Monthly Archives: June 2011

2011-06-30 SJ-R Our Opinion: “Smoking ban is not what ails casinos”

This editorial appeared today in the State Journal-Register, Springfield, IL. It is a strong endorsement of continuing the present comprehensive smoke-free state law and not exempting casinos. It notes how the methodology used in the recently released study, “Exempting casinos from the Smoke-free Illinois Act will not bring patrons back: they never left” contrasts with that used by smoking proponents, namely: “Gambling revenue dropped in Illinois when indoor smoking was banned, therefore smoking is the cause.”

I sneezed and simultaneously my stock portfolio went down, so it’s my fault for sneezing! Well, not quite.

But the very first reader’sa comment is already dismissing the study as akin to “climate ‘experts’ using computer models to decide what the weather/climate will be instead of actually using historical data. They had to adjust the data to get to their predetermined conclusion.”

Naysayers abound aplenty these days, obviating the need for the tobacco industry to leap to its own defense anymore.

Our Opinion: Smoking ban is not what ails casinos

The State Journal-Register, Springfield, IL
The Associated Press – Posted Jun 30, 2011 @ 12:05 AM

The end of the spring legislative session marked one more milestone of survival for the Smoke-free Illinois Act, which withstood yet another challenge from the state’s gambling industry and its unwavering desire to live in the smoky past.

As strong proponents of the act, we feel obligated to remain vigilant about attempts to weaken it. This is especially true when big-money interests like the gambling lobby use spurious data to back their efforts.

So in the interest of getting ahead of the inevitable next round of attacks on the state’s indoor smoking ban from the Illinois casino crowd, we call to your attention a study published online this month in the journal Tobacco Control.

Appearing under the self-explanatory title “Exempting casinos from the Smoke-free Illinois Act will not bring patrons back: they never left,” the study compares state unemployment and home construction data with casino admission figures in Illinois, Iowa, Indiana and Missouri.

It’s conclusion?

“When economic conditions were accounted for, casino admissions in Illinois did not decline significantly relative to neighbouring (sic) states, nor did admissions increase in neighbouring (sic) states,” the study says.

The study’s methodology is a far cry from the evidence we’ve heard from the pro-smoking side since the Illinois smoking ban went into effect in January 2008. That evidence generally goes something like this: Gambling revenue dropped in Illinois when indoor smoking was banned, therefore smoking is the cause. By contrast, this study takes into account different admission reporting procedures among the states, focuses strictly on border casinos and compares unemployment and housing construction data — two important economic indicators for gauging a recession — among the states.

“Illinois experienced a steeper recession than neighbouring (sic) states…,” the authors note.
We’re certain that this study will be greeted with eye-rolling by the pro-smoking side. It’s the work of researchers at Washington University in St. Louis and Roberts Wesleyan College in Rochester, N.Y., but it’s also funded in part by the St. Louis-based Missouri Group Against Smoking Pollution.

But the authors go to great lengths to define their data and justify their conclusion that the recession, which arrived a month ahead of the Illinois smoking ban in December 2007, is to blame for the state’s gambling downturn.

Being an academic study, it does not make a couple points we believe will be relevant as long as this debate survives.

First, that the Illinois casinos in the St. Louis metropolitan area are simply outclassed by the giant, new Lumiere Place complex in St. Louis.

Second, that when an Illinois casino builds something like Lumiere Place, as happened in December 2008 with Jumer’s Casino & Hotel in Rock Island, it will crush its across-the-river, smoke-friendly competition.

Third, and most important, that Illinois’ indoor smoking law is designed to protect the health of all employees and business patrons in the state. That includes nonsmoking casino employees and nonsmoking gamblers.

2011-06-28 P-D Guest commentary: “Smokers need not apply”

A rather provocative title.

As I believe I’ve noted before, it was John Britton, former Jefferson City lobbyist for the now-defunct Tobacco Institute who inserted language into the Missouri Clean Air Act, passed in 1992, that made it illegal to discriminate against smokers in hiring decisions. There were a few exemptions, employers like SSM Healthcare mentioned below being one.

Guest commentary: Smokers need not apply

By Tyler S. Gibb | Posted: Tuesday, June 28, 2011 12:00 am

It has been a difficult time recently for smokers. Reports that the FDA issued new, more graphic warning labels and images for tobacco packaging followed on the heels of a report that SSM Health Care, a large health care provider in the St. Louis area, will not consider job applications from smokers.

SSM’s hiring policy is not discriminatory. Federal and state anti-discriminatory laws are intended to protect individuals in narrowly defined groups. These groups are identifiable by one or more immutable characteristics, such as ethnicity or having a disability. The theory behind these anti-discrimination laws is simple: Our society should not tolerate prejudice based upon characteristics that are outside the volition of the individual — one did not choose to be disabled anymore than one chose to be Hispanic. Traditionally, these groups lacked sufficient political or social power to protect themselves, thus, protective laws were created. Stiff penalties exist to punish employers who hire or fire workers based upon these group characteristics.

Being a smoker is not a recognized group in need of protection for two key reasons.

First, regardless of a smoker’s addiction to nicotine, at some point, beginning to use tobacco, regardless of peer-pressure, social norms or enticing advertising, was a personal choice. Second, smokers are not a socially or politically disadvantaged group that laws need to protect. Smoking cuts across all segments of society and includes people from all walks of life and all demographics.

