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The Family that Smokes Together

Before Dad was a physician, he was a smoker. And, because we lived in his house, we were smokers too.

Throughout my life, people have thought it odd that a doctor could also smoke, but it’s not really so strange because Dad started his habit at 14. He was already a veteran of smoking before he ever set foot in med school, and any doctor will tell you that med school is incredibly stressful—it’s not the best environment for quitting anything, except maybe sleep. Plus, he enjoyed it. These were the days before the Surgeon General’s package warnings, the terrifying ads, and the lawsuits. By 1966, when the warnings started appearing on cigarette packaging, he’d already spent half of his time on Earth as a smoker.

As kids, my sister and I waged a failing war against the cigarettes: We begged and pleaded, we pinched our noses and remarked about the horrible smell. We hid the packs and the ashtrays. I’ll bet many of you did the same things to your parents. One time I even “loaded” a cigarette, which resulted in a small explosion that angered Dad, not because he was surprised by it but because the cinders nearly burned his shirt. But every time we tried, he proved that his love of smoking was somehow stronger than we were.

For a year or so, he smoked a pipe. The pipe smoke smelled better than the cigarettes, but it was still smoke that wafted through the halls.

So we grew up with smoke in the house every morning before, during, and after breakfast. Some people wake up to the aroma of eggs or bacon, but we woke to the acrid odor of cigarettes. The other thing I woke up to almost without fail was a lump in the back of my throat—an actual lump of gunk that accumulated there while I slept. Part of my morning routine was to get up and expel a gob of phlegm into the sink. It didn’t end there, either—several times a day I repeated this ritual, right up until bedtime. Every day, for years.

My mother thought it was disgusting, and she told me so. I agreed, but what was I supposed to do about it? “I gotta get it out somehow,” I said grimly as I continued to hack away.

Now, you’d think from this description that my house was absolutely hazy with smoke all the time, but it wasn’t. Dad had very long hours throughout the week and when he was away, we didn’t notice any lingering smell.

Something unexpected happened when I left for college. Within a few weeks, my coughing subsided. A few more, and it ended altogether. Honestly, I hadn’t noticed it happening, probably because it was so gradual and because I hadn’t made any conscious changes to my lifestyle. I only noticed it when I woke up on the first full day of my fall break. The lump in my throat was back, which must’ve meant that it had stopped sometime while I was away. My mother heard me and commented again about the horrible noise and what a disgusting habit it was. I told her that no one was more disgusted by it than I, but it was funny because this morning was the first time I’d done it in a long time—there must be something in the house that was making me sick.

It wasn’t long after that I started hearing about the dangers of secondhand smoke. Secondhand smoke is the smoke that the other people in the presence of a smoker breathe, the smoke that my father expelled from his lungs after every drag from his cigarettes or puff from his pipe as well as the smoke that rises from these tobacco products as they burn. In short, it’s what my sister and I complained about for roughly 20 years. All the things that can happen to a person as a result of smoking can happen to a nonsmoker too if they’re exposed to secondhand smoke. Secondhand smoke is a known trigger for people with asthma and can lead to lung cancer, too.

You may not have heard of it, but there’s also a thing called “third hand smoke,” which is the chemical residue left behind on surfaces that we take into our bodies by touching contaminated surfaces, ingest from hand-to-mouth contact (or possibly via our food), or breathe in as dust after the actual smoking stops. These would be the chemicals trapped in curtains, on wallpaper or painted surfaces, or the foul odor you detect in a smoker’s car. Whatever you smell in the car is the particulate residue of various chemicals including carbon monoxide, arsenic, butane, lead, toluene, and hydrogen cyanide. If you’ve spent any time on our website at all, you may already know how dangerous carbon monoxide and lead are. Butane is used in lighter fluid and  fuel for camping stoves, and toluene is found in paint thinner. Anything with a name like “hydrogen cyanide” can’t possibly be good for you; this substance is used in chemical weapons. If that’s not frightening enough, polonium-210 is a radioactive carcinogen (meaning it can cause cancer). And arsenic is, well, arsenic. That’s what you’re taking into your lungs when you’re breathing second- and third hand smoke. And before you say anything about air fresheners, forget it: They’re masking the chemical smell, not removing it; you’re still breathing smoke residue and to it you’ve added other chemicals blended to smell like pine or vanilla.

