Tobacco Documents Online

Tobacco Control in California Cities

We thank the following publications for permission to reproduce or adapt their copy- righted material: Journal of the American Medical Association (Appendices 0, R), Institute for Health Policy Studies, School of Medicine, University of California, San Francisco (Appendices L, M, N, P, Q). Fdited by 7'ed Fourkas Cover Design by Page Design Inc. Publication Design by Martinez/Hardy Design & Communication December 1992 This guidebook was developed with the support of the California Department of Health Services, Tobacco Control Section, under contract no. 90-10964 using ftuids generated by the passage of Proposition 99. © California Department of Health Services

• CAN SMOKI NG CONTROL ORDINANCES SAVE MONEY FOR BUSINESSES? Yes-whichisonereasonmoreandmore businesses prohibit smoking. Smoking damages the health of all employees, smokers and nonsmokers alike, and increases costs due to cleaning, absenteeism, tardiness, higher medical expenses and lost productivity. In fiscal year 1991, the economic cost of smoking to California businesses was $7.6 billion-for smokers alone. The figure is even higher if the impact on nonsmokers is added in, as detailed in Chapter 5. H OW DOES TH E TOBACCO I N DU STRY FIGHT LOCAL Historically,the ORDI NANCES? t y ha.~foc~sed its attention and its campaign funds on Congress and State Legislatures. But with the steady increase in local ordinances, atten- tion is shifting to the community level. The industry typically works behind the scenes, organizing and financing local groups to challenge ordinances. When all else fails, it turns to the courts. For details, see Chapter 11. WHY ENACT LOCAL ORDINANCES TO CONTROL SMOKING? WHY NOT STATE OR FEDERAL LAWS? Cities and countieshave taken the foreftont in the battle to reduce smoking. Smoking is a local health issue, and local constituents have strong feelings about it. State and federal lawmakers have not only been reluctant to adopt anti-smoking mea- sures, they often seem more interested in passing laws to preempt stiffer laws in local jurisdictions. For details, see Chapter 2. HowmanyCal ifornia cities have passed smok- ing pollution control measures? More than halfofCalifornia's 468 cities now have ordinances on the books which restrict smoking. The trend is toward measureswhich totally ban smoking in worksites and public places. A matrix in Appendix D provides comprehensive data on how individual cities in California control smoking. 51423 0250 ,J i • •

• 8. CONSTRUCTING A SMOKING POLLUTION CONTROL ORDINANCE ....................................................43 Elements of an ordinance ...................................................................................43 9. PUBLIC TESTIMONY AND REFERENDA .................................................47 Council study committees ..................................................................................47 Public hearings .................................................................................................. 47 Controversial issues ............................................................................................ 48 Referenda .................................................................................................... .....50 10. OTHER WAYS TO REDUCE TOBACCO USE ........................................... 53 California Smoke-Free Cities mini-grants ............................................................53 Long-term commitments ................................................................................... 57 Modest outside funding ..................................................................................... 59 A focus on youth ............................................................................................... 59 City employees .................................................................................................. 60 11. THE TOBACCO INDUSTRYS REACTION ............................................... 61 Industry supported groups .................................................................................62 Industry activities ..............................................................................................63 Other tactics .................................................................................................... .63 Common strategies ............................................................................................ 64 12. LEGAL PERSPECTIVES ............................................................................... 65 Constitutional issues .......................................................................................... 65 Federal legislation .............................................................................................. 66 California laws ..................................................................................................67 The workplace .................................................................................................. 69 13. FRAMING THE ISSUE ................................................................................71 Presenting the Issue ........................................................................................... 71 Press releases and personal contacts ..................................................................... 73 Press conferences and other approaches ...............................................................73 Gaining access to the media ...............................................................................74 14. MAKING HEALTHIER CHOICES EASIER CHOICES ...............................75 The "health" agenda ..........................................................................................75 Healthy choices .................................................................................................76 REFERENCES .................................................................................................... 77 • •

HOWARD RICE LIBRARY SAN FRAnICiqro JUN 3 0 '993 10 TOBACCO CONTROL IN CALIFORNIA CITIES: A GUIDE FORACTION 0 CALIFORNIA HEAITHY CITIES PROJECT IN PARTNERSHIP WITH LEAGUE OF CALIFORNIA CITIES AMERICANS FOR NONSMOKERS' RIGHTS HEAITH OFFICERS ASSOCIATION OF CALIFORNIA AND MANAGED BY THE WESTERN CONSORTIUM FOR PUBLIC HEALTH Ln r ~ N m N The Western Consortium for Public Health is a nonprofit corporation sponsored by the Schools of Public Health and Ln University Extensions, University of California at Berkeley and University of California at Los Angeles. The San Diego State University School of Public Health is an affiliate member.

Chapter One • The Health Risk • • • . Concentrations of environmental tobacco smoke indoors are in general directly proportional to the number of smokers, and inversely proportional to the ventilation rate. This means that if its concentration is not to increase, smoke must be removed by the ventilation system as fast as it is generated.  In a typical 1,000 square-foot office occupied by two smokers, a ventila- tion system has to move more than 4,000 cubic feet of air per minute per smoker to remove tobacco smoke particles as fast as they are generated.  The American Society of Heating, Refrigerating and Air Conditioning Engineers' Standard for Acceptable Indoor Air Quality (62-1981) currently recom- mends 5 cubic feet of outside air per minute per occupant in buildings where smoking is prohibited, and 20 cubic feet per minute in buildings where smoking is permitted.  Ventilation standards for tobacco smoke developed by the American Society of Heating, Refrigerating and Air Condi- tioning Engineers are not based on health. They are designed to reduce the offensive odor of tobacco smoke to an acceptable level for 80 percent of visitors to a building.  According to the National Re- search Council, a ventilation rate greater than 50 cubic feet of outside air per minute (2.5 times the current standard) is necessary just to make odor in smoking areas acceptable to more than 80 percent of adult smokers and nonsmokers combined. Levels satisfactory to 80 percent of nonsmokers have not been defined. 9 The Environmental Protection Agency and the National Institute on Occupational Safety and Health have both recommended that if smoking is permitted, the smoking area should be enclosed, separately ventilated and directly exhausted to the outside. Scientific evidence suggests that no reasonable amount of ventilation will eliminate environmental tobacco smoke from an enclosed area. At the same time, the Environmental Protection Agency recognizes no safe level of exposure to Class A carcinogens. Environmental tobacco smoke must be eliminated from enclosed areas to remove the health risk.

• TABLE OF CONTENTS Frequently Ask ed Qu estio ns About Smoking Pollution Control ........................... i - ii INTROI)UCT Overview .. California j Proposition California S About the p Acknowled ION ......... oins th 99 ... moke artner gemen ...... ....... e He ....... -Frec s ...... ts .... ...................................................................................... ........................................................................................ althy Cities movement ..................................................... ........................................................................................ Cities ............................................................................. ....................................................................................... ....................................................................................... ..1 ..1 ..1 .. 2 ..3 .. 3 ..4 1. THE HEA LTH RISK .................................................................................... .. 5 The danger s of en viron mental tobacco smoke ..................................................... .. 5 The facts sp eak fo r the mselves ............................................................................ .. 7 Ventilation is not the a nswer .............................................................................. ..8 • 2. TOBACCO CO NTR OL - A LOCAL ISSUE ............................................... 11 Why local a ction? ....... ................................................................................... .... 12 Barriers to s uccess ....... ................................................................................... .... 13 Preemption of loc al law s .................................................................................... 14 3. THREE CA SE S TUD IES ............................................................................... 15 I .odi's break throu gh ... ....................................................................................... 15 San Luis Ob ispo's smo ke-free bars ...................................................................... 19 Sacramento phase s in a ban ................................................................................ 21 4. THE WOR KPL ACE . ..................................................................................... 25 City govern ment as em ployer ............................................................................. 25 Workers' co mpen satio n costs ............................................................................. 26 Trends in th e wor kplac e ..................................................................................... 27 5. IMPACT O N B USIN ESS .............................................................................. 29 Costs of wo rkplac e smo king ............................................................................... 29 Restaurants: a spe cial c ase ................................................................................... 30 A final note ........ ........ ............................................................................. .......... 32 6. ACCESS F OR M INO RS ................................................................................ 35 Vending ma chine s ...... ....................................................................................... 36 Licensing m ercha nts ... ....................................................................................... 37 Banning fre e samp les .. ....................................................................................... 37 Ln Other appro aches ....... ................................................................................ ....... 37 ~-' ~ 7. ADVERTIS ING AND PROMOTION .......................................................... 39 u, Public trans portat ion .. ....................................................................................... 40 m Tobacco bill board s ..... ....................................................................................... 40 ~' ~ ~

Chapter Three • Three Case Studies • 0 had signed both petitions. The signature of a resident from the unincorporated area was invalid on the city petition, but acceptable on the county petition. On June 2, 1992, the voters of Sacramento County, by a 56 to 44 margin, upheld the County's smoking regulation. The tobacco industry outspent proponents of the measure by 30 to 1, but did not overcome the public's growing disdain for tobacco smoke. Leadership on the tobacco control issue came from city council member Lynn Robie. The political pressure she felt included a personal element: Robie is an enthusiastic booster of her local high school alma mater, and the ordinance would eliminate smoking at the bingo games from which school athletic programs received more than half their revenue. Following the successful implementa- tion of its comprehensive and restrictive smoking ordinance, the city passed an ordinance banning tobacco vending machines in the city limits. The clearest lessons of Sacramento's story are the importance of attention to the details of referendum procedures, the potential rewards of inter-departmental city-county teamwork and, once again, the decisive role of a single council member. Sacramento was also the first to demon- strate the political usefulness of a phase-in period, an approach now popular else- where. ~ ~ ~ N m N J W 23

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • recommended at its February 19, 1991 meeting that ETS be identified as a toxic air contaminant. The Board said the docu- mented adverse health effects of ETS are greater than many of the compounds already identified as toxic air contaminants; and many substances in environmental tobacco smoke, such as benzene and vinyl chloride, are themselves classified as toxic air contaminants. The Environmental Protection Agency (EPA) estimates that about 467,000 tons of tobacco are burned indoors each year. Over a 16-hour day, the average smoker smokes about two cigarettes Environmental tobacco smoke is one of the most widespread and harmful indoor air pollutants-and the state Air Resources Board estimates Californians spend roughly 86 percent of their time indoors. per hour, spending about 10 minutes per cigarette. It takes only a few smokers to release a steady stream of environ- mental tobacco smoke into the indoor air 40 The first compre- hensive report on the health effects of environ- mental tobacco smoke was the 1986 Surgeon General's Report on the health consequences of involuntary smoking37 (See Appendix G). It concluded that:  involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers;  children of parents who smoke, when compared to the children of non- smoking parents, have an increased frequency of respiratory infections, in- creased respiratory symptoms and reduced rates of increase in lung function as the lung matures; and  the simple separation of smokers and nonsmokers within the same air space may reduce but not eliminate the exposure of nonsmokers to environmental tobacco smoke. Also in 1986, the National Research Council reported that nonsmokers who live with smokers suffer a 30 percent higher incidence of lung cancer than those living with nonsmokers.22 Since 1986 the evi- dence on the harmful effect of environmen- tal tobacco smoke has continued to mount:  In 1990, the Environmental Protection Agency recommended that tobacco smoke be classified as a Class A carcinogen, joining a list which includes such substances as benzene and asbestos.41  By 1990, research was also suggest- ing that nonsmokers who grew up with parents who smoked have twice the risk of lung cancer as nonsmokers whose parents did not."  A 1991 University of California, San Francisco study concluded that passive smoking takes 53,000 American lives a year from heart disease and cancer, making it the third leading cause of preventable death in the United States behind active smoking and alcohol related deaths.14  In the first official government statement on the dangers of workplace cigarette smoke, the National Institute for Occupational Safety and Health concluded in its June 1991 report that "all available preventive measures should be used to minimize occupational exposure."Z' (See Appendix I.) According to the EPA's May 1992 draft report, "Respiratory Effects of Passive Smoking: Lung Cancer and Other Disor- ders," the following are just some of the effects of smoking on nonsmokers: 12 51423 0251 6 •

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • to quietly pass a tobacco control measure and as California's first 100 percent smoke- free restaurant ordinance, it became a milestone on the road to a smoke-free California. City leaders were committed to increasing public awareness of the hazards of both smoking and environmental Lodi's experience signaled an end to any attempt to quietly pass a tobacco control measure and as California's first 100 percent smoke- free restaurant ordinance, it became a milestone on the road to a smoke-free California. tobacco smoke. In 1992, the city prepared a grant application and received a California Smoke-Free Cities mini-grant (see chapter 10 for more details). Lodi's example offers several lessons. One lesson is familiar to decision makers: the role of opportunity in the development of public policy. Policy is seldom a rational conclusion to a set of events or constitu- ent pressures, especially in an area that at least initially is of little local public interest. A second lesson is that each city's tobacco control campaign will reflect its own particular ideals. In Lodi, the success of the local smoking ordinance was based on the popularity of the mayor, the notoriety of the TUFF leader, the mixing of tobacco regulation with other local campaign issues and, perhaps, the limited appeal of health information. The emphasis by TUFF on perceived democratic values is a theme that will be seen elsewhere. The position that smoking is an expression of individual rights guaranteed by the first Amendment is encouraged by the tobacco industry. Characterizing smoking as a right and an expression of freedom of choice, has popular appeal and superficially seems consistent with the first Amendment guarantee to freedom of expression. Legally, however, smoking is not a first Amendment issue and a major responsibility of govern- ment is to protect the public health. Ironically, the theme of ordinance support- ers also appealed to democratic values: home rule and local pride, and the right of a community to maintain its independence despite outside influence. The experience in Lodi suggests that professional help may be useful if a public vote becomes necessary. Supporters stress the importance of that professional assis- tance. "You need a consultant to get tobacco control. There will be opposition from the tobacco industry anywhere. You must have an organized effort. They do and they have money." At the same time, the campaign was costly and some supporters felt the consultant was an unnecessary expense. Since enactment of the ordinance, enforcement problems have been minimal. TUFF attributed the failure of a local restaurant to the smoking ordinance, but the restaurant owner had in fact filed for bankruptcy prior to its enactment. A small coffee shop, Mom's Corner Kitchen, declared itself a private club for smokers-but lost its case at both the trial and the appellate court levels (People of the State of California v. Judith Ann Smith, Case No. 50887, San Joaquin County Superior Court Appellate Department). Owner Judith Smith refused repeated informal attempts to comply with the city's ordinance and was finally cited for failing to post required "No Smoking" signs. The case was tried in May 1991 and she was convicted and fined $100. The court found that her restaurant did not meet the qualifications of a private club, and that simply posting the required 0 51423 0268 18

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • But consumers (in this case smokers) and tobacco producers are not operating on an equal footing. The free market system is not equal for all participants. Misleading What's more, the market-justice approach ignores millions of Americans who have little or no role in the marketplace decision- nonsmokers. Yet their quality of life is worsened, and their health endangered, by tobacco smoke in the environment. information or distortions can create demand and can lead consumers to uninformed choices. Misleading messages that smoking is glamorous or sexy cloud its immense personal health risks. Activities which associate positive results with tobacco use are attempts to mislead the public for financial gain. What's more, the market-justice approach ignores millions of Americans who have little or no role in the market- place decision-non- smokers. Yet their quality of life is wors- ened, and their health endangered, by tobacco smoke in the environment. Another barrier is the notion that government intervention into the lives of private citizens should be minimized. The dilemma faced by nonsmokers should be solved by "common courtesy." This approach places the burden on the non- smoker to ask others to refrain from smoking. This is impractical, and it makes a healthy option far more difficult to attain. Local efforts to discourage tobacco use and create cleaner indoor environments have been met with efforts by the tobacco industry to portray itself as an advocate of civil rights, a protector of free speech and competitive business practices. But these arguments ignore the health risk, which is a far greater concern. PREEMPTION OF LOCAL LAWS Proposed state tobacco laws often threaten local regulation of tobacco through preemption of local ordinances. A preemp- tion provision in state law removes the power and authority to regulate from local government. The tobacco industry promotes preemption clauses in federal and state legislation to eliminate their need for involvement at the local level. Preemption generally precludes stronger local laws and establishes maximum rather than mini- mum standards. A recent example of attempted preemption in California was Senate Bill 376, introduced during the 1990-91 Session and supported by the tobacco industry. This comprehensive but weak tobacco control bill was designed to occupy the entire field of tobacco control. It contained explicit preemption language prohibiting enactment of stronger legisla- tion at the local level. The bill was defeated by city and county officials and a strong coalition of health professionals. 14 •

I n t r o d u c t i o n • • • A State master plan called not only for developing community based programs, but also for creating tobacco control leadership in county health departments to provide direction and support to local anti- tobacco eflorts.10 These were new resources for cities to draw upon. (A list of contacts for each county health department appears in Appendix C.) The goal of the master plan is to reduce tobacco consumption in California by 75 percent by 1999. If it succeeds, the number of smokers in California will drop from I in 5 to I in 20, saving thousands of lives and billions of dollars." The State master plan calls for a media campaign and various policy interventions. Hard-hitting commercials on television and radio, and in newspapers, along with administrative and legislative no-smoking policies, have delivered a strong anti-smoking message. This shift in approach, like the Healthy Cities model, promotes the inextricable link of health to the social and cultural environments of our cities. CALI FORN IA SMOKE' FREE CITIES In 1990, the California Healthy Cities Project was awarded a competitive grant from the California l)epartment of Health Services to create California Smoke- Free Cities. Funded by tobacco tax rev- enues, California Smoke-Free Cities is sponsored by the California Healthy Cities Project and administered by the Western Consortium for Public Health. It is a unique partnership which includes the California Healthy Cities Project, the League of California Cities, Americans for Nonsmokers' Rights and the Health Officers Association of California. (See Appendix A.) California Smoke-Free Cities is a major new resource for cities interested in tobacco control. Its comprehensive 1990 survey provides an extensive bank of information about local tobacco control policy and leadership. It has implemented a comprehensive technical assistance network to provide immediate service and informa- tion to municipal officials. The project also conducts educational seminars, provides educational materials, administers a mini- grants program to cities, and provides recognition programs for cities with tobacco control ordinances. ABOUT TH E PARTN ERS The California Healthy Cities Project is a statewide program which helps cities and public health agencies promote healthful community environments. Through resource brokering and referral, technical consultation, sponsorship of educational programs and development and distribution of products and publications, the Project works with cities to address the specific challenges confronting their communities. The League of California Cities is a nonpartisan association which represents cities in policymaking decisions, offers training and information services for local officials, and promotes cooperative efforts to improve the quality of life for city residents. Americans for Nonsmokers' Rights is a national advocacy group with expertise in tobacco policy issues at municipal, county, state and federal levels. It provides technical consultation and resource materi- als on a variety of tobacco related issues. Health Officers Association of California is a private, nonprofit organiza- tion that provides local health officers an independent voice for public health advo- cacy.

C h a p t e r F o u r • T h e W o r k p l a c e • I environmental tobacco smoke. Compared to other women, they have almost four times the expected lung cancer mortality and two-and-a-half times the expected heart disease mortality rate.28 In spite of the evidence that second- hand smoke endangers workers, unions have been slow to press for smoke-free workplace policies. Unions after all repre- sent smokers as well as nonsmokers. Instead, union leaders have sometimes emphasized that a smoke-free workplace policy constitutes a change in working conditions and is thus an item for collective bargaining. TRENDS IN THE WORKPLACE Early workplace policies typically required nonsmoking areas of specified sizes or locations. Most banned smoking in common areas like elevators, hallways and lobbies, and required nonsmoking areas in cafeterias and lounges. Private offices occupied by smokers were exempt. As more Californians quit smoking and as support for nonsmoking policies increased, empha- sis shifted to authorizing nonsmoking workplaces, giving preference to the wishes of nonsmokers in offices where both smokers and nonsmokers worked, and designating limited areas for smoking. First and second generation work- place policies proved to be inadequate. Smoke from private offices and designated smoking areas could not be eliminated from nonsmoking areas. Even the best ventilation systems did not eliminate known carcinogens in cigarette smoke. Three major Califor- nia cities-Sacramento, Walnut Creek and Oak- land-along with several First and second generation counties and smaller cities have prohibited smoking in both public and private workplaces. The effectiveness of local ordinances was borne workplace policies proved to be inadequate. Smoke from private offices and designated smoking out by the Proposition 99 areas could not be eliminated from funded California Tobacco Survey of public use and attitudes toward tobacco. It concluded that, "local nonsmoking areas. ordinances may have a greater impact than voluntary policy alone on the exposure of nonsmokers to environmental tobacco smoke through a combination of increasing the likelihood that worksites would have a ban on smoking at least in the work area and increasing the likelihood that indi- vidual smokers would obey the restrictions that are present in the worksite." 4(See Appendix F.) ON 27

• • APPENDIX A. Description of Organizations in the Partnership .................................................. 81 B. California Tobacco F,ducation Program ..............................................................85 C. County Health Department Tobacco Control Programs ......................................88 D. Tobacco Control Ordinance Matrices (5 charts) .................................................. 95 E. Sample Ordinances ..........................................................................................134 F. excerpts from "Tobacco Use in California, 1990-1991 " ....................................... 164 G. excerpts from "The Health Consequences of Involuntary Smoking: A Report of the Surgeon General," 1986 .............................................................................181 H. excerpts from "EPA Indoor Air Facts No. 3, Ventilation and Air Quality in Offices" .....185 1. excerpts from NIOSH Current Intelligence Bulletin #54, "Environmental Tobacco Smoke in the Workplace: Lung Cancer and Other Health Effects" ....... 189 J. excerpts from "Smoking and Restaurants: A Guide for Policy-makers" .................. 193 K. excerpts from "The Cost of Smoking in California, 1989" ................................... 194 L. excerpts from "The Effect of Ordinances Requiring Smoke-Free Restaurants on Restaurant Sales in California" .....................................................................196 M. excerpts from "An Update, The Effect of Ordinances Requiring Smoke-Free Restaurants on Restaurant Sales in California" ................................................... 198 N. excerpts from "Response to Tobacco Industry Criticisms ofThe Effect of Ordinances Requiring Smoke-Free Restaurants On Restaurant Sales in California" ............... 199 O. reprint of `The Politics of Local Tobacco Control" ............................................. 202 P. excerpts from "Political Expenditures by the Tobacco Industry In California State Politics from 1976 to 1991" .....................................................................210 Q. excerpts from "Undoing Proposition 99: Political Expenditures by the Tobacco Industry in California Politics in 1991" ...............................................212 R. reprint of "The Effects of Combining Education and Enforcement to Reduce Tobacco Sales to Minors....................................................................... ...... 215 S. excerpts from "Publications from the Office on Smoking and Health" ..................219 m N 1P l0

CALIFORNIA HEALTHY CITIES PROJECT WESTERN CONSORTIUM FOR PUBLIC HEALTH • CALIFORNIA HEALTHY CITIES • LEAGUE OF CALIFORNIA CITIES • AMERICANS FOR NONSMOKERS' RIGHTS • HEALTH OFFICERS ASSOCIATION OF CALIFORNIA

C h a p t e r T w o • T o b a c c o C o n t r o l - A L o c a l / s s u e • proportion of local employees and send a symbolic message to all who have contact with the city and its services. . The businesses most conspicuously affected by tobacco control are local retailers and restaurants, businesses which serve and employ local residents. Even if not locally-owned, they pay local taxes, need local licenses and must comply with local building, planning, sign, health and other codes. Tobacco regulation is a local issue for businesses.  The public debate and increased awareness that accompany a local policy proposal make an enacted policy easier to implement.  Local enforcement mechanisms are already in place. Local businesses must have local business licenses; local restaurants are regularly inspected by local health officials; local code inspectors visit commercial buildings; local fire inspectors visit local businesses for fire safety. All of these mechanisms can be used for tobacco control education, and for responding to complaints.  Many local organizations can assist with tobacco education and regulation: voluntary health agencies such as the American Lung Association, the American Cancer Society and the American Heart Association; county health departments; local programs funded by Proposition 99 revenues; health care providers; educators; All of these factors support the appropriateness and the necessity of regulating tobacco by local policy making. There is also an educational advantage implicit in local policy making and local implementation: all participants will learn about the dangers of secondhand smoke. A comprehensive local ordinance will create a community environment in which public smoking is not socially acceptable. In that environment, nonsmokers will not involuntarily be exposed to the dangers of secondhand smoke, fewer youths will begin smoking-and smokers who wish to quit will have strong support. The California Tobacco Survey of public use and attitudes towards tobacco, funded by Proposition 99, found that "when smokers who live in areas where there were strong ordinances were com- pared to smokers who live in areas where there were no ordinances, there was slightly greater readiness to quit among those who lived in areas with strong ordinances." 4(See Appendix F.) Local policy helps to create and maintain a healthier community for all. In a democracy local governments exist to allow for the expression and representation of local interests. No current health issue better expresses that purpose than tobacco control. BARRIERS TO SUCCESS As mea_ninafi-il anrl annrnn_ri2_rP a~ W

Chapter Three • Three Case Studies • • bans hurt business. However, the tobacco industry generally kept a low profile. One ordinance supporter observed, "They might have been better off if they had been public;" the TUFF spokesperson's style alienated voters. Emotions ran high, creating turmoil among political alliances. TUFF's major emphasis was indi- vidual rights and personal freedom of choice. According to the TUFF, "The issue is not a health issue; the issue is not a smoking issue; it is a rights issue-your rights-everyone's rights-American rights." National magazines distributed free in Lodi by Philip Morris and R. J. Reynolds urged voters to vote to protect their rights. "Don't let them get away with it!" "Outrageous new rules." "Speak out for your rights." Ordinance supporters stressed the dangers of secondhand smoke but later downplayed the significance of that information: "You can't persuade people with health information." More influence was attributed to resentment toward the tobacco industry. "Meddling in local affairs, in your politics, in your town." As one piece of literature distributed by the Lodi Clean Indoor Air Coalition stated, "The tobacco industry is trying to dictate to Lodi what laws can be passed to protect our health and safety. With a huge campaign war chest, tobacco companies are trying to dissuade Lodi from passing our own local legislation. Local control over local affairs is a basic principle of our democracy. It shouldn't be swept away on a selfish tide of tobacco industry money." The brochure went on, "Measure M upholds the principle that Lodians should legislate for themselves, without intrusion of the tobacco industry. If you believe that big, out-of-state tobacco companies should not control our local legislation, Vote yes on Measure M." Health organizations remained on the sidelines during the campaign. One week before the election, a popular community figure who had supported the ordinance died from lung cancer; he was a nonsmoker who had worked with smokers for twenty years. The family allowed ordinance supporters to publicize the circum- stances of his death. The referendum appeared on a ballot on which six candidates were running for three council seats. Three incumbents on the ballot were identified with the ordinance. Two of them, who were also identified with growth-related National magazines distributed free in Lodi by Philip Morris and R. J. Reynolds urged voters to vote to protect their rights. "Don't let them get away with it!" "Outrageous new rules." "Speak out for your rights." decisions, were defeated. The third, incumbent Mayor Randy Snider, was re- elected. More important, the voters supported the ordinance by a 60 percent majority. Mayor Snider was strongly linked with support for the ordinance. The vote took three days to tally because of the closeness of the race and the unusually large number of absentee ballots. Snider retained his seat, but believes the referendum cost him about 2,000 votes. "Supporters of the referendum were not going to vote for me. I had to compete with the others from a much smaller pool of available voters." Public health was ultimately victori- ous in Lodi. However, the events there- the unsuspecting council, the strength of the opposition, the reaction from those previously unheard at City Hall-pointed to a new era in tobacco control. Lodi's experience signaled an end to any attempt 17

