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WC CWF Health District Board Minutes - 04/25/2014 WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES April 25, 2014 Wichita Falls-Wichita County Public Health District = EGEIVED IN 1700 Third Street - Parker Conference Room CITY CLERK'S OFFICE Wichita Falls, Texas DATE: ,374/4- ! _TIME: ,1 :44-2_ MEMBERS PRESENT: Board Members Julie Gibson, D.V.M, Vice-Chair Kirk Harlow, Ph.D. Michael Lamar, M.D. Larry Rains, D.D.S. MEMBERS ABSENCE EXCUSED: Scott Plowman, Chair Jane Leach, R.N., Ph.D., Secretary Robin Moreno, MHA-HAS, ACHE Lou Kreidler, R.N., B.S.N. Director of Health Amy K. Fagan, M.P.A. Assistant Director of Health Dr. Ahmed A. Mattar Health Authority Kevin Hugman Assistant City Manager Miles Risley City Attorney Peter Scott Assistant City Attorney Ben Hoover Council Liaison Not Present County Judge I. CALL TO ORDER Dr. Julie Gibson called the Health Board meeting to order at 12:02 pm followed was the new member induction in order to attain a quorum. II. NEW MEMBER INDUCTION Appointment of new Health Board member was conducted by Janice Flores, Notary. Dr. Larry Rains was inducted into the County appointed Practicing Dentist left by Dr. Tracy Hill. III. APPROVAL OF MINUTES AND ABSENCES Dr. Gibson called for the review and approval of minutes from the meeting held on February 28, 2014. Dr. Lamar introduced a motion to approve the minutes as presented and Dr. Harlow seconded the motion. Motion passed unanimously. • At this time it was noted the excused absence of Dr. Jane Leach, Robin Moreno, and Scott Plowman. IV. TOBACCO ORDINANCE Lou Kreidler, Director of Public Health began the presentation with the Health District Vision: Healthy People, Healthy Community and the Mission: Preventing Illness and Injury, Promoting a Healthy and Safe Community, Protecting all Member of Our Community. The Tobacco Ordinance was formed out of the Wichita County Health Coalition that formed in 2012 there are 40 community members which include the leaders of all the major Hospitals, major Medical groups, Physicians groups, Clinics of North Texas, MSU, WFISD, Indigent Healthcare, Dieticians, area Food Banks, Board of Health liaison, and SAFB. The Health Coalition developed a community health improvement plan within that was detailed 6 strategic goals to accomplish; 3 comprehensions and 3 systems based. One of the sub group goals was to reduce the prevalence of those individuals whom use tobacco products out of review they realized they needed to revise provisions to the current ordinance based on feedback from the entire Coalition. Representatives from all physician groups signed a letter in support of the need for a comprehensive smoke free ordinance and formed a partnership with the Health Departments new grant the Tobacco Prevention & Control (TPCC) with an entire focus on education. The Coalition looked first at the current ordinance found when last revised in 1994 it was the strongest in the state of Texas currently it is one of the weakest it allows separate smoking sections in restaurants, smoking in bars and private clubs, also allows designated smoking sections for employees, smoking in hotels and motels rooms rented to guests. They looked at the Surgeon General 50th Anniversary Report this year out of 20 million American's that lost their lives to smoking over the past 50 years that 2 million of those were nonsmokers exposed to second hand smoke. The report stated it was clear there was no safe level of exposure to second hand smoke. In Texas second hand smoke is the number 1 health risk. Cigarette smoke contains more than 7 thousand chemicals and 70 of those are known to cause cancer. Second hand smoke is the third leading cause of preventable death in the US, killing 46,000 to heart disease and 3,400 due to lung cancer annually. The information is important to Wichita Falls (WF) looking at WF data found that in Wichita County the current adult smoking rate is 21% and the State rate is 18%, over the past from when the County facts was put out to this year the smoking rate in Texas declined and WF increased. An average of 18% of women aged 18 to 29 years reported smoking while pregnant in 2010. Currently we do not have data on youth smoking it is one thing the TPCC grant will do in conjunction with the State a behavioral risk factor surveillance study in the Junior and High schools to determine what the smoking rate among our youth is. The premature birth rate in Wichita County is ranked 176 out of 230 per county thiat puts us in a lower one third counties in the state of Texas. In Wichita County cancer and heart disease are the two leading deaths of those 49 years and older. Cardiovascular disease and high blood pressure rates are all higher in Wichita County than in Texas. The immortality rate in Wichita County is 8 deaths per 1,000 and