Aux Etats-Unis, le tabac hors-la-loi dans les bars, au travail, en voiture et même chez soi

vendredi 8 décembre 2006, 11h49

Aux Etats-Unis, le tabac hors-la-loi dans les bars, au travail, en voiture et même chez soi

Par Virginie MONTET

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WASHINGTON (AFP) - La cigarette, que l'Amérique a popularisé à travers le monde, devient de plus en plus hors-la-loi aux Etats-Unis, où comme ailleurs on l'interdit dans les bars-restaurants et au travail mais aussi parfois chez soi et en voiture.Dix-neuf Etats et 2.300 villes, dont New York, Los Angeles, Chicago et au 1er janvier Washington, ont passé des lois contre la cigarette au nom de la protection contre le tabagisme passif. 21% d'Américains fument encore contre 26,5% il y a vingt ans.
En Ohio (nord), le dernier Etat en lice qui a interdit jeudi la cigarette au travail et dans les lieux publics, on encourt une amende de 100 dollars si l'on fume dehors juste devant l'entrée de son lieu de travail, une habitude qu'avaient depuis longtemps pris les fumeurs.

Les autorités recommandent de ne pas fumer à moins de six mètres d'une entrée afin d'éviter que la fumée ne pénètre dans un bâtiment.
Des interdictions de fumer à l'air libre sont en vigueur également devant les porches des entreprises dans l'Etat de Washington (nord-ouest), dans certains parcs de San Francisco, sur des plages et dans de nombreux parcs zoologiques. Des chaînes d'hôtels, telles Marriott et Westin, sont devenues totalement non-fumeurs cette année.

Dans plusieurs Etats depuis quelques mois, comme la Louisiane, l'Arkansas et le Texas, il est aussi défendu de fumer en voiture si l'on transporte des enfants de moins de six ans. La Californie, Etat le plus peuplé du pays, y songe aussi.

La vague d'interdiction n'épargne pas les bastions des manufacturiers de tabac. A Louisville dans le Kentucky (centre-est), où on fabriquait un temps une cigarette sur six vendues dans le monde, la fumée va être bannie de tous les lieux publics d'ici juillet.

"Les recherches montrent que 126 millions d'Américains sont exposés au tabagisme passif qui provoque plus de 3.000 morts par cancer du poumon chaque année chez les non-fumeurs. Le débat sur les effets du tabagisme passif n'est plus en question", affirme à l'AFP Colleen Wilber, porte-parole de l'Association américaine contre le cancer qui a beaucoup poussé à l'adoption de lois contre la fumée dans les lieux publics. "Il y a un soutien sans faille de l'opinion publique pour ces lois", ajoute-t-elle.
La puissante organisation ne se mêle pas en revanche d'obtenir des interdictions de fumer chez soi, un nouveau type d'initiatives qui suscite davantage de polémiques. "Ce n'est pas notre politique", indique l'American Cancer Society.

Pour Jeffrey Schaler, professeur de droit à la faculté d'administration publique d'American University et auteur du livre "Addiction is a choice" ("L'accoutumance est un choix"), ces interdictions relèvent du syndrome de "l'Etat thérapeutique". "Le gouvernement ne devrait pas s'occuper de nous protéger de nous-mêmes", affirme-t-il pour l'AFP.
De plus en plus de complexes résidentiels toutefois demandent à leurs locataires de signer un contrat affirmant qu'ils ne sont pas fumeurs et qu'ils ne recevront pas de fumeurs chez eux.

Dans les tours "The Blairs" de Silver Spring près de Washington, les locataires des 1.400 appartements viennent de recevoir une lettre les informant qu'à partir du 1er janvier le complexe entier devient non-fumeur.

Des résidents depuis dix ans ne pourront pas renouveler leur bail s'ils fument et la presse locale a dénoncé cette nouvelle "tyrannie du sans-tabac".

De telles politiques sont suscitées par la crainte de procès de résidents non-fumeurs qui se plaignent d'asthme et de sinusites.