Missouri anti-discrimination laws support this position. Unlike other states in which policies against hiring smokers have been successfully challenged in courts, Missouri law permits SSM’s policy.

But is SSM’s policy ethical? Assuming that by ethical we mean supportive of individuals and society’s endeavor to seek out the human flourishing, or the “good life,” as described by Aristotle and his ilk, the policy is ethical. SSM has a duty as a provider of health care to provide quality health care and, as an organization, to embody the ideals (or virtues, according to Aristotle) they espouse. A policy against hiring individuals with blue hair has no rational bearing on SSM’s organizational mission or on promoting the good life, and would thus be unethical. Encouraging employees to develop healthful habits, and enforcing those habits, is a necessary and ethically justifiable position by SSM.

As a private organization, SSM has more latitude in policing the personal lives of its employees than a public employer, such as state government. This assumes that the activities the employer chooses to police have a direct and identifiable relationship to the mission of the organization and do not run afoul of other existing laws.

If we can agree that smoking is bad for individuals, we may also agree that it is bad for society. SSM defended its hiring policy by providing statistics showing it is more expensive to employ a smoker versus a non-smoker. By implementing this policy, SSM, like other leading health care providers such as Cleveland Clinic, are increasing the pressure on individuals who consume a higher percentage of finite health care resources.

Public health campaigns long have sought to end smoking. First they tried to inform, then educate, then scare and, most recent, shame people into not using tobacco. SSM, within its limited sphere as one employer in the Midwest, is taking this campaign one step further by placing real, tangible, economic consequences on personal choices that negatively impact society at large.

There is little public support for outlawing tobacco use, although recent legislation has severely restricted where smoking can occur and governments at all levels levy ever-increasing taxes on tobacco. Americans love their freedoms too much, and rightly so. I should be able to smoke an exquisite hand-rolled cigar if I so choose. However, SSM is taking a rational, justifiable step in deciding what type of workforce it will employ by filtering job applications on the basis of an individual’s exercise of their rights. Some fear this will lead down a slippery slope of intrusion by employers into the personal lives of employees, but SSM’s policy is narrowly tailored, directly relevant to its role as a health care provider and fiscally prudent.

Perhaps in addition to disturbing photos of the ills of tobacco use, the U.S. Food and Drug Administration should warn the public that smoking could make you unemployable. Perhaps then individual choices will begin to support our society’s fiscal and health goals.

Tyler S. Gibb studied health care law at St. Louis University, where he is a doctoral student in health care ethics.

2011-06-28 P-D: “Smoking ban didn’t hurt Illinois casinos, study says”

I conceived the idea of comparing smoke-free casinos in Illinois with nearby smoking-permitted casinos in Missouri in April, 2007, when it started to look like Illinois would pass a comprehensive statewide Smoke Free Air law which would include casinos. That possibility became closer to reality when the Smoke-Free Illinois Air Act was signed into law on July 23, 2007.

A group of researchers in the Center for Tobacco Policy Research, led by Douglas A. Luke, PhD, expressed interest and wrote grant proposals for a major study but the effort was stymied by a lack of funding.

Fortunately, MoGASP managed to obtain a small grant from a private foundation to pay for one researcher, Jenine K. Harris, PhD, to work on the project part-time. It has been a long and arduous undertaking for Dr. Harris. In reality, she devoted far more time to this project than was covered by MoGASP’s grant, and the other coauthors provided assistance without charge. All have PhDs except for me. They are Bobbi J. Carothers, Douglas Luke, Hiie Silmere, Timothy D. McBride, and Martin Pion, BSc., MoGASP president and author of this blog. Some background on the coauthors:

Jenine K. Harris has a PhD in Public Health Studies/Biostatistics. Her main job is teaching Biostatistics courses in the Public Health graduate program within the Brown School of Public Health, Washington University in St. Louis. She has an affiliation with the Center for Tobacco Policy Research, which is where she does most of her research, but her primary affiliation is the Brown School.

Bobbi J. Carothers works for the Center for Tobacco Policy Research full time as a data manager/analyst

Professor Douglas A. Luke is a leading researcher in the areas of health behavior, organizations, policy, and tobacco control. A top biostatistician and social science methodologist, Professor Luke has made significant contributions to the evaluation of public health programs, tobacco control and prevention policy, and the application of new methods to community health interventions.

Hiie Silmere has a PhD in Social Work and helped with much of the early data collection and writing of the introductory/background text

Tim McBride is an economist who works with the Brown School of Social Work and typically studies healthcare reform; he helped identify the economic variables, including the housing variable, for this study.

Garrett and Pakko are mentioned among the critical comments of this study on stltoday. Dr. Harris responded that Garrett and Pakko are professional economists, yet they did not include a measure of the housing market in their models; the housing market is a well-known driver of the Great Recession, as generally agreed upon by economists.

Dr. Harris also notes that, contrary to the comments on stltoday, she is NOT a social worker, nor a social work student.

Finally, Dr. Harris wanted to emphasize this important point:

“This report is NOT about revenue, and makes no claims about revenue: It is about admissions. We were driven by the arguments that casinos in Illinois would lose patrons to neighboring states. This is a point that David Nicklaus’s Post-Dispatch article may not have made clear.”

Personally, embarking on this effort it wasn’t evident at all that we would get this result since accepted wisdom has often suggested the reverse to be true, i.e. that making a casino smoke-free leads to a net loss in revenue. And I should emphasize that MoGASP was not, and never has been interested in funding research to reach a foregone conclusion.

