“Policy change takes time, often decades," says Ellen Hahn, a professor of nursing and public health and director of the Kentucky Center for Smoke-free Policy at the University of Kentucky.

LEXINGTON — Hard to believe: Almost a generation of Kentuckians has never had to come home from a night out with their throats stinging and hair stinking from tobacco smoke.

I’m thinking of people who grow up or go to college in Lexington, which is celebrating the 20th anniversary of Kentucky’s first-smoke free law on July 1.?

Clearing the air of smoke makes life more pleasant.

More important: It makes life longer and people healthier. The benefits of workplace smoking bans kick in immediately and compound over time, as a bevy of peer-reviewed research by the University of Kentucky has established. Lung cancers, heart attacks, premature births all decline.

Twenty years on, what once seemed nearly impossible, downright miraculous, in this tobacco state is something many of us take for granted: More than 1 in 3 Kentuckians (38%) live in a municipality that has enacted comprehensive protections from secondhand smoke.?

The number of people benefiting is considerably higher as residents of counties that don’t protect against secondhand smoke travel to cities that do in order to work, shop, do business, dine and have fun.

Fifty-eight local governments, large and small, have enacted some degree of smoke-free policy.?

That’s not nearly enough. But it’s also remarkable, considering that in 2003 even doctors had to be convinced with scientific evidence that breathing others’ tobacco smoke was a real and serious threat to health.

At the state level, Kentucky’s tobacco policies are an abject failure — by design. The hold that tobacco maintains on this state’s politics defies logic or compassion. And Kentuckians pay dearly, as all our grisly health standings attest.

Policy change is a team sport

So, one of the questions I had for UK’s Ellen Hahn — Kentucky’s preeminent crusader for smoke-free lungs, hearts and laws — is how she keeps going in such a hostile environment. More than anyone, Hahn, her colleagues at the Kentucky Center for Smoke-free Policy and their allies have sown the seeds that bloomed into grassroots movements that led to local smoking bans.

Here’s what she said: “Policy change takes time, often decades. Policy change is also a team sport. While a few people can make a difference, I could not stick with it without support from others.

“As a nurse, I am naturally a patient advocate, giving voice to the voiceless, and as a public health nurse, my patient is the community. I am willing to wait for effective change. … The payoff for society is definitely worth the wait.”

I also asked, if she suddenly magically had the power to make tobacco policy for the whole state, what would she do?

That, she says, is a “no brainer.”

• “A comprehensive smoke-free law that covers every community in the state would make a huge difference.” UK research has shown that moderate or weak laws do not confer the same health and economic benefits, so any state law should cover all workplaces — with no exceptions for bars, bowling alleys, gambling venues, etc., or ventilation because it’s ineffective. A statewide law that preempted stronger local ordinances would be a giant step in the wrong direction.
• ?The “second pillar” is price, which lawmakers can increase through taxation. Kentucky has increased the per pack tax on cigarettes in recent years to $1.10 (37th highest among the states, D.C. and three territories) and added taxes to electronic products. Price increases are known to deter young people from starting and to motivate adults to quit.
• Access to cessation services is next on the list. Kentucky looks great on paper. We have a law guaranteeing access to quit-smoking medications and counseling, but it has not been implemented the way it should be.
• “The fourth pillar is funding for a strong, hard-hitting media campaign — public education.” This is something Kentucky has never done. “It’s really hard to reach people with messaging and the tobacco companies are still spending millions and millions in Kentucky marketing their products.”?

Kentucky spends just 3.5% of what the Centers for Disease Control and Prevention recommends on tobacco control and prevention.

“So it’s really not a shock that we have such high smoking rates,” says Hahn. “Because we don’t invest in prevention. And the sad part is we know what works to reduce smoking. We’re just not doing it.”

Kentucky and West Virginia run neck and neck for the nation’s highest rate of adult smokers, almost 24%. In 2021, only West Virginia and Mississippi exceeded Kentucky’s death rate from cancer. Kentucky has the second-highest prevalence of chronic obstructive pulmonary disease (COPD) among adults. And we’re cultivating one of the highest rates of youth smoking, more than double the national rate.

Smart tobacco-control policies bestow so many economic advantages — not just in health-care savings to business and government but also in creating a quality of life attractive to employers and tourism. I told Hahn that I see Kentucky’s tobacco-control failures deepening the inequities between the state’s “haves” and “have nots.”

She didn’t disagree but was quick to point to quite a few places that have defied stereotype by enacting comprehensive smoke-free laws. Owsley County, for instance, which usually gets attention for its poverty. Hahn credits people like Cale Turner, former judge-executive in Owsley County, and Perry County Judge-Executive Scott Alexander for enlightened leadership on this critical public health issue.

At the recent Kentucky Tobacco Control Conference, the first since the pandemic, Alexander participated in a panel discussion with Ryan Salzman, a member of the Bellevue City Council which recently added that picturesque Ohio River town to the smoke-free list, and Mayor Linda Gorton, who voted for Lexington’s smoke-free law as a council member.?

“It was so good just to hear them talk about the issues,” Hahn said, “and, you know, nothing’s easy. But they all three of them feel like it’s one of the best legacies that they’re going to leave their communities.”