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • attorney to develop a new measure. A change in the city attorney's office delayed drafting of the ordinance, but in May 1990 Reiss finally introduced the ordinance. It was passed 4-1 by the council. Interested individuals and members of the voluntary health groups-including The Restaurant Association chapter eventually dropped its opposition (citing) fears of workers' compensation claims as influencing employer support for smoking bans. the American Lung Association, the American Heart Association, the American Cancer Society and the local medical society-actively sup- ported the proposal. They offered expert testimony at hearings and recruited others with direct experience. During public hearings, testimony by Dr. Steve Hansen, a local delegate to the American Medical Association, was particularly persuasive. A number of individuals were against the measure, arguing the issue was over a fundamental right in a free society. Opposi- tion also came from the Central Coast chapter of the California Restaurant Association which emphasized the vulner- ability of restaurants dependent on tourists and travelers. (Reiss countered that San Luis Obispo's isolated location would keep consumers from going to other communi- ties.) The Tobacco Institute funded mailers to smokers urging them to call a list of council members and voice their concerns. The local newspaper interviewed several rigidly opposed senior citizens, the regular daytime clientele of a long-established local bar frequented at night by college-age nonsmokers. The Restaurant Association chapter eventually dropped its opposition because the ordinance covered all businesses without singling out restaurants. A spokes- person for the chapter cited fears of workers' compensation claims as influenc- ing employer support for smoking bans. The lone dissenter on the council supported strengthening the earlier ordi- nance but felt that free-standing bars not connected to a restaurant should be exempt and that, instead of a total ban, restaurants should accommodate smokers with better ventilation. Reiss had originally planned to exempt bars, but decided that could not be justified. He concluded that smoking threatens the health of the public and directly endangers employees in workplaces where it is permitted. The ordinance has been in effect since mid-1991, long enough for residents to experience its impact and long enough for emotions to cool off. There are several useful aspects to the San Luis Obispo case. The development of the ordinance again demonstrated the indispensable role of a committed council member. There is a wide contrast of social and economic environments in Lodi and San Luis Obispo, but the activities of the two councils in fact were remarkably similar. Second, the San Luis Obispo ordinance legislates California's most comprehensive regulation of smoking in eating and drinking places, making it a test of public reaction. Finally, implementation of the ordinance is an administrative test case for enforcement issues. The unique import of the San Luis Obispo ordinance is probably less in its development than in its history since adoption. Local newspaper attention was frequent during the five months the ordinance was under consideration prior to passage on July 3, 1990. The newspaper featured letters to the editor, interviews and field visits with supporters and opponents. Between August 1990 and May 1991 there were three newspaper stories on issues related to the ordinance: a report of a recall attempt, an informal survey by a longtime • 20 51423 0270

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • thought we should." From another, "The county ordinance was not important. It was weak and not enforced anyway." From a third, "It was really the mayor's idea." In fact, a county-wide voluntary health association first approached the Lodi City Council about enacting a smoking ordinance. Smoking ordinances had been passed in the nearby City of Stockton as well as by San Joaquin County, but more than a year passed before the Lodi council gave the suggested ordinance attention. A council study session found fault with a variety of provisions to limit smok- ing in restaurants, including the county Despite its relatively stable and conservative politics, in 1990 Lodi ordinance. First consid- ered was an ordinance requiring designated smoking sections, but discussion centered on the difficulty of implement- enacted a remarkable and ing and enforcing size and capacity limitations. Local courageous tobacco control restaurateurs were ordinance. The city went from no regulation to stringent tobacco control restriction following a tough fight. expected to object to separate room and ventilation requirements. At the mayor's sugges- tion, the ordinance introduced completely banned smoking in restaurants and public places. The approach was appealing because it presented the fewest enforcement problems. Bars and bingo games were among the few exemptions allowed. Just one council member opposed the ordinance as introduced, and the council moved on to other business. Within two weeks, the issue grew from spring shower to hail storm. The local newspaper was filled with letters to the editor. The council chambers were jammed with impassioned speakers at a three-hour hearing. A subsequent hearing was sched- uled and testimony continued. As the hearings continued, however, the mayor became fully committed to the ordinance. While opposition was vocal, business organizations were inexplicably quiet. A proposal to put the measure on the ballot was defeated 3-2 and the council supported the ordinance as before. Opponents began gathering signa- tures to place a referendum on the ballot, linking their efforts to an active voter registration drive. About 1,000 new voters were registered, an indication of the newness of the constituency uncovered by the smoking control issue. The petition qualified despite a high rate of invalid signatures, and the referendum was placed on the ballot after the Council refused to rescind its action. A group to become known as the Lodi Clean Indoor Air Coalition organized and sought the advice of a national re- saarcher in tobacco control efforts. After learning about methods employed by the tobacco industry to block local control, the coalition hired a political consultant for advice. A survey conducted with the help of a local real estate association indicated that nonsmokers would not voluntarily express objections to a smoker. The findings supported the need for tobacco control legislation. Both sides of the issue paid for advertisements and mailers. Monies for the pro-smoking group, Taxpayers United For Freedom (TUFF), came from a San Francisco consultant employed by the tobacco industry. A tobacco industry representative outlined a campaign to organize restaurant owners and their employees as well as other retail businesses, with the campaign message that smoking ® • 16 51423 0266

C h a p t e r N i n e • P u b l i c T e s t i m o n y a n d R e f e r e n d u m s • 5. Ballot alternatives. On the same ballot with a referendum the council may sponsor a revised ordinance, judged to be preferable to the one being challenged. In this case, the voters must be informed that the alternatives before them are inconsistent and of the "factual basis for the inconsis- tency." The alternative with the most affirmative votes prevails. 6. Reenacting the ordinance. If a successful referendum forces repeal, a council may not enact an essentially similar ordinance for one year. Ln r - W m N l0 C1 51

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s The Western Consortium for Public Health is an independent, non- profit corporation committed to improving public health by linking academic expertise with public health practice. ACKNOWLEDGEMENTS The partners who authored this guidebook could not have produced it without the support and contributions of many individuals. Our appreciation is extended to the members of our Advisory Committee for their many helpful sugges- tions that improved the text: Ellen Alkon, M.D. Medical Director/Deputy I)irector Los Angeles County Health Department Dianc Baiter Deputy City Attorney City of Sacramento Emil Berkanovic, Ph.D. Professor, Behavioral Sciences & Health Education, U.C.L.A. Carolyn Bovat Executive Director American Lung Association, Alameda County Allen Briggs City Attorney City of Cathedral City Maureen Casey Vice Mayor City of Santa Rosa John Dunn City Manager City of San Luis Obispo Steven Gourley Council member City of Culver City Robert Melton, M.D. Health Officer Monterey County Randy Snider Council member City of Lodi I,aurie "I'ully-Payne Council member City of Highland For her overall support of this project and review of the guidebook we thank Carol Russell. For careful reviews and contributions to the text that also strength- ened it we thank Michael Johnson Ph.D., Stanton Glantz, Ph.I)., Ken August, Cynthia Hallett, and Kirk Evans. Thanks also to Joel Moskowitz, Ph.D. and Judy Porat for data management and analysis of our ] 990 city manager and city clerk tobacco control survey. And finally, sincere appreciation to the support staff for their dedication to the completion of this guidebook: Ingrid Hart, Kitty Olmos, Donna Lehmann, Neal Lindhjem, Drew Froelicher, Victoria Chinn, and Judith Edmonds. AUTHORS: California Healthy Cities Project: Anne Klink Ron Lawrick Joan 7'wiss League of California Cities: Joan Hogan Clark Goecker Americans for Nonsmokers' Rights: Mark Pertschuk Julia Carol Robin Hobart Kevin Goebel 4 • • •

C H A P T E R 2 • TOBACCO CONTROL - ALOCAL ISSUE WHY LOCAL ACTION? BARRI ERS TO SUCCESS PREEMPTION OF LOCAL LAWS Until recently, tobacco use has had a long history of social acceptance. Advertis- ing and tobacco industry sponsorship of sports and cultural events have created demand and enhanced the social accept- ability of smoking. Smoking has tradition- ally been acceptable in enclosed public places and workplaces. During the 1980's, society's attitude toward smoking changed. Social acceptance of smoking in public places began to disappear. The change has been most dramatic in California where many cities have enacted local ordinances restricting tobacco use. In 1988, approximately 159 of California's cities had some form of tobacco control ordinance. By 1992, over 250 of California's 468 cities had enacted local smoking pollution control ordinances. (See Appendix D.) Today, four out of five Californians do not smoke. Two trends are clear from recent local tobacco control ordinances. The first is toward totally smoke-free environments. As of September 1992, 26 cities had com- pletely eliminated smoking in restau- rants or workplaces. Thirteen eliminated smoking in both locations, while five focused on workplaces alone and eight on restaurants. A second trend is to restrict access to tobacco products by youths. The major target is tobacco vending machines because the machines are unattended, even very young children can use them despite a California law prohibiting tobacco sales to minors. In the past three years, California cities and counties have been in the forefront of a national trend in adopting local ordinances eliminating or limiting tobacco vending machines. By September 1992, 49 local California ordinances had banned tobacco vending machines or limited their location to places inacces- sible by law to minors. Restricting the access by minors to tobacco vending machines is supported by 84 percent of all Californians, according to the State's 1990 report on tobacco use.4 An emerging trend is to reduce advertising and promotion of tobacco products, especially in cities with large African American and Latino populations. Both are targeted by advertisers. The State's 11 health and Well- being of others.'"

Chapter One • The Health Risk 0 • . An estimated 3,0001ung cancer deaths per year among nonsmokers age 35 and over are attributable to ETS in the United States. . ETS is causally associated with additional episodes and increased severity of asthma in children. In addition, the smoke is a risk factor for inducing asthma in previously asymptomatic children.  Passive smoking has subtle but significant effects on the respiratory health of nonsmoking adults, including coughing, phlegm, chest discomfort and reduced lung function. Individuals with asthma or allergies are particularly susceptible to the adverse effects of environmental tobacco smoke.  ETS exposure contributes 150,000 to 300,000 cases annually of lower respira- tory tract illness in infants under 18 months of age; 7,500 to 15,000 of them require hospitalization. To date, there have been 30 validat- ing epidemiological studies of nonsmokers' lung cancer from exposure to environmen- tal tobacco smoke. The May 1992 draft of the EPA report on respiratory effects of passive smoking makes a significant finding-that the results of these studies of exposure to ETS in the home can be generalized to all nonsmokers. It also found that exposures to ETS out of the home are often greater than exposure from spousal smoking. Therefore, "by extension of the results from spousal smoking studies, coupled with biological measurements of exposure, more lung cancer deaths are estimated to be attributable to ETS from combined nonhome exposures-2,200 of both sexes-than from spousal exposure-800 of both sexes.42 THE FACTS SPEAK FOR THEMSELVES The bare facts are a compelling indictment of smoking: CALIFORNIA.. .  42,000 Californians die each year from smok.ing.25  5,300 nonsmokers in California die each year from secondhand smoke (based upon ten percent of the national total14).  22.2 percent of California's adults (4.78 million individuals) smoke cigarettes 4  California businesses lose $7.6 billion each year because of smokers.25  The adverse health effects of smoking annually costs $256 per Califor- nian or $1,543 per smoker.Zs  109,500 California teenagers every year (or 300 each day) start smoking.3o . 204,000 Californians quit smoking each year. . The tobacco industry gave away 96.7 million cigarettes in California in 1990 according to the State Board of Equalization.  From 1976 to 1991 the tobacco industry spent $42 million on lobbying in California.Z THE UNITED STATES.. .  434,000 Americans die each year from smoking.27  53,000 nonsmokers die each year from secondhand smoke.14  26.5 percent of all Americans over age 16 (50 million) smoke cigarettes.36  American businesses lose more than $52 billion each year because of smokers.36

C H A P T E R 0 • THE WORKPLACE CITY GOVERNMENT AS EMPLOYER wORKERS' COMPENSATION COSTS TRENDS IN THE WORKPLACE • Of all varieties of local tobacco regulations, those governing the workplace have the most direct impact on the health of individuals. The importance of work- place regulation may be overlooked by the press and the public because there is no organized representation of those most directly affected- nonsmokers working in an area with others who smoke. Attending public entertainment, eating in a restaurant, stopping by a bar for cocktails, shopping, banking-all are relatively unconstrained individual choices exercised in a private marketplace with a variety of options. Working, on the other hand, is for most persons a necessity, and choices are narrowly constrained by training, location and the state of the economy. In the workplace, businesses are typically organized hierarchically and the power of rank may be further enhanced by personality, social prominence or family connections. Workers are far less free than shoppers to influence or select their indoor environment, and they must usually inhabit that space for eight hours a day, five days a week. For restaurant workers particularly, exposure to environmental tobacco smoke is considerably higher than exposure in most other workplaces.28(See Appendix J.) Proprietors and entrepreneurs are often organized, as indicated by the proliferation of service clubs and chambers 25 of commerce. They attend council meet- ings and help determine local conditions for doing business. Workers are organized, if at all, only for collective bargaining purposes; in other areas, their interests and needs often go unrecognized. CITY GOVERNMENT AS EMPLOYER Many cities begin developing a tobacco control policy with an ordinance or administrative policy covering city facilities. City government is itself a major employer, often one of the two largest employers in a community. (The other is the public school system.) Smoke-free policies covering city facilities protect a large portion of the local workforce from a significant threat which individual workers have little power to avoid on their own. There are other reasons for a smoke- free policy in city facilities. Government entities traditionally have been model employers. Government agencies, for example, are in the forefront of affirmative action hiring policies, responsible retire- ment policies and benefits, disciplinary policies with explicit and comprehensive worker protections, and many other worker protections. A healthy, smoke-free work- place environment furthers the expected and traditional model of public employ- ment.

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • Local government benefits in unique ways from a smoke-free workplace. Firefighters and law enforcement officers are entitled to special protection because of the nature of their work. If they develop pulmonary disease, cancer or heart disease it is presumed to be a work-related illness and covered by workers' compensation benefits. (California Labor Code sections 3212 through 3212.5) There is a large body of convincing evidence that smokers develop those diseases at far higher rates than nonsmokers. To minimize worker's compensation costs, many cities now hire only nonsmokers as firefighters. This policy also limits city insurance costs and reduces the exposure to environmental tobacco ... waitresses have the highest mortality of any female occupational group as a direct result of exposure to environmental tobacco smoke. Compared to other women, they have almost four times the expected lung cancer mortality and two-and- a-half times the expected heart disease mortality rate. smoke of all who work with firefighters. An additional advantage to municipali- ties is in the area of law enforcement administra- tion. Scheduling the use of patrol cars and recog- nizing the preferences of nonsmoking officers is much easier with an ordinance in place that bans smoking in city facilities. The most signifi- cant aspect of a smoke- free policy in city facilities may be its contribution to more comprehensive tobacco regulation. Smoke-free environments in city-owned facilities do more than protect municipal employees; they send a powerful message to the public. Nearly every local resident comes into a city facility periodically and that facility symbolizes local standards and local authority. Tobacco regulation covering city facilities may be authorized by administra- tive policy rather than by legislative action of the city council. City managers can demonstrate the advantages of a smoke-free environment for cost savings and for the health of the workforce, and can offer a model to the community at large. The increasing number of smoke-free facilities and the excessive costs associated with smoking has caused some cities to adopt a policy of hiring only nonsmoking employees. wORKERS' COMPENSATION COSTS Workers' compensation, risk manage- ment and health benefits are of special concern for local governments, but they are major considerations for all cost conscious and responsible employers. Employees who smoke are absent more often and are less productive than nonsmokers. Workers' compensation costs are escalating rapidly in California and have become an important factor for many businesses. In skilled nursing facilities, for example, workers' compensation is second only to payroll as a cost of doing business. In the landmark Uhbi case, a nonsmoking, vegetarian waiter in Sausalito suffered a heart attack and received an out of court settlement on his workers' com- pensation claim. He contested successfully that he had no known risk factors except the smoke-filled restaurant in which he worked. One recent study on smoking and restaurants reports that workers in restau- rants are as much as twice as likely to die from lung cancer because of exposure to environmental tobacco smoke. Addition- ally, the report indicates that waitresses have the highest mortality of any female occupa- tional group as a direct result of exposure to 0 • 51423 0275 26

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s ^ 3,500 Americans quit smoking each day.3s ^ The adult per capita consumption of cigarettes in 1989 is 2,936.32 ^ Americans annually smoke 600 billion cigarettes, 4 billion cigars and 11 billion pipefulls of tobacco 40 THE TOBACCO INDUSTRY.. . ^ Tobacco sales in the United States total $35 billion each year.31 ^ Cigarette sales in California were $4.5 billion in FY 1991.27 ^ The industry annually spends $3.27 billion on advertising nationally and $360 million on advertising in California.31,20 ^ The tobacco industry earns after tax profits of $6.7 billion each year.' WORLDWIDE... ^ 3 million persons worldwide die each year from smoking.43 CIGARETTES.. . ^ Cigarette smoke contains more than 4,700 chemical compounds. They include carbon monoxide, nicotine, carcinogenic tars, sulphur dioxide, ammo- nia, nitrogen oxides, vinyl chloride, hydrogen cyanide, formaldehyde, radionu- clides, benzene and arsenic.40 ^ 43 of the compounds in cigarette smoke are known cancer causing agents.'o ^ 400 of the compounds in cigarette smoke are toxins.13 YOUTH SMOKING.. . ^ 3 million American youths under age 18 smoke cigarettes.' ^ 1,095,000 American teenagers (3,000 per day) become smokers each year.3s ^ 80 percent of smokers started before the age of 21.31 ^ American youths under 18 illegally consume 947 million packs of cigarettes and 26 million containers of smokeless tobacco yearly.7 PUBLIC OPINION.. . ^ 95 percent of Californians believe that tobacco education activities should be increased or stay the same.4 ^ 84 percent of Californians support outlawing cigarette vending machines that are accessible to minors.4 ^ 55 percent of Californians support ending tobacco sponsorship of sporting and cultural events. 4 ^ 54 percent of Californians support ending tobacco advertising and billboards.4 ^ 82 percent of Americans believe smokers should not smoke around non- smokers.'Z ^ 86 percent of Americans believe ETS is harmful to nonsmokers.'Z ^ 88 percent of Americans believe ETS is harmful to pregnant women.12 ^ 89 percent of Americans believe ETS is harmful to infants and young children. 12 VENTILATION IS NOT THE ANSWER Ventilation is often proposed as a way of removing environmental tobacco smoke from enclosed areas-but it is both technically and economically impractical. According to the Environmental Protection Agency, controlling the source of indoor air pollution is vital because modern mechani- cal, heating, ventilation and air-condition- ing systems are simply not capable of removing it. (See Appendix H) In its 1988 publication, "Indoor Air Facts No. 3," the EPA makes these points: 39 • is • 8 51423 0259

• • • C h a p t e r F i v e Cities considering ordinances to control smoking in restaurants are bom- barded by claims that the net effect of a smoking ordinance will be a major loss of business. When Beverly Hills passed the first 100 percent smoke-free restaurant ordinance in California in 1987, the tobacco industry helped organize the Beverly Hills Restaurant Association (BHRA), led by political consultant Rudy Cole. The association claimed that Beverly Hills restaurants lost 30 percent of their business following passage of the ordinance. The panic created by that claim caused the Beverly Hills City Council to amend the ordinance four months after passage to allow restaurants a smoking section of up to 40 percent of seating capacity. The BHRA claim has been refuted by several studies. Least convincing was a follow-up study for Restaurants for a Sensible Voluntary Policy, also founded by Rudy Cole, was conducted by the Certified Public Accounting firm of Laventhol and Horwath. The study covered just six restaurants, chosen neither at random nor as a scientific representation of the entire local restaurant community. The actual loss found by the study was 6.7 percent, not the 30 percent claimed earlier. The study also predicted that economic losses among Los Angeles restaurants under a potential 100 percent smoke-free ordinance would be about 5.5 percent. The BHRA's claims of business loss were more convincingly disproved by Stanton A. Glantz, Ph.D., Professor of Medicine, at the University of California, San Francisco, School of Medicine. Dr. Glantz reviewed sales tax receipts from eight cities, four with 100 percent smoke- free restaurant ordinances and four without similar restrictions.15•'6 The 100 percent smoke-free cities included Bellflower, Lodi, Beverly Hills and San Luis Obispo. In the second group were Lakewood, Los Angeles, • 1 m p a c t o n B u s i n e s s Woodland and Atascadero. To control for the effects of the recession, Dr. Glantz also analyzed the proportion of restaurant receipts to total business receipts for each city. A decrease would indicate a drop in business compared to other retail busi- nesses, while an increase would indicate a proportionate increase in restaurant sales. (See Appendices L, M, N.) His study showed that restaurant revenues in cities with 100 percent smoke-free ordinances increased as a percentage ... restaurant revenues in cities with 100 percent smoke-free ordinances increased as a of total local retail sales, percentage of total local retail from 13 to 14 percent. Separate research conducted for the city of Bellflower supports the sales, from 13 to 14 percent. conclusion of the Glantz study. In Bell- flower, sales tax receipts for a three-month period after the smoking control ordinance was in place were compared to earlier periods. The sales tax receipts for restau- rants increased after the ordinance went into effect while other retail businesses experienced an overall decline attributed to the recession. San Luis Obispo is the only Califor- nia city that includes bars in its 100 percent ban on smoking in restaurants and other retail areas open to the public. The San Luis Obispo Chamber of Commerce has received only a handful of opinions about the ordinance. The general sentiment is that the ordinance has had little economic impact. A study by the Sonoma County Public Health Department in January 1991 provides additional evidence that smoking control does not hurt restaurant businesses. The Department surveyed 726 restaurants in Sonoma County, and found 78 which 31

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • was associated with direct medical costs, $860 million with lost productivity due to smoking-related illness, and $4.4 billion with productivity losses because of prema- ture deaths. This study did not include the additional costs to employers of nonsmok- ers harmed by environmental tobacco smoke. According to the same study, the economic loss in California translates into a cost to businesses of $256 per Californian or $1,543 per smoker per year.25(See Appendix K.) In 1990, the U.S. Environmental Protection Agency (EPA) released a draft report identifying environmental tobacco smoke as a human carcinogen 4' The EPA report focused attention on the responsibil- Employers are encouraged to ity of employers to protect nonsmoking employees and customers from the effects of "minimize occupational exposure to environmental tobacco k Th ETS by using all available smo e. e economic cost of smoking suddenly rose still higher: employ- preventive measures." ers must consider their potential liability for health problems of nonsmoking employees who work in an enclosed area with smokers. In June 1991, the National Institute for Occupational Safety and Health determined that "environmental tobacco smoke is potentially carcinogenic to occupationally exposed (nonsmoking) workers." It recommended that environ- mental tobacco smoke "be regarded as a potential occupational carcinogen in conformance with the OSHA carcinogen policy, and that exposures to ETS be reduced to the lowest feasible concentra- tion." Employers are encouraged to "minimize occupational exposure to ETS by using all available preventive measures." 33 (See Appendix I.) Most studies of the economic costs of smokers to employers exclude the additional expense involving the nonsmoking co- worker. Damage to nonsmokers caused by environmental tobacco smoke has been shown to equal that suffered by light smokers, those who smoke from one to ten cigarettes per day. Consequently, businesses can add to the bill created by tobacco use in the workplace, another $169 to $346 per year per smoker in insurance and other costs incurred by nonsmokers, according to a study by Dr. Marvin M. Kristein, a health economist with the State University of New York.18 Many businesses have got the message. The Bureau of National Affairs recently reported that the number of businesses with smoking control policies jumped from 36 percent to 85 percent between 1986 and 1991. During that same period, the percent- age of businesses which adopted 100 percent smoke-free workspaces went from 2 percent to 34 percent.29These percentages include both voluntary and legislatively mandated smoking control. Federal laws have eliminated smoking on all domestic airline flights of less than six hours, in effect banning smoking on all but 8 to 10 daily domestic flights. Airlines have reported better flight attendant morale and lower airplane maintenance costs. Northwest Airlines, which banned smoking on domestic flights prior to the federal law, reported no change in passenger volume after that ban went into effect. RESTAURANTS: A SPECIAL CASE For many retailers, the fear that smoking restrictions will drive away custom- ers overshadows concern for the unhealthy impact of environmental tobacco smoke on employees or nonsmoking customers. 51423 0278 30 0 •

C h a p t e r S e v e n • A d v e r t i s i n g a n d P r o m o t i o n • burden on any community that seeks to regulate the 'content' of speech. However, the U.S. Supreme Court has long upheld laws that regulate the 'time, place, and manner' of speech. In practical terms, this means that it is easier to ban all billboards or to regulate the size, height, placement, and number of billboards than it is to ban only alcohol and tobacco billboards."" Using the Posadas case for guidance, municipalities may regulate cigarette billboard advertising. Some cities have already taken that step: San Diego and San Jose have banned the construction of all new billboards; Richmond has limited billboard advertising near schools, and churches; others have prohibited billboards in residential districts, historic districts or downtown commercial cores. 0 41

• • C h a p t e r F i v e Even if smoking restrictions did cause business losses, there is compelling justifica- tion for a broader view. In a 1987 article in the Journal of the American Medical Association, Dr. Kenneth E. Warner discussed the health and economic implica- tions of a tobacco-free society. He con- cluded that, "Health, not money, motivates the call for a tobacco-free society. The elimination of tobacco use would have a more profound impact on this nation's vital statistics than virtually any other conceiv- able public health measure. Nevertheless, diverse and powerful economic interests constitute a significant barrier to increasing the pace at which we approach a society freed of the illness burden of tobacco use. "The tobacco industry implies that the demise of tobacco consumption would wreak havoc with the economy. By contrast, some anti-tobacco activists suggest that the end of tobacco use would yield a multibillion dollar fiscal dividend. Each argument is fundamentally flawed. The economic impacts of a tobacco-free society would be modest and of far less consequence than the principle implication: a significantly enriched quality and quantity of life." 43 33 • 1 m p a c t o n B u s i n e s s

H A P T E R © • IMPACT ON BUSINESS COSTS OF WORKPLACE SMOKI NG RESTAURANTS: A SPECIAL CASE A FINAL NOTE 0 • Of the critical issues that emerge when local policy makers consider a tobacco control ordinance, probably none is more discussed than the economic impact on local businesses, especially restaurants. The major concern is over lost customers: local businesses often argue that an ordinance that controls smoking will drive their patrons to other locations where smoking is allowed. There is no evidence that a smoking control ordinance causes restaurant customers to seek out businesses where smoking is allowed. However, there is convincing evidence that a ban on smoking will maintain if not increase restaurant sales. The concern over revenues usually overlooks the hidden costs of smoking regularly incurred but rarely recognized by businesses. They include absenteeism, tardiness, employee morale, health care, accidents, fires, lost productivity, ventila- tion costs, property damage, compensation claims, maintenance costs and insurance expenses. On the other hand, businesses which limit or eliminate smoking have reduced medical costs and less absenteeism and tardiness, among other savings, all resulting in greater productivity and financial savings. A 1979 survey by the National Center for Health Statistics concluded that smokers are far less healthy and require more medical care than individuals who do not smoke. Smokers required 6 percent more doctor visits and lost 26 percent more work days. The economic issues must also be placed in the proper perspective; they center around a practice which is the single greatest health risk in this country. For nonsmokers alone, environmental tobacco smoke causes 53,000 deaths in the United States every year.14 COSTS OF WORKPLACE SMOKING A recent study by Dorothy P. Rice, a professor of social and behavioral sciences at the University of California, San Francisco, reported the total cost of smoking in the United States for the year 1984 at $53.7 billion. That total included $23.3 billion in direct costs for medical care required by smokers and $30.4 billion in indirect costs for losses attributed to absenteeism, tardiness or premature death?4 Another Rice study, "The Cost of Smoking in California, 1989," found the economic cost to California businesses caused by smokers in fiscal year 1989 was $7.6 billion. Of that amount, $2.4 billion 29 "If smokers were taxed to cover the health cost of smoking-related illnesses, every smoker would pay $478 a year. productivity losses A

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s ENFORCEMENT Cities provide for enforcement of smoking control legislation in various ways. The usual choice is the city manager or the local health department, although some cities have chosen other departments. Placing enforcement with the police may give the impression that law enforcement resources are being diverted. Enforcement by the health department sends the correct message that smoking is a health issue. A complaint mechanism for private citizens is essential, particularly for nonsmoking employees. PENALTIES A fine schedule gives the enforcement agency leverage to encourage compliance. Violations are often made an infraction, the least serious category of crime. However, criminal sanctions may be avoided alto- gether by providing for a civil penalty instead of a fine. Citations have in fact rarely been required. NON-RETALIATION This is a common clause which protects nonsmokers from retaliation by supervisors or employers for expressing the right to a smoke-free environment. It is similar to many labor law provisions prohibiting employers from taking action against employees who report health and safety violations. The clause explicitly protects the nonsmoking employee from discharge, refusal to hire, or other retalia- tion. EXEMPTIONS Exemptions should be cautiously applied. They should be health related and express their rational basis. Because a legislative body is not obligated to regulate 46 the entirety of a problem, and therefore may regulate only some aspects of a problem (City of New Orleans v. Dukes, 427 U.S. 297, 303; 49 L.Ed.2d 511, 96 S.ct. 2513 (1976)), rationally-based exemptions will be upheld. PUBLIC EDUCATION Provisions for a public education program can smooth implementation and enforcement. Ideally begun before the ordinance takes effect, public information programs often provide, at a minimum, for distributing an explanatory pamphlet to local businesses. The pamphlet is some- times mailed with annual business license information at little additional cost. OTHER APPLICABLE LAWS This provision explicitly states that the law does not inadvertently permit smoking in areas previously prohibited by another law. SEVERABILITY This is a standard provision to ensure that if part of the law is struck down by the courts, the remainder will remain in effect. EFFECTIVE DATE Most ordinances become effective 30 days after adoption. The effective date should reflect the time necessary for adequate public education. A recent development is to phase in stronger restrictions with a succession of effective dates.

