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					the secrets
to eliminating
 environmental
tobacco smoke
 Environmental Tobacco Smoke (ETS), also described as secondhand smoke, passive
 smoke and toxic tobacco smoke, is one of the most preventable causes of cancer, coronary
 heart disease and asthma. It affects us no matter where we are exposed to it—in our
 homes, at our jobs, while we eat, or when we are out with our families. The only way to
 protect ourselves from the carcinogenic and toxic effects of ETS is to never be exposed to
 ETS. Science has shown us that only ventilation systems with tornado-like air currents can
 remove ETS from the air quickly enough to prevent damaging exposure. The simplest,
 easiest and most cost effective safety measures are stronger ETS policies which protect us
 from any exposure to ETS.

 The benefits of advocating for an ETS-free environment are many; the first and foremost
 being health. We will be less likely to develop lung cancer or heart disease, our children will
 be less likely to develop asthma, chronic bronchitis, and ear infections. We will get fewer
 colds and chest infections, so we will miss less work and school and enjoy our time off even
 more. Our environment will be cleaner and less polluted by cigarette butts, stained walls
 and burned carpets. Finally, ETS represents a public health issue which effects everyone—
 us, our families and our community. Making a stand against ETS is taking a stand against
 something that harms everyone.

 Implementing a new ETS-free policy is a challenging task. As a health advocate proposing
 such a policy, you may be faced with opposition from business owners and managers,
 smokers, and those who worry more about perceived economic concerns rather than health
 concerns.

 Just because you face a challenge does not mean that you face an impossibility! Many
 before you have passed successful ETS policies—many private workplaces, counties and
 cities have passed smoke-free policies and are willing to share the secrets of their success.

 This toolbox is just that contains tools you need to advocate for a successful ETS policy. It
 consists of specific tools which you can use as you strategize, enact and evaluate your
 policy goals, whether your goal is to make a school smoke free or improve clean air regula-
 tions. The toolbox is itself a tool that can be used again and again, and passed on as a
 community resource.




                                                                                           k
 Equipped with this toolbox and fueled by a mission to promote healthier air for everyone,
 you are now ready to begin your ETS                                                               ets
                      advocacy               campaign!
                                                                                        TOOLBOX
                                Page Section
                                 3   Introduction
                                 4   Section I The Science of ETS
                                 4        Medical Science
                                 7        Ventilation Science
                                 8        Measurements
                                10        Public Attitudes

                                12    Section II Steps for Successful Policy Change

                                14    Section III An A to Z Toolbox for ETS Policy Change
                                15         Advocacy: Internal
                                                     Establishing Contact with Key Players
                                                     Meetings and Negotiations
                                20         Advocacy: External
                                                     I: Legal Options & Americans
                                                          with Disability Rights
                                                    II: Legislation: NC Law
                                                   III: Media Advocacy

                                34        Benefits of an ETS-Free Environment
                                35        Business Owner’s Guide
                                38        Cessation Programs
                                40        Coalition Partners
                                41                  Clinicians’ Role
                                42                  Youth Activities
                                43        Evaluation Tools
                                45        Ideas and Places
                                47        Incentives
                                48        Resources
                                               Agencies- National
                                                         Statewide
                                               Consultants- National
                                                          Statewide
                                               Literary




 contents
                                51        Surveys
                                54        Tobacco Industry and ETS

                                61    Section IV An A to Z Toolbox for Policy Success
                                60        Airports
                                62        Apartments
                                66        Ballparks
                                68        Bowling Centers
                                70        Camps
                                72         Colleges and Universities
                                74        Community Centers
                                76        Entertainment Arenas
                                80        Government Buildings
                                84        Homes
                                86        Malls/Stores/Shops
                                88        Prisons
                                90        Restaurants/Bars/Nightclubs
                                94        Schools- K-12
                                98        Work Sites
                                102        YOU! Personal Advocacy

                                      Appendix

“Never doubt that a small       104
                                105
                                          Bibiography
                                          Gov. Easley’s letter to North
group of thoughtful,                           Carolina School Boards

committed citizens can          106       Heart Healthy Restaurants
                                               Survey
change the world.”
                MARGARET MEAD
environmental
ENVIRONMENTAL TOBACCO SMOKE (ETS) IS A MAJOR HEALTH HAZARD TO THE CHILDREN AND ADULTS IN NORTH CAROLINA.



tobacco
THE PURPOSE OF THIS TOOLBOX IS TO PROVIDE LOCAL, GRASSROOTS ORGANIZATIONS WITH A VERSATILE AND USEFUL
TOOLKIT, FULLY EQUIPPED WITH RESOURCES, FACT SHEETS, AND GUIDES FOR SPECIFIC ETS POLICY CHANGE.



smoke
COALITIONS CAN UTILIZE THIS TOOLKIT TO INITIATE CHANGE ON A LOCAL LEVEL AND TO HELP TRAIN GRASSROOTS
ORGANIZERS.

                                                                                                                     k
                                                               how to use this guide
                                                                              This toolbox is designed to facilitate
                                                                              all ETS policy activities for coalitions
                                                                              and individuals in North Carolina.
                                                                              Because the scientific basis for ETS
                                                                              policy is so well-established, the bulk
                                                                              of this documsent is designed to
                                                                              provide advocates with tools they
                                                                              may need to actively advocate for
                                                                              ETS protection for nonsmokers.

                                                                                Section one presents scientific
                                                                                evidence on the health effects of
                                                                                exposure to ETS, ventilation,
                                                                                measurements and public attitudes
                                                                                and behaviors towards ETS. Section
                                                                                two of the toolbox presents steps
                                                                                that lead to ETS policy change.
                                                                                Section three offers steps for
                                                                                changing ETS policies, and section
                                                                                four offers venues for successful
change. While comprehensive, statewide ETS protection would offer the widest and surest way to protect North
Carolina citizens from ETS exposure, current state law offers little public protection. Thus, voluntary policy change,
along with regulation, education and advocacy, will remain viable options for lessening ETS exposure in North
Carolina. ETS policy change in North Carolina can, does and will occur as the result of individual and collective
action. Anthropologist Margaret Mead once said, “Never doubt that a small group of thoughtful, committed citizens
can change the world.”
                                                                                                                         003
The document was compiled by Adam O. Goldstein, MD and Anne Y. Butzen at the University of North Carolina
School of Medicine, Department of Family Medicine. Tremendous thanks goes to Fred Charles for his great work
on the graphic design for this document. Thanks also goes to the NC Project ASSIST coalition coordinators who
                                                                                                                         ets community change toolbox




shared success stories and pictures for this project, and to Ann Houston for her help in editing. The North
Carolina Tobacco Prevention and Control Branch as well as the North Carolina Advisory Committee on Cancer
Coordination and Control provided invaluable financial support. Finally, appreciation goes to the dedicated
advocates across the U.S. who have given effort and ingenuity championing smoke-free environments. Their
knowledge and expertise helped to create this manual.
                                                                  University of North Carolina School of Medicine

To order additional copies of this toolbox,     contact :         Department of Family Medicine Campus Box 7595


                                                                                                                    k
                                                                  Chapel Hill, NC 27599-7595
                                                                  (919) 966-4090
                                SECTION ONE:



                                The Science of ets


                                               thefollowing health effects are causally
                                                  associated with exposure to
                                                  Environmental Tobacco Smoke.




                                ETS Medical Science
                                Environmental tobacco smoke (ETS) causes cancer and is toxic. Since ETS is considered a Class A carcinogen, the
                                only acceptable level of exposure is no exposure. Here are a few quick facts on the health effects of ETS.

                                   R E S P I R AT O R Y E F F E C T S
                                       q Acute lower respiratory tract infections in children (e.g., bronchitis and pneumonia)
                                       q Asthma induction and exacerbation in children
                                       q Chronic respiratory symptoms in children
                                       q Eye and nasal irritation in adults
                                       q Middle ear infections in children

                                   CARCINOGENIC EFFECTS
                                     q Lung Cancer
                                     q Nasal Sinus Cancer
004




                                   CARDIOVASCULAR EFFECTS
                                     q Heart disease mortality
                                     q Acute and chronic coronary heart disease morbidity
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                                   D E V E LO P M E N TA L E F F E C T S
                                       q Fetal Growth: Low birth weight or small for gestational age
                                       q Sudden Infant Death Syndrome (SIDS)
                                                              (National Cancer Institute 1999)




                                                                                                                                          k
                                           ETS FACT SHEET
ETS AND M O R T A L I T Y
   Exposure to environmental tobacco smoke causes approximately 81 deaths due to lung cancer and 945 to
   1674 deaths due to coronary heart disease every year in North Carolina.
                                                 (Census Report 2000 and Environmental Protection Agency 1993)

   The lifetime risk from passive smoking is more than 100 times higher than the estimated effect of 20 years
   of exposure to asbestos.
                                                                                   (British Journal of Cancer 1986)

   Passive smoking is responsible for at least 40,000 deaths each year in the United States, including 3,000 from
   lung cancer, at least 35,000 from cardiovascular disease and 1900 from sudden infant death syndrome.
                                                                                   (National Cancer Institute 1999)

   Secondhand smoke kills more Americans every year than does drug abuse and causes the same number of
   deaths each year as those that died in the Vietnam War.
                                                                                          (Circulation 1991)

   Premature death from secondhand smoke is twice as likely as dying from a car accident and nearly 15 times as
   likely as dying in a fire.
                                                                                                    (Pion 1997)




ETS AND C A N C E R
   Passive smoking is a Group A carcinogen comparable to the most potent cancer-causing agents such as
   benzene, asbestos, arsenic, and vinyl chloride.
                                                                         (Environmental Protection Agency 1993)

   There are [several thousand] lung cancer deaths in nonsmokers in the United States each year caused by
   exposure to parents’ smoke during childhood and adolescence.
                                                                          (New England Journal of Medicine 1990)

   Nonsmoking workers exposed to secondhand smoke are 34% more likely to get lung cancer. Waiters and
   waitresses have a 50% greater risk of lung cancer than other workers mostly because of ETS exposure.
                                                                                 (National Cancer Institute 1999)

   People who are routinely exposed to large amounts of secondhand smoke, such as workers in bars and
   restaurants, can see their risk of lung cancer triple. The data absolutely backs a smoking ban in all
   workplaces, including bars.
                                                                                 (International Journal of Cancer 2001)




                                                                                                                      005
ETS AND H E A R T D I S E A S E
   Exposure to secondhand smoke is estimated to increase the risk of heart disease in nonsmokers by 30%,
   causing an estimated 35,000 to 62,000 deaths a year due to ischemic heart disease.
                                                                         (Environmental Protection Agency 1993)
                                                                                                                          ets community change toolbox




   Nonsmokers living with smokers have a 30% increase in the risk of death from myocardial infarction or
   ischemic heart disease.
                                                                          (New England Journal of Medicine 1994)

   Exposure to ETS causes acute deterioration in aortic function even among healthy people and some
   adverse effects may be cummulative and irreversible.
                                                                  (Journal of the American Medical Association 1998)




                                                                                                                 k
                                                                          ETS FACT SHEET


                                    Passive smoking substantially reduces Coronary Reserve in healthy nonsmokers. This finding provides direct
                                    evidence that passive smoking may cause endothelial dysfunction of the coronary circulation in nonsmokers.
                                                                                                 (Journal of the American Medical Association 2001)

                                    The death toll attributable to passive smoking from CHD is estimated to be 10 to 20 times as large as deaths
                                    from lung cancer.
                                                                                                 (Journal of the American Medical Association 1995)




                                ETS AND R E S P I R A T O R Y D I S E A S E
                                   Passive smoking causes annually 150,000 to 300,000 cases per year of lower respiratory infections in babies
                                   under the age of 18 months, resulting in 15,000 hospital admissions, and worsening of asthma in 400,000 to
                                   1,000,000 children, each year in the United States.
                                                                                                                (National Cancer Institute 1999)

                                    Children with asthma exposed to the most passive smoke [ETS] had 70% more asthma attacks than those
                                    with little or no exposure.
                                                                                                       (New England Journal of Medicine 1993)

                                    One million asthmatic children in the United States are exposed to their parent’s tobacco smoke.
                                                                                                                           (Journal of Asthma 1993)

                                    Nonsmoking adults with asthma with exposure to tobacco smoke at home have more acute asthma episodes,
                                    more emergency room visits, lower expiratory flow measurements, and more work missed than asthmatics not
                                    exposed to environmental tobacco smoke.
                                                                                                                                (Chest 1994)




                                SCIENTIFIC        LINKS:

                                    Executive summary of NCI report http://www.oehha.org/air/environmental_tobacco/leadets.html

                                    Complete NCI Monograph on ETS http://rex.nci.nih.gov/NCI_MONOGRAPHS/MONO10/M10-ExSummary.pdf

                                    California Environmental Protection Agency’s Office of Environmental Health Hazard Assessment (OEHHA)
                                    http://www.druglibrary.org/schaffer/tobacco/caets/ets-main.htm
006
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                                                                                                                                             k
             ETS Ventilation Science
                  VENTILATION SYSTEMS IN BUILDINGS ARE DESIGNED TO RECIRCULATE AIR, NOT TO FILTER
                  IT. FOR THIS REASON, THEY ARE OFTEN RESPONSIBLE FOR BRINGING POLLUTED AIR FROM
                  SMOKING AREAS INTO DESIGNATED “SMOKE-FREE” AREAS. A POPULAR OPTION TOUTED
                  BY THE TOBACCO INDUSTRY IS TO ESTABLISH DESIGNATED SMOKING AREAS, IN THE
                  BELIEF THAT “ACCOMODATION” OF SMOKERS AND NONSMOKERS IN PUBLIC PLACES CAN
                  OCCUR. IN MOST SITUATIONS, HOWEVER, ETS DIFFUSES RAPIDLY IN BUILDINGS RESULT-
                  ING IN SUBSTANTIAL EXPOSURE AMONG NONSMOKERS. TWENTY SIX PERCENT OF NORTH
                  CAROLINA WORKERS REPORT THAT THEIR WORKPLACE SMOKING RULES RESULT IN
                  DESIGNATED SMOKING AREAS INSIDE THEIR WORKPLACE. MOST OF THESE WORKERS
                  LIKELY HAVE UNACCEPTABLY HIGH LEVELS OF ETS EXPOSURE AT THEIR WORKPLACE.
                  APPROXIMATELY ONE MILLION SQUARE FEET OF BUILDING AREA PER SMOKER IS RE-
                  QUIRED FOR MINIMAL, SAFE, WORKSITE ETS EXPOSURE LEVELS.


E T S A N D V E N T I L AT I O N :
    The carcinogenicity of [ETS] discounts the use of general ventilation as an engineering control for this
    contaminant.
                                                                                                        (OSHA 1994)

    To achieve de minimis risk would require in excess of one hundred thousand cubic feet per minute per occu-
    pant (50,000 litres per second per occupant), which would need tornado-like levels of air flow to achieve.
                                                                                               (Risk Analysis 1998)

    Ventilation systems are not the solution; there is no way to completely remove secondhand smoke from an
    enclosed environment.
                                                                                            (Stanton Glantz 2001)

    Science has not demonstrated any safe level of exposure to ETS. Also, national ventilation standards
    (ASHRAE 62-1999) do not allow for smoking in the vast majority of public venues. At best, ventilation
    technology only removes the smoke odor and irritation.
                                                                         (Americans for Nonsmokers’ Rights 1996)

B A S I C V E N T I L AT I O N S TA N DA R D S :
A policy option sometimes touted is to establish separately ventilated areas in public places. When these desig-
nated smoking areas do not leak, they may provide adequate protection for nonsmokers. Two concerns with such
smoking areas are: 1) designated smoking areas may increase the risk of lung cancer among smokers over and
beyond that to which they have from their own smoking; and 2) the installation of separately ventilated smoking
lounges is very costly.

The North Carolina Division of Public Health states that ventilation is only an acceptable alternative to a no-

                                                                                                                      007
smoking policy when the ventilation system meets many requirements, including:
n A space designated for a smoking lounge must not require entry for any purpose other than smoking with
    the exception of cleaning or maintenance.
n It must provide a minimum of 14 square feet of floor space per smoker based upon maximum use.
n It must block or remove all HVAC returns in the lounge. It must provide 60 cfm of exhaust ventilation per
                                                                                                                          ets community change toolbox




    smoker based upon maximum air use. Air should be exhausted outdoors and away from building openings.
n If intermittent exhaust ventilation is used (e.g., an exhaust fan switch fan tied into a light switch), the fan
    should operate whenever the lounge is occupied.
                    Adapted from the Occupational and Environmental Epidemiology Branch, meets ASHRAE Standard 62-1999.


SCIENTIFIC LINKS:
Can Ventilation Control Secondhand Smoke in the Hospitality Industry? Summary of ETS and Ventilation pre-
pared by Jim Repace. http://www.repace.com/fact_cardio.html

American College of Occupational and Environmental Medicine’s Review of Epidemiological Basis for an
Occupational and Environmental Policy on ETS. http://www.acoem.org/paprguid/papers/etspaper.htm
                                          ETS Measurements
                                               SCIENTIFIC EVIDENCE HAS DEMONSTRATED WITHOUT A DOUBT THAT WE ARE
                                               EXPOSED TO CARCINOGENS WHEN WE ARE EXPOSED TO ETS. THERE IS NO
                                               KNOWN SAFE LEVEL OF EXPOSURE TO THIS CANCER CAUSING AGENT. ETS IS
                                               COMPOSED OF CHEMICALS GENERATED DURING THE BURNING OF TOBACCO,
                                               WHOSE MAIN COMPONENT IS “SIDE STREAM SMOKE,” THE SMOKE EMITTED
                                               FROM THE SMOLDERING TOBACCO PRODUCT BETWEEN PUFFS. OTHER
                                               IMPORTANT COMPONENTS INCLUDE “MAINSTREAM SMOKE” WHICH IS EMITTED
                                               DURING AND EXHALED AFTER PUFFS. ACUTE IRRITANT EFFECTS OF ETS ARE
                                               CAUSED BY MANY CHEMICALS, INCLUDING AMMONIA, CARBON MONOXIDE,
                                               FORMALDEHYDE, HYDROGEN CYANIDE, NICOTINE, PHENOL AND SULFER DIOXIDE.
                                               MORE THAN 50 CARCINOGENIC COMPOUNDS ARE PRESENT IN ETS.




                                [
                                INDIRECT METHODS SHOW HOW MUCH ETS IS IN THE AIR.           ]
                                    A . Measurements of indoor air concentrations of ETS constituents.
                                    B. Population surveys and questionnaires used to assess the characteristics,
                                        patterns and extent of exposure.

                                        Data collected using the indirect methods show how much ETS is in the air. Given the complex
                                        chemical composition of ETS, air concentrations are typically assessed by measuring individual ETS
                                        constituents, referred to as tracers, markers, or proxy compounds. Scientists sometimes suspend
                                        tracers in midair above or attach the tracer to a surface near an area where people are allowed to
                                        smoke. Nicotine and respirable suspended particulates (RSP) are the most widely used markers for
                                        the presence and concentration of ETS in indoor environments. Recently, some researchers have used
                                        3-ethenylpyridine, solanesol, and ultraviolet particulate matter as markers of ETS and suggested that
                                        they may be better correlated with other constituents of ETS than nicotine and RSP .

                                        Population surveys and questionnaires also help determine exposure levels and risk. Please see our
                                        Surveys section, page 54, for examples of useful surveys.

                                [
                                DIRECT METHODS SHOW THE AMOUNT OF ETS A PERSON HAS ACTUALLY BEEN EXPOSED TO.                     ]
008




                                    A . Personal monitors.
                                    B. Measurement of bio-markers of exposure.