Although there are plenty of pro-smoking comments on stltoday, I did notice some that were positive, like the following two:

frp706 said on: June 28, 2011, 2:53 pm
the only casino i go to is the casino queen and i live in west county.i will not go to any casino that has smoking, and if illinois changes it’s ban, i won’t go there either

BRIAN W said on: June 28, 2011, 2:42 pm
All I know is that the only casino in the St. Louis area that has gotten my money has been the Casino Queen, DUE to the smoking ban…I will not set foot in the smoke infested Lumiere or Rivercity casinoes….

Related stories:
         Illinois, other states consider smoking exemptions for casinos
         Bill to allow smoking in Illinois casinos passes House
         Illinois looks to squeeze more revenue from gambling

Smoking ban didn’t hurt Illinois casinos, study says

BY DAVID NICKLAUS • > 314-340-8213 | Posted: Tuesday, June 28, 2011 7:58 am | Comments (55 as of June 28, 2011, 7:00 pm)

Ever since Illinois implemented a smoking ban in January 2008, the state’s casinos have been lobbying for an exemption. As Kevin McDermott reported in March, the industry blames the ban for as much as $800 million in lost revenue.
         Now an academic study, funded in part by Missouri Group Against Smoking Pollution, says the ban didn’t cost them a cent. The article in the journal Tobacco Control carries a provocative title:
         Exempting casinos from the Smoke-free Illinois Act will not bring patrons back: They never left
         The study’s authors, led by Jenine K. Harris of Washington University’s George Warren Brown School of Social Work, analyze casino admissions in Illinois and four neighboring states* in 2007 and 2008, before and after the ban took effect. They control for economic conditions by including each state’s unemployment rate and building-permit activity in their equation.

*mogasp correction: Illinois casinos were compared with those in the following three, not four, neighboring states: Missouri, Iowa and Indiana.

         The economic part was important, the authors note, because a nationwide recession began in December 2007, almost simultaneously with the smoking ban. In the end, they end up blaming all of the casinos’ lost business on the recession:

Illinois experienced a steeper reession than neighbouring states ….

When economic conditions were accounted for, casino admissions in Illinois did not decline significantly relative to neighbouring states, nor did admissions increase in neighbouring states. Reductions reported in Illinois casinos are therefore not due to patrons leaving Illinois casinos for neighbouring states where they could smoke.

         The study contradicts a 2009 assessment by the Illinois Commission on Government Forecasting and Accountability, which concluded:

It appears that the indoor smoking ban and Illinois’ lack of gaming expansion in recent years (especially as compared to other states) is likely why other states have not struggled like Illinois.

         The commission didn’t take economic conditions into account.
         Given that Illinois is considering a major expansion of gambling to raise revenue, we probably haven’t heard the last word on this issue. The study may also be influential in Missouri, where St. Louis and St. Louis County currently have smoking bans that exempt casinos. And when St. Charles County Executive Steve Ehlmann recently blocked a smoking-ban referendum, he criticized a provision that would exempt Ameristar Casino from the proposed ban.

2011-06-26 P-D Letters: “Political reality”

The following letter I submitted appeared on the St. Louis Post-Dispatch Letters to the Editor page on Sunday, June 26. It followed a brief conversation I had with St. Charles County Executive, Steve Ehlmann, after I sent him a letter recently on the subject of comprehensive smoke-free air laws in the metro area, including St. Charles. That related to his recent veto of a St. Charles smoke-free ballot initiative. While I point out the rationale behind legislation with exemptions, which I agree should not occur with a health and welfare issue, his insistence on legislation with no exemptions should motivate him to try and work with other area legislators, like St. Louis County Chairman Steve Stenger, to pass such legislation.

Political reality

St. Charles County Executive Steve Ehlmann picked two examples of exemptions for comment in his veto of a proposal to put a smoke-free air bill on the 2012 ballot. He wrote: “If the purpose of the smoking ban is to protect the health of employees, there is no rational reason to exclude casino floor workers. If tobacco smoke is harmful, there is no reason to exempt cigar bars, while regulating bars that allow cigarette smoking.”
         That sounds reasonable, except for political reality.
         For example, in 2009, former St. Louis County Councilwoman Barbara Fraser introduced a comprehensive smoking ban but couldn’t garner the necessary council support without exempting casinos and small bars. Missouri Group Against Smoking Pollution and others strongly opposed the exemptions and urged County Executive Charlie Dooley to veto the measure. However, after it passed and went on the November 2009 ballot as Proposition N, we supported it after getting overwhelming positive feedback to do so from our members.
         Proposition N’s overwhelming success resulted in both St. Louis and St. Louis County going largely smoke-free on Jan. 2.
         Since then, St. Louis County Council Chairman Steve Stenger, who originally had insisted on the Harrah’s Casino and small bar exemptions, has gone on record as seeking legislation to remove the existing loopholes.
         If only private homes were exempted when not being used for child care, that would bring our metropolitan area up to the current standard for 100 percent smoke-free air laws. Paraphrasing Mr. Ehlmann, why should we do otherwise?

Martin Pion • St. Louis County
President, MoGASP

Read more:

2011-06-21 P-D Editorial “Smokers: ‘Move ’em out of here.'” and Letters

I missed this Post-Dispatch editorial, published on June 21, 2011, when it first appeared but two letters from readers alerted me to it today and I went back and retrieved it on-line. The editorial ends with this observation and plea:

Smokers are merely people who struggle with a dangerous and expensive addiction. Some of them, like some non-smokers, are obnoxious. But they deserve better than “Move ’em out of here! They disgust me.”