Sure, it’s your life—you can do what you like with it, but what about your family and your friends? Are their lives yours too? And what about your pets? Does old Rufus have to suffer because you don’t feel like quitting? He might be “man’s best friend” to you, but if he knew what you were doing to him, he might not hold you in the same regard. So, if you're a smoker, why not quit? If not for yourself, then how about for your family? And if you’re not willing, or haven’t been able to break the habit, at least take it outside.

As for my own Dad, well, he finally did stop. It happened after he spent a month on the ventilator after a surgery, a procedure that followed angioplasty and an open-heart bypass. His lungs were really weak. When he finally left the hospital, roughly 20 days later than expected, he realized that he was never going to wake up from the next surgery at all if he kept smoking. All of the surgeries he'd endured might've been avoided had he not smoked or even if he’d quit sooner. Suddenly, smoking seemed to be a lot less enjoyable to him, and so he quit—at age 60—but he’d done too much damage to his body. He was already suffering from emphysema by then and often used an oxygen pump to assist his breathing. Still, I think quitting did allow him to live a longer life, and he got to meet his first grandchild before he passed.

Democrats Add Eliminating Lead Poisoning to Party Platform



On July 9, 2016, history was made: A major U.S. political party added the words "we must make it a national priority to eradicate lead poisoning" to its platform. Never in the history of American politics has a major party called for the elimination of lead poisoning explicitly as a portion of its platform.

That finally changed late Saturday night as the Democratic Platform Committee approved Amendment 176 to add the following language to their platform:

"Democrats believe we must make it a national priority to eradicate lead poisoning which disproportionately impacts low-income children and children of color and can lead to lifelong health and educational challenges, as a public health threat. We will prioritize hiring and training workers from affected communities to clean up toxic brownfields and expand clean energy, energy efficiency, and resilient infrastructure."

As a nonpartisan organization, NCHH hopes that all of the political parties will recognize the importance of this provision and add it to their respective platforms. The health, safety, and well-being of America’s children is important to all Americans.

Kudos to platform committee members Mara Keisling and Mary Kay Henry, President of the Service Employees International Union (SEIU), for promoting and offering this amendment. 

Watch a video of the amendment's introduction by Mara Keisling and its subsequent approval here.

Taking Action: HUD's Lead Poisoning Prevention Announcement – June 13, 2016

Today, Department of Housing and Urban Development (HUD) Secretary Julián Castro issued welcome news about lead poisoning prevention, continuing the department’s leading role. He announced a series of HUD lead poisoning prevention initiatives as part of a "Lead-Safe Housing, Lead-Free Kids" toolkit. His goal that every child in this great nation must be safe from lead poisoning is exactly the right one. His announcement of additional funding to help local jurisdictions create lead-safe homes is also welcome news; those funds will enable thousands of children to live in lead-safe homes for decades to come

The announced initiatives track closely with many of the goals of the "Find It, Fix it, Fund It Lead Elimination Action Drive" (#findfixfund) launched last month by the National Center for Healthy Housing (NCHH) and the National Safe and Healthy Housing Coalition (Coalition). Indeed, Secretary Castro's announced toolkit addresses:

  • Finding lead hazards: improving lead paint hazard assessments and identifying water hazards in HUD-assisted housing, as well as identifying hazards in private-sector housing;
  • Fixing: updating standards to match recent science and better protect children; developing mechanisms and guidance to address lead hazards in public and assisted housing more quickly and effectively; and providing millions of dollars in grants for lead-hazard control in privately owned low-income housing, where the risks are greatest;
  • Funding: calling on philanthropic partners to join the effort to eliminate lead poisoning.
The announced initiatives include urgently needed actions, such as anticipated regulatory changes to HUD's Lead-Safe Housing Rule, to align the blood lead level requiring response in assisted housing to the CDC reference level, lowering it to 5 μg/dL (micrograms per deciliter). These rule changes are currently being reviewed by the Office of Management and Budget (OMB), and we call for quick release to ensure children are protected. In the meantime, we urge local housing and health agencies to adopt the CDC level; nothing in the current regulation prevents local authorities from taking such action.

