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“The bottom line is that the creation
of smokefree environments for indoor places is the only
public health policy solution to the problem of exposure
to secondhand smoke."
-Fundamentals
of Clean Indoor Air Policy
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TABLE
OF CONTENTS
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It’s exhilarating to watch as a baseball team builds momentum
during a season—the players’ actions are in sync and
the excitement and energy of the crowd can carry a team to victory.
This kind of momentum, energy and success is no stranger to tobacco
control, especially with local Clean Indoor Air initiatives (CIA).
In this issue of extra! we bring you and your team the tools for
success in eliminating secondhand smoke—it’s like spring
training for CIA. We highlight the challenges you’ll encounter
in developing and implementing effective smokefree policies, translate
the latest research about establishing CIA regulations into practical
steps for building a local smokefree initiative from the ground
up, and give you an inside glance at how Massachusetts communities
used accepted best practices to build on a local initiative and
turn it into a home run for the state.
We know CIA policies work to lower the actual number of cigarettes
smoked and effectively protect everyone from tobacco smoke. And
we know that the local level is the best place to start because
the industry has a much harder time blocking local action.
Let’s swing for the fences with Clean Indoor Air in our communities
and make everyone a winner.
Dearell Niemeyer, MPH
Director, Tobacco Technical Assistance Consortium
Putting together a winning lineup for Clean Indoor Air (CIA) requires
thoughtful planning, and a whole lot of pre-season preparation.
Let’s take a quick look at three of the top challenges you
may encounter along the way and a couple of things you can do to
meet them head on.
Assessing and building support
within a community
- Recruit business and community leadership for your team.
- Make it a priority to allay the fears of restaurant and bar
owners that disgruntled patrons will take their business to the
next community.
Defining your goals and planning
your tactics
- Come to a consensus and clearly define the ordinance you are
supporting.
- Engage socio-economically disadvantaged communities that need
the protection of CIA ordinances, and are unlikely advocates.
Implementing policy with the minimum
of resistance
- Know the opposition—and expect them to throw you a curveball
or two. Opponents will push for weak ordinances in hopes that
stronger, more effective laws won’t pass.
- Help opponents see smokefree initiatives as the will of the
local population, rather than brainchild of tobacco advocates.
“The best advocate is
the one behind the scenes . . .
Clean Indoor Air is not about us, it’s about them.”
- Allyson Doyle, American Heart Association
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Back to Table of Contents
Study after study points toward the strong, positive impact Clean
Indoor Air (CIA) regulations have on reducing tobacco use. According
to the Surgeon General’s 2000 Report on Reducing Tobacco Use,
CIA laws that prohibit smoking have been shown to persuade smokers
to quit, lower the number of cigarettes that continuing smokers
consume, and discourage kids from taking up the habit. Source:
US Department of Health and Human Services (HHS), Reducing tobacco
use: A report of the Surgeon General, 2000, http://www.cdc.gov/tobacco/sgr/sgr_2000/
In light of these facts, the Task Force on Community Preventive
Services strongly recommends smoking bans and restrictions
for workplaces and public areas. Source:
Centers for Disease Control and Prevention. Strategies for reducing
exposure to environmental tobacco smoke, increasing tobacco-use
cessation, and reducing initiation in communities and health-care
systems. A report on recommendations of the Task Force on Community
Preventive Services. MMWR 2000;49(No.RR112) And from the
basic skills to the fine-tuning stage, the literature offers abundant
support and guidance for CIA initiatives:
Establish a strong, diverse coalition
Anticipate and be prepared for
resistance from opponents
- Chief among the tactics employed by opponents of CIA is the
push for weaker laws based on “accommodation and ventilation.”
Although the American Society of Heating Refrigeration and Air
Conditioning Engineers (ASHRAE) acknowledges that no ventilation
system can remove 100 percent of smoke from the air, the tobacco
industry has worked for years to influence standards for ventilation.
