110th CONGRESS

1st Session

S. 2005
To amend the Public Health Service Act to provide education on the
health consequences of exposure to secondhand smoke, and for other
purposes.

IN THE SENATE OF THE UNITED STATES

August 3, 2007
Mrs. CLINTON (for herself, Mr. SANDERS, and Mrs. MURRAY) introduced
the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions

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A BILL
To amend the Public Health Service Act to provide education on the
health consequences of exposure to secondhand smoke, and for other
purposes.

Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Secondhand Smoke Education and
Outreach Act of 2007'.

SEC. 2. FINDINGS.

Congress makes the following findings:

(1) Secondhand smoke contains more than 50 carcinogens (California
Environmental Protection Agency, 2005; `The Health Consequences of
Involuntary Exposure to Tobacco Smoke', A Report of the Surgeon
General, 2006).

(2) Secondhand smoke causes approximately 46,000 cardiac deaths in
the United States annually (California Environmental Protection
Agency, 2005).

(3) Secondhand smoke causes 3,000 lung cancer deaths a year in the
United States (California Environmental Protection Agency, 2005).

(4) There is a causal relationship between infants' and children's
exposure to secondary smoke and their development of lower
respiratory illnesses. Involuntary exposure to tobacco smoke causes
an estimated 150,000 lower respiratory tract infections each year in
infants and children under 18 months of age. These illnesses result
in as many as 15,000 hospitalizations every year (`Respiratory
Health Effects of Passive Smoking: Lung Cancer and Other Disorders',
Environmental Protection Agency, 1992; `Health Effects of Exposure
to Environmental Tobacco Smoke', National Cancer Institute Report,
1999; `The Health Consequences of Involuntary Exposure to Tobacco
Smoke', A Report of the Surgeon General, 2006).

(5) Children exposed to secondhand smoke are at an increased risk
for acute respiratory infections and more severe asthma, among other
diseases (California Environmental Protection Agency, 2005; `The
Health Consequences of Involuntary Exposure to Tobacco Smoke', A
Report of the Surgeon General, 2006).

(6) Secondhand smoke exposure has both immediate and long-term
adverse health effects on the adult cardiovascular system. Exposure
to secondhand smoke for 30 minutes can damage coronary arteries,
potentially leading to the constriction of blood vessels, abnormal
fatty deposits in arteries, and blood clot formation. Sustained
exposure to secondhand smoke can increase the risk of coronary heart
disease by 25 to 30 percent (Otsuka et al., `Acute Effects of
Passive Smoking on the Coronary Circulation in Healthy Young
Adults,' Journal of the American Medical Association, 2001; `The
Health Consequences of Involuntary Exposure to Tobacco Smoke,' A
Report of the Surgeon General, 2006).

(7) Living with a smoker increases a non-smoker's risk of developing
lung cancer by 20 to 30 percent (Hackshaw et al., `The Accumulated
Evidence on Long Cancer and Environmental Tobacco Smoke.' British
Medical Journal, 1997; Zhong et al., `Exposure to Environmental
Tobacco Smoke and the Risk of Lung Cancer: A Meta-Analysis. ' Lung
Cancer, 2000; `The Health Consequences of Involuntary Exposure to
Tobacco Smoke', A Report of the Surgeon General, 2006).

(8) The Surgeon General declared that there is no safe level of
exposure to secondhand smoke.

(9) Although more than 20 States have passed smoke-free laws,
including laws that ban smoking in restaurants and bars, Americans
of all age groups are involuntarily exposed to tobacco smoke through
exposure in workplaces, homes, cars, apartments, and even outdoor
public spaces.

(10) Annually, an estimated 11 percent of American children aged 6
years were reported to be exposed to secondhand smoke in their homes
on a regular basis. Nearly 60 percent of children between the ages
of 3 and 11 years of age are exposed to secondhand smoke each year
(`The Health Consequences of Involuntary Exposure to Tobacco Smoke',
A Report of the Surgeon General, 2006).

(11) Air conditioning, ventilation, and heating systems can not
reduce or eliminate the risks associated with exposure to secondhand
smoke in indoor environments (ASHRAE position document on
environmental tobacco smoke, American Society of Heating,
Refrigerating and Air-Conditioning Engineers (ASHRAE), 2005).

(12) Racial and ethnic minorities in the United States have higher
rates of occupational exposure to secondhand smoke, with Latinos and
Native Americans having the highest rates (National Cancer
Institute, 1997).

(13) Nationally, an estimated of 20.9 percent of American adults
currently smoke cigarettes. This statistic includes the estimated
16.2 percent of Hispanic adults, 13.3 percent of Asian Americans,
21.9 percent of Caucasians, 21.5 percent of African Americans, and
32.0 percent of American Indians/Alaska Natives who smoke cigarettes
in the United States (Centers for Disease Control and Prevention,
2005).

