Tobacco Documents Online

C Appendix B ~~~~~

. Special Communication a The Politics of Local Tobacco Control Bruce Samuels, Stanton A. Glantz, PhD Until the nonsmokers' rights movement, tobacco control activity was at the federal.or state levels, which is where the tobacco industry dominates. Since the appearance of the nonsmokers' rights movement, progress in tobacco control has occurred primarily at the local level. In response to the success of this movement, the tobacco industry has developed "srnokers' rights" groups and other tactics to fight local legislation. Several recent local campaigns in California illustrate these tactics. Tobacco control forces follow many paths, from sitting on the sidelines to making a serious commitment to smoking control legislation. Despite the tobacco industry5 superior financial resources, the outcome of proposed local tobacco control legislation appears to depend on how seriously the health advocates mobilize in support of the local legislation. When the health community makes a serious commitment of time and resources, it wins. When it fails to make such a commitment, the tobacco industry prevails, more by default than by its superior financial resources. cJA.AlA. 19912662110-21 l 7) BEFORE the emergence of the non- smokers' rights movement, -.•irtually all legislative and regulatory activity relat- ed to tobacco took place at the federal and state levels. The tobacco industry combined its money and lobbying skills to maintain an impressive record of po- For editorlat comment see p 2131. litical victories:" In contrast, the non- smokers' rights movement emerged around the country during the 1970s as a grass-roots campaign.' In 1981, after several unsuccessful attempts to enact state legislation in California, one such grass-roots nonsmokers' rights group organized as Americans for Nonsmok- From the Department o1 Medicrtu and the tnstitute for lieatth Policy Studies. University of California. San Frarxisco. The opinions expressed in this article are those of the authors alone and do not necessarily reflect the indivrd- uats and orpanizations who graciously assisted in this research. Reprrnt requests to Division of Cardiolopy. Room 11 86M. Box 0124. University of Ca/dorna. San Francis- co. CA 94143-0124 (Dr Glantz). 2110 JAMA, October 16.1991-Vo1266. No 15 ers' Rights t.o promote local legislation in Californizand elsewhere. They be- lieved that local legislators would be more sensitive to constituents and less responsive t.o campaign contributions and pressurte from out-of-town tobacco industry lobbyists.'-' This strategy suc- ceeded. By 1986, more than 75 ordi- nances had been enacted in California alone.' Nationaide by 1990, over 400 local ordinances had been passed.' Recent local campaigns in California illustrate the tobacco industryis strate- gy at the local level and its successes and failures. At first, the tobacco industry tried to use the same lobbying tech- niques at the local level that worked at the national level, with little success. 7b counter the nonsmokers' rights move- ment, the tobacco industry has devel- oped new strategies for the local level. This article reports the results of sev- eral case studies in California that illus- trate these strategies and how the health comr.iunity has responded to them. These case studies were conduct- ed by attending public hearings, re- viewing newspaper articles, analyzing financial disclosure statements, review- ing materials distributed by the tobacco industry, health groups, and associated organizations, and interviewing partici- pants (local officials, business represen- tatives, restaurant owners, health agency employees, tobacco control ac- tivists, tobacco industry lobbyists, smokers' rights activists, and journal- ists). While these case studies are all from California, they are representa- tive, to a greater or lesser degree, of activities throughout the United States. A few key people with ties to the to- bacco industry are appearing in commu- nities throughout California to ward off local ordinances controlling tobacco. These individuals often attempt to con- ceal their tobacco industry ties by creat- ing "front" organizations. The most in- tensive effort has been the organization of smokers into a "grass-roots" move- ment to oppose local legislation. Addi- tionally, tobacco industry interests have played a significant role in creating pseudo business coalitions to fight spe- cific ordinances. The industry and its front groups make unsubstantiated claims to sway public and decision-mak- er opinions in their favor. In contrast to the tobacco industry's systematic actavity, the tobacco control advocacy groups have followed many different paths, from watching from the sidelines and making little effort to in- tervene to calling the plays and guiding the decision makers through potential obstacles. Despite the tobacco indus- try's superior financial resources, en- actment of a specific local ordinance de- pends not on the tobacco industry but on how seriously the health advocates mo- bilize in support of the legislation. When the health community makes a serious commitment of time and resources, it wins, but when the health community Politics of Local Tobacco Control-Samuels 8 Glantz Reprinr.O from •l4MAc 71ro Joumal of tM Ameriun A/.dicu/ Association OctcON 76. 1291, Volume 266 CopyripNt 1997. Am.rican Modreal Associahon

( I fails to make such a commitment, the fact that it had little credibility with the tobacco industry prevails, more by de- public. A national poll that waa conduct- fault than because it has superior finan- ed for the Tc,bacco Institute in 1978" cial resources. highlighted the tobacco industry's prob- CREATING THE SMOKERS' RIGHTS MOVEMENT The emergence of nonsmokers rights and environmental tobacco smoke (ETS) as important public issues, par- ticularly since the 1986 Surgeon Gener- alb report on passive smoking,' has cre- ated a serious problem for the tobacco industry The 1990 Environmental Pro- tection Agency (EPA) draft report' that identified ETS as a class A (known hu- man) carcinogen and the 1991 report' that implicated ETS as a cause of heart disease have increased popular pres- sure for restrictions on smoking. In- creasing restrictions on smoking in pub- lic places to protect nonsmokers from the toxins in ETS undermines the social acceptability of smoking. Decreasing the social acceptability and mandating restrictions on where and when one can smoke, in turn, discourage children from starting to smoke and facilitate adults' decisions to cut down or stop smoking.' While generating significant health benefits for smokers and non- smokers, this drop in cigarette con- sumption translates into fewer sales and lower profits for the tobacco industry.10 As the tobacco control groups, backed by increasingly compelling sci- entific evidence, have become more for- midable adversaries at the local level, the tobacco industry has recognized the need to place more emphasis on battling local legislation. In 1986, Raymond Pritchard, chairman of the board of Brown and Williamson Tobacco said: Our