Source:
Bialous SA, Glantz SA. ASHRAE Standard 62: Tobacco Industry’s
influence over national ventilation standards. Tobacco Control
2002 Dec;11(4):315-28. http://www.tobaccoscam.ucsf.edu/pdf/Bialous-ASHRAE.pdf
- Go straight to the source—the tobacco industry documents—to
learn about opposition tactics and barriers you might encounter.
To learn more, link to Get
the facts from ttac! – Know Your Opposition.
- A case study from Duluth, MN suggests that framing CIA ordinances
as a workplace safety issue or worker’s rights issue is
the best strategy. Ordinances that target children and young people
allow for too many loopholes in local policies. Source:
Tsoukalas T, Glantz SA. The Duluth clean indoor air ordinance:
Problems and success in fighting the tobacco industry at the local
level in the 21st century. Am J Public Health 2003 Aug;93(8):1214-21.
http://www.tobaccoscam.ucsf.edu/pdf/Duluth.pdf
- The dirty tricks of the tobacco industry also include preying
on the worries of restaurant and bar owners, who fear patrons
will take their business to communities that do allow smoking.
According to a 2003 review, the studies that hint of dire economic
effects were not only poorly designed, but also tainted by association
with the tobacco industry. Source:
Scollo M, Lal A, Hyland A, Glantz G. Review of the quality of
studies on the economic effects of smoke-free policies on the
hospitality industry. Tobacco Control 2003; 12:13-20. http://tc.bmjjournals.com/cgi/content/full/11/4/DC1
Include the populations at greatest
risk from Environmental Tobacco Smoke (ETS)
- Researchers who are tracking the CIA movement in Massachusetts
have identified a number of factors that make it easier to pass
CIA policies in a community e.g., higher education and income
levels, board of health funding to promote CIA, strong regulations
in bordering towns. Unfortunately, these factors also tend to
reinforce socioeconomic and geographic disparities in health protection—those
who need the protection most, don’t receive it. Source:
Skeer M et al. Town level characteristics and smoking policy adoption
in Massachusetts: Are local restaurant smoking regulations fostering
disparities in health protection? Am J Public Health. 2004 Feb;94(2):286-292.
Tell the truth about support for
CIA
- The truth of the matter is it’s not just tobacco control
advocates who are in favor of CIA. Public opinion polls increasingly
support the notion that most people, smokers and non-smokers alike,
support smoking bans—and that includes bar patrons! Source:
McMillen RC et al. US adult attitudes and practices regarding
smoking restrictions and child exposure to environmental tobacco
smoke: changes in the social climate from 2000-2001. Pediatrics.
2003 Jul;112(1 Pt 1):e55-60 http://pediatrics.aappublications.org/cgi/content/full/112/1/e55;
and Tang H et al. Changes of attitudes and patronage behaviors
in response to a smoke-free bar law. Am J Public Health. 2003
Apr;93(4):611-7.
To find out how
CIA policies save lives:
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Back to Table of Contents
| What
local advocates can do |
Your local community is in a great position to establish Clean
Indoor Air ordinances and make a difference in the lives of your
neighbors. Read on for concrete steps you can take in your community,
and links to the best resources.
Build your team and gain support
within your community
- Invite a diverse group of traditional and nontraditional partners
faith-based organizations, unions, restaurant and bar workers
to be part of the discussion and the planning right from the beginning.
Get more information
on these relevant resources:
|
- Develop a written plan. A written plan allows for role delineation—when
all understand their roles, gaps in the plan are less likely.
To learn more
about the steps and resources needed to implement these
steps, see:
-
Action
Steps in CDC’s Taking Action Against Secondhand
Smoke toolkit
-
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Come to a consensus and clearly
define the ordinance you are supporting
- Decide before you start what your goals are and what the “deal
breakers” will be.
Walk away from a weak law
- Evidence collected from the field and captured in the ANR database
clearly indicates that a weak law won’t be strengthened.
The bottom line—it’s better to have no law than a
bad law that maintains the social acceptability of smoking, while
giving the false impression that the law has helped patrons and
workers. Examples include red light/green light laws sign on the
door indicating whether smoking is allowed or not; hours provision
exp., after 9 p.m.; minors only; and ventilation as an alternative.