Here’s the full editorial. Maybe the point is that as long as smokers don’t pollute the air nonsmokers breathe they shouldn’t be treated as pariahs. What do you think?

Doctor-approved Camels cigarette ad

Editorial: Smokers: ‘Move ’em out of here.’

By the Editorial Board | Posted: Tuesday, June 21, 2011 12:00 am Comments (12 as of June 22, 2011, 10:42 pm)

The last cigarette smokers in America were located in a box canyon south of Donner Pass in the High Sierra by two federal tobacco agents in a helicopter who spotted the little smoke puffs just before noon.

So begins “End of the Trail,” a well-known short story by the humorist Garrison Keillor published in 1984 in The New Yorker. The story imagines that the last five smokers “had been on the run since the adoption of the 28th Amendment.”
         Some 27 years later, things aren’t quite that bad for the one in five American adults who still smokes. There has been no 28th Amendment making smoking unconstitutional. But the attitude of the chief tobacco agent in Mr. Keillor’s story is pretty common: “Move ’em out of here! They disgust me.”
         Consider some of the 370 comments posted (at last count) at to a story in the Friday Post-Dispatch by reporter Blythe Bernhard. Seven SSM Health Care hospitals in the area will start a tobbaco-free hiring policy next month.
         “If you smoke at all you stink of it,” wrote one reader. “You reek. Your eyes are yellow. You have fatty deposits around your eyes. You look old and leathery before your time. Your fingers are dry and cracked, yellow and unattractive. You can’t quit because you are addicted.”
         The other side is heard from: “Our rights are being taken away little by little. First this, then it’ll be if you eat fast food, or Twinkies or if you are single [and] you have sex outside of marriage.”
         Live and let live (or not, as the actuaries suggest) is not an attitude that the Internet encourages.
         A spokesman for SSM said the company took the action to “encourage our employees to take better care of themselves and set good examples for our patients.” A side benefit, he said, is that having “healthier employees does mean lower health care costs.”
         It should be noted that SSM has the absolute right under Missouri law to set rules for its employees’ off-hour drinking and smoking habits. Most companies don’t have that right, but the law makes an exception for religious and church groups and not-for-profit health care organizations. SSM could have applied the rule retroactively to current employees, but it chose not to.
         Still, we wish SSM would rethink the policy. Low-income workers — about a third of whom smoke — will be disproportionately affected. For them, life is hard enough and jobs are scarce enough. And will it really reflect poorly on the hospital if a food-service worker is spotted smoking off-hours?
         Studies show only about one in every 20 physicians in America smokes and only one in every 12 nurses. They know the risks better than most people. Also, they’re more employable than most people.
         As to the fast-food-and-Twinkie argument, that day may come. But right now federal law suggests that obesity is a disability that deserves protection, not a life-choice that can be proscribed.
         Is there a “right” to smoke? No, courts have said smoking is “not fundamental to the concept of ordered liberty.” Further, courts have ruled, smokers do not qualify as a protected class under the 14th Amendment.
         Smokers are merely people who struggle with a dangerous and expensive addiction. Some of them, like some non-smokers, are obnoxious. But they deserve better than “Move ’em out of here! They disgust me.”

Following are the two published letters prompted by the above editorial:

Letters Page: June 24, 2011

Cost of smoking
The editorial “Nicotine stain” (June 21) brought together two separate thoughts. First, Garrison Keillor had the right idea. If smoking is as bad as it is being viewed, maybe it should be illegal, It’s certainly heading that way. Second, how does anyone who is at the poverty level afford to buy cigarettes? The price is about $5 a pack. A two-pack-a-day habit would cost more than over $3,600 per year.

Phillip Wells • Dellwood

Stop enabling
The editorial “Nicotine stain” (June 21) really pushed the limit of responsibility. I do not quarrel with the statistic that “about one-third” of low-income workers smoke. However, for the paper to suggest that this group would be “disproportionately affected” neglects the responsibility to care for one’s self.
         I am shocked by the price of cigarettes. Maybe if poor people would accept responsibility and quit smoking, life would be less hard — by maybe as much a $40 a week — and they might improve their chances of getting a job. Sounds like a “win-win” situation to me.
         When are we going to stop enabling people and relieving them of taking personal responsibility for their lives?

Don Hammond • Lake Saint Louis

2011-06-23 P-D Letters: “Anti-smoking policies improve employee productivity, health”

The following is the original text of a letter submitted to the St. Louis Post-Dispatch recently and published today. Please click Anti-smoking policies improve employee productivity, health to view the edited on-line version published in the newspaper.