record in defeating state amoking re- strictions has been reasonably good. Unfor- tunately, our record a-ith respect to local measures ... has been somewhat less en- couraging. We must somehow do a better job than we have in the past in getting our side of the story told to city councils and county commissions. Over time, we can lose the bat- t!e over smoking natrictiotta as decisively in bits and piueea-at the local leve(-aa rrith atate or jedcr+al measures [emphasia added)." Since then, the tobacco industry has moved aggressively to counter the pop- ular local pressure for smoking restric- tions by seeking to develop its own grass-roots "smokera' rights" move- ment. In 1990, RJ Reynolds chief execu- tive James Johnston stated, 'his is something I wish we had done a decade ago "u By attempting to counter grass-roots pressure for nonsmoker protections, the tobacco industry had to confront the JAMA. October 16.1991-Vol 266. No.15 lem; it concluded that "favorable atti- tudes toward the tobacco industry are at their lowest ebb," and "more people say they would vote for than against a political candidate who takes a position favoring a bfm on smoking in public places." Another study done for the Tb- bacco Institute in 1982" found that overt industry opposition to proposed non- smokers' rights legislation actually in- creased support for the legislation: "Knowledge of tobacco company sup- port (on an is-sue] does move a signifi- cant number of respondents into the 'yes column (supporting a nonsmokers rights measureJ." In 1989, of nine na- tionally recognized special interest groups, the 7bbacco Institute had the lowest public credibility and the most negative ratings."As a result, the insti- tute's lobbyist.s tried to stay out of pub- lic view. For example, the Tobacco In- stitute's West Coast lobbyist, Ron Saldana, attended hearings on local smoking control ordinances but rarely testified publicly; when asked why, he said, "I've learned from experience that as soon as I'm identified as a representa- tive of the Tobacco Institute, I lose all credibility. Tt ey just sneer us away ... so I try to work behind the scenes when- ever I can."" The industry-created smokers' rights groups provide a local identity and mechanism for funneling tobacco industry resources into the fight against local legislation without the overt appearance of the tobacco industry. Philip Mon-is and RJ Reynolds, the two dominant US cigarette manufactur- ers, both hav<>e active programs to iden- tify smokers and mold them into a politi- cal force to counter genuine grass-roots pressure for nonsmoker protections. These progrbsns use major computer databases, professional public relations firms, sophisticated telephone and mail campaigns, and glossy publications. Smokers have been identified over the past few years through rebate coupons and correspondence with the tobacco companies. Philip Morris has a database with 12 million smokers that includes information on their jobs and on their history of po;utical involvement." Nei- ther company will disclose how much money it has devoted to the smokers' rights effort.' The cigarette manufacturers use pub- lications such as Philip Morris Maga- zine and newsletters such as Smokers' Advocate (PMlip Morris) and Choice (RJ Reynolds) to recruit'and "educate" smokers. In 1988, Philip Morris Maga- zine claimed it had 11 million nonpaying readers, making the magazine, accord- ing to the company, the nation's fifth largest periodical. Smokers are encouraged to become a politically active force by signing peti- tions, writing letters, making phone calls, and showing up as a group at city or county meetings where smoking re- strictions are being discussed.'Ibll-free telephone numbers are used to assist individuals in reporting pending legisla- tion and to oppose it. When the compa- nies receive notice of a proposed ordi- nance, an "Action Alert" or 'Priority Letter" is sent out to the local people on the database to mobilize action against the ordinance. In the past 3 years, RJ Reynolds and other tobacco companies have claimed to establish at least 600 smokers' rights groups across the country." Using the company's mailing list, the meetings are publicized to local residents and are or- ganized using a network of political consultants. For example, RJ Reynolds consul- tant Tim Pueyo of San Francisco,.Calif, who is active throughout northern Cali- fornia, held an organizing meeting in Eureka, Calif, on September 25, 1990, which was attended by approximately 40 people. Pueyo encouraged the smok- ers to organize a grass-roots group to meet once a month. He told the group to contact him if they heard about any smoking restrictions in the area, so that he could come in and help the group get organized to defeat the ordinance. He called the nonsmoking activists "hypo- chondriacs," and he sought to under- mine the scientific evidence that ETS is dangerous" by stating, "The health question is extremely debatable." He told the group that RJ Reynolds could not give out free cigarettes because it would then be considered to be pa,ving the participants to come, but that it aas legal to distribute ashtrays and lighters. Pueyo also suggested a catchy name for the group, such as TUFF, Taxpayers United for Fairness. In June 1990, a group called TUFF Taxpayers United for Freedom was formed in Lodi, Calif, 400 km southeast of Eureka, to oppose a nonsmoking ordi- nance being considered there." (After failing to stop the Lodi City Council from passing the ordinance, TUFF mounted an unsuccessful campaign to have it repealed in a referendum.) The TUFF group claimed to be a grass-roots organization with no ties to the tobacco industry. Adam Dados, a spokesperson for the group, said, "We've only re- ceived some ashtrays and lighters from the tobacco companies." The smokers rights campaign is Politics of Local Tobacco Control-Samueis 3 Glantz 2111

ing .rd- ( I" h ie a eti- )ne hty re- roe •..rt sla- pa- -di- ity •on nst md red hts :he are or- t) is clearly a new fi.xture on the tobacco con- trol scene, which must be anticipated in any tobacco control effort. It is also rea- sonable to expect the tobacco industry to continue to build on to its database and become more sophisticated in its use. Referendum campaign organiza- tions, such as Sacramentans for Fair Business Policy, are also created by the tobacco industry in an attempt to over- turn ordinances enacted by a local legis- lative body. By forcing a referendum, the industry seeks to move decision making away from the elected body that approved the ordinance to a vote by the public, in hope that the industry's supe- rior financial and advertising clout will influence the decision process. 7b date, however, all attempts by the tobacco industry to overturn nonsmokers' rights legislation by referendum have failed."'