Arkansas Department of Health than petty politics but unfortunately, at least when it concerns tobacco, that has not been the case.

ADH Insults Tobacco Prevention Advocacy

I’ve had issues w the Arkansas Department of Health for about as long as I’ve known anyone associated. I’ve met some of the most insincere and self serving bureaucrats known to humanity working, ostensibly, toward tobacco prevention. That said, I’ve also known some of the most dedicated and committed individuals you could imagine.  The Tobacco Prevention and Cessation Program, with a few notable exceptions, has enjoyed talent and sincere advocacy.  Somehow they seem to move right along to other issues with too much frequency. 

Tobacco use is the leading cause of preventable death in the U.S. and in Arkansas.  The tobacco industry is responsible for the leading risk factors for heart disease, stroke, and lung disease. 90% of lung cancer is due to cigarette smoking killing more than the next top three cancer killers combined.  Tobacco kills.  Got that?

This week, I had the unfortunate opportunity to visit the Tobacco Prevention and Cessation Program’s offices. I had proposed to the Arkansas Cancer Coalition and was funded for a small grant to do air quality monitoring for a couple of the significant exemptions to Arkansas’ Clean Indoor Air Act of 2006. This was dependent on collaboration w the use of TPCP’s SidePak pm2.5 air monitors and damned if the device, that was actually purchased new for this venture, failed to work properly. Much to my disappointment I had to touch base w Debbie Rushing and lay the repair or replacement of this device on her table.  I have to say that she and Dr. Gary Wheeler have been more than supportive for my proposed activity.  Advocates need this kind of data to rectify our lame assed clean indoor air law.  And Gary and Debbie are both savvy and honest enough to admit it.

Enough about my complaining.  I had to return the SidePak.  This was my heuristic experience.  The last time I’d been to the TPCP offices was to meet Michael Johnson with the Rand Institute upstairs to discuss grantee evaluation about 2004.  The office was bustling with folks upstairs a in corner office space filled with windows.  Brochures and educational materials, were stacked in the hallways. 

On Monday I limped to the top of the exterior stairs to the main ADH security desk to return the SidePak.  The guard had to look up on his computer to discover where the TPCP offices were. “They are in the basement,” he said.  I took the elevator down into a short corridor with janitorial offices.  I could see stacks of paper towels in door windows.  I went back upstairs and a new police guy said I had to go through the double doors marked “No Admittance.”  I went back down and fortunately caught some gentleman to ask how to find the Tobacco Prevention offices and let me through.  He told me to follow him through the double door onto a loading dock and out through another.  He said the Tobacco Prevention office was down the hall and to the left.  I thanked him.  Stumbling down the hallway I found the TPCP sign on a door.  Inside, was a relatively empty roomful of cubicles, no reception.  Making my way to Ms. Rushing’s office I heard what makes her my hero for today speaking to the TSI SidePak people on the phone.  “And so, as a good customer service representative, what are you going to do for me?”  This after the failure of an unused, expensive, device.

Debbie, I apologize for adding to your workload.

My issue is that the Arkansas Department of Health literally has buried the people burdened with challenging the leading cause of death and disease in the basement. 

But wait there’s more!  I left Debbie on the phone with whatever cretin at TSI who may or may not make things right.  They sure won’t make the three days right I sat in smoke filled space at a horse track to get data. The notable thing here is that the Arkansas Department of Health does not really give a shit about the leading cause of death in Arkansas.

I left the TPCP offices and went through the double doors at the loading dock.  A young lady actually held the door for me.  Unfortunately, the doors on the other side, and that side too, were locked.  The door buzzer for assistance on my return went unheeded leaving me locked outside. I was starting to hike around the building when I saw a pair of women pushing a mail cart. She asked me if I was trying to get into the building and told me I was not supposed to be there.  I thanked her and took the elevator to give the young police guy my visitor’s sticker. (He was probably the most sympathetic and helpful individual I met with the exception of Ms. Rushing.)

The whole point of this missive despite my whining was to note that the Arkansas Department of Health and in consort with the Department of Human Services has done their very level best to hide the individuals charged with challenging the leading cause of preventable death in offices behind the janitors, a loading dock, and the mail room, w two doors that lock behind you.  This sucks.

If the state of Arkansas had any sincere ambition to protect the public health the political figureheads would do more than pay lip service to tobacco prevention.  And the actual individuals charged with the actual work would get better treatment than they do now.  I knew that the powers that be had abused and driven away a celebrated thoracic surgeon and one of the leading tobacco prevention advocates on the planet in Dr. Carolyn Dresler.  I did not know how far they had gone to discourage anyone of merit to make any habit of challenging the tobacco industry.  

Just in case anyone in Arkansas had any optimism about the political courage our policy makers have for tobacco prevention you should make more of an effort to thank the TPCP people who continue to work in Little Rock. The folks that run the Department of Health would rather we don't find the tobacco prevention branch.

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The Right Message

Here is the link to the previously mentioned presentation: The Right Message. Why not, Why, and How.  I was encouraged reading in the new 2014 Best Practices for Tobacco Control the emphasis on Mass Reach health Communication.  The tobacco industry is pretty clear in their goal of selling a profitable product.  Public health on the other hand has been divided in its efforts and less than honest about actually saying what it should be doing is making that product unprofitable.  This is one reason I tend to try and recognize tobacco free space as not merely the clean indoor air but also the parking lot free of signage or the counter top free of product.  It is not merely that tobacco is a health risk.  The tobacco industry is a health risk.

Anyway, here is the link to the video again.