                                        Data using these direct methods measures the amount of ETS to which a person has actually been
                                        exposed. Personal monitors measure concentrations of ETS constituents at or near the breathing
 ets community change toolbox




                                        zone and are worn by individuals to assess exposures occurring in a specific location or accumulated
                                        throughout the day, thus providing an integrated measure of short-term exposure. They are often
                                        used in conjunction with other methods to compare or validate assessment of exposure.

                                        Nicotine levels in the air are highly specific to the burning of tobacco products, and detection of
                                        nicotine is thus a marker for ETS. Nicotine disappears from air faster than other ETS constituents,
                                        and using it as a marker for exposure is likely to underestimate the full health exposure to ETS.



                                                                                                                                          k
Measurement of bio-markers, ETS constituents or their metabolites in physiological fluids (such as urine, serum
and saliva), is the most direct assessment of ETS exposure available. Nicotine and cotinine (a major metabolite of
nicotine) measured in blood, saliva or urine, are the most widely used bio-markers of ETS exposure. Cotinine is a
good indicator of ETS exposure over the previous 2-3 days because its half-life is 1-2 days. Many researchers
believe the best way to monitor ETS exposure is by testing urine for cotinine and nicotine levels. Check with your
local hospital to see the costs involved with these tests.

SCIENTIFIC LINKS:
National Cancer Institute- Health Effects of Exposure to ETS, 1999.
http://www.druglibrary.org/schaffer/tobacco/caets/ets-main.htm




                                                                                                                 009 ets community change toolbox




                                                                                                            k
                                               ETS and Public Attitudes
                                                      THE SCIENCE BEHIND ETS ALONG WITH THE EFFORTS OF ETS POLICY ADVOCATES HAS
                                                      CREATED AN ENVIRONMENT THAT IS ALREADY RECEPTIVE TO THE IDEA OF ETS AS
                                                      AN IMPORTANT HEALTH POLICY ISSUE. THE MAJORITY OF PEOPLE IN NORTH
                                                      CAROLINA ARE AWARE OF THE HEALTH EFFECTS OF EXPOSURE TO ETS AND SUPPORT
                                                      ETS POLICIES. HERE ARE SOME DATA, BOTH NATIONAL AND SPECIFIC TO NORTH
                                                      CAROLINA, ON PUBLIC ATTITUDES TOWARDS ETS.



                                NORTH CAROLINA
                                In 1996, the CDC conducted a survey of more than 500,000 North Carolinians about their knowledge and opin-
                                ions regarding ETS. Here are some of the results:

                                                   ETS ATTITUDES                                                    ETS POLICY
                                100%                                                          100%
                                                                                                                                             90%

                                80%                                                           80%                                 76%
                                                                     66%      70%
                                           62%         64%
                                60%                                                           60%                    58%
                                                                                                          52%

                                40%                                                           40%


                                20%                                                           20%



                                      North Carolinians feel                                        North Carolinians prefer
                                      n government should regulate smoking in public places         n a no-smoking workplace policy
                                      n restaurants should be smoke free                            n smoking restrictions at outdoor sports events
                                      n businesses should do more than they are currently           n smoking restrictions in clubs/ bars
                                        doing to protect their employees from ETS                   n smoking restrictions in bowling alleys
                                      n businesses should do more than they are currently
                                       doing to protect their customers from ETS


                                                      ETS KNOWLEDGE                                                   ETS BEHAVIOR
                                 100%
                                                                                              100%

                                  80%                                      71%                                                65%           70%
                                                               66%                             80%
010




                                                65%
                                 60%
                                                                                               60%             43%

                                 40%
                                                                                               40%
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                                 20%
                                                                                               20%



                                        North Carolinians know that ETS                               North Carolinians
                                        causes...                                                     n exposed to ETS reporting ETS-related discomfort
                                        n ear aches in young children                                 n with asthma experiencing worsened asthma
                                        n premature birth                                               symptoms around ETS
                                        n lung cancer                                                 n exposed to ETS by their spouse/partner
                                                                                                                                                      k
N AT I O N A L LY
“Policies regulating smoking at the workplace for the protsection of employees’ health are a trend of the 1980s.
As of 1986, smoking is restricted or banned in 35 to 40 percent of private sector businesses and in an increasing
number of federal, state and local government offices....Actions to restrict or ban smoking at the workplace are
supported by a large majority of both smokers and nonsmokers.”
                                            (US Surgeon General: Health Consequences of Involuntary Smoking 1986)



                                                NATIONALLY
                                     CPS 1994, USDHHS 1992, CDC 1991
                           100%
                                                       87%            90%
                                          86%
                           80%

                           60%

                           40%

                             20%



                                   People support ETS-Free policies
                                   n percentage of Americans who favor a ban or
                                    restrictions on smoking in work areas
                                   n percentage of work sites that have formal tobacco
                                     control policies
                                   n percentage of Americans who support restrictions
                                     or bans in private work sites




                                                                                                                011 ets community change toolbox
                                SECTION TWO:

                                     Steps for Successful
                                     Policy                                         BEFORE YOU CAN CHANGE A
                                                                                    POLICY, YOU MUST HAVE A
                                                                                    CLEAR STRATEGY. THIS QUICK
                                                                                    GUIDE WILL HELP YOU
                                                                                    REMEMBER THE KEY POINTS OF
                                                                                    POLICY CHANGE AND PREPARE
                                                                                    FOR THE TASK AHEAD!




                                                                      change
                                  1. Decide on a specific goal for policy change.           thought about how you will use media, and if
                                     What is the goal? Do you want to convert one           you will use education, regulation, litigation or
                                     restaurant into a Smoke-Free Zone, or do you           other forms of Advocacy (page 17)?
                                     have larger ETS regulatory policy goals for your
                                     county or city? Are you an established group
                                     searching for Ideas and Places (page 48) for
                                                                                         5. Decide on roles and responsibilities.
                                     ETS policy change?                                      Have you developed small, specialized, working
                                                                                             groups? Is everyone working together? Have you
                                                                                             clarified your goals?
                                  2. Strategic assessment.
                                     How prevalent is the smoking issue?
                                     What are the current laws on the books?
                                                                                         6. Enact your plan.
                                     How open are the managers/owners to                    Is your time-line well delineated and accurate? Do
                                     changing their smoking policy? Are there other         you need follow-up meetings to assess your
                                     people who support your goal? Have you                 progress? Have you incorporated positive
                                     thought about using Surveys (page 54) to               incentives? Have you involved children, media and
                                     determine support for policy change?                   ETS sensitive victims and survivors?


                                  3. Develop a working coalition for policy change. 7. Defend your policy.
                                     How large does the coalition need to be?                Has your policy come under attack? What are some
                                     Who are the strategic players? Have you                 responses to these attacks? Are your coalition
                                     represented the diversity of the community?             members prepared to meet these attacks? Have
                                     Have you involved non-traditional partners              you developed a rationale that includes all of the
                                     and influential players on your list of                 Benefits of an ETS-Free Environment (page 37)?
                                     Coalition Partners (page 43)? What resources,
                                     financial and/or human, do you need? Have you
                                                                                         8. Acknowledge the need for Cessation Programs.
012




                                     chosen someone who will be in charge of
                                     communications and media? Have you                      Have you found some basic information to help
                                     developed trust among the coalition through             those who may come to you as a source for
                                     speaking honestly and openly?                           Cessation information (page 41)?
 ets community change toolbox




                                  4. Clarify your strategy.                              9. Evaluate the impact of the policy.
                                     What is your plan and time-line? Have you               Can you use Evaluation Tools (page 46) that
                                     thought about potential points of conflict?             empower the coalition? What parts of your strategy
                                     What are your back-up plans if your primary             can you evaluate as- you- go to be sure you are
                                     strategy is unsuccessful? Are influential players       working towards your overall goals? Have you
                                     backing or opposing your action? Have you               publicized your success?



                                                                                                                                                k
SECTION THREE:




An A to Z Toolbox for ETS Policy




                                          change
                 advocacy


                     Current Environmental Tobacco Smoke policies
                     can only be changed when public opinion and
                     attitudes shift about secondhand smoke. This is
                     where advocacy plays an important role. Advocacy
                     becomes both a strategy and vehicle of change.
                     You will find in this section the information and
                     proven methods that can educate and influence
                     opinion leaders to change attitudes and policies
                     about secondhand smoke in your community.


                                                                         013
                                                                         ets community change toolbox




                                                                         k
                                Advocacy: Internal Strategy
                                           AN INTERNAL STRATEGY IS ONE IN WHICH YOU WILL NEGOTIATE WITH A PERSON WHO IS AN
                                           INSIDER WHERE THE POLICY CHANGE NEEDS TO HAPPEN. THE TOOLS BELOW CAN HELP YOU
                                           SUCCESSFULLY CONTACT, MEET AND NEGOTIATE WITH THOSE WITH WHOM YOU WANT TO CHANGE
                                           A POLICY.


                                                                                           DURING THE MEETING:
                                E S TA B L I S H I N G C O N TA C T                        q Keep the meeting short, no more than 30 minutes.
                                W I T H K E Y P L AY E R S                                 q Be polite, thank the person for meeting with you.
                                A key player is someone who can influence a policy
                                                                                           q Explain why you are meeting. Be sure to frame
                                change. Perhaps they sit on a board of directors or are
                                                                                              the discussion as a public health issue and
                                a member of a health organization. The person need
                                                                                              stress your common ground. Remember your
                                not be a major decision maker, but may have the ear of
                                                                                              specific goals—including new policy, time table,
                                a decision maker. Use these questions to help you
                                                                                              enforcement, etc.
                                formulate your strategy:
                                                                                           q Document the nature of the problem. Produce
                                                                                               evidence of ETS exposure.
                                q   Do I already have a relationship with someone
                                    who is a key player?                                   q   Support your issue with facts. Bring a short
                                                                                               summary of information on ETS and
                                q   How do I develop a relationship with someone
                                    whom I don’t know but want to know?                        community attitudes in your area that you can
                                                                                               leave behind after the meeting.
                                q   How can I contact this person to meet with
                                    them and talk about ETS?                               q   Document how you and others are affected. Be sure
                                                                                               to include the short term (asthma, eye and
                                q   Can this person affect a policy change?                    throat irritation, smells, etc) as well as long
                                q   Is this person sympathetic to issues                       term effects of exposure (carcinogenic, lowers
                                    surrounding ETS?                                           worker productivity, destroys furniture, etc.).
                                                                                           q   Offer positive benefits such as media attention,
                                M E E T I N G S A N D N E G O T I AT I O N S                   publication in a newspaper or smoke-free guide,
                                Whether you are meeting with an elected official or a          community support and so forth.
                                supervisor you’ve known and worked with for years, it is   q   Be prepared for counterpoints and have ready
                                important to remember these key points:                        responses. If you are unprepared for a
                                                                                               counterpoint, respond honestly that you will do a
                                BEFORE THE MEETING:                                            little research and get back to them after the
                                q Research the person’s history with ETS, and                  meeting.
                                   be prepared for responses. What kind of obstacles
                                   might arise? What are solutions to these obstacles?
                                q What common ground do you share? For                     A LIST OF DON’TS:
                                   example, how does an ETS-policy benefit both            G Don’t rush for closure.
                                   parties?                                                    If the meeting is dragging on or getting too
                                q Consider asking 2-3 supporters to join you at an             heated, ask for a short break or reschedule.
                                   initial meeting.                                            Don’t settle just to leave!
                                q Choose one person to be the spokesperson for
                                   the group.                                              G Don’t burn your bridges.
014




                                q Prepare a bottom line and a goal for policy                 Keep the conversation positive and solution-
                                   change.                                                    oriented. You want to work with this person in
                                q Demonstrate that people in the area support an              the future to help implement the new policy!
                                   ETS policy change by gathering surveys, petitions,
                                   testimonials and editorials.                            G Don’t go below your bottom line.
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                                                                                              Once you have determined what is
                                                                                             fundamental to your coalition, you must not go
                                                                                             below this line. If you cannot reach a
                                                                                              resolution then re-evaluate your strategy and
                                                                                              try from another angle—don’t give up and
                                                                                              don’t settle for a muddled and ineffective
                                                                                             plan!


                                                                                                                                              k
 Advocacy: External Strategy
           Part I- Legal Options
       LEGAL OPTIONS AS AN EXTERNAL STRATEGY ARE USEFUL IN CONJUNCTION WITH AN INTERNAL
       STRATEGY OR ONCE YOU HAVE TRIED AN INTERNAL STRATEGY AND IT HAS FAILED. IT IS NOT
       RECOMMENDED THAT YOU SPEAK WITH A LEGAL EXPERT ABOUT PERSUING LEGAL OPTIONS UNTIL
       YOU HAVE FIRST TRIED TO WORK WITH MANAGERS.




AMERICANS WITH DISABILITIES ACT (ADA)
                                                            accommodation, including facilities that offer lodging,
Pursuing your policy goals through a court of law can
                                                            food, entertainment, sales or rental services, or health
be effective and create precedence for future ETS
                                                            care and other professional services.
related cases. It is also time consuming and very
expensive. Before you involve a legal expert, remember
                                                            Public facilities such as courthouses, jails, hospitals,
that most courts accept a claim of discrimination or
                                                            parks, and other facilities owned and operated by State
unfair treatment only once you have proof that you
                                                            and local government entities cannot discriminate in
have sought and been denied appropriate treatment.
                                                            their services because of race, color, religion, national
You must try an internal strategy first before you can
                                                            origin, or disability.
take the matter to court— send letters, meet with the
manager or owner, petition your claim, etc. Not only
                                                            People with disabilities cannot be discriminated against
does this help you build a future case but internal
                                                            or excluded from services, programs, or activities offered
strategies are often faster and more cost-effective
                                                            by state or local governments. All public transportation
means of implementing a new policy. Once you have
                                                            systems must be accessible to people with disabilities,
tried every other avenue of compromise and
                                                            regardless of whether the system receives federal
negotiation and still you are ignored, contact a legal
                                                            financial assistance.
expert and discuss these options.

Some people seriously affected by exposure to ETS           A recent decision by the Supreme Court limits the rights
have sought regulatory refuge using the Americans with      of federal employees to file a claim using the ADA
Disabilities Act (ADA). The ADA prohibits                   against their federal employer. This restriction does not
discrimination on the basis of disability in places of      eliminate the majority of eligible claims. For example,
public accomodation. Public facilities such as              these people would be able to successfully pursue a
courthouses, jails, hospitals, parks and other facilities   claim using the ADA:
owned and operated by State and local government
entities cannot discriminate in their services because of       q   An individual who suffers from asthma
race, color, religion, national origin or disability. A             challenges an ETS policy that allows smoking
person with a disability is defined as one who has a                outside the state courthouse because the
physical or mental impairment that substantially limits             people smoking outside prevent him from
one or more major life activites. People with chronic               entering the building.
                                                                                                                         015
respiratory illnesses such as asthma have filed claims          q   An individual who suffers from emphysema
using the ADA, claiming successfully that breathing is              challenges the ETS policy of a restaurant
one of life’s “major activities.” Using the ADA does not            because she is unable to eat there when
necessarily mean calling a legal expert and filing a                smoking is allowed in the restaurant.
claim. It often means informing an employer about the           q   An individual with a history of laryngeal or lung
                                                                                                                         ets community change toolbox




ADA, whom it protects and to whom it applies, the                   cancer who works at a private business
potential publicity surrounding the claims, and other               challenges the ETS policy because it allows his
people’s successful claims.                                         coworkers to smoke near his work space.

When does the ADA apply?                                    How does the ADA apply to ETS?
The ADA prohibits discrimination on the basis of            The ADA has a three-part definition of “disability.” This
disability in a wide range of places of public              definition reflects the specific types of discrimination
                                experienced by people with disabilities. Accordingly, it                         impairment. (Suspicion and rumor)
                                is not the same as the definition of disability in other                    l    The individual may have no impairment but
                                laws, such as state workers’ compensation laws or                                be regarded by the employer or other
                                other federal or state laws that provide benefits for                            covered entity as having a substantially
                                people with disabilities and disabled veterans.                                  limiting disability.

                                Under the ADA, an individual with a disability is a                ADA complaints fall into one or more of the following
                                person who:                                                        categories:
                                    q has a physical or mental impairment that                             Title I: employment
                                        substantially limits one or more major life                        Title II: state or local government—programs,
                                        activities, including any physiological disorder                             activities, and services of public entities
                                        or condition, cosmetic disfigurement, or                           Title III: public and commercial—programs,
                                        anatomical loss affecting one or more of the                                 activities, and services of private
                                        following body systems: neurological,                                        entities
                                        musculoskeletal, special sense organs,
                                        respiratory (including speech organs),                     Using the ADA as part of an inside strategy.
                                        cardiovascular, reproductive, digestive,                   The ADA is effective in one of two ways: you can use an
                                        genitourinary, hemic and lymphatic, skin,                  inside strategy utilizing letters and meetings to educate
                                        and endocrine. An individual must be unable                a business owner or employer about the ADA and their
                                        to perform, or be significantly limited in the             liability under the law. The second way to use the ADA is
                                        ability to perform, an activity compared to an             to file a claim in court alleging discrimination on the
                                        average person in the general population. This             basis of a disability.
                                        is measured according to:
                                       l      its nature and severity                              If the owner or manager of a business is not listening to
                                       l      how long it is expected to last                      the reason of an ETS policy, it may be time to educate
                                                                                                   that person about the ADA, what and whom it covers
                                       l      its permanent or long term impact, or
                                                                                                   and how it can be used. Please see page 20 to view a
                                              expected impact
                                                                                                   sample of a letter informing a business manager about
                                    q has a record of such an impairment; or                       how the ADA protects smoke- sensitive persons ex-
                                    q is regarded as having such an impairment.
                                                                                                   posed to ETS.
                                        l    The individual may have an impairment
                                             that is not substantially limiting but is
                                                                                                   Campaigns such as this have been very successful.
                                             perceived by the covered entity as
                                                                                                   Often, employers and business owners only need to be
                                             constituting a substantially life limiting
                                                                                                   informed about the ADA and they will decide to change
                                             impairment (when you are treated as
                                                                                                   their policy. Consider offering the business owner who is
                                             having a life-limiting impairment).
                                                                                                   considering changing his workplace ETS policy a copy of
                                        l    The individual may have an impairment
                                                                                                   a model policy included in this tool box (pages 26 and
                                             that is only substantially limiting because of
                                                                                                   27).

                                    Airport’s smoking policy under fire                            Dr. Adam Goldstein, a physician and the University
                                    Anti-Tobacco group cites disability law                        of North Carolina at Chapel Hill and an anti-smoking
                                    By Catherine Clabby                                            activist who helped found SAVE. “It’s an avenue for
                                    Raleigh News and Observer                                      public health protection when the local or state
                                    Thursday, October 22, 1998                                     governmnet can’t offer it.”
                                                                                                         “A cloud of smoke is as much a barrier to a
                                    In its first assault on North Carolina’s permissive smoking    smoke-sensitive person as a flight of stairs is to a
                                                                                                   person in a wheelchair,” said Sarah Elsner, SAVE’s
016




                                    laws, a statewide anti-tobacco group is using federal law to
                                    attack Raleigh-Durham International Airport’s policy of        program coordinator.
                                    permitting smoking in open areas.                                    A.B. Elkins II, senior attorney for the Govenor’s
                                          The small group-- Survivors and Victims of Tobacco       Advocacy Council for Persons with Disabilities, said
                                    Empowerment (SAVE)-- says RDU violates the Americans           North Carolinians have used the federal disability
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                                    with Disabilities Act because the air quality poses a threat   statute in the past to shield themselves from cigarette
                                    to people disabled by breathing discorders such as asthma      smoke. A resident of Eastern North Carolina
                                    and emphysema.                                                 convinced a District Court judge to hold a hearing
                                          “This is applicable to any place in the state where      outdoors after complaining that the amount of smoke
                                    people encounter environmental tobacco exposure,” said         in a county courthouse made it impassible. . . .