° BEVERLY HILLS, CALIF In addition to smokers' rights groups, the tobacco industry has also created groups with names suggesting that they are independent business or restaurant coalitions, such as the Beverly Hills Restaurant Association (BHRA), to lobby local legislators on specific ordi- nances without divulging the nature or extent of their ties to the tobacco indus- try. Similar to smokers' rights groups, these organizations provide a local iden- tity and mechanism for the tobacco in- dustry to allocate resources against lo- cal legislation. Beverly Hills, Calif, illustrates how the industry has used such organizations. In 1987, the Beverly Hills City Coun- cil proposed a 1009E smoke-free require- ment 'for the citys restaurants. This would have been only the second such ordinance in the country and the first in California. For the proposal to become law, the city council had to approve it on two readings. At first reading, the ordi- nance passed unanimously without strong public opposition. Between the first and final city council vote, the To- bacco Institute hired a political consul- tant, Rudy Cole, to create the BHRA to oppose the ordinance." The 4bbacco In- stitute's role in creating the BHRA was not disclosed at the time. At the second reading, Cole appeared as spokesper- son of the newly formed BHRA to pro- test the ordinance. Nonetheless, the city council unanimously voted in favor of a smoke-free restaurant ordinance. Michael Kantor, one of the most prominent attorneys in the politically influential law firm of Manatt, Phelps, Rothenberg, and Phillips, was hired to represent the BHRA, with the legal bills being paid by the Tbbacco Insti- tute.' The BHRA attempted to get a temporary court order to stop the im- plementation of the ordinance; howev- er, the effort failed.° Kantor then filed a lawsuit against 'the city claiming that the ordinance was unconstitutional, dis- criminatory, and disastrous for busi- ness. This action also failed.' Having failed to void the law in court, the BHRA claimed that restaurants had suffered a 30%drop in business after the ordinance went into effect.' This claim was never challenged or investigated by the health community, despite the fact that only about 25% of adults in Califor- nia smoked at that time. As a result, the report of a serious impact on business was widely accepted. Four months after the ordinance ~x•as enacted, the city council, at the urging of the BHRA, voted five to zero to allow restaurants to establish smoking sections of up to 40% of their seating. The tobacco industry claimed a victory because the Beverly Hills experiencre represented the first time a nonsmokers rights ordinance that was on the books had been weak- ened after it was enacted. The fact that the industry worked through the BHRA to mobilize local restaurants, rather than directly appearing as the Tbbacco Institute, played an important role in its success. LOS ANGELES, CALIF Three years later, the Los Angeles City Council oonsidered an ordinance similar to the original Beverly Hills or- dinance, which would have prohibited smokingg in all restaurants. In 1990, Councilman Msuroin Braude introduced the ordinance because of concern raised by the EPA report that identified ETS as a class A carcinogen.' In Los Ange- les, the tobacco industry's campaign against the ordinance illustrates the ef- fective use of both a front group and direct lobbying by the tobacco industry. These activities by the tobacco indus- try, combined with the failure of the health community to organize effective- ly in support of the ordinance, contrib- uted to its failure. Just as in Beverly Hills, no Los Ange- les restaurant trade organization exist- ed prior to the ordinance's introduction. During the summer of 1990, after the ordinance was proposed, Rudy Cole created Restaurants for a Sensible Vol- untary Policy (RSVP)." As in Beverly Hills, the tobacco industry's involve- ment was not disclosed. However, after the final city council vote that defeated the proposal, Cole, under pressure from the media, acknowledged that RSVP received money from Philip Morris and from the Tobacco Institute, but he re- fused to say how much. The Tobacco Institute also refused to disclose the amount of money spent in Los Angeles. The RSVP group put together a pow- erful team in its effort to fight Council- man Braude's proposal. The group hired the same international public rela- tions and advertising fu-m that the To- bacco Institute, Philip Morris, and RJ Reynolds use (Ogil%y and Mather) and the same law firm that Philip Morris and the BHRA use (Manatt, Phelps, Roth- enberg, and Phillips). In fact, at the same time that the Los Angeles office of Manatt, Phelps, Rothenberg, and Phil- lips was representing RSVP, the Wash- ington, DC, office was busy dealing with the EPA on behalf of Philip Morris, try- ing to head off the EPA report' that motivated Councilman Braude in the first place. The tobacco industry also attempted to mobilize local smokers in Los Ange- les. During August 1990, a week prior to the first committee hearing, Philip Mor- ris sent a Priority Letter to local smok- ers listed in the companyls database, urging them to contact the mayor and city council members by phone or by "handwritten" letter to express opposi- tion to the -unprecedented, discrimina- tory legislatiori." The addresses and telephone numbers of the elected offi- cials were included, as well as "tallring points" that could be used in communi- cstions. A toll-free telephone number was given to answer any questions. On August 13,1990, the Emvronmen- tal Quality and Waste Management Committee, of which Councilman Braude was the chairperson, and the Arts, Health, and Humanities Commit- tee jointly considered the proposal to make all restaurants smoke-free. The RSVP group recruited restaurant oam- ers and civic leaders, such as the presi- dent of the Los Angeles Business Coun- cil, to testify at the hearing. Representatives of health groups, in- cluding the American Lung Association (ALA), American Cancer Society (ACS), and American Heart Associa- tion (AHA), testified in favor of the or- dinance. The committee voted three to one in favor of the proposal, directing the city attorney to write an ordinance to present to the full council. Having lost the first vote, Cole con- centrated on molding the restaurants into a political force. He recruited mem- bers through mass mailings, telephone calls, and personal visits. In September 1990, RSVP conducted a letter-writing campaign for restaurants to contact the city council members. The letters were compiled'and submitted to all the coun- cil members the day before the final vote. The text of most of the letters was exactly the same; all the restaurant 111 2112 JAMA. October 16.1991-Vol 266. No. 15 Politics ol Local Tobacco Controd-Samuels & Glantz

