SB 1-REGULATION OF SMOKING  10:00:31 AM CHAIR STOLTZE announced the consideration of SB 1. 10:00:53 AM SENATOR PETER MICCICHE, Alaska State Legislature, Juneau, Alaska, Sponsor for SB 1, stated that his hope is that with everyone's help that some lives can be saved and less spent on healthcare. He read the following sponsor statement into the record: SB 1 seeks to safeguard working Alaskans and their children from the adverse health effects of secondhand smoke by providing a statewide smoke-free workplace law for businesses and public places. This is about protecting workers, this is not an anti-smoker bill at all. As a conservative Alaskan, I actively support a philosophy that works to limit and reduce the role of government in our daily lives. I work towards that every day in this building, but I believe Thomas Jefferson got it right when he said, "The legitimate powers of government extend to such acts only as are injurious to others." This case, I believe that both the right to breathe smoke-free air and the significant, documented public health risks of secondhand smoke exposure compel us to view the protection of Alaska's labor force and their families as an appropriate governmental responsibility. With the new issues with marijuana Mr. Chairman, I also believe this bill reduces the potential of folks smoking marijuana at the workplace as well. Similar comparisons include the government role in establishing speed limits, seat belt laws, motor vehicle design safety improvements, electrical codes, pipeline safety laws, and agency responsibilities. There are places in our society where regulation is the right thing to do and it's largely why we are here in this building. As judicial philosopher Zechariah Chafee said in the Harvard Law Review in 1919, "Your right to swing your arm ends just where the other man's nose begins;" that's kind of what SB 1 is about, it doesn't preclude Alaskans' right to smoke, but it protects the rights of working Alaskans who choose not to smoke. This law is much like the law that is in half of the states right now. Over half of the population of Alaska including those in Bethel, Anchorage, Juneau, Barrow, Dillingham, Haines, Skagway, Petersburg, Klawock, Nome, Unalaska, and Palmer are currently living under a similar law. You also can't smoke in healthcare facilities, schools, childcare facilities, and public meeting rooms in government buildings. These laws are well established and once they have been on the books there has been some effort to reverse them and not once have those reversal processes been successful. Communities, once they have been successful learn the value of smoke-free workplaces, they've kept them intact. 10:03:38 AM This applies a uniform safeguard from secondhand smoke for workers in Alaska. Why is a conservative willing to take on this issue? The reality of it is for me, simply to protect the lives of nonsmokers. We think about the staggering health costs of secondhand exposure to tobacco products and I'm not talking about the over half million Americans that die from lung cancer that do smoke, we are talking about the folks that choose not to. It's a critical public health issue in my view and when you think about it, people are now talking about expanding Medicaid, people are talking about us taking on expanded roles of healthcare in the state, this is just an added expense and it hits the taxpayer heavily. It kills more than 41,000 adult non-smokers from coronary heart disease and lung cancer each year. For example, it is four times the number for DUI fatalities each year. While our DUI laws are rightfully stringent, our response to stopping an enormous loss of life due to secondhand smoke has been comparatively lax. I often hold up a photo of my dad, who I lost last year, this bill is not about my father, my father chose to smoke, that was his right. This is about the folks that are effected that choose not to but have to go to work every day. What this bill is about is essentially asking smokers to take it outside. More than 860 Alaskan businesses and organizations, and many more representing all regions of the state have signed on to support this smoke-free workplace law. We have some opposition as well, I believe we have a few hundred opposition letters; virtually 100 percent of those letters are asking us to exclude vaping or e- cigs from the bill. 10:05:44 AM There are very many well-meaning governmental actions that are simply not good examples of the use of common sense; one of them is Positive Train Control. For the billions of dollars it will cost to do Positive Train Control, it will save about three American lives per year in the U.S., that's a government added control trying to spend a lot of money protecting folks that are not at risk. In this case we have the number, we have the overwhelming evidence that at no cost to our government, and we can protect a lot of Alaskans. I've got to say out of respect for you and your committee that we are listening. We will be listening to your comments, we're open to suggestions, we want this to be the best bill it can be, and we want to impact Alaska businesses as little as possible, so we are open to reasonable exemptions. This bill effects my core belief in the self-evident truths and the Declaration of Independence and its desire to conserve life and protect liberty. I think forcing Alaskan employees to smoke on the secondhand aspect is challenging those rights. The other thing that I've got to say is this bill is purposely designed not to be heavy handed, it doesn't come with control, it comes with no imposing enforcement actions, all this bill does is it asks smokers to take it outside while they are at work, it's just respect for their