By Philip Huang, MD, MPH, Medical Director/Health Authority at City of Austin
In Travis County, tobacco is the number one preventable cause of death; it is estimated that 11 people die each week in Travis County from tobacco-related disease. Tobacco kills more than AIDS, crack, heroin, cocaine, alcohol, fires, car accidents, suicides and murder combined. To prevent the chronic and deadly conditions that come from tobacco use, Travis County and the City of Austin focused on policies and programs that would shift the population and environment away from tobacco use and ensure long-term sustainability and positive gains.
Since the city already had a strong clean indoor air ordinance, we looked to go beyond smoke-free and address tobacco-free campuses and outdoor areas. To obtain community involvement, we partnered with a large coalition that included members from the business community, healthcare providers, local foundations, schools and universities, local non profits, and city and county agencies.
From a clinical standpoint, we worked with the Integrated Care Collaboration, a coalition of local indigent care providers including the Federally Qualified Health Centers. These efforts modified electronic health records to ensure every patient was assessed for tobacco use and offered cessation services at every visit. We also challenged these groups to adopt 100 percent tobacco-free campus policies — not just smoking, but chewing tobacco and other forms as well. We found that there was very little perceived difference between tobacco-free and smoke-free, so it’s far easier to start with the more encompassing tobacco-free initiatives. Collaborators on this project include Seton Family of Hospitals, Lone Star Circle of Care, Central Health (Travis County Healthcare District), CommUnity Care, El Buen Samaritano and Peoples Community Clinic.
One of our own employees was dramatically impacted by the Seton Family of Hospitals smoke-free campus policy when she was caring for her husband at Seton after he was diagnosed with lung cancer.
After over 40 years of smoking, she finally quit because of the inconvenience of having to walk across the street to smoke. She found that she saved thousands of dollars and was able to give up smoking after just two weeks of trying.
Austin/Travis County Integral Care (ATCIC), the local mental health and substance abuse authority, was one of the first in our community to adopt a tobacco-free campus policy. Data shows that persons with serious mental illness are two to four times more likely to develop a nicotine addiction, consume nearly half of the cigarettes sold in the United States, and have a 25-year shorter life expectancy than the rest of the general population.
ATCIC heard from their clients that they really didn’t want to be smoking; they just smoked because everyone else was and they were bored. The policy changed the environment: cigarettes were once seen as rewards for positive behaviors, but now the entire center is tobacco-free, healthier and even more successful in dealing with all of their clients’ addictions.
In addition, there is support for tobacco-free policies in worksites and universities. The Mayor’s Fitness Council has a certification program that rewards employers that promote healthy behaviors, including physical activity, good nutrition and tobacco-free policies.
After tobacco-free policies were implemented at participating companies, some of the most vocal employees who had initially been opposed to the tobacco-free policies sent thank you e-mails detailing how they quit smoking because of the policies and how it changed their lives. At Dell Computer, smoking rates went from 13 percent to three percent — very few interventions can have that kind of impact on behavior. Quite simply, going tobacco-free at workplaces promotes healthy behaviors and can prevent health consequences and save healthcare dollars down the line.
As we were working to limit outdoor tobacco use, we also began to look at our parks. Texas has been in extreme drought, and in September, 2011, we had the most catastrophic fire in Texas history just outside of Austin in Bastrop. Partnering with the Parks and Recreation Department, we were able to get the media to warn people about tobacco-use in parks and the potential for setting fires. Because of a burn ban in place, for the first time ever, the Austin City Limits Music Festival was officially smoke-free. Then, in December 2011, the Austin City Council passed a smoke-free park ordinance. Through all our initiatives, we’ve found that if you give communities and leaders resources and information, they can make impactful changes and prevent illness down the road.
Our work is by no means complete, we still need tobacco free policies for multi-unit housing and restaurant and bar patios, but we know our community is an engaged and active participant in this movement.
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