I owner had to do was sign and post it, with RSVP sending out petitions to res- taurants for employees and customers to sign in opposition of the proposal. To persuade council members that such an ordinance would adversely af- fect business, RSVP hired Laventhol and Horwath, one of the six largest na- tional firms of certified public accoun- tants, to conduct an economic irrpact study of the proposed ordinance.s' The report w as made available to the council the day before the vote. The study com- pared Beverly Hills restaurants' sales during the 3 months of a smoke-free ordinance in 1987 and the same 3 months of the previous year and found an aver- age decrease in business of 6.7%. The discrepancy between this figure and the 30% that the tobacco industry continues to use was never explained. Based on the Beverly Hills data, the study pro- jected a 5.5% decline in sales in Los Angeles and 3300 fewer jobs. According to the report, Los Angeles could also lose about E 1.5 million a year in sales tax revenues and $148 million in business. Councilman Braude questioned the ac- curacy of these conclusions, but because the report w asn't released until the day before the vote, it was not subjected to any independent scrutiny. At the public hearing on the ordi- nance on October 16, 1990, RSVP claimed to represent 1000 of the approx- imately 8000 restaurants in Los Ange- les. A roster that was provided to all council members the day before the vote listed only 440 restaurants. In a survey of a sample of those 440 restaurants, 88 (20%) stated that they were not mem- bers of RSVP." The funding of RSVP is also in ques- tion. While admitting to taking money from the tobacco industry, RSVP claimed to be financed substantially from its members. Cole said that there is a membership fee of $10 for smaller restaurants and between $100 and S500 for larger restaurants. However, in a survey of restaurants listed as members of RSVP, only 13% said they had con- taibuted money. Thus, even if all the restaurants that contributed to RSVP donated the Eb00 maximum, this would yield only E28 600." To employ an ex- pensive law firm and an international public relations firm, in addition to the costs of mailings to restaurants, the La- venthol and Horwath study, and Cole's salary, the budget for RSVP must have substantially exceeded the donations from restaurants. Funding and expen- diture disclosure for RSVP is not re- quired by law because RSVP repre- sents itself as a trade organization, not a lobbying group or campaign committee, so the precise role of the tobacco indus- JAMA. Actober 16.1991 - Vol 266. No.15 try cannot be determined. In addition to campaigning through RSVP, the tobacco industry directly lobbied council members. For example, council members were contacted by Alma Fitch, a lobbyist on retainer aith Philip Morris," who encouraged a nega- tive vote on the ordinance. The tobacco industry also made campaign contribu- tions to several members of the city council (;Cable 1). On October 16, 1990, the city council heard testimony on the proposal. Citing the health evidence against ETS, the Los Angeles County Medical Associa- tion, the AHA, the ALA, the ACS, and Americans for Nonsmokers' Rights, among others, urged the council to vote for the proposed smoke-free restaurant ordinance. During the hearing, Cole openly con- sulted with tobacco industry represen- tatives, including consultant Fitch and Tbbacco Institute lobbyist Saldana. Two Ogilvy and Mather employees were present to assist in the planning, pass out press releases, and organize a press conference immediately following the vote. In testimony against the ordi- nance, RSVP organized restaurateurs, business groups, and a representative of a hotel and restaurant w orkers union. The RSVP group banked heavily on the argument that smoke-free restaurants would cause a drop in business, result- ing in layoffs and lost revenue. The council voted six to six; propo- nents fell two votes short of the neces- sary eight for passage (three council members were absent). The tobacco in- dustry succeeded, via RSVP, in defeat- ing the ordinance. Los Angeles is an example where elected officials, rather than health pro- ponents, were the key force behind the proposal. Although the voluntary health agencies testified at both hear- ings, there was no substantial attempt to mobilize support for the ordinance among their membership. In fact, a community health coalition was not formed to push for the ordinance until the final hours before the vote. In con- trast to the voluntary health agencies, the grass-roots lobbying group-Amer- icans for Nonsmokers Rights-mobi- lized its local membership in a letter- writing campaign. This campaign, while not effective enough to secure passage of the o:rdinance, did influence some votes; Councilman Zev Yaroslavaky re- ported that the ratio of his mail in sup- port of the ordinance was 20:1.s The lack of sustained activity by the health community contributed to the proposal's defeat. Arias stated that the three voluntary health agencies spent only 11/2 days actively lobbying for the Table 1.-Los Mpebs (CaIH) Clly Council MerrM bers' Receipt of Tobacco Industry Money.nG Their Vote on the Proposed Ordinance to Prohibit Smok• kp in AII Restaurents• ouncil Members Tobacco InMwtry Gmpalpn Contrlbutfona, S ote Nate HolOen 1000 No Michael Woo 1000 No Gkxia Molina 900 No Richard Alarorre soo Abserrt Halaernsen 500 No Robert FarntM 500 Yes John Ferraro S00 No .by Picus 6oo Yes Ernara Bernardi 0 Yes Marvin Brautle 0 Yes Joan MNke Fkxes 0 Absent Ruth Ga4nlar 0 Yes GNben UnOsay 0 Absent Joe/ Wachs 0 No Zev Yaroslevsky 0 Yes 'From January 1. 1969, through December 31. 1990 s•" The vote was taken on October 16.1990. ordinance: "If we had 2 weeks of full- time effort, then we could have had more success." If the health agencies had formed a Los Angeles community coalition and had mobilized all their vol- unteers and members, perhaps the pro- posal would have passed, despite the effort made by the tobacco industry. SACRAMENTO, CALIF At about the same time as the Los Angeles vote, the city and county of Sacramento, Calif (two distinct political entities), each enacted strong ordi- nances prohibiting smoking in all public and private workplaces and all public places, including restaurants. In con- trast to Los Angeles, where there was ineffectual activity on the part of the health agencies, in Sacramento the ALA prompted the ordinance and took an active role in shaping the law and ensuring its passage. The Foundation for Action The most significant factor in Sacra- mento's success in passing this progres- sive tobacco control law was the strong connection between the ALA and com- munity leaders. The ALA has recruited influential civic leaders from various backgrounds to serve on its 35-member board of directors. It was no coincidence that a county supervisor, a city council member, and the chairperson of the En- vironmental Commission-individuals who were instrumental in passing the ordinance-had served as volunteers or staff members of the Sacramento ALA. The strength of their influence was illus- trated by the pivotal role they played in strengthening the existing smoking ordinance. Politics of Local Tobacco Control-Samuels & Glantz 2113