Ernie Wolf, recent photo from Facebook page

Date: Sat, 18 Jun 2011 21:13:56 -0500
From: Ernest Wolf
Subject: Smokers unwanted at work

The Post-Dispatch, in its June 17 article, makes it sound as if SSM hospitals are starting a new trend in our area.  Far from it. 
         This policy was pioneered by Sky-Top Sunroofs Ltd. in St. Louis over 30 years ago.  At first the P-D refused to accept help wanted ads for Sky-Top staff members with the admonition “non-smokers only should apply”.  It required the firm’s attorney to convince the paper that this selectivity is not a federal EEOC issue.  A search in the P-D Help Wanted columns of the early ’80s will confirm this fact. 
         This information was adequately publicized at the time, having been cited in local publications, during television interviews, and through discussions at employer association meetings. 
         Unfortunately, it seems few employers learned from Sky-Top’s experience.   This experience was even the basis of free employer consulting provided by the federally funded ASSIST (American Stop Smoking Intervention Study) program in the early ’90s. 
         Sky-Top’s experience included hard data which showed that in the unionized assembly operation with about 45 employees, the non-smokers were far more productive than the smokers.  With that data, plus the fact that the company-paid health and life insurance for employees was more expensive for smokers, our Teamster local agreed to hiring only non-smokers for the assembly operation after 1986 or 1987.  The savings could be used to provide more benefits as well as in-house smoking secession classes for smokers who desired to quit.  Sky-Top’s experience was well before the Centers for Disease Control and Prevention came out with the fact that each smoker costs a company an additional $3,400 annually in health care costs and lost productivity.
         It is never too late for employers to recognize that smoking policies can be mutually beneficial for both employees and employers.  Missouri has one of our country’s highest smoking rates.  A likely cause is that our State legislature has chosen not to pass an effective Clean Air act, allows the head tobacco lobbyist to smoke anywhere in the otherwise smoke-free State Capitol building, and persists in maintaining the lowest cigarette tax in the country at just 17 cents per pack while the overall States average is $1.45 per pack. 
         Effective employer policies could reverse that smoking rate and lead to a healthier state population.

Ernest Wolf
Founder, Sky-Top Sunroofs
St. Louis County

2011-06-22 P-D “New FDA cigarette-pack labels are graphic, gruesome”

Today’s St. Louis Post-Dispatch reproduced on the front page most of a story by New York Times reporter Duff Wilson. The Post-Dispatch headline in the print version was “Labels pull no punches on cigarettes” but on-line it was “New FDA cigarette-pack labels are graphic, gruesome.”

The NYT story headline was “U.S. Releases Graphic Images to Deter Smokers” and kicked off by showing 8 of them. The ninth shows a smoker exhaling through a stoma, a hole in his throat resulting from laryngeal cancer surgery. That, of course, demonstrates the powerfully addictive nature of nicotine: when you still can’t quit after surviving that kind of life-threatening operation.

It’s really hard to predict with certainty this latest effort to reduce smoking rates.

Previously, the most effective programs were those like the first one started in California and funded by a statewide proposition which paid for hard-hitting TV ads. One of the best, with a memorable punch line, shows cigarette executives in a darkened conference room with tobacco smoke wafting towards the ceiling discussing the need to recruit more smokers. An executive at the head of the table says:

“Gentlemen, gentlemen. The tobacco industry has a very serious multi-billion-dollar problem.
We need more cigarette smokers. Pure and simple.
Every day, 2,000 Americans stop smoking and another 1,178 also quit. Actually, technically, they die.
That means that this business needs 3,000 fresh, new volunteers every day.
So, forget all that cancer, heart disease, stroke stuff.
Gentlemen, we’re not in this for our health.”
(He laughs, and the others join in.)

For those who are smoke-sensitive, the fewer smokers the less likelihood of scofflaws polluting the air with tobacco smoke, and the more likely that politicians will do their job and implement comprehensive smoke-free air ordinances instead of worrying about offending smokers.

Incidentally, the St. Louis Post-Dispatch version of the story added some quotes from Bill Hannegan, obtained by health reporter Blythe Bernhard, which I’ve highlighted below.

Eight of the nine new graphic warnings on cigarette packs

By DUFF WILSON • New York Times | Posted: Wednesday, June 22, 2011 12:00 am

Ninth cigarette pack image

Federal health officials released on Tuesday their final selection of nine graphic warning labels to cover the top half of cigarette packages beginning next year, over the opposition of tobacco manufacturers.
         In the first major change to warning labels in more than a quarter-century, the graphic images will include photographs of horribly damaged teeth and lungs and a man exhaling smoke through a tracheotomy opening in his neck. The Department of Health and Human Services selected nine color images among 36 proposed to accompany larger text warnings.
         Health advocacy groups praised the government plan in the hope that images would shock and deter new smokers and motivate current smokers to quit.
         The images are to cover the upper half of the front and back of cigarette packages produced after September 2012, as well as 20 percent of the space in cigarette advertisements.
         “These labels are frank, honest and powerful depictions of the health risks of smoking, and they will help encourage smokers to quit, and prevent children from smoking,” Kathleen Sebelius, the secretary of health and human services, said Tuesday in a statement.
         Bill Hannegan, a St. Louis opponent of smoking bans, said he agreed with some limits on tobacco advertising. But he called the new package labels a “hostile and offensive” action by the government.
         “This campaign crosses a line of what can be done in a civil society, even for the sake of someone’s health,” Hannegan said. “And I don’t think it will work.”