(14) Nationally, an estimated 69.5 percent of current adult smokers
want to quit smoking, this includes the estimated 61.5 percent of
Hispanic adult smokers, 70.3 percent of Caucasian adult smokers,
70.7 percent of African American adult smokers, and 68.8 percent of
Asian American adult smokers who want to quit smoking (National
Center for Health Statistics, 2005).

(15) Racial and ethnic minority communities are disproportionately
targeted with advertising campaigns for tobacco products (U.S.
Department of Health and Human Services, 1998).

(16) The tobacco industry has contributed to primary and secondary
schools, funded universities and colleges, and supported scholarship
programs targeting racial and ethnic minorities. Tobacco companies
have also placed advertising in community publications and sponsored
cultural events in racial and ethnic minority communities (U.S.
Department of Health and Human Services, 1998).

SEC. 3. SENSE OF CONGRESS ON HEALTH AND ENVIRONMENTAL CONSEQUENCES
OF SECONDHAND SMOKE.

It is the sense of Congress that--

(1) scientific research has found that children and adults suffer
adverse health consequences from exposure to tobacco smoke;

(2) individuals, especially children, who do not smoke should not be
exposed to tobacco smoke;

(3) there is a continued need for--

(A) the dissemination of educational material on the adverse health
consequences of secondhand smoke; and

(B) parents to receive education about the adverse health
consequences that they and their children may suffer as a result of
exposure to tobacco smoke so that they no longer expose their
children and themselves to secondhand smoke; and

(4) in order to lessen the human and economic toll of tobacco, it is
critical that the Department of Health and Human Services take
action to ensure that all healthcare professionals receive training
in the delivery of evidence-based tobacco dependence treatment.

SEC. 4. GRANTS FOR EDUCATION CAMPAIGNS ON THE CONSEQUENCES OF
SECONDHAND SMOKE IN MULTI-UNIT HOUSING, DEMONSTRATION PROJECTS TO
SUPPORT EDUCATION IN PUBLIC SPACES ON THE CONSEQUENCES OF SECONDHAND
SMOKE, AND TOBACCO CONTROL EDUCATION.

Part A of title V of the Public Health Service Act (42 U.S.C. 290aa
et seq.) is amended by adding at the end the following:

`SEC. 506C. GRANTS FOR EDUCATION CAMPAIGNS ON CONSEQUENCES OF
SECONDHAND SMOKE IN MULTI-UNIT HOUSING.

`(a) In General- The Secretary, acting through the Administrator and
in consultation with the Secretary of Housing and Urban Development,
shall award grants for the implementation of educational campaigns,
developed or disseminated, with emphasis on, but not limited to,
organizations that involve the participation of youth, on the health
consequences of secondhand smoke in multi-unit housing.

`(b) Requirements- To be eligible to receive a grant under this
section an entity shall--

`(1) be a private nonprofit entity, a State or local Government, a
faith-based or community-based organization, or other tax exempt
organization;

`(2) not accept anything of value from, or have any affiliation or
contractual relationship with, any tobacco company, its affiliates,
its subsidiaries, or its parent company, or enter into any
affiliation or contractual relationship that could create a conflict
or perceived conflict of interest at any time during the term of the
grant; and

`(3) include with any grant application, a statement that discloses
information (if any) on the applicant's existing affiliations and
contractual relationships with tobacco companies or their
subsidiaries.

`(c) Considerations in Awarding Grants-

`(1) IN GENERAL- In awarding grants under this section, the
Secretary, to the extent feasible and acting through the
Administrator, shall ensure that--

`(A) grant activities are funded in a variety of geographic areas,
including urban and rural areas and frontier areas as well as
American Indian/Alaskan native and native Hawaiian communities; and

`(B) grant activities impact a variety of populations, including
racial and ethnic minorities, including American Indian, native
Alaskan, native Hawaiian, and low-income.

`(2) SPECIAL CONSIDERATION- In awarding grants under this section,
the Secretary shall give special consideration to--

`(A) organizations whose participants include secondary school or
college-age individuals and that provide adult supervision and
mentorship; and

`(B) organizations that reach racial or ethnic populations that
experience a disproportionate share of the cancer burden through
community-based participation in education, research, and training.

`(d) Duration- A grant shall be awarded under this section for a
period of not to exceed 3 years, with an extension period of an
additional 2 years, at the discretion of the Secretary.