Take a look at
these great resources:
|
Know your facts and be ready to
share information
- Survey your community to measure support for CIA.
- Visit
Tobacco Scam for the straight story on the economic impact
of CIA ordinances on the hospitality industry.
- If funds are available, enlist a public relations firm in telling
your story. If not, establish relationships with local media and
work for earned media exposure.
Learn how to engage with communities
of color and unions in CIA
Make it easier for businesses
to accept and implement CIA policy
- Develop materials that explain the policy to workers and patrons.
- Visit affected businesses to explain the ordinance.
Review best practices for a community
CIA campaign
Developed by Americans for Nonsmokers’
Rights in cooperation with Campaign for Tobacco-Free Kids, the American
Cancer Society, the American Lung Association, the American Heart
Association, and SmokeLess States, Fundamentals
of Clean Indoor Air Policy takes you through:
- Developing a local ordinance, the pitfalls of defining your
goals, and alerts you to possible resistance.
- Carrying out a local CIA campaign, with an emphasis on the importance
of planning and pacing, and demonstrations of how you can avoid
compromising your goals.
It’s important to know who your opponents are when you’re
trying to go smokefree. Link to Know
Your Opposition, a fact sheet designed by ttac
to help you search the tobacco industry documents and other sources
to understand ways that Big Tobacco tries to undermine your CIA
efforts.
Back to Table of Contents
Leveling the local playing field
We want to share a success story with you . . . read on to find
out how communities in Massachusetts put together a winning team
that is steamrolling toward a statewide CIA law.
Public health officials in Cambridge and Boston thought first of
pushing for a statewide ban, but they believed the timing wasn’t
right. Instead, they came up with the idea of a regional approach
. . . Clean Air Works.
Clean Air Works was born when 19 adjoining communities
around Cambridge and Boston came together with a common goal to
work together to “protect all workers from exposure to environmental
tobacco smoke through educating communities about the danger of
secondhand smoke and securing smokefree workplaces” (Cambridge
Public Health Department).
Picking the team
Before moving, they did their homework they:
- Surveyed the public in Boston to ascertain
that the majority would, in fact, support smokefree ordinances.
The survey was funded through Tobacco Free Massachusetts: The
Massachusetts Coalition for a Healthy Future. For more information
about the survey instrument used by Clean Air Works,
contact Allyson Doyle at Allyson.Doyle@heart.org.
- Invited a broad variety of businesses and organizations
to partner with them in the planning phase—allies
included traditional partners such as the Massachusetts Association
of Health Boards, the American Heart Association, and the American
Cancer Society, as well as non-traditional partners such as unions
and restaurant and bar workers.
- Agreed on a model regulation—100% smokefree
workplaces with certain specific exceptions private homes, private
clubs, tobacconists, and cigar bars.
Practicing the skills
With a plan in place, they:
- Educated the public about what second hand
smoke does to workers, especially restaurant and bar workers.
- Launched a print ad campaign sharing information
about environmental tobacco smoke, with a carefully developed
earned media campaign.
- Met informally with business owners, held public hearings,
and testified at Board of Health and City Council meetings and
in the media in support of the initiative during the
next year.
- Invited bartenders and wait staff to tell their stories
in support of Clean Air Works at these meetings. For more information
about Clean Air Works media and public relations materials,
contact Allyson Doyle at Allyson.Doyle@heart.org.
Playing the championship game
By June of 2003, 15 of the 19 Clean Air Works communities had passed
ordinances requiring 100% smokefree workplaces, building momentum
throughout the state.
- Two new Clean Air Works campaigns took form in the western
and northern regions of the state, inspired by the success of
the Boston area. As a result, 97 communities in Massachusetts
currently have smokefree workplaces. Passage of a statewide law
that will make all workplaces in Massachusetts smokefree now seems
imminent.