         The four leading tobacco companies were all threatening legal action, saying the images would unfairly hurt their property and free speech rights by obscuring their brand names in retail displays, demonizing the companies and stigmatizing smokers.
         The government won one case last year in a federal court in Kentucky on its overall ability to require larger warning labels with images; the specific images released Tuesday are likely to stir further legal action. The Kentucky case is before the 6th U.S. Circuit Court of Appeals.
         The new labels were required under landmark antismoking legislation giving the Food and Drug Administration power to regulate, but not ban, tobacco products. The Family Smoking Prevention and Tobacco Control Act required FDA action on the graphic warning labels by today, the second anniversary of President Barack Obama’s signing it into law.
         The United States was the first nation to require a health warning on cigarette packages more than 25 years ago; but since then, at least 39 other nations, including Canada and many in Europe, have imposed more eye-catching warnings, including graphic photographs.
         “This is a critical moment for the United States to move forward in this area,” the FDA commissioner, Dr. Margaret Hamburg, said in an interview. “The trends in smoking really support the need for more action now. For four decades, there was a steady decline in smoking, but five to seven years ago, we leveled off at about the 20 percent level of adult and youth smoking in this country.”
         Dr. Lawrence Deyton, director of the Center for Tobacco Products at the FDA, said the government estimated — based on other countries’ experience — that the new warning labels would prompt an additional 213,000 Americans to quit smoking next year.
         The nine images chosen in the United States include some that are among the most graphic of the 36 draft images. But they also include some of the less vivid.
         The images, which are to appear on cigarette packs on a rotating basis, also include one of a man proudly wearing a T-shirt that says: “I QUIT.”
         All of the packs will also display a toll-free telephone number for smoking cessation services.
         The government surveyed 18,000 Americans of all ages to determine which of the 36 proposed labels would be most effective to deter smoking.

Blythe Bernhard of the Post-Dispatch contributed to this report.

2011-06-17 P-D: “7 area SSM hospitals will no longer hire smokers”

Ernie Wolf, recent photo from Facebook page

Not mentioned anywhere in this story, but deserving to be for historical reasons, is Ernest “Ernie” Wolf, who operated Skytop Sunroofs Ltd in St. Louis for twenty years until 1992.
         He was a pioneer in only hiring nonsmoking employees well before it became accepted practice.
         He found that his nonsmoking employees were more productive, they didn’t take as much sick leave, and had lower healthcare and life insurance coverage costs than smokers.
         Ernie Wolf and the union ended up agreeing to only add nonsmokers to the workforce, the same policy as SSM Healthcare is about to implement.

Following is a comment I submitted earlier to the St. Louis Post-Dispatch comments page following the SSM hospital story, which is arousing a lively debate among readers:

Martin Pion said on: June 17, 2011, 11:31 am
This is a contentious issue.
Missouri GASP doesn’t take a position on it, but speaking personally, if I were to hire an employee to work in my home office they would have to be a nonsmoker. I wouldn’t be prepared to allow them smoking breaks outside and wonder where they’re throwing their cigarette butts for me to pick up after them. Plus, they would still be smelling of tobacco smoke when they came back inside my house. And finally, even when smoking outside, I would be concerned about the smoke wafting in my direction if I were to go outside myself.
Yes, I can certainly understand smokers feeling unfairly targeted by an employer’s policy of only hiring nonsmokers, but one could argue that it’s another incentive for smokers to quit.

Related Stories
         Big tobacco prevails in St. Louis lawsuit by hospitals
         From 2004: SSM Health Care outlaws smoking on its properties

11/16/04: SSM Healthcare is instituting a policy Thursday that will prohibit smoking on their property. Sonya Johnson of Portageville, Mo. takes a break for a cigarette outside Cardinal Glennon Hospital Tuesday. Her daughter Bailey, 4 mos., is being treated there for an undiagnosed infection.
File photo by Karen Elshout

Sonya Johnson was quoted in the photo caption as saying: “I think it sucks that the hospital is going to force us to go elsewhere to smoke, ” she said. “This isn’t the safest neighborhood. Aren’t we stressed out enough?

7 area SSM hospitals will no longer hire smokers

BY BLYTHE BERNHARD 314-340-8129 | Posted: Friday, June 17, 2011 12:15 am | Comments (115 as of June 17, 2011, 9:39 am; 237 as of June 17, 2011, 3:05 pm)