`(e) Application- To be eligible to receive a grant under this
section, a entity shall--

`(1) submit an application to the Secretary (at such time, in such
form, and containing such information as the Secretary may specify);
and

`(2) agree to report to the Secretary a description of the manner in
which grant funds were used, and the degree of dissemination of the
information produced under the grant concerning the health
consequences of exposure to secondhand smoke in multi-unit housing.

`(f) Evaluation- Not later than July 31 of the second calendar year
after the date of enactment of this section, and July 31 of every
year thereafter, the Secretary shall submit to Congress a report,
consistent with the Government Performance and Results Act of 1993,
evaluating the activities conducted under grants awarded under this
section for such year.

`(g) Supplement, Not Supplant- Funds made available under this
section shall supplement, and not supplant, other Federal, State, or
local funds available to an entity to carry out activities of the
type described in this section.

`(h) Authorization of Appropriations- There is authorized to be
appropriated such sums as may be necessary to carry out this section
for fiscal year 2008 and each fiscal year thereafter.

`SEC. 506D. DEMONSTRATION PROJECTS TO SUPPORT EDUCATION IN PUBLIC
SPACES ON CONSEQUENCES OF SECONDHAND SMOKE.

`(a) In General- The Secretary, acting through the Administrator,
shall award grants to public and private nonprofit entities for the
conduct of projects to demonstrate ways of educating the public
about the health consequences of secondhand smoking in public
spaces, including public parks, playgrounds, and national parks.

`(b) Requirement- To be eligible for a grant under this section--

`(1) the grantee shall be a private nonprofit entity, a State or
local government, an Indian or tribal organization, a faith-based or
community-based organization, or other tax exempt organization;

`(2) the project to be carried out by the entity under the grant
shall be designed to provide information on the health consequences
of secondhand smoking in public spaces, including the findings from
the 2006 Surgeon General's report entitled `The Health Consequences
of Involuntary Exposure to Tobacco Smoke';

`(3) the grantee may not accept anything of value from, or have any
affiliation or contractual relationship with, any tobacco company,
its affiliates, its subsidiaries, or its parent company, or enter
into any affiliation or contractual relationship that could create a
conflict or perceived conflict of interest at any time during the
term of the grant; and

`(4) the grantee shall include with any grant application, a
statement that discloses information (if any) on the applicant's
existing affiliations and contractual relationships with tobacco
companies or their subsidiaries.

`(c) Considerations in Awarding Grants-

`(1) IN GENERAL- In awarding grants under this section, the
Secretary, to the extent feasible and acting through the
Administrator, shall ensure that--

`(A) projects are funded in a variety of geographic areas, including
urban and rural areas and frontier areas as well as American
Indian/Alaskan native and native Hawaiian communities; and

`(B) a variety of populations, including racial and ethnic
minorities, including American Indian, native Alaskan, native
Hawaiian, and low-income populations, are served by projects funded
under this section.

`(2) SPECIAL CONSIDERATION- In awarding grants under this section,
the Secretary shall give special consideration to

`(A) organizations whose participants include secondary school or
college-age individuals and that provide adult supervision and
mentorship; and

`(B) organizations that reach racial or ethnic populations that
experience a disproportionate share of the cancer burden through
community-based participation in education, research, and training.

`(d) Duration- A project may receive funding under a grant under
this section for a period of not to exceed 3 years, with an
extension period of an additional 2 years, at the discretion of the
Secretary.

`(e) Application- To be eligible to receive a grant under this
section, a public or private nonprofit entity shall--

`(1) submit an application to the Secretary (at such time, in such
form, and containing such information as the Secretary may specify);
and

`(2) agree to report to the Secretary the information, and
accompanying citations, on health consequences of exposure to
secondhand smoke that will be disseminated through the demonstration
project.

`(f) Evaluation- Not later than July 31 of the second calendar year
after the date of enactment of this section, and July 31 of every
year thereafter, the Secretary shall submit to Congress a report
evaluating the projects receiving awards under this section for the
year involved.

`(g) Supplement, Not Supplant- Funds made available under this
section shall supplement, and not supplant, other Federal, State, or
local funds available to an entity to carry out activities of the
type described in this section.

`(h) Authorization of Appropriations- There is authorized to be
appropriated such sums as may be necessary to carry out this section
for fiscal year 2008 and each fiscal year thereafter.

`SEC. 506E. GRANTS FOR THE IMPLEMENTATION OF REGIONAL OR LOCAL
TOBACCO CONTROL EDUCATION FOR HEALTH CARE WORKERS AND PROVIDERS.

