Gotham Gazette http://www.gothamgazette.com/component/tags/tag/2239 Sun, 24 Mar 2019 21:50:29 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) The City’s New Pharmacy Ban and Next Steps in Fighting Cigarette Smoking http://www.gothamgazette.com/130-opinion/8178-the-city-s-new-pharmacy-ban-and-next-steps-in-fighting-cigarette-smoking http://www.gothamgazette.com/130-opinion/8178-the-city-s-new-pharmacy-ban-and-next-steps-in-fighting-cigarette-smoking de Blasio New York City anti-smoking

(photo: Michael Appleton/Mayor's Office)


Shoppers at pharmacies are there to buy products that will make them healthier, whether that’s tissue boxes to help with colds or prescription medication for a chronic issue. Pharmacies shouldn’t be home to items that make people sick.

CVS recognized this in 2014 when it took the unprecedented step of stopping the sale of tobacco products in its stores. Many public health professionals thought this would be the beginning of a wave of pharmacies following CVS’ lead. That didn’t happen.

Until January 1 of this year New Yorkers could still buy tobacco products at 500 pharmacies throughout the city. That’s when a new law went into effect that banned New York City pharmacies from selling tobacco products. This rule was part of a package of legislation signed into law by Mayor de Blasio in August 2017 aimed at reducing the number of smokers in the city by 160,000 by 2020. More than 5 decades after the U.S. Surgeon General first warned against the dangers of smoking, more than 880,000 adults in New York City still smoke.

The ban on tobacco sales in pharmacies is another important step in the long fight against tobacco use in New York City. Despite many years of progress, that fight is far from over, and we’re now facing unprecedented challenges. Policymakers need to continue pushing for a healthier, smoke-free city by taking an even more restrictive approach to purchasing tobacco products and turning their attention more closely to the dangers of products that can act as a gateway to traditional cigarettes.

There are many ways to continue building on the anti-smoking momentum that has been accelerating since the passage of the Smoke Free Air Act in 2002.

Now that pharmacies no longer sell cigarettes, policymakers should turn their attention to where else New Yorkers are buying tobacco products. After it pulled tobacco products from its shelves, CVS found that 38 percent of people who exclusively bought cigarettes at their stores were more likely to stop buying them at all. Imagine the impact that can be made if access were further restricted at other stores that traditionally sell cigarettes, along with restricting access near places that young people frequent, including schools, houses of worship, playgrounds, and libraries. An aggressive campaign to reduce access – whether through halting sales altogether or continuing to increase prices – will pay dividends in public health and lower the number of smokers in New York City.

Looking beyond traditional cigarettes, one of the most pressing new challenges in public health is the rise of addictive e-cigarettes, which have exploded in popularity among youth. More than 20 percent of U.S. 12th-graders reported that they vaped nicotine in 2018. Alarmingly, a study found that teens that used e-cigarettes had three times the level of cancer-causing chemicals in a urine test than their non-using peers.

The New York CIty pharmacy ban includes e-cigarettes, but there are still too many avenues through which young people can buy these dangerous products. There is also a persistent, misleading narrative that e-cigarettes help people quit smoking, despite the blatant lack of evidence to support this assertion. Policymakers need to take comprehensive action to prevent the further spread of e-cigarettes by continuing to limit sales and launching comprehensive education programs, or we risk reversing decades of progress in curbing smoking.

While we celebrate the critical milestone achieved by this ban and its companion legislation, we must turn our attention to the next frontier in reducing the number of smokers and improving the health of all New Yorkers. There are still too many places to buy tobacco products, and the looming threat of e-cigarettes grows bigger every day. We’ve recognized the dangers of smoking for long enough, and it has only become clearer that increasingly firm action is critical to combatting this problem.

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Lisa David is president and CEO at Public Health Solutions (PHS). PHS’ NYC Smoke-Free program has contributed to changes in tobacco control measures in New York City. On Twitter @wearephsny.

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The City’s New Pharmacy Ban and Next Steps in Fighting Cigarette Smoking Sun, 06 Jan 2019 05:00:00 +0000
NYCHA Prepares to Implement Smoking Ban http://www.gothamgazette.com/city/7318-nycha-prepares-to-implement-smoking-ban http://www.gothamgazette.com/city/7318-nycha-prepares-to-implement-smoking-ban de blasio anti smoking presser 2020

(photo via the Mayor's Office)


Following the announcement of a nationwide smoking ban in public housing residences last year, the New York City Housing Authority (NYCHA) has been preparing to implement the controversial federal policy across its more than 320 developments that house approximately half-a-million residents.