neighbor's right to breath clean air. I'd like to reiterate again, this bill is not about my father, this is not about folks who choose to smoke, if they choose to smoke, they have every right to continue to do that, we just ask for them to not affect the rights of their friends at work. 10:07:42 AM CHUCK KOPP, Staff, Senator Micciche, Alaska State Legislature, Juneau, Alaska, noted that the bill packets contain a copy of the slide show that is considered the "Take it Outside Act." It is from the Smoke Free Alaska website. MR. KOPP read the following statement: SB 1 is about healthier citizens and spending less on healthcare, providing a smoke-free work environment for workers in Alaska and a statewide standard with regard to secondhand smoke, it puts all businesses and workplaces in Alaska on a level playing field. About half of the population in Alaska is covered by workplace law now. In the members' packets was a 2012 Dittman Research survey that shows 82 percent of Alaskans support a statewide, smoke-free indoor air law that includes restaurants and bars. You see the support we have from across the state from every members' district, which is consistent with that 82 percent polling. Also in the members' packets is a documentation from the Institute of Social and Economic Research (ISER) in 2014, and a Journal of Cancer article in 2007 which shows that smoke-free air laws do not have adverse economic consequences for restaurants and bars subject to them. What does SB 1 not do? SB 1 does not ban cigarette smoking and it does not ban e-cigarettes. What does SB 1 do? SB 1 provides a statewide smoking prohibition in enclosed public spaces, public transportations and facilities, places of employment, government owned or operated places, buildings or residences that are used to provide paid childcare, healthcare facilities, the Pioneer Homes and the Veterans Homes, and vehicles that are places of employment with certain exceptions. Included are school grounds, public parks for children, outdoor arenas sitting, and areas within certain distances from entrances, open windows, and air intake vents where smoking is prohibited. The bill requires the Commissioner of Health and Social Services to adopt regulations for filing, processing, and investigating reports of violations of the smoking prohibition, which may include filing complaints and issuing citations. The Department of Health and Social Services (HSS) role in implementing this statewide smoking prohibition is to provide education and respond to complaints as they come forward. Under the Anchorage law, which was enacted in 2000 and updated in 2007, the average number of enforcement actions a year is between 3 and 6. The bill allows the HSS commissioner to delegate to other agencies any other responsibilities to implement the bill's provisions. The bill also requires a person who is in charge of a place where smoking is prohibited to post it with specific signs saying that smoking is not allowed and it requires the HSS department to furnish signs to anyone who had requested them. The Division of Public Health's Tobacco Prevention and Control Program would be responsible for developing public education materials regarding the new requirements and for educating business owners, grantees, and the public on the specifics of the law. 10:11:01 AM MR. KOPP addressed "2014 Surgeon General Report" and "Premature Deaths Caused by Smoking, 1965-2014" as follows: Over the last 50 years, there have been 31 Surgeon General's reports that have utilized the best available evidence to expand our understanding of the health consequences of smoking and involuntary exposure to tobacco smoke. We have heard of these staggering statistics about the repercussions of this exposure and the recent data indicates it is something akin to a public health emergency. Just looking at smoking related incidents all together, including primary and secondhand exposure for the last 50 years, we see there's been over 20 million American lives lost. Looking at just secondhand smoke in two categories: lung cancer and heart disease, it's almost 3 million Americans. Looking at just the numbers in comparison just for analysis, there have been 20 million Americans die in that period, 2.5 million were non-smokers, and more than 100,000 babies were impacted due to smoking related issues with secondhand smoke. That's a lot of people, it's 68 times the combat deaths in WWII and 30 times the number of U.S. deaths from the 1919 flu pandemic. 10:12:16 AM He addressed "What We've Learned in 50 Years" as follows: With respect to secondhand smoke, we know now that smoking and passive smoking causes disease in nearly every organ. Exposure to secondhand smoke is causally linked to cancer, respiratory and cardiovascular diseases, and adverse effects on the health of infants and children. 41,000 non-smokers a year die from secondhand smoke according to the U.S. Surgeon General's report in 2014, and as Senator Micciche said, this is 4 times the number of DUI fatalities in 2013, which according to the National Highway Transportation Safety Association was 10,046. In our 50 year history of progression with our response to DUI as a country, we started off with no jail and a 0.15 breath alcohol limit, lowered that to a 0.10 and started bringing on jail time, now we are down to a 0.08 with mandatory 3 days in jail as a national standard in all 50 states. The point here is the response to something that kills at 4 times the rate is we think, more measured than that. 10:13:16 AM MR. KOPP addressed "Health Consequences Causally Linked to Secondhand Smoke" as follows: Stroke is more recently acknowledged by the U.S. Surgeon General as being causally linked to secondhand smoke with