Secretary Castro also announced efforts to carry out more validated lead risk assessments in federally assisted housing. We hope that the initiatives announced will result quickly in lead risk assessments being required in all federally assisted housing including pre-1978 Section 8 Housing Choice Voucher program homes in which children under six reside or are expected to reside. Currently, only visual assessments are required in the voucher units, which cannot measure the presence of lead dust hazards. We urge Congress to provide needed direction and funding so that HUD can implement these protections for children.

The toolkit also includes development of a consistent standard for and response to water quality issues. We appreciate this initiative and encourage HUD to carry out testing water for lead, a relatively inexpensive procedure, as part of HUD inspections and assessments and to coordinate this testing with local health and water authorities.

We encourage HUD to build on the critical steps announced today by updating the nation's Healthy Homes Survey, which estimates the number of houses at risk for both lead and other housing-related diseases and injuries. Furthermore, we call for the creation of a plan to identify specific locations of both lead-based paint and lead pipes in all the nation's housing stock, so that we know where the lead hazards are. This would supplement CDC's efforts to provide GIS mapping of elevated blood lead levels called for by the Senate appropriations committee last week in its report language for the health appropriations bill.  

In addition to addressing public housing, Castro's announcement includes efforts to remediate lead hazards in low-income private sector housing where the risks are greatest. He announced $46.5 million in new lead hazard control grants to 15 state and local jurisdictions, with millions more to follow in the coming months.

In a very positive step, the toolkit encourages interagency collaboration with CDC and EPA on lead poisoning prevention. The Coalition and NCHH strongly support this and urge the Administration to convene a cabinet-level interagency task force to develop and implement a plan to eliminate lead poisoning. One us (Jacobs) participated in the prior such presidential task force in 2000, but Congress didn't provide adequate funding to carry out the plan and met the goal of eliminating lead poisoning. The plan and funding numbers need to be updated, and we must commit ourselves as a nation to provide the resources to get the job done. The savings will be enormous‎ – HUD's lead hazard control program is estimated to have a return on investment of at least $17 per dollar spent.

Indeed, both Secretary Castro and I would be the first to acknowledge that the goal of protecting all children from lead poisoning will not be achieved at current funding levels. That is why the NCHH and the Coalition and others have been working with Congress to increase funding. And we have had some success. Committees in Congress have provided for an increase in $50 million for HUD’s lead poisoning prevention efforts in both public and private housing. The Coalition has requested that HUD’s program be increased from $110 million last year to at least $230 million – a funding level drawn from the interagency plan on lead developed 15 years ago. There is simply no excuse to permit this problem to continue for even more decades into the future; we know how to solve it, and we should act on what we know. We need to #findfixfund: Find exactly where the lead hazards are, fix them using both short- and long-term proven methods, and obtain the funding to make it a reality.
 
Finally, the Secretary’s call means that all of us must do more. That means the private sector should contribute to the solution, as should philanthropy. We need real partnerships with housing, medical, public health, financing, community development, environmental, construction, inspection, and other allied professions – and, of course, parents and community groups. All of us can and must redouble our efforts to end this entirely preventable disease.

If you're attending the National Environmental Health Association/HUD conference in San Antonio this week, we encourage you to join our "Find It, Fix It, Fund It" meeting Tuesday, June 14, 2016, at 4:50 p.m. in conference room 11, where we'll work together on a plan to eliminate lead poisoning.