                                                                                              And it worked!
                                                                                     Raleigh- Durham International


                                                                                                                                                             k
                                                                                  Airport is now virtually smoke free!
                                                                                                                    LARYNGECTOMY
                                                                                                                    SURVIVORS
                                                                                                                    EXPLAIN HOW
                                                                                                                    ETS EFFECTS
                                                                                                                    THEM
                                                                                                                    PERSONALLY.




Sample ADA educational letter to a business owner.

                                                                                                                                      YOUR
                                                                                                                                    ADDRESS
                                                                                                                                       INFO
  NAME OF BUSINESS
  ADDRESSEE’S
  INFO
                                                                                                                                 DATE
  Dear (FILL IN APPROPRIATE NAME OF MANAGER, DIRECTOR, ETC.),

  I/ The NAME OF YOUR COALITION am writing to inform you that ___ NAME OF BUSINESS ___ is inaccessible to persons vulnerable
  to environmental tobacco smoke (ETS). These people are typically those with breathing and cardiopulmonary impairments including but
  not limited to asthma, allergies, emphysema, chronic bronchitis, chronic obstructive pulmonary disorder, congestive heart failure, heart
  disease, otitis media and lung cancer. We request that steps be taken that would eliminate discrimination against those individuals most
  sensitive to the effects of ETS.

  This letter has dual purposes: to help educate the reader(s) and those people in charge of decisions about the physical structures and to
  influence the solution to this problem of ETS. Please consider this letter as a request to change the current situation.

  The health risks of ETS are well established. There is consensus that ETS represents a health hazard, especially for people with active or
  intermittent symptoms. These are the people who need the most protection from harm and need ____NAME OF BUSINESS____ to be
  an accessible public facility. The exposure to ETS by people with breathing disorders is clearly included in the federal anti-discrimination
  laws such as the Americans With Disabilities Act of 1990 (ADA) (42 USC 1203 et seq.) and the Rehabilitation Act of 1973. These federal
  anti-discrimination laws preempt and prevail over any conflicting state or local law with weaker requirements. They do not supersede
  state or local laws that are stronger. They are the minimum standards under which ____NAME OF BUSINESS____ should be governed/
  maintained.

  People with pulmonary disabilities often become more symptomatic in the presence of ETS. Those people who enter these areas do so at
                                                                                                                                                 017
  great risk to their health. Some medical and legal experts offer the analogy that ETS to a person with pulmonary difficulties is as much a
  barrier as a flight of stairs is to a person confined to a wheelchair.

  There is one optimal solution, making the indoor spaces of ____ NAME OF BUSINESS ____ smoke free. This would be in compliance
                                                                                                                                                 ets community change toolbox




  with the ADA and protect BOTH (FILL IN CUSTOMERS, SHOPPERS, ETC.) ________________ and employees from ETS. A less
  healthy, more expensive step would involve construction of separately ventilated, enclosed smoking areas with exhausts to the outside.
  The rest of the building would then be made smoke free. Enclosed is a list of (FILL IN DEPARTMENT STORES, RESTAURANTS,
  ETC.)_______________ which have become smoke free.

  We feel this is of immediate concern. We will be glad to meet with you anytime. Please reply within the next four weeks.




                                                                                                                                              k
  Sincerely,
                                Pursuing your claim in court

                                Complaints should be filed with:                           If the Disability Rights Section of the Civil Rights
                                   q Any federal agency that provides funding              Division believes that there is a pattern or practice of
                                       to the public entity that is the subject of         discrimination, or the complaint raises an issue of
                                       the complaint.                                      general public importance, it may attempt to negotiate
                                   q A Federal agency designated in the Title II           a settlement of the matter, or bring an action in U.S.
                                       regulation to investigate Title II complaints.      district court. Any such action would be taken on
                                   q The Equal Employment Opportunity                      behalf of the United States. You also have the option of
                                       Commission, regarding employment, if the            filing your own lawsuit in U.S. district court.
                                       State or local government is subject to Title I.
                                   q The Department of Justice.                            For more information on the Americans with Disabilities
                                                                                           Act, or to file a claim:
                                Your complaint should be in writing, preferably typed or       Disability Rights Section
                                printed neatly, dated, signed, and should include the          Civil Rights Division
                                following information:                                         U.S. Department of Justice
                                     q Your name;                                              Post Office Box 66738
                                     q Your address, and your home and work                    Washington, D.C. 20035-6738
                                         telephone numbers;
                                     q The name(s) and address(es) of the person(s)        Call to obtain answers to general and technical
                                         and/or establishment you believe discriminated    questions about the ADA and to order technical
                                         against you;                                      assistance materials:
                                     q Establish that you have approached someone              800-514-0301 (voice)
                                         who could affect the policy and has decided not       800-514-0383 (TDD)
                                         to change the policy.                                 http://www.usdoj.gov/crt/ada/adahom1.htm
                                     q A description of the act(s) of discrimination.
                                         This should include the date and place of the     To view a sample claim:
                                         action(s), and what you believe to be the basis       http://www.raggededgemagazine.com/archive/
                                         for discrimination (race, sex, etc.); and the         proform.htm
                                         name(s), address(es) and telephone number(s)
                                         of any person(s) with information concerning
                                         your complaint.

                                When your complaint is investigated, you may be asked      HOW ONE FAMILY TOOK FAMILY RESTAURANTS TO
                                to provide copies of receipts, contracts, or other         COURT, AND WON!
                                records supporting your claim of discrimination. Any
                                materials that you would want returned should not be       Staron v. McDonald’s Corp., 51 F   .3d 353 (2d Cir. 1995)
                                sent with your initial complaint.                          Three asthmatic children and one adult with lupus
                                                                                           brought a case against Burger King and McDonald’s
                                Generally, most government agencies require that           claiming that the restaurant chain’s policy of allowing
                                complaints be postmarked within 180 days of the            smoking in their facilities violated the ADA’s public
                                discriminatory action. You should, however, inquire        accommodations provisions. The court ruled that a
                                about specific deadlines that may apply to your case.      smoking ban in the restaurants “would fully
                                Depending on your type of case or your status, you may     accommodate the plaintiff’s disabilities but impose
                                be required to file your complaint earlier.
018




                                                                                           little or no cost on defendants.”
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                                                                                                                                               k
OTHER LEGAL OPTIONS
Other legal actions exist which you can take to help convince a business owner or landlord to establish health
protections against ETS exposure. Some of these options only apply to living conditions. You should discuss these
options with someone with legal expertise before using them.




Violation of Health Regulations                             agreement. The invasion must be intentional and
The regulation may take the form of a county, district,     unreasonable, and must consist of an act or the failure
city or municipal sanitary or housing code, or a landlord   to act under circumstances where there is a duty to
tenant regulation. The code or regulation would set         take positive action to prevent or abate the
forth the standards by which some public health body        interference. The invasion also must cause significant
may take action in the event of a violation, or grant       harm.
rights to a resident whose health may be affected by his
neighbors’ or peers’ actions.                               The harm must be substantial and prolonged, and
                                                            enough to affect an ordinary person. People forced out
Because these methods rely on local sanitary codes and      of their surroundings due to ETS exposure, including
local state boards of health (which will have already       the effect of smoking on children are potential
determined the health effects of exposure to ETS—           examples of when someone could consider using this
which means that you don’t have to!), your claim is         strategy.
automatically framed as an accepted public health
issue, not a “smoker’s rights” issue. The person            Covenant of Quiet Enjoyment
ultimately responsible is the business owner or             The right of quiet enjoyment included in a lease
landlord, who is most likely to be able to effect           addresses the tenant’s right to freedom from serious
immediate change.                                           intrusions with his tenancy “such as acts or omissions
                                                            that impair the character and value of the leased
While there are always specific health codes on certain     premises.” Another tenant’s smoking infringes on your
issues, such as asbestos in insulation or lead in paint,    right to enjoy the privacy of your home by poisoning the
there are not often specific health codes about ETS.        air and creating foul odors. Since landlords may be held
Your best bet in this situation is to look for broad        responsible for the actions of third parties beyond their
language, such as “other violations” and “endanger          control, it would be the responsibility of the landlord to
health and well-being.” Evidence of the harmful effects     implement a policy which protected the tenant’s right
of ETS must support the specific and detailed claims of     to enjoy their privacy under the covenant of quiet
employees/tenants.                                          enjoyment.

Violations such as this could result in a fine and/or       Warranty of Habitability
ordering repairs. The repairs could be eliminating          All states have an implied warranty of habitability for
smoking from the area or installing more effective ETS      tenants. The warranty dictates that a landlord must
blockers (such as better insulation and ventilation).       provide residential rental premises fit for human
                                                            occupation—that there are no latent or patent defects
                                                            in the facilities—from the inception of the rental
Nuisance                                                    agreement through its entire term. Since ETS is
A private nuisance is a non-trespassory invasion of         carcinogenic, it could be argued that a home in which
another’s interest in the private use and enjoyment of      the resident is exposed to carcinogens is not fit for
land, and would be included in a lease or rental            habitability.                                             019ets community change toolbox




                                                                                                                k
                                       Advocacy: External Strategy
                                                 Part II- Legislation
                                           NORTH CAROLINA’S LAW ON ETS DOES NOT MANDATE ETS POLICIES, IN FACT THE LAW LIMITS
                                           THEM IN ALL STATE CONTROLLED BUILDINGS. FURTHERMORE, THE LAW IS PREEMPTIVE IN THAT IT
                                           PROHIBITS LOCAL COMMUNITIES FROM TO PASSING LAWS MORE STRICT THAN THE STATE LAW.
                                           SOME AREAS ARE PROTECTED, SUCH AS DAYCARE CENTERS AND HOSPITALS. THE LAW DOES NOT
                                           PREVENT PRIVATE BUSINESSES FROM HAVING AN ETS POLICY.


                                NORTH CAROLINA’S LAWS ON ETS:
                                North Carolina currently does not have a statewide law mandating protection from ETS exposure. Instead, North
                                Carolina has a law entitled “Smoking in Public Places” (GS 143-597), which states that the legislative intent is
                                “…to address the needs and concerns of both smokers and nonsmokers in public places by providing for desig-
                                nated smoking and nonsmoking areas.” Yet, within the law there are no requirements for smoke-free areas in
                                state government worksites, private worksites or restaurants. The law states that libraries, museums and health
                                care instructional buildings “may be designated as nonsmoking.” State controlled buildings, such as auditoriums,
                                may establish nonsmoking areas if at least 20% of the interior space is designated as smoking, including a
                                designated smoking area in lobbies, unless it is “physically impracticable.” When nonsmoking and smoking areas
                                are designated, no structural or other physical modifications need to be made to existing ventilation systems to
                                reduce or eliminate ETS exposure. The primary exemptions to the law are schools, child care centers, public
                                school buses, hospitals, nursing homes, health departments and nonprofit agencies whose primary purpose is to
                                discourage tobacco use.

                                North Carolina’s law (GS 143-597) also prohibits local governments from determining their own public health
                                ordinances for clean indoor air after October 15, 1993. State laws of this kind law are called preemptive because
                                they restrict local counties from passing their own clean indoor air laws which are stricter than the statewide clean
                                indoor air laws.

                                THE HISTORY OF NORTH CAROLINA’S PREEMPTIVE CLEAN INDOOR AIR LAW:
                                North Carolina’s preemptive legislation was initially introduced in April 1993 to protect the “rights” of smokers
                                and to supposedly reduce confusion for North Carolinians who were subjected to smoking regulations in one county
                                and allowed to smoke anywhere in another. When the legislation passed the N.C. General Assembly in July 1993,
                                it gave local public health advocates three months to pass clean indoor air ordinances before all ordinances were
                                preempted by the state law. Public health advocates responded to passage of the legislation by working with city
                                councils, county commissioners and county boards of health to pass 89 new local smoking rules across the state.
                                Most of these regulations were passed by county boards of health and included an exemption for small restau-
                                rants and bars, because of the fear that prohibiting smoking would put an unfair economic burden on those
                                businesses. The speed with which these new local ordinances were passed came at a price because there was
                                little time for local coalitions to educate their communities about ETS as a health hazard and build outspoken
                                community support for the ordinances that were enacted.

                                In November 1993, suits contesting new local smoking ordinances were filed against the local Boards of Health in
                                four counties. Buncombe County won their case at the local level; Guilford County, under threat of suit, withdrew
                                its rules without contest; and Wake County suspended enforcement of its rules under pressure from area restau-
020




                                rants that sued with resources provided by the tobacco industry. The Halifax County Board of Health was sued by
                                cities and businesses within the county. Subsequently, the Halifax District Court ruled that the smoking ordinance
                                passed by the Halifax Board of Health was illegal because they included reference to the economic impact of the
                                ordinance. That is, the Halifax Board of Health had taken economic and health factors into consideration when
                                making the smoking ordinances, and the court ruled that the Board of Health had the right to pass only health
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                                related rules. Therefore, the smoking regulations were considered null and void. Because that ruling was not
                                subsequently appealed, all Board of Health ordinances passed across the state using a similar model are now in
                                question.

                                CURRENT STATUS:
                                North Carolina citizens and public health advocates are left with few legislative policy options under the current
                                law. Since GS 143-597 was passed in 1993, no local communities in the state have enacted new ETS legislation.
                                Many local rules are suspended, a District Court ruling nullifies most of the current local Boards of Health rules as
                                they were written, and the state law preempts new local ordinances. The text of the law reads:
                                                                                                                                                k
EXCERPTS FROM NORTH CAROLINA GENERAL STATUTE
CHAPTER 143, ARTICLE 64 “SMOKING IN PUBLIC PLACES”




                 NONSMOKING AREAS IN STATE-CONTROLLED BUILDINGS.
                  (A)ALL OF THE FOLLOWING AREAS MAY BE DESIGNATED AS
                 NONSMOKING IN BUILDINGS OWNED, LEASED, OR OCCUPIED BY STATE
                 GOVERNMENT:
                      (1) ANY LIBRARY OPEN TO THE PUBLIC.
                      (2) ANY MUSEUM OPEN TO THE PUBLIC.
                      (3) ANY AREA ESTABLISHED AS A NONSMOKING AREA, SO LONG
                         AS AT LEAST TWENTY PERCENT (20%) OF THE INTERIOR
                          SPACE OF EQUAL QUALITY TO THAT OF THE NONSMOKING
                         AREA SHALL BE DESIGNATED AS A SMOKING AREA, UNLESS
                          PHYSICALLY IMPRACTICABLE.     IF   PHYSICALLY
                         IMPRACTICABLE, THE PERSON IN CHARGE OF THE FACILITY
                          SHALL PROVIDE AN ADEQUATE SMOKING AREA WITHIN THE
                         FACILITY AS NEAR AS FEASIBLE TO TWENTY PERCENT        (20%)
                         OF THE INTERIOR SPACE.
                      (4) ANY   INDOOR SPACE IN A   STATE-CONTROLLED      BUILDING SUCH
                          AS AN AUDITORIUM, ARENA, OR COLISEUM, OR AN
                         APPURTENANT BUILDING THEREOF; EXCEPT THAT A
                         DESIGNATED AREA FOR SMOKING SHALL BE ESTABLISHED IN
                         LOBBY AREAS.
                      (5) ANY   EDUCATIONAL BUILDINGS PRIMARILY INVOLVED IN
                         HEALTH CARE INSTRUCTION.


                 EXEMPTIONS.
                  ALL OF THE FOLLOWING FACILITIES SHALL BE EXEMPT FROM THE
                 PROVISIONS OF THIS ARTICLE:
                       (1) ANY PRIMARY OR SECONDARY SCHOOL OR CHILD CARE
                          CENTER, EXCEPT FOR A TEACHER’S LOUNGE.
                      (2) AN ENCLOSED ELEVATOR.
                      (3) PUBLIC SCHOOL BUS.
                      (4) HOSPITAL, NURSING HOME, REST HOME, AND STATE
                         FACILITY OPERATED UNDER THE AUTHORITY OF
                        G.S. 122C-181.
                     (5) LOCAL HEALTH DEPARTMENT.
                      (6) ANY NONPROFIT ORGANIZATION         OR CORPORATION WHOSE
                         PRIMARY PURPOSE IS TO DISCOURAGE THE USE OF TOBACCO
                                                                                          021
                         PRODUCTS BY THE GENERAL PUBLIC.
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                                                                                          k
                                LOCAL COMMUNITIES CAN STILL ACT
                                Local communities may be able to bring forth legislation that is within the limits of the preemptive law. Attorney
                                Anne Dellinger, in a comprehensive review of North Carolina’s laws regarding ETS regulations, wrote:

                                   [C]ommissioners and council members retain some authority and may need to use it to avoid claims of
                                    workers’ compensation, unemployment benefits, violations of handicapped protection statutes and
                                   constitutional violations. State law allows local officials to designate as smoke free up to 80 percent of
                                   public space. This percentage is higher at certain sites such as health departments. Federal statutes
                                   protect people disabled by smoking or secondhand smoke and preempt state law if the two conflict.
                                    People being detained have the right to a minimally healthy environment guaranteed by the Eighth
                                    Amendment of the United States Constitution.

                                Since North Carolina does prohibit strict clean air ordinances at the local level, Dellinger concludes by suggesting
                                that local health departments can support clean air regulations by encouraging voluntary ETS policies:

                                    Given the majority’s preference for smoke-free facilities and the very high level of public support for
                                    keeping minors from using tobacco, voluntary efforts relying on these points may well succeed.
                                    Numerous local governments and health institutions encourage voluntary limitations and one health
                                    department, in Catawba county, now focuses primarily on this strategy. The department discusses
                                    customer complaints about smoking with business people, provides non-smoking signs, presents
                                    certificates to smoke-free businesses, and categorizes restaurants’ policies on smoking and describes
                                    the policies in local papers bimonthly. The department also, with some success, is seeking grants to
                                    pay for counseling and education about tobacco use and it cooperates with other organizations
                                    sponsoring similar activities. Voluntary programs should gain strength from recent evidence in the
                                    nation and the state that smoking restrictions do not hurt business.
                                                                       (Anne M. Dellinger, What May North Carolina’s Local Governments Do to Restrict Smoking?
                                                                                                          Local Government Law, Number 83, February 1998.)

                                Dellinger goes on to say that another policy option utilizes the complex language of the preemptive law to push for
                                more appropriate standards. For instance, state buildings are required to set aside 20% of the interior space for
                                smoking areas, unless such a rule is “physically impracticable.” Some state level managers in state controlled
                                buildings have deemed these rules “impracticable” because the space is too small or ventilation systems are not
                                adequate to protect the health of nonsmokers. They have subsequently adopted 100% ETS- free policies.

                                Day care centers, schools, health care facilities and persons with disabilities are all protected by Federal law.
                                Schools are defined as both school buildings and school grounds, and thus schools can pass 100% smoke-free
                                policies that apply to students, faculty and visitors on campus and at all school sponsored events.

                                The legislative policy options that offer the greatest public health gains are ultimately the most difficult to achieve:
                                the repeal of North Carolina’s preemptive tobacco law (GS 143-597) or the passage of a truly protective state
                                clean air measure. Overturning preemptive tobacco legislation is exceedingly difficult: out of the 16 plus states
                                that have passed tobacco industry sponsored clean indoor air preemptive legislation in the last decade, none
                                have successfully repealed the law. Only a few states (i.e. Vermont, California) have enacted comprehensive clean
                                air legislation. Overturning preemption or passing true clean air legislation in North Carolina will be difficult given
                                the historically friendly relationship between the tobacco industry and the legislature.