"Fumer n'est pas un droit constitutionnel", argumente sur son site le groupe "Smokefreeapartments" qui milite pour un environnement privé sans cigarette et justifie, armes juridiques à l'appui, les procès que peuvent encourir les promoteurs qui laissent leurs locataires fumer.

Smoking Laws

----- Original Message -----
From: Kenneth Sandale
sandale111@bellsouth.net
To: schaler@american.edu
Sent: Sunday, December 10, 2006 10:40 AM
Subject: Smoking Laws

In an AP story on smoking today you are quoted as saying "The government shouldn't protect me from myself,"

Bizarrely you miss the whole point. Laws restricting smoking protect NON-smokers from smokers. As far as I am concerned, I wiuld strongly encourage people like yourself to kill yourselves, but not in a way that exposes other people to poison. (I do not say that with malice, but rather for protection of the gene pool.)

Do you also think drunk driving laws are there to protect drunk drivers from themselves?

Smoking becoming taboo in US workplace, homes and even in public

Smoking becoming taboo in US workplace, homes and even in public

Published at www.physorg.com
Dec. 10, 2006

The property manager at The Blairs, an apartment complex near Washington, recently sent tenants a letter that has many up in arms: Stop smoking at home come January or move out, the note essentially said.

The letter came as a rude awakening to residents of the 1,400-unit complex, some of whom have been living there for more than 10 years and who would not be allowed to renew their lease if they do not comply with the new rule. But the measure is by no means an isolated incident in a country where smoking is increasingly becoming taboo in restaurants, in the workplace, outdoors and even in one's own car and home.

So far, 19 US states and 2,300 cities, including New York, Los Angeles and Chicago, have adopted legislation against cigarette smoking, citing health concerns. The US capital joins the list beginning in January.

In the midwestern state of Ohio, which this week became the latest state to ban smoking in the workplace and in public areas, violators face 100 dollars if caught puffing on a cigarette on the doorstep of their workplace, as has become the custom in many cities.

The law calls for smokers to stand at least six meters (20 feet) away from a building's entrance so as not to allow smoke to enter.

Outdoor smoking bans are also in effect on the balconies and porches of companies in the northwestern state of Washington, in some San Francisco parks and on beaches and various zoos across the country. Several hotel chains, including the Marriott and Westin, have also implemented smoking bans this year.

Even cities that came to symbolize the cigarette industry are not spared. In Louisville, located in the central-eastern state of Kentucky, where much of the world's cigarettes were once produced, smoking will be banned in public places come July.

"Research shows that more than 126 million Americans are exposed to second-hand smoke and there are more than 3,000 deaths a year due to lung cancer of non-smokers," said Colleen Wilber, spokeswoman for the American Cancer Society, which has lobbied to pass anti-smoking laws in the country.

"So the debate on that is pretty much over, ... and there is overwhelming support for these laws in the United States," Wilber told AFP.

She added, however, that the powerful organization is not involved in lobbying to ban smoking in private residences.

According to statistics, some 21 percent of Americans are smokers, compared with 26.5 percent 20 years ago.

Jeffrey Schaler, a law professor at American University in Washington and author of "Addiction is a Choice", said the anti-smoking laws being adopted nationwide are "characteristics of the therapeutic state".

"The government shouldn't protect me from myself," Schaler argued.

© 2006 AFP
This news is brought to you by PhysOrg.com

Reply/Comment at http://www.physorg.com/news84949716.html

America Continues Crackdown on Smoking

INTERNATIONAL12.10.2006 Sunday - ISTANBUL 05:09

America Continues Crackdown on Smoking
By Anadolu News Agency (aa),
Washington Saturday, December 09, 2006
www.zaman.com

"First Turkish Paper on the Internet"

"Certainly there are people who are unhappy with the regulations. Jeffrey Schaler, a law professor and author of “Addiction is a Choice,” describes these types of bans as the syndrome of the ‘treating state’."

