Ohio S. 78Prohibiting Secondhand Smoke Exposure in Motor Vehicles: Children Under 6 University of CincinnatiNURS 8008Brittany RidnerAbstractIn March of 2019, Senate Bill (S.) 78 was introduced to the Ohio Senate. This bills objective is to prevent secondhand smoke exposure to children, who are under the age of 6 years old, while riding in a motor vehicle. Nurses have long advocated for patients and their health care and this bill aspires to advocate as well. The motivation for this bill deals with protecting children and preventing long-term health issues for them. The bill currently sits in the hands of the judiciary committee and no date has been set for a hearing (Connelly, 2019). Opposers to this bill protest that the effects of secondhand smoke are not as harmful as research claims. However, much evidence-based research has proved otherwise. Supporters of this bill understand that less exposure to secondhand smoke means fewer adverse health issues. Providers and consumers will experience both positive and negative consequences should this bill pass. Effects include the tobacco industry being affected financially, providers seeing improvements in children’s overall health, and fewer cases of adverse health issues. If the bill passes, Ohio will join a handful of other states who have passed similar bills. Keywords: Senate Bill 78, secondhand smoke, childrenOhio S. 78: Eliminating secondhand smoke in motor vehicle: Children under 6S. 78 was introduced into Ohio Legislation on March 06, 2019 by Senator Tina Maharath (Ohio Legislative Service Commission, 2019). This bill aims to eliminate smoking in motor vehicles if a child under the age of six is present (The Ohio Legislature, 2019a). By preventing secondhand smoke exposure, the Nurse Practitioner (NP) should see a decrease in patients suffering from low birth weight, asthma, otitis media, sudden infant death syndrome, lower respiratory infections, pneumonia, and cancers (Continente, Arechavala, Fernandez, Perez-Rios, Schiaffino, Soriano, Carreras, Lopez-Nicolas, Gorini, & Lopez, 2019). The NP would be prescribing fewer antibiotics since the incidence of otitis media and respiratory tract infections would decrease. Patient’s asthma would be stable resulting in prescribing fewer medications for asthma management and exacerbations. There would be a decline in the rate of low birth weight which would result in fewer formula changes. Overall, the patient would not need to be seen in the office as often due to the stability of their health. This stability reduces the risk for death and long-term health issues. Sociocultural EnvironmentEvents that have occurred in the sociocultural environment which have brought secondhand smoke exposure to light include the high rate of individuals smoking. The Health Policy Institute of Ohio (2017) revealed that Ohio ranks 43rd out of 50 in regards to adult smokers and 49th out of 50 in regards to children subjected to secondhand smoke. These numbers are astounding and illustrate how abundant secondhand smoke exposure is to children. Poor health literacy is another environment that has brought this bill to the light. Many individuals lack the knowledge of cigarette smoke effects on themselves and children. The United States (U.S.) Department of Health and Human Services (n.d.) states that “nearly nine out of ten adults may lack the skills needed to manage their health” (p. 1). Due to this high rate of inadequate health literacy, more children suffer secondhand smoke exposure and consequently health issues. Ethical Environment Ethical issues that have brought secondhand smoke exposure to the forefront include how children cannot choose for themselves if they want to be exposed to secondhand smoke or not. They lose their freedom of choice and the exposure can lead to many health problems. The American Lung Association (2019) states “23 million” children are subjected to secondhand smoke exposure (p. 1). The American Lung Association (2019) also revealed this exposure leads to multiple adverse health outcomes including death. Another issue that has brought this bill to the forefront is the code of ethics that applies to the nursing profession. Nursing ethics state that nurses shall do good and “protect an induvial when health is endangered by another person” (Burkhardt & Nathaniel, 2014, p.133). According to the code of ethics, the nurse aims to protect and advocate for these children since another individual is endangering their health. This bill supports the nursing’s code of ethics. Economic EnvironmentThe amount of money spent on healthcare in this country is exorbitant. The cost of health issues related to secondhand smoke exposure cost society an estimated 132 million dollars (Mason, Wheeler, & Brown, 