--Regina Benjamin, U.S. Surgeon General, How Tobacco Smoke Causes Disease (2010)
Since 1964, U.S. Surgeons General have issued more than 30 reports detailing the hazards of tobacco smoke exposure. The most recent report, How Tobacco Smoke Causes Disease, issued in 2010, is a comprehensive and scientific discussion of how tobacco smoke exposures damage the human body, based on decades of research.
The picture that is clearly and consistently emerging from these studies is that there is no safe level of exposure to tobacco smoke. According to the Surgeon General, tobacco smoke contains more than 7,000 chemicals, hundreds of which are toxic, and at least 69 of which cause cancer. The Surgeon General’s 2010 report shows that the harmful effects of tobacco smoke are immediate: the chemicals are rapidly absorbed by the body, damaging blood vessels, weakening the immune system, and inflaming the delicate lining in the lungs. For both smokers and nonsmokers, exposure to tobacco smoke increases risk for heart disease, respiratory disease, diabetes, and cancer. For cancer patients, exposure to tobacco smoke weakens the body’s ability to fight cancer and can promote tumor growth. For diabetics, exposure to tobacco smoke increases risk of heart and kidney disease, amputation, eye disease, nerve damage, and poor circulation. Across the nation, more than 440,000 people die every year from diseases related to smoking and exposure to tobacco smoke.
Many people are at least generally familiar with the hazards of firsthand and secondhand smoke. Less commonly known, but still hazardous to human health, is thirdhand smoke. Thirdhand smoke consists of the pollutants in tobacco smoke that linger in rooms and react with other compounds found in the indoor environment, long after cigarettes have been extinguished. According to a 2010 study led by researchers at the Lawrence Berkeley National Laboratory, the reactions between the chemicals in thirdhand smoke and other common indoor pollutants can produce carcinogens for days, weeks, and even months after smoking in the room has stopped. Contrary to what some may believe, thirdhand smoke is much more than a lingering odor or an aesthetic irritation: it is a health hazard. Semivolatile compounds from thirdhand smoke settle on indoor surfaces, mix with dust and air, and are absorbed by carpets, upholstery, fabric, or other porous materials commonly found indoors. Infants and young children are especially at risk for exposure to thirdhand smoke because of common behaviors at their age that include crawling and hand-to-mouth contact, as well as because of their immature respiratory and immune systems. Nonsmokers who live or work in indoor environments where smoking occurs are also at risk of health complications because of frequent and/or prolonged exposure to both secondhand and thirdhand smoke.
In her preface to How Tobacco Smoke Causes Disease, the Surgeon General notes, “The cost [of smoking and exposure to smoke] to the nation is tremendous: a staggering amount is spent on medical care and lost productivity. But more importantly there is immeasurable cost in human suffering and loss.”
One of the most effective ways to improve public health and protect communities from exposure to tobacco smoke is to ban smoking in public places. According to the National Conference of State Legislatures, studies have shown that the benefits of smoke-free laws around the country include significant declines in hospital admissions for heart attack; reduced coronary disease; reduced public exposure to tobacco smoke; encouragement to smokers to quit; and either no effect or a positive effect on total restaurant and bar revenues. In the state of Hawaii, a 2008 study commissioned by the Hawaii State Department of Health showed that tourism and hospitality economic indicators were unaffected by the state’s smoke-free law one year after its enactment. Hawaii, like the CNMI, is heavily dependent on tourism, including tourism from Asian countries.
Indeed, public smoking bans have become a common trend, and have been implemented across the nation and around the world. As of 2010, as many as 36 states, plus the Virgin Islands, Puerto Rico, Guam, and the CNMI, and many other cities and municipalities in countries around the world, including Japan, China, Korea, Hong Kong, Taiwan, Australia, New Zealand, and the Philippines, have enacted smoke-free laws to protect public health.
Here in the CNMI, several bills have been introduced that would amend the Smoke-Free Air Act of 2010 in order to expand smoking in public places. One of the main objectives of these bills is to increase the percentage of smoking-designated rooms in hotels in response to requests made by the hospitality industry and the Saipan Chamber of Commerce. Currently, CNMI hotels are allowed to designate up to 20% of their rooms as smoking rooms. Earlier this month, the House of Representatives passed House Bill 17-70, HS1 to permit hotels to designate up to 80% of their rooms for smoking. (The original bill also proposed to allow smoking in restaurants, but that provision was deleted in the version that ultimately passed the House.) The House bill is now before the Senate for action, along with another bill, Senate Bill 17-37, which proposes to allow hotels to designate up to 30% of their rooms for smoking, and to further permit smoking in professional offices and in bars (including attached bars in restaurants) as long as the areas are “fully ventilated.” (The law presently allows smoking in bars and attached bars in restaurants after the kitchens have closed, provided that smoke from these places does not infiltrate into areas where smoking is prohibited). Some senators have indicated that additional amendments are likely to be proposed on the Senate floor at their next session, including one that will limit the scope of legislation to allow smoking in up to 30% of hotel rooms and balconies only, and another that would allow smoking in restaurants.
Both the House and the Senate bills indicate that economic reasons are the primary force behind the effort to expand smoking areas in the CNMI. Neither bill, however, cites any studies to show that the CNMI’s Smoke-Free Air Act has had any negative economic impact on the hospitality industry, or on any other industry. The statistics that are cited in the bills relate to the prevalence of smoking in countries from which many of the CNMI's tourists originate; however, these statistics warrant further examination. For example, Senate Bill 17-37 states that 350 million people smoke in China; this equates to approximately less than 30% of China’s total population. In other words, more than 70% of the people in China do not smoke. As another example, the same bill states that 40% of the Japanese male population are smokers; overall, however, the actual prevalence of smoking in Japan as of 2010 is approximately 24%, a record low for that country for the 15th consecutive year. Russia has a high prevalence of smoking (53% according to the Senate bill, but more like 43% according to other reports), but even Russia is today contemplating smoke-free laws for public places.
Meanwhile, the Community Guidance Center at the Department of Public Health is planning to conduct surveys of CNMI tourists regarding their views of the CNMI’s smoke-free law, and to compile local tobacco-related data including tobacco-related deaths, medical referral costs, and other health and economic impacts. Many health advocates believe that more objective studies on the economic and health impacts of the CNMI’s Smoke-Free Air Act, as well as more public hearings, are critical for informing the community and policymakers in making evidence-based decisions regarding policies that affect public health.