While tobacco was introduced to the world by America in 1492, some states in the U.S are now considering a ban on smoking in cars and even homes. Nineteen states and the administrators of nearly 2,300 cities are passing a law to protect people from being affected by second-hand smoke in as many places as possible.

When in 1950 Dr. Evart Graham discovered that tobacco caused cancer, the number of addicts gradually declined, owing to the campaigns launched and legal regulations in developed countries.

During the two decades between 1950 and 1970, 50 million Americans quit smoking and the amount of tobacco consumed by the population dropped to 25 percent from 40 percent.

Nowadays, 21 percent of the American population smokes.
Losing an important part of their markets in developed countries, multinational tobacco producers have gravitated toward markets in underdeveloped countries, including Turkey.

For instance, while America is doing its utmost to protect its own citizens from the lethal effects of tobacco, it backs the policy of selling tobacco to third-world countries.

It has launched a fierce battle against tobacco through legal regulations.
The state of Ohio recently passed a law banning smoking in workplaces and public places.

Even those smoking outside their workplaces will be fined $100.
According to a legal regulation made to prevent smoke from entering business buildings, smokers will not be allowed to smoke within the proximity of six meters from the company building.

For example, it is forbidden to smoke under the company building porches in Washington and on some beaches and parks in San Francisco, California. Moreover, in states such as Louisiana, Arkansas and Texas, people are not allowed to smoke in cars with children under 6 years old.
Certainly there are people who are unhappy with the regulations. Jeffrey Schaler, a law professor and author of “Addiction is a Choice,” describes these types of bans as the syndrome of the ‘treating state’.

The professor noted that the state had to give up protecting its citizens from themselves. Despite criticisms, the number of landowners who rent property to non-smokers is growing by the day.

09.12.2006Anadolu News Agency (aa)Washington
http://www.zaman.com/?bl=international&alt=&hn=39076

Medicaid Plan Prods Patients Toward Health

Medicaid Plan Prods Patients Toward Health
NY Times
December 1, 2006

By ERIK ECKHOLM

HAMLIN, W.Va. — No question, John Johnson is a doctor’s nightmare.
Speaking from the easy chair where he spends his days in a small wooden house near this small Appalachian town, his left trouser leg folded by a safety pin where a limb was lost to diabetes, he lighted another cigarette.
Mr. Johnson, 61 and a former garbage collector, takes insulin and goes to a clinic once a month for diabetes checkups. Taxpayers foot the bill through Medicaid, the federal-state health coverage program for the poor.

But when doctors urged him to mind his diet, “I told them I eat what I want to eat and the hell with them.”

“I’ve been smoking for 50 years — why should I stop now?” he added for good measure. “This is supposed to be a free world.”

Ignoring doctors’ orders may now start exacting a new price among West Virginia’s Medicaid recipients. Under a reorganized schedule of aid, the state, hoping for savings over time, plans to reward “responsible” patients with significant extra benefits or — as critics describe it — punish those who do not join weight-loss or antismoking programs, or who miss too many appointments, by denying important services.
The incentive effort, the first of its kind, received quick approval last summer from the Bush administration, which is encouraging states to experiment with “personal responsibility” as a chief principle of their Medicaid programs. Idaho and Kentucky are also planning reward programs, though more modest ones, for healthful behavior.
In a pilot phase starting in three rural counties over the next few months, many West Virginia Medicaid patients will be asked to sign a pledge “to do my best to stay healthy,” to attend “health improvement programs as directed,” to have routine checkups and screenings, to keep appointments, to take medicine as prescribed and to go to emergency rooms only for real emergencies.

“We always talk about Medicaid members’ rights, but rarely about their responsibilities,” said Nancy Atkins, state commissioner of medical services.

“We’re in an Appalachian culture where there’s a fatalism, and many people don’t go in for checkups or preventive services,” Ms. Atkins said, noting that West Virginia had some of the country’s highest rates of obesity, smoking, heart disease and diabetes. “We want to reach people before they get chronic and debilitating diseases that will keep them on Medicaid for the rest of their lives.”