Chapter Three • Three Case Studies • 0 • signs did not hinder or interfere with her fundamental right to use her property and engage in business. The court went on to make two additional points: Even if fundamental rights were involved, they must "yield to compelling state interests"- to fair and reasonable regulation for the general welfare. That the smoking ordi- nance was reasonable regulation was convincingly set out in its stated purpose and findings. Further, there is "no constitu- tional right to engage in smoking." Lodi may have experienced every procedure possible in municipal regulation of tobacco: enactment of a strict ordinance, successful petition drive for a referendum, active referendum campaign, wide margin of votes supporting the ordinance, citation and conviction of a local business owner for failure to post signs and a decision by an appellate court upholding the city's position. When the dust settled, Lodi had become the first city in California to require restaurants and other public places to be 100 percent smoke-free. SAN Luis OBISPO'S SMOKE-FREE BARS San Luis Obispo's beautiful location, along with its historic mission and its large state university-California Polytechnic at San Luis Obispo-makes it a popular destination for tourists and visitors. With a population of 42,000, San Luis Obispo is nearly twice the size of all other cities in San Luis Obispo County. The city is known for its liberal views and well-educated constitu- ency, and as the first city in California to ban smoking in bars as well as all other public places. Municipal economies with signifi- cant support from tourists and visitors benefit from serving a broad range of tastes and values, and are generally reluctant to 19 take action that might be construed as inhospitable or exclusionary. University faculty members and graduate students may be inclined to support informed and timely legislation, but university support staff are not unlike the general population. University students rarely vote in local elections yet often express themselves at council hearings and in public demonstra- tions. Such a constituency would hardly seem the backbone upon which to build tobacco control coalitions-and in fact the ordinance was not initiated by a tobacco control coalition although one did form later to support it. San Luis Obispo had a weak smoking control ordinance on the books since 1983 but the new, tougher ordinance resulted from the interest and commitment of one council member, Jerry Reiss. "I didn't contact anyone ahead of time," said Reiss. "There was no orchestration. The ordi- nance originated in my own concern about it." Like Lodi's Mayor Snider, Reiss was a local businessman without links to any health or public interest group. He became aware of the growing evidence of the effects of environmental tobacco smoke and concluded that local government had a responsibility to act to protect community health. At the same time he remained sensitive to the council's responsibility for sustaining the local business climate. For several months, Reiss observed the impact of a voluntary nonsmoking policy on two local restaurants. The proprietors reported no negative effect on business revenues, but they said employee morale had improved. Reiss was encour- aged to strengthen the existing smoking control ordinance and asked the city

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s steadily increasing 'elegance' content in California advertising, with a special appeal to women, and the introduction of an aggressive cartoon campaign (Camels) appealing to youth."'o Recent evidence clearly links tobacco advertising and promotion to childhood tobacco addiction. One study concluded that "teenagers buy the most heavily promoted cigarettes, and 80 percent of all youths consider advertising influential in encouraging them to smoke." Three articles in a December 1991 issue of the Journal of the American MedicalAssociation arrived at these conclusions: 1) Old Joe, the cartoon camel which promotes Camel cigarettes, has the same level of recognition among six-year-olds as Mickey Mouse," 2) youths have higher recognition rates for Old Joe than do adults,23 and 3) Camel's share of the under 18 market has increased from .5 percent to 33 percent since the campaign was introduced in 1988. There are a several options for cities to counter local tobacco industry advertis- ing and promotion, ranging from policies to eliminate tobacco advertising from city property and public transportation, to challenging federal preemption affecting billboard advertising. PUBLIC TRANSPORTATION Many cities and transit agencies in California and elsewhere have eliminated tobacco advertisements on public transpor- tation, either by ordinance or administra- tive policy. The Board of the Bay Area Rapid Transit (BART) system voted in 1988 to eliminate tobacco advertising on the BART system. In 1991, San Francisco's Public Utilities Commission did the same for buses and trolleys in the MUNI system. Advertising on public transportation has been banned by the City of San Diego, Santa Clara County and Alameda County. Public transportation advertising bans have also been adopted in cities nationwide, including Amherst and Boston, Massachu- setts; Denver, Colorado; Seattle, Washing- ton; and Portland, Oregon. Some cities have eliminated tobacco advertising on municipal property such as transit depots, train stations, auditoriums and sports facilities. There has been no successful challenge to such policies. Limiting the location of advertising does not violate the free speech provisions of the first Amendment. That issue was resolved by the United States Supreme Court in 1986 in Posadas de Puerto Rico Association v. Tourism Company ofPuerto Rico. In that case, the court concluded that advertising of legal products or activities, such as cigarettes and gambling, could legally be banned or limited. TOBACCO BILLBOARDS Six of the top seven billboard advertisers in the United States are tobacco companies. Tobacco companies spent an estimated $421 million on billboard advertising in 1989.'9 And in California, the independent evaluation of the tobacco industry's response to Proposition 99 revealed there was considerably greater outdoor advertising in Latino and African American neighborhoods than in white and Asian/Pacific Islander neighborhoods. There was also a steady increase in the use of characters like "Joe Camel" rather than human models in advertising copy.'o According to Scenic America, a non- profit organization favoring billboard and sign control, efforts to ban only billboards advertising tobacco or to regulate the message on selected billboards "is difficult because the first Amendment places a heavy • • • 40 51423 0286

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s health renaissance which started in the 1970's. Support began to increase for returning to the central themes of conven- tional public health practices which focused on public policy and environmental action, in concert with individual behavior change. The World Health Organization (WHO) was a leader in this movement. In 1985, WHO initiated the first international network of Healthy Cities. Today, hun- dreds of cities participate in state, national and international Healthy Cities networks. Since 1988, the California Healthy Cities Project has supported cities in their efforts to protect the environment, improve education, preserve open space, reach under-served populations, improve human services and discourage tobacco use. The development of community-based tobacco control strategies, including the formula- tion of local policies and the fostering of a social climate which discourages tobacco use, is a critical element in a comprehensive Healthy A State master plan called not only Cities program. WHO has also for developing community based programs, but also for creating tobacco control leadership in county health departments ... organized individual cities and those in national networks around the issue of tobacco control, giving top priority to policy changes and establishing environments which support nonsmokers. Twelve European cities are currently taking part in the WHO's Tobacco Free Healthy Cities network. They include: Barcelona, Spain; Belfast, United Kingdom; Dublin, Ireland; Frankfurt-am-Main, Germany; Glasgow, United Kingdom; Gothenburg, Sweden; Kaunas, Lithuania; Milan, Italy; Ncs, Hungary; Rennes, France; Stockholm, Sweden; and Warsaw, Poland. Each is pursuing an action plan to help achieve the goal of increasing the number of Europeans who are nonsmokers to 80 percent by the year 2000. In Victoria, Australia, a participant in the global Healthy Cities movement, The Tobacco Act of 1987 established the Victorian Health Promotion Foundation which distributes approximately $25 million a year from levies on wholesale sales of tobacco products. The funds are used to buy out tobacco sponsorships of cultural and sports events; support sports and physical activities programs; sponsor art and cultural projects which communicate health messages; finance health promotion by community-based groups; and pay for research. PROPOSITION 99 The second development was passage in 1988 of the Tobacco Tax and Health Protection Act, Proposition 99, which levied a tax on tobacco products. Twenty percent of the tobacco surtax fund was earmarked for the Health Education Account to fund California's'I'obacco Education Program, the most comprehen- sive approach to reduce tobacco use ever undertaken. (See Appendix B.) Efforts to reduce tobacco use have traditionally been limited to smoking prevention and cessation programs. With Proposition 99, the California Department of Health Services added aggressive media advocacy and policy development-both unprecedented courses of action. Proposition 99 was a turning point in the history of anti-smoking activities in California. It launched an extraordinary statewide campaign attacking the percep- tion of smoking as glamorous and sexy. It challenged the motives of the tobacco industry and created new resources for communities to attack the problems created by tobacco use. • • • 2 51423 0253

T o b a c c o C o n t r o I i n C a 1 i f o r n i a C i t i e s were 100 percent smoke-free. These 78 restaurants were asked in a second survey about the economic effect of their policy. Of the 61 responses, 61 percent felt the no- smoking policy had no effect on business, and 29 percent felt it had increased their business. Smoking control receives special attention when a proposed ordinance forces restaurants to change their policies. Often at council hearings, a few vocal restaurant ...29 percent of smoke-free restaurants surveyed in Sonoma county felt smoking control had increased their business. owners complain that there will be an exodus of customers to nearby communities without smoking restrictions. The 3,000-member California Restaurant Association testified during a hearing on a tobacco control ordinance in Walnut Creek that, effective June 1990, it supports enactment of a 100 percent smoke-free state law that includes all enclosed places open to the public. It opposes ordinances that apply only to restaurants. To attract more families, Carl Karcher Enterprises of Anaheim banned smoking in al1433 of the company-owned Carl's Jr. restaurants as of January 1, 1991. The company also encouraged owners of its 145 franchises to do the same. California Cafe, a restaurant chain based in Corte Madera, banned smoking at its restaurant in Walnut Creek following passage of a local smoking ordinance. After business jumped approximately 20 percent and customer comments ran 25 to 1 in favor of the policy, company officials extended the same smoking policy to all their restaurants in California. The Chez Panisse restaurant in Berkeley banned smoking in 1990 after customers complained about cigarette smoke. "We haven't seen a huge rise in business," said Richard Mazzera, business manager. "But I know we're saving about $300 a year in ashtrays." Barry Fogel, owner of Jacopo's Pizzerias, a southern California chain of Italian restaurants, announced in a May 1991 press release that his four Los Angeles area restaurants would be smoke-free, and he urged other restaurateurs to do the same. Ironically, Fogel was a past president of the Beverly Hills Restaurant Association and a leader of the fight against the 100 percent smoke-free ordinance in Beverly Hills. "The mandatory ordinance would have put the restaurants of Beverly Hills at a com- petitive disadvantage with those in Los Angeles then. However, I now urge other restaurant owners to try what I have done. We now know too much about second- hand smoke to ignore the facts." Despite the myth perpetrated by the BHRA and other groups, smoking restric- tions clearly have not had a negative effect on restaurant sales. A FINAL NOTE Opposition to smoking restrictions continues to focus on the presumed impact on local business, even though:  There is no evidence of lost business because of smoking controls.  There are indications that a ban on smoking may actually improve restaurant sales.  Smoking increases health, absenteeism and other overhead costs of employers.  Many employers have successfully banned smoking. 32 51423 0280

C h a p t e r S i x • A c c e s s f o r M i n o r s • • • The tobacco industry has challenged three local vending machine bans in California, arguing they were preempted by Penal Code Section 308, which regulates tobacco sales to minors. In the first defini- tive ruling in this area the Fourth District Court of Appeal has upheld the city of Rancho Mirage's ordinance which simply bans sales of cigarettes through vending machines, without reference to the location of the machines or the age of permissible purchasers. LICENSING MERCHANTS A license to sell tobacco gives munici- palities a powerful mechanism for enforcing compliance with state laws prohibiting tobacco sales to minors. Merchants will avoid selling cigarettes to youths if they risk suspension of their license to sell tobacco to adults. This type of ordinance can be revenue neutral; licensing fees can offset the cost of enforcement. The city of Woodridge, Illinois, found its licensing ordinance was extremely effective in reducing tobacco sales to minors. Not only did the rate of sales to minors fall following passage of the ordinance, but a school survey found a 69 percent drop in regular smokers. A vital component of the success of the Woodridge ordinance is an active enforce- ment system which uses youth inspectors to periodically visit stores and attempt to purchase tobacco. Enforcement of licensing ordinances by the local health department or city manager's office sends a message that selling tobacco to youths is a health issue as well a legal issue. BANNING FREE SAMPLES California state law, as of January 1, 1992, prohibits the free distribution of cigarettes or smokeless tobacco in most public places, including public buildings, parks, playgrounds and sidewalks. This measure was a response to tobacco compa- nies who regularly gave free tobacco products to youths. The new state law includes an explicit non-preemption clause which allows local governments to pass their own more restrictive ordinances. OTHER APPROACHES Local jurisdictions can take additional actions to reduce tobacco use by youths. Several cities and counties have begun voluntary merchant education programs to increase compliance with the state law prohibiting tobacco sales to minors. These programs have reduced over-the-counter sales to minors but have had little effect on vending machine sales. Over time, how- ever, the impact of a merchant education program weakens and illegal over-the- counter tobacco sales return to previous levels. Jurisdictions can also work with school districts to encourage smoke-free policies. While it is illegal for students to smoke on public school grounds, some school districts allow their personnel to smoke. Such a policy is inconsistent with school-based smoking education and prevention messages. The policy also exposes nonsmoking personnel and students to environmental tobacco smoke. All school districts must be smoke-free by 1996 or lose state Tobacco Use Prevention and Education program monies. A number of school districts are already smoke-free, including the large San Juan Unified School District in Sacramento County. 37

C H A P T E R © • THREE CASE STUDIES I,OD1'S BREAKTHROUGH SAN Luis OBISPO'S SMOKE-FREE BARS SACRAMENTO PHASES IN A BAN 0 There are so many cities in California-468 now and more on the way-and cities are each so different, that only general guidelines can be useful for all of them. Developing helpful tobacco control specifics is a frustrating task and an elusive goal. No guidebook about tobacco control can be an all-encompassing instruction manual, but the experiences of others can be revealing. Cities learn from each other and California cities work together. Case studies are the nearest things they have to experi- mental situations. The following cases illustrate some specifics and also demon- strate the predictable variety in local tobacco policy. LODI'S BREAKTHROUGH The experience encountered by the city of Lodi during its pioneer effort to develop a strong tobacco control ordinance is an appropriate place to begin a review of case studies. Although Lodi has grown significantly in recent years, it remains a politically stable Central Valley community with an agriculturally based economy. Republicans outnumber Democrats by a significant margin. There is a significant Latino minority. None of these distinguish- ing characteristics can be linked to support for strong tobacco control. Lodi has been a city since 1906. It gives a visitor the feeling of a home town, a traditional community that respects its past. It has a population of 53,186 and a median age of 33.6 years, older than most other Central Valley cities. Wealth appears to be relatively concentrated: per capita income is higher and median household income lower than in comparable Central Valley cities. The city is surrounded by much productive agricultural land. Among its largest private local employers are the grape and wine industry and food processors. Major political issues are related to growth: Lodi has grown to its present size from a population of 29,000 in 1970. Agricultural interests have guided the scope and direction of growth to preserve agricultural uses. Despite its relatively stable and conservative politics, in 1990 Lodi enacted a remarkable and courageous tobacco control ordinance. The city went from no regulation to stringent tobacco control restriction following a tough fight. Lodi's experience illustrates the difficulty in tracing the origins of a public policy decision. Even major participants have different recollections: "It started with the county. They had an ordinance and 15

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s may be reopened at any subsequent meeting, and must be reopened if the language is substantially changed. For most ordinances, public testimony is offered only at one hearing, but tobacco regulation generates so much interest that two hearings are typical. CONTROVERSIAL ISSUES Most indoor areas covered by smoking ordinances have not raised difficult issues. A number of California communities eliminated smoking in specified enclosed public places years ago What are the costs associated with accommodating customers or employees who smoke? Do smoke- free establishments have lower costs for cleaning, and damage to furniture and carpets? without significant opposition and without compliance or enforce- ment difficulties. A comprehensive smoking ordinance may generate controversy over one or two provisions, while the remaining provisions draw little opposition. The hotly debated issues include smoke-free restaurants versus designated smok- ing areas; smoking in bowling alleys and other recreational facilities, and at bingo games; ventilation considerations; and enforcement costs. The issues may not be difficult, but smoking is addictive and feelings about smoking control can run high. Opposition ranges from the imaginative ("It'll cost a fortune; the city will need cigarette patrols tracking down smokers in hallways") to the mistaken ("They have never proved that secondhand smoking is bad for people") 48 and the simply misguided ("I have a constitutional right to smoke wherever I want to"). Nearly all the issues raised in testimony are dealt with in more detail in other parts of this guidebook. BUSINESS RESISTANCE Many smokers say the "smoke" they enjoy the most is the one after a meal. Because smoking is associated with eating, restaurant owners worry that a smoking ban will result in lost business. They fear that patrons will eat out less or will go to unincorporated areas or neighboring cities that permit restaurant smoking. There is no evidence to support these fears. Similarly, smoking is identified with relaxation and socializing and therefore is seen as an integral part of recreational activities like bowling and bingo. But the claim that a ban on smoking will hurt business has not been clearly demonstrated. Smoking has customarily been allowed at bingo games. Revenues from bingo may help fund local charities, churches and school athletic programs. Their supporters, who otherwise might support smoking restrictions, may make special pleas to exempt bingo games. However, the same health concerns that affect workplaces and restaurants should take precedence in bingo parlors as well. Fears of potential business losses are taken very seriously by responsive local officials. If local businesses suffer, sales tax revenues to local government decline. However, the concerns over business losses have proved to be unfounded. As discussed in greater detail in Chapter 5, there is no evidence that smoking regulations hurt restaurants or other businesses.

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • New ordinances are typically accom- panied by extensive informational cam- paigns. Information efforts may include brochures in restaurants and employee common areas, articles in city newsletters sent to every resident, and inserts with business licenses. A key to successful implementation of an ordinance is ad- equate signage and public education. REFERENDA Because people feel strongly about smoking and because more cities are regulating smoking in increasingly restric- tive ways, threats of a referendum may occur, often supported by representatives of the tobacco industry. A referendum election allows voters to approve A key to successful implementation or disapprove a newly passed ordinance. of an ordinance is adequate Most cities use the signage and public education. referendum procedures set out in the Elections Code, but a charter city may specify different procedures. A referendum is initiated with a petition for an election on a disputed ordinance. If enough registered voters sign up, the council must repeal the ordinance or set it for a vote of the people. The chief procedural requirement is that both signers and petition circulators be registered voters in the jurisdiction affected. (See the Sacramento case study for one city's experience with this requirement.) Signatures are validated by the city clerk's office, and the number required depends on the city's population. In large jurisdic- tions, the law permits the city clerk to use a sampling procedure to verify at least 5 percent of the signatures. Time limits apply for circulating a petition, for verifying signatures and for council response. There are other ways to place tobacco control issues on the ballot; a council may request an advisory vote, or may place a proposed ordinance directly before the voters. With the exception of an election in the City of Oroville, whenever the public has expressed its opinion in an election, tobacco regulation has been upheld. Nonetheless, more referendum campaigns can be expected not only because of increasingly restrictive local measures but also because of available funding from the tobacco industry. The tobacco industry was generous in its funding for referendum campaigns in Lodi, Paradise and Sacra- mento County. Funding may support petition circulators, local groups opposing the ordinance and advertisements. A quick check list for referendum procedures: 1. Time limits. Except for urgency measures, ordinances become effective 30 days after final passage. A referendum challenging an ordinance must be filed with the city clerk within that period. Because signature gathering activity can be time consuming and subject to delay, many petitions are submitted close to the dead- line. Complications can result if holidays intervene, or if the clerk's office hours are not adequately publicized. These and other problems have been subject to court action. 2. Petition form. The full text of the challenged ordinance must be included in the petition. 3. Public information. Signed peti- tions are not public records. If the clerk finds the petition does not qualify, only the petitioners may examine the petition. 4. Collecting signatures. The tobacco industry may fund paid circulators who do not live in the jurisdiction where petitions are being circulated. This makes their petitions invalid. • • 50 51423 0295

Chapter Eight • Constructing a Smoking Pollution Control Ordinance • • • behavior. Today, local legislation assumes nonsmoking to be the norm. This shift in public policy makes healthier choices easier choices. WoxxrLACEs Ordinances which restrict or ban workplace smoking place specific responsi- bilities directly on employers. Employers must adopt a smoking policy in writing and make it known to current and prospective employees. The policy should cover treatment of private offices occupied exclusively by smokers, and should require posting of appropriately-sized "no smok- ing" signs. If permitted, smoking areas must be clearly defined and, if in employee cafeterias, limited in size. A separate room with a separate ventilation system may be required; however, some ordinances which permit optional smoking areas state that structural modifications are not required. The clearest, simplest and most effective workplace smoking regulations ban smoking entirely, including all private offices. Findings in the ordinance must support such a requirement by addressing the inadequacy of ventilation systems. Ordinances that allow some smoking in the workplace often protect nonsmoking employees by requiring employers to support and publicize a policy that gives the preferences of nonsmokers precedence over those of smokers in case of a dispute. RFSTAURANTS Restaurants, although they are both enclosed public places and workplaces, are usually addressed separately in smoking ordinances. Restrictions which allow some smoking in restaurants should state the percentage of seating available for a smoking section, whether seats in a contiguous bar must be included in that 45 calculation, and whether restaurants below a specified size are exempt or must be smoke-free. A requirement that restaurants be 100 percent smoke-free is the simplest and the easiest to enforce. Such a require- ment should rest on explicit findings that smoking sections and ventilation systems do not effectively protect nonsmokers. Typical ordinances enacted during the 1970's and early 1980's mandated nonsmoking sections of between 40 and 60 percent and exempted small restaurants. More recent ordinances have either entirely eliminated smoking in all restaurants or enlarged the nonsmoking area. Some ordinances phase in restrictions in gradual steps. Restaurant provisions are often the most controversial part of an ordinance. UNREGULATED AREAS A section that clarifies where smoking is not regulated emphasizes that there is no infringement of the right to privacy; only places regularly frequented by the general public are regulated. This provision also reaffirms the right of any business owner to ban smoking on his or her property. POSTING OF SIGNS A law that does not require the posting of signs is essentially useless. Ordinances often specify where the signs are to be posted, what they should look like, and what the minimum size should be. Restaurants often have to post a sign at every entrance clearly stating the availability of nonsmoking sections. Movie theaters may be required to show a "no smoking" message on the screen prior to a feature motion picture. Most smokers willingly comply with "no smoking" signs that are prominently displayed, which minimizes the need for active enforcement.