                                Model Environmental Tobacco Smoke Legislation that could be used before preemption took effect in North
                                Carolina is shown on the next page.
022




                                HOW YOU CAN RESPOND
                                For more information about a policy campaign to advocate for clean air, see:
                                       AMERICAN LUNG ASSOCIATION                        AMERICAN CANCER SOCIETY
                                       (800) 892-5650                                   1-800-ACS-2345
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                                       http://www.lungusa.org                           http://www.cancer.org

                                SCIENTIFIC LINKS:
                                For more on this subject, see the article Labored Breathing: Policies to Eliminate Environmental Tobacco Smoke
                                Exposure in North Carolina, which appears in the September/October 2001 edition the North Carolina Medical
                                Journal: http://www.ncmedicaljournal.com/sept-oct-01/toc0901.htm



                                                                                                                                                       k
MODEL ENVIRONMENTAL TOBACCO SMOKE (ETS) REGULATION

A Measure to Completely Eliminate ETS Exposure in Public Places Including Restaurants, Work Places and Municipal Buildings




       A. Statement of Purpose:
       Whereas conclusive evidence exists that tobacco smoke causes cancer, respiratory and cardiac diseases, negative
       birth outcomes, irritations to the eyes, nose, and throat; and whereas the harmful effects of tobacco smoke are not
       confined to smokers but also cause severe discomfort and illness to nonsmokers; and whereas environmental
       tobacco smoke [hereinafter ETS] causes the death of 53,000 Americans each year; and whereas in 2000, the
       Public Health Service’s National Toxicology Program listed environmental tobacco smoke as a known human
       carcinogen (U.S. DHHS, 2000, citing Cal. EPA, 1997), now, therefore, the Town of XXXXXXX recognizes the right of
       those who wish to breathe smokefree air and establishes this regulation to protect and improve the public health
       and welfare by prohibiting smoking in public places.

       B. Definitions: For the purposes of this regulation, the following words shall have the meanings respectively
       ascribed to them by this paragraph:

       Bar: An establishment whose business is devoted to the serving of alcoholic beverages for consumption by guests
       on the premises and in which the serving of food is only incidental to the consumption of such beverages.
       Employee: Any natural person who performs services for an employer.
       Employer: A natural person, partnership, association, corporation, trust, or other organized group of individuals,
       including the Town of XXXXXXX or any agency thereof, which utilizes the services of one (1) or more individual
       employees.
       Health Care Facility: Any office or institution providing care or treatment of diseases, whether physical, mental or
       emotional, or other medical, physiological or psychological conditions including but not limited to rehabilitation
       hospitals or other clinics, including weight control clinics, nursing homes, homes for the aging or chronically ill,
       laboratories, offices of any surgeon, chiropractor, physical therapist, physician, dentist and all specialists within
       these professions.
       Indoor Sports Arena: Any sports pavilions, gymnasiums, health spas, boxing arenas, swimming pools, roller and ice
       rinks, bowling alleys and other similar recreational facilities where members of the general public assemble either
       to engage in physical exercise, participate in athletic competition, or witness sports events.
       Person: Any person, firm, partnership, association, corporation, company or organization of any kind including, but
       not limited to an owner, operator, manager, proprietor or person in charge of any building, establishment, business,
       or restaurant or retail store, or the agents or designees of any of the foregoing.
       Public Place: Any building or facility owned, leased, operated or occupied by the municipality, including school
       buildings or grounds; any area open to the general public including, but not limited to, libraries, museums, theaters,
       auditoriums, indoor sports arenas, recreational facilities, inns, hotel and motel lobbies, educational facilities,
       shopping malls, public restrooms, lobbies, staircases, halls, exits, entrances, elevators accessible to the public,
       and licensed childcare locations.
       Public Transportation: Buses, taxis, and other means of transportation available to the general public while such
       means of transportation is operating within the boundaries of the town
       including indoor platforms by which such means of transportation may be accessed.
       Restaurant: Any coffee shop, cafeteria, sandwich stand, private and public school cafeteria, and other eating
       establishment which gives or offers food for sale to the public, guests, or employees for on-premises consumption,
       as well as kitchens in which food is prepared on the premises for serving elsewhere, including catering facilities.
       Retail Food Store: Any establishment commonly known as a supermarket, grocery store, bakery, or convenience
       store in which the primary activity is the sale of food items to the public for off-premises consumption.
       Retail Store: Any establishment whose primary purpose is to sell or offer for sale to consumers, but not for resale,
       any goods, wares, merchandise, articles or other things, including retail food stores. “Retail store” shall not include
       restaurants as defined herein.
       Smoking: Inhaling, exhaling, burning or carrying any lighted cigar, cigarette, or other tobacco product in any form.
       Town: The Town of XXXXXXX.
                                                                                                                                 023
       Workplace: Any enclosed area of a structure or portion thereof at which one (1) or more employees perform
       services for their employer (including the personal residence of the employer during those hours when used as a
       place of employment).
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                                                                                                                                 k
                                                                                  MODEL ENVIRONMENTAL TOBACCO SMOKE (ETS) REGULATION

                                A Measure to Completely Eliminate ETS Exposure in Public Places Including Restaurants, Work Places and Municipal Buildings




                                   C. Posting Notice of Prohibition:
                                   Every person having control of premises upon which smoking is prohibited by and under the authority of this regula-
                                   tion shall conspicuously display upon the premises “No Smoking” signs provided by the Department of Public Health
                                   and available from the Board of Health or the international “No Smoking” symbol (consisting of a pictorial representa-
                                   tion of a burning cigarette enclosed in a red circle with a red bar across it) and comparable in size to the sign provided
                                   by the Department of Public Health and available from the Board of Health.

                                   D. Smoking Prohibited:
                                   No person shall smoke nor shall any person, employer, or other person having control of the premises upon which
                                   smoking is prohibited by this regulation, or the agent or designee of such person, permit a person to smoke in any of
                                   the following places as defined herein: bars, health care facilities, public places, public transportation, restaurants,
                                   retail stores, and workplaces except as otherwise provided in Paragraph F of this regulation. Additionally, no person
                                   shall smoke in any place in which a sign conforming to the requirements of Paragraph D of this regulation is posted.
                                   No person shall remove a sign posted under the authority of Paragraph D of this regulation.

                                   E. Exceptions:
                                   Notwithstanding the provisions of Paragraph D of this regulation, smoking may be permitted in the following places
                                   and/or circumstances:

                                   Private residences, except those portions used as a child care or health care office when operating as such.

                                   Hotel and motel rooms rented to guests that are designated as smoking rooms.

                                   Hotel and motel conference/meeting rooms and private and public assembly rooms while these places are being used
                                   for private functions.

                                   F. Conflict with Other Laws or Regulations:
                                   Notwithstanding the provisions of the foregoing Paragraph E of this regulation, nothing in this regulation shall be
                                   deemed to amend or repeal applicable fire, health or other regulations so as to permit smoking in areas where it is
                                   prohibited by such fire, health or other regulations.

                                   G. Violations:
                                   Any person who violates this regulation shall be subject to a fine of one hundred dollars ($100) for a first offense, two
                                   hundred dollars ($200) for a second offense within one year of the date of the first offense and three hundred dollars
                                   ($300) for a third or subsequent offense within one year of the date of the first offense.

                                   H. Enforcement:
                                   As an alternative to initiating criminal proceedings, violations of this regulation may be enforced in the manner
                                   provided in General Law statutes or by the Board or its agents. Any fines imposed under the provisions of this
                                   regulation shall enure to the Town of XXXX for such use as the town may direct. One method of enforcement may be
                                   periodic, unannounced inspections of those establishments subject to this regulation. Any citizen who desires to
                                   register a complaint under this regulation may request that the Board of Health initiate enforcement.

                                   I. Non-Criminal Disposition:
                                   Whoever violates any provision of this regulation, the violation of which is subject to a specific penalty, may be
                                   penalized by the non-criminal method of disposition as provided in General Laws statutes or by filing a criminal
                                   complaint at the appropriate venue. Each day on which any violation exists shall be deemed to be a separate offense.
024




                                   Penalty:
                                   $100 for first offense
                                   $200 for second offense
                                   $300 for third offense
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                                   Enforcing Persons:
                                   XXXX Police Department, XXXX Board of Health and its designees

                                   J. Severability:
                                   If any paragraph or provision of this regulation is found to be illegal or against public policy or unconstitutional, it
                                   shall not affect the legality of any remaining paragraphs or provisions.




                                                                                                                                                              k
   External Strategy III: Media
            DEVELOPING A SUCCESFUL ADVOCACY CAMPAIGN: MEDIA ADVOCACY IS THE
            PROCESS OF STRATEGICALLY UTILIZING MEDIA TO ADVANCE YOUR POLICY AGENDA.
            FOR ETS POLICY CHANGE IN NORTH CAROLINA, IT IS CRITICAL TO THINK PRACTICALLY
            ABOUT WHICH MEDIA EFFORTS WILL BEST SUPPORT ETS POLICY CHANGE. INVOLVING
            THE MEDIA IS A VERY EFFECTIVE WAY OF QUICKLY GAINING SUPPORT FROM THE
            COMMUNITY AND THE ATTENTION OF THE BUSINESS OWNER OR MANAGER.


              KNOW THE PULSE                                             DEVELOP A
Step 1:       ON ETS IN THE
              COMMUNITY
                                                           Step 3:       MEDIA
                                                                         CAMPAIGN

WHAT IS THE COMMUNITY CONVERSATION ABOUT ETS?              REMEMBER: NEWS IS CREATED; IT DOESN’T JUST HAPPEN.
   Look at current and past editorial pages, letters          Consider all kinds of media in your strategy.
   to the editor, and news reporting on ETS and                  l Editorials/ Opposition Editorials (Op-Ed)
   similar health issues. Are people worried about               l Billboards, posters, print, radio, TV
   asthma, emphysema, lung cancer, or other health               l Smaller community newspapers, church
   issues related to smoking?                                       bulletins, etc.
                                                                 l Cinema Ads, Airport/Mall Posters
   Consider doing brief surveys and intercept                    l Giveaways: tee shirts, hats, baby-bibs,
   interviews (see Surveys section, 54), focus groups,              buttons, stickers, etc.
   or simply talk to family and friends about their
   views on ETS and the community.                            Select your media.
                                                                  l Will it reach my audience?
   Become familiar with media sources. Watch, listen              l Will my message get through?
   and read. What are the local papers, alternative               l Can I share it with others?
   weeklies, periodicals, radio and television stations,          l Will they editorialize in my favor?
   including cable, reporting on health issues?                   l Am I going to get enough bang for my buck?


   Monitor local news. Consider these links:                  Develop a Media Strategy.
      www.tobacco.org                                            l What is your policy goal?
      www.newslibrary.com                                        l What is your message?
      Video Taping Service—                                      l Who needs to hear it?
               Charlotte (704) 332-2158                          l Who is the best spokesperson(s)?
               Raleigh (919) 755-0104                            l Do they need training?
      www.stateline.org/NorthCarolina/                           l Which media can best transmit messages?
                                                                 l How will you keep the story alive?
              DEVELOP                                            l How can you create opportunities?
Step 2:       RELATIONSHIPS
              WITH LOCAL MEDIA                                Decide when to activate the media.
                                                                 l Is there a new significant event, new
   Start a media list.                                              information, an emergency situation, the
       l Consider buying a directory (352)383-3023                   appearance in town of a prominent person,
       l Keep a list of reporters who cover health.                 etc.?
                                                                                                                 025
       l Visit local media outlets’ websites.
       l Look at the following links:                         Be clear about what you want people to do in
               www.Newsdirectory.com                          response to your message.
               www.radio-locator.com
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   Develop a relationship with a local reporter, and
   become a trusted source of ETS facts.
      l Email reactions to articles.
      l Bring or send information bimonthly.
      l Talk to reporters about issues before things
         start happening.
      l Call to suggest new or breaking story ideas.
      l Always return a reporter’s phone calls!
                                             BE NEWSWORTHY:                                 Breakthrough
                                Step 4:      FRAMING YOUR STORY                                Release newly discovered information, such as
                                                                                               a recent asthma study or another document
                                             FOR ACCESS
                                                                                               from the tobacco companies’ web sites.
                                TRY TO FRAME YOUR STORY SO THAT IT INCLUDES ONE OR
                                MORE OF THE FOLLOWING ELEMENTS THAT MAKE A STORY            Anniversary/ Seasonal Peg
                                TRULY ‘NEWSWORTHY’:                                            From the Great American Smoke-Out to
                                                                                               Mother’s Day, many opportunities exist to tie
                                   Controversy/Conflict                                        in a date with a media event. October 15,
                                      Students picketed a local family-oriented                2003 will be the ten year anniversary of North
                                      restaurant, because it did not offer a safe,             Carolina’s preemption law. See the “Ideas and
                                      smoke-free environment, with signs that said             Places,” page 48, for more ideas and a
                                      “Go smoke free!” The restaurant bowed to                 calendar of ETS-related events!
                                      public pressure and went smoke free at all its
                                      locations!                                            Celebrity
                                                                                                Former cigarette models come out to
                                   Broad interest                                               speak against tobacco use. Role models for
                                      Combine the press release of your county’s                youth, such as Boyz II Men and Christy
                                      asthma report with information about the                  Turlington, produce videos and posters
                                      number of young people exposed to smoke in                shunning tobacco use. See
                                      their homes.                                              http://www.cdc.gov/tobacco/celebs.htm

                                   Irony
                                       Many tobacco disease survivors who have lost                    FRAMING YOUR
                                       their voices to smoking are outraged by the
                                       “Find your voice” ad campaign for Virginia
                                                                                         Step 5:       STORY FOR
                                                                                                       SUCCESS
                                       Slims. Survivor Wade Hampton told his story
                                       to the Charlotte Observer health columnist        THE WAY YOU FRAME YOUR STORY DETERMINES HOW THE
                                                                                         TARGET AUDIENCE RECEIVES IT.
                                       Karen Garloch, who saw the irony and included
                                       Wade’s point of view in her column.
                                                                                            Vision and Values—The words and symbols used
                                   Injustice                                                are important. Start by ensuring that you trans-
                                       The 4-H award winner protests that her               late the issue as a social issue and not an indi-
                                       asthmatic mother cannot attend the award             vidual problem.
                                       ceremony, because it’s not in a smoke-free
                                       facility; the elderly bowler has to wear an          Consider how to use “conservative” language
                                       oxygen mask to bowl at the smoke-filled              that links your desired goal with core Amercian
                                       bowling center; the pregnant worker has to           values.
                                       quit her job in order to protect her unborn
                                       child from ETS.                                      Get tough Standards         Common Sense
                                                                                            Hard work Authority         Character
                                   Local Peg                                                Earn      Breakdown         Self-reliance
                                       Ensure that the local community angle is             Freedom   Elite             Reward
                                       involved in your campaign. How does your             Heritage  Privacy           Respect
                                       tobacco school policy measure up as youth
                                       smoking rates increase? A national story on          Be careful with “liberal” language that may make
                                       smoke-free bars is more interesting when             you sound unsophisticated, protective or wild.
                                       combined with the smoky bar situation in your
                                       community.                                           Alienation Big Business     Corporate Welfare
026




                                                                                            Safety      Ecology         Social Forces
                                   Personal Angle                                           Deprivation Bio-diversity   Free Expression
                                      Jessie Lee Smith of Henderson County has
                                      told the story many times of how her father
                                      died of cancer from smoking and dipping while
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                                      she was still in high school. Her personal story
                                      of growing up fatherless, because of tobacco,
                                      really brings the message home. SAVE of
                                      North Carolina specializes in personalizing
                                      media stories (see http://www.main.nc.us/
                                      save/ or http://www.tobaccosurvivors.org).



                                                                                                                                          k
               DEFINE THE STORY
Step 6:        ELEMENTS, VISUAL IMAGES
               & MEDIA BITES
TO MAKE THE STORY MORE DYNAMIC AS WELL AS MORE
LIKELY TO MAKE THE PAPERS AND THE 6 O’CLOCK NEWS,
CONSIDER THESE IDEAS:

    Consider closely what audiovisuals support the
    message. For example, the picture of youth rallying
    in the state capitol, a group of cancer survivors
    (with a prosthesis for their larynx showing) discuss-
    ing the cardiovascular dangers of exposure to ETS,
    or doctors speaking about ETS while wearing their
    white coats are excellent physical cues.

    Develop clear and clever campaign titles:
       l “Don’t Breathe—it’s the only way tobacco
           smoke won’t harm you.”
       l “Take it outside”
       l PASS—Power Against Secondhand Smoke
       l SAFE—Smoke-free Air for Everyone


    Make sure you individualize statistics to make
    them highly relevant, and develop appropriate,
    accurate “sound bites.”

    If we hear any statistics repetitively we become
    more immune to the impact of the facts. “Social
    math,” or creative epidemiology, is the act of
    taking a statistic and breaking it down into terms
    that highlight the severity of the numbers.
                                                                            PREPARE
          One creative epidemiology strategy is to
         break national numbers into more localized
                                                            Step 7:         FOR AN
                                                                            INTERVIEW
         statistics, so that the listener is personally
         involved in the message. One California            WHEN INTERVIEWING, IT IS IMPORTANT THAT THE
         television ad is a wonderful example of this:      REPORTER UNDERSTAND YOUR MESSAGE.
                                                            q   Prepare three main points.
     This moment of silence is brought to you               q   Practice your main points until they flow naturally.
     today by the California Department of Health           q   Provide written background information/statistics.
b    Services in memory of the 14 Californians
     who died today because they were forced to             q   Practice “bridging statements,” to get back to your
     breathe someone else’s tobacco smoke.”                     main points.
                                                            q   Have your sound bites ready.
        ment of silence is brought to you
        tAnother idea is to compare ETS statistics to       q   Have your visuals prepared.
         another social issue so that the listener is       q   Stay focused and on your agenda, nothing else.
         reminded to think about ETS as a public
                                                                                                                       027
                                                            q   Attitude is important!
         health issue rather than an issue of
         individual rights. Sound bites are short, to       q   SCORE Points by:
         the point and emotional.                                  Smiling
                                                                   Casually confident
                                                                   Open and relaxed
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       The lifetime risk from secondhand smoke is                  Reasonable
       more than 100 times higher than the effect                  Ever present and responsive
       of 20 years of exposure to asbestos.                        Sympathetic to smokers
                                               NEWS RELEASES                                                 GRASSROOTS
                                Step 8:        AND NEWS                                      Step 9:         MEDIA
                                               CONFERENCES                                                   ADVOCACY
                                CONSIDER WHETHER YOUR MEDIA EVENT WARRANTS A                 IT IS IMPORTANT TO BUILD SUPPORT FOR POLICY CHANGE
                                NEWS RELEASE OR A NEWS CONFERENCE.                                               .
                                                                                             FROM THE GROUND UP HERE ARE SOME STRATEGIES TO
                                                                                             BUILD YOUR GRASSROOTS CAMPAIGN FOR CLEAN AIR:
                                   News releases are an important way to generate
                                   media strories that support a campaign. News              LETTER-WRITING CAMPAIGNS
                                   releases must capture the imagination of a re-               Writing letters is an effective tool in getting the
                                   porter or news editor who sees dozens of them                attention of a landlord, business owner, newspaper
                                   every day. Your news release must look, act and be           editor, school administrator or an elected official.
                                   professional. See page 35 for a sample news
                                   release.                                                      There are two important parts of a letter-writing
                                                                                                 campaign: writing a letter and getting lots of other
                                   News releases must have:                                      people to write letters. Remember that you can
                                      l Date and time of release                                 easily circulate letters via email that people can
                                      l Contact information                                      personalize, print out and send themselves.
                                      l Short, strong title
                                      l Contact information for further information              Remember these key points when writing a letter:
                                         and telephone numbers                                      l Keep it short (no more than 1 page)
                                      l Factual content that lets reporter know                     l Stick to one point
                                         information is accurate and important                      l Be polite
                                      l Several short quotes from coalition members                 l Explain:
                                      l Soundbites                                                      l Why you are affected and writing.