`(a) In General- The Secretary, in consultation with the
Administrator, may award competitive grants to eligible entities to
implement regional or local education programs at medical schools,
hospitals, health centers and Federally qualified health centers,
and rural health clinics as well as through medical professional
membership organizations to provide health care providers and
workers (including primary care physicians, nurses, licensed mental
health professionals, and addiction counselors) with minimum tobacco
cessation training as part of their ongoing medical education.

`(b) Eligibility- To be eligible to receive a grant under subsection
(a) an entity shall--

`(1) be a--

`(A) medical school;

`(B) hospital (including a hospital that provide services to low
income and underserved populations such as critical access or
disproportionate share hospitals as well as native hospitals);

`(C) health center or Federally qualified health center;

`(D) medical professional membership organization; or

`(E) rural health clinic or American Indian/Alaskan native and
native Hawaiian clinic;

`(2) demonstrate that the entity has included tobacco cessation
training to improve healthcare quality and curricula;

`(3) ensure that healthcare providers will be required to complete
course work in training curricula as described in subsection (e),
appropriate to their practice, regarding treatment of tobacco use
and dependence;

`(4) not accept anything of value from, or have any affiliation or
contractual relationship with, any tobacco company, its affiliates,
its subsidiaries, or its parent company, or enter into any
affiliation or contractual relationship that could create a conflict
or perceived conflict of interest at any time during the term of the
grant; and

`(5) prepare and submit to the Secretary an application in
accordance with subsection (c), that includes a statement that
discloses information (if any) on the applicant's existing
affiliations and contractual relationships with tobacco companies or
their subsidiaries.

`(c) Application- To be eligible to receive a grant under this
section, an entity shall--

`(1) submit an application to the Secretary (in such form,
containing such information, and at such time as the Secretary may
specify); and

`(2) agree to report to the Secretary standardized performance data
necessary to facilitate evaluations across participating programs.

`(d) Use of Funds- Amounts received under a grant under subsection
(a) shall be used to establish and implement a regional or local
tobacco control education program for health care workers in
accordance with this section. Such education program may include
cessation training relevant to other substances (legal or illegal,
including alcohol and drugs). Grantees may provide services under a
grant under this section through the use of technology, including
telemedicine technology, to educate patients about tobacco use
remotely, as opposed to educating patients through person-to-person
contact.

`(e) Training Curricula-

`(1) PURPOSE- The training curricula to be funded under this section
shall provide the knowledge and skills necessary to implement
evidenced-based strategies to--

`(A) assist smokers to quit smoking;

`(B) educate smokers and nonsmokers about the health consequences of
secondhand smoke; and

`(C) promote at the community level, as well as the healthcare
system level, self-sustaining networks for the delivery of
affordable, accessible, and effective cessation services.

`(2) CONTENT- The training curricula to be funded under this section
shall--

`(A) be consistent with the recommendations of the Public Health
Service Clinical Practice Guideline: `Treating Tobacco Use and
Dependence' and the Department of Health and Human Service
Interagency Committee on Smoking and Health's `National Action Plan
for Tobacco Cessation';

`(B) ensure that individuals providing tobacco cessation services
have received education and training consistent with current best
practices described in this section and have demonstrated competency
in core skills associated with such practices;

`(C) enhance the capacity of communities to provide tobacco
cessation services at multiple levels of intensity; and

`(D) incorporate- -

`(i) behavioral treatment;

`(ii) pharmocotherapy;

`(iii) relapse prevention; and

`(iv) smoking cessation in special populations including pregnant
women, adolescents, and individuals with comorbidities including
psychiatric illness and other chemical illnesses.

`(f) Evaluation-

`(1) IN GENERAL- Not later than July 31 of the second calendar year
after the date of enactment of this section, and July 31 of every
year thereafter, the Secretary, in consultation with the
Administrator, shall submit to Congress a report evaluating the
tobacco cessation education programs receiving awards under this
section for such year.

`(2) CONTRACTS- The Secretary, in consultation with the
Administrator of the Substance Abuse and Mental Health Services
Administration, may enter into contract where appropriate, with
public health organizations with established infrastructure,
research, and experience for the conduct of evaluations of tobacco
dependence treatment and educational programs under this section.

`(g) Clarification- An eligible entity that receives a grant under
this section shall not mandate tobacco use training as a condition
of employment.

`(h) Authorization of Appropriations- There is authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2008 through 2012.'.

quote:

`(2) not accept anything of value from, or have any affiliation or contractual relationship with, any tobacco company, its affiliates, its subsidiaries, or its parent company, or enter into any affiliation or contractual relationship that could create a conflict or perceived conflict of interest at any time during the term of the grant

Guess that this means that there can be no money from 'drug companies',that would be a conflict of interest!!

Ho,Ho, fat chance.
Gary K.