about a 30 percent increased risk due to secondhand smoke exposure. The annual number of deaths attributable to smoking and exposure to secondhand smoke is now approaching 500,000 people. The exposure to secondhand smoke we now know is more immediate than thought, even a decade ago, as far as its impact to the cardiovascular system, damage to blood vessels, making blood more likely to clot, and increasing the risk for heart attack and stroke. The 2006 and the 2010 Surgeon General's report both reported that there is no safe level of secondhand exposure. Our national cost in 2006 was $5.6 billion in lost productivity alone due to exposure to secondhand smoke. The estimate from the American Cancer Society for Alaska is 60 deaths and more than $1 million per year. The evidence is sufficient to infer a causal relationship between the implementation of a smoke free law or a policy and a reduction in coronary events among people under 65 years of age. Doctor Urata with the Juneau hospital is here to speak to that. In conclusion, this is a question of rights, the choice to smoke versus the need to breathe. A clean indoor air policy does not prohibit smoking, it only requires that those who choose to smoke do so in a manner that does not threaten or harm others. 10:15:06 AM MR. KOPP addressed "What About E-cigarettes?" as follows: There's a lot of discussion about e-cigarettes. The science is still maturing with respect to e- cigarettes, there are studies that show that because of the unregulated nature of the market, depending on the tool that is being used, that you can have a significant amount of toxins, ultra-fine medical particles, volatile compounds, and other carcinogens that become part of the vaping or the aerosolized air. The biggest problem is that the U.S. Food and Drug Administration (FDA) has not assumed regulation of them and there are 470 different brands. According to Alaska state law, it is illegal to sell or give any product containing nicotine to anyone under 19 years old, and because e-cigarettes retailers do not need a sales license endorsement to sell their products like tobacco retailers, there is no program of compliance checks for youth sales in place for these retailers. 10:16:06 AM He addressed "Why Smoke-Free Workplaces?" as follows: The implantation of comprehensive clean indoor laws has been shown to significantly reduce heart attacks. We talked about separating smokers from non-smokers. Air clean technologies and ventilation systems, it's very hard to get those to remove carcinogens from the air, you can sometimes get down toward the detectable smoke is not there, but they are not reliable to protect public health. In addition, eliminating exposure of secondhand smokers to secondhand smoke helps reduce tobacco use among smokers. The Surgeon General's quote is probably the most relevant on the page, "The right of smokers to smoke ends where their behavior effects the health and wellbeing of others." 10:16:51 AM He addressed "Smoke-free Laws in Alaska" as follows: Half of Alaska's population is protected by a local law from secondhand smoke at work and the remaining part, largely in the unorganized boroughs or boroughs that do not have healthcare laws, are not affected. We also recently have support from the Kodiak Borough, and Bristol Bay Native Corporation just signed on with this bill, not the smoke-free Alaska act, but actually this bill. 82 percent of Alaskans agree, according to the Dittman 2012 survey, that Alaska workers should be protected from secondhand smoke in the workplace. Support even among smokers is strong for a smoke-free indoor workplace laws according to Dittman. Alaska's support for smoke-free indoor workplaces is high throughout all regions of the state. CHAIR STOLTZE commented that the bill's concept is simple and there is no reason to go through a sectional analysis. He said he believes that the committee understands the politics and the public opinion. He related that C. Everett Koop was vilified when he was a nominee for Surgeon General because he was pro- life and deified when he was anti-tobacco. 10:18:40 AM DR. JAY BUTLER, MD, Chief Medical Officer/Director, Department of Health and Social Services, Anchorage, Alaska, stated that he wants to provide perspective of a physician as well as a bit of a baseline skeptic and touch briefly on the health effects of secondhand smoke, but really focus on the health benefits of avoiding smoking environments. He stated that he would focus on one outcome which is heart attacks, an outcome that is not junk- science and not an idea that is based on a single study in the journal of irreproducible results. DR. BUTLER detailed the link between heart attacks and cigarette smoke as follows: There are three lines of evidence, two of which have already been touched on. There's multiple epidemiological studies linking smoke exposure to the risk of heart attack; we also understand how this works, the path of physiology if you will, this isn't magic, the platelets become stickier, the lining of the vessels in the heart change function within minutes after tobacco smoke exposure for people who are non-smokers, increasing the risk of a clot, which is what causes a heart attack. Finally, I wanted to really emphasize the fact that taking cigarette smoke outdoors has been found in numerous places to reduce the overall hospitalization rates for heart attacks and in places as diverse as Helena, Montana; Saskatoon; to the entire nation of Scotland. I also wanted to stress that in most of these places, the enforcement is passive, there's not storm troopers sweeping in with squirt guns to extinguish the stogies the cigar bars. It is worth pointing out though that some of the very earliest evidence of the very short term benefits of smoke-free laws were observed among barkeepers and tavern owners. It's also worth noting that in places where these laws have been in place for a number of years, these benefits have been sustained and actually increased as time passes. 