l a I r Although Sacramento city and county had enacted a uniform smoking ordi- nance in 1984, in recent years the ALA's legislative committee grew concerned about the inadequacies of the existing ordinance in light of new information about ETS. The ALA asked the Envi- ronmental Commission, an organization responsible for advising the city and county on environmental issues, to ad- dress the issue of passive smoking, par- ticularly in regard to smoking in the workplace. Rob McCray, chairman of the com- mission, attorney, and former volun- teer for the ALA, appointed a task force that included the three voluntary health agencies (ALA, AHA, and ACS), the Sacramento Restaurant Association (a bona fide organization of restaurants), the Chamber of Commerce (one repre- sentative from small business and one from large business), Arco Arena (the indoor sports arena), Pacific Gas & Electric (a major employer), and the airport. The health advocates on the task force successfully pushed to recommend a total nonsmoking policy in the work- place. They also wanted to increase the percentage of nonsmoking seats in res- taurants from a minimum of 10% (under the previous ordinance) to 50%. The Sacramento Restaurant Association eventually accepted a 50% nonsmoking requirement for all restaurants. Addi- tionally, the task force decided to rec- ommend a smoke-free environment for the airport, supported by the airport representative. The task force recommendations went to the Environmental Commis- sion, and the commission held public hearings on them. Significantly, the Chamber of Commerce, an organization representing 26001ocal businesses, en- dorsed the recommendations of the En- vironmental Commission. McCray was expecting the Chamber of Commerce to protest the requirement for smoke-free workplaces. The Chamber of Com- merce had invited the Tobacco Insti- tute, the Sacramento Restaurant Asso- ciation, and the ALA to a committee meeting to decide whether to support the recommendations. No strong oppo- sition from businesses was expressed. In fact, some business representatives voiced support for the ordinance. The Tobacco Institute did not attend. With the support of the Chamber of Com- merce, the Environmental Commission recommendations went to the city coun- cil and the County Board of Supervisors. The only local group to publicly op- pose the Environmental Commission recommendations was Smokers' Rights of Sacramento, a group that had been formed in October 1988. On June 12, 1990, the organization sent letters to people in the county, urging them to "write a short personal letter to your county supervisor that says smoking bans are unreasonable and current smoking restrictions are tough enough." Each letter included the name, address, and telephone number of the supervisor for their district. At the County Board of Supervisors meet- ing on September 11, 1990, the presi- dent of Smokers' Rights of Sacramento presented 8300 signatures of persons opposed to the ordinance.'° Throughout the process, the task force, the ALA, and the Environmental Commission kept in close contact with the elected officials to find out what pro- visions wotild be supported. In addition to providing suggestions based on other cities ordinances, the task force collect- ed data about the health effects of pas- sive smoldng. Fact sheets were com- piled and newspaper articles were collected to present to the elected offi- cials. Consequently, the decision mak- ers were extremely aware of the scien- tific evidence concerning the health effects of' ETS and the options being considere d. The Ordinance At the! hearing before the County Board of Supervisors, the tobacco in- dustry flr>.w in some of their "expert wit- nesses" who frequently testify before legislative bodies. Among those from out of town who testified in opposition to the ordinance were Gan• Robertson of Fairfax, Va, who minimized tobacco smoke as a significant cause of indoor air pollution; David Weeks, a physician from Boise, Idaho; Malinda Sidak, an attorney from Covington & Burling in Washington, DC, who represented the Tobacco Institute; and John C. Fox, an attorney from San Francisco. When it came to voting, County Su- pervisor Sandy Smoley, a registered nurse and volunteer for the ACS, op- posed the ordinance, saying during the hearing that if the county approved such stringent measures against smoking then it should also "outlaw alcohol and fatty foods and mandate that everyone ride their bikes." Supervisor Toby Johnson agreed, "It's almost a 'Big Brothe:r' approach to government."° In cantrast, Supervisor Jim Streng, former president of the ALA Board of Directors, who said he is normally one to support the rights of individuals, found the testimony by the voluntary health agencies (ALA, ACS, and AHA) and physicians to be particularly per- suasive. Supervisor Grantland Johnson 2114 JAMA, October 16.1991-Vo1266. No. 15 also cited the health evidence and the encouragement by the health coalition as the key factors in con.incing him that they were dealing with a serious public health issue. Citing the need to protect the health of workers in the workplace, Supern•isor Streng first proposed to strengthen the Environmental Commission 's. recom- mendation for restaurants from a 50% nonsmoking requirement to a smoke- free restaurant policy. Originally, a smoke-free restaurant requirement was not advocated by the health coali- tion because they thought it would be too contentious, thus endangering the entire ordinance. Some of the city coun- cil members and county supen-isors thought that if ETS was such a health hazard, the goal should be the elimina- tion of smoking in all public places, in- cluding restaurants. Over the protest of the Sacramento Restaurant Associa- tion, a staging process w as proposed for restaurants whereby during the initial months of the ordinance, the require- ment would be 50%, increasing to 75%, and, finally, a 100% nonsmoking re- quirement for all restaurants. Staging was seen as a means of allowing custom- ers and restaurateurs to gradually ad- just to the goal of smoke-free restaurants. On October 2, 1990, the County Board of Supervisors passed the ordinance by a vote of three to two. One week later, on October 9, the city council passed a nearly identical ordinance by a vote of eight to one. Both ordinances prohibit- ed smoking in all workplaces, public and private; all enclosed public areas, in- cluding stores, banks, theaters, beauty shops, laundromats, and recreational facilities; public areas of hotels and mo- tels, except during private functions; restaurants, after a phase-in period (18 months for the city, 3 years for the coun- ty); the airport; hospitals and health care facilities; and child care facilities. Bars, residences, tobacco stores, and private clubs were excluded. The combination of encouragement and guidance from the ALA and public officials who were supportive of tobacco control formed the foundation for the passage of these comprehensive ordi- nances. The ALA had key players asso- ciated with it at all levels of decision making: the task force, the Em•uron- mental Commission, the County Board of Supervisors, and the city council. These individuals and groups were in- strumental in the process. Council Member Lynn Robie, a nurse and for- mer staff member of ALA, had priori- tized the smoking ordinance as one of her most important goals. Commenting after the city council vote about the lack Politics of Local Tobacco Control- Samuels & Glantz