C h a p t e r T h r e e • T h r e e C a s e S t u d i e s • -I • political activist concerning amending the ordinance, and a report of a second citation issued to the same bar. The recall petition failed to gain sufficient support and was succeeded by a referendum petition which also failed. Both petition drives and the informal poll were led by defeated council candidates and the recall petition included other local issues, including water policies. Signature gathering efforts featured a booklet that discussed both water and smoking policies and was reportedly funded by tobacco industty contributions. Since passage, San Luis Obispo officials have emphasized merchant education and voluntary compliance rather than sanctions. The ordinance provides for three warnings before the police depart- ment is alerted and a citation becomes imminent. Warnings follow citizen complaints or violations encountered in the course of routine bar checks by police. In the first two months following enactment, 20 to 25 warnings were issued, but no warnings have been issued since April 1991. Penalties range from a $100 fine for the first citation to $500 for the third. Two citations issued at one local lounge were the city's only failure to gain voluntary compliance. A long-established local bowling alley attributed a serious loss of business to the tobacco control ordi- nance. However, a new competitor with newer equipment accounted for part of the loss. The rest may have been caused by repairs of a bowling alley roadway access which was closed in the evenings for four months. Council member Reiss introduced an ordinance governing cigarette sales through vending machines which was passed by the council. San Luis Obispo broke the barrier for legislating environmental tobacco smoke in bars. Other cities have recently banned smoking in bars attached to restaurants, or have required nonsmoking areas in free- standing bars. But San Luis Obispo remains the first and only city in California to entirely ban smoking in bars. The city has received a California Smoke-Free Cities competitive mini-grant to continue its evaluation of the precedent-setting ordi- nance. SACRAMENTO PHASES IN A BAN Sacramento's experience may be particularly useful. Not only is its develop- ment instructive, but the ordinance is comprehensive in its application and thorough in the protection for nonsmokers. Its significance gains by the symbolic value that attaches to the state capitol. City-county cooperation is essential to effective policy implementation in Sacramento County. Thirty-three percent of the county's 1,041,219 residents live in the city In Sacramento, emerging support for tobacco regulation was directed to the joint city-county Environmental Commission, a nine member body of of Sacramento. Most of representatives appointed by the the remaining 694,633 residents live in the unincorporated area and receive urban services county and its four cities. from the county. Fewer than 50,000 people live in the three remaining cities of Folsom, Isleton and Galt combined. In Sacramento, emerging support for tobacco regulation was directed to the joint city-county Environmental Commission, a nine member body of representatives appointed by the county and its four cities. The Environmental Commission is one 21

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s tobacco education material to employees, and to assist them to quit smoking. The Chamber of Commerce has helped with promotional activities and will sponsor an awards program for businesses that go smoke-free. The City of Vallejo is one of 11 communities in North America taking part in an eight-year research project to help people quit smoking. The support of city leaders was essential to Vallejo's selection for the Community Intervention Trial for Smoking Cessation (COMMIT), the largest smoking cessation project ever undertaken. The city is part of a partner- ship that includes Vallejo citizens and the National Cancer Institute through a contract with the Kaiser Foundation Research Institute. According to the project's director, to "COMMIT Vallejo to a smoke-free future" one special challenge has to be met: overcoming the popular belief that nicotine is not dangerous in the same way as are alcohol, marijuana, "crack" cocaine, cocaine, "speed" and other drugs. Through a comprehensive educational effort involv- ing all segments of the community, Vallejo hopes to reduce smoking 10 percentage points more than a comparison commu- nity. A pre-intervention survey in 1988 and a post-intervention one in 1993 will let city leaders know if their goal was reached. It will also provide valuable information about the efficacy of this type of commu- nity health promotion effort. The City of Richmond recently completed a trial project called "Richmond Quits'Smoking." Begun in 1985, the five- year project was designed to develop and evaluate an intensive community-wide campaign to reduce smoking in a predomi- nantly African American community. The project included a diverse media campaign, stop smoking services, community-wide "quit" nights, and recruitment of commu- nity organizations to conduct project activities. This all-encompassing program, the first of its kind in the nation, brought together community groups, churches, volunteer agencies, the business commu- nity, the health care community and local government to determine whether a united community public education campaign could reduce smoking. The project trained over 260 physi- cians, health professionals and neighbor- hood and church-based volunteers on counseling smokers who wanted to quit. The project was financed by a grant from the National Cancer Institute and adminis- tered by the Kaiser Permanente Medical Care Program. Some media campaign slogans were, "Quitters Are Winners," and "Kick Their Butts Out Of Richmond," which appeared in billboard advertisements, bus posters and direct mailings. The project also produced a youth oriented, anti-smoking rap video, "Stop Before You Drop." Participants in the video included more than 300 young- sters from Richmond schools, youth groups, parents, teachers, community organizations and local merchants. The project included a pre-program survey, continuous field observation by a team of sociologists and a follow-up survey. Data will compare change over a four-year period in smoking prevalence in Richmond compared to other communities and national norms. Although project results are not yet available, community leaders say the program made a "tremendous difference" and promise to continue the anti-smoking campaign. Funds to continue the project are expected to come from rentals of the anti-smoking "Stop Before You Drop" video. Funds from the distribution of the video will also support various programs involving the people and community of Richmond. 0 • 58 51423 0302

I S "ENVI RONMENTAL TOBACCO SMOKE" WORTH WORRYING ABOUT? Absolutely. Environmental tobacco smoke in- cludes both "sidestream" smoke from a burning cigarette as well as exhaled smoke. It is the direct cause of death of 53,000 nonsmoki ngAmericans each year and a major contributor to many illnesses, as explained in Chapter 1. WHY HAVE CITIES REGULATED SMOKI NG I N TH E WORKPLACE? The greatest involuntary exposure to environmental tobacco smoke is usually in the workplace. Workers can be exposed to smoke for many hours each day, even if they are nonsmokers, and they are often in a poor position to do anything about it. See discussion in Chapter 4. ASIDE FROM ORDINANCES,WHAT CAN CITIES DO TO REDUCE TOBACCO USE? A smoking control ordinance is the most direct and cost-effective way to reduce smoking activity, but many cities have undertaken educational programs and a variety ofcommunity activities aimed at reducing tobacco use. For a briefreviewofthem, see Chapter 10. WHAT CAN CITI ES DO TO CONTROL CIGARETTE ADVERTISING AIMEDAT MINORS? Cigarette companies spend enormous sums to promote their products-particularly with youths. Although banned from ad- vertising on television, tobacco companies have found alternative ways to reach the public. Local restrai nts on advertising are lim ited, but not out of the question. More details appear in Chapter 7. WHAT CONTROVERSIAL ISSUES COME UP WH EN A CITY CON SI DERS A SMOKI NG CONTROL ORDI NANCE? Typically, only one or two issues are the rallyingpoint for opposition. They often focus on smoking in restaurants, bingo games and bowling alleys; on ventilation; on personal rights; and on enforcement costs. These controversial topics are discussed in Chapter 9. H OW CAN TOBACCO BE KEPT AWAY FROM CHILDREN AND TEENAGERS? Youths pu rchase cigarettes and smoke- less tobacco illegally from merchants and vending machines. By controlling these sources, smoking by minors can be sharply reduced. See Chapter 6 for more information. WILL RESTAURANTS LOSE CUSTOMERS BECAUSE OF SMOKI NG CONTROLS? No. A recent ' studyofeightcit- ies-fourwith and fourwithout smoking ordinances-showed that restaurants in cities with a smoking ordinance actually had increases in business compared to other local businesses. More and more restaurant customers prefer a smoke-free environment. For more information on this topic, see Chapter 5. How CAN SMOKING BE REGULATED WITHOUT INFRINGING ON PERSONAL RIGHTS AND FREEDOM OF SPEECH ? Ihe courts have long held that smoking is not a"personal right." Nor does it violate freedom of speech to limit the advertising of smoking products. For a discussion of these and other legal issues, turn to Chapter 12. WHAT CAN CITIES EXPECT WHEN THEY CONSIDERAN ORDINANCE TO CONTROL Slvt OKI N G? California's cities are the most progres- sive in the nation in controlling environ- mental tobacco smoke. See Chapter 3 for case studies of the problems and politics in three cities that broke new ground in the battle against smoking. tn Fj ~ N w m N tJ1 N Il

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s "tobacco-free" message were given to city- sponsored athletic teams. Youths are producing murals with a tobacco-free message in several public schools. Pencils and other promotional items were given away in some schools as rewards for good performance. One indirect consequence of the campaign-not entirely surprising since the grant was written by the Chief of Police and Director of Public Safety-was a new policy making the Public Safety Building and police patrol vehicles smoke-free. Cotati: "Second-Hand Smoke Aware- ness Project"involved youth from 8-18 years-old in educating the community about secondhand smoke and in advocating policies to protect nonsmokers. In a contest coordinated with the Chamber of Com- merce, elementary school students pro- duced posters on secondhand smoke awareness. The grand prize was a trip to Disneyland; four other winners received $50 bonds donated by a local bank. Middle school children produced a video public service announcement in a joint effort with the local public television station. They were helped by high school students in the school district's "HEALTHY KIDS Teens as Teachers" project. The high school students also wrote articles about the project for the "HEALTHY KIDS QUARTERLY" newsletter, and made presentations on secondhand smoke issues to local policy making bodies and school children. Culver City: "Culver City Teen Tobacco Access Project"began by surveying the city's middle school children for information on how they obtain cigarettes. Youths from city-sponsored organizations also surveyed stores to assess how likely they are to sell cigarettes to youths. Information from both sources will be used for retail merchant education. The city hopes to empower youth to remain tobacco-free while reducing youth access through non- regulatory means. Davis: "Davis' Smoke-Free Future" took advantage of a unique city staff position, that of substance abuse coordina- tor, to work with other community-based tobacco use and substance abuse prevention efforts to increase public support for smoke-free environments and to decrease tobacco use among minors. Approximately 300 retail sales people in Davis have been trained in responsible tobacco sales. The recognition for partici- pating merchants included a float in the Davis Picnic Day parade. Worksite training programs in cooperation with the Yolo County Health Department will reach nearly all city and county employers and increase support for smoke-free workplaces. A stronger smoking control ordinance is under consideration by the city. Duarte: `Public Policy Development and Implementation "used a professional firm to poll residents on their opinion about tobacco control policies and other smoking issues. In addition, city staff surveyed restaurants about their experience with Duarte's current ordinance and concerns about its expansion, and the school district surveyed middle grade and high school students. The community was involved in developing questions and determining how results should be applied. Because Duarte participates in the California Healthy Cities Project, a broadly based steering committee was already in place. The city hopes this participatory model will bolster support for any resultant policy changes. Ultimately, the city will assess how well this process worked in guiding public policy. • • • 54 51423 0298

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • year older than Proposition 99, but the two quickly became a match made in heaven. The commission began by addressing environmental concerns, including the On June 2,1992, the voters of Sacramento County, by a 56 to 44 margin, upheld the County's smoking regulation. The tobacco industry outspent proponents of the measure by 30 to 1, but did not overcome the public's growing disdain for tobacco smoke. traditional concerns of air quality and environmen- tal health, with an eye to avoiding city-county rivalry or duplication. The Commission operates in some ways as a quasi-planning com- mission, hearing appeals from some regulatory decisions. It has been useful in formulating and compromising difficult issues. Elected officials respect the commission's decisions although it is not unusual for them to disagree. The smoking ordinance originally developed by the Environmental Commis- sion reflected the recommendations of a task force with representation from the Chamber of Commerce and local restau- rant owners. It provided for 50 percent nonsmoking areas in restaurants and recreation halls, and for a ban on smoking in public places and in both public and private workplaces. If a restaurant had a bar, bar seats were included in calculating the nonsmoking section. The workplace provisions were a considerable change from the existing ordinance with its optional smoking areas and exceptions for offices occupied exclu- sively by smokers. The ordinance proposed by the task force and the Environmental Commission was carefully crafted to assure acceptance. Said one member, "I was satisfied. I feel strongly that 90 percent of a smoking ordinance's value comes in the workplace and we had that. It's more „ important. However, the ordinances passed by the city and county were not what the Environmental Commission recom- mended. The County Board of Supervisors favored a three-year phase-in to reach a 100 percent smoke-free environment in restaurants. At the same time, a City Council committee recommended a total ban immediately. The Council preference for a ban on restaurant smoking led to close work between city and county legal departments to develop wording acceptable to both bodies. In the end, the city council enacted an ordinance which banned smoking in the workplace and phased in a ban on restau- rant smoking over 18 months, moving in nine-months intervals to 50 percent smoke- free, then 75 percent and finally 100 percent. The ban included bowling alleys and bingo games. Only bars, tobacco retailers and private meeting facilities were exempt. The proposal also provided for exemptions based on economic hardship or alternative technology. Once passed, the ordinances triggered signature-gathering for a referendum. Ostensibly led by local restaurant owners organized as Sacramentans for a Fair Business Policy, the effort received virtually all funding came from tobacco companies. Signature-gatherers carried petitions for both city and county referendums and many voters signed both. When the City Clerk's staff began verifying signatures on the city referendum petition, they discov- ered that many petition circulators were not city residents as required by the law. There were insufficient valid signatures on valid petitions to qualify for the ballot. The referendum petition directed at the county ordinance did qualify, which was not unexpected. Many Sacramentans 51423 0272 22 •

C H A P T E R 0 • ADVERTISING AND PROMOTION PUBLIC TRANSPORTATION • • TOBACCO BILLBOARDS Cigarettes and other tobacco prod- ucts are the most heavily marketed com- modities in America. From 1975 to 1988, the tobacco industry's advertising and promotion expenditures increased more than sixfold, from $500 million to $3.3 billion annually.34 In California alone, the industry in 1988 spent more than $360 million to promote cigarettes and smokeless tobacco products20 These activities include both traditional advertising-such as billboard, magazine and newspaper ads- and promotional activities such as sponsor- ship of sports and cultural events. Tobacco revenues began falling after a 1968 court ruling required broadcast stations to air free commercials revealing the harmful effects of smoking. Tobacco industry representatives then began lobbying Congress for a ban of tobacco advertising on all broadcasting stations, which would eliminate the free time for counter-advertising. Congress responded with the Public Health Cigarette Smoking Act of 1969, which went into effect on January 2, 1970, and banned cigarette advertising on television and radio. The tobacco industry was then free to redirect its advertising dollars to promotions. Today, the tobacco industry circum- vents the ban by sponsoring sports and cultural events with national television exposure. The tobacco industry now spends more on promotions than on advertising. Sponsoring activities like professional tennis tournaments (the Virginia Slims Open) and auto races (the Camel-sponsored Long Beach Grand Prix) has allowed the tobacco industry to keep its products before the public on television. Despite vehement denials by the tobacco industry, these efforts are primarily directed at encouraging youths to smoke. Advertising and promotion activities use themes which appeal to youths: shapeliness, popularity, glamour, sex appeal and athletic prowess. Some advertising campaigns, such as the R.J. Reynolds company's Joe Camel, use cartoon characters to promote their product. Promotions focusing on popular athletic or cultural events often reach huge youth audiences. An independent evaluation funded by Proposition 99 found that "there is strong evidence of concerted tobacco advertising campaigns targeting California youth and women following enactment of Proposition 99. Whereas tobacco advertis- ing containing youthful and female models decreased markedly during the year of the debate and enactment of Proposition 99 (1988) compared to the previous year, it increased dramatically to all-time high levels after 1989... Additional evidence that the industry has increasingly targeted these markets comes from observations of 39

C h a p t e r T e n • 0 t h e r W a y s t o R e d u c e T o b a c c o U s e 0 • Lodi: "Smoking Ordinance Promotion Project"promoted the city's strict smoking control ordinance through a public information campaign targeting adults and children. "Breathing Space," a regular feature in the city newsletter, provided residents with information about the ordinance, its enforcement, and the health consequences of smoking and exposure to environmental tobacco smoke. A public information pamphlet was distributed to businesses, and youth in city recreation programs received no-smoking booklets. Children also developed posters which were distributed throughout the city. The city is also studying the impact of the smoking ordinance. An unexpected positive outcome of this project has been the strong ties devel- oped between the city and the San Joaquin County Public Health Department-each helping the other to achieve a mutual goal. Loma Linda: Just For The Health Of It"used a wide range of activities to expand on the city's comprehensive smoking ordinance adopted in 1987. An omnibus project, it targeted many sectors of the city to implement and enforce its policy. To advocate the merits of a smoke- free environment to local businesses, the city has sponsored workshops, engaged in a smoke-free business community recogni- tion program, integrated the requirement of a smoking policy into the business license application process, and established a process to monitor business compliance. The public has become more aware of the city's goal through announcements of smoke-free activities and recognition of smoke-free businesses published in the city newsletter and the chamber of commerce newsletter. Posters with a smoke-free message are being installed at bus stop shelters. 55 Loma Linda's elementary school children have benefited from the city's purchase of tobacco education materials loaned to the schools; general assemblies have featured city officials as well as popular characters presenting a smoke-free message. Media attention on the city's project led a number of local residents to express strong approval of the city's efforts. City staff researched stronger policies at the request of the council and ultimately a strong revised ordinance was enacted. Merced: "Smoke-Free Workplace Assistance Program (SWAP) "took advantage of the city's close working relationship with the business sector and its strong customer service philosophy to help local employers implement policies and action plans to make worksites smoke-free. Two executives of local firms with 100 percent smoke-free policies will receive special recognition for helping the city to make contact with other targeted worksites. Worksites that participated in the project and adopted a smoke-free policy will also be recognized in the city's newsletter to residents and through other media. Businesses have been polled about their attitude toward the current ordinance. Most calls to the city about smoking are from employees seeking protection from environmental tobacco smoke at the worksite. San Luis Obispo: "Smoking Ordi- nance Economic Analysis "will expand upon an earlier study comparing sales tax revenues for San Luis Obispo, which has a 100% smoke-free restaurant ordinance, with those for Atascadero where no similar ordinance is in effect. The city's economic analysis will review sales tax revenues of other cities in the region, for a better comparison with cities which also depend heavily on tourism.

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s youth. The City of Berkeley surveyed access by minors to tobacco products at convenience stores near Berkeley High. The finding that teenagers could easily purchase tobacco has led to exploration of new strategies. The city has provided additional funds for students to continue surveillance of 98 stores. Gathering hard data on youth access to tobacco products is also an important activity of cities in the multi-city Stop Tobacco Access for Minors Project (STAMP). The cities in this four-county, 10-city project are: Santa Rosa, Rohnert Park, Cotati, Petaluma, Napa and Novato; and under the auspices of the Solano County Cancer Prevention Program, the cities of Vallejo, Benicia, Fairfield and Vacaville. The goal is to develop strategies to reduce tobacco sales to minors now and prevent serious health problems and premature deaths later. Efforts begin with an assessment of tobacco availability to minors by surveying minors directly, or by measuring the frequency of purchases from merchants during controlled, police- approved buys. A coalition of community health advocates works with the media to increase public awareness of easy access to tobacco. Educational materials and staff training help merchants prevent tobacco sales to minors and restrict youth access to tobacco. Public recognition is given to merchants who obey the law and congratu- latory letters thank merchants for not selling tobacco to minors. Finally, a second survey is conducted to measure the effec- tiveness of the campaign. CITY EMPLOYEES A starting point for health in the workplace is the city's own work force. City facilities are the most frequent target of local regulation, and a growing number of cities are also providing employee wellness programs and employee assistance pro- grams that include smoking cessation. The City of Walnut Creek, for example, reimburses tuition for smoking cessation up to $200 a participant. The City of Reedley provides information to its employees through its employee assistance program. Many cities have joined with their respec- tive counties to provide employees smoking cessation services. In an unusual approach to worksite tobacco education, the City of Chula Vista was selected for the CITYFOLKS program sponsored by the Alcohol and Drug Abuse Prevention Task Force (ADAPT). This is not a smoking cessation program, but is designed to help educate city employees, create a healthy worksite environment and improve the effectiveness of the city's worksite smoking policy. Smokers and nonsmokers are brought together to decide policy options. After leadership training seminars, participants have three options for use of their skills and education. One is to facilitate education classes for city employees interested in tobacco education and policy development. Another is to participate in a worksite smoking policy review committee. The third option is to participate on an internal communications committee to spread the project throughout the municipal work force. As diverse as these various efforts are, they share two ingredients which are the foundation of the Healthy Cities concept: formation of sound public policy and widespread public participation. 51423 0304 60 • •

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • One reason children begin using tobacco products is to emulate adult behavior. Their access to tobacco products can be restricted, but this strategy may unintentionally reinforce the image of A recent survey shows that over 85 percent of Californians, including many smokers, support the elimination of vending machines to reduce youth access to tobacco. smoking an acceptable adult activity. The California Tobacco Survey found overwhelming public support for eliminating access by minors 4 Ordinances can limit access for youths while minimizing the impres- sion that smoking is an adult activity by eliminat- ing sales of tobacco through vending machines, licensing tobacco retailers and banning free samples of tobacco products. VENDING MACHINES A ban on tobacco vending machines is supported by both Secretary of Health and Human Services Louis Sullivan and former U.S. Surgeon General C. Everett Koop. Vending machines account for a small portion of total tobacco sales, but many of the sales are to very young chil- dren. The Surgeon General found that youths nearly always use vending machines to first purchase tobacco products. Young children are often intimidated by over-the- counter purchases, but face no barrier with a vending machine. In Contra Costa County, the Health Services Department found that 10-11 year-old youths had little success in purchasing tobacco products over the counter following a systematic education program designed to encourage merchants to enforce the state law. However, the children were totally successful at locating and using vending machines even after the program. To date, 49 local jurisdictions in California have partially or completely banned tobacco vending machines. A recent survey shows that over 85 percent of Californians, including many smokers, support the elimination of vending ma- chines to reduce youth access to tobacco 4 For the most part, the only opponents of such ordinances have been local vending machine companies and the tobacco industry. Opponents of vending machine bans often favor equipping the machines with locking devices controlled from behind a counter. These effectiveness of these devices in preventing tobacco sales to youths is questionable. The state of Utah and the city of Seattle, Washington, both passed legislation requiring locking devices, but concluded they were ineffective. Surveys found that few machines in Utah were actually equipped with locking devices. In addition, clerks operating the machines failed to confirm the age of purchasers. Some businesses simply disabled the locking devices, leaving the machines readily available for use by to youths. Ultimately, both Utah and Seattle abandoned locking devices because of their ineffectiveness and amended their laws to ban tobacco vending machines except in bars. California ordinances often limit vending machines to bars or other areas which by law are inaccessible to minors. If exceptions are allowed for adults-only locations, vending machines must be at least 25 feet from any entry into the premises in order to prevent purchases from unattended machines. But a National Automatic Merchandising Association survey found that only 11% of minors had ever been stopped from buying cigarettes from a machine. 36' 51423 02g3 •

Chapter Eleven • The Tobacco's Reaction • • • INDUSTRY ACTIVITIES In 1978, a confidential report prepared for the tobacco industry by the Roper organization cited the growing nonsmokers' rights movement as "the most dangerous development to the viability of the tobacco industry that has yet occurred."1z Today, just one in five Californians smoke, and the majority of California nonsmokers (as well as some smokers) support strong smoking control ordinances. To counter popular support for local ordinances, several tobacco companies have tried to stimulate grass roots opposi- tion. The R.J. Reynolds tobacco company has been particularly active in organizing and assisting various local smokers' rights groups throughout California. Industry assistance to these groups includes strategy sessions, mailing lists from R.J. Reynolds and Philip Morris databases of smokers, help with writing and circulating petitions and financial assistance to organize cam- paigns against local ordinances. Philip Morris U.S.A., which started with a list of 100,000 smokers, has compiled a computer database of 12 million names which it uses to rally smokers against local ordinances. According to Walker Merryman, vice- president of the Washington D.C.-based Tobacco Institute, a crucial part of the tobacco lobby's strategy is contacting people and groups within a state to mobilize against proposed smoking restrictions. OTHER TACTICS The tobacco industry has used political contributions in an attempt to derail local ordinances. In 1990, eight of 15 Los Angeles city council members received contributions of $500 to $1,000 from tobacco industry interests during a battle over a smoke-free restaurant ordinance. The tobacco industry has threatened to withhold financial support for local athletic or cultural activities. In 1987, the city council of Rancho Mirage weakened a strong smoking control ordinance after RJR Nabisco, parent company of R.J. Reynolds, threatened to pull its annual Dinah Shore Golf Tournament out of the city. When other tactics have failed, the tobacco industry has gone to court. When Beverly Hills passed a smoking control ordinance in 1987 the Beverly Hills Restaurant Association, backed by the Tobacco Institute, twice challenged the ordinance in court and lost. But later the Beverly Hills Restaurant Association persuaded the council to amend the ordinance by claiming that restaurants had lost 30 percent of their business as a direct result of the ordinance. This claim was incorrect but went unchallenged at that time. In its lobbying efforts, the tobacco industry often contends that the anti- smoking effort in California is led by government, not by ordinary citizens. However, Proposition 99, the Tobacco Tax and Health Protection Act, was a ballot measure initiated by voters and became law only with the approval of the voters. While the legislature has failed to pass effective smoking restriction, more than 250 California cities, at the urging of individuals and community groups, have enacted tobacco control. 63

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s restaurant and bowling alley opposition. The Alliance received financial backing from the tobacco industry and helped coordinate opposition to the ordinance during the hearings. In spite of this effort, the ordinance passed. The tobacco industry has stepped up its efforts at the state level as we1l2, 3(See Appendices P, Q). Between 1986 and 1989, the tobacco industry contributed $3.3 million to California legislators. In 1990 alone, the industry contributed nearly $4 million. These totals do not include the $21.2 million the tobacco industry spent in 1988 against Proposition 99, the Tobacco Tax and Health Protection Act.z INDUSTRY SUPPORTED GROUPS The various business coalitions or associations supported by the tobacco industry typically materialize shortly after a tobacco control ordinance is proposed. They approach the local business commu- nity, often citing undocumented evidence of a loss of business in cities with smoking control ordinances. Meetings with local businesses encourage opposition to the proposed ordinance. Industry-sponsored groups provide assistance like posting flyers, funding newspaper ads, circulating peti- tions and sponsoring mail-in postcard campaigns. Representatives of these associations occasionally testify at public hearings, but more often attend without speaking in order to avoid questions concerning their creation, local member- ship and sources of funding. The most visible of these industry- supported associations have included the Beverly Hills Restaurant Association, Restaurants for a Sensible Voluntary Policy, the California Business and Restaurant Alliance, Sacramentans for Fair Business Policy and Californians for Fair Business Policy. 62 In 1983, San Franciscans Against Government Intrusion was formed to try to overturn a workplace smoking ordinance passed by the San Francisco Board of Supervisors. The group paid petition circulators to collect signatures for a referendum and financed an extensive media campaign. Nearly all of the group's funds came from tobacco industry dona- tions. Of over $1.25 million spent in the campaign against the ordinance, all but $3,300 came from the tobacco industry. San Franciscans voted to retain the ordi- nance. In April 1991, the Long Beach City Council passed a tough anti-smoking ordinance that by 1994 would have banned smoking in restaurants. After Californians for Fair Business Policy began circulating petitions calling for a referendum, the Council suspended the new law. A new, less restrictive ordinance went into effect in September 1991. Records filed with the California Secretary of State indicate the organization was largely financed by tobacco manufacturers and wholesalers. Both the City and County of Sacramento passed stringent smoking control ordinances in October 1990, six years after adopting measures that did not deal comprehensively with the effects of environmental tobacco smoke. Sacramentans for Fair Business Policy organized to oppose the ordinances. Of the group's $376,000 in declared donations, $367,000 came from the tobacco industry. The organization failed to stop either ordinance but succeeded in getting a referendum on the ballot to challenge the county ordinance. The voters approved the ordinance in June 1992. • • •

T o b a c c o C o n t r o 1 i n C a I i f o r n i a C i t i e s COMMON STRATEGIES Opponents of tobacco control ordinances typically focus on three main areas: economic impact, smokers' rights and the threat of a lawsuit. Representatives of tobacco industry sponsored groups like Restaurants for a Sensible Voluntary Policy (RSVP) and the California Business and Restaurant Alliance (CBRA) regularly attend city council, chambers of commerce and local restaurant association meetings throughout the state. They perpetuate the myth that restaurants have lost 30 percent of their revenues in cities which have passed smoke-free ordinances. In fact, restaurants in those cities have shown increases in business as a percentage of total local business receipts. This topic is discussed in greater detail in Chapter 5. Opponents of a smoking control ordinance often argue that smoking is an individual rights issue. Their language draws from the Bill of Rights, and is in- tended to polarize and divide a community. Smoke-free ordinances no more violate a person's right to smoke than drunk driving laws violate a right to drink alcohol. They simply limit use which is a danger to others. The lawsuit is a favorite strategy of the tobacco industry when municipalities try to control or ban tobacco product vending machines. While cigarette vending machines account for less than 4 percent of all cigarettes sold in California, they are the primary source of tobacco for those who are under 12-years-old and are experimenting with their first cigarettes. Vending ma- chines offer no barrier to tobacco purchases by children and are an easy way to recruit the new smokers necessary to replace those smokers who die or quit. 64 Three vending machine ordinances in California have been challenged in court. In a recent case, Rancho Mirage's vending machine ordinance was challenged by the Bravo Vending Company, which received support from the Tobacco Institute. In the first definitive ruling in this area the Fourth District Court of Appeal has upheld the City of Rancho Mirage's ordinance which simply bans sales of cigarettes through vending machines, without reference to the location of the machines or the age of permissible purchasers. City officials should scrutinize claims made by groups opposing tobacco control ordinances, because information is often not well documented. Anecdotal claims or informal surveys are not as compelling as scientific information from the medical community or a careful analysis of Board of Equalization tax receipts. City councils will benefit from scrutinizing the source of organized opposition and from developing information about an organization and its funding. The tobacco industry can organize considerable opposition against a proposed local ordinance. But a well-conceived, well- constructed ordinance is likely to succeed. More and more California cities are proving the point.