in Texas 6 deaths per 1,000. You can see from the facts in Wichita County the health is poor in the community. It has been asked why electronic cigarettes are included in the ordinance. Currently e-cigarettes are unregulated there are no restrictions on the ingredients that manufacturers can or cannot include. Laboratory tests have confirmed that the vapor from e-cigarettes contain glycerin, pieces of tin, aluminum, iron, nickel, arsenic, copper, lead, carcinogenic compound, volatile organic compounds, they mainly increase experimentation of young adults and it renormalizes smoking. It also can lead smokers who have quit begin to vapor and reestablish nicotine addiction and makes the enforcement facility for managers and owners easier they do not have to spend time to determine what that person is smoking a real cigarette or e-cigarette. Electronic cigarettes and youth middle and high school students who used electronic cigarettes were more likely to smoke real cigarettes and less likely to quit then students who did not use the device. A new study showed 2 that children were more likely to smoke heavy as they were older. A graph presented showed the rate of electronic cigarette use drastically increased among high school students. Second hand smoke is a known cause of lung cancer, heart disease, low birth weights, chronic ailments such as bronchitis, asthma, and other health problems. Pregnant women who have been exposed to high levels of second hand smoke have a higher rate of miscarriages, stillbirths, and fetal deaths. The American Society for Heating and Refrigerating and Air Conditioning Engineers have stated at present the only means of effectively eliminating the health risk associated with indoor exposure to second hand smoke is to ban smoking activity. The groups that build these systems, put them in and design them openly say these systems do not work to prevent harm to second hand smoke. Tobacco smoke contains odorless chemicals that you cannot see or smell that does not mean you are not at risk. The other thing always done when we look to revise an ordinance is what other cities in the state of Texas are doing. There are 35 cities with comprehensive smoke free ordinances we looked at those between a 90,000 and 180,000 population in comparison to other cities of our population. Followed was the review of definitions found in Section 58-101. —Definitions. Director means chief administrative officer of the city-county public health district. Electronic cigarette means a battery-operated heating device that vaporizes a nicotine-containing solution from a replaceable cartridge in a process triggered by the pressure drop that occurs when the user inhales from the device, or any similar device intended for the vaporization and inhalation of a nicotine-containing solution. Employee means a person who is employed by an employer in consideration for direct or indirect monetary wages or profit, and a person who volunteers his or her services for a non-profit entity. Employer means any person, including a municipal corporation, or non-profit entity who employs the services of one or more individual persons. Enclosed area means a space that is enclosed on all sides by solid partitions that extend from the floor to the ceiling, including but not limited to screens, walls, windows, and doors. Fraternal organization means a non-profit organization that: a) is chartered by a national organization in existence since 1953; b) is tax exempt under Section 501 (c) (8), (10), or (19) of the Internal Revenue Code; c) operates under a lodge system with a representative form of government; and d) is organized for the exclusive benefit of the members of the organization and their dependents. Operator means the owner or person in charge of a public place or workplace, including an employer. Park means the outdoor areas of land dedicated and used as parkland, or city-owned land used for a park or recreational purpose that is under the administrative control of the Parks and Recreation Department. The term includes city-owned athletic fields, nature preserves, farmers markets, golf courses and swimming pools. Public Place an enclosed area or any portion thereof to which the public is invited or to which the public is permitted or allowed access including but not limited to banks, bars, bingo halls, educational facilities, fraternal organizations, healthcare facilities, hotel/motel rooms, laundry mats, public transportation facilities, reception areas, restaurants, retail food production, marketing establishments, retail service establishments, retail stores, shopping malls, sports arenas, theatres, waiting rooms, and work places. A private residence is not a "public place" unless it is used as a child care, adult day care, or health care facility. Retail tobacco store means a retail store utilized primarily for the sale of tobacco products and accessories, to include electronic cigarettes, in which the sale of other products is merely incidental. Smoking means inhaling, exhaling, burning or carrying any lighted cigar, pipe, cigarette, weed or plant in any manner or form as well as the use of an electronic cigarette. 