Those signing and abiding by the agreement (or their children, who account for a majority of Medicaid patients here) will receive “enhanced benefits” including mental health counseling, long-term diabetes management and cardiac rehabilitation, and prescription drugs and home health visits as needed, as well as antismoking and antiobesity classes. Those who do not sign will get federally required basic services but be limited to four prescriptions a month, for example, and will not receive the other enhanced benefits.

In future years, those who comply fully will get further benefits (“like a Marriott rewards plan,” Ms. Atkins said), their nature to be determined but perhaps including orthodontics or other dental services.

No one questions that West Virginia, more than most other states, needs more healthful lifestyles and better primary and preventive care. But the new plan has stirred national debate about its fairness and medical ethics. A stinging editorial in The New England Journal of Medicine on Aug. 24 said it could punish patients for factors beyond their control, like lack of transportation; would penalize children for errors of their parents; would hold Medicaid patients to standards of compliance that are often not met by middle-class people; and would put doctors in untenable positions as enforcers.

“What if everyone at a major corporation were told they would lose benefits if they didn’t lose weight or drink less?” said a co-author of the editorial, Dr. Gene Bishop, a physician at Pennsylvania Hospital in Philadelphia.

Denying mental health aid to those who do not sign seems especially counterproductive, Dr. Bishop said in an interview.

“If you think about the people least able to do simple things like keep appointments and take all their medications,” she said, “people with mental health and substance abuse problems are right up there.”
Judith Solomon of the private Center on Budget and Policy Priorities, in Washington, said that the plan was unlikely to save West Virginia money or improve patient health and that it carried “the risk that some very vulnerable people may be denied health care they need.”

But Ms. Atkins, the state health official, said critics had misunderstood the plan, which, she said, simply “gives people rewards and incentives to improve their health.”

Here in Lincoln County, as in the two other counties in the pilot phase, there is a federally subsidized primary-care center that is a leader in developing “care management” programs, nudging people into preventive services and lifestyle changes voluntarily.

The Lincoln Primary Care Center in Hamlin, a town of 1,500 an hour’s winding drive west of Charleston, is a showcase for preventive medicine, with its own fitness center, an exercise physiologist, a dietary adviser and a mental health counselor — resources that are lacking in many rural clinics. The center stays open until 9 most nights, making it easier for sick people to come in for urgent care rather than driving to distant emergency rooms.

A former tobacco-growing area, Lincoln is one of the state’s poorest counties, with a population of 22,000 scattered through the hills. About 9,000 use this care center, a majority of them uninsured or on Medicaid, said Brian Crist, the chief executive.

Some doctors here and throughout the state were initially alarmed by the new rules, which were delayed six months for discussions and fine-tuning. But state officials appear to have allayed some fears, and many doctors are now taking a wait-and-see attitude.

Officials have offered assurances, for example — and Ms. Atkins emphasized in an interview — that doctors will be able to provide medically necessary drugs and care to children even if their parents have not followed the agreement. This was not clear in the written plan and may be needed in any case, critics said, to comply with federal law.
Dr. Syem B. Stoll, a physician at Lincoln, said the clinic’s three-year-old effort to promote lifestyle changes for patients with hypertension, obesity, diabetes and other problems had already made a difference for many.

“We’re doing a lot more than just giving people pills and sending them home,” Dr. Stoll said.

Of the new Medicaid rules, he said: “My interactions with patients won’t change — I am who I am. But giving people responsibility and initiative is the way to go.”

In interviews with several residents of the Hamlin area, including Medicaid recipients, none said they had heard about the new rules.
When they were outlined for Mr. Johnson, the cantankerous diabetic, he said he had no intention of participating. “Hell, no,” he said. “I wouldn’t sign an agreement like that.” Somewhat incongruously, he appears to be off the hook: as a disabled person he will be exempt under the rules.

Full