T o b a c c o C o n t r o 1 i n C a I i f o r n i a C i t i e s FINDINGS AND PURPOSE This section of the ordinance explains why it is required and what the law is supposed to do. It should briefly present the latest medical evidence about passive smoking. Do not rely solely on sample ordinances; their evidence may be out- dated. The ordinance should unequivocally declare its purpose to 1) protect the health and welfare of the citizens, and 2) recognize that the need to breathe smoke-free air has priority over the desire to smoke. This section is critical because the ordinance may be judged or even attacked by how well it addresses its purpose. As an example, the 1992 appellate decision in the challenge of the ordinance adopted by the City of Lodi held that: "With the stated purposes of the ordinance, prevention of fires, preservation of citizens' health (whether or not they object) and reduction in air pollution in establishments serving food, this activity [smoking] is subject to either regulation or prohibition within the police power..." DEFINITIONS Key terms used in the ordinance should be precisely defined to establish the scope of the law and avoid misinterpreta- tion. This is fundamental for the successful implementation. Well-written definitions also eliminate loopholes in the law. For example, most laws exempt bars, so some restaurants have attempted to be exempted based on the fact that they have a bar section. This problem can be solved by defining bar so that it does not include a restaurant dining room. Terms with an obvious and narrow meaning need not be defined. APPLICATION TO GOVERNMENT FACILITIES The law should state expressly its application to facilities owned or leased by the city, including vehicles. A city ordi- nance does not apply to county, state or federal government facilities, but a provi- sion calling for voluntary compliance from these entities is often included. ENCLOSED PUBLIC PLACES There are three major areas typically addressed through smoking pollution control ordinances: enclosed public places, workplaces and restaurants. Enclosed public places are places accessible to the public. This section typically lists some of the facilities intended to be covered by the law-such as retail stores, lobbies, elevators, waiting areas, sports facilities and medical offices. Often facilities already covered by state law, such as food markets, are in- cluded to provide a local mechanism for enforcement. But this section is often not all-inclusive; any exceptions are specified. Many recent ordinances completely eliminate smoking in all enclosed public places, without allowing designated smoking areas. Exceptions specified in these 100 percent ordinances are tobacco retailers, bars, private homes ("except when used as a child care facility") and rooms in hotels or restaurants rented for private parties. Exempt bars may be defined as only those not part of restaurants. (As of 1992 only one California city, San Luis Obispo, bans smoking in all bars). Hotels may be required to maintain a specified percentage of sleeping rooms as nonsmoking. Until the mid 1980's most laws allowed smoking except in specified nonsmoking sections. Such a public policy assumed that smoking was a normal • • 44 51423 0289

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s Letters to the editor of a local newspaper are an excellent way to voice support for a smoking control effort. Newspapers like to publish representative letters from the public, but they may have to edit them because of limited space; it is im!wi t(lJPP*131-YPJ' ShfiCt 1C,],m2k wLLt- Y 1 L e GAINING ACCESS TO TH E MEDIA The media will give extensive coverage to a proposed smoking control ordinance. But gaining the media's atten- tion for other tvpes of anti-smokiniz efforts i ~ Lis r

Chapter Twelve • Legal Perspectives • 0 • imposition of restrictions on, smoking in places of employment covered by Title L" Language in the Act on refusal to hire smokers is unclear and municipalities should have the issue addressed by legal counsel. However, the Act does appear to allow cities to refuse to provide an area for smoking. CALIFORNIA LAWS State legislation on smoking origi- nated with California's Indoor Clean Air Act of 1976, now Health and Safety Code, Sections 25940 through 25947. Health and Safety Code Sections 25948 through 25949.8 were added in 1987. Section 25941 of the code allows a prohibition on "smoking of tobacco in designated areas of publicly owned places while a meeting is in process." Section 25946 of the code specifically states that "the legislature declares its intent not to preempt the field of regulation of the smoking of tobacco. A local governing body may ban completely the smoking of tobacco, or may regulate such smoking in any manner not inconsis- tent with this chapter or any other provi- sion of state law." Further, in Section 25949.6, the code specifically states that "this article does not preempt any local ordinance on the same subject where a local ordinance is more restrictive to the benefit of the nonsmoker." Various other state regulations also protect the public. The following summa- rizes California codes pertinent to tobacco control. PUBLIC TRANSPORTATION Smoking is prohibited on all forms of public transportation, including buses and trains. Train stations, airports, bus stations, and other transit depots must set aside a minimum of 75 percent as a smoke-free area. Although no enforcement agency is specified, the law may be enforced by the local Health Department, and violations are an infraction and subject to fine. (Health and Safety Code, Sec. 25949) GROCERY STORES Smoking is prohibited in grocery stores and retail food stores. (Health and Safety Code, Sec. 25947) Smoking is also prohibited in all food preparation, storage and utensil cleaning and storage areas. (Health and Safety Code, Sec. 27605) STATE OFFICES State government agencies must adopt smoking policies recognizing the right of employees to a smoke-free environ- ment. The policy is set by individual agencies which must, at a minimum, include smoke-free work stations and meetings. (Government Code, Sec. 19994.30) Restaurants in state buildings with a seating capacity of 50 or more must designate a minimum 20 percent non- smoking area. (Health and Safeiy Code, Sec. 25944) SCHOOLS Smoking by students on school campuses is prohibited. (Education Code, Sec. 48901.5) Bus drivers are prohibited from smoking on buses in which young people ride. (Licenses, Sec. 12423) HEALTH CARE FACILITIES Smoking is prohibited in patient areas of clinics, except rooms designated for occupancy exclusively by smokers. Smok- ing is prohibited in patient care areas, waiting rooms, and visiting rooms of a 67

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s health facility, except areas designated as smoking areas. Smoking is prohibited in patient rooms unless all persons assigned to a room have requested a smoking room. (Health and Safety Code, Sec. 1234, 1286) SALES TO MINORS It is unlawful to sell or in any way furnish cigarettes or other tobacco products to persons under the age of 18. Violations are a misdemeanor subject to a fine of up to $1,000, enforced by the city attorney, county counsel, or district attorney. Cities and counties are preempted from altering the fine schedule. (Penal Code, Sec. 308) Businesses which sell tobacco must post a copy of the State law banning tobacco sales to those under the age of 18. (Penal Code, Sec. 308) The tobacco industry has challenged local ordinances which restrict or ban the use of tobacco vending machines on the basis of preemption by Penal Code Section 308. Prior to 1988, Section 308(c) specifi- cally stated that "nothing in this section or any other provision of law shall invalidate an ordinance of, or be construed to prohibit the adoption of an ordinance by, a city or county or a city and county regulating the sale or display to persons under the age of 18 years of items described in this section." However, a 1988 amendment substituted Section 308(e) for 308(c). It states that "It is the Legislature's intent to regulate the subject matter of this section. As a result, no city, county, or city and county shall adopt any ordinance or regulation inconsistent with this section." To avoid a conflict, vending machine ordinances should avoid language about limiting distribution of cigarettes to children. OUT-OF-PACKAGE CIGARETTE SALES In 1991, the California Legislature enacted a law prohibiting selling cigarettes except in the manufacturer's original package, sealed and properly labeled under federal labeling requirements. (Penal Code, Sec. 308.2) I,ICENSING Any tobacco distributor (not a retailer) must obtain a license from the State Board of Equalization. (Revenue and Taxation Code, Sec. 30140) SAMPLING It is unlawful for any person to distribute free samples of smokeless tobacco products, except when the free sample is provided in response to a mail-in coupon which includes verification that the respondent is 18 years of age or older. It is unlawful to distribute free samples of tobacco products within a two block radius of any facility whose primary purpose is directed toward persons under the age of 18 such as schools, clubhouses and youth centers. (General Regulations, Sec. 17537.3) Effective January 1, 1992, the distribution of free samples of tobacco products is prohibited on all public property, including sidewalks and fair- grounds. Local municipalities may go further and ban the practice on private property as well. (Health and Safety Code, Sec. 25967) Toxic ExPOSURE Proposition 65, the Toxic Enforce- ment Act passed by the voters in 1986, applies to tobacco smoke along with other toxic substances. Businesses that allow • ® • 68 51423 0312

• 0 • C h a p t e r T h i r t e e n PRESS RELEASES AND PERSONAL CONTACTS Their volume and depth of news reporting make newspapers the top choice for disseminating news in each community. Reporters originate and research many of their stories, but they also rely heavily for information and story ideas on press releases generated by businesses, industry, local organizations and government entities. A press release or series of releases is a logical first step toward notifying the media, particularly newspapers, about an event or issue. A press release is also a logical vehicle for providing sources to aid the media in gathering additional informa- tion. Putting together a news story can be a time-consuming task for a reporter; providing sources of information makes the job easier. The form for a press release was originally fashioned by the needs of typesetting on linotype machines. Now input is almost universally by computers in the newsroom, but the old style persists: lines are double spaced, paragraphs are short, the bottom of each page says "(more)" to indicate there is more to the story, the article ends with a"#" or "30." Substance is more important than style. Have something newsworthy to say, and say it quickly--certainly by the end of the first page of the release. A release usually should not be more than two or three pages long, but even so a bombshell late in the release is likely to explode only in the waste basket. Second only to content in impor- tance is the name and phone number of a contact at the top of the first page; make sure that person is available for questions, preferably at any time of day. • F r a m i n g t h e I s s u e s If possible, make personal contact with reporters or city editors to discuss anti- smoking activities and to provide contacts for articles. Be prepared to answer ques- tions, and make sure you can back up any of your statements. PRESS CONFERENCES AND OTHER APPROACHES A press conference, photo opportu- nity or other event sponsored solely for the benefit of the media can draw public attention to a tobacco control effort and focus on the health concerns involved. Several things should be kept in mind when planning this type of promotional activity. First, determine a focus for the conference and include prominent commu- nity backers to demonstrate commitment to the effort. Next, select a time when few media activities generally occur, such as a Monday morning, to maximize the potential for coverage. Provide advance notice to the media, follow up with a reminder just before the event, and be prepared to distribute press packets during your press conference or event which support the need to reduce smoking in the community. Finally, keep presentations to a maximum of 30 minutes, and use visuals or other graphics to help illustrate key points; visuals are particularly necessary if television stations are covering. Start on time, finish on time and provide the media an opportu- nity to ask questions. A statement read at a press conference should be short and to the point. Keep in mind that your control over a press conference is limited to reading the statement itself; questions by reporters may take off in any direction. 73

C h a p t e r T w e l v e • L e g a l P e r s p e c t i v e s • 0 • smoking must provide individuals on the premises with adequate warning of the toxic exposure. Adequate signage must include the language: "This facility permits smoking, and tobacco smoke is known to the State of California to cause cancer in nonsmokers as well as smokers." (Health and Safety Code, Sec. 25249.6and Sec. 25249.7) HEALTH EDUCATION Proposition 99, the Tobacco Tax and Health Protection Act, designates that 20 percent of the revenue generated be used to support comprehensive, anti-tobacco education programs. For a description of the California Tobacco Education Program see Appendix B. THE WORKPLACE Evidence of the danger of environ- mental tobacco smoke has grown substan- tially in recent years. A growing body of case law also indicates employers should be concerned about liability for exposing employees to environmental tobacco smoke. Nonsmoking workers have success- fully filed suits based on workers' compen- sation, employment discrimination, common law, wrongful discharge and unemployment benefits. HIRING POLICIES In some instances, employers have adopted policies of hiring only nonsmokers. These practices, most common for fire and police departments, are designed to limit the expenditure of public funds on smok- ing-related disease. Firefighters and the police benefit from legal presumptions under workers' compensation. Heart disease in police officers, and lung disease in firefighters, is presumed to be work related. As a result, cities and counties may pay workers' compensation benefits for lung and heart disease actually caused by smoking. To limit workers' compensation costs, some fire and police departments hire only nonsmokers. With the possible exception of the Americans with Disabili- ties Act which is unclear on the point- there are no federal constitutional or statutory impediments to such a policy. Prior to the Disabilities Act, the United States Equal Employment Opportunity Commission had indicated that it was not illegal to hire only nonsmokers. Virginia and several other states have adopted "smokers' rights" laws which limit the right of certain employers to hire only nonsmok- ers. California has no such law. Cities should consult legal counsel on this evolving issue. WoIxxERS' COMPENSATION It is well established that workers may receive workers' compensation benefits for conditions caused by exposure to workplace smoking. The most recent example in California is Ubhi v. State Compensation Insurance Fund, Cat n'fiddle Restaurant, No. SFO-0341691 (California Workers' Compensation Appeals Board). In that case, a waiter suffered a heart attack, even though he was a vegetarian and a healthy nonsmoker with no history of heart disease. He claimed it was caused by environmental tobacco smoke in the restaurant in which he worked. In a 1990 settlement, the plaintiff was awarded $85,000 by the California Compensation Insurance Fund. EMPLOYMENT DISCRIMINATION California's Fair Employment and Housing Act prohibits discrimination on the basis of a handicap. This law clearly 69

C H A P T E R 1 1 • THE TOBACCO INDUSTRY'S REACTION ~pY INDUSTRY SUPPORTED GROUPS I NDUSTRY ACTIVITIES OTHER TACTICS COMMON STRATEGIES • • The tobacco industry has tradition- ally concentrated its efforts on lobbying at the state and federal levels, where it has won important victories. The tobacco lobby spends more than any other industry to influence state and federal legislators. However, since the proliferation of local smoking pollution control ordinances, the tobacco industry has directed more of its energies to local jurisdictions.z6 (See Appendix 0.) The tobacco industry's initial efforts in direct lobbying at the local level met hostile opposition. By the late-1980's, the industry refocused its lobbying efforts, moving smokers, restaurant owners and others to the forefront. "Smokers' rights" groups have organized to fight local tobacco control policies and "business coalitions" have launched lobbying efforts financed by the tobacco industry. These organizations provide a local conduit through which money from the tobacco industry can be funneled to challenge local smoking policies. The tobacco industry remains in the background because its identification with organized resistance has had a negative effect at the local level. A 1982 study conducted for the Tobacco Institute found that industry opposition increases local support for nonsmokers' rights legislation. The institute's West Coast lobbyist, Ron Saldana, told the Los Angeles Times in August 1986, "I've learned from experience that as soon as I'm identified as a represen- tative of the Tobacco Institute, I lose all credibility. They just sneer us away ... so I try to work behind the scenes when- ever I can." In 1985, the Contra Costa County Board of Supervisors passed a comprehen- sive ordinance regulating smoking in public places, workplaces and restaurants. A representative from the Tobacco Institute attended the public hearing to speak against the ordinance. In June of 1991, the same board conducted public hearings on amending the existing ordinance to eliminate smoking in restaurants and work- places, as well as to add a provision reduc- ing youth access to tobacco products. This time, the Tobacco Institute did not become directly involved in hearings, but another group, the California Business and Restau- rant Alliance (CBRA), organized local 61

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s establishes a right to a smoke-free work- place; nonsmokers sensitive to tobacco smoke are considered physically handi- capped and entitled to effective measures of accommodation. Smoking must be completely eliminated if that is the only effective protection for the nonsmoker. In County ofFresno v. Fair Employment and HousingAuthority, 226 CA3d 1541, the court ruled that the county should have eliminated smoking in the area in which nonsmoking employees worked before tobacco smoke aggravated their lung ailments. WRONGFUL DISCHARGE An employee who is terminated for seeking a smoke-free workplace has a cause of action for wrongful discharge based on retaliatory dismissal. In Hentzel v. Singer Co., 138 Cal. App. 3d 290, the court held that such a discharge violated the public policy in favor of worker safety. In Califor- nia, a cause of action for termination in violation of public policy gives rise to tort and potential punitive damages. COMMON LAW An employer's common law duty to provide a reasonably safe working environ- ment for employees has led to numerous lawsuits dealing with smoking in the workplace. In just one case, Shimp v. New Jersey Bell Telephone Company, 368 A.2d 408, has the court held that this common law protection extends to smoking. UNEMPLOYMENT BENEFITS Nonsmokers have fared better under statutory claims, such as Lapham v. Unemployment Compensation Board of Review, 519 A.2d 1101, which provided unemployment benefits to an employee forced to leave because an employer failed to provide a nonsmoking work space. Likewise, in Parodi v. Merit Systems Protection Board and Office ofPersonnel Management, 702 F.2d 743, the court allowed disability benefits to cover smoke- related injuries. COLLECTNE BARGAINING Nationally, employers have been found in violation of collective bargaining agreements when unilaterally banning smoking in private workplaces. The National Labor Relations Act prohibits an employer from changing the terms and conditions of employment without bargaining with the union representing the employees. In re Parker Pen U.SA., 90 Lab. Arb. (BNA) 489, a labor arbitrator found the employer violated the terms of the collective bargaining agreement, subject to future negotiations of the subject. Likewise, in Johns-Manville Sales Corp. v. Interna- tionalAssociation ofMachinists, 621 F.2d 756, the union successfully challenged an asbestos manufacturer's attempt to imple- ment a no smoking policy. In California, a popular approach for employers is to "meet and confer" with union representatives to avoid problems with collective bargaining issues. • S • Ln ~ ~ N W 70

T o b a c c o C o n t r o I i n C a 1 i f o r n i a C i t i e s HEALTH OFFICERS ASSOCIATION OF CALIFORNIA The Health Officers Association of California is a private, non-profit organization that provides local health officers an independent voice for public health advocacy. The contracts for the Health Officers Association of California are managed by Western Consor- tium for Public Health. Founded in 1968, the Health Officers Association of California is a statewide organization committed to improving public health through research, education, communi- cation and public policy. The Association has immediate access to the expertise of health officers and public health officials throughout California, providing valuable experience and skills to assist in helping health officials develop, implement and evaluate health programs at the local, state and national levels. Information about the Health Officers Association of California and its programs may be obtained by contacting: Health Officers Association of California 5050 Laguna Blvd., Suite #112-580 Elk Grove, California 95758 (916) 684-5377 84

C h a p t e r N i n e • P u b l i c T e s t i m o n y a n d R e f e r e n d u m s • • Local elected officials may be able to place testimony in perspective by considering. What is the local membership of any identified group? If a business group, what proportion of local businesses are members? Does the group receive significant financial support from outside the community? If information is presented from surveys or other studies, what period is covered? Data from a single quarter may be misleading. What is the basis for any conclusions reported? A survey of attitudes, or opinions, or sales tax reports? If an attitude or opinion survey was done, who were the respondents or to whom was the survey administered? Does the study compare results from different groups or periods? What are the costs associated with accommodating customers or employees who smoke? Do smoke-free establishments have lower costs for cleaning, and damage to furniture and carpets? SMOKERS' RIGHTS Smokers may protest that eliminating optional smoking areas violates their personal freedoms. But smoking regulations do not make smoking per se illegal; they protect nonsmokers by limiting where smoking occurs-much as other behavior (drinking, making loud noises, etc.), not illegal in itself, is regulated when it affects others. The courts have consistently held that smoking is not an inalienable right protected by the constitution. VENTILATION SYSTEMS In their willingness to accommodate employees or customers who smoke, some business owners may offer to install sophisticated ventilation systems. For an adequate response, local officials need information on ventilation standards effective not just against odor but against the carcinogens in tobacco smoke. Chapter 1 on The Health Risk indicates that removing environmental tobacco smoke through ventilation is technically and economically impractical. ENFORCEMENT Opponents of smoking regulation may contend that potential enforcement costs will be too high. However, local smoking controls are nearly always self- enforcing. In the 1990 survey by California Smoke-Free Cities, 66 percent of the respondents from cities with tobacco control ordinances indicated that in the six months prior to the survey an average of two hours or less per month was devoted to enforcing tobacco control laws. The survey also revealed that while complaints from the public were generally rare, twice as many respondents said complaints came from citizens concerned that the regulations were too weak or not enforced. Existing ordinances, as indicated in the matrix published in Appendix D., specify a variety of enforcement mecha- nisms. The range includes city manager's office, police department, fire department, environmental health office in either the city or county, and public information offices. The number of existing ordinances and the variety of enforcement mechanisms has provided wide-ranging experience in smoking control. Variations in enforcement methods are not associated with variations in compliance. Police are almost never necessary. Enforcement by the police department could be costly and could interfere with response to emergencies. Smoking regulations are typically enforced only in response to complaints and cita- tions are rarely necessary. 49

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s Additionally, the city will survey its bars and restaurants about the economic benefits of the city's current smoke-free environment. This new information will help the city respond to the numerous inquiries it receives from groups interested in adopting comparable ordinances. Santa Cruz: "Because We Care" resulted from the increased awareness created through the process of adopting a tobacco vending machine ordinance. The City Council wanted to take a closer look at youth access to tobacco products as well as at its current smoking pollution control policies. Because of intense demands on city staff in earthquake recovery, a health education consultant was asked to review smoking pollution control ordinances from other jurisdictions. Recommendations will be made about the city's current smoking policies and a potential ban of tobacco industry sponsorship for city events. Other activities included a merchant education program on sales of.tobacco to minors; and a city-wide survey of signs and product promotions that encourage tobacco use. Vallejo: "Vallejo Youth Access Reduc- tion Project: A Community/Merchant Partnership" built upon the city's leader- ship in reducing youth access to tobacco by collaborating with the business community. A voluntary compliance approach reduces over-the-counter sales of tobacco products to minors and provides economic incen- tives and rewards for merchants imple- menting such measures. The project is one component of Vallejo's strategy to prevent drug use among its young people. It takes advantage of a local coalition that includes staff from the North Bay Health Resources Center/Stop Tobacco Access for Minors Project; the National Cancer Institute project, COMMIT; the Robert Woods Johnson Foundation project, Fighting Back; a city council member; and a parent youth leader. Early efforts in community organiz- ing and consensus building ultimately led to inclusion of the local retail clerks union, retail tobacco merchants and other repre- sentatives from the business community on the coalition steering the project. Com- bined with a letter from the Mayor to each chamber of commerce (there are several ethnic chambers of commerce), the stage was set for a large scale campaign. Approximately 100 stores were surveyed for tobacco sales to youths, and "good performers" were publicly recog- nized. Walnut Creek "Contra Costa County Mini-Cities Project" involved 13 of the county's 18 cities in improving enforce- ment of local smoking pollution control ordinances. In cooperation with the well- established Smoking Education Coalition (SEC) and the County Health Services Department, the city sponsored training meetings and offered technical assistance to city managers and compliance officers. Information on effective enforcement procedures and the impact of environmen- tal tobacco smoke were the major focus. Assistance in developing, producing and disseminating public information brochures about local smoking pollution control regulations has also been provided. The brochures have raised business aware- ness about local ordinances. This approach was a logical extension of an earlier partnership with the SEC that included visits to all 138 of Walnut Creek's restaurants before October 1, 1991, when the city's ordinance went into effect. 56 51423 0300

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • victims to discover why they are falling, or being pushed, into the river upstream. Health promotion requires action upstream to change the environment that contributes to a problem. Success requires more attention to preventing unhealthful habits, rather than solely on treating the dismal outcomes. Shifting resources upstream may not be politically easy, but rescue efforts alone are ultimately doomed. California cities are clearly interested in "upstream" efforts to reduce tobacco use. In the 1990 survey by California Smoke- Free Cities, a third of city managers said it was "somewhat" to "highly" likely that they would be asked by the city council about tobacco control issues. In addition, 76 percent said they were "somewhat" to "very" interested in tobacco control issues. HEALTHY CHOICES A city's "health" cannot simply be left to the medical profession or the local public health department. It requires going beyond conventional bounds and typical strategies. Public policy now affects virtually every aspect of life, says Dr. Nancy Milio, a professor of health policy at the University of North Carolina. "For example, combina- tions of policy choices by such organiza- tions as city government and public and private housing, transportation, and banking firms concerning land use set the range of options available to people concerning where they may or must live and work, and the means and speed of their transportation (therefore how physically active they may be, how fatiguing or compact their day, how clean their air)."21 She goes on to say that such policies also determine which of the available array of options are likely to be chosen, because "Most organizations-whether health agencies, schools, producers, marketers or advertisers-and most individuals most of the time make the 'easiest choice,' i.e. the least 'costly' in value for what they expect to » receive. She contends that strategies for health promotion should aim at changing the range of options available to people, "to make health-promoting choices easier and to diminish health-damaging options by making them more difficult to choose." The underlying theme of this guidebook has been "to make healthier choices easier choices." When smoking is eliminated in the workplace, a healthy choice becomes easier. Eating out in a smoke-free setting makes a healthy choice easier. Merchant education programs or bans on tobacco vending machines make an unhealthy choice more difficult. The concept of making healthy choices easier need not be limited to tobacco use. That is a vital place to start, but it is only a beginning. Ideally making healthy choices easier will be extended throughout the local community, to make ours truly Healthy Cities. • 76