                                      l Follow-up before and after release                               l What is the problem.
                                                                                                         l What facts support support your issue

                                   News conferences are more appropriate when                            l What specifically you want the reader to

                                   information is exciting, new and of high relevance to                   do/understand.
                                   community. News conferences are also more
                                   appropriate when the call to action is strong, the               To view a sample letter, please see page 34.
                                   issue is emotionally salient, children are involved, or
                                   a new initiative unfolds. Finally, news conferences       EMAIL
                                   must have strong background visual images as they            As a wonderful tool in reaching large numbers of
                                   are frequented more by television than other forms           people quickly, consider using email to send
                                   of media.                                                    newsletters, announcements, quick links and action
                                                                                                alerts.
                                   News conferences must have:
                                      l Great preparation                                        Collect email addresses from members, support-
                                      l Attention to setting                                     ers, volunteers, media representatives and legisla-
                                      l Attention to sound needs of speakers                     tive contacts. Create lists of people who might be
                                      l Attention to reporters’ needs for seating,               interested in public health issues.
                                        electronic access
                                      l Attention to background noise                            To increase chances that the end user will respond
                                      l Attention to visuals for press                           to the email, consider ways to assist the user in
                                      l Written materials to take home                           wanting to open the message.
                                      l Primary message of campaign
                                      l Follow-up before and after release                           l   The subject line must be short and
                                                                                                         compelling!
028




                                                                                                     l   Be clear who is sending the email and how to
                                                                                                         reach you.
                                                                                                     l   Tell the reader the importance of your
                                                                                                         message.
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                                                                                                     l    Keep text short and focused.
                                                                                                     l   Use ascii-friendly symbols (i.e. # or ^ or =) to
                                                                                                          break up text.
                                                                                                     l   Don’t use wide margins.
                                                                                                     l   Include the date in the text of your message.
                                                                                                     l   Give readers a clear and simple course of
                                                                                                         action to take.
                                                                                                     l   Use hyperlinks to allow readers to inform

                                                                                                                                                  k
                                                                                                          themselves about the subject.
    For info about on-line activism, see:                                   PAID
    http://www.netaction.org/training/part1.html
    For a good source for youth activism, see:
                                                         Step 10: MEDIA
                                                                            ADVOCACY
    http://www.webpetitions.com/
                                                         PAID MEDIA ADVOCACY IS AN EFFECTIVE ADJUNCT TO ALL
                                                         CAMPAIGNS WHEN RESOURCES ARE SUFFICIENT TO ACCESS
PETITIONS                                                MEDIA.
   A petition is an excellent tool for educating the
   community about ETS as well as getting the
                                                         Consider some specific places to support smoke-
   attention of a landlord, business owner, newspaper
                                                         free environments or to advertise a policy change:
   editor, school adminstrator or an elected official.
                                                                  l billboards
                                                                 l posters
    Petitioning requires some strategic planning as to
                                                                 l print ads
    where and when to petition, what materials and
                                                                 l cinema slides
    resources you should have available as well as
                                                                 l giveaways-- tee-shirts, keychains, buttons,
    volunteers to actually ask people to sign the
                                                                     stickers, baby bibs, etc.
    petition.
                                                                 l videos
                                                                 l tv ads
    Every typewritten/printed sheet of the petition
                                                                 l be creative-- place mats for school trays,
    must contain:
                                                                     book covers, calendars!
        l An addressee (the owner of a business, local
           legislator, etc.)
                                                         When resources are slim:
        l Clear and respectful request, including:
                                                               l Seek additional supplemental funding from
                 l The current policy/ offense
                                                                  national organizations interested in your
                 l The specific action requested
                                                                  campaign. Please see the Resources section
                 l Chart which leaves space for the
                                                                 for contact information for some of the
                    signers printed name, signed name,
                                                                   national agencies which have supported
                    and address
                                                                  local, grassroots media campaigns.
        l There should not be any erasures or
                                                               l Seek additional funding from a local
           insertions.
                                                                  organization, such as ASSIST, or the health
                                                                   department.
    Remember that you can also circulate petitions
                                                               l Ask the advertising agency, newspaper
    over the internet!s
                                                                  owner, cinema manager, etc., if they are
                                                                  willing to offer space, labor, supplies,
    To view a sample petition, please see page 36.
                                                                   creativity, etc. towards your efforts. Many of
                                                                  these sorts of donations are pro bono and
                                                                   therefore tax deductable.
                                                               l Get volunteer support from area youth,
                                                                   survivors and other concerned community
                                                                  members.

SAMPLE PAID MEDIA PRINT ADS:

     Nonsmoking sections do not eliminate                             What’s in cigarette smoke . . .
     nonsmokers’ exposure to secondhand                               There are over 4,000 chemicals, including:
     smoke; the smoke does not remain in                  CANCER CAUSING AGENTS:         OTHER NASTY STUFF:
                                                          Nitrosamines                   Acetone- nail polish remover
     the smoking section.                                 Crysenes                       Acetic Acid- vinegar
   The Health Consequences of Involuntary Smoking: A      Benzo(a)pyrene                 Ammonia- floor/ toilet cleaner
   Report of the Surgeon General, 1986                    Polonium 210                   Arsenic- poison
                                                          Nickle                         Butane- lighter fluid
                                                                                                                                 029
           Everybody Sucks                                P.a.h.s                        Cadmium- rechargeable batteries
                                                          Dibenz Acidine                 Carbon Monoxide- car exhaust fumes
             Secondhand Smoke                             B-naphthylamine                DDT/ Dieldrin- insecticides
                                                          Urethane                       Ethanol- alcohol
                                                          N. Nitrosanornicotine          Formaldehyde- preserves body tissue
      MAKE IT                                                                            Hexamine- barbeque lighter
                                                                                                                                 ets community change toolbox




                                                          METALS:                        Hydrogen Cyanide- gas chamber poison
        PART OF YOUR PLANS . . .                          Aluminum                       Methane- swamp gas
                                                          Zinc                           Methanol- rocket fuel
         +Good Service                                    Magnesium
                                                          Mercury
                                                                                         Naphthalene- mothballs
                                                                                         Nicotine- insecticide/ addictive drug
              +Great Food                                 Gold
                                                          Silicon
                                                                                         Nitrobenzene- gasoline additive
                                                                                         Nitros Oxide Phenols- disinfectant

              +Smoke-Free Atmosphere                      Silver
                                                          Titanium
                                                                                         Stearic Acid- candle wax
                                                                                         Tuolene- industrial solvent
                                                          Lead                           Vinyl Cloride- makes PVC pipe.
                                SAMPLE LETTER TO THE EDITOR


                                    Dear Editor,

                                    I am writing this letter in response to your paper’s recent article “Local Schools Fight for Students
                                    but not for Faculty.”

                                    Environmental tobacco smoke (ETS) poses a serious threat to students and faculty alike. ETS is a
                                    cancer causing substance, and there is no safe level of exposure. Besides causing thousands of
                                    deaths and hospitalizations every year, ETS causes school absences and decreased productivity
                                    for adults. Smoke-free schools protect everyone- students and faculty.

                                    As a student and youth activist in the local county schools, I have been working with groups for
                                    two years to pass this measure. This is a common sense measure that all of us should support.
                                    There is no excuse for any community member to oppose creating healthier, smoke-free schools for
                                    everyone. After all, if not now, when?

                                    Judy Johnson
                                    Sophomore, Townsville High School
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SAMPLE LETTER TO A SCHOOL BOARD

                                                                                            Judy Johnson
                                                                                            Coalition for Clean Air
                                                                                            123 Clean Air St.
                                                                                            Townsville, NC 12345
                                                                                             (123) 456 - 7890

 County School Board
 Townsville, NC 12345
                                                                                             August 1, 2001

 Dear School Board Members,

 I am writing to urge strong consideration of the proposal for a 100% tobacco-free policy this year. There are
 clearly many factors which come into play as you make decisions for your schools. But, if the health of your
 students and staff is a priority, this particular decision can be made with less difficulty.

 Tobacco clearly threatens the health of “passive smokers” as well as that of the smokers themselves. For your
 students and staff with asthma, or other lung diseases, the effects of tobacco smoke are even more pro-
 nounced. Passive smoking has been identified as a Group A carcinogen by the Environmental Protection
 Agency. This category includes only the most potent cancer-causing agents such as benzene, asbestos, arsenic,
 and vinyl chloride. Passive smoking also causes a worsening of asthma in 400,000 to one million children, plus
 8,000 to 26,000 new cases of asthma each year in the United States (Respiratory Health Effects of Passive
 Smoking, Environmental Protection Agency report, Jan 1993). Smoking is the leading preventable cause of
 death in our state. More than one out of four North Carolinians smoke. Nearly 12,000 North Carolinians die
 every year from smoking related illnesses. The vast majority of our adult smokers began smoking before age 20
 – the average age being 13 or 14. More than 38% of high school students use tobacco in North Carolina.

 A policy prohibiting tobacco on school grounds would make a difference. “Place restrictions” (e.g. forbidding
 tobacco products on school grounds) have been shown to be an effective means- actually the most effective
 means- of enhancing tobacco quit rates. For those students and staff who want to quit, this policy would
 significantly improve their chances of success in this effort.

 This tobacco-free policy would also have an effect on kids who are not (yet) smoking. Advertising effectively
 increases smoking rates. I can think of no more effective advertising campaign than to have respected role
 models- teachers and coaches- not smoking and using tobacco products during the day. Their continued
 tobacco use gives a clear message to students- one that contradicts a conviction to health and good decision-
 making. Prohibiting tobacco on school grounds would send a clear message that, as administrators and educa-
 tors, student and staff health is of central importance.

 Finally, I am also advocating for continued, organized smoking cessation efforts for staff and students. Tobacco
 is a powerfully addictive drug. Those who have become dependent on this drug certainly deserve our best
 efforts in cessation programs.

 I would like to work with you, if needed, to facilitate this effort.
 Sincerely,
 Judy Johnson
                                                                                                                      031
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                                SAMPLE NEWS RELEASE


                                FOR IMMEDIATE RELEASE

                                                                                                                         December 1, 2001
                                                                                                                      CONTACT: Judy Johnson
                                                                                                                           (123) 456 - 7890

                                Restaurant to Eliminate Exposure to Secondhand Smoke:
                                Community Members Hold Rally Applauding Policy Change
                                Townsville, USA -- Members of the community plan to meet outside of “Joe’s Restaurant” tomorrow at 5pm to

                                celebrate the new smoke-free policy at Joe’s.

                                    The owner, Joe Blow, will be awarded a clean-air certificate by community members, including some of his own

                                employees and his most loyal customers.

                                    According to Judy Johson, chairperson of the Coalition for Clean Air which is sponsoring and organizing the

                                award ceremony, Mr. Blow was glad to change his policy when some of the coalition members approached him

                                about the benefits of making his restaurant smoke free.

                                    “I want to provide a good, fun and healthy restaurant for my employees and customers,” said Mr. Blow.

                                    Environmental tobacco smoke is a Class A carcinogen, in the same category as asbestos or benzene. There

                                are more than 40 cancer causing substances in secondhand smoke, and it is responsible for more than 30,000

                                heart attack deaths each year in the United States.

                                    More and more store and restaurant owners are deciding to make their businesses smoke free to protect their

                                employees and their customers from the cancer causing effects of secondhand smoke.

                                    “More owners and managers recognize that secondhand smoke is lethal, and there is no safe

                                level of exposure,” said Johnson.

                                    The Coalition for Clean Air and other community members will meet tomorrow night at 5pm at the restaurant

                                to award the certificate and thank Joe Blow for making his restaurant a healthier place for everyone!

                                                                                      -- end--
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SAMPLE PETITION


    PETITION: Proposing a Smoke-Free Policy in the Johnson Bldg.

    We, the undersigned, object to the Johnson Building’s current policy of allowing
    smoking in the cafeteria and in the lobby. Smoking areas are not seperately
    ventilated and enclosed, and nonsmokers are exposed to the cancer causing smoke.
    Environmental tobacco smoke (ETS) is a health hazard to all employees and visitors
    to the Johnson Building. Please implement a smoke-free policy which will protect your
    employees and visitors from ETS



       NAME                         SIGNATURE                        ADDRESS




    page 1of X




                                                                                            033
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                                         Benefits of an
                                         ETS-Free Environment
                                              A FACT SHEET IS A VERY IMPORTANT TOOL TO EDUCATE PEOPLE ABOUT ETS.
                                              CONSIDER EMPHASIZING THE FOLLOWING BENEFITS OF AN ETS-FREE ENVIRONMENT.




                                IMPROVE        H E A LT H

                                    ETS is the third leading preventable cause of death; for every eight smokers [that die from tobacco],
                                    one nonsmoker will also die from exposure to ETS.
                                                                                                                                  (Circulation 1991)

                                    ETS causes 30 times more lung cancer deaths than all regulated air pollutants.
                                                                                                           (Environmental Protection Agency 1993)

                                    The lifetime risk from passive smoking is more than 100 times higher than the estimated effect of
                                    20 years of exposure to asbestos.
                                                                                                                    (British Journal of Cancer 1986)


                                E L I M I N AT E   EXPOSURE

                                    Smoke-filled rooms can have up to 6 times the air pollution as a busy highway.
                                                                                                                 (Centers for Disease Control 1993)

                                    Nonsmoking sections do not eliminate nonsmoker’s exposure to secondhand smoke; the smoke knows no
                                    boundaries.
                                                                                             (Health Consequences of Involuntary Smoking 1986)

                                    Science has not demonstrated any safe level of exposure to ETS. National ventilation standards
                                    (ASHRAE 62-1999) do not allow for smoking in the vast majority of public venues. At best, ventilation
                                    technology only removes the smoke odor and irritation.
                                                                                                         (American’s for Nonsmokers Rights 1996)



                                SOLID     ECONOMIC          SENSE

                                    Even in the number one tobacco producing state in the U.S., ETS regulations present no adverse
                                    economic impact, and there is no need for exceptions to the ordinances based on such fears.
                                                                                                             (North Carolina Medical Journal 1998)
034




                                    ETS exposure is associated with 24% more hospitalizations and 43% more lost school days.
                                                                                                (9th World Conference on Tobacco or Health 1994)
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                                    A patient with asthma won a $85,000 dammage settlement because of 13 years of passive smoke exposure
                                    which worsened her condition.
                                                                                                                             (Lancet 1993)




                                                                                                                                               k
 Business Owners Guide
    to implementing policy change
   THE BUSINESS OWNER’S GUIDE TO IMPLEMENTING AN ETS POLICY CHANGE COULD BE
   USEFUL AT TWO POINTS IN TIME: AS A COUNTERPOINT TO THE OBJECTION THAT THERE IS
   NO WAY TO IMPLEMENT A SMOKE-FREE POLICY (THIS OBJECTION MIGHT COME UP WHEN
   YOU ARE PRESENTING A CHANGE IN THE CURRENT POLICY) AND AS A POLICY GUIDE,
   ONCE AN OWNER IMPLEMENTS A NEW ETS POLICY.




Steps   :

  1. Decide on a specific goal for policy change.
  2. Strategic Assessment.
            What is the current policy?
            What are the current county ETS regulations?
            Identify your company’s strengths and weaknesses that would effect implementing the policy.
            Have realistic expectations—rely on other smoke-free business owners’ experience.
            Conduct a survey to assess staff attitudes about ETS and an ETS-free policy.

  3. Develop a working coalition for policy change.
            Involve all potentially effected—unions, staff, management, smokers and nonsmokers, etc.
            Choose a point person, someone well-respected and who has a genuine concern about ETS as
            a health issue.

  4. Clarify your strategy.
            Determine a time-table for implementing the new policy.
            Develop incentives for smokers who quit.
            Draft the statement: where and when policy takes effect, disciplinary actions, who is included
            (visitors, staff, supervisors).

  5. Decide on roles and responsibilities.
            Who will be primarily responsible for implementing and enforcing the policy?
            Who will be in charge of posting signs and notices?
            Who will communicate with unhappy employees?

  6. Enact your plan.
            Meet with managers and likely opponents to gain their support.
            Communicate plan to staff via newsletters, paycheck stuffers, signs, flyers, etc.
                                                                                                             035
  7. Enforce and Defend Your Policy
            Enforce it as you would any other policy.
            Train managers to deal with opposition and complaints.

  8. Acknowledge the need for cessation programs and decide how to address the need.
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  9. Evaluate the impact of the policy.



                                                                                                             k
                                Consider utilizing the following tool to help “Grade” a business based on its ETS policy.
                                ETS BUSINESS REPORT CARD


                                  CATETGORY        GRADE DETERMINANTS                                                       POSSIBLE         YOUR
                                                                                                                            SCORES           SCORE

                                  POLICY           ETS FREE on entire business campus, in business owned vehicles
                                                   and at business sponsored events.                                        40
                                                   ETS FREE inside business, but smokers are allowed to smoke
                                                   outside, away from windows and entrances.                                35
                                                   ETS FREE in most of building with separately ventilated rooms
                                                   for smokers.                                                             30
                                                   ETS FREE in most of the building; smoking sections in lounges
                                                   and lobbies.                                                             20
                                                   Smokers are allowed to smoke anywhere in building.                       0
                                  PARTNERS IN      Everyone, including employees, managers, owners, customers
                                  THE POLICY       and guests, are prohibited from smoking.                                 10
                                                   Employees are prohibited from smoking but guests are allowed
                                                   to smoke in prohibited areas.                                            5
                                                   Employees and guests are allowed to smoke anywhere.                      0
                                  ENFORCEMENT Policy is strictly enforced by both employees and managers
                                              who respect the policy.                                                       20
                                              Policy is reluctantly enforced by managers, leaving the work
                                              to employees who feel strongly about the policy.                              10
                                                   The policy is not enforced by employees or managers.                     0
                                  CESSATION        Any employee who expresses an interest in quitting is provided
                                                   with cessation resources, positive incentives to quit and breaks
                                                   on the costs of quitting.                                                20
                                                   Employees who are smokers and who want to quit have access to
                                                   cessation pamphlets and are compensated by their insurance for
                                                   cessation aides.                                                         15
                                                   Employees who are smokers are encouraged to quit through
                                                   education as well as by peers.                                           10
                                                   Employees who want to quit are encouraged to look for cessation
                                                   resources when they’re not at work.                                      5
                                                   There are no cessation resources offered                                 0
                                  COMMUNITY        Business sponsors community events that educate people about
                                                   ETS and smoking, and offers advice to businesses that are
                                                   changing their ETS policies.                                             10
                                                   Sponsors some community events as long as they are tax
                                                   deductible and promote the business’ logo.                               5
036




                                                   Does not sponsor community events and is not willing to talk to
                                                   other businesses about ETS policy                                        0
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                                                                                                         Tally your score for a final grade _______


                                  A:   Outstanding          85   to   100 points
                                  B:   Above Average        71   to   84 points
                                  C:   Average              56   to   70 points
                                  D:   Below Average        41   to   55 points
                                  F:   Failing              40   or   less

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A MODEL WORKPLACE NONSMOKING POLICY




 ABC Company is dedicated to providing a healthful, comfortable and productive work environment for our
 employees, clients and visitors.