Both House and Senate Move to Increase HUD Lead Hazard Control Funding

Thanks to all of you who called your senators last week to urge them to pass the HUD funding bill! The bill did pass the Senate, with $50 million in funding increases for lead hazard control, half of which will go to HUD’s Office of Lead Hazard Control and Healthy Homes (OLHCHH) – raising their budget to $135 million – and half for lead hazard control in public housing.  

Similarly, the House appropriations committee just passed a House funding bill that also increases HUD’s OLHCHH budget – to $130 million, an increase of $20 million. Both bills also provide level funding for CDBG and HOME and allow continued assistance to all households currently served by HUD programs, with some targeted increases. We'll need your help over the summer and fall to ensure that these lead hazard control funding increases are enacted at the Senate level.

Of course, this is only a fraction of the funding needed to eliminate lead poisoning, but it's a strong step forward in an austere budget environment. To help us press for more funding, sign up for the Find It, Fix It, Fund It campaign and/or register for our Find it, Fix it, Fund It webinar rollout meeting tomorrow (1 p.m. EDT).

We thank Chairman Mario Diaz-Balart (R-FL-25) of the HUD appropriations subcommittee for working closely with ranking members Representative Nita Lowey (D-NY-17) and Representative David Price (D-NC-4) to increase spending on lead hazard control. All three brought the issue up as a key success of the bill at the markup hearing today.

I was able to thank them personally and urge you to thank you them too by tweeting:

@MarioDB thank you for increasing @HUDgov #lead hazard control funding and protecting America's children!
@NitaLowey thank you for increasing @HUDgov #lead hazard control funding and protecting America's children!
@RepDavidEPrice thank you for increasing @HUDgov #lead hazard control funding and protecting America's children!


Here are additional highlights from the Senate bill in which Chairman Susan Collins (R-ME) and Ranking Member Jack Reed (D-RI) crafted numerous policy changes to improve lead poisoning prevention! The new bill will accomplish the following:
  • Provides more resources to the Office of Lead Hazard Control and Healthy Homes ($25 million) and lead hazard control in public housing ($25 million). 
  • Allows lead hazard control grants to serve zero-bedroom units for the first time.
  • Requires HUD to align its blood lead level standard with CDC’s (changing the standard from 20 μg/dL to 5 μg/dL).
  • Doubles the staffing at the Office of Lead Hazard Control and Healthy Homes’ Enforcement Division.
  • Also: Increases funding for Section 202 Housing for the Elderly program and the Section 811 Housing for People with Disabilities program, and homeless assistance programs.
Thanks for all you do, and don’t forget to join the next full National Safe and Healthy Housing Coalition webinar on June 7, which will include a panel on Healthy Housing for Older Adults!

Four Proposals to Make Homes Healthier through Better Model Codes: ICC Member Vote by May 26

Building a home that lasts generations, withstands the elements, is energy efficient, and keeps us safe all at a reasonable cost is a marvel in engineering, design, and management. Renovations are even more complicated as we adapt the latest designs into homes built decades ago.

With thousands of contractors working on millions of homes every year, we rely on our local building code officials to ensure the work is done properly. We may not like it when they take too long to issue a permit for our kitchen remodeling or stop work when the contractor is cutting corners, but without their oversight, most homeowners have no way of knowing whether they got what they paid for from the contractor.

Many state and local code officials rely on model codes from the International Code Council (ICC) when they issue permits. These model codes often incorporate by reference regulations by federal agencies, but only when the code officials vote to support proposals in a three-year consensus process cycle led by ICC. Contractors have to comply with both the code and the federal regulations, but code officials only consider the model code as adapted to their community.

In April, in the first step of the most recent ICC consensus process, committees considered and did not approve four proposals that will make our homes healthier and safer. All ICC members now have until May 26 to vote for healthier homes. Then the proposals will be open for public comments and potential revisions before a final vote by the voting government official members of ICC in October. The following are the proposals and their ICC-assigned official number.