Chapter Ten • Other Ways to Reduce Tobacco Use • • • The ordinance, one of the strongest in the country at the time, eliminated smoking in the workplace and phased out smoking in restaurants. The city's police department, which was charged with enforcing the new ordinance, also received training. The outreach greatly facilitated acceptance of the new smoking restrictions by the restaurant community and was therefore used as a model for outreach to all county businesses. LONG-TERM COMMITMENTS The City of Rohnert Park, a partici- pant in the California Healthy Cities Project since 1990, committed itself to creating a Tobacco-Free City by maximiz- ing resources already available in the community. The city's priority as a Healthy City participant was to reduce tobacco use significantly by both adults and youths through the cooperative efforts of multiple community resources. The effort had four primary target groups-students, adult residents, employ- ers and the hospitality industry-and it identified a number of strategies to use with them. Included were community-wide educational activities, integration of smoking related information into the junior and senior high school curricula and development of workplace tobacco control policies. The project worked with members of Stop Tobacco Access for Minors Project (STAMP), a multi-county project spon- sored by the North Bay Health Resources Center and funded by the California Department of Health Services, to survey the availability of tobacco to minors. The survey found youths succeeded 48 percent of the time in making illegal purchases over the counter and from vending machines. STAMP and the city's public safety officers have combined efforts to educate mer- chants on better compliance with the law. In April 1992, the City Council adopted a policy discouraging sale and distribution of tobacco products to minors. The city's policy will be reviewed after a year to determine if amendments are necessary. Youth baseball and softball coaches were approached with information on the dangers of tobacco use and asked to be nonsmoking role models. In addition, the city enlisted support from Little League sponsors to place a non-smoking message on a baseball field billboard. Local sponsors also agreed to remove bubble gum tobacco product "look-a-likes" from concessions. The local school district initiated a Healthy Kids program that, among other activities, produces a quarterly newsletter with feature articles on tobacco. The newsletter is sent home with every elemen- tary school student in the city. With the assistance of the American Nonsmokers' Rights Foundation, a Teens as Teachers program has been introduced. The pro- gram is expected to train about 70 high school students who will in turn conduct smoking prevention programs in elemen- tary school classes. And in cooperation with the Sonoma County Health Department, the city played host to Dave Goerlitz, the ex-"Winston Man" who spoke to several local school assemblies about the hazards of smoking. While the aforementioned activities were achieved with no outside funding, worksite intervention was enhanced in 1991 by a grant for $150,000 from the California Department of Health Services for developing the Tobacco Free Business Project. The city has used this competitive grant, the only one awarded in that fiscal year directly to a city, to help small busi- nesses develop smoking policies, provide 57

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s The purpose of the Project is to help cities focus on the total environment, includ- ing the physical surroundings, economic conditions and social climate as arenas for health promotion activities. The Project works with municipal leaders to adopt a broad definition of health, recognizing the contribution of education, living conditions, employment opportuni- ties, and support services to individual and community well-being. The Project also promotes a style of municipal governance that involves all sectors and embraces ethnic and cultural diversity as part of a commitment to full community participation. The Project fosters collaborative community partnerships to identify and respond to health concerns and related issues of livability. For cities interested in formal participation, the Project provides technical assistance and staff support, extensive program resources including a comprehensive Resource Guide and a wide array of reference materials, educational opportunities and access to a computer- ized database on Healthy City-type projects. The Project is particularly helpful in providing assistance for cities seeking financial and programmatic resources for local projects and marketing information to help with promotion of locally developed programs. A brochure is available that outlines the program and application procedures for cities wishing to participate. The Project may be reached by contacting: California Healthy Cities Project Health Promotion Section P.O. Box 942732 Sacramento, California 94234-7320 (916) 327-7017 (916) 324-7763 (FAX) LEAGUE OF CALIFORNIA CITIES The League of California Cities is a statewide, nonpartisan association that provides legislative representation for cities and offers extensive training, technical support and infor- mation services for local officials. The League also promotes cooperative efforts to improve the quality of life for city residents. Founded in 1898 as the "official representative of California cities," the League is the largest and most influential organization representing the interests of cities statewide. Both elected and appointed officials are represented through the League's organization. The League provides an extensive selection of training seminars for both elected and appointed officials through regional workshops and annual departmental conferences. Training workshops and conferences focus on specific professional concerns and contempo- rary job-related issues. The League's Annual Conference, a gathering of about 2,500 mayors, council members, city managers, and department heads, presents more than 100 workshop sessions that emphasize practical education and are designed to allow city officials an opportu- nity to learn from each other and from agency personnel and private experts. The League maintains a research and inquiry service for city officials and a full municipal lending library of city staff reports, city attorney papers and opinions, ordinances, reports from League surveys, and other city-generated materials. The League's monthly 82

Chapter Ten • Other Ways to Reduce Tobacco Use • • • MODEST OUTSIDE FUNDING The City of Dixon has two separate state grants dealing with tobacco control. One is sponsored by the California Depart- ment of Education. The other is a competi- tive grant administered through the Association of Bay Area Health Officials (ABAHO), with the City of Dixon acting as the fiduciary agent. Both are conducted in cooperation with Dixon Family Services, a nonprofit, private organization. The goal of the California Depart- ment of Education's Tobacco Use Preven- tion Program is to prevent or reduce tobacco use among school-aged youth. The program, now in its second year, is carried out primarily in the classroom by a partner- ship between Dixon Family Services, Dixon Schools and the Dixon Police Department. The city of Dixon assigns a Police Department youth officer to the Tobacco Program. The youth officer presents the legal aspects of tobacco control, enforces the nonsmoking rule at school and con- ducts the detention education program geared toward educating youth on the dangers of tobacco. Activities include smoking cessation groups at the high school, a tobacco use and attitude survey, classroom instruction on the health and cosmetic impact of tobacco use, home visits and counseling, and teacher workshops on the social influences and factors that lead to tobacco use. The other Dixon grant is the "Greater Bay Area Cities for Tobacco Control" competitive award which focuses on the education of youth and their parents outside the classroom. Some completed activities include: tobacco education sessions to local adult organizations; tobacco education movies on cable televi- sion; health booths at community events; visits to homes of families with smoking parents; and talks at local youth clubs on the dangers of tobacco. One educational effort was the mayor's declaration of Apri123, 1991, as "Dixon Tobacco Awareness Day." Another ABAHO grant recipient is the City of Pacifica. The goal of Pacifica's Tobacco Control Project is to protect public health by reducing environmental tobacco smoke and to prevent tobacco use by children and youth. The grant is administered through Pacifica's Parks, Beaches and Recreation Department. The project uses a Tobacco Advisory Board of 20 community and youth leaders to organize community efforts in tobacco control and to educate community mem- bers about local tobacco issues. The project aims to build support for regulating tobacco use in public places and limiting access of youths to tobacco products; to prevent tobacco use by youths through an education program which targets youths, parents and community leaders; and to use community events to stress the value of not smoking and the dangers of tobacco use. The project has participated in such community events as Earth Day, the Health Fair, Fourth of July fiesta, Fog Fest and the Great American Smokeout. It has already generated a positive editorial and numerous articles in the local paper, and recognition awards for smoke-free posters from the Pacifica City Council. A FOCUS ON YOUTH Smoking prevention for youth has captured the attention of numerous communities. The City of Oakland, supported by the Association of Bay Area Health Officials, is using Proposition 99 funds to direct anti-smoking messages to 59 t

C H A P T E R 1 2 • LEGAL PERSPECTIVES CONSTITUTIONAL ISSUES FEDERAL LEGISLATION CALIFORNIA LAWS TH E WORKPLACE 0 • Of nearly 500 smoking ordinances enacted in the United States, none has been successfully challenged in court, although a variety of Constitutional and other issues continue to be raised by opponents, according to Americans for Nonsmokers' Rights. Nearly all existing smoking regula- tions deal with smoking in one or more of three locations: public places, workplaces and restaurants. In addition, local vending machine ordinances have attempted to control illegal distribution of cigarettes and smokeless tobacco products to youths. CONSTITUTIONAL ISSUES The 10th Amendment to the U.S. Constitution provides that "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respec- tively, or to the people." Stated another way, the states are free to pass laws which do not conflict with the Constitution or with other laws passed by Congress. No federal law exists which preempts state or local jurisdictions from passing laws which restrict or prohibit smoking or tobacco vending machines. The only states with a legal impediment to local smoking ordi- nance are the few which have passed preemptive state laws: Florida, Iowa, Illinois and Virginia. There is no preemptive state statute covering smoking ordinances in California. The California Constitution states in Article XI, Section 7 (adopted June 2, 1970), "A county or city may make and enforce within its limits all local, police, sanitary, and other ordinances and regula- tions not in conflict with general laws." Thus, the foundation for local regulation of smoking is firmly established. Yet both smokers and nonsmokers have brought suit under various aspects of the U.S. Constitution, all with equal lack of success. Cases have been filed over cruel and unusual punishment (8th Amendment to the U.S. Constitution), depriving a citizen of life, liberty or property without due process of law (5th and 14th Amend- ments to the U.S. Constitution), and equal protection (14th Amendment to the U.S. Constitution). Smokers have filed lawsuits claiming an unrestricted Constitutional right to smoke, while nonsmokers have filed 65

A P P E N D I X B • 0 • CALIFORNIA'S TOBACCO EDUCATION PROGRAM California's highly successful campaign to reduce the toll that tobacco use takes throughout the state is largely the result of a very effective comprehensive program modeled after the National Cancer Institute's Standards for Comprehensive Smoking Prevention and Control. The program derives its success in large part from its ability to mobilize various local, regional and statewide agencies to form linkages and networks to address local tobacco control problems. Funds for the tobacco education campaign were initially specified for support of five primary areas:  the creation of 61 local lead agencies through county and city health departments  in-school education programs  competitive grant programs designed to plan and implement community-based programs  a statewide anti-tobacco media campaign  a clearinghouse for anti-tobacco resources and information. Recently added components indude the regional linkage networks and ethnic networks. These resources have provided cities with a new technical support network for tackling tobacco control issues. Cities can draw upon the expertise provided by local lead agencies as well as local, regional and statewide competitive grant programs such as California Smoke-Free Cities. Presently, community coalitions exist in 60 of the state's 61 local lead agencies. These coalitions, with a membership totalling 1,814, have contributed to the success cities have had in promoting tobacco control ordinances. Local lead agencies and these coalitions have been instrumental in challenging such activities as the Marlboro Ski-athons as well as tobacco industry sponsorship of Cinco de Mayo and Mexican Independence Day celebration events in the San Francisco Bay area and the industry sponsorship of the Bill of Rights Tour. Technical support provided by the California Department of Health Services to assist local lead agencies has provided training for 7,500 health and social service providers as well as the 55,330 attendees of formal training sessions. The creation of ethnic networks has allowed the state's Tobacco Control Section to assist in developing and disseminating new strategies, interventions and materials in the state's four major ethnic groups: African Ameri- cans, Asians/Pacific Islanders, Latinos and American Indians. Additionally, the recent 85

C H A P T E R 0 • CONSTRUCTING A SMOKING POLLUTION CONTROL ORDINANCE ELEMENTS OF AN ORDINANCE 0 • There has been a sharp increase in the adoption of tobacco control policies during the past decade. The labels vary: Clean IndoorAir, Nonsmokers'Rights, or Smoking Policies. Some are statutes, others are voluntary policies. Many private employers, restaurant owners and other business owners have voluntarily adopted non-smoking policies. Voluntary policies, however, cannot be relied on for adequate protection. Not all workplaces and public places have volun- tary policies, and nonsmokers may fear retaliation if they seek a ban on smoking- especially if their supervisors smoke. Nonsmokers need the support of authorita- tive regulation. A smoking ordinance typically limits smoking in workplaces, restaurants and enclosed public places to protect nonsmok- ers. The earliest local smoking ordinances are now seen as both weak and narrow. They permitted smoking sections in most environments and failed to include all workplaces and public places. However, their success and an increased demand for smoke-free air has led to stronger, more comprehensive laws. ELEMENTS OF AN ORDINANCE Smoking pollution control ordi- nances should be clear and concise in order to serve an educational function and to facilitate implementation and enforcement. The following material reviews parts of a proposed ordinance. Sample ordinances appear in Appendix E. TITLE Although Smoking Pollution Control Ordinance is an appropriate and descriptive name, most local laws are simply called Smoking Ordinance. A title like Clean IndoorAir may be misconstrued to cover all possible indoor air contaminants. 43

C H A P T • FRAMING THE ISSUE . • E R 1 3 PRESENTING THE ISSUE PRESS RELEASES AND PERSONAL CONTACTS PRESS CONFERENCES AND OTHER APPROACHES GAINING ACCESS TO THE MEDIA Tobacco control efforts at the local level have generated more press over the last two years than any other local issue. The topic gets so much attention for the same reasons that it is a local issue: it affects individual behavior and local conduct of business. Everyone, smoker and nonsmoker alike, is affected by local policies on smoking, and nearly everyone has an opinion about smoking. Tobacco use is the leading preventable cause of illness and death, yet its desirability is promoted each year by $3.27 billion in advertising.34 Efforts to limit smoking through ordinances, public education or other approaches, are news. One of the many elements in a local anti-tobacco effort is working with the news media. The media-including newspapers, radio stations and, in larger urban areas, televi- sion and magazines-are usually the best and fastest way to communicate with the community-at-large. Local politicians also tend to pay careful attention to local news stories. Whether the topic is an ordinance, a special event, publication of a brochure or some other tobacco control activity, be prepared early in the process to work with the news media through personal contacts and interviews, press conferences, press releases and letters to the editor. Even though tobacco companies are one of this nation's leading print advertisers, newspapers treasure their independence; reporters are likely to be fair and objective, and a newspaper may well editorialize against smoking. PRESENTING THE ISSUE Whether the vehicle is a city newslet- ter or a local newspaper, the success of a smoking pollution control campaign may depend on the way the issue is framed. If the goal is a smoking pollution control ordinance, leading rather than trailing the tobacco industry in providing information will focus the issue and prevent deception. The real issues are controlling youth access to cigarettes and eliminating the harmful effects of environmental tobacco smoke on nonsmokers, not "smokers rights" or the myth of business losses. Following are examples of how to frame the issue before the public and the media to demonstrate the health benefits 71

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s SUTTER COUNTY Peggy Morentin, M.P.H. Tobacco Program Coordinator Sutter County Health Department P.O. Box 1510 Yuba City, CA 95992 (916) 741-7215 (916) 741-7223 (FAX #) TEHAMA COUNTY Beth Wray Tobacco Control Program Coordinator Tehama County Health Department 1860 Walnut Street Red Bluff, CA 96080 (916) 527-6824 (916) 527-0249 (FAX #) TRINITY COUNTY Marjorie McClintock Program Manager Tobacco Education Program Trinity County Health Department P.O. Box 1257 Weaverville, CA 96093 (916) 623-1358 (916) 623-3480 (FAX #) TULARE COUNTY Harry Van Pelt, M.P.H. Tobacco Control Project Director Tulare County Health Department 1062 South K Street Tulare, CA 93274 (209) 685-2530 (209) 685-2643 (FAX #) TUOLUMNE COUNTY Ross Payson Program Coordinator Tobacco Control Program Tuolumne County Health Department 2 South Green Street Sonora, CA 95370 (209) 533-7232 (209) 533-7233 (FAX #) VENTURA COUNTY Eileen Gordon Tobacco Control Ventura Co. Public Health Services 3210 Foothill Road Ventura, CA 93003 (805) 652-6503 or (805) 652-5914 (805) 652-6230 (FAX #) YOLO COUNTY Kathryn Shack Tobacco Control Project Coordinator Yolo County Health Department 825 East Street, Suite 125 Woodland, CA 95695 (916) 666-8448 (916) 666-8674 (FAX #) YUBA COUNTY Robert Norton Tobacco Control Project Coordinator Yuba County Health Services Department P.O. Box 429 Marysville, CA 95901 (916) 741-6366 (916) 741-6397 (FAX #) 94

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s KERN COUNTY Manzoor Massey, Ph.D. Tobacco Control Program Kern County Health Department 1700 Flower Street Bakersfield, CA 93305-4198 (805) 861-3631 (805) 861-2018 (FAX #) KINGS COUNTY Paula Ayres, M.S.N. M.P.H. Tobacco Control Project Director Kings County Dept. of Public Health 330 Campus Drive Hanford, CA 93230 (209) 584-1401 (209) 582-0927 (FAX #) LAKE COUNTY Jerry Street Health Administrator Lake County Health Department 922 Bevins Court Lakeport, CA 95453-9780 (707) 263-2241 (707) 263-1662 (FAX #) LASSEN COUNTY Laura J. Roberts Tobacco Control Program Lassen County Health Department 555 Hospital Lane Susanville, CA 96130 (916) 257-8311 Ext. 183 or (916) 257-9600 (916) 257-8177 (FAX #) LONG BEACH CITY Judy Ross Health Promotion Coordinator Tobacco Control Program City of Long Beach 110 W. Ocean Blvd., Suite 510 Long Beach, CA 90802 (310) 983-1893 (310) 983-1854 (FAX #) LOS ANGELES COUNTY Ingrid Lamirault, M.P.H., Director Tobacco Control Program Los Angeles County Health Department 3580 Wilshire Blvd., Suite 1660 Los Angeles, CA 90010 (213) 387-7810 (213) 387-9122 (FAX #) MADERA COUNTY G. Dale Freewald Tobacco Control Project Director Madera County Department of Public Health 14215 Road 28 Madera, CA 93638 (209) 675-7627 (209) 674-7262 (FAX #) MARIN COUNTY Elizabeth Emerson Tobacco Control Project Director County of Marin Department of Health & Human Services 10 N. San Pedro, Suite 1002 San Rafael, CA 94903 (415) 499-7508 (415) 499-3791 (FAX #) MARIPOSA COUNTY Carol Bryant, Ph.D. Tobacco Control Project Director Mariposa County Health Department P.O. Box 5 Mariposa, CA 95338 (209) 966-3689 (209) 966-4929 (FAX #) MENDOCINO COUNTY Jane Piper Project Director Tobacco Control Program Mendocino County Public Health Department Courthouse Ukiah, CA 95482 (707) 463-4133 (707) 463-4138 (FAX #) 90

C H A P T E R 1 4 • MAIUNG HEALTHIER CHOICES EASIER CHOICES THE "HEALTH" AGENDA HEALTHY CHOICES 0 • Smoking is the nation's single largest cause of preventable death and disease. There is simply little or no rationale for not doing something about an activity which is so dangerous, costly and offensive. The focus of this guidebook has been on environmental tobacco smoke because of its importance, and because Proposition 99 provided the funds to do something about it. But efforts to reduce smoking can serve as both a model and a catalyst for other actions by cities to promote the health of their citizens. Public interest in health has never been greater, and cities are in the forefront of efforts to improve it. The initiative is theirs partly by default: the state and federal governments seem paralyzed by conflicting pressures and crippling budget deficits. But local government also is the level of government most trusted by citizens. It is best equipped to evaluate special local needs and problems, and tailor programs to meet them. "Today the city with its own political mandate and often highly developed sense of civic pride is again uniquely placed to develop the kind of citizen-responsive health promotion initiatives which are necessary to tackle the new health problems of the twenty-first century," says Dr. John Ashton of the Department of Community Health, University of Liverpool, in his Concepts and Visions booklet for Healthy Cities. "As the most decentralized adminis- trative level which can marshall the necessary resources and which has wide ranging responsibilities and networks, it is in an ideal position to support the type of intersectoral process which leads to creative, effective and efficient action."' THE "HEALTH AGENDA » There is an old story about a man walking alongside a swiftly-flowing river when he hears a desperate cry for help and sees someone thrashing in the water. He dives in, swims out to the victim and hauls him to dry land-only to hear another cry for help. He jumps into the river again and saves another victim. He hears another cry and the process repeats itself-again and again. He is too busy rescuing drowning 75

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s PLUMAS COUNTY Karen Jaggard Health Education Coordinator Tobacco Control Program Plumas County Health Department P.O. Box 480 Quincy, CA 95971 (916) 283-6334 (916) 283-6425 (FAX #) RIVERSIDE COUNTY Florence Neglia Tobacco Control Project Director Riverside Department of Health Services 4065 County Circle Drive Riverside, CA 92503 (714) 358-5380 (714) 358-5384 (FAX #) SACRAMENTO COUNTY Quintilla Smith Tobacco Control Program Coordinator Sacramento County Health Department 3701 Branch Center Sacramento, CA 95827 (916) 366-4469 (916) 366-2388 (FAX #) SAN BENITO COUNTY Elaine Cantu Project Director San Benito Health Foundation 910 Monterey Street Hollister, CA 95023 (408) 637-5306 Ext. 43 (408) 637-9640 (FAX #) SAN BERNARDINO COUNTY Michelle Jacknik Program Manager Tobacco Use Reduction Now San Bernardino County Health Department 505 North Arrowhead, Suite 500 San Bernardino, CA 92415-0048 (714) 387-6000 (714) 387-6006 (FAX #) SAN DIEGO COUNTY Carol St. Cook Assistant Chief San Diego Department of Health Services Division of Public Health Education P.O. Box 85222 1700 Pacific Highway San Diego, CA 92186-5222 (619) 236-2705 (619) 239-2925 (FAX #) SAN FRANCISCO Alyonik Hrushow, M.P.H. Project Director for Tobacco Control San Francisco Department of Public Health 1540 Market Street, Room 250 San Francisco, CA 94102 (415) 554-9152 (415) 241-0484 (FAX #) SAN JMUIN COUNTY Ramakrishna Ram, M.P.H., Director Health Education Services San Joaquin County Health Department P.O. Box 2009 Stockton, CA 95201 (209) 468-3415 (209) 468-2072 (FAX #) SAN LUIS OBISPO COUNTY Barbara J. Wells, Director Health Promotion Services San Luis Obispo County Health Department 285 South Street, Suite J San Luis Obispo, CA 93401 (805) 549-5564 (805) 546-1235 (FAX #) • 0 92

C H A P T E R 0 . PUBLIC TESTIMONY AND REFERENDA COUNCIL STUDY COMMITTEES PUBLIC HEARINGS CONTROVERSIAL ISSUES REFERENDA • As every city council member knows all too well, there is more to enacting an ordinance than ironing out its formal construction. In fact, that may be the easiest part of the job. A number of procedural and informal matters will inevitably arise. COUNCIL STUDY COMMITTEES Tobacco ordinances often start with the commitment of a single council member, an impression supported by the 1990 survey by California Smoke-Free Cities. The survey found that two of the three key factors influencing adoption of an ordinance were a commitment from the city council and the presence of identifiable leadership. A committed council member often informally explores potential support on the council and suggests formation of a council study committee. A council study committee-usually made up of the most interested council members-allows for careful attention to proposed regulations. An alternate ap- proach is for the entire council to meet in study session to discuss the issue. Without the pressure of a formally-introduced ordinance before them, council members can explore their concerns with staff and direct staff to develop desired information. PUBLIC HEARINGS The first step in the enactment process is to introduce an ordinance. Any reasonable practice will suffice. In some cities, introduction of an ordinance is made customarily by a motion and the approval of a majority of council members. This procedure is not legally required but does prevent introduction of ordinances which have no chance of passage. A public hearing is required before adoption of an ordinance. The ordinance is read and voted upon at two separate meetings, although the actual "reading" is usually waived in both cases. The vote may immediately follow a public hearing, or may be taken at a later meeting. A hearing 47

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s 18. Kristein, MM. "How Much Can Business Expect to Profit from Smoking Cessation?" Preventive Medicine v12, 1983: 358-381. 19. McMahon, ET and Taylor, PA. "Citizens' Action Handbook on Alcohol and Tobacco Billboard Advertising," Center for Science in the Public Interest & Scenic America, Washington DC, 1990. 20. McNichol, T. "Blowing Smoke in Sacramento," California RepublicJuly 1991: 32-33. 21. Milio, N. "Healthy Cities: The New Public Health and Supportive Research," Health Promotion International v5,n4, 1990: 291-297. 22. National Research Council. "Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects," National Academy Press, Washington, D.C., 1986. 23. Pierce, JP, et al. "Does Tobacco Advertising Target Young People to Start Smoking?" Journal of theAmerican MedicalAssociation v266, 1991: 3154-3158. 24. Rice, DP, et al. "The Economic Costs of the Health Effects of Smoking, 1984," The Milbank Quarterly v64, n4, 1986: 489-547. 25. Rice, DP and Max, W. The Cost of Smoking in California, 1989. Sacramento, CA: California Department of Health Services, 1992. 26. Samuels, B and Glantz, SA. "The Politics of Local Tobacco Control, Journal ofthe American MedicalAssociation v266, 1991: 2110-2117. 27. Shultz, JM. "Smoking-Attributable Mortality and Years of Potential Life Lost -- United States, 1988," Morbidity and Mortality Weekly Reportv40, n4: 62-63, 69-71. 28. Siegel, M. Smoking and Restaurants: A Guide for Policy-makers. American Heart Association, California Affiliate, Alameda County Health Care Services Agency, Tobacco Control Program, September 1992. 29. Society for Human Resources Management and Bureau of National Affairs, "Smoking in the Workplace, 1991," Survey No. 55, 1991. 30. TEOC. Toward a Tobacco-Free California: A Master Plan to Reduce Californians' Use of Tobacco. Submitted to the California Legislature by the Tobacco Education Oversight Committee, January 1991. 31. Ticer, S and King, RW. "Big Tobacco's Fortunes are Withering in the Heat," Business Week July 27, 1987: 47-52. 32. USDA, Economic Research Service, Commodities Economic Division. United States Department of Agriculture, 1989. 33. USDHHS. Current Intelligence Bulletin 54, Environmental Tobacco Smoke in the Workplace, Lung Cancer and Other Health Effects. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, Division of Standards Development and Technology Transfer, Division of Surveillance, Hazard Evaluations, and Field Studies, June 1991. 34. "Cigarette Advertising-United States, 1988" Morbidity and Mortality Weekly Report. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Massachusetts Medical Society, Waltham, MA. v39, n16, Apri127, 1990. 78 51423 0322