- The Boston Public Health Commission’s (BPHC) Tobacco
Control Program developed an extensive implementation plan and
public awareness campaign coined “Smoke-free Boston…Breathe
It In” to assist workplaces affected by the regulation,
as well as owners of restaurants and bars and the public. For
more information about the implementation plan developed by BPHC,
contact JoAnn Landers at JoAnn_landers@bphc.org.
The winning equipment
Keys to the Success of Clean Air Works:
- The regional approach—if all the communities
around you are going smokefree, this “levels the field,”
and takes the economic argument right off the table.
- The secondary role of tobacco control advocates in
Clean Air Works—it belonged to the public health
departments and the coalition. Tobacco control advocates played
a supporting role, providing technical support, and enabling others
to carry the message.
- Involving a diverse set of stakeholders in the planning
process from the beginning, so that they have ownership
of the initiative and their needs are met by the plan.
- Basing messages on the rights of workers and keeping
it positive. Messages that are based on diners or children
give adult-only venues an out.
- Strong support of the mayor and the participation of
restaurant and bar workers in the campaign. This defused
opposition from the tobacco industry. Although tobacco lobbyists
were present at meetings, they were not fighting.
- Presence in Massachusetts of an integrated cessation
network, “Quitworks.” This public/private
partnership between health care plans and health care providers
is linked to the statewide quitline. Partnering around cessation
was a good way to build rapport with the unions in Massachusetts.
- Support of labor unions. Because unions have
a strong focus on the health of their members, they are a natural
partner in smokefree initiatives.
- 1-size fits all message/varying timelines.
Although all the communities in Clean Air Works agreed on the
same goal, each community worked on its own timeline.
Back to Table of Contents
This issue of extra!
features Tobacco
Scam—an exceptional tool designed to educate tobacco control
advocates and members of the hospitality industry about the benefits
of CIA ordinances AND the tobacco industry arguments against them.
Read on for just a few of the great resources you can find at this
site . . .
Understand the Issue:
Uncover the Tobacco Industry Tactics:
Don’t Miss:
This comprehensive resource
is brought to you by Stan Glantz at the University of California,
San Francisco and is supported by grants from the Robert
Wood Johnson Foundation and the Richard and Rhoda Goldman
Fund.
|
Back to Table of Contents
“If
your community is ready to go smokefree, there is more assistance
available now than ever before.”
- Bronson Frick, Americans for Nonsmokers’
Rights
|
Americans
for Nonsmokers’ Rights (ANR)
ANR’s Web site is a comprehensive resource on issues related
to CIA, including effects of secondhand smoke, policymaking and
industry tactics. The site includes tips and tools for advocates
including model policies, smokefree ordinances lists, and a searchable
industry tracking database.
Clean
Indoor Air Ordinances: Why Work on Clean Indoor Air Policy?
This guide provides tips on building support for ordinances and
suggestions on policy development, including common pitfalls.
Fundamentals
of Clean Indoor Air Policy
These recommended guiding principles for conducting effective local
CIA campaigns are based on the experiences of local tobacco control
advocates throughout the United States over many years.
Guide
to Community Preventive Services: Tobacco
Read the Task Force on Community Preventive Services recommendations
based on a systematic review of published studies on the impact
of smoking bans and restrictions.
Local
ETS Discussion List (localets-talk)
This private list-serv for advocates working to pass local CIA ordinances
is an excellent source of breaking news and a forum to exchange
information and strategies.
Primer
on Clean Indoor Air Ordinances
This guide provides an overview on the research behind the impact
and popularity of CIA ordinances, details on opposition tactics,
and resources.
Back to “Resources and links” Menu
| Toolkits,
sample materials, and case studies |
Minnesota
Smoke-Free Coalition: Secondhand Smoke
This Web site provides a range of tools for communities, including
sample assessments and polls, tips on coalition building and policy
advocacy, and background on opposition tactics.
California
Lessons in Clean Indoor Air: A Compilation of Campaign Stories,
Implementation Tools, and Compliance Strategies
This guide compiles lessons learned and tips from local CIA campaigns
in California. It includes stories on policy development, implementation,
and compliance.