3 Work Place means an enclosed area under the control of public or private employer in which employees work or have access to during their course of employment. Section 58-102. — Smoking prohibited in certain places as described below. The proposed ordinance would prohibit smoking: a) In a public place or park. b) Any enclosed City building or facility. c) Any enclosed area of a work place. d) Within 20 feet of an entrance or openable window of an enclosed area which prohibits smoking. e) The owner or operator of a public place commits an offense if the person fails to take necessary steps to prevent or stop another person from smoking in an enclosed area in a public place. f) It prohibits smoking in the seating area of any outdoor arena, stadium, bleachers, and grandstands for the use of spectators at sporting and other public events. Section 58-103. —Exemptions. It does not apply to private residences except when used as a child care, adult day care, health care facility, retail tobacco store, retail electronic cigarette store, or outdoor area of a work place that is not in the area described by this article except that a park shall not be exempt. Section 58-104. — Voluntary designation of a non-smoking campus. Nothing in this article shall be construed to prohibit the owner or operator of an enclosed or outdoor public place from voluntarily designating his or her property as non-smoking. Section 58-105. —Smoking in taxicabs prohibited. a) It shall be an offense for any individual to smoke in a taxicab. b) An owner or holder of a taxicab franchise commits an offense if the owner or his designee permits any individual to smoke in a taxicab. c) The holder of a taxicab service franchise shall conspicuously post a sign in each taxicab that indicates smoking is prohibited. Section 58-106. — Signs required. The owner or operator of a public place shall conspicuously post a "No Smoking" sign, the international "No Smoking" symbol, or other sign containing words or pictures that could reasonably be understood as intent to prohibit smoking. Section 58-108. —Enforcement. a) This section is cumulative of other laws providing enforcement authority. b) A person may report a violation of this article to the Director of the Health District or his/her designee. c) The Director or his/her designee may enforce this article and may 1 seek injunctive relief in addition to any civil or criminal penalties associated with a violation. d) The Director or his/her designee may suspend or revoke a permit or license issued by the Director to the operator of a public place or work place where a violation of this article occurs, in addition to any other available remedies. Dr. Rains inquired who would enforce. Lou Kreidler replied Environmental Health was to enforce but the Police would be the primary enforcer. A Public Education component is in the grant and the ordinance Section 58-109 it is important that it contains the public education component. We are not opposing laws about educating 4 people and not only about the laws being put in place but the health risk associated with smoking it probably will be done by the TPCC grant not only to the general public but to all consumers that are business owners. One of the most important things in the ordinance Section 58-110.-Minor access to tobacco process limits the minor's access to tobacco products it already is in the ordinance but it adds electronic cigarettes so electronic cigarettes and vaporing liquid will be placed behind the counter so minor's do not have access. 2. Penalty Violations of this ordinance shall be punishable by a penalty of up to $500 per violation and as provided by Section 1-14 of the Wichita Falls Code of Ordinances. Dr. Harlow asked what about violations at MSU; you cannot prosecute the entity would you prosecute the student. Miles Risley replied the offender would be prosecuted not the entity. It has been shown there is not negative economic impact from smoking ordinances that are put in place. The CDC did a comprehensive smoke free ordinance done by El Paso, Texas it did not affect the bar and restaurant revenue in the year after it took effect in January 2002. A 2010 analysis of economic outcome of smoke free laws that smoke free legislation does not hurt restaurant or bar business in some cases business may improve. The 2006 Surgeon General report said that evidence from peer review study that smoke free policies and regulations do not have an adverse economic impact on hospitality industry. The 2008 Zagat survey the verdict on smoking was overwhelming it was 77% of diners said they would eat out less if smoking was permitted in local restaurants and 2% said they would dine out more. The youth behavioral risk factors surveillance survey that the survey done in 2009 of adults the question asked was, if there was a total ban on smoking in restaurants would you eat out more? 27.4% said they would eat out more, only 5.6% would eat out less, 67% said it would make no difference. Asked f there were a total ban on smoking in bars and music clubs would you go to bars and music clubs more often? 