• REFERENCES • 1. Ashton, J. Concepts & [/isions: A Resource for the WHO Healthy Cities Project. Department of Community Health, University of Liverpool, 1988. 2. Begay, ME and Glantz, SA. Political Expenditures by the Tobacco Industry in California State Politics from 1976to 1991. Monograph Series, Institute for Health Policy Studies, University of California, San Francisco, September 1991. 3. Undoing Proposition 99: Political Expenditures by the Tobacco Industry in California Politics in 1991. Institute for Health Policy Studies, University of California, San Francisco, April 1992. 4. Burns, D and Pierce, JP. Tobacco Use in California 1990-1991. Sacramento, CA: California Department of Health Services, 1992. 5. CDHS, Tobacco Control Section. IndependentEvaluation ofEfforts to Prevent and Control Tobacco Use in California, Annual Report. Sacramento, CA: California Department of Health Services, Tobacco Control Section, October 1991. 6. CaIEPA, "Reducing Indoor Air Pollution." Brochure by the California Air Resources Board, Research Division, May 1992. 7. DiFranza, JR, et al. "RJR Nabisco's Cartoon Camel Promotes Camel Cigarettes to Children," Journal of the American Medical Association v266, 1991: 3149-3153. 8. DiFranza, JR and Tye, JB. "Who Profits From Tobacco Sales to Children?" Journal of the American Medical Association v263, 1990: 2784-2787. 9. Duhl, LJ. "The Health of Cities," In R. Carlson & B. Newman (Eds.), Issues and Trends in Health. St. Louis: CV Mosby, 1987: 58-62. 10. Elder, JP and Kenney, E. "Independent Evaluation of Efforts to Prevent and Control Tobacco Use in California." Report presented to the California Department of Health Services, Tobacco Control Section, July 1992. 11. Fischer, PM, et al. "Brand Logo Recognition by Children Aged 3 to 6 Years," Journal of theAmerican MedicalAssociation v266, 1991: 3145-3148. 12. Gallup Organization tobacco survey commissioned by the American Lung Association, 1989. 13. Glantz, SA. Tobacco, Biology and Politics. Waco, TX: HEALTH EDCO, 1992. 14. Glantz, SA and Parmley, W. "Passive Smoking and Heart Disease: Epidemiology, Physiology and Biochemistry," Circulation v89, 1991: 1-12. 15. Glantz, SA and Smith, LRA. The Effect of Ordinances Requiring Smoke-Free Restaurants on Restaurant Sales in California. Monograph Series, Institute for Health Policy Studies, University of California, San Francisco. March 1992. 16. The Effect of Ordinances Requiring Smoke-Free Restaurants on Restaurant Sales in California: an Update. Monograph Series, Institute for Health Policy Studies, University of California, San Francisco. June 1992. 17. Janerich, DT, et al. "Lung Cancer and Exposure to Tobacco Smoke in the Household," New England Journal ofMedicine v323, 1990: 632-636. 77

CHART I - GENERAL 0 EXPLANATORY NOTES 1. DATE OF ENACTMENT: The date listed is the original date of enactment of the city's tobacco control ordinance. 2. CITY-OWNED FACILITIES: This column indicates whether a city ordi- nance restricts smoking in city-owned facilities. A "yes" indicates that smoking is expressly limited in city-owned facilities. 3. RESTAURANTS: This column indicates whether the city restricts smoking in restaurants. 4. WORKPLACES: This column indicates whether a city restricts smoking in places of employment. 5. ENCLOSED PUBLIC PLACES: This column indicates whether a city restricts smoking in enclosed public places. An enclosed public place is any facility open to the general public. 6. VENDING MACHINES; ADVERTISING/SAMPLING: This column indicates whether a city restricts the sale or promotion of tobacco products, typically by restricting the location of vending machines, advertising, or sampling activities. VM = vending machines; A = advertising; S = sampling 97

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • have tobacco vending machine restrictions which prevent access by minors: El Cerrito, Hercules, Los Gatos, Oakland, Orinda, Paradise, Sacramento, Solana Beach, Walnut Creek and Whittier. Twenty-four cities had totally smoke-free restaurants and workplaces. An important milestone was passed in December 1992 when the Fourth District Court of Appeal upheld Rancho Mirage's ordinance banning cigarette vending machines, denying Bravo Vending's claim that the field was preempted by state law. 2. The charts do not report all tobacco control ordinances in California but only city ordinances. Counties were also very active in tobacco regulation during this period and cities often coordinated their efforts with the county. 3. Also missing are administrative policies. Tobacco regulation covering city-owned facilities may not be the subject of an ordinance or even be part of a comprehensive ordinance regulating tobacco use in other places as well. Tobacco use in city-owned facilities does not have to have the force of law or be in the form of an ordinance to be effective. A city manager may authorize an administrative policy which regulates tobacco use in city-owned facilities. 4. Similarly missing are the voluntary policies in place in many worksites. 5. For a discussion of state laws regulating tobacco, see Chapter 12 on Legal Perspectives. • 96

• 9 • SAN MATEO COUNTY Jodie Quintana Tobacco Control Program San Mateo County Health Education Department 225 West 37th Avenue San Mateo, CA 94403 (415) 573-2227 (415) 573-2751 (FAX #) SANTA BARBARA COUNTY Dena Rubin, M.P.H. Tobacco Control Project Director Santa Barbara County Health Care Services 300 San Antonio Road Santa Barbara, CA 93110 (805) 681-5365 (805) 681-5191 (FAX #) SANTA CLARA COUNTY Stephen A. Coray, M.D. Tobacco Control Project Director Santa Clara County Health Department 2444 Moorpark Avenue., Suite 308 San Jose, CA 95128 (408) 299-2566 (408) 998-3158 (FAX #) SANTA CRUZ COUNTY Jennice M. Singer Senior Health Educator Santa Cruz County Health Services Agency 1080 Emeline Ave.; P.O. Box 962 Santa Cruz, CA 95061 (408) 425-2511 (408) 458-7240 (FAX) SHASTA COUNTY Lynda Scheben Tobacco Education Coordinator Shasta County Health Services 1826 Butte Street Redding, CA 96001 (916) 225-5466 (916) 225-5251 (FAX #) SIERRA COUNTY Stephen Hall Program Manager Tobacco Control Program Sierra County Health Department P.O. Box 7 Loyalton, CA 96118 (916) 993-6720 (916) 993-6741 (FAX #) SISKIYOU COUNTY Marie T. Smith Director of Tobacco Control Siskiyou County Health Department 806 South Main Street Yreka, CA 96097 (916) 842-8230 (916) 842-8239 SOLANO COUNTY Robin Cox Tobacco Control Coordinator Solano County Health Department 717 Missouri Street, Suite B Fairfield, CA 94553 (707) 421-6680 (707) 421-6682 (FAX #) SONOMA COUNTY Richard Goldberg, Ph.D., M.P.H. Director of Health Education Sonoma County Public Health Department 3313 Chanate Road Santa Rosa, CA 95404 (707) 576-4776 (707) 576-4694 (FAX #) STANISLAUS COUNTY Jill Chiesa Tobacco Control Project Coordinator Stanislaus County Health Department 2020 Coffee Road D-3 Modesto, CA 95355 (209) 558-6053 (209) 558-8318 (FAX #) 93

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s addition of the Regional Linkage Networks will 1) facilitate interaction between local agencies, individuals, and their activities; 2) coordinate services and events and pool resources (local and state) to support joint activities in a region; 3) foster media promotion and certain magnet events better accomplished by agencies sharing the same media and program markets; 4) enhance and orchestrate advocacy and policy development activities within a region; and 5) establish a body that can recruit and foster volunteer tobacco control efforts in order to develop a sustained tobacco education campaign that is not dependent on the Cigarette and Tobacco Products Surtax. A BRIEF HISTORY OF CALIFORNIA'S TOBACCO CONTROL MOVEMENT Public involvement was instrumental in the grass roots movement that led voters to approve Proposition 99, the Tobacco Tax and Health Promotion Act of 1988. In 1987, the American Lung Association of California, the American Cancer Society (California Division) and the California Planning and Conservation League proposed a statewide tobacco tax bill which ultimately failed to win the necessary legislative support. That failure helped launch the tobacco tax initiative which passed in 1988 with 58 percent of the vote. Twenty percent of the monies to be collected from the tax were specifically designated to fund anti-tobacco education programs. The enabling legislation passed in 1989 (Assembly Bill 75) created the Tobacco Education Oversight Committee (TEOC), whose purpose is to advise the California Depart- ment of Health Services (CDHS) and the California Department of Education (CDE) on policy development, funding priorities, integration and evaluation of tobacco education programs; and to develop a bi-annual Master Plan for future implementation. AB 75 also established the CDHS and CDE as administrators of the comprehensive statewide tobacco control program in consultation with the TEOC. Assembly Bill 75 sunseted on July 1, 1991. In 1991, Assembly Bill 99 and Senate Bill 99 extended the funding provisions required in Proposition 99 through June 30, 1994. This legislation made substantial changes in the program. One change established a preferred priority for the provision of outreach services targeting pregnant women, women of childbearing age, and infants and young children by local county and city health departments. One-third of the monetary allocation to local health departments was designated to be used to expand perinatal outreach activities. The legislation also removed the requirement that funds used for support services cannot exceed five percent of the total appropriation for those programs and specified that school districts and county offices of education adopt smoke-free policies by no later than July 1, 1996. EVALUATION OF THE PROGRAM THUS FAR An important element of the Tobacco Education Program is the evaluation compo- nent, which has measured the success the program has had during its first two years of existence and provided crucial information to cities and countries interested in formulating new public policy. The evaluation component consists of an ongoing random-sample telephone survey of 117,000 Californians to determine their knowledge, attitude and practices related to tobacco use. Additionally, the program has evaluated the effectiveness of the media campaign and other statewide, regional and local program activities. 86

T o b a c c o C o n t r o I i n C a 1 i f o r n i a C i t i e s CHART III RE STAURANTS AN D BARS EXPLANATORY NOTES 1. NON-SMOKING SECTION MINIMUM SIZE: If an ordinance specifies that a nonsmoking section be at least a specified percentage of a restaurant's seating, the minimum size percentage is indicated in this column. 2. SMALL RESTAURANT SIZE EXEMPTION: If small restaurants are exempt from smoking regulation, the seating size required to qualify as exempt is listed in this column. A few cities ban smoking in restaurants below a minimum size. 3. OTHER EXEMPTIONS: "Specified" indicates whether an ordinance specifies conditions for additional exemptions. 112

C H A P T E R 0 • ACCESS FOR MINORS VENDING MACHINES LICENSING MERCHANTS BANNING FREE SAMPLES OTH ER APPROACH ES ® • Approximately 80 percent of current smokers became addicted to tobacco by the age of 21 years.35 Contrary to popular belief, the problem of tobacco use by youths is not rapidly improving. While smoking rates among high school seniors fell nine percent from 1977 to 1981, they have dropped just two percent since then. This trend is in sharp contrast to the decline in most other drug use, including alcohol, over the same period. The 1991 California Tobacco Survey concluded that 9.3 percent of youths between the age of 12 and 17 smoke regularly. The rate among 12-13 year-olds was 2.5 percent, 14-15 year-olds 7.8 percent, and 16-17 year-olds 16.5 percent.4 Currently, 300 teenagers daily, or nearly 110,000 yearly, become smokers in California. They help to replace most of the 42,000 Californians who die each year from smoking and the 204,600 who successfully quit.3o The earlier a youth begins to use tobacco, the more difficult it will be to quit. Alarming evidence suggests that youths are beginning to smoke at younger ages; the average is now between 11 and 14 years of age. Young smokers underestimate the harmful effects of tobacco use and do not recognize the process that quickly leads them to addiction. In a National Institute on Drug Abuse study, 95 percent of daily smokers in high school predicted they would not be smoking five years after high school, yet 75 percent were still smoking in follow-up studies seven to nine years later. In California, the 16.5 percent rate of smoking among 16-17 year-olds is not far behind the 22.2 percent rate of adults.4 This is a particularly striking and disturbing figure because state law prohibits sales of tobacco products to youths under the age of 18. Nevertheless, teenagers have no difficulty purchasing cigarettes. Studies conducted in San Diego, Solano, Sonoma, San Mateo and Contra Costa counties and other parts of the state have consistently shown high rates of sales and accessibility to cigarettes for youths. (See Appendix R.) Underage youths succeed about 70 percent of the time in purchasing cigarettes over the counter and 90-100 percent of the time in purchases from cigarette vending ma- chines. Youths also obtain cigarettes from family and friends, as well as through shoplifting. The fifth source of cigarettes for youths is free samples distributed by tobacco companies. 35 "Children can buy tobacco from stores and vending machines 70 -100% of the time." [Toward a Tobcrcco-Fzee Ca~~4rnia: A Maste Plan to Reduce Ca Tobacco.

A P P E N D I X A • • • A DESCRIPTION OF THE ORGANIZATIONS IN THE PARTNERSHIP California Smoke-Free Cities is sponsored by the California Healthy Cities Project in partnership with the League of California Cities, Americans for Nonsmokers' Rights, and the Health Officers Association of California. It is managed by the Western Consortium for Public Health. WESTERN CONSORTIUM FOR PUBLIC HEALTH The Western Consortium for Public Health is an independent, nonprofit corpora- tion sponsored by the Schools of Public Health and University Extensions of the University of California, Berkeley and the University of California, Los Angeles. Affiliated with the Western Consortium for Public Health is the San Diego State University School of Public Health. The Western Consortium for Public Health is committed to improving public health by linking academic expertise with public health practice. Located in Berkeley, California, the Western Consortium for Public Health encourages member institutions to work together to provide state-of-the-art knowledge and skill to public health professionals and policy makers throughout California and the world. The organization is governed by a board of trustees that includes University Deans and faculty members from these institutions and public health practitioners. The Consortium may be reached by contacting: Western Consortium for Public Health 2001 Addison Street, Suite 200 Berkeley, California 94704-1103 (510) 644-9300 (510) 644-9319 (FAX) CALIFORNIA HEALTHY CITIES PROJECT The California Healthy Cities Project is a collaborative program of the California Department of Health Services and the Western Consortium for Public Health. The Project encourages health-oriented planning and public policy and advocates that locally identified concerns be addressed through the involvement of the public and private sectors and the community's residents. 81

C H A P E R 1 • OTHER WAYS TO REDUCE TOBACCO USE CALIFORNIA SMOKE-FREE CITIES LONG-TERM COMMITMENTS MODEST OUTSIDE FUNDING A FOCUS ON YOUTH CITY EMPLOYEES • A strong local ordinance protecting the public from ETS and reducing access to cigarettes by youths is the single least expensive yet most effective step a city can take to improve the health of its citizens. But regulation is not the only way to curtail the toll taken by smoking. California cities are active in a variety of other ways to reduce tobacco use in their communities. Some of these activities achieve important local goals and also contribute to new public health information that will serve other cities worldwide. Sponsoring projects and promoting activities that do not require legislative action can be quite useful to cities. Each city discussed below has benefited directly and indirectly from its work to reduce tobacco use. Some cities identified new resources both inside and outside of their community; others found new allies to support a smoke-free ordinance; many gained heightened visibility; and all found satisfaction in addressing a major health concern. MINI-GRANTS 0 CALIFORNIA SMOKE-FREE CITIES MINI-GRANTS There are many strategies to reducing tobacco use, but one of the newest and most relevant to cities was the availability of mini-grants from Proposition 99 funds, administered by California Smoke-Free Cities. Awards for single city projects ranged from $8,500 to $20,000, with one mul- tiple-city project awarded $35,000. An interesting feature of these projects is how clearly they reflect the character of each city and its readiness to institutionalize tobacco control measures. A list of the grant recipients and a summary of each project follows: Ceres: "Striving to be Tobacco-Free" created a partnership with the School Board aimed at making youths "tobacco-free." Banners were produced for use in the city throughout the year. T-shirts with a 53

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • 1990 survey on tobacco use found that there is considerable support for such restrictions among the population at large; the highest levels of support come from African American and Latino smokers 4 WHY LOCAL ACTION? Smoking is local government's business. When tobacco is smoked in public, it threatens the health not only of smokers but of nonsmokers as well. Local governments have a responsibility to protect the health of their constituents and the authority to regulate individual behavior. A comprehensive local ordinance will create a community environment in which ... nonsmokers will not involuntarily be exposed to the dangers of secondhand smoke, fewer youths will begin smoking-and smokers who wish to quit will have strong support. Cities have a direct responsibility to their employees. Health risks that are tolerated and go unchallenged in the work place are a drain on human and financial resources. They worsen working conditions and lessen the quality of life; they promote human suffering and they substantially increase employer costs. To be sure, tobacco control measures have been enacted by the State government, and have helped discourage tobacco use and improve public health. (They are detailed in Chapter 12.) How- ever, the success of the tobacco control movement during the past decade has occurred almost exclusively at the local level. There are in fact several political as well as practical reasons why tobacco control is more efficiently and easily implemented at the local level. Action at the state level is difficult, because the legislative process makes it far easier to kill a bill than to pass one. The typical bill has to win at least four committee votes and at least two floor votes and must then be signed by the Governor. The tobacco industry spends millions on campaign contributions, hires top lobbyists and needs to win the votes of just one committee. It had little trouble killing a proposed tobacco tax bill prior to passage of Proposition 99. Tobacco regulation is a local issue because of the way residents feel about smoking and their hometown. American cities have a measure of independent authority and have citizens loyal to them who share in that power. Constituents will accept regulation if they understand and agree to the reasons for it. At the local level they can participate personally in the shaping of tobacco control policy. Even if opposed, they will accept a policy because they contributed to its formulation and because they care about the health of fellow citizens. Local residents identify with local governments and take pride in their community's image. A host of considerations make tobacco regulation a local issue: ^ Local officeholders are less depen- dent than state legislators on financial contributions, and are more accessible and responsive to local constituents. In local policy making, the tobacco industry is an unwelcome outsider. ^ Many local officeholders are recruited by local organizations, friends and neighbors and serve from a sense of civic duty. They generally do not seek higher office. Their personal values are more likely to reflect community interests rather than the interests of the tobacco industry. ^ Local governments are major local employers. Restrictions on smoking in city facilities directly benefit a substantial • • 12 5 1423 0262

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s which will be realized; the arguments are tailored to support smoking ordinances, but the process can be extended to other activities as well. Eliminating environmental tobacco smoke saves lives. Every year, 53,000 nonsmokers die from exposure to the secondhand smoke.14 These deaths could be prevented by eliminating exposure to environmental tobacco smoke. Cities have the authority and have an obligation to eliminate environmental tobacco smoke from areas where nonsmokers have tradi- tionally been exposed. By eliminating smoking in workplaces, restaurants, and public buildings, municipalities are improving the health of their citizens. Reducing youth access to cigarettes saves lives. Even though cigarette sales to youths are illegal for youths in California, they nevertheless account for 3 percent of all cigarette sales.8 And, smoking as a youth leads to smoking as an adult; 90 percent of today's adult smokers began smoking before the age of 21.35 One of every two adult smokers began smoking as a youth before the age of 15. Cigarette smoking is the leading cause of premature death in the United States-and it is entirely prevent- able.3s Licensing retailers who sell tobacco products, eliminating tobacco vending machines, as well as enforcing state laws and educating merchants, are positive ways to promote the health of any community. By controlling youth access to tobacco products, a municipality can strike a serious blow for the health and safety of the lives of thousands of its citizens-today and tomorrow. Public opinion favors nonsmokers' rights. Ninety-five percent of adult Americans believe that cigarette smoking is harmful to health. Almost as significant, 82 percent of all Americans believe smokers should not smoke around nonsmokers. These statistics are from a 1989 Gallup poll which also reported that 85 percent of Americans believe smoking should be banned (44 percent) or restricted (41 percent) in restaurants.12 Considering that more than 26 percent of American adults smoke cigarettes, the figures indicate that many smokers are also concerned about the hazards of smoking and support nonsmok- ers' rights. Tobacco control legislation protects us aff Government often intervenes on behalf of the health of its citizenry-when, for example, it requires restaurant employ- ees to wash their hands or wear hair nets, or when it prohibits littering. Tobacco control ordinances are public health measures, and cities have both the right and the responsi- bility to enact them. Smoking control protects the health of nonsmokers and youths. The health of everyone-not just smokers-is at stake. A smoke free environment is good business. Recent studies have found that smoking ordinances do not hurt and may in fact encourage additional restaurant business. Often overlooked is the fact that fewer and fewer Americans smoke ciga- rettes, so controlling exposure to environ- mental tobacco smoke is welcomed by greater and greater numbers. Only 22.2 percent of California adults smoke 4- so it may pay restaurants to give priority to those who enjoy dining in a smoke-free environ- ment Costs are significantly reduced in a smoke-free environment. Not only are maintenance costs reduced, but health costs are lower, absenteeism declines, liability for workers' compensation claims is reduced, and employee morale is likely to improve. A smoke-free workplace makes a lot of sense and makes a lot of cents. • • • 72 51423 0316

A P P E N D I X C COUNTY HEALTH DEPARTMENT TOBACCO CONTROL PROGRAMS ALAMEDA COUNTY Ruth Shane Tobacco Control Project Director Alameda County Health Care Services 160 Franklin Street, Suite 205 Oakland, CA 94607 (510) 268-7940 (510) 268-9912 (FAX #) ALPINE COUNTY Willie Edwards Tobacco Control Coordinator Alpine County Health Department P.O. Box 545 Markleeville, CA 96120 (916) 694-2771 (916) 694-2544 (FAX #) AMADOR COUNTY Jeri Day Project Director Tobacco Control Program Amador County Public Health Dept. 108 Court Street Jackson, CA 95642 (209) 223-6638 (209) 223-0499 (FAX #) BERKELEY CITY Karen Young-Ervin Health Educator Tobacco Control Program City of Berkeley 2180 Milvia Street, 3rd Floor Berkeley, CA 94704 (510) 644-6641 (510) 644-6015 (FAX #) BUTTE COUNTY Ellen Michels Tobacco Education Project Coordinator Tobacco Control Program Butte County Dept. of Public Health 18-B County Center Drive Oroville, CA 95965 (916) 538-7596 (916) 538-2165 (FAX #) CALAVERAS COUNTY Joyce Miller Tobacco Program Coordinator Calaveras County Health Department Government Center #51 San Andreas, CA 95249 (209) 754-6460 (209) 754-6459 (FAX #) • W N 88

• • • COLUSA COUNTY Rebecca Martinez, Director Tobacco Control Program Colusa County Health Department 251 E. Webster Street P.O. Box 610 Colusa, CA 95932 (916) 458-2501 (916) 458-4136 (FAX #) CONTRA COSTA COUNTY Galen Ellis Tobacco Control Project Director Contra Costa County Prevention Program 75 Santa Barbara Road Pleasant Hill, CA 94523 (510) 646-6521 (510) 646-6520 (FAX #) DEL NORTE COUNTY Adele J. Sandry Health Educator Del Norte County Tobacco Use Prevention Program 909 Highway 101 N. Crescent City, CA 95531 (707) 465-0817 (707) 465-4573 (FAX #) EL DORADO COUNTY Virginia Powell Program Manager Tobacco Use Prevention Program El Dorado County Health Department 279 Placerville Drive, Suite E Placerville, CA 95667 (916) 621-6116 (916) 626-4713(FAX# Emergency only) FRESNO COUNTY Steve Ramirez, M.P.H. Health Promotion Manager Tobacco Control Program Fresno County Department of Health P.O. Box 11867 Fresno, CA 93775 (209) 445-3276 (209) 445-3370 (FAX #) GLENN COUNTY Sharon Gibbs Tobacco Control Program Glenn County Health Services 242 North Villa Willows, CA 95988 (916) 934-6582 (916) 934-6592 HUMBOLDT COUNTY Peggy Falk Health Education Program Manager Humboldt County Health Department 529 I Street Eureka, CA 95501 (707) 445-6097 (707) 445-7328 (FAX #) IMPERIAL COUNTY Betty Mullendore Tobacco Control Coordinator County of Imperial Health Department 935 Broadway El Centro, CA 92243 (619) 339-4469 (619) 352-9933 INYO COUNTY Sharon Rose Tobacco Control Program Coordinator Inyo County Health Department P.O. Drawer H Independence, CA 93526 (619) 872-3733 (619) 872-3193 89

• • • MERCED COUNTY Michael Ford, M.P.H. Tobacco Control Project Director Merced County Department of Public Health 240 East 15th Street P.O. Box 471 Merced, CA 95341-0471 (209) 385-7700 (209) 385-7887 (FAX #) MODOC COUNTY Linda Nelson Tobacco Control Program Modoc County Health Department 131 B West Henderson Street Alturas, CA 96101 (916) 233-6311 EXT.311 (916) 233-5754 (FAX #) MONO COUNTY Nancy Mahannah Program Coordinator Tobacco Education & Cessation Program Mono County Health Department P.O. Box 7307 Mammoth Lakes, CA 93546 (619) 934-7059 (619) 934-3021 (FAX# Emergency only) MONTEREY COUNTY Janine N. Robinette, Chief Chronic Disease Prevention Branch Tobacco Control Program Monterey County Health Department 955 Blanco Circle, Suite D Salinas, CA 93901 (408) 755-4583 (408) 758-4770 (FAX #) 91 NAPA COUNTY Bernard Walters Project Director Tobacco Control Program Napa County Health Department 2281 Elm Street Napa, CA 94559 (707) 253-4171 (707) 253-4155 (FAX #) NEVADA COUNTY Linda Weidert Tobacco Control Coordinator Nevada County Health Department 10433 Willow Valley Road Nevada City, CA 95959 (916) 265-1450 (916) 265-1426 (FAX#) ORANGE COUNTY Marilyn Cowan Tobacco Use Prevention Program Coordinator Orange County Health Care Agency P.O. Box 355, Building 62 Santa Ana, CA 92702 (714) 834-3547 (714) 834-3492 (FAX #) PASADENA CITY Deborah Sherwood Tobacco Control Coordinator City of Pasadena 66 Hurlbut Avenue Pasadena, CA 91105 (818) 799-8638 (818) 799-3942 (FAX #) PLACER COUNTY Sharon Rolph Tobacco Prevention Program Coordinator Placer County Alcohol, Drug & Tobacco Program 11533 C Avenue Auburn, CA 95603 (916) 889-7258 (916) 889-7275 (FAX#)

• 0 magazine, Western City, is mailed to mayors, council members, city managers and department heads in all cities in California. The 70-year-old magazine also is distributed to the California legislature and the state's congressional delegation. Paid subscribers bring the circulation total to about 10,000 individuals. Another of the League's valuable services is CITYLINK, its state-of-the-art telecom- munication service that allows member cities to receive and exchange pertinent information using a computer and modem. CITYLINK includes a special area of information devoted entirely to tobacco control issues. The League may be reached by contacting: League of California Cities 1400 K Street Sacramento, California 95814 (916) 444-5790 (916) 444-8671 (FAX) AMERICANS FOR NONSMOKERS' RIGHTS Started in 1976 as a statewide California organization composed of local groups opposed to smoking pollution, Americans for Nonsmokers' Rights became a national advocacy organization in 1986. With its office in Berkeley, California, Americans for Non- smokers' Rights is a non-profit organization whose primary goal is to protect the rights of nonsmokers to smoke-free air and to protect youth from tobacco addiction. It works toward achieving this goal by using its expertise in tobacco policy issues at the municipal, county, state, and federal levels to advocate smoke-free environments in all workplaces, public places, and restaurants. Americans for Nonsmokers' Rights provides technical consultation and resource materials through its National Resource Center on a variety of tobacco related issues to government and other entities interested in furthering the cause of smoke-free air. The educational arm of Americans for Nonsmokers' Rights is the American Non- smokers' Rights Foundation, established in 1982. American Nonsmokers' Rights Foundation develops and distributes smoking prevention and education programs, and produces highly successful smoking prevention curricula for children. One of American Nonsmokers' Rights Foundation's featured smoking prevention programs is "Teens as Teachers," designed to train teenagers to teach younger children about the dangers of tobacco use. Americans for Nonsmokers' Rights may be reached by contacting: Americans for Nonsmokers'Rights 2530 San Pablo Avenue, Suite J Berkeley, California 94702 (510) 841-3032 (510) 841-7702 (FAX) Ln N ~ W m W N 011 83