Smokers need not apply at SSM Health Care hospitals, which will start a tobacco-free hiring policy next month.
         Job applicants at the seven SSM hospitals in the St. Louis area will be asked whether they have used tobacco in the last six months. Anyone who answers yes will be eliminated from the hiring process.
“As an organization that provides health care, we want to encourage our employees to take better care of themselves and set good examples for our patients,” said SSM spokesman Chris Sutton.
         Cost-cutting is a side benefit of the new policy, Sutton said, because “healthier employees does mean lower health care costs.”
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         Each smoker costs a company an additional $3,400 annually in health care costs and lost productivity, according to the federal Centers for Disease Control and Prevention.
         Current SSM employees will not be bound by the policy when they’re off-duty. All SSM facilities have been tobacco-free since 2004.
         Thursday evening, beyond the parking garage on the east side of St. Mary’s Health Center in Richmond Heights, a half dozen hospital employees were lighting up on a city sidewalk. Word of the new policy came as a shock.
         “They wouldn’t hire you because you’re a smoker?” said Angela Mueller, who said she has been working at the hospital just over a month. “That’s not right.”
         The new policy will apply only to SSM hospitals in Missouri, where about 25 percent of adult residents smoke. About 6,000 companies nationwide have stopped hiring smokers, according to the New Jersey nonprofit National Workrights Institute. Missouri law supports the practice for certain employers, including health care providers.
         SSM officials said they will lobby for similar legislation in Illinois, Wisconsin and Oklahoma, where they also operate hospitals.
         Workers’ rights groups argue that the shift to a smoke-free workforce could lead to similar crackdowns on health behaviors like drinking alcohol and eating fast food. Others have warned that the policies punish lower-paid employees like janitors and cafeteria workers who are addicted to nicotine.
         “If enough of these companies adopt these policies and it really becomes difficult for smokers to find jobs, there are going to be consequences,” said Michael Siegel, a professor at Boston University School of Public Health. “Unemployment is also bad for health.”
The trend started 20 years ago when companies like Union Pacific, Turner Broadcasting and Alaska Airlines adopted smoke-free hiring policies.
         Since then, more than half the states have passed laws that prohibit discrimination against smokers.
         But courts in some of those states have upheld the hiring bans when challenged.
Health care providers have led a more recent trend away from employing smokers. The Cleveland Clinic stopped hiring smokers in 2007. Hospitals in Florida, Georgia, Massachusetts, Ohio, Pennsylvania, Tennessee and Texas have recently made the move.
         Staring this year, St. Francis Medical Center in Cape Girardeau, Mo., only hires nonsmokers.
“We felt it was unfair for employees who maintained healthy lifestyles to have to subsidize those who do not,” Steven Bjelich, the hospital’s chief executive. “Essentially that’s what happens.”
         Most smoke-free policies are enforced with the honor system. Truman Medical Centers in Kansas City investigates accusations of tobacco use and has fired employees who violate the smoke-free policy.
         BJC HealthCare, the largest hospital system in St. Louis, has no plans to implement a tobacco-free hiring policy. The company provides discounts on health insurance to nonsmokers and offers incentives to employees to quit smoking.
West County EMS and Fire Protection District has mandated since 2010 that all employees abstain from smoking or chewing tobacco. The firefighters union unanimously approved the policy.
         There have been few challenges to employee smoking bans.
         In the 1980s, a firefighter in Oklahoma City sued after being fired for smoking during a lunch break.
         The court eventually ruled that anti-smoking policies are reasonable to protect employees’ health.

Marlon A. Walker of the Post-Dispatch and The New York Times contributed to this report.

2011-06-15 P-D: “Ehlmann blocks smoking ban from going to voters in St. Charles County”

St. Charles County Executive, Steve Ehlmann, appears to be taking a principled position in his veto message of this bill, arguing that it isn’t acceptable to allow exemptions for casinos, for example, if it is genuinely a health measure to protect employees. He added:

If tobacco smoke is harmful, there is no reason to exempt cigar bars, while regulating bars that allow cigarette smoking.

In a rational world free from pressures from special interests, government policy should work this way, but certainly when it comes to secondhand smoke, it hasn’t for most of the past twenty five years I’ve been actively involved in this issue. That is why MoGASP supported the successful Proposition N on the November 2009 ballot, which ushered in the sweeping smoke-free air ordinances in St. Louis City and County despite their exemptions, the most objectionable being casino gaming floors and small bars.

The voluntary health agencies – American Heart, Lung and Cancer – did not support Prop N, having earlier echoed County Executive Ehlmann’s position: that casino and small bar exemptions were unacceptable. This all or nothing approach would be laudable if it offered a realistic way forward on this contentious issue. Unfortunately, it’s typically obstructive.

If County Executive Steve Ehlmann is truly interested in protecting the public health, as his veto message implies, he will need to demonstrate it by working with St. Louis County and City on their efforts to forge a comprehensive regional approach to the issue of secondhand smoke pollution, which includes St. Charles County.

For the record, below is reproduced a letter published in yesterday’s St. Louis Post-Dispatch from Kay Young, wife of laryngeal cancer survivor Don Young, who live in St. Charles and are both very active on this issue. It’s evident that County Executive Ehlmann had already made up his mind before this was published.

Let voters decide

Posted: Wednesday, June 15, 2011 10:15 am

Kay Young celebrating success of smoke-free O'Fallon vote in April, 2011

The St. Charles County Council passed a bill that will allow voters to decide if they want the county to be smoke-free. The bill has been sent to County Executive Steve Ehlmann, who will decide whether or not county residents get the opportunity to vote on this important health issue.
         For over three decades, I’ve called St. Charles County home. Due to health issues, my husband and I cannot go anywhere smoking is allowed, severely limiting our choices of entertainment and dining in our own community.
Secondhand smoke is a real danger. And, sure, smokers have a right to smoke, but not in ways that harm other people. So why must I and others have to endanger our health because of someone else’s choice? Every St. Charles County resident and employee has the right to breathe smoke-free indoor air.
         If our county were smoke-free, it would mean that myself and others would have the freedom to patronize any establishment, the choice to go anywhere without the forced consequences to our health. After all, five minutes outside isn’t a lot to ask to keep toxic smoke out of other people’s lungs.
         I hope County Executive Ehlmann will allow residents the opportunity to make their voice heard and place the county-wide, comprehensive smoke-free ordinance on the ballot for a vote of the people.

Kay Young, St. Charles

Related Stories
         O’Fallon, Mo., smoking ban starts Thursday
         St. Charles County Council passes bill for vote on smoking ban
         Survey shows St. Charles County supports indoor smoking ban

Related Documents
         Ehlmann’s veto letter June 15, 2011

Ehlmann blocks smoking ban from going to voters in St. Charles County

BY MARK SCHLINKMANN • > 636-255-7203 | Posted: Wednesday, June 15, 2011 12:16 am | Comments (47 as of June 15, 2011, 9:31 pm)

Friday June 10, 2011--Jason Fletcher, left, and his mother Pat Edwards, owner of P&R Lounge in O'Fallon, Missouri enjoy a smoke and a beer together as they relax at Edwards' bar on Friday. Edwards fears the recently passed smoking ban in O'Fallon will hurt small bars like hers.
Click to enlarge. Photo: David Carson, Post-Dispatch

ST. CHARLES COUNTY • A countywide smoking ban is in doubt after County Executive Steve Ehlmann on Tuesday blocked a ballot referendum, saying it had too many exemptions, including for the Ameristar Casino.