 The U.S. Surgeon General, in the 1989 report, Reducing the Consequences of Smoking, concluded that:
     n Secondhand smoke is a cause of disease, including lung cancer, in healthy nonsmokers, and
     n The simple separation of smokers and nonsmokers within the same air space may reduce,
         but does not eliminate, the exposure of nonsmokers to environmental tobacco smoke.

 In addition, the U.S. Environmental Protection Agency and the National Cancer Institute concluded that
 passive smoke causes cancer and heart disease, including approximately 3,000 lung cancer deaths and more
 than 30,000 heart disease deaths annually among nonsmoking adults.

 In light of these findings, ABC Company shall be entirely smoke free, effective January 1, 2002.

 Smoking will be strictly prohibited within or immediately outside of company-owned or leased buildings,
 including offices, hallways, waiting rooms, restrooms, lunch rooms, elevators, meeting rooms, and all
 community areas, entrances and exits to buildings. This policy applies to all employees, clients, contractors
 and visitors.

 Breaks will be granted to all employees in accordance with ABC Company’s Personnel Policies. Smoking must
 be confined to these breaks (and the ##minute lunch break for full-time employees) and to the outside,
 designated smoking area only.

 Adoption of this policy is being announced three months in advance of the effective date to allow a smooth
 transition to a smoke-free workplace. Those employees who smoke and would like to take this opportunity to
 quit smoking are invited to participate in stop-smoking programs offered by this company.

 All individuals share in the responsibility for adhering to and enforcing the policy. Any problems should be
 brought to the attention of the appropriate supervisor and handled through the normal chain of command.
 Employees who violate this policy will be subject to the same disciplinary actions that accompany infractions of
 other company rules.

                                        Adapted from Is Smoking Affecting Your Workplace? A Nonsmoking Policy Handbook




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                                                                                                                  k
                                     Cessation Programs

                                C E S S AT I O N P R O G R A M S

                                Having a few resources available on cessation will be        Be sure to be empathetic, promote the smoker’s
                                handy in two respects: there will be smokers who will        autonomy (eg, choice among options), avoid
                                have to smoke less during the day because of the new         arguments, and support the smoker’s self-efficacy
                                ETS-free policy and there should be ready resources to       (eg, by identifying previous successes in efforts to
                                help them fight their addiction to nicotine.                 change behavior).
                                Furthermore, some people will be encouraged to quit
                                by the increased concern for public health. Anyone who q     For the smoker who has recently quit:
                                is interested in quitting should be given immediate          Reinforce the smoker’s decision to quit, and review
                                encouragement and the resources to quit successfully.        the benefits of quitting. Assist the smoker in
                                                                                             resolving any residual problems arising from
                                If you are offering one-on-one cessation advice for          quitting.
                                smokers, keep these things in mind:
                                     l   Tobacco dependence is a chronic condition             Offer brief relapse prevention treatment for recent
                                         and requires repeated treatment until                 quitters (although most relapse occurs early in the
                                         abstinence is achieved.                               quitting process, some relapse occurs months or
                                     l   Not every smoker who tries to quit will achieve       even years after the quit date).
                                         her goal. While many fail, many also succeed on
                                         their next attempt.                               There are three types of counseling: practical, social
                                     l   All tobacco users should be offered treatment. support within treatment and social support
                                     l   Every intervention helps convince a smoker she independent of treatment.
                                         should quit, even a brief intervention.
                                     l   No matter how resistant the smoker may be,            l    Practical: counsels smoker to have concrete
                                         simply making cessation rationale and materials            plans other than smoking.
                                         available can slowly affect the smoker’s decision     l    Social Support Within Treatment: provides
                                         to quit.                                                   group support and forum to discuss and find
                                                                                                    solutions to problems with quitting.
                                HERE ARE SOME INTERVENTION TIPS:                               l    Social Support Independent of Treatment:
                                                                                                    provides support for smoker from peers,
                                q Offer a brief intervention.                                       smokers, former smokers and nonsmokers, and
                                     Even a three minute talk on the dangers of                     steady encouragement and reminders of the
                                     smoking can be a significant force in a person’s               goal of quitting.
                                     decision to quit.
                                                                                           Pharmacotherapy, medications and nicotine
                                q To the smoker who is willing to quit:                    replacements are extremely effective. Nicotine is
                                     The most successful treatments offer counseling       perhaps more addictive than cocaine or heroin. The
                                     and pharmacotherapy.                                  withdrawal symptoms alone can convince a smoker not
                                                                                           to quit. These pharmacotherapies are very helpful in
038




                                q To the smoker who is unwilling to quit:                  easing the body’s addiction from nicotine.
                                     Educate, reassure and motivate. Offer a more
                                     detailed intervention focused towards motivating      Because treatments are more cost-effective than
                                     the smoker to quit. The smoker may lack               treating a tobacco-related illness, insurance companies
                                     information about the harmful effects of tobacco,     may provide reimbursement for counseling and
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                                     the required financial resources, may have fears or treatments.
                                     concerns about quitting, or may be demoralized
                                     because of previous relapse.




                                                                                                                                              k
C E S S AT I O N L I N K S :

North Carolina hospitals, health departments and            National Institute on Aging:
mental health clinics offer many cessation resources,           It’s Never Too Late to Stop:
including group meetings and materials. Contact one             http://www.nih.gov/nia/health/agepages/
of these national or statewide organizations for                smoking.htm
information on cessation programs in your area.
                                                            North Carolina Prevention Partners
American Cancer Society                                         Excellent database of national and statewide
   Tips to quit, on-line chat, “Diary of A Former               cessation resources.
   Smoker” and information on tax deductions.                   (919) 966-9267
   (919) 834-1636                                               http://www.ncpreventionpartners.org
   1-800-282-4914
   http://www.cancer.org                                    Not On Tobacco (NOT) and Teens Against
                                                            Tobacco Use (TATU)
American Family of Physicians                                   Health Action Council of NC
   Why I Should Quit                                            11 S. Boylan Ave.
   http://familydoctor.org/handouts/289.html                    Raleigh, NC 27603
   Do I Want to Quit?                                           1-888-888-6231 (toll free)
   http://familydoctor.org/handouts/618.html                    http://www.nchealthaction.org
   How to Control Weight Gain:
   http://www.niddk.nih.gov/health/nutrit/pubs/             Resources in Spanish:
   quitsmok/index.htm                                          American Cancer Society
   Quitting and Recovering Alcoholics:                         http://www.cancer.org
   http://familydoctor.org/handouts/269.html                   click on the “Espanol” button!

American Heart Association                                      Medline
   How Can I Quit Smoking? How Can I Handle the                 http://www.nlm.nih.gov/medlineplus/
   Stress?                                                      hispanicamericanhealth.html
   (919) 968-4435                                               and click on the “Espanol” button!
   1-800-242-8721
   http://www.americanheart.org                                  National Institute on Drug Abuse (NIDA)
                                                                  1–888–NIH–NIDA
American Lung Association                                        http://www.nida.nih.gov/
   Contact Person: Eleanor Blackwell
   Freedom From Smoking Program offers support
   for people at any stage of quitting smoking:
   thinking about it, quitting and staying quit.
   Groups are held on the 1st and 3rd Monday of         Please see our Resources section for additional
   the month from 6-7 on an on-going basis. ALA         information on the local offices which can provide you
   also has smoking cessation guides and                with printed cessation materials.
   audiotapes.
   (919) 832-8326
   http://www.lungusa.org

American Medical Association
   For more information about cessation and
   interventions, check out:
   http://jama.ama-assn.org/issues/v283n24/rfull/
   jst00005/html
                                                                                                                 039
Cancer Information Services
   Why Do You Smoke?, Clearing the Air: How to
   Quit Smoking and Quit for Keeps, Smoking Facts
   and Tips for Quitting, Smoking and Cancer (fact
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   sheet)
   1-800-4-CANCER

Centers for Disease Control:
   Consumer’s Guide to Quitting:
   http://www.cdc.gov/tobacco/quit/canquit.htm



                                                                                                           k
                                              Coalition Partners
                                               REMEMBER YOUR GREATEST RESOURCES ARE THE PEOPLE YOU HAVE INVOLVED!
                                               HAVE YOU THOUGHT ABOUT INVOLVING ANY OR ALL OF THE FOLLOWING PEOPLE
                                               IN YOUR COALITION EFFORTS?




                                        Employees At Target Site                              Health Advocates
                                        Doctors                                               Nurses
                                        Dentists                                              Successful ETS-Free Business Owners
                                        Religious Groups                                      Teachers
                                        Survivors                                             Law Enforcement
                                        Community Groups                                      Media
                                        Government Liaison                                    Insurance
                                        National Health Groups                                Pharmaceutical Company
                                        Athletes                                              Board of Health Members
                                        Academia                                              Fire Fighters
                                        Teachers                                              Youth Groups-Boy Scouts & Girl Scouts
                                        Managers & Owners Of Site                             Lawyers


                                A large coalition represents community support, varied resources and a powerful network, but a coalition can only
                                move as fast as its slowest partner. It might be wise to create a smaller, more active subgroup, which is
                                empowered by the larger coalition to make decisions about the policy campaign. The smaller subgroup should
                                contain at least the following:

                                        A health advocate—someone who understands ETS science and the public health implications of
                                        exposure.
                                        An insider—either a political or legal analyst, administrator or employee; someone who works within the
                                        system your coalition is trying to approach with a new ETS policy.
                                        Dedicated workers—people who have the time and interest to help with mailings, organization, etc.

                                INCREASING GROUP COHESIVENESS
                                Consider utilizing the following strategies to increase group cohesiveness.

                                   1.   Ensure that all members complete worthwhile tasks and feel they are appreciated by the group.
                                   2.   Ensure that all members clearly perceive the group goals and consider them to be realistic.
                                   3.   Ensure that all members perceive the group as its own entity, calling it “the group” or “our group.”
                                   4.   Ensure that the group has prestige.
                                   5.   Ensure that all members possess knowledge or material needed by the group.
040




                                   6.   Ensure that all members perceive the issues at hand to be of importance.
                                   7.   Ensure that all personal interaction among members is based on equality, with no one exercising much
                                        authority over anyone else.
                                   8.   Ensure that no members are jealous and competitive with one another.
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                                         Adapted from Holli BB, Calabrese RJ (1991) Communication and Education Skills (2nd ed.). Philadelphia: Lee and Febiger.

                                ADDITIONAL LINKS:
                                An excellent overview on building coalitions can be found at http://ohioline.osu.edu/bc-fact/0001.html




                                                                                                                                                         k
Coalition Partners- Clinicians
Health care professionals play a vital role in educating people about ETS and in enacting new ETS policies. They
are essential members of coalitions since they have a specialized understanding of the health effects of exposure.
They have a unique and trusted relationship with smokers as patients. They have credibility and the trust of the
community. Here are a few things that health care professionals can do to help advocate for ETS policies.

    n     Educate patients, employers and the public as to who is effected by ETS and what kind of changes should
          be made to prevent further harm.
    n     Offer to speak to children at the local school about the dangers of smoking and ETS.
    n     Inform at-risk patients (asthmatics, heart patients) about their legal rights.
    n     Write letters to patients’ employers, recommending ETS-free environments.
    n     Take advantage of media outlets to educate people about ETS.
    n     Write an affidavit or letter of support for a citizen utilizing the Americans with Disabilities Act.

SAMPLE PHYSICIAN AFFIDAVIT

                                                      THE UNITED STATES DISTRICT COURT
                                                 FOR THE EASTERN DISTRICT OF NORTH CAROLINA
                                                              WESTERN DIVISION
                                                                NO. XXX-10000

                                     JAMES DOE, Plaintiff                )
                                              v.                         )                                   AFFIDAVIT
                                     MISCELLANEOUS, et al.,              )                                   SUPPORTING
                                     Defendants                          )                                   PLAINTIFF

  John Smith, MD, being duly sworn, hereby deposes and says:

  1. I am an adult over the age of 18, have never been judged incompetent, suffer from no mental or emotional illness and make this affidavit of my
  own free will, stating facts based on personal knowledge or on information or belief.
  2. I am a Board-certified Physician, licensed to practice medicine in North Carolina. I have reviewed the medical records of the Plaintiff, and my
  statements are based upon a review of these records as well as a review of the scientific literature on ETS.
  3. The Plaintiff writes that he is exposed to high levels of ETS and suffers from high blood pressure, cough and shortness of breath. Exposure
  to ETS, or involuntary smoking, occurs when nonsmokers are exposed to tobacco smoke from smokers. ETS is classified as a known human
  carcinogen (similar to Benzene, Asbestos, and Vinyl Chloride) by the U.S. Government and for which no safe level of exposure has been
  established. There are over 40 cancer causing agents in ETS. A nonsmoker seated next to a smoker will have dose-related amounts of smoke by-
  products in their body.
  4. The Plaintiff ’s medical claims of suffering from ETS exposure are consistent with the known consequences of ETS exposure. The medical and
  scientific evidence conclusively demonstrate that ETS: is causally related to over 30,000 cases of heart attacks in nonsmokers every year, at least 3000
  cases of lung cancer among nonsmokers every year, 300,000 cases of bronchitis/pneumonia, the development of asthma in nonsmokers, declines
  in lung function and chest discomfort in nonsmokers and nasal sinus cancer among other diseases.
  5. Continued exposure of the Plaintiff to ETS goes against accepted medical recommendations. In 1991, the National Institute of Occupational
  Safety and Health stated that workers should not be exposed involuntarily to tobacco smoke and that “employers should protect nonsmokers from
  ETS by isolating smokers,” reducing exposure to the lowest feasible concentration. On February 7th, 1994, Carol Browner, the EPA Administrator,
  in testimony before the U.S. House of Representatives, stated that the scientific evidence warrants actions to protect nonsmokers from involuntary
  exposure to ETS “either through complete bans or limiting exposure (to separately ventilated rooms).” In 1999, the National Cancer Institute issued
  a comprehensive assessment of ETS calling for strong policy protections of nonsmokers from involuntary exposure to ETS.
                                                                                                                                                                      041
  6. Patient’s concerns over short as well as long term cardiovascular health effects of ETS exposure are highly relevant as three recent reports
  (Stefanadis, Annals of Internal Medicine, 1998; Howard, Journal of American Medical Association, 1998; and Otsuka, Journal of American Medical Association, 2001)
  demonstrate that exposure to ETS causes acute deterioration in the elastic properties of the aorta, deterioration in aortic function even among
  healthy people exposed, substantially reduces coronary reserve in healthy nonsmokers, and effects may be cumulative and irreversible.
  7. The healthiest and least costly policy option is to eliminate ETS exposure. Bans on public smoking, if enforced, are clearly effective in reducing
  nonsmokers’ exposure to ETS. One study found a strong correlation between distributions of nicotine concentrations and workplace smoking
                                                                                                                                                                      ets community change toolbox




  policies, with median nicotine concentrations varying from 8.6 µg/m3 in open offices that allowed smoking, to 1.3 µg/m3 in workplaces that
  restricted smoking, to 0.3 µg/m3 in sites that banned smoking (Vaughan, J Air Waste Manag Assoc, 1990).
  8. In summary, the plaintiff may be at high risk for developing any one of a myriad of ETS-caused medical problems, many of which are
  irreversible. It is not medically justifiable to wait until he develops a heart attack or irreversible lung disease to ensure protection from ETS
  exposure.

  This is the ____ day of ____, 2001
                                                                    Signature                                               Notary
                                Coalition Partners- Youth
                                CHILDREN ARE A VITAL PART OF YOUR COALITION:
                                q   Children are often more effective at gaining individual and media attention.
                                    People are more likely to listen to a youth who asks them to sign a petition than an adult.
                                q   Youth are innovative and creative in their ideas—some of the best anti-smoking posters are drawn
                                    by kids for contests (see example below).
                                q   Children and young adults may have more spare time and energy to devote to volunteer efforts, such as
                                    helping with mailings, asking for signatures for petitions and going door to door to talk with business owners.
                                q   Children are more adversely effected by exposure to ETS because of their smaller body masses;
                                    therefore, the destructive effects of ETS are most notable in children.
                                q   Children are future health advocates!

                                SOME TIPS ON INTERACTING WITH YOUTH
                                q   Youth respond to interaction—talk with them and incorporate their ideas and energy into your strategy.
                                    Create activities that both engage children in learning about ETS now and remembering what they’ve learned
                                    after you leave.
                                q   Interactive games, poster projects, and activities keep children’s attention and engage their imagination as
                                    you teach them about the dangers of smoking and ETS.
                                q   Toys and stickers are eye catching, fun and appeal to both older
                                    and younger children.                                                         To breathe or not to breathe
                                q   Awards for creative and innovative artists may occur by laminating            That shouldn’t be the question.
                                    posters onto lunch trays and putting posters onto billboards.                 Every day we make difficult
                                                                                                                  decisions,
                                                                                                                  Breathing smoke should not be
                                                                                                                  one of them.
                                                                                                                  To inhale or exhale.
                                                                                                                  Why is that even a questiuon?
                                                                                                                  So please don’t ponder away
                                                                                                                  At such a silly question.
                                                                                                                  Just say no.
                                                                                                                  Just savor your food,
                                                                                                                  And flavor your healt
                                                                                                                               Jasmine Royster, 16
                                                                                                                               Greensboro, NC

                                YOUTH RESOURCES:
                                Here are some well established, tobacco prevention-focused youth groups around the nation.
                                q American Legacy Foundation
                                    http://www.americanlegacy.org
                                q Campaign for Tobacco Free Kids
                                    http://www.tobaccofreekids.org
                                q NOT (Not on Tobacco) American Lung Association’s teen cessation program.
042




                                    http://www.lungusa.org/tobacco/not/index.html
                                q STEP-UP NORTH CAROLINA website directs youth towards local programs working on the issues they’re
                                    most interested in. http://stepupnc.com/do/youcando.htm
                                q TEENS AS TEACHERS, Americans for Nonsmokers’ Rights’ teen advocacy program
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                                     http://www.no-smoke.org/tatblurb.html
                                q TATU (Teens Against Tobacco Use), American Lung Associations’ peer based education program
                                    http://www.lungusa.org/smokefreeclass/index.html
                                q TIPS (Tobacco Information and Prevention Source), Center for Disease Control’s youth oriented website.
                                    http://www.cdc.gov/tobacco/index.htm
                                q UJIMA Conference for African-American Youth Initiative. An advocacy and empowerment program designed to
                                    mobilize African-American youth to participate in community interventions and policy initiatives that reduce
                                    smoking. Contact the NC Tobacco Prevention and Control Branch for more information.
    Evaluation Tools
           EVALUATION TOOLS WILL ALLOW YOU TO BETTER DEFINE STRATEGIC OBJECTIVES,
           DETERMINE IF YOU ARE MEETING YOUR GOALS AND HOW TO MAKE MID-COURSE
           CORRECTIONS. AN EVALUATION FORM IS USEFUL AS YOU BUILD A COALITION OR TO
           SHARE WITH A BUSINESS OWNER WHO WANTS TO ASSESS A NEW ETS-FREE POLICY.



 E T S E VA LUAT I O N T O O L
The results of your evaluation will be more accurate and useful if you include coalition members and employees
in the process. Using evaluating tools that empower your coalition will ensure their commitment and confidence
in the program. See the survey section (page 54) of the guide for more empowerment evaluation tools.

TAKE STOCK

    q   Rate the current program and use as baseline for further assessment:

            What is your ETS-policy goal?



            How close are you to this goal?



    q   What kinds of indicators are you currently using to gauge your success (i.e. cooperation with em-
        ployees and managers, support from customers and community, etc)?



ESTABLISH THE ROLE OF COALITION PARTNERS

    q   How are coalition partners involved in setting goals and establishing methods of measuring these
        goals?



    q   Have partners incorporated their own, daily interaction towards achieving these goals?