Taking
Action against Secondhand Smoke: An Online Toolkit
The Centers for Disease Control and Prevention’s Office on
Smoking and Health prepared this secondhand smoke online toolkit
on public places, workplaces and the home. The toolkit brings together
resources developed by tobacco control organizations around the
country on the health effects of secondhand smoke, coalition building,
community assessment, and material development.
Tobacco-Free
Michigan Clean Indoor Air Regulation Toolkit
This toolkit brings together sample materials used in Michigan communities.
It includes tools for community and coalition assessment, strategic
planning, working with the media, and sample opinion surveys.
Back to “Resources and links” Menu
| Community
mobilization and coalition building |
Center
for Civic Partnerships: Tips, Tools and Resources
Find tips and links to additional resources on a number of community
building issues, such as building and maintaining collaboratives,
community organizing, and facilitation.
Community Tool
Box
The Tool Box provides over 6,000 pages of practical skill-building
information on over 250 different topics on promoting community
health and development.
The
Learning Center
The Learning Center is a set of online learning modules for community
tobacco control staff and volunteers. The current modules cover
building coalitions, policy advocacy, and media advocacy, and provide
an overview of each with steps, and links to related publications
and web sites.
The
Praxis Project
Check out the Praxis Project Web site for tools on community building
and information on upcoming trainings on community organizing and
building networks.
Reaching
Higher Ground: A Guide for Preventing, Preparing for, and Transforming
Conflict for Tobacco Control Coalitions
Watch the ttac
Web site
for this forthcoming guide that will provide practical advice for
working in coalitions and partnerships that resolve real problems,
while strengthening relationships.
Back to “Resources and links” Menu
| Hospitality
industry issues |
Economic
Impact of Smoke-free Policies on Restaurants and Bars
This PowerPoint Presentation by Andrew Hyland at Roswell Park outlines
the issues surrounding economic impact studies and provides a review
of the literature.
Strange
Bedfellows: The History of Collaboration between the Massachusetts
Restaurant Association and the Tobacco Industry
Ritch WA, Begay ME. American Journal of Public Health 2001;91(4):598-603.
This article examines the historical relationship between the tobacco
industry and the Massachusetts Restaurant Association, a nonprofit
trade association aligned with the food and beverage industry.
Summary
of Studies Assessing the Impact of Smoking Restrictions on the Hospitality
Industry
This chart prepared by VicHealth Centre for Tobacco Control in Melbourne,
Australia summarizes the findings of a large number of studies that
analyzed the economic impact of CIA laws on the hospitality industry.
The chart indicates whether the studies were peer-reviewed and if
they were financed by the tobacco industry. See also accompanying
Tobacco
Control article.
Tobacco
Industry Manipulation of the Hospitality Industry to Maintain Smoking
in Public Places
Dearlove JV, Bialous SA, Glantz SA. Tobacco Control 2002;11:94-104
This article describes how the tobacco industry used the “accommodation”
message to mount an aggressive and effective campaign to recruit
hospitality associations to serve as the tobacco industry’s
surrogate in fighting against smokefree environments.
Tobacco
Scam
Read about this comprehensive resource for the hospitality industry
in the Resource Spotlight [hyperlink to Resource Spotlight].
What
to Look for in an Economic Impact Study
This ANR fact sheet outlines questions to consider in assessing
the validity of a study on the economic impact of CIA ordinances.
Back to “Resources and links” Menu
Are
Jurisdictions with Significant Concentrations of Communities of
Color More or Less Likely to Have Tobacco Control Ordinances?
To explore disparities in health protection, this Praxis Project
study examined the racial and ethnic composition of the jurisdictions
listed ANR’s Local Tobacco Control Ordinance Database.
Clean
Indoor Air and Communities of Color: Challenges and Opportunities
This article by the Praxis Project examines issues related to CIA
and communities of color to explore the various factors that influence
involvement, or lack of involvement, with local tobacco control
policy making activity.