2015). Two-thirds of that cost was attributed to asthma and ear infections (Mason, Wheeler, & Brown, 2015). It Is important to note that sudden infant death syndrome can result from secondhand smoke exposure and is included in the estimated 132 million dollars (Mason, Wheeler, & Brown, 2015). This high cost has helped shed light on S. 78. Another economic issue that has helped shed light on secondhand smoke exposure is the low socioeconomics of Ohio. The Ohio Department of Medicaid (2018) revealed that children and adults aged 0 to 24 years old showed the highest levels of living in poverty. Mason, Wheeler, & Brown (2015) expressed how individuals living in poverty have a higher rate of secondhand smoke exposure. Political and Legislative environmentThe political and legislative environment that has brought S. 78 to the public’s attention has been in the making for many years. According to the Institute of Medicine (2010) the surgeon general attempted to ban smoking in 1971 and by 1972 had a report published regarding the adverse health effects of secondhand smoke. In 1986, the surgeon general goes a step further and release a report stating lung cancer can be caused by secondhand smoke (Institute of Medicine, 2010). In 1992, hospitals banned smoking for everyone on a hospital premises and the Environmental Protection Agency list secondhand smoke as a carcinogen (Institute of Medicine, 2010). Fast forward to 2019 and you have smoking bans in public places, restaurants, public transportations, work places, and in motor vehicles that have a child in attendance (Institute of Medicine, 2010; California Legislative Information, 2007a). Also, as of October 17, 2019 the state of Ohio has raised the legal age to buy and possess tobacco and tobacco-like products to age 21 (29 Ohio Rev. Code, 2019b). It seems that the state and federal governments have been working for many years to bring to light the adverse health effects of secondhand smoke. These previous legislative actions have paved the way for prohibiting smoking in motor vehicles. Without them, society would still be smoking in public places, bars, restaurants, and hospitals; thus, exposing many more individuals to secondhand smoke and adverse health effects. It is also important to note that the state and federal governments are actively fighting smoking and its adverse health effects. Ohio has attempted to address prohibiting smoking in cars with a child in 2015, 2017, and again in 2019 (The Ohio Legislature, 2019a; The Ohio Legislature, 2019b, The Ohio Legislature, 2019c). The bills failed in both 2015 and 2017, but have paved the way and grabbed the attention of some senators which makes S. 78 more recognizable. Ohio is one of forty-two states that does not have a restriction on smoking in vehicles while children are in attendance. Hopefully, with the prior legal and political actions, Ohio can ban smoking in motor vehicles and reduce the exposure to secondhand smoke. Progression, Sponsors, and Stakeholders of S. 78S. 78 was authored and introduced by Tina Maharath in March of this year with no coauthors identified (The Ohio Legislature, 2019a). This bill currently awaits hearing, which means sponsors have not been identified yet (Connelly, 2019). However, according to Collins (2019) Senator Sean O’Brien supports the bill and expects no issues with it passing. Pagonakis (2019) reports that Dr. Kristie Ross at Rainbow Babies and Children’s Hospital Cleveland supports the bill. As far as Ohio Governor, Mike Dewine, Bischoff (2019) reports that he has not seen the bill so he could not voice his opinion. In 2015 S. 89 was introduced by Senator Charleta Tavares and the same bill with title S. 106 was introduced in 2017 (The Ohio Legislature, 2019b; Ferguson, 2017). Due to Senator Tavares having presented this bill in the past, I think she would support S. 78 and Thomas, Yuko, and Brown who were cosponsors of S. 106 would also support the bill should they still be in office (The Ohio Legislature, 2019b). Other supports and stakeholders include the American Academy of Pediatrics, local health care providers, individuals who do not smoke, lung cancer survivors, the Campaign for Tobacco-Free kids, the American Lung Association, the Centers for Disease Control and Prevention (CDC), and the National Institute of Health. Actions supporters have taken to promote S. 78 include Dr. Kristie Ross stating to the public that she supports the bill and why (Pagonakis, 2019). The American Academy of Pediatrics has published several articles on secondhand smoke exposure and its effect on children. The Campaign for Tobacco-Free Kids works at the State and Federal level trying to reduce secondhand smoke exposure (Campaign for Tobacco-Free Kids, 2019).