C , Table 2.-Contributions to Saeranbntans Ior Fair Business Policy and Cigarane Martret Shares By the deadline, the county had re- us wrra ceived approximately 60 000 signa- &,a„ a tures. Enough were deemed valid to compa"r contriaewn, $' X d Total Company tn toe9, x~ force a referendum at the county level. FU Fler^okiS 134 4U 36 29 Philip Morris t24%3 33 42 &ow" and "fMia^bon 38 727 10 12 Arr+s^e." Brands 21569 B 7 t,orinare 15627 4 s uggen 0 0 3 Tob.coo ~e 32901 0 Call" Cigar Co 1000 0.2 Non-+ooaoeo aooroea 9150 2 Toui 373971 100 100 Supervisor Streng said that they could have had many of the county petitions invalidated because the person who signed thc bottom of the form most like- ly did not witness every signature, as required, particularly in restaurants where the petitions were left at the re- ception stand. He decided not to protest and to let the voters decide in the next county wide election, probably in 1992. •Data trom Saaa"rsnuns /or Fair Bwinass FroGCy Vale Of the 31135 signatures submitted to " the city, not enough were valid to make the 19 334 minimum required to force a referendum vote. As a result, the cit}''s of lobbying by the industry at the city firm, to fulfill legal obligations. Vigo ordinance went into effect on December level, Mayor Anne Rudin stated,'They Nielson, of the aforementioned law 14,1990. probably gave up." firm, has been a key player for the to- From December 14, 1990, to March The Referendum bacco industry in California for over a 31, 1991, there were 164 complaints of decade. The firm also represents the noncompliance registered by the en- The tobacco industry had not given lbbacco Institute, five tobacco compa- forcement agency, the Environmental up. nies (Philip Morris, RJ Reynolds, Loril- Health Division of the Environmental On October 3,1990, the same day that lard, Brown and Williamson, and Amer- Management Department. When a the County Board of Supervisors ican Tobacco), the California complaint was received, a letter was passed the ordinance, the Zbbacco In- Association of Tbbacco and Candy Dis- sent to the offender with a copy of the stitute loaned $20 000 to a referendum tributors Political Action Committee, ordinance. Ken Stewart, the enforce- campaign committee that had not yet and the California Medical Associa- ment officer, says that the ordinance is been formed." On October 5, 1990, 3 tion."This firm has been paid more than largely self-enforcing; no citations have days after the County Board of Supervi- $1 million by tobacco interests for lobby- been issued. According to Stewart, sors vote and prior to the city council ing since 1985.° "Once people become aware of the law vote, Sacramentans for Fair Business Within 2 weeks, SFBP was using the and realize that we are not out to arrest Policy (SFBP) filed a statement of orga- tobacco money to distribute referen- smokers, they comply." nization to force a referendum on the dum petitions by mail. Despite being Mayor Rudin has found that city resi- smoking ordinances. Pueyo, the San organized and essentially fully funded dents are supportive of the ordinance. Francisco political consultant for RJ by out-of-state tobacco companies, Council Member Robie agrees; about Reynolds, was hired to run the cam- throughout the campaign SFBP 90% of the constituent correspondence paign for SFBP. That same day, RJ claimed to be a local independent orga- she has received has been in support of Reynolds contributed almost half of its nization. In an October 17, 1990, letter the ordinance. She also stated that total contribution of $134 000. As of De- addressed to "Dear Neighbor," Pueyo many employers are happy with the or- cember 31, 1990, SFBP had received wrote, "We're an independent coalition dinance because they have been in favor $375 971 in cash, loans, and services, of of smokers, nonsmokers, small business of a smoke-free workplace but have which only $9150 (2%) came from non- owners, restaurant workers, restau- been unwilling to establish their own tobacco interests (mostly restaurants) rant owners, and other concerned Sa- policy. Now if anyone complains, they (Table 2). The tobacco industry contri- cramentans." A. referendum petition can blame it on the city and county elect- butions highly correlate with their do- with instructions was enclosed in the ed officials. mestic market shares (r=.94; P=.005). envelope. Sam Manolakas, president of the Sac- While the tobacco industry has a long The county required 30 433 signa- ramento Restaurant Association, said history of spending large sums to op- tures and the city required 19 334 to that their strategy in the referendum pose nonsmokers' rights initiatives force a referendum vote. Most of the campaign will be to portray the ordi- sponsored by tobacco control advo- tobacco money went to a Sacramento nance as unfair to business. He also said cates,' the industry had only rarely at- company specializing in petition drives. that SFBP may put up its own ordi- tempted to overturn enacted ordi- The city clerk or Sacramento said that nance for the public to vote on, with a nances by referendum. In 1983, the signature gatherers were being paid $3 50% nonsmoking area in restaurants tobacco industry spent $1.3 million in an to $5 per signature, when $1 is usually and reinstatement of the old workplace unsuccessful attempt to overturn by considered a competitive rate. As in San policy that required "reasonable accom- referendum a workplace ordinance en- Francisco in 1983,° SFBP employed modation" between smokers and non- acted in San 1~'rancisco.° In 1984, the nonresidents a:c signature gatherers smokers. Using San Francisco as an ex- industry also lost at an attempt to over- from as far away as southern California. ample,'° Sacramento could be facing a turn a similar ordinance in Ft Collins, According to Mayor Rudin, California multimillion-dollar campaign. Colo. The referendum tactic then lay state law requins petition solicitors for It will be difficult for the tobacco in- fallow for 6 years, until it reappeared in a city referendum to reside in the same dustry to argue that the law is unpopu- Sacramento. jurisdiction. Mayor Rudin publicly lar or unworkable since the city ordi- The SFBP group hired Nielsen, questioned the legality of the out-of- nance has been working well. It is Merksamer, Hodgson, Parrinello, and town solicitors," but the district attor- expected that a steering committee will Mueller, a politically influential law ney did not take action. be formed to spearhead the effort in JAMA, October 16,1991-Vol 266. No. 15 Politics of Local Tobacco Control-Samuels d Glantz 2116