Engaging
the Latino/Hispanic Community in Clean Indoor Air Campaigns
This ANR fact sheet provides facts on secondhand smoke specific
to the latino/community to assist in the development of a culturally
competent smokefree air coalition, public education campaign, and
supporting materials.
Mobilizing A Low-Income African-American
Community around Tobacco Control: A Force Field Analysis
Ellis GA, Reed DF, Scheider H. Health Education Quarterly 1995;22(4):443-57.
This article describes the process undertaken by a county health
department to mobilize a low-income African American community in
a San Francisco Bay Area city to support a local ordinance mandating
100% smokefree workplaces and restaurants.
Moving
Toward Health: Achieving Parity through Tobacco Control for All
Communities
The parity kit developed by the Task Force on Advancing Leadership
and Parity in Tobacco Control for Priority Populations addresses
the tobacco and health inequities faced by communities of color
and other priority populations.
Smoke-free
Air is a Union Issue
Check the ANR
Web site for this forthcoming resource on working with unions.
Teleconference:
Getting on the Right Side of the Rights Issue: Organizing Workers
and Communities of Color on Clean Indoor Air
Mark your calendar to participate in this teleconference on strategies
for organizing restaurant workers and others around CIA issues.
Town-Level
Characteristics and Smoking Policy Adoption in Massachusetts: Are
Local Restaurant Smoking Regulations Fostering Disparities in Health
Protection?
Skeer M, et al. American Journal Public Health 2004;94(2):286-292.
This article identifies and quantifies differences in sociodemographic
characteristics of communities relative to the strength of local
restaurant smoking regulations in Massachusetts.
Back to “Resources and links” Menu
ANR:
Tobacco’s Dirty Tricks
This ANR resource includes details on tobacco industry strategies
and front groups, highlights evidence from industry documents, and
links to the ANR Tobacco Industry Tracking Database.
Science for Hire: A Tobacco Industry
Strategy to Influence Public Opinion on Secondhand Smoke.
Muggli ME, Hurt RD, Blanke DD. Nicotine and Tobacco Research
2003;5(3):303-14.
This review of internal tobacco company documents reveals that members
of the tobacco industry and its corporate attorneys created an international
scientific consultants program to influence public opinion on secondhand
smoke.
Tobacco
Industry Surveillance of Public Health Groups: The Case of STAT
(Stop Teenage Addiction to Tobacco) and INFACT (Infant Formula Action
Coalition)
Malone RE. American Journal of Public Health 2002;92(6):955-60.
The goal of this study was to reveal tobacco industry strategies
for collecting information about public health groups.
Back to “Resources and links” Menu
Back to Table of Contents
Let ttac
help your community join together to become smokefree. Consider
the following services specific to Clean Indoor Air that are available
to you through ttac:
- Help strategize a firm and timely CIA initiative in your area.
- Help develop media campaigns and messages to promote CIA regulations.
- Help identify ways to work with the media to spread messages
to the public about the benefits of going smokefree.
- Help identify an expert to testify at a public hearing in support
of CIA policies.
- Point you to the latest information and materials on CIA and
secondhand smoke issue through our extensive inventory of resources
available on the
ttac Web site.
Back to Table of Contents
Allyson Doyle
American Heart Association
Northeast Affiliate
Allyson.Doyle@heart.org
Bronson Frick
Americans for Nonsmokers’ Rights
Bronson.frick@no-smoke.org
JoAnn Landers
Boston Public Health Commission
JoAnn_landers@bphc.org
Anne Landman
American Lung Association of Colorado
Tobacco Document Research Annex
afoxland@starband.net
Cheryl Sbarra
Massachusetts Association of Health Boards
Sbarra@mahb.org
Back to Table of Contents
Aliki P. Weakland, MPH, MSW
Editor
Alison Sipler, MPH, CHES
Managing Editor
Madeline H. Barrow, MEd
Writer/Researcher
Samantha Helfert, MLS
Information Specialist
Back to Table of Contents
|