10:20:56 AM DR. BUTLER explained the impact of cigarette smoke on children as follows: Secondhand smoke exposure has been associated with the sudden infant death syndrome, respiratory infections, middle ear infections, and asthma attacks in kids; in fact, in Scotland they found that their trends in asthma or hospitalizations among children which had been increasing, part of a global trend, actually began to turn after they passed their smoke-free laws. It's also worth pointing out that concerns that smoke- free laws force people to smoking indoors at home has not been borne out, in fact the data has shown that using Cotinine in urine as a marker of cigarette exposure, this marker has actually gone down among children in areas where these laws have been enacted. We are all concerned about the high cost of healthcare. Avoiding secondhand smoke helps avoid the cost of illness associated with secondhand smoke that employers, government, and all of the "average Joes," with the exception of Joe Camel, have to bear. 10:22:15 AM SENATOR MCGUIRE asked Dr. Butler to comment about e-cigarettes. She noted that the bulk of complaints she has received pertains to the bill defining smoking to include the use of e-cigarettes. She revealed that there have been some pretty personal e-mails from folks in her community where individuals at one point were addicted to smoking nicotine through tobacco use and have found reprieve smoking e-cigarettes as a perceived health benefit. DR. BUTLER replied that the role of e-cigarettes as a harm reduction tool or even as a tobacco cessation tool is an ongoing debate. He pointed out his concerns with e-cigarettes as follows: · Aerosol exhaled from an e-cigarette is not always easy to detect unless a person is very close. · E-cigarettes normalize smoking behaviors. · Using marijuana in an e-cigarette is virtually impossible to differentiate. He reiterated that e-cigarettes are not regulated by the FDA and not approved as tobacco cessation instruments. He noted that nicotine replacement products already exist. He revealed that he has received more than a dozen emails that all cite the same study that addresses contaminants and not what is intentionally in the liquids. He said he questions the renormalization of smoking where e-cigarettes target the junior high school age group with flavors like Candy Crush, Vanilla Dream, Captain Crunch, and Mountain Dew. He stated that he remains skeptical and asserted that e-cigarettes should be included in the bill for ease of enforcement. 10:25:12 AM JOE DARNELL, Investigator, Tobacco Youth Education & Enforcement Program, Division of Behavioral Health, Alaska Department of Health and Social Services, Anchorage, Alaska, stated that he works on under aged tobacco enforcement and compliance. He said enforcement of SB 1 will be done statewide through passive enforcement with the use of a toll-free number and website. MR. DARNELL specified that an initial complaint will result in a letter to let a business know that a complaint was received. He added that educational information about the bill with details on health effects will be sent as well. He said a second complaint will result in a more strongly worded letter as well as a follow up by a local coalition or one of the statewide grantees. He stated that a third complaint will lead to a follow up in-person. He opined that he does not anticipate a third complaint situation. He noted that Anchorage has never had a third complaint and added that a second letter has rarely been sent out. 10:26:52 AM DR. ROBERT URATA, MD, volunteer, American Heart Association, Juneau, Alaska, revealed that he was born and raised in Wrangle, Alaska and that he has practiced medicine in Juneau since 1984. He noted that he has been an American Heart Association volunteer for the past 15 years. He stated that he supports SB 1 with the inclusion of e-cigarettes. DR. URATA read the following statement: Every 34 seconds an American dies of a heart attack, every 40 seconds an American dies of a stroke. Cancer and cardiovascular disease are the number one and two causes of death in Alaska. Secondhand smoke kills over 100,000 Americans every year and it also costs a lot of money. This state may save up to $5 million if this law goes through. Smoke-free working places are really important for the health of this country and this state. In Pueblo, Colorado, smoke-free ordinance found a 20 percent gain in their combined bar and restaurant sales tax and a 27 percent decrease in heart attacks when they compared a year and a half before the law and a year and a half after the law; I believe this was also reproduced in Helena, Montana when they passed their clean air law. I would also wish to include e-cigarettes because there are serious questions to their safety. The FDA has found known toxins in nicotine, but currently there are over 240 products and they are not all tested, so it is hard to know what's going on there. The FDA is still studying this and my feeling is this should be included because what we do in medicine is first, "do no harm;" I think this should be included in this bill until we have more knowledge because harm could be done. Imagine the many lives saved if cigarettes had been studied properly before putting it on the market. On behalf of the American Heart Association I urge you to support this bill and thank you for your time. 10:29:58 AM CHAIR STOLTZE announced that SB 1 will be held in committee.