Chapter 3 – Tobacco-Free Policy

Title	Section
Introduction	5-3.1
Purpose	5-3.1A
Background	5-3.1B
Policy	5-3.1C
Definitions	5-3.2
Authorities	5-3.3
Scope	5-3.4
Implementation	5-3.5
Responsibilities	5-3.6
Enforcement	5-3.7

5-3.1  INTRODUCTION

1. PURPOSE. This chapter is to revise and update the Indian Health Service (IHS) policy prohibiting the use of tobacco products in IHS-operated properties to protect the health, safety, and comfort of IHS employees, contractors, patients, and visitors. This policy also supports employees’ efforts to cease using tobacco products through a “Tobacco Cessation Program” or any effective similar program. It is recognized that this policy will require behavior modification on the part of individuals who use tobacco products.
2. BACKGROUND. Research indicates that smoking is the major preventable cause of illness and premature death in the United States. According to the Centers of Disease Control and Prevention, over 480,000 people die annually as a result of cigarette smoking, including second-hand smoke. Moreover, exposure to second-hand smoke is linked to a variety of negative health consequences and is responsible for approximately 7,300 lung cancer deaths annually among nonsmokers in the United States.

   The Assistant Secretary of Health issued the current Department of Health and Human Services (HHS) Tobacco-Free Policy (effective July 1, 2011), which specifically requires all properties owned or leased by HHS agencies (including IHS) to be tobacco free, insofar as labor and lease agreements permit. The goal of this policy is to improve the health of all HHS employees by promoting and supporting tobacco cessation, and protecting employees and the public from exposure to environmental tobacco smoke in the workplace. This IHS Tobacco-Free Policy complies with HHS standards.

3. POLICY. The use of tobacco products is prohibited on all IHS-operated properties, unless such use is allowed under terms of the current lease. In all such cases, the lease terms will be renegotiated at the earliest opportunity to reflect a zero tolerance for the use of tobacco products. This includes IHS Headquarters, Area Offices, hospitals, health clinics/stations, and all other offices or facilities. All areas that were previously designated for outdoor smoking are hereby eliminated. The use of tobacco products is prohibited, in any form, at IHS-operated properties including, but not limited to:
   1. All interior and exterior spaces of IHS-operated properties.
   2. All IHS-operated spaces in multi-tenant buildings.
   3. All Government vehicles regardless of their location.
   4. Private vehicles while on HHS property.

5-3.2  DEFINITIONS.

1. Property Owned or Leased by the IHS. All properties, whether owned or leased, directly operated by IHS.
2. Tobacco. The term “tobacco” includes cigarettes, e-cigarettes, cigars, pipes, chewing tobacco, smokeless tobacco, electronic nicotine device system, and any other tobacco products.
3. Second-Hand Smoke. Environmental tobacco smoke that is inhaled involuntarily or passively by someone who is not smoking.

5-3.3  AUTHORITIES.

1. Assistant Secretary for Health memorandum “Prohibition of Tobacco Use in HHS Occupied Facilities dated June 23, 2011 Exit Disclaimer: You Are Leaving www.ihs.gov  effective July 1, 2011.
2. Executive Order 13058 Exit Disclaimer: You Are Leaving www.ihs.gov , “Protecting Federal Employees and the Public from Exposure to Tobacco Smoke in the Federal Workplace,” effective date August 9, 1997.
3. 41 CFR § 102-74.315 through § 102-74.351 Exit Disclaimer: You Are Leaving www.ihs.gov  – Smoking   

5-3.4  SCOPE. This policy applies to all IHS employees, clients, contractors, and visitors with the exception of:

1. Traditional Beliefs and Ceremonial Practices. The IHS continues to recognize the value and efficacy of patients’ traditional beliefs and ceremonial practices. The use of tobacco for ceremonial purposes is allowed in the designated traditional healing room, including any space designated for a ceremony, or in a patient’s hospital room.

   Safety Precautions: Refer to the local facility policies or consult safety officer, for safety precaution required during use of tobacco products for ceremonial purposes.

2. Space Not Operated by the IHS. Any spaces outside the leased areas of multi-tenant facilities not solely operated by the IHS.
3. Residential Property. Any IHS residential property such as Government housing quarters.

5-3.5  IMPLEMENTATION.

The implementation of the Tobacco-Free Policy is a component of a larger initiative to improve the health and wellness of our employees, contractors, patients, and visitors.

The implementation of this policy that supports tobacco cessation will be accompanied by an emphasis on education and awareness programs, such as:

1. Insurance coverage for tobacco cessation is available through the Federal Employee Health Benefit (FEHB) Plan for Federal employees and their covered dependents, at no cost or co-pay. Similar services are included in many other insurance plans for contractors and members of the public. Individuals should check with their insurance providers about coverage for tobacco cessation services.
2. Other Tobacco Cessation Resources and Important Links.
   1. Free Quitline Smoking Cessation: 1-800-QUIT-NOW (1-800-784-8669)
   2. American Cancer Society Exit Disclaimer: You Are Leaving www.ihs.gov 
   3. American Lung Association Exit Disclaimer: You Are Leaving www.ihs.gov 
   4. American Heart Association Exit Disclaimer: You Are Leaving www.ihs.gov 
   5. Be Tobacco Free Exit Disclaimer: You Are Leaving www.ihs.gov 
3. The IHS will promote activities that highlight the importance of health and wellness in general.