“Smoke-Free NYCHA” involves updating resident leases with language that prohibits smoking, running an awareness campaign to inform residents about the new ban as well as the harms of secondhand smoke, and crafting an enforcement plan for repeat offenders. According to the city's health department, NYCHA residents "smoke at higher rates than other New Yorkers, and suffer from higher rates of chronic disease including heart disease, diabetes, and asthma."

Required by the federal government to have a smoke-free policy in place by July 2018, NYCHA has encountered skepticism and criticism from its residents. Moreover, while anti-smoking advocates applaud the new federal policy and NYCHA’s efforts to implement it, they worry that Mayor Bill de Blasio’s administration will fail to provide the necessary financial resources to support meaningful tobacco cessation efforts across NYCHA campuses.

De Blasio has expressed support for the ban and has backed other anti-smoking measures, including a recent legislative package he signed into law, aimed at reducing smoking in New York City writ large. The mayor has also invested heavily in NYCHA overall, though City Hall has not yet made competely clear what it will do to support implementation of the NYCHA smoking ban, while the Department of Health and Mental Hygiene is working with NYCHA stakeholders to prepare for implementation of the smoking ban.

In late November of 2016, shortly before the end of President Barack Obama’s second term, the Department of Housing and Urban Development (HUD) declared that all public housing authorities were required to prohibit smoking within their campuses. "Every child deserves to grow up in a safe, healthy home free from harmful second-hand cigarette smoke," said then HUD Secretary Julian Castro in a press release. "HUD's smoke-free rule is a reflection of our commitment to using housing as a platform to create healthy communities.”     

Upon learning of the new policy, NYCHA, the largest public housing authority in the United States, began to ready its residents and staff. Given that City Council Member Donovan Richards had previously proposed banning smoking in city-funded housing, and earlier experience regulating smoking in its developments, the agency was not unprepared. “We certainly ramped up our planning and collaboration as soon as we heard the rule was being made final, but we already had a foundation of work before that time,” said Andrea Mata, Director of Health Initiatives at NYCHA, in an interview with Gotham Gazette.

She explained that, in 2012, NYCHA began working with the New York City Department of Health (DOH) on a pilot project at 830 Amsterdam, a single building development on the Upper West Side, to create a “resident-led and initiated strategy” to reduce secondhand smoke exposure. After three years, the project culminated with representatives of 85 percent of all units voluntarily signing a pledge to not smoke within the building.

Upon announcement of the federal ban, NYCHA sought to build on the 830 Amsterdam pilot as well as pull from earlier examples of public housing authorities implementing smoking bans within their developments, including those of Philadelphia and Albany.

NYCHA began by reaching out to residents and experts to develop a comprehensive policy. Representatives engaged the Resident Advisory Board, a collection of public housing leaders, conducted community meetings across the city, and are now beginning to brief all local Resident Associations in the five boroughs. They also consulted organizations like the New York University School of Medicine as well as the American Cancer Society for feedback.

In addition to ongoing community engagement, the housing authority is also preparing to update resident leases with language that stipulates adherence to the smoking ban. According to NYCHA’s plan for 2018 released mid-October, the agency will begin informing residents of changes to their lease in early 2018, who will then have the opportunity to comment on the new clause. After revisions, they will mail residents an updated lease.

Finally, NYCHA is in the midst of developing an enforcement process to ensure residents comply. “At this point we don’t have a final policy that we can share, but we’d imagine that it would have a few points of escalation,” explained Sideya Sherman, Executive Vice President for Community Engagement and Partnerships at NYCHA, in an interview with Gotham Gazette.

A policy of “graduated enforcement,” it will begin with warnings, then interventions, continuing to escalate until NYCHA staff announces a “commencement of termination of tenancy proceedings,” said NYCHA spokesperson Jasmine Blake to Gotham Gazette of the outline of the enforcement plan.

