BILL ANALYSIS                                                                                                                                                                                                    �



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          ASSEMBLY THIRD READING
          AB 1278 (Hill) 
          As Amended January 26, 2012
          Majority vote 

           HEALTH              12-5        APPROPRIATIONS      12-5        
           
           ----------------------------------------------------------------- 
          |Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield,     |
          |     |Bonilla, Eng, Gordon,     |     |Bradford, Charles         |
          |     |Hayashi,                  |     |Calderon, Campos,         |
          |     |Bonnie Lowenthal,         |     |Chesbro, Gatto, Hall,     |
          |     |Mitchell, Pan,            |     |Hill, Ammiano, Mitchell,  |
          |     |V. Manuel P�rez, Williams |     |Solorio                   |
          |     |                          |     |                          |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Logue, Garrick, Mansoor,  |Nays:|Harkey, Donnelly,         |
          |     |Silva, Smyth              |     |Nielsen, Norby, Wagner    |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY  :  Extends the current ban on tobacco use in workplaces, 
          including hospitals, to include the entire hospital campus.  
          Specifically,  this bill  :  

          1)Prohibits, on and after March 1, 2013, smoking in all areas of a 
            general acute care hospital and throughout the entire hospital 
            campus, including, but not limited to, buildings, parking areas, 
            plazas, vehicles, underground passages, and sidewalks, unless 
            there is a government-mandated exception.

          2)Exempts public thoroughfares and sidewalks adjacent to the 
            general acute care hospital, but not owned by the hospital, and 
            specified property owned or leased by the hospital that is used 
            for purposes unrelated to health care from the prohibition in 1) 
            above.

          3)Permits smoking on a hospital campus by a patient with the 
            written approval of the treating physician. 

          4)Requires a general acute care hospital to post conspicuous signs 
            of the no smoking policy at building entrances and other 
            locations and to inform new and current employees of the policy. 
             









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          5)Allows a general acute care hospital to provide interested 
            patients, visitors, and staff with information on, or refer them 
            to, smoking cessation services.

          6)Permits a city, county, or city and county to adopt and enforce 
            additional smoking and tobacco control ordinances, regulations, 
            or policies that are no less stringent than the applicable 
            standards in this bill.

          7)Declares the intent of this bill to encourage and assist smokers 
            to quit tobacco use and to reduce the associated risks of 
            tobacco and secondhand smoke to hospital patients, staff, and 
            visitors.

           EXISTING LAW  :  

          1)Prohibits smoking in an enclosed space at a place of employment 
            including lobbies, waiting areas, elevators, stairwells, and 
            restrooms that are a structural part of the building.

          2)Exempts specified areas of workplaces from the smoking ban 
            including:  a specified percentage of hotel and motel rooms; 
            parts of hotel lobbies; warehouses; patient smoking areas in 
            long-term care facilities; small businesses; and, certain 
            employee break rooms.

           FISCAL EFFECT  :  According to the Assembly Appropriations 
          Committee:

          1)Negligible state fiscal impact to the Department of Public 
            Health to continue oversight of hospital licensure.

          2)To the extent that this more comprehensive smoking ban on 
            hospital campuses reduces the number of cigarettes purchased by 
            hospital employees, visitors, and patients, there could be a 
            minor reduction in revenues to various state tobacco tax funds. 

           COMMENTS  :  The author states that while smoking is generally 
          prohibited in patient areas, waiting rooms, and visiting rooms of 
          health facilities, there are still many areas within a hospital 
          campus where smoking is permitted.  The author asserts that 
          exposure to second-hand smoke should be eliminated to the extent 
          possible for staff, visitors, and patients, in particular, while 
          they are recovering and/or seeking medical treatment.  
          Furthermore, the author maintains that hospitalization for 








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          treatment of an acute health problem, specifically an illness 
          related to tobacco use, forces smokers to confront the 
          consequences of their addiction and, frequently, to make a 
          commitment to stop.  The author argues that smoke free hospital 
          campuses motivate patients, visitors, and employees to quit 
          tobacco use in a supportive environment that is prepared to 
          provide cessation assistance to smokers.

          According to research published in 2009 in the British Medical 
          Journal Tobacco Control, more than half of accredited hospitals in 
          the U.S. have instituted completely smoke-free medical campuses.  
          Many of these hospitals report that they took this step because 
          smoking was contrary to their mission of treating the ill and 
          promoting public health.  Research published in the January 2010 
          Journal of Hospital Medicine that evaluated the impact of a 
          smoke-free medical campus policy at an acute care facility in New 
          York found that the employee smoking rate fell from 14% in the 
          year preceding the ban to 9% in the year after the ban was 
          implemented.  Similarly, an article in the September 2010 American 
          Journal of Health Promotion reported that the quit rate among 
          medical staff at smoke-free hospitals was higher than at other 
          hospitals and 60% of those employees who reported quit attempts or 
          not smoking indicated that a tobacco-free hospital policy was 
          influential in their efforts.  Smoke-free laws have been shown to 
          reduce cardiac hospitalizations by decreasing second-hand smoke 
          exposure among non-smokers and reducing smoking. The larger 
          contribution to improved health has been the reduction in 
          second-hand smoke. 

          The sponsor of this bill, Breathe California, states that 
          hospitals that have established smoke-free campuses have taken an 
          important step in advancing public health and report almost no 
          problems with compliance or enforcement of their restrictions, 
          with minimal cost.  The California Hospital Association notes in 
          support that, on a daily basis, California hospitals see the 
          negative effects smoking can have on the health of their patients 
          and the increased costs it can have on the health system.


           Analysis Prepared by  :    Cassie Royce / HEALTH / (916) 319-2097 

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