A. ADM78-16: Ensuring that only EPA- or state-certified contractors disturb lead-based paint [pdf of proposal]

To obtain a permit to renovate housing and child care centers, contractors must submit extensive documentation so the code official can verify the work will comply with the code and be conducted properly. NCHH and others proposed requiring that those documents include the EPA- or state-issued lead-safe renovation firm certificate when disturbing paint in multifamily housing and childcare facilities built before 1978.

Since 2010, contractors have been required to be certified in order to conduct this work in order to comply with the Environmental Protection Agency’s (EPA) Renovation, Repair, and Painting (RRP) Rule. There are minor exemptions for zero-bedroom apartments, housing only for the elderly, or when very small amounts of paint are being disturbed. Contractors become "lead-safe certified" when they promise to follow the rule, use trained people to supervise the work, and pay a fee.

NCHH and others crafted the proposal to protect children from dangerous but invisible lead-contaminated dust too easily left behind when contractors don’t use lead-safe work practices. These work practices were designed to prevent generating dust, enable easier cleanup in case dust is made, and check the work to ensure it was done properly. The National Association of Remodeling Industries (NARI) supported the proposal because it levels the playing field so that uncertified contractors do not undercut those who are certified and committed to following the rules.

EPA representatives testified at the hearing and strongly supported the proposal. They cited successes in similar approaches in the state of Minnesota and in the cities of Milwaukee, WI; Rochester, NY; and Oakland, CA. When the Minnesota legislature mandated the requirement, EPA saw a 40% increase in certifications for renovators – a sign of success. They made clear that the code official would only have to ensure the contractor has a valid certificate, not verify that the work was done properly – that's EPA’s job.

This proposal only affects multifamily housing and child-occupied facilities. A matching proposal for single-family homes and for townhouses is not up for a vote in May but will be in October.


B. RB361-16: Ensuring that homeowners choosing radon-resistant features in new home construction get a system that functions properly [pdf of proposal]

When a homeowner wants a home built to prevent radon from coming into the home from the ground, they demand “radon-resistant new construction.” It costs about $1,200 and helps to protect residents from the second leading cause of lung cancer. But it only works if it is installed properly.

The American Association of Radon Scientists and Technologists (AARST) proposed a change to the International Residential Code (IRC) to provide that a code official has a basis to inspect the work to ensure the system functions as designed.


C. RB152-16: Allowing below-grade foam insulation to be free of brominated flame retardants
[pdf of proposal]

The current IRC requires that foam insulation contain flame retardants even if the foam is sandwiched between the concrete foundation and the ground outside. The chemicals serve no purpose in this situation. Providing architects, builders, and homeowners with the option for foam insulation free from flame retardants is important given the serious health questions that have been raised about some of these chemicals, especially brominated flame retardants.

A coalition led by the Green Science Policy Institute proposed giving architects, builders, and homeowners the ability to choose flame-retardant-free foam insulation for below-grade uses. Mandating the use of chemicals that serve no purpose and may create a health risk is contrary to the ICC’s purpose of protection health, safety, and general welfare.


D. PM7-16: Requiring carbon monoxide alarms in all homes with combustion sources or an attached garage [pdf of proposal]

The International Fire Code (IFC) and the IRC require a carbon monoxide (CO) alarm in all homes with combustion sources, such as a fireplace or gas-fired appliance, or with an attached garage. These alarms protect residents from brain damage or death when combusting appliances fail or when air from a garage with an idling car is pulled into the home. More than 300 people die each year from CO poisoning.

As of 2011, 49 million homes – 46% of owner-occupied and 33% of renters – had CO alarms. NCHH proposed adding the CO alarm requirement to the International Property Maintenance Code to better ensure the likelihood of a home receiving one since the homes the code inspector visits are the ones most neglected and most likely to have a malfunctioning gas-fired appliance.

The objective of the model codes is to protect public health, safety, and welfare. Each of these proposals are narrowly crafted to accomplish that objective with minimal burden on the code official, the contractor, and the owner. Each deserves approval by the ICC and provides a common approach for states and local jurisdictions to consider when they adapt the model code to the needs of their community.

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