Steve Ehlmann, St. Charles County Executive and former state senator

         If the purpose of the smoking ban is to protect the health of employees, there is no rational reason to exclude casino floor workers,” Ehlmann said in his veto message. “If tobacco smoke is harmful, there is no reason to exempt cigar bars, while regulating bars that allow cigarette smoking.”
         The bill’s sponsor, County Councilman Joe Cronin, R-St. Paul, said it was unlikely that he could muster the required five votes on the seven-person council to override the veto. He said he would rather not take that “adversarial” approach anyway. The council passed the bill, 4-2, with one opponent absent, on May 31. It would have set up a ballot referendum in November 2012.
         Cronin said he instead would try to craft a new version that could get the support of both the executive and a council majority.
         However, he said that would be difficult because some who voted for the vetoed measure were adamant about exempting Ameristar in St. Charles. They worry that some of the casino’s jobs could be in jeopardy if smoking is banned there while smoking is allowed at the competing Harrah’s gambling facility across the Missouri River in Maryland Heights. St. Louis County’s current smoking ban exempts casinos.
         “I got a feeling that maybe the petition form might be the best way,” Cronin said, referring to the possibility that an anti-smoking coalition might gather signatures to put a smoking ban on the ballot.
         Late last year, coalition members did just that in O’Fallon, St. Charles County’s largest city. Voters there in April overwhelmingly approved a ban. The O’Fallon measure takes effect Thursday. The only other part of the county with a ban is Lake Saint Louis, where one started last October.
         Councilman Jerry Daugherty, D-Portage des Sioux — who supports a smoking ban election but voted against the measure because of his opposition to the casino exemption — said he agreed with Ehlmann that the measure wasn’t fair to small business owners.
         “I basically think it’s a dead issue” on the council, he said.
         However, two supporters of the bill who had wanted the casino exemption, Republicans Terry Hollander of St. Charles and John White of St. Charles County, said there was at least a chance something could be worked out.
         “The big question is St. Louis County,” White said, referring to efforts on the St. Louis County Council to repeal exemptions for casinos. Progress on that front could get him to support banning smoking at Ameristar, he said.
         In St. Louis County, Council Chairman Steve Stenger and County Executive Charlie A. Dooley, both Democrats, say they want a smoking ban without exemptions. Stenger met last month with three St. Charles County Council members to discuss trying to work out a common approach across the region.
         Stacy Reliford, an American Cancer Society official active in the anti-smoking coalition, confirmed that a countywide petition drive in St. Charles County was a possibility but emphasized that no decision had been made.
         “November 2012 is still a long ways away,” she said.
         Reliford said that although it was unfortunate that the veto apparently would keep the council plan off the ballot, it was promising “that everybody’s talking about ways to strengthen it than ways to weaken it.”
         Ehlmann, a Republican, said he was willing to discuss revisions. Asked if he’d support a no-exemption measure, he said, “I’m open to that and a lot of things.”
         Ehlmann’s decision was applauded by Bill Hannegan, a dogged opponent of smoking bans across the metro area, and Council Chairman Joe Brazil, R-Defiance, who also objects to governmental restrictions on business owners’ rights.
         “He did the right thing,” Hannegan said. “He said the casino exemption had no rational basis.”
         Ehlmann said in his veto message that government shouldn’t pick “winners and losers” in establishing regulations. He said the bill would have led to casinos’ and cigar bars’ winning “at the expense of the nonprofit organizations and small businesses that compete against them for the entertainment dollars of individuals who smoke.” He also objected to a provision allowing hotels and motels to set aside 20 percent of their rooms for smokers.
         The countywide proposal would have covered both unincorporated areas and cities. Unlike current bans in St. Louis and across St. Louis County, the St. Charles County proposal wouldn’t have exempted bars in which food service is a small portion of their business. City bans in O’Fallon, Lake Saint Louis, Clayton, Brentwood, Creve Coeur, Kirkwood and Ballwin also do not have exemptions for bars.
         The veto Tuesday was only the second issued by Ehlmann since he became executive in 2007. Ehlmann, a historian and former circuit judge, began his veto letter by quoting from President Andrew Jackson’s 19th-century veto of a bill to recharter a national bank.
         Jackson objected to a law he said gave “artificial distinctions … to make the rich richer and the potent more powerful.”

2011-06-09 “For Better or For Worse” comic strip

When you read today’s “For Better or For Worse” comic strip the first three panels convince you that Ellen Patterson’s brother is finally feeling the ill-effects of his smoking, but the punch-line suggests otherwise.

For Better or For Worse, by Lynn Johnston
Please click to enlarge

The brother’s shortness of breath etc. could still be related to his smoking though.

On her web page accompanying the strip, Lynn Johnston wrote:

My brothers’ smoking was always a bone of contention. He was still puffing when I did this strip and I was still trying to get him to stop. I don’t think he ever blew up the kiddie pool, but he did play the trumpet professionally and I wondered how his lungs held out!