The possibility of eviction for offenders has been a point of contention, as has an alleged lack of information about the smoke-free rule being provided by NYCHA to residents. “I think it’s a horrible policy,” said Charlene Nimmons, resident of Wyckoff Gardens and president of the Wyckoff Gardens Resident Association from 2003 to 2015, in a phone call. “There’s this privileged rule and law being forced down upon public housing residents.”

A resident of Fort Greene’s Ingersoll Houses also expressed frustration in comments to DNAinfo earlier this year. “How can they kick you out for something that’s just like a disease, basically?” said Curtis Flemister. “It’s not like you can say, 'I’m just not going to do it if I’m going to get kicked out.'”

“I have not received and have not had any information about it,” said Geraldine Lamb, president of the Bronx’s Castle Hill Resident Association, in an interview with Gotham Gazette.

When the public housing smoking ban was first proposed, in 2015, de Blasio said that “the goal is a good one,” but that there would be “a lot to work through” in terms of implementation. NYCHA Chair and CEO Shola Olatoye has also expressed concern about enforcement, wanting it to be “resident-led” as opposed to involving the NYPD.

On Monday, City Hall spokesperson Melissa Grace said in a statement, “This administration is dedicated to creating healthy living environments for all New Yorkers, and NYCHA and the City Department of Health are working closely with our public housing residents, advocates and the federal government as this ban takes effect.”

According to the Department of Health (DOHMH), there is a position within its Center for Health Equity that is dedicated to supporting NYCHA's Health Initiatives Unit. Since the start of this year, NYCHA and DOHMH have spoken with more than 1,200 NYCHA residents at community meetings and other activities, and will continue to engage residents to craft the smoke-free NYCHA policy. The process is being led by an advisory group of NYCHA residents, academics, healthcare practitioners, and representatives of community organizations. The group is drafting a set of priorities to help guide implementation of the ban, according to DOHMH, including principles related to education, cessation support, communication, and enforcement.

In December, DOHMH will be launching new efforts to help NYCHA residents connect to smoking cessation resources and to "help them address the longstanding injustices brought by tobacco companies who target low-income communities and communities of color." According to DOHMH, "NYCHA residents have made their priorities clear: they want to live in smoke-free environments, but the implementation of Smoke-free Public Housing must be resident-led, include resources and support from NYCHA and DOHMH, and focused on celebrating success."

City Council Member Ritchie Torres, who chairs the Council’s Committee on Public Housing and grew up in NYCHA, expressed reservations in a Monday interview with Gotham Gazette. “I agree with the sentiment,” Torres said of the smoking ban. “I agree with investing in more programs to curb smoking. But, I disagree with a coercive approach.”

Torres said that while he may not chair the committee next year when a new class of the City Council is seated and new positions assigned (Torres is running to be the speaker of the Council), “We should have a hearing ahead of implementation.”

Despite criticism from residents and skepticism from high-ranking city officials, anti-smoking advocates are impressed with NYCHA’s efforts so far. “They are doing a lot,” affirmed Michael Davoli, Director of New York Metro Government Relations at the American Cancer Society Cancer Action Network. “They have a concrete plan.”

However, Davoli questioned the mayor’s and governor’s financial commitment to financing the distribution of effective tobacco cessation services to NYCHA residents, like written materials and nicotine replacement therapy (NRTs). “The question is, is the money going to be put into it to really provide NYCHA the resources to provide smoking cessation,” said Davoli. “This is an opportunity for the mayor and the governor to really help these people quit once and for all.”

When pressed for more information on how much funding the mayor will provide the authority, NYCHA did not provide specifics. “We are working with the Office of the Mayor throughout this process to further support his tobacco and smoking control policies,” said Blake.

Although the amount of money City Hall is willing to commit is unclear, the city’s current efforts against smoking support NYCHA’s. In April of this year, the Health Department launched a media campaign to educate New Yorkers “on the dangers of secondhand smoke at home and encouraging them to make their home smoke-free.” The press release announcing the effort says it “is aligned with the recent smoke-free rule passed by the U.S. Department of Housing and Urban Development” that will require NYCHA to go smoke-free.

“We certainly don’t have lots of financial resources and so we’re leveraging our partners to make sure we’re that connecting residents to appropriate services,” explained NYCHA’s Sherman, possibly in reference to NYCHA’s budget woes. “But we certainly are putting our best foot forward to taking a multi-faceted approach to implementing this policy.”