SET GOALS

    q   What is your goal for the next rating of your program?
                                                                                                                 043

    q   What intermediate goals will help serve as steps towards this “goal rate”?
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    q   Have you included goals that relate to daily activities?




                                                                                                            k
                                DEVELOP STRATEGY

                                  q   What are the indicators that your coalition is accomplishing your program directives?



                                  q   What is your strategy to achieve your ETS-policy goal?



                                  q   How are you evaluating your success along the way?



                                  q   Is there agreement from all the partners that the strategy is effective and appropriate?


                                DOCUMENT PROGRESS

                                  q   What is your method of monitoring your progress (i.e. have you used surveys, one-on-one interviews,
                                      cessation rates, enforcement of ETS-policy, etc.)?



                                  q   How is each step of monitoring your progress relevant (i.e. such that you are not wasting time tracking
                                      useless information)?



                                  q   How can your documentation be more credible and rigorous?
044
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                                                                                                                                                k
       Ideas and Places
              IF YOU ARE INTERESTED IN CHANGING ETS POLICY, BUT DON’T HAVE A
              SPECIFIC POLICY OBJECTIVE IN MIND, TRY ONE OF THESE ON FOR SIZE.


Take Action in the Community
    n Set a goal to make a school, store, bowling alley or other business smoke free.
    n Assess local support for overturning North Carolina’s preemption law through local surveys.
    n Circulate a petition to the local city council or county commission asking for a repeal of preemption.
    n Work with prominent restaurants on smoke-free dining options.
    n Hold scientific forums on ETS for local health professionals, medical society, etc.
    n Offer to speak on your experience as an ETS advocate to business owners, rotary clubs, school
        administrators and policy makers.
    n Involve youth in writing a letter to the editor of the local paper about ETS exposure.
    n Host a pro-health poster contest asking kids in the community to enter drawings about ETS. Post
         award winning poster on a billboard or make into a t-shirt as the first prize.
    n Place an ad in the local newspaper listing some facts about ETS.
    n Put up a booth at local community fairs.
    n     Sponsor a smoke-free night for a minor league baseball team.

Raising Community Awareness about ETS in the Home
     n Post quick facts on the medical effects of ETS on children in community boards, in stores and shops,
        schools, break-rooms and other public places.
     n Write an op-ed in the local paper about the health problems caused by ETS exposure in the home.
     n Involve day-care centers and teachers in educating parents about ETS.
     n Call the local fire department to see what programs they use to educate people about cigarettes and fires.
        Would they talk with kids at the next fire truck demonstration?
     n Consider making an ETS Calendar of Events to ensure ongoing policy efforts!



                                        AN ETS CALENDAR OF EVENTS

  JANUARY             Anniversary of January 1993 EPA Report on ETS. Send out a press release as a reminder
                      of this important scientific event. Use the time of year when everyone is making resolutions
                      anyway to spark resolutions about ETS policy campaigns—chose a site and make it
                      smoke free! To read the report see http://www.epa.gov/ncea/smoking.htm

  FEBRUARY            Family Friendly February: Send families out to do surveys of restaurants according to the
                      Family Friendly guidelines. Attract media attention by holding an awards ceremony at the
                      end of the month, complete with awards to all those restaurants who qualify and a grand
                      prize award to the friendliest restaurant in the area. For a success story, see
                      http://www.wilmingtonstar.com/news/stories/2354newsstorypage.html

  MARCH               Anniversary of Surgeon General’s first report on Smoking and Health in 1964. Launch a
                                                                                                                     045
                      media campaign, including letters to the editors, ads in the local newspaper, public service
                      announcesments and press releases about ETS.
                      To read the report see http://www.cdc.gov/tobacco/sgr/sgr_1964/sgr64.htm
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  APRIL               Kick Butts Day. Kick Butts day is a national event which encourages kids to become
                      actively involved in the fight against tobacco. Amend the holiday this year to target ETS.
                      Involve local restaurants, clubs, bars, community centers, and businesses to go smoke free
                      for the day. Involve kids in creating and implementing the strategy. Be sure to involve the
                      media through public service announcements, news releases and advertisements in the
                      local newspaper by publishing names of the businesses that participated in the event.
                      See:http://kickbuttsday.org/ for more information.


                                                                                                               k
                                MAY         World No Tobacco Day. World No Tobacco Day is an international event which
                                            focused its 2001 program on ETS. Involve local businesses in implementing a smoke-free
                                            policy for one day, one week, one month or more! Involve kids in poster contests; feature
                                            the contestants and award a winner in a weekend day fair which is endorsed by smoke-free
                                            businesses. Pass out information on ETS and educate the community on the current
                                            preemption laws in North Carolina. For more information, see: http://tobacco.who.int/en/
                                            Advocacy/wntd2001a.html

                                JUNE        Smoke-Free Sports: Sports teams sign a pledge to write sponsoring organizations to
                                            establish institutional policy on ETS exposure during sporting events. Involve businesses
                                            that are already smoke free as potential sponsors, offering incentives such as media
                                            coverage and free advertising on jerseys and uniforms. Release a public service
                                            announcement advertising the smoke-free, family-friendly games.
                                            For more see http://www.smokefree.gov/

                                JULY        Second-Hand Roses: Send out literature to all restaurants in your area educating them
                                            about the health and economic effects of exposure to ETS. Include information about how
                                            many people in your area would support more smoke-free restaurants. Include an
                                            application to be a part of “Second Hand Roses” when your coalition will send them a rose
                                            for every ashtray in their restaurant for one night of going smoke free. Heavily advertise
                                            participating restaurants. On the day of the event, send roses to each restaurant and ask
                                            them to float the roses in the empty ashtrays. Include information, like a “table tent”, which
                                            they can leave on the table, about ETS. Encourage each restaurant to change their ETS
                                            policy. Get media attention to those that do to go smoke free. For more on the health
                                            effects of ETS exposure, see http://ash.org/who-ets-rpt.html#toc77

                                AUGUST      Healthy, Wealthy and Wise: Develop a media campaign that focuses on terms we can
                                            all understand—money! Send out public service announcements, letters to the editor,
                                            op-eds and news releases which highlight some basic fiscal facts on ETS. How much money
                                            does a nonsmoker lose from missed days at work due to ETS exposure? How much money
                                            do we spend on health care costs due to ETS for illness such as asthma, ear infections, cold
                                            and flu treatments, bronchitis, lung cancer, heart disease? How much money do businesses
                                            spend on renovating and repairing smoke damaged property? For more information, see
                                            http://www.tcsg.org/sfelp/economic.htm

                                SEPTEMBER   Smoke-Free Schools Campaign: School is just starting again, images of chalkboards, apples
                                            and notebooks are abundant, kids have energy and now is the time to get folks involved in
                                            a 100% smoke-free schools campaign. Involve youth by asking them to talk to their peers
                                            and parents, make posters, and write letters to the school board and to the local paper.
                                            Hold PTA meetings and involve parents in writing letters to the board of education and to
                                            the local newspaper. Gain the support of the teachers and administrators by offering ETS
                                            information and education. Use the “Grassroots Guide for Tobacco-Free Schools” and check
                                            out http://www.stepupnc.com/know/schoolpolicies.htm for more strategy ideas!

                                OCTOBER     Race for Clean Air: Organize a community event where smoke-free businesses sponsor a
                                            race/walk for clean air to raise awareness about ETS. Combine the race with a street fair in
                                            which smoke-free restaurants and businesses can set up their booths. Businesses get their
                                            names and logos on t-shirts to all who enter the race, and a prize is given to 5 entrants
                                            (chosen at random so that adults or athletic people are not favored). Pass out ETS
046




                                            literature. For more ideas, see http://www.smokefreewomen-kids.org/tbac_heart.html

                                NOVEMBER    Great American Smoke-Out: Every third Thursday of November smokers “commit to quit”
                                            for one day. Encourage smokers to quit for more than one day by focusing a media
                                            campaign on the effects of ETS on smokers’ families and loved ones. Involve youth by
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                                            encouraging kids to write their parents a letter asking them to quit. Develop a media
                                            campaign by sending letters to the editor, op-eds, public services announcements, ads in
                                            the local paper and press releases. For details, see: http://www2.cancer.org/gas/index.cfm.

                                DECEMBER    Smoke-free Holidays: Focus a media campaign on the health effects of ETS exposure in the
                                            homes. Focus on some of the religious attitudes about smoking by involving area churches
                                            and synagogues. Distribute materials about the risks of ETS exposure in homes. For more
                                            on religion and tobacco, see http://www.comminit.com/stcc2001/sld-1813.html
        Incentives
          POSITIVE INCENTIVES ARE A GREAT WAY TO INVOLVE PEOPLE IN IMPLEMENTING A NEW
          POLICY AND GAINING POSITIVE SUPPORT FOR THE NEW POLICY. THE FORMS OF POSITIVE
          INCENTIVES YOU USE DEPEND ON WHOM YOU ARE TRYING TO INFLUENCE.



YOUTH
  Youth respond to interaction—talk with them and incorporate their ideas and energy into your strategy.
      n Interactive games, poster projects, and activities keep children’s attention and engage their
          imagination as you teach them about the dangers of smoking and ETS.
      n Toys and stickers are eye catching, fun, and appeal to older and younger children.

EMPLOYEES
  Employees respond to feeling financially secure and having healthcare protection.
     n Offer health benefits, such as discounted cessation programs and decreased benefits packages
         for nonsmokers.
     n Offer Cessation Kits which include information on how to quit and hard candy to help smoking
         employees quit during their first smoke-free day.
     n Offer prizes for employees who successfully quit smoking.
     n Offer food and events during the work day. Kicking off the first smoke-free work day with
         refreshments and healthy snacks is a great way to inform and remind people about the new
         policy. The Seventh Day Adventists believe that quitting smoking is a great time to change your
         lifestyle and improve your health. Consider offering healthy snacks like veggies and fruit juices to
         inspire healthier living and discourage weight gain after quitting.
     n Many health insurance companies offer cessation resources as a covered health benefit. For more
         information as to whether your employer offers cessation resources, contact North Carolina
         Prevention Partners (see Resources section, pages 51-53, for more information).

BUSINESS OWNERS
  Business owners respond to the basic elements of business—profit, customers, publicity!
      n Employees who do not smoke take fewer breaks and are healthier, which means fewer sick days.
      n Family Friendly Dining is a great way to get publicity for businesses that thrive on a family
          atmosphere.
      n Keep lists of petitioners and community members who supported your drive for ETS-policy and
          ask them to come out and support the business. Invite the media to cover the event.
      n Consider taking out a paid newspaper ad as a way to thank smoke-free businesses and as an
          incentive for local businesses to become smoke free:
                         LOCAL SMOKE-FREE BUSINESSES WORKING TOWARD CLEARING THE AIR
           Apartments                 Bus Lines                 Flower Shops                Pet Grooming Salons
           Main Street Apartments     Central Transit           Bloomers                    Domestic Den Grooming
           Willow Springs             Carolina Bus Lines
                                                                                                                     047
                                                                Main Street Flowers         Wag n’ Tails Pet Salon

           Art Galleries              Child Care Centers        Golf Clubhouses             Real Estate Offices
           Object D’Arte Gallerie     First Step Day Care       Carolina Greens Clubhouse   Carolina Realty
           Jessica Studios            Kiddie Kollege                                        Main Street Realty
                                                                Laundry Mats
           Auto Repair Shops          Coffee Shops              Washing Well                Restaurants
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           Brad’s Body Repair         Jesse’s Java              Homestyle Laundry           Mom and Pops
           Central Auto Shop          Grounds on Down                                       Carolina Deli
                                      Brew Masters              Law Offices                 Budget Bistro
           Banks                                                Johnson Smith Law Offices   Annie’s Pastas
           North Carolina Bank        Convenience Stores                                    The Donut Den
           First Carolina Bank        Main Street Mart          Media                       Coastline Cafe
                                      County Store              WABC News                   Pasta Paradise
           Beauty Salons/Barber Shops                           WXYZ News radio             Gryos and More
           The Hair Affair            Clubs                     WSYB Media Source           Deb’s Delicacies


                                                                                                                     k
           Ben’s Barber Shop          Central Women’s Society
                                                 Resources
                                Agencies- National
                                ACTION ON SMOKING AND HEALTH (ASH)                   FLORIDA DEPARTMENT OF HEALTH
                                   Action on Smoking and Health (ASH)                   Bureau of Facility Programs
                                   2013 H Street, NW                                    Radon and Indoor Air Quality
                                   Washington, DC 20006                                  4052 BaldCypress Way, Bin #A08
                                   (202) 659-4310                                        Tallahassee, FL 32399-1710
                                   http://www.no-smoking.org                            1-800-3 FRESH AIR
                                                                                        http://www.doh.state.fl.us/environment/facility/fciaa/
                                AMERICAN CANCER SOCIETY
                                   11 South Boylan Avenue                            MASSACHUSETTS TOBACCO CONTROL PROGRAM
                                   Raleigh, NC 27603                                    (617) 482-9485
                                   (919) 834-1636                                       http://www.state.ma.us/dph/mtcp/
                                   1-800-ACS-2345
                                   http://www.cancer.org/                            NATIONAL CENTER FOR TOBACCO-FREE KIDS/
                                                                                     CAMPAIGN FOR TOBACCO-FREE KIDS
                                AMERICAN HEART ASSOCIATION                              1707 L Street NW, Ste 800
                                   300 Silver Cedar Court                               Washington, DC 20036
                                    .O.
                                   P Box 2636                                           (800) 284-KIDS
                                   Chapel Hill, NC 27515-2636                           http://www.tobaccofreekids.org
                                   (919) 968-4453
                                   http://www.americanheart.org/nc/                  NATIONAL INSTITUTES OF HEALTH-
                                                                                     NATIONAL CANCER INSTITUTE
                                AMERICAN LUNG ASSOCIATION                               NCI Public Inquiries Office
                                   1323 Capital Boulevard, Suite 102                    Building, 31, Room 10A03
                                   Raleigh, NC 27603                                    31 Center Drive, MSC 2580
                                   1-800-892-5650                                       Bethesda, MD 20892-2580 USA
                                   http://www.lungusa.org/northcarolina/index.html      (301) 435-3848
                                                                                        1-800-4-CANCER
                                AMERICANS FOR NONSMOKER’S RIGHTS                        www.nci.nih.gov
                                   American Nonsmokers' Rights Foundation
                                   2530 San Pablo Avenue, Suite J
                                                                                     NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY
                                   Berkeley, CA 94702
                                                                                     AND HEALTH
                                   (510) 841-3032
                                                                                        http://www.cdc.gov/niosh/homepage.html
                                   anr@no-smoke.org
                                   www.no-smoke.org                                     1-800-35-NIOSH

                                ARIZONA DEPARTMENT OF HEALTH SERVICES                S.A.F.E. SMOKE-FREE AIR FOR EVERYONE
                                TOBACCO EDUCATION AND PREVENTION PROGRAM                  .O.
                                                                                         P Box 246
                                    1740 West Adams, #203-S                              Newbury Park, CA 91320 U.S.A.
                                    Phoenix, Arizona 85007-2670                          http://www.pacificnet.net/~safe/
                                    (602) 364-0824
                                    http://www.tepp.org                              ROBERT WOOD JOHNSON FOUNDATION
                                                                                         .O.
                                                                                        P Box 2316
                                CALIFORNIA TOBACCO CONTROL SECTION                      College Road East and Route 1
                                   Department of Health Services                        Princeton, NJ 08543-2316
                                   P Box 942732, MS #555
                                    .O.                                                 1-888- 631-9989
                                    Sacramento, CA 94234-7320                           http://www.rwjf.org/index.jsp
                                    (916) 327-5425
                                   http://www.dhs.cahwnet.gov/tobacco/               SMOKE-FREE APARTMENT HOUSE REGISTRY
048




                                                                                        10722 White Oak Avenue, Suite 5
                                                                                        Granada Hills, CA 91344
                                CENTERS FOR DISEASE CONTROL                             (818) 363-4220
                                   Office of Smoking & Health, CDC,                     smokefreeapartments@pacificnet.net
                                   Mailstop K-50                                        http://www.smokefreeapartments.org
                                   Attn: Media Campaign Resource Center
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                                   4770 Buford Hwy, NE                               SMOKE-FREE ENVIRONMENTS LAW PROJECT
                                   Atlanta, GA 30341-3717                               The Center for Social Gerontology
                                   (770) 488-5705, press 2                              2307 Shelby Avenue
                                   http://www.cdc.gov                                   Ann Arbor, MI 48103
                                                                                        (734) 665-1126
                                ENVIRONMENTAL PROTECTION AGENCY                         SFELP@tcsg.org
                                   1200 Pennsylvania Avenue, NW                         http://www.tcsg.org/sfelp/law.htm
                                   Washington, DC 20460
                                   http://www.epa.gov/iaq/ets/
THE TOBACCO CONTROL RESOURCE CENTER, INC.
   102 The Fenway                                                 ?Y Youth Empowerment Center, Asheville
   Suite 117                                                      Director, Theresa Rath
   Boston, MA 02115                                               (828) 232-4424
   (617) 373-2026
   http://www.tobacco.neu.edu/ETS/adainfo1.htm
                                                              Consultants- National
                                                              JIM HARRINGTON
Agencies- Statewide                                               Health Educator,
HEALTH ACTION COUNCIL OF NC                                       Marquette County Health Department
   Sponsors of NOT (Not On Tobacco)                               Marquette, MI
   and TATU (Teens Against Tobacco Use)                            184 US Highway 41 East
   11 S. Boylan Ave.                                              Negaunee, Michigan 49866
   Raleigh, NC 27603                                              (906) 475-7848 x281
   (919) 833-4400                                                 jharrington@hline.localhealth.net
   1-888-888-6231
   www.nchealthaction.org                                     JAMES REPACE, MSc., Physicist
                                                                 REPACE ASSOCIATES
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT                         Secondhand Smoke Consultants
AND NATURAL RESOURCES                                            101 Felicia Lane
   North Carolina Division of Air Quality                        Bowie, MD 20720, U.S.A.
   1641 Mail Service Center                                      (301) 262-9131
   Raleigh, NC 27699-1641                                        repace@erols.com
    (919) 733-3340
                                                              THOMAS SCHMOKEL
   http://daq.state.nc.us/
                                                                 ADA Expert
                                                                 http://www.istal.com/smoke/
NC (GASP) GROUP TO ALLEVIATE SMOKING
POLLUTION
   Wade Hampton, President                                    MICHAEL SIEGEL
   31 College Plac, 13-A                                         Associate Professor
   Asheville, NC 28801                                           SPH Social & Behavioral Sciences
   ncgasp@smokescreen.org                                        Boston University
                                                                 715 Albany St T2w
NORTH CAROLINA PREVENTION PARTNERS                               (617) 638-5160 X44584
   School of Public Health                                       mbsiegel@bu.edu
   CB# 7400, Rosenau Hall
   UNC-Chapel Hill                                            Consultants-Statewide
   Chapel Hill, NC 27599-7400                                 PHIL BOORS
   (919) 966-9267                                                 Restaurant Heart-Health Survey Project
   www. ncpreventionpartners.org                                  Cardiovascular Health Unit- Division of Public Health
                                                                  1915 Mail Service Center
S .A .V.E .                                                       Raleigh, NC 27699-1915
     Survivors and Victims (of tobacco) Empowerment Program       919-715-2131
     Lisa Sarasohn, Program Coordinator                           phil.bors@ncmail.net
     31 College Place, 13-A
     Asheville, NC 28801                                      SANDRA COLT
     (828) 236-0110                                              Field Director for Local and Regional Program Management
     888-8-VOICES (888-886-4237)                                 and Clean Indoor Air Advocacy Expert
     www.tobaccosurvivors.org                                    Tobacco Prevention and Control Branch
                                                                 Rt. 10 Box 48
TOBACCO PREVENTION AND CONTROL BRANCH                            Burnsville, NC 28714
   Sally Herndon Malek, Director                                 (828)678-9886
   Smoking & Health. Branch, ASSIST Project.                     Sandra.Colt@ncmail.net
   North Carolina Dept. of Environment,
   Health and Natural Resources                               ADAM O. GOLDSTEIN, MD
   PO Box 27687                                                  University of North Carolina
                                                                                                                            049
   Raleigh, NC 27611-7687                                        School of Family Medicine
   (919) 733-1340                                                CB 7595
   Sally.Malek@ncmail.net                                        Chapel Hill, NC 27599-7595
                                                                 (919) 966-4090
                                                                 aog@med.unc.edu
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YOUTH EMPOWERMENT CENTERS
   Wilmington Health Access for Teens
   Coordinator, Steve Johnson
                                                              ANN HOUSTON
   (910) 790-9949
                                                                 Media Specialist
                                                                 Tobacco Prevention and Control Branch
    ?Y Youth Empowerment Center, Durham
                                                                 9132 Parkhurst Lane
    Director, Bronwyn Glen
                                                                 Charlotte, NC 28227
    (919) 560-7446
                                                                 (704) 545-3224
                                                                 ncs1395@mindspring.com
                                MEG MOLLOY                                                      CLEARING THE AIR:
                                   Cessation Specialist                                            A Guide to Passing Clean Indoor Air Ordinances
                                   NC Prevention Partners
                                   School of Public Health                                      HOW TO BUTT IN:
                                   CB# 7400, Rosenau Hall                                          Teens Take Action Guidebook
                                   UNC-Chapel Hill                                                 Americans for Nonsmokers’ Rights
                                   Chapel Hill, NC 27599-7400                                      2430 San Pablo Avenue, Suite J
                                   (919) 966-8213                                                  Berkely, CA 94702
                                   meg_molloy@unc.edu                                              (510) 841–3032
                                                                                                   www.no-smoke.org or anr@no-smoke.org
                                WILL SERVICE
                                   Industrial Hygiene Consultant                                “GRASSROOTS GUIDE FOR TOBACCO-FREE SCHOOLS”
                                   NC Division of Public Health                                    Tobacco Prevention and Control Branch
                                   Occupational and Environmental Epidemiology Branch              (formerly project ASSIST)
                                   1912 Mail Service Center                                        1915 Mail Service Center
                                   Raleigh, NC 27699-1912                                          Raleigh, NC 27699-1915
                                   (919) 715-6431                                                  (919) 733–1881
                                    will.service@ncmail.net
                                                                                                KY-ACTION
                                                                                                    Kentucky Alliance to Control Tobacco in Our Neighborhoods
                                Literary Resources                                                  PO Box 9067
                                AMERICANS WITH DISABILITIES ACT                                     Louisville, KY 40209
                                   To file a claim:                                                 (502) 363-2991
                                              Disability Rights Section                             http://www.realsolutions.org/KYgrguide/grguide.htm
                                              Civil Rights Division
                                              U.S. Department of Justice                        NORTH CAROLINA STATUTES
                                              Post Office Box 66738                                Chapter 130: Public Health
                                              Washington, D.C. 20035-6738                          http://www.ncleg.net/statutes/statutes%5Fin%5Fhtml/
                                   Call to obtain answers to general and technical questions       chp130a.html
                                   about the ADA and to order technical assistance materials:      GS 143-597: Preemptive Law
                                   800-514-0301 (voice) 800-514-0383 (TDD)                         http://www.ncleg.net/statutes/statutes%5Fin%5Fhtml/
                                   http://www.usdoj.gov/crt/ada/adahom1.htm                        chp1430.html

