Presented by Gayle Harris, MPH, RN

April 26, 2012

Provide a summary of the Durham County experience

Discuss lessons learned

Concept presented to BOH on July 8, 2010 ◦ Occupancy of new facility to begin in 2011◦ Department directors desired smoke-free policy◦ Policy to cover county property on two city blocks

Request from Duke University Hospital in September 2010

• BOH meeting September 2010– Introduction of request from Duke– Presentation by Sally Herndon

• HB – 2 clause that allows BOH to establish stricter rules

• Statewide compliance with HB -2 in bars and restaurants

• Services available from Tobacco Prevention and Control Branch

– Board’s concern regarding authority “to take smoking rights away from citizens”

BOH meeting in November 2010◦ Introduction of Frieden’s Health Impact Pyramid

• BOH meeting in November 2010– Frieden’s Health Impact Pyramid– Draft Rule

• “Regulation of Smoking and the use of Other Tobacco Products in Durham County Health Department buildings, on Durham County Health Department grounds, in The Durham Center, on the Durham Center Grounds, in Healthcare Facilities, in Veterinary Offices, in Pharmacies, in City or County Bus stops and on Abutting Sidewalks”

– Discussion and lots of it– Subcommittee appointed– Inclusion of other public places

BOH meeting January – May 2011- Board discussions to refine the proposed Rule- Decision to hold a written public comment period

May 2011- Written public comment period (May 16th –

June15th) advertised- Links to the Rule and CDC’s website (“How

Tobacco Smoke Causes Death” and “Facts about Tobacco Smoke and How It Impacts Your Health”) posted on website.

- Mailing and e-mail addresses posted on website- Newspaper article (“Ban Smoking in Public?”) and

story on blog site (“County health department proposes outdoor smoking restrictions…”)

BOH meeting in July 2011- Public comments reviewed- Subcommittee to reconvene to consider impact of

comments BOH meeting in August 2011

- Subcommittee reports no changes to Rule- Proposed amended Ordinance presented- Mock-up of proposed signage and educational

tools, budget, and Awareness Campaign presented

Presentations to Elected Officials- November 15th – Joint City County Meeting- November 22nd – City Council Worksession- December 5th – BOCC Worksession

Official comments from City staff via City Manager- Agreed to make entire park system and shelters at bus

stops smoke-free - Did not agree with authority to address sidewalk

maintained by the City in State right-of-way- Recommended an enforcement strategy with

designated staff rather than involving law enforcement

BOH Subcommittee reconvened in December 2011 to consider feedback received and made adjustments to the Rule.

BOH meeting in January 2012 changes to Rule approved.

Individual meetings held with BOCC members to review the changes (January 18th – 19th)

Local governments may restrict smoking in public places.(a)        Except as otherwise provided in subsection (b1) of this section, and notwithstanding any other provision of Article 64 of Chapter 143 of the General Statutes to the contrary, a local government may adopt and enforce ordinances, board of health rules, and policies restricting or prohibiting smoking that are more restrictive than State law and that apply in local government buildings, on local government grounds, in local vehicles, or in public places. A rule or policy adopted on and after July 1, 2009 pursuant to this subsection by a local board of health or an entity exercising the powers of a local board of health must be approved by an ordinance adopted by the Board of County Commissioners of the county to which the rule applies. The definitions set forth in G.S. 130A‑492 in Part 1A of this Article apply to this section and shall apply to any local ordinance, rule, or law adopted by a local government under this section.

(e)        A county ordinance adopted under this section is subject to the provisions of G.S. 153A‑122.  (2007‑193, ss. 2, 3.1; 2007‑484, s. 31.7; 2008‑95, s. 1; 2008‑149, s. 4; 2009‑27, s. 1.)

February 13, 2012 BOCC regular meeting

The Board adopted the Board of Health Smoking Rule with an effective date of August 1, 2012

“Smokers’ worlds are shrinking, yet again, and it happened in Durham without so much as a raised eyebrow. That in and of itself may be a sign that we have reached a tipping point in our city in the anti-smoking movement…We applaud the County Commissioners unanimous support of the measure…We’re glad commissioners have made it a smaller world.”

The Herald-SunFebruary 15, 2012

Where you start is just that – where you start.

This is an iterative process. Use all available resources. Communication and education are key

components in the process.