5-3.6  RESPONSIBILITIES.

1. Director, IHS.  The Director, IHS, or his/her designees is responsible for implementing and ensuring compliance with the Tobacco-Free Policy across the entire IHS. The Director, IHS, or his/her designees will:
   1. ensure that Headquarters Office Directors, Area Directors, and Service Unit Chief Executive Officers (CEO) are responsible for the implementation of and compliance with the “Tobacco-Free Policy” in their respective programs and administrative areas, and
   2. designate the Headquarters Tobacco-Free Coordinator.
2. Director, Division of Grants Management. The Director, Division of Grants Management, is responsible for encouraging all recipients of IHS grants to provide their employees a tobacco-free workplace and promote the non-use of all tobacco products.
3. Director, Office of Human Resources. The Director, Office of Human Resources, will include a copy of this policy in all new employee and student orientation programs.
4. Director, Division of Acquisition Policy. Will ensure that all contractors are informed of the Tobacco-Free Policy.
5. Headquarters Tobacco-Free Coordinator. A designated Health Promotion/Disease Prevention Consultant serves as the Headquarters Tobacco-Free Coordinator. The Tobacco-Free Coordinator will:
   1. ensure that suitable uniform signs for Headquarters stating, “Do Not Use Tobacco in Facility or on Grounds” are posted at the entrance to the property and near entrance doors of buildings for the public to view,
   2. ensure that all levels of staff are informed of the Tobacco-Free Policy,
   3. ensure that managers and supervisors at all levels are responsible for the enforcement of this policy, and
   4. increase employee awareness of this Tobacco-Free Policy via written and electronic notices.
6. Area Director. The Area Director or his/her designees, is responsible for the distribution of the Tobacco-Free Policy to the Service Unit CEOs and Health Clinic Directors to ensure that their facilities comply with the Tobacco-Free Policy. The Area Director or his/her designees, will:
   1. ensure that Area and Service Unit managers, supervisors, and employees are informed of and comply with the Tobacco-Free Policy,
   2. ensure that suitable uniform signs for Headquarters stating, “Do Not Use Tobacco in Facility or on Grounds” are posted at the entrance to the property and near entrance doors of buildings for the public to view,
   3. ensure the appropriate manuals are updated to include this Tobacco-Free Policy, aligns with health care facility accreditation standards, outline local policies and procedures for exceptions, and enforcement,
   4. encourage Tribal Leaders to adopt and implement a similar Tobacco-Free Policy, and
   5. designate the Area Tobacco-Free Coordinator.
7. Contracting Officers. Contracting Officers shall ensure that all contractors are notified of the Tobacco-Free Policy.
8. Regional Human Resources Officers. The Regional Human Resources Officers shall include a copy of this circular in all new employee and student orientation programs.
9. Chief Executive Officer. The CEO, or his/her designee, is given the responsibility of implementing and informing the Service Unit staff of the Tobacco-Free Policy through memoranda, staff meetings, newsletters, e-mail broadcasts, bulletin announcements, and/or department meetings. The CEO or his/her designee will:
   1. ensure that suitable uniform signs for Headquarters stating, “Do Not Use Tobacco in Facility or on Grounds” are posted at the entrance to the property and near entrance doors of buildings for the public to view,
   2. notify the local Tribal Health Boards about the IHS Tobacco-Free Policy,
   3. notify the public about the IHS Tobacco-Free Policy through public meetings, radio, posted announcements, newsletters, community bulletins, Website announcements, and/or local newspapers in accordance with IHS Public Affairs policies,
   4. ensure that employees are informed and in compliance with the Tobacco-Free Policy,
   5. ensure that the IHS Property Security Contract (Scope of Work) includes responsibilities for security personnel to document the number of visitors who refuse to comply with the policy and to report employees who refuse to comply to the appropriate management,
   6. instruct the Property Security supervisor to ensure that incidents of non-compliance are documented (including visitors, patients, and employees),
   7. ensure the appropriate manuals are updated to include this Tobacco-Free Policy, aligns with health care accreditation standards, outline local policies, and procedures for exceptions and enforcement, and
   8. designate the Tobacco-Free Coordinator.
10. Area and Service Unit Tobacco-Free Coordinator. Tobacco-Free Coordinators will assess the progress of implementation by summarizing reports on policy implementation, barriers to implementation, and recommendations to improve compliance progress reports.
11. Facility Management Supervisor. The Facility Management Supervisor ensures that signs stating that no tobacco products may be used in this tobacco-free environment. The signs should be posted at the entrance to the property and near the entrance doors of the building for the public to view. The signs should be posted in each location no later than 60 days after implementation of the policy.

5-3.7  ENFORCEMENT.

Managers and supervisors at all levels are responsible for the enforcement of this policy and for documenting verbal warnings.

1. Employee Violation. Employees who fail to comply with this policy may be subjected to appropriate corrective action.
2. Visitors and Patient Violations. Visitor and patient violations shall be handled accordingly:
   1. The visitor or patient is to be informed politely and tactfully of the IHS Tobacco-Free Policy.
   2. Security personnel shall ask patients or visitors who refuse to comply with the policy to leave the property and shall document the incident.