CHART I - SUMMARY OF ORDINANCE PROVISIONS ity ouulation oun Date Enacted City- Owned Facilities Restau- rants/ Bars Work- lv aces Enclosed Public Places Vending Machines; Advertising; Sanrolin¢ Union City 50,454 Alameda 5/88 yes yes yes yes no Vacaville 70,628 Solano 4/87 yes yes yes yes no Vallejo 107,175 Solano 12/87 yes yes yes yes VM,A,S Ventura 92,254 Ventura 9/87 yes yes yes yes no Victorville 40,734 San Bernardino 5/88 yes yes no yes no Visalia 74,169 Tulare 4/80 yes no no no no Vista 67,832 San Diego 1/90 no yes yes yes no Walnut 29,294 Los Angeles 11/87 yes yes yes yes no Walnut Creek 63,868 Contra Costa 5/91 yes yes yes yes VM Wasco 11,652 Kern 3/88 yes no no no no Watsonville 30,882 Santa Cruz 4/91 no no no no VM West Hollywood 68,463 Los Angeles 3/86 no yes yes yes no Westminster 73,763 Orange 10/84 yes no no no no Woodside 5,761 San Mateo 10/90 no yes yes yes no Yorba Linda 52,367 Orange 9/85 yes yes yes yes no Yountville 3,242 Napa 11/90 no yes yes yes no Yuba City 26,327 Sutter 9/86 yes yes yes yes no Total number of cities with tobacco-related regulation in this area: 142 180 170 187 10 Enforcement Penal city manager fine city manager fine city manager fine code enforcement offcr infraction city manager infraction dept. of health svcs. fine city manager fine infraction any aggrieved person costs & fees city administrator fine misdemeanor town administrator infraction county health dept fine 8pF0 eZotS

T o b a c c o C o n t r o 1 i n C a I i f o r n i a C i t i e s lawsuits claiming an unrestricted constitu- tional right to an environment free of smoke. Courts have in general rejected both ideas, holding there is neither a constitu- tional right to smoke at work nor a consti- tutional right to a smoke-free workplace. In Grusendorf v. City of Oklahoma City, (816 F.2d 539), the court held that the state maintains a legitimate interest in the health and safety of its workers and has the right to terminate employees (in this case firefighters) who had agreed not to smoke during a probationary period and violated that agreement. Yet the court did not extend this right to other employees. Nonsmoking prison inmates have claimed that allowing smokers to be their cellmates amounts to cruel and unusual punishment. In Kensell v. State of Okla- homa, (716 F.2d 1350) and Caldwell v. Quinlan, (728 FSupp 4) nonsmoking state employees and prison inmates failed in their claim that exposure to passive smoke was cruel and unusual punishment, and that their due process/equal protection rights were violated. At the same time, however, in McKinney v. Anderson, 924 F.2d 1500, the Ninth Circuit Court of Appeals agreed that it was cruel and unusual punishment. The Supreme Court has only recently decided to review this constitutional issue. In Rossie v. Wisconsin Department of Revenue, (133 Wis 2d 341, 395 N.W.2d 801 rev. denied, 134 Wis. 2d 457, 401 N.W. 2d 10), the court rejected the contention that a Wisconsin statute prohibiting smoking in all but certain designated areas of state-owned buildings violated the equal protection clause of the 14th Amendment. On the other hand, in Gaspar v. Louisiara, Stadium andExposition Distr~ (418 F Supp 716, 577 F.2d 897, cert. denied, 439 U.S. 1073), the courts rejected the notion that nonsmoking employees or members of the public have a constitutional right to a smoke-free environment. FEDERAL LEGISLATION Only a few federal laws deal with smoking. In the 1991 book "Legislative Responses to Tobacco Use," the World Health Organization outlined the federal laws dealing with smoking. They include a ban on smoking on domestic air flights (parts 121, 129 and 135 of Title 14, Aeronautics and Space, of the U.S. Code of Federal Regulations), required health warning labels on cigarette and smokeless tobacco packaging and advertising (The Comprehensive Smoking Education Act of 1984 and The Comprehensive Smokeless Tobacco Health Education Act of 1986) and an allowance for smoking restrictions in federal buildings controlled by the General Services Administration (Part 101- 20 of Title 41, Public Contracts, of the United States Code of federal Regulations). The Americans with Disabilities Act has opened a new arena for smokers. Passed by Congress in 1990, it became effective for businesses with 25 or more employees on July 26, 1992, and for businesses with 15 or more employees, a year later. The Act prohibits discrimination against qualified disabled individuals in hiring, advance- ment, discharge, compensation, training, and other terms and conditions of employ- ment. It remains unclear whether Congress intended to include smoking as a protected disability. Neither the text nor the legisla- tive history addresses the issue. While the Americans with Disabili- ties Act may be unclear on protection for smokers, it does not appear to prevent a local jurisdiction from enacting legislation to restrict smoking in public places, workplaces or restaurants. Smoking is mentioned is Section 12201, Public Health and Welfare, Title 42 of the United States Code, which states that "nothing in this Act shall be construed to preclude the prohibition of, or the • • 66 51423 0310

• • One measure of success is the rate of smoking among Californians. The percentage of Californians who smoke declined between 1988 and 1990 from 26 percent to 22.2 percent, a 14.6 percent drop. This drop coincided with the tax increase and implementation of the various program components. The decline during this period represents a doubling of the average rate of decline in smoking that occurred between 1974 and 1987. This decline translates into economic benefits. Dorothy Rice and Wendy Max of the University of California, San Francisco reported in "The Cost of Smoking in California, 1989", that the 528,223 fewer smokers in California in 1990 will result in an economic cost savings (including health care costs and costs from lost productivity and wages) of $815 million. Weighed against the estimated $200 million spent by the tobacco education program during the program's first two years, the cash benefits of the program are apparent. Among the evaluation's findings was the fact that 87.5 percent of school-aged youths and 78.7 percent of adult smokers recalled various elements of the media campaign. Another sign of success was the rate of passage of tobacco control ordinances and policies throughout the state. By August of 1992, over 250 of California's 468 cities had policies discouraging tobacco use. PLAN FOR THE FUTURE The Tobacco Education Oversight Committee, while continuing to strive to satisfy the intent of the Proposition 99 mandate, has established the following two-year plan for fiscal years 1993/1994 and 1994/1995 to enable California to reach its stated goal of reducing tobacco consumption by 75 percent by the year 1999:  Institutionalize goals and programs.  Restore the ful120 percent of tobacco tax use for tobacco education.  Expand smoke-free policies to cover at least 66 percent of Californians at work and in public places by 1995.  Solidify the societal norm that tobacco use is not acceptable. The TEOC foresees reaching these goals by encouraging school boards and districts to incorporate tobacco use prevention policies and curriculum into their long-term plans, encouraging the passage of local tobacco control ordinances, incorporating tobacco use control into the long-term plans of local health departments, focusing on relapse prevention programs, targeting the tobacco industry for an additional tobacco tax, supporting local and state mandates to eliminate tobacco advertising and/or sponsorship of local, regional and statewide sports and leisure events, and encouraging broad public participation to ensure adherence to smoke-free policies in public places. Future successes of the Tobacco Control Program depend upon a willingness by the legislature and the governor to support the intent of Proposition 99 by committing the fu1120 percent of the tobacco tax funds for educational purposes. To that end, the Tobacco Educa- Ln tion Oversight Committee continues to work. ~ W B W W m 87

• INTRODUCTION • • Tobacco Control in California Cities: A Guide ForAction is for elected city officials, city staff, local health professionals and anyone interested in working toward a smoke-free city. It explores health and economic issues as well as a number of successful tobacco control strategies. Some of these employ public policy, others community education; some require major outside funding, others minimal municipal financial support; some use short-range planning, others demand a long-term commitment. This guidebook shares the collective knowledge of a remarkable alliance of local and state governments, public health agencies and institutions, the private sector and advocacy groups. It clarifies the options and the issues involved in tobacco control, and summarizes some of the key strategies and activities undertaken in California. It describes federal and state legislation, and discusses current legislation at the local level, legal issues and the tobacco industry's response to local initiatives. Perhaps most important, it provides information on resources for city leaders interested in tobacco control. OVERVIEW The role of cities in the broader arena of health is often underestimated. Public works, police and fire departments protect the health and safety of the citizenry. Exercise, sports and leisure programs offered by parks and recreation depart- ments promote fitness. Decisions by civic leaders concerning employment, transpor- tation, education and even the arts all affect the overall health of a city. Increasingly, city officials are embrac- ing the integrative model of the Healthy Cities concept, which defines health as including the physical environment, economic conditions and social climate. Not only city personnel, but also the diverse sectors of the constituency are asked to work together on issues affecting health. Municipal policies and program delivery decisions are made with consideration of the profound impact they have on resi- dents' health. Leonard J. Duhl, author of "The Health of Cities," in the 1987 publication Issues and T rends in Health Care, said: "A city is an interrelated system whose separate fiinctions ideally act in concert with one another. When one part of the city falters, the city as a whole suffers. In looking at a city, one usually sees things of the obvious infrastructure: the streets, the transportation system, communications, disposal systems, schools, fire and police services, and the like. However, these parts are only the beginning of a process. There is also the soft infrastructure-the rules by which we play-and it is probably here that individual cities are unique..." "If we are interested in improving our lives and the lives of those close to us-the lot of man, his total health and function- ing--we see that to have healthy people we must have healthy cities. They cannot be separated, and what improves one improves the other." ' CALIFORNIA JOINS THE HEALTHY CITIES MOVEMENT This guidebook is the outgrowth of two developments that have enlarged commonly held concepts of public health. The first can be best described as a public 0 ~it llilt-llillil ~ E:~ E al}:j(a~~ ~ a.~} ~~1~]il=al~ll It'~ ~liil~)I1!~ Iil~f1'/(~fll:lC:I~~ m N ~ N

• 35. Reducing the Health Consequences ofSmoking.• 25 Years ofProgress. A Report ofthe Surgeon 6. General U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 89-8411, Prepublication version, January 1989. Smoking and Health, A National Status Report. U.S. Department of Health and Human 7. Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 87-8396 (revised 2/90). The Health Consequences oflnvoluntary Smoking.• A Report of the Surgeon General U.S. 8. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 87-8398, 1986. "The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General," U.S. Department of Health and Human Services, Center for Health Promotion and Education, Office on Smoking and Health. DHHS Publication No. 88-8406, 1988. 39. USEPA. Indoor Air Facts No. 3, Ventilation and Air Quality in Offices. U.S. 0 Environmental Protection Agency, Air and Radiation, Publication 20A-4002, revised July 1990. 40. Indoor Air Facts No. 5, Environmental Tobacco Smoke. U.S. Environmental 41. Protection Agency, Air and Radiation, June 1989. Health Effects ofPassive Smoking.• Assessment ofLung Cancer in Adults and Respiratory 42. Disorders in Children. External Review Draft, EPA/600/6-90/006A, May 1990. Respiratory Health Effects ofPassive Smoking.• Lung Cancer and Other Disorders. U.S. Environmental Protection Agency, Air and Radiation. EPA/600/6-90/006B, May 1992. 43. Warner, KE. "Health and Economic Implications of a Tobacco-Free Society," 44. Journal oftheAmerican MedicalAssociation v258, 1987: 2080-2086. Warner, KE and Connolly, GN. "The Global Metastasis of the Marlboro Man," American Journal ofHealth Promotion v5,n5, 1991: 325-327. W N W 79

A P P E N D I X D • • • TOBACCO CONTROL ORDINANCE MATRICES This Appendix presents in chart form a ready-reference outline to tobacco control ordinances in California cities. The information reported here resulted from the California Smoke-Free Cities survey done in late 1990. Cities are much like individuals in their endless and surprising variety. Communi- ties legislate for local circumstances as seen by local decision makers. That ability to take care of local matters probably explains the continuing vigor of local civic life during this period of widely declaimed disaffection with government. But although local autonomy and variety may explain local participation, they make understanding local legislation a tricky business. Identical terms found in similar ordinances from different cities may not have identical definitions. When local ordinances including those terms are compiled into columns and the columns grouped into tables, the implications can be misleading. The ordinances were read and compiled by reasonable individuals who were not lawyers but who were knowledgeable about cities and familiar with tobacco regulation. The authors of this book reasoned that ordinances should after all be understandable by ordinary citizens without a professional legal review. The following charts can really only do two things: give generalized quantitative information about the status of municipal tobacco control in California, and give generalized-and probably oversimplified -information about a specific ordinance in a single city. If a reader is interested in the details of a particular ordinance, only a careful reading of the ordinance will do. The League of California Cities maintains a lending library which includes ordinances, policies, and other information. See Appendix A for information about inquiries to the partners in California Smoke-Free Cities. The explanatory notes which precede each chart are essential to understanding the chart. They can not include all details, but they will alert the reader to the range of variations in ordinances. Things to keep in mind while using the charts: 1. 1991 was a year of intense activity in local tobacco control. Ordinances which may have come to the reader's attention because they were well-publicized beyond their local jurisdictions may not be found here because they did not receive final passage until after the cut-off date for this appendix. Results of a second survey will be available in early 1993. Preliminary results from the 1992 California Smoke-Free Cities Survey indicate that at least 90 cities initiated or strengthened tobacco control measures in 1991 and 1992. As of September 1992, ten cities had 100 percent smoke-free restaurants and workplaces and also 95

CHART I - SUMMARY OF ORDINANCE PROVISIONS City- Restau- Enclosed Vending Machines; Crt Poyulation Coun Date Enacted Owned Facilities rants/ Bars Work- Iaces Public Places Advertising; Samnling Alameda 77,194 Alameda 10/87 no yes yes yes no Alhambra 76,011 Los Angeles 2/89 yes yes yes yes no Anaheim 247,822 Orange 3/86 yes yes yes no no Antioch 62,032 Contra Costa 11/85 yes yes yes yes no Arcadia 49,816 Los Angeles 11/75 no no no yes no Arcata 15,613 Humboldt 12/85 no yes yes yes no Atherton 8,028 San Mateo 6/88 yes no no no no Auburn 9,812 Placer 3/91 yes yes yes yes no Baldwin Park 63,789 Los Angeles 7/89 yes no no no no Bellflower 61,314 Los Angeles 1/91 no yes yes yes no Belmont 25,160 San Mateo 4/87 no yes yes yes no Benicia 25,342 Solano 3/84 yes yes yes yes no Berkeley 106,803 Alameda 7/86 no yes yes yes no Beverly Hills 34,731 Los Angeles 1/89 yes yes no yes no Big Bear Lake 9,021 San Bernardino 5/87 yes no no yes no Brea 33,815 Orange 7/85 no yes yes yes no Brentwood 7,060 Contra Costa 11/85 yes no yes yes no Burbank 95,256 Los Angeles 1/87 no no no yes no Burlingame 27,396 San Mateo 5/87 yes yes yes yes no Camarillo 50,043 Ventura 7/83 no yes yes yes no Campbell 34,855 Santa Clara 2/88 no yes yes yes no Carlsbad 63,451 San Diego 6/83 no yes yes yes no Carpinteria 13,067 Santa Barbara 10/85 yes no yes yes no Carson 88,814 Los Angeles 8/90 yes no no no no Cathedral City 31,753 Riverside 12/82 yes no no yes no Cerritos 58,433 Los Angeles 5/76 yes no no no no Chico 38,530 Butte 10/86 yes yes yes yes no Chino 59,619 San Bernardino 2/87 yes no no no no Chula Vista 131,603 San Diego 10/84 no yes yes yes no Clayton 6,901 Contra Costa 11/85 yes yes yes yes no Enforcement city manager city manager fire marshal city administrator city manager dept of health city manager city manager city attorney city manager city manager city manager health officer city manager city manager Penal -1 fine fine fine O Cr m ~ 0 0 fine fine n o fine ~ infraction .. ~ fine o fine - infraction _. nuisance abatement ~ fine fine nuisance abatement infraction n m ~ 0 fine ~ infraction ~ fine infraction fine fine m ~ fine infraction fine eo N IfiiEO £ZVIS

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s CHART V ENCLOSED PUBLIC PLACES EXPLANATORY NOTES The column headings indicate the most frequently specified kinds of enclosed public places. The extent of restriction in each kind of public place listed varies widely among cities and is not indicated here. Nearly every city with a tobacco control ordinance lists some enclosed public places besides the most frequently-used categories listed as one through six below. See note 7. 1. RETAIL STORES: Indicates whether smoking is expressly prohibited or limited in retail stores. 2. SHOPPING MALLS: "Yes" indicates that smoking is expressly prohibited in shopping malls. 3. FOOD MARKETS: "Yes" indicates whether smoking is expressly prohibited in food markets or grocery stores. 4. HEALTH FACILITIES: "Yes" indicates that smoking is restricted in hospitals and other type of health care facilities. 5. CHILDCARE FACILITIES: "Yes" indicates that smoking is expressly prohib- ited in childcare facilities. 6. HOTEL/MOTEL FACILITIES: Indicates whether smoking is expressly limited in hotel/motel facilities. A common restriction provides that a specified percentage of sleeping rooms be smoke-free. 7. MISCELLANEOUS ENCLOSED PUBLIC PLACES: Frequently specified miscellaneous places include theaters, sports facilities, banks, auditoriums, galleries and museums. 8. COMMON AREAS: This column indicates whether common areas such as meeting rooms, hallways, elevators, restrooms, lobbies, vestibules, entryways, waiting rooms, and service lines are expressly covered in the ordinance. Some ordinances specify certain common areas (specified), or refer to common areas generally (non-specified), and some do not regulate smoking explicitly in common areas (none). 9. PUBLIC TRANSPORTATION: A "yes" indicates that smoking is expressly restricted in public transportation facilities. 10. EXEMPTIONS: "OSA" indicates that specified areas are designated as optional smoking areas. Many workplace ordinances state that employers are not required to make structural modifications in order to provide smoke-free work areas. Such a provision in an ordinance which provides a total ban on workplace smoking is considered an exemption here. 126

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s CHART I I CITY'OWNED FACILITIES EXPLANATORY NOTES 1. TOTAL BAN: This column indicates whether an ordinance provides that all city-owned or leased facilities and vehicles, and city-owned public transportation facilities are smoke-free. 2. CITY-OWNED FACILITIES: This column refers to whether smoking is explicitly restricted in certain city workplaces (specified), in city workplaces generally (non- specified), or whether city workplaces are not mentioned in an ordinance which nonetheless may restrict smoking in certain common areas which belong to the city (none). 3. CITY-OWNED TRANSPORTATION: This column refers to whether city- owned buses, trains, taxi cabs or other means of public transit owned by the city are covered by the ordinance. 4. COMMON AREAS: This column indicates whether common areas such as meeting rooms, hallways, council chambers, courtrooms, elevators, restrooms, lobbies, vestibules, entryways, waiting rooms, and service lines are expressly covered in the ordinance. Some ordinances specify certain common areas (specified), or refer to common areas generally (non-specified), and some do not regulate smoking explicitly in common areas (none). 5. MISCELLANEOUS CITY-OWNED FACILITIES: Designated miscellaneous facilities include council chambers, libraries, museums, aquariums, sports facilities, health facilities, airports, community centers, park facilities and others. 6. EXEMPTIONS: "Exemptions" refers to whether an ordinance provides "specified" exemptions or "none". 7. PUBLIC INFORMATION: This column indicates whether an ordinance requires distribution of information, posting of signs, or other education about the smoking policy in effect in city facilities. 106

CHART II - CITY-OWNED FACILITIES ity Total Ban City Worlmlaces City-Owned Transportation Common Areas Miscellaneous City-Owned Facilities xemptions signage or Other Public Information Alhambra yes not specified specified not specified not specified none - Anaheim no -- - - specified - - Antioch no not specified specified specified specified specified yes Atherton no specified specified specified not specified none no Auburn no not specified specified specified not specified specified yes Baldwin Park no not specified none specified specified none yes Benicia no not specified specified specified none specified yes Beverly Hills no not specified none none specified specified yes Big Bear Lake no not specified none none not specified none yes Brentwood no not specified specified specified not specified specified - Burlingame no specified specified none specified specified yes Carpinteria no not specified not specified specified not specified specified - Carson no not specified none none not specified specified yes Cathedral City no none none specified not specified specified yes Cerritos no none none none specified none no Chico no not specified specified specified not specified specified yes Chino no none none none specified none yes Clayton no not specified specified specified specified specified yes Cloverdale no not specified specified specified not specified specified yes Colfax no not specified specified specified specified specified yes Compton no not specified none none not specified none yes Corona yes not specified not specified none not specified none yes Cotati no not specified specified specified specified specified yes Crescent City no not specified not specified specified not specified specified yes Culver City no not specified specified specified specified specified yes Cupertino no not specified specified specified not specified specified yes Danville no not specified not specified specified specified specified yes Delano no specified none specified none specified yes Dixon no not specified specified specified not specified specified yes El Cerrito no not specified specified specified specified specified yes 0S£0 £ZVTS

CHART II - CITY-OWNED FACII,ITIES Signage Miscellaneous or Other Total City City-Owned Common City-Owned Public Citv Ban Workplaces Transoortation Areas Facilities Exemptions Information Monrovia no specified none specified specified none no Monterey no not specified specified specified specified specified yes Monterey Park no none none specified specified specified yes Moorpark no specified specified specified specified specified yes Moraga no not specified not specified none specified specified yes Moreno Valley no not specified specified specified specified specified yes Morro Bay no not specified none none not specified specified yes Mountain View no specified specified specified specified specified yes Needles no specified none none specified none yes Newark no not specified none specified specified specified yes Novato no not specified not specified none not specified specified yes Oakdale no not specified none none not specified specified yes Oakland no not specified none specified specified specified yes Ojai no not specified not specified specified specified specified yes Ontario no specified - specified specified specified yes Orinda no none specified specified specified specified yes Oroville no not specified specified specified specified specified - Oxnard no - specified specified specified specified yes Paradise no not specified specified specified specified specified yes Paso Robles no none none specified none none yes Petaluma no not specified specified specified specified specified yes Piedmont no not specified specified specified specified specified yes Pinole no not specified specified specified specified specified yes Pittsburg no not specified specified specified specified specified yes Placentia no not specified none specified specified none - Pleasant Hill no not specified specified specified specified none yes Pleasanton no not specified specified specified specified specified yes Point Arena no specified none none specified specified yes Pomona no not specified none none none specified yes Port Hueneme no not specified specified specified specified specified yes ZSEO £ZVIS

CHART I - SUMMARY OF ORDINANCE PROVISIONS City- Restau- Enclosed Vending Machines; City Population Coun Date Enacted Owned Facilities rants/ Bars Work- ly aces Public Places Advertising; SamplinQ Oakdale 11,362 Stanislaus 5/88 yes yes yes yes no Oakland 357,788 Alameda 7/90 yes yes yes yes no Oceanside 125,823 San Diego 5/90 no yes yes yes no Ojai 7,988 Ventura 1/88 yes yes no yes no Ontario 129,286 San Bernardino 5/87 yes yes yes no no Orinda 38,643 Contra Costa 12/85 yes yes yes yes no Oroville 10,656 Butte 5/91 yes yes yes yes no Oxnard 129,908 Ventura 4/88 yes yes yes yes no Pacific Grove 16,685 Monterey 7/88 no yes no yes no Palm Desert 20,659 Riverside 8/87 no yes yes yes no Palm Springs 43,813 , Riverside 3/87 no yes yes yes no Palo Alto 57,366 Santa Clara 10/88 no yes yes yes no Paradise 26,786 Butte 5/91 yes yes yes yes VM Pasadena 133,900 Los Angeles 4/84 no yes yes yes no Paso Robles 17,474 San Luis Obispo 6/88 yes no no no no Petaluma 42,930 Sonoma 12/87 yes yes yes yes no Piedmont 10,529 Alameda 1/88 yes yes yes yes no Pinole 16,949 Contra Costa 1/90 yes yes yes yes no Pittsburg 45,663 Contra Costa 11/85 yes yes yes yes no Placentia 42,060 Orange 6/76 yes no no no no Pleasant Hill 32,296 Contra Costa 1/87 yes yes yes yes no Pleasanton 55,266 Alameda 11/89 yes yes yes yes no Point Arena 484 Mendocino 8/90 yes no no no no Pomona 121,643 Los Angeles 5/89 yes no no no no Port Hueneme 21,242 Ventura 1/89 yes yes yes yes no Porterville 28,839 Tulare 6/87 yes no no no no Poway 51,237 San Diego 12/89 no yes yes yes no Rancho Cucamonga 114,954 San Bernardino 12/88 no yes no no no Rancho Mirage 9,268 Riverside 12/90 no yes yes yes VM Redding 63,412 Shasta 9/87 no no yes yes no SVE6 EZV1S Enforcement Pena city administrator fine city manager fine city manager infraction city manager infraction city manager fine county health dept fine city manager fine city manager police infraction city council city manager et. al. city health officer infraction infraction fine infraction city manager fine police chief fine city manager fine city manager fine city manager infraction city manager fine fine city manager fine city council fine city manager fine city council infraction county health officer infraction 0 0 0 0

• THE RISK • '1'tlF DANC;I1ZS ol: 1'~,NVnioNM1~.N'lAI. "1'o1;AC(:O SMOKE T11F, FAC:TS SI'T.AK VOR TlILMSFIVF,S VFN'1'llA'I-JON IS NO"I~ 7'lM ANSWLFL If cigarettes were a recent invention, they are unlikely to have becn approved by the Federal Food and I)rugAdministra- tion. But smoking on this continent predated the arrival of the first I?uropean explorers. 7'he first evidence of human tobacco use has been traced to the Mayan culture through 1,000 year old stone carvings. After his arrival in the New World, Christopher Columbus chronicled the curious habit of natives who rolled tobacco leaves into a tube, lighted one end and inhaled on the other. '1'obacco led to prosperity for American colonists during the 17th and 18th centuries. '1'oday's postmark for the '1'obacco Institute, the industry's lobbying arrn in Washington, proclaims its position as "America's Fiist Industry." In 18841, inventor James Ponsack perfected a cigarette manufacturing machinee which could produce 60 times the nurnber of cigarettes which could be manufactured by hand in a day. Within five years, a factory of cigarette manufactur- ing machines was turning out nearly one billion cigarettes yearly. 7'he tremendous growth in tobacco use