k support of the county ordinance. If the health agencies continue to exhibit the same commitment that was responsible for passage of the ordinance in the first place, then the referendum is likely to fail and the county ordinance will be- come law. METASTASIS The tobacco industry can be expected to persist in making unsubstantiated claims about the business consequences of smoking ordinances. In January 1991, after Cole departed, the BHRA (w hich had become an ongoing organiza- tion) stated that the 30% figure, which wa used in tobacco industry publica- tions, exaggerated the actual loss of business during the smoke-free ordi- nance. The Laventhol and Horwath study, which was commissioned by to- bacco industry-sponsored RSVP, clear- ly refutes the claim that restaurants suf- fered a 30% drop in business when the ordinance was in effect. In fact, Cole himself stated in April 1991 that busi- ness had decreased but not by 30%. Yet the tobacco industry persists in promot- ing this deception. Most recently, the Winter 1991 edition of Philip Morris Magazine stated, "Business in the city's restaurants dropped 30%.'w No docu- mentary evidence has ever been prov id- ed to support the 30% claim. As more cities in CaliSornia and else- where propose smoking restrictions in public places, tobacco industry-spon- sored RSVP, or similar organizations, continues to appear on the scene to fight the measure. Since successfully oppos- ing the Los Angeles ordinance, Cole has traveled to various other communities and to the state legislature to testify on bills that would restrict smoking in res- taurants. According to an RSVP press release, RSVP has expanded into "a statewide organization formed to op- pose restrictive prohibition on smoking in restatuants."" Cole does not disclose his ties to the tobacco industry in testi- mony or in statements issued by RSVP; he simply claims to represent concerned restaurants. Los Angeles restaurants, Cole insists, pay for his travel expenses to communities throughout California, such as Auburn, Walnut Creek, San Luis Obispo, Bellflower, Sacramento, and Lodi. Meanwhile, a new group has formed with connections to RSVP. The Califor- nia Business and Restaurant Alliance, based in Los Angeles, has been involved during April and May 1991 in organizing opposition to proposed ordinances in Walnut Creek and Contra Costa County in northern California. The leader of the group, Fred Karger, formerly of RSVP, has been contacting businesses, 2116 JAMA. October 16.1991-Vo1266. No.15 restaurants, and government officials in these communities. Another individual who represents the group, Peter Gam- bee, organized a press conference in Walnut Creek in May. They claimed to be a grass-roots organization, yet they shared the same telephone number as RSVP." Karger has declined to answer questions concerning tobacco industry funding for the group.° Another person who continues to be active on behalf of the tobacco interests is Pueyo. While traveling throughout the state to organize smokers' rights groups for RJ Reynolds, he has also led the referendum drive in Sacramento and has made an interest-free loan to the TUFF organization, which is spon- soring a referendum effort against an ordinance in Lodi. He also became in- volved most recently in Walnut Creek. When asked if he would attend the Wal- nut Creel: hearing, Pueyo said that he would not. "As soon as someone on the council asks if there are any representa- tives from the tobacco industry here, I'd have to stand up. I could see the head- lines in the next day's paper,'Big'Ibbac- co Bucks in Walnut Creek.:` Besides the consistency observed in the individuals the tobacco industry is using to fight its battles at the local level, it is also important to note that the industry repeatedly hires a small num- ber of prominent firms to represent it. Tfie involvement of the Manatt, Phelps, Rothenberg, and Phillips law firm and of the Ogih•y and Mather public rela- tions and advertising firm at both the national and local levels, as well as the involvement of attorneys associated with Vig:i Nielson's firm in tobacco in- dustry-funded initiative and referen- dum drives and tobacco lobbying over the past 13 years, illustrate how the industry uses the same agents to repre- sent its interests in different jurisdictions. CONCLUSIONS As the tobacco industry continues to successfiilly battle tobacco control legis- lation at the state and national"' levels, the local level has become increasingly important for both sides. While national and state efforts by the tobacco industry continue to concentrate on campaign contributions and lobbying, which are less effective at the local level, the in- dustry has developed a nationwide strategy to counter local tobacco control efforts. (The tobacco industry still works to exploit its strength in state legislattu•es by pushing for weak state legislation with a preemption clause that ovvrturns or prevents passage of strong tobacco control legislation at the local level. Philip Morris also has an ag- gressive nationwide campaign under- way to make smoking a civil right through state legislation outlawing em- ploy~ment decisions based on smoking status.) The industry strategy for di- rectly opposing local legislation includes sending consultants to establish local smokers' rights groups throughout the nation; encouraging local political action among smokers through mailings and expensive publications; creating groups, in the form of business coali- tions, funded by the industry and direct- ed by individuals tied to the tobacco industry; in some cities, contributing money to election campaigns and hiring lobbyists to lobby against proposals; and keeping a low profile and denying or mi;nimizing tobacco industry involve- ment in local politics. In contrast to the efforts of the tobac- co industry, which are centralized and well coordinated, the local nonsmokers' rights groups and chapters of national voluntary health agencies act indepen- dently. Consequently, the degree of en- couragement, cooperation, and support for tobacco control legislation among these local groups varies greatly. An example of a national organization that continuously provides support and advice to communities considering a to- bacco control ordinance is the small pub- lic interest lobby group, Americans for Nonsmokers' Rights. This group took an active role in the communities men- tioned in this article, and it assists doz- ens of local government bodies every year by testifying and providing model ordinances on issues ranging from re- stricting smoking in the workplace to eliminating cigarette vending ma- chines. flirthermore, Americans for Nonsmokers Rights aggressively mo- bilizes its members in the respective community to encourage support for proposed nonsmokers' rights laws. The fact that small, aggressive nonsmokers' rights groups such as this one have been successful aithout the resources of the established health organizations sug- gests that the potential for meaningful tobacco control has hardly been tapped. Two key ingredients are required for health advocates to overcome the tobac- co industry: a strong coalition within the local community and sympathetic politi- cal leadership within the elected body. When these two ingredients combine, as in Sacramento, they form a credible foe for the tobacco industry. In smaller communities, established health groups usually play a key role, but sometimes enough support can be gathered from the community at large with a dedicated effort by nonsmokers rights activists." However, in large cities, if the health community is not mobilized at an early Poiilics of Local Tobacco Control-Samueis 3 Glantz