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by Ben Weiss, Gotham Gazette

Read more by this writer.

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NYCHA Prepares to Implement Smoking Ban Mon, 13 Nov 2017 05:00:00 +0000
Bills Fight Smoking by Keeping Pace with Tobacco Companies http://www.gothamgazette.com/130-opinion/6985-bills-fight-smoking-by-keeping-pace-with-tobacco-companies http://www.gothamgazette.com/130-opinion/6985-bills-fight-smoking-by-keeping-pace-with-tobacco-companies de Blasio anti-smoking

Mayor de Blasio & co. (photo: Michael Appleton/Mayor's Office)


Thanks to aggressive policies and programs over the past decade, the adult smoking rate declined significantly in New York City, from 21.5% in 2002 to 14.0% in 2010. However, to maintain these gains we need to continue to update our tobacco control policies to respond to an ever-changing market where tobacco company strategy attempts to circumvent current regulations.

As a physician whose primary practice involves helping New Yorkers quit smoking, I strongly support the four bills proposed by New York City Mayor Bill de Blasio and City Council members to strengthen the city’s tobacco control policies.

I have seen firsthand the many challenges smokers face when trying to quit. On top of the addictive properties of tobacco products, New Yorkers who smoke are faced with a retail environment that creates cues to smoke on every corner. The widespread availability of tobacco products in retail outlets, along with extensive marketing at the retail point-of-sale, is designed to attract new tobacco users, discourage quitting and create a normative environment that makes tobacco use acceptable and even makes it desirable. To reduce smoking, we cannot simply focus on the individual smoker: we must also change an environment that encourages young people to initiate tobacco use and blocks efforts by smokers to quit. This package of bills moves New York City closer to that goal.

Individually, each of these bills represents an effective method for addressing gaps in current policies. Implemented together, they represent a powerful, comprehensive and synergistic approach to addressing multiple aspects of the retail environment that undermine tobacco tax policy and create environmental triggers to smoke.

One bill would limit new licenses to sell tobacco products, setting caps for retail outlets to sell tobacco products in community districts. It responds to strong evidence that a high-density retail environment in residential neighborhoods is associated with recent initiation of tobacco use among young adults and greater difficulty quitting among smokers.

Another bill in the package prohibits pharmacies or retail stores that contain pharmacies from selling cigarettes and electronic cigarettes, which will act synergistically with the previous bill to further reduce retail density. In 2014, CVS led the way in ending the sale of cigarettes and tobacco products saying that it was “inconsistent with our purpose – helping people on their path to better health.” Although an important step, other national chains have not adopted this policy, creating the need for government action.

There is precedent and evidence supporting the pharmacy ban. Other cities have already passed similar bills—backed by high levels of public support—and subsequent studies demonstrated the link between these bans and reduced retail density in communities.

Finally, the proposal to establish price floors for cigarette packages, other tobacco products and non-tobacco shisha, and to establish taxes on previously untaxed tobacco products, will reduce the likelihood that smokers switch from cigarettes to cheaper products. This will create a tax and price environment that will reduce youth initiation of tobacco use and encourage people to quit.

Unfortunately, the tobacco epidemic is not static. New products are introduced at an alarming rate, the tobacco industry continues to look for loopholes to circumvent tobacco policies, and sometimes policies have unintended consequences that need to be remedied. To continue to achieve our prevention and cessation goals, we must be proactive and keep pace with this changing environment by introducing new laws to fill gaps in current policies, particularly when the evidence points us in the right direction.

The evidence-based policy package put forth by Mayor de Blasio and City Council members represents a tremendous step forward for New York City’s efforts to meet the National Healthy People 2020 goal of 12% smoking prevalence and, most importantly, will prevent individuals—especially young people—from picking up a habit that is much easier to start than to stop.

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Donna Shelley, MD, MPH is an associate professor of Medicine and Population Health at NYU School of Medicine and leads the smoking cessation service at NYU Langone Medical Center’s Laura & Isaac Perlmutter Cancer Center and directs NYC Treats Tobacco, which helps healthcare organizations help their patients quit. Dr. Shelley has conducted research on health disparities related to tobacco use for over 15 years.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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Bills Fight Smoking by Keeping Pace with Tobacco Companies Sun, 11 Jun 2017 04:00:00 +0000