18.7% more often, 8% less often, and 73.3% no difference. Graphs were presented of studies done from El Paso in 2002 that you can see when the ordinance went into effect and the graph shows clearly there was no decline in restaurant, bar, and mixed beverage sells. In Austin the same thing when the ordinance went into place in 2006 not only did it not decline but increased arid Dallas the same as well. Of smokers 80.7% reported that smoke free dining laws had not affected their dining habits. The smoke free laws are associated with increases of hotel revenues in Mesa, Arizona, Los Angeles, New York, and Utah. California and New York tourism increased after the enactment of smoke free policies. A 2014 analysis of 129 cases of smoking bans in bars and restaurants showed that overall there were no substantial gains or loses. Included were some testimonies from city leaders because it is important to see what the impact has been. In May 2013 Lewisville Mayor Pro Tem Leroy Bond in the State of the City Address said the new ordinance has been in place for nearly 5 months and has not slowed down the restaurant traffic in the slightest in fact city wide restaurant receipts was up 4.25% year over year over the first quarter operated under the new ordinance. In addition to increased food sales mixed drink sales increased by 2.18%. James Cook, Community Relations and Tourism Director said that sales did not go down due to the ordinance some places insisted the ordinance would cause restaurants to lose money or even close and that did not happen. In February 2009 a study conducted by the City of Houston found that a smoke free air ordinance has no economic impact on businesses the former Mayor Bill White said it is reassuring that we did the right thing we protected workers who often do not have a say in where they work. What is the cost of smoking vs. nonsmoking? If the CDC places a price tag on those employees that smoke for each employee that smokes a business will pay an additional $1,760 in loss of 5 productivity and $1,623 in excess medical expenditures. Estimated costs associated with second hand smoke on nonsmokers can add up to $490 per smoker per year plus a smoker cost an employer $3,853 more per year than a nonsmoker, absenteeism is decreased smokers miss an average of 6.16 days of work due to sickness while nonsmokers miss an average of 3.86 days of work. The American Productivity audit conducted a study with data from the US Workforce that tobacco was one of the greatest variables observed when determining workers loss production time greater than alcohol consumption, age, education, and family emergencies. Benefits of our community where we live, work and play comprehensive smoke free laws that include restaurants and bars was associated with a rapid decrease in hospitalizations for all of heart attack, stroke, asthma, and other respiratory illnesses. The graph presented showed between 2011 and 2013 the percentage of Texas voters that supported a statewide smoke free law increased from 70% to 74%. A video of Texas restaurants represented a positive impact of a smoke free ordinance which concluded the presentation. Dr. Lamar stated there are no data for e-cigarettes it is an over reach no moral authority to ban. Dr. Mattar disagreed they do more harm than good the idea for e-cigarettes was to be safer and to help quit. Amy Fagan added that 9 counties ban e-cigarettes all passed within the last 6 months to a year. Dr. Gibson said she was a non-smoker and does not want to see, smell, or be around it. Lou Kreidler stated that in the second full week of May will be the stake holders meetings. In preparation to take to Council on June 3rd as a discussion item a special Health Board meeting would need to be held in May to obtain a recommendation or not for Council. Available dates will be emailed out to determine the most convenient date for everyone to attend. V. NEXT MEETING June 27, 2014 VI. ADJOURN Dr. Gibson requested a motion to adjourn. The motion was made by Dr. Lamar and seconded by Dr. Harlow the motion carried and the meeting was adjourned at 12:58 pm. Signatur �C (3 I 6 GO (ivl 1/4 ✓U Print Name Scott Plowman, Chair,Julie Gibson, D.V.M., Vice-Chair, or Jane Leach, R.N., Ph.D., Secretary WFWC Public Health Board Title 6