stage of the process, even the most com- tnitted elected official, such as Los An- geles Councilman Braude, will have dif- ficulty hurdling the obstacles erected by the tobacco manufacturers. On the oth- er hand, when the health community is seriously committed to the cause from beginning to end, the tobacco industry will have a difficult task keeping tobacco control measures from being enacted. RN.e.rIe.a 1. Tsvlor P. T7u' Smoke Ring. New York, NY: Pantheon Bookslnc;1984:189-207. 2. Sylvester K. The tobacco industry will vealk a mile to stop an anti-smoking law. Governing States Localities: Congressional Quarterly. May 1989:34- 40. 3. Hanauer P, Barr G. Glantz SA. Legislative Ap- proach.es to a Smokefree Society. Berkley, Calif: Americans for Notumokers' Rights Foundation; 1986:1-7. 4. Glanu SA. Achieving a smoke-free society. Cir- culation.1987;76:746-752. 5. Pertschuk M. Shopland DR, eds. Major Local Smoking Ordinances in the United Statea Wash- ington, DC: LB Dept of Health and Human Ser- vices; 1989. 6. TheHealthConsequencesoflnroluntarySmok- ing: A Report ojthe Surgeon Geniral. Washington, DC: US Dept of Health and Human Senices;1986. 7. Environmental Protection Agency. Health Ef- fects of Fbasit•e Smoking: Assessment of Lung Cancer in Adults and Respiratory Disorders in Children. Washington, DC: Environmental Pro- tection Agency; 1990. Publication EPA 60016- 90/006A. 8. Glantz SA. Parmley WW. Passive smoking and heart disease: epidemiology, ph,rsiology, and bio- chemistry. Circulatian. 1991;83:1-12. 9. Stillman FA. Becker DM, Swank RT, et al. Ending smoking at The Johns Hopkins Medical Institutions: an evaluation of smoking prevalence and indoor air pollution. JASiA. 1990264:1565- 1569. 10. Warner KE. Effects of the antismoking cam- paign: an update. Am J Public Health. 1989;79:144- 151. 11. Pritchard R. Tobacco industry speaks with one voice, once again. C'S lbbacco Candy J. July 17- August 6,1986:86. 12. Konrad W, Lander M. Reynolds draws a bead on the Marlboro man. Business Week. December 24,1990:48. 13. Roper Organization. Public Attitudes 7buxird Cigarette Smoking and the 7bbacco Industry. Pre- pared for the Tobacco Institute; May 1978. This study aas supported by funds pro%ided by the Cigarette and Tobacco Surtax }lurd of the State of California through the 7bbacco-Related Disease Research Program of the University of California under award 1RT 520. A more detailed report of this research that pro- vides documentation of the information from these sourcesisavailable." We would like to thank the following individuals and organizations for granting interviews or pro- viding inform::.tion in support of this research: Tamma Ademek, Ron Arias, Glenn Barr, Michael 14. V Lance Tarrance & Aaaoeiates, Houston, '1lex. Sern County Smoking Study. Confidential report prepared for the Tobacco lnstitute; September 1982. 15. Gallup G:Ir. Cancer society gives highest rat- ing< in test of special interest groups. Gall up Poll. Aprii 16, 1989. Enclosure 4. 16. Stumbo B. Where therek smoke. Los Angeles 75mea August 24,1986:11-15, 2428. 17. Frcedtnan A. Smokers' rights campaign suf- fers from lack of dedicat.ed recruits• Wall St J. April 11,1988. 18. Jason J. Smokers 5ght tobacco industrpk bat- tles. Daily Ret•. March 17,1991:1. 19. Samuels BE, Glantz SA. 7bbacco Control Ac- tinitiea and the 7bbacco Industryb Response in Calijornia Ccmmunities• 2990-1991. San f ncis- co: Universitr of California Institute for Health Policy Studies; July 22, 1991. Monograph Series. 20. Hanauer P. Proposition P: anatomy of a non- smokers righta ordinance. l,' 1' State J Med. 1985;85:369-374. 21. lfergan :J, Milligan M. Tobacco Institute ar knowledges role in 5ght against B. H. no-smoke lan: Beverly Hills Courier. May 1987. 22. Ferris J. Smoke screen clouds tobacco industry action. Contnra Costa Times. June 23, 1991. 23. Arnold R. Judge rejects challenge to Beverly Hills smoking ban. Los Angeles Times. April 3. 1987. 24. Hager P. High court declines to review smok- ing ban in Beverly Hills. Los Angeles 7lmea May 21.1987. 25. RJ Reynolds Inc. ln the news. Choice. 198i;1:4. No. 6. 26. Jacobs C. Ban on smoking in L. A. restaurants is snuffed out, for now. Loa Angeles Business J. October 22,1991. 27. Laventhol & Horwath. Preliminary Analysis of the /rnpac,' ojthe Proposed Los Angeles Ban on Smoking in Restauranta Los Angeles, Calif: La- venthol & Hcrv-ath; October, 1990. 28. Fitch A.. Municipal Legialatite Advocate Quarterly Expenses and Earnings Report. Los Angeles, Calif: City Hall: July-December 1990. Begay. PhD. Roy Brewer. Valerie Burrows. Ju6a Carol, Rudy Cole, Adam Dados. Jacquolpn Duerr. Kevin Goebel, Anna Haran. PhD. Robin Hobart• Grantland Johnson. Jack Johnston• Dian Kiser, Paul Knepprath. Sam Manolakas• Rob McCn}-. Bob McNatt, Dave Monk. Candace Moorman. Mark Pertschuk, Tim Pueyo, Lynn Robie. Alice Reimche, Jerry Reiss, Anne Rudin, Ron Saldana, Eilleen St 7•ves, Randc Snider. Ben Stansbury. Ken Stewart. Sandy Stoddard. Jim Streng. Bud Sullivan, Margaret Talbot. JoLinda Thompson, Betty Turner, and Bev Williams. 29. Ferrel D. Council rejects ban on smoking in restaurants. Los Angeles Times. October 17, 1990:A1. 30. Dempster D. Bad news for smokers in capital. Sacrnoiento Bee. September 12• 1990:A1. 31. Sacrarnentan< for Fair Business Policy. Gener- al Purpose Recipient Committee Statententa Sae- rament.o, Calif: City and County Clerks; January 1- December31, 1990. 32. Secretary of State.1991-94 Directory o•fLobby- iata, Lobbying Firms, and Lobbyists Employera Sacramento. Calif: Secretary of State Political Re- form Division: April 1991:195. 33. Begay ME, Glantz SA. Political Expenditures by the Tobacco Industry in California State Fbli- tics San Francisco: University of California Insti- tute for Health Policy Studies: 1991:55. Monograph Series. 34. Chavez K. Rudin thinks foes of smoldng ban broke state law. Sacramento Bee. December 1, 1990:B1. 35. The lesson of Beverly Hills. Philip Morris Magazine. 1991,fi22. 36. Restauranta for a Sensible Voluntary Policy. SLO Restaurants Join Forces to Oppose Smoking Ordinance; FYtitionCityCouncilSeekingReason- able Compromise. Los Angeles. Calif: Restaurants for a Sensible Voluntar;• Policy..January 14, 1991. Press Release. 37. King J. Where thereS local smoke, therek out- of-toscn fire. Contra Costa Times. May 11, 1991:5A. 38. Bloom S. Bitter 8ght over vast curbs on smok- ing in Walnut Creek. Sacramento Bee. April 19. 1991:B1. 39. Mathews J. No-smoking bills fade in legisla- ture. Sacramento Bee. April 22.1991. 40. Philip Morris. Independent.NaiorponorCom- mitiee. Sacramento: California Secretary of State; January 1-December 31,1990. 41. RJ Rej•nolds. Independent Expenditure and Major Donor Committee. Sacramento: California Secretary of State; July 1-December 31• 1989. 42. Maxwell JC. Cigarette skids continue. Adver- tising Age. December 4,1989. Politics ot Local Tobacco Control-Samuels & Glantz JAMA. October 16. 1991-Vol 266. No.15 Printed and PubOshed in the United States of Amer ca