                                    To view a sample claim:                                     RESPIRATORY HEALTH EFFECTS OF PASSIVE SMOKING
                                    http://www.raggededgemagazine.com                              California Environmental Protection Agency’s Office
                                    The Americans with Disabilities Act and the Sensitive          of Environmental Health Hazard Assessment (OEHHA)
                                    Nonsmoker: How to Eliminate Discriminatory Barriers of         http://www.druglibrary.org/schaffer/tobacco/caets/ets-
                                    Environmental Tobacco Smoke in Public Places 1997.             main.htm

                                ADA: HOW IT CAN PROTECT YOU FROM                                WHAT MAY NORTH CAROLINA’S LOCAL GOVERNMENTS
                                SECOND-HAND SMOKE                                               DO TO RESTRICT SMOKING?
                                    http://www.tobacco.neu.edu/ETS/adainfo1.htm                    Anne M. Dellinger. In Local Government Law, Number 83,
                                                                                                   February 1998.
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            Surveys
            SURVEYS ARE AN EXCELLENT TOOL TO ASSESS CURRENT POLICIES AND WILLINGNESS TO
            CHANGE THESE POLICIES. ONCE THIS INFORMATION IS GATHERED, YOUR COALITION CAN
            DETERMINE YOUR STRATEGY. YOU CAN EVEN USE SURVEY DATA TO PERSUADE A BUSINESS
            OWNER, SCHOOL ADMINISTRATOR OR HOME OWNER THAT THE COMMUNITY SUPPORTS AN
            ETS-FREE ENVIRONMENT.



A PA R T M E N T   SURVEY

This survey is an excellent tool for equipping an advocate with the general feelings and opinions of the tenants of
the apartment. Use the information you gather here to develop your ETS-policy advocacy strategy. Tally the
responses and present them to the owner. This survey could easily be reworded so that it applies to business
owners and their customers.




                     QUESTION                                                          YES NO         DON’T KNOW

 POLICY              Is there currently an ETS policy?
 IMPLEMENTATION Does the policy require smoke-free apartments with separate
                     ventilation from apartments where smoking is allowed?
                     Does the policy require no smoking in the apartments but
                     smoking is allowed in sections outside, away from windows
                     and entrances?
                     Is there any smoking at all on the premises?


  OWNER              Do you feel that ETS is dangerous?
  PERCEPTION         Does ETS cause lung cancer?
                     Does ETS cause heart disease?
                     Does ETS cause asthma and bronchitis?
                     Does ETS irritate asthma and bronchitis?
                     Are you willing to change your ETS policy?
                     Would you be willing to change your ETS policy if:
                     ... Your tenants asked you to?
                     ... You knew the dangers of ETS?
                     ... You knew that doing so would save you money?                                                 051
  TENANT             Do you smoke?
  PERCEPTION         Do you smoke in your home?
                     Do you feel that ETS is dangerous?
                     Does ETS cause lung cancer?
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                     Does ETS cause heart disease?
                     Does ETS cause asthma and bronchitis?
                     Does ETS irritate asthma and bronchitis?
                     Are you effected by ETS?
                     Would you prefer an ETS-free policy?
                                BUSINESS          SURVEY

                                The Business Report Card discussed earlier in the toolbox (page 39), is useful for employers and employees. An
                                alternative “In-A-Glance Survey” is useful for an unobtrusive quick survey of a business or restaurant. This would
                                be helpful if you are trying to decide how prevalent ETS is in this area. If a fast glance survey shows a lot of
                                exposure, then this is probably a good site for ETS policy advocacy.

                                ETS BUSINESS SURVEY

                                          QUESTION                                                               YES     NO   CAN’T TELL


                                          Is smoking prohibited on premises?
                                          Are no-smoking signs posted?
                                          Is the smoking section separately ventilated?
                                          Are people smoking only within a designated smoking section?
                                          Are employees protected from high levels of smoke?
                                          Are children free from exposure to ETS?

                                           Score:
                                           1 = yes
                                           0 = no

                                           0 –1      Grave danger, needs serious improvement
                                           2–3       Danger, needs improvement
                                           4–5       Good job—keep it up!
                                           6         Congratulations—you have a model ETS policy!


                                CUSTOMER          SURVEY

                                Here is a set of easy questions about ETS which you can ask customers and diners as they leave the business or
                                restaurant. You can then tally these results and present them to the owner as one reason they should consider
                                an ETS-free policy.
                                ETS BUSINESS SURVEY

                                                     QUESTION                                                      YES        NO        DON’T
                                                                                                                                        KNOW


                                  KNOWLEDGE          ETS   exposure to adults is dangerous.
                                  OF ETS             ETS   exposure to children is dangerous.
                                                     ETS   causes lung cancer.
                                                     ETS   causes asthma and bronchitis.
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                                                     ETS   irritates asthma and bronchitis.

                                  PREFERENCE         An ETS-free environment is the best way to protect
                                                     yourself from ETS.
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                                                     I mind being exposed to ETS.

                                  AFFECT ON          I am more likely to eat/shop at an ETS-free
                                   PATRONAGE         restaurant/store.
                                                     I would be more likely to tell my friends if a
                                                      restaurant/store was ETS free than if it allows smoking.
                                                     I prefer a facility that is smoke free.
SCHOOL         SURVEY

Before enacting a school ETS policy it is important to gain support from both faculty and students. This survey will
help you assess how well educated faculty and staff are about ETS and their willingness to change an ETS policy.

 ETS SCHOOL SURVEY
                       QUESTION                                                      YES      NO        DON’T
                                                                                                        KNOW

   POLICY              Does the school have an ETS policy?
                       Are faculty allowed to smoke on campus?
                       Are faculty allowed to smoke in front of students?
                       Are students allowed to smoke on campus?
                       Are smoking areas outside and away from windows?
                       Are indoor smoking areas separately ventilated?

   STUDENT             Do students comply with the ETS policy?
   PERCEPTIONS         Are students exposed to ETS?
                       Would students support an ETS-free policy?

   FACULTY             Do faculty comply with the ETS policy?
   PERCEPTIONS         Are nonsmoking faculty members exposed to ETS?
                       Would faculty support an ETS-free policy?

   CESSATION           Are faculty offered cessation resources and incentives?
                       Are students offered cessation resources and incentives?

   ETS AND             Are students educated about the dangers of tobacco use?
   TOBACCO             Are students educated about the dangers of ETS?
   EDUCATION           Is there signage and other media to inform both
                       students and faculty about the dangers of ETS?




                                                                                                                       053
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                                      Tobacco Industry and ETS
                                       THE TOBACCO INDUSTRY RECOGNIZES THAT THEIR BIGGEST THREAT COMES FROM LOCAL,
                                       GRASSROOTS COALITIONS ADVOCATING FOR LOCAL POLICY CHANGES. THE INDUSTRY HAS
                                       DEVELOPED STRATEGIES THAT CHALLENGE OR UNDERMINE MANY LOCAL EFFORTS. IT IS
                                       IMPORTANT TO KNOW THE ARGUMENTS THE TOBACCO INDUSTRY MAY USE TO COUNTER YOUR ETS
                                       POLICY EFFORTS.



                                BE PREPARED FOR THESE TOBACCO INDUSTRY STRATEGIES:
                                   n PREEMPTIVE ETS LEGISLATION.
                                      (Clean Indoor Air: A Guide to Developing Policy, 1994)
                                   n UTILIZING SMALLER BUSINESSES and organizations to challenge ETS protection such as
                                       Smokers’ Rights organizations or hospitality business organizations.
                                        (The Independent Weekly, 1994)
                                   n ATTACKING THE SCIENCE OF ETS.
                                       (Journal of the American Medical Association, 1998)
                                   n OFFERING WEAK ALTERNATIVES to ETS-free policies.
                                       (Phillip Morris, 1996; American’s for Nonsmoker’s Rights, 2001)
                                   n LEGAL CHALLENGES to the new policies.
                                        (Dellinger, 1998)


                                WHAT YOU CAN DO:
                                   n ALWAYS REMEMBER that an ETS-free policy is a public health issue. Remember that the facts are on your
                                      side: ETS is carcinogenic and toxic. ETS policies stem from a right to healthy and clean air for everyone.
                                   n DO YOUR RESEARCH.
                                      Be sure you are aware of all the necessary steps to achieve a new policy ahead of time and have included
                                      each step in your strategy. Some health boards have to sign off on local policy initiatives. Some businesses
                                      require an employee vote on a new policy. Be prepared for these possibilities.
                                   n KNOW YOUR SCIENCE.
                                      Be sure that you have sound science based upon well recognized and accepted sources, such as the CDC,
                                      EPA, Journal of American Medical Association, etc. Do some research on opposition sources—are
                                      they ultimately funded by a group that receives funding from the tobacco companies, such as the Chelsea
                                      Research Group?
                                   n STICK OUT FOR THE STRONGEST POLICY.
                                      Tobacco industry allies may offer policy alternatives which are weak, confusing or complicated. These
                                      policies are often ineffective, hard to enforce and easy to ignore. Do not settle for a weakened, muddled
                                      policy—hold out for something stronger which truly protects the public health interest.
054
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This useful educational chart can assist you in thinking about responses to common tobacco industry views.




  WHAT THE TOBACCO INDUSTRY MAY SAY                       AN APPROPRIATE PUBLIC HEALTH RESPONSE

  People have the right to smoke.                         People have the right to breathe smoke-free air.

  Smoke-free ordinances are needless regulation           Smoke-free ordinances are public health laws similar to
  and government interference.                            drunk driving or traffic laws.

  Let common sense and courtesy dictate                   Common sense tells us that people should not be
  how people behave, not the government.                  exposed to carcinogens.

  Scientists are still debating the effects of            Established medical evidence proves that second
  environmental tobacco smoke.                            hand smoke kills.

  Smoke-free ordinances inconvenience adults.             Most adults, including smokers, support smoke-free
                                                          ordinances.

  Smoke-free ordinances hurt businesses                   Virtually all research shows that smoke-free
  economically.                                           ordinances are good for the bottom line and do not
                                                          harm business.

  Smoking is an issue of personal freedom.                Smoking is a documented chemical addiction. Most
                                                          smokers want to quit. Nonsmokers must have the
                                                          freedom from exposure to cancer causing smoke.

  Improved ventilation technology makes smoke-            Science has not demonstrated any safe level of
  free policies unnecessary.                              exposure to ETS. Also, national ventilation standards
                                                          (ASHRAE 62-1999) do not allow for smoking in the
                                                          vast majority of public venues. At best, ventilation
                                                          technology only removes the smoke odor and irritation.

                                                                 (Modified from the American’s for Nonsmoker’s Rights “Clearing the Air”)




                                                                                                                                        055 ets community change toolbox




                                                                                                                                 k
                                         In their own words...                                                 ]
                                Even in the face of mounting evidence that ETS is harmful, toxic and carcinogenic, the tobacco industry still challenges the
                                validity of the science.

                                “In our view [ETS] appears to be an area of exaggerated           concern... the question is not really one of      a
                                health hazard but perhaps more of an annoyance.”
                                                                                                           (British American Tobacco (BAT) 1977)
                                “No conclusive proof exists to support the claim that exposure to environmental tobacco smoke in public
                                places is a health risk to non-smokers.
                                                                                                                      (The Tobacco Institute 1989)
                                “There is no statistical evidence linking passive smoking to lung cancer.”
                                                                                                      (Tobacco Manufacturers Association 1998)

                                “If children don’t like to be in a smoky room, they’ll leave ,” said an RJ Reynolds CEO. When asked by a
                                shareholder about infants who can’t leave a smoky room, he stated, “At some point, they begin to crawl.”
                                                                                                                            (R.J. Reynolds 1996)

                                Internal documents, now available on-line, reveal tobacco companies’ true knowledge of the science of ETS, as well as the
                                powerful economic effect smoke-free policies have on cigarette sales.

                                “What the smoker does to himself may be his business, but what the smoker does to the non-smoker is quite a
                                different matter…This we see as the most dangerous development yet to the viability of the tobacco
                                industry that has yet occurred...The strategic and long run antidote to the passive smoking issue is, as we see
                                it, developing and widely publicising clear-cut, credible, medical evidence that passive smoking is not harmful to
                                the non-smoker’s health.”
                                                                                                                           (US Tobacco Institute 1978)

                                “All allegations that passive smoking is injurious to the health of non-smokers, in respect to the social cost of
                                smoking as well as demands for no smoking areas in public places, should be countered strongly.”
                                                                                                                                       (BAT 1982)

                                “Philip Morris are proposing, in key countries, to set up a team of scientists organized by one national
                                coordinating scientist and American lawyers, to review scientific literature or carry out work on ETS to
                                keep the controversy alive. . .Their idea is that the group of scientists should be able to
                                produce research or stimulate controversy in such a way that public affairs people in the relevant countries
                                would be able to make use of, or market the information...”
                                                                                                                                         (BAT 1988)
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                                Review of industry documents points out consistant themes and strategies.

                                “Publicly, the tobacco industry has denied that exposure to ETS has been proven dangerous to health. It has
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                                criticized the methodology of published research on ETS, even when its own consultants have privately
                                acknowledged that the research was valid. In addition, the industry has funded scientific research with the stated
                                purpose of anticipating and refuting the evidence against ETS.”
                                                                                                     (Journal of American Medical Association 1995)

                                “A director of the analytical chemistry division at Oak Ridge National Labarotory received more than $1 million
                                from the Council for Tobacco Research (CTR) and the Center for Indoor Air Research (CIAR).”


                                                                                                                                                        k
                                                                                                                                   (Science 1996)
106 review articles on the health effects of passive smoking were identified. Of these, 94% of those written by
tobacco industry-affiliated authors concluded that passive smoking is not harmful, compared to only 13% of the
75 reviews by authors without any tobacco industry affiliation. These findings suggest that the tobacco industry
may be attempting to influence scientific opinion by flooding the scientific literature with large numbers of
review articles supporting its position that passive smoke is not harmful to health.
                                                                       (Journal of American Medical Association 1998)

Bennett LeBow of the Liggett Group testified in Philip Wiley’s lawsuit against the tobacco industry that he believes
cigarettes are addictive. When asked about the Environmental Protection Agency (EPA)’s estimate that 3,000
nonsmokers die from lung cancer per year as a result of secondhand smoke exposure, LeBow stated he
had “no reason to disagree with that.”
                                                                                             (Indianapolis Star 1998)

“As smokefree air policies become more prevalent ...across the country, tobacco companies and their allies
devise new variations of old tricks to thwart smokefree air efforts. Accommodation, Red Light-Green Light,
Peaceful Coexistence or however the program is branded, these ... tactics all have the same goal- to
stifle clean indoor air campaigns by creating the appearance that the problems relating to secondhand
smoke are addressed without actually creating smoke-free places. However [these] are public relations solutions
that only serve the tobacco industry purpose of derailing the enactment of smoke-free air
policies; they do nothing to address health hazards of secondhand smoke or to protect
nonsmokers from secondhand smoke. The tobacco industry plan to fight clean indoor air ordinances is explained in
an internal Philip Morris strategy memo entitled “Conceptual Framework of Comprehensive Public Smoking
Program.”... Philip Morris lays out ... its plan to derail clean indoor air regulations, and ventilation is a major
component. The stated goals of the plan are to defeat mandatory and voluntary smoking restrictions and to slow
the decline of social acceptability of smoking.”
                                                                                  (Americans for Nonsmokers Rights 2001)



SCIENTIFIC LINKS
ANR web site:
   http://www.no-smoke.org/shenanigans.html

CDC web site:
   http://www.cdc.gov/tobacco/industrydocs/index.htm

Links to tobacco industry documents:
    http://www.tobacco.neu.edu/apact/doclinks.htm

The Brown and Williamson Documents. Journal of the American Medical Association, July 1995
     http://jama.ama-assn.org/

Chelsea Group and Industry Connection
    http://www.no-smoke.org/images/ and look for image number 2024207276_7281
    or information specific to clean indoor air: http://www.invironment.com/inv_news.htm#top
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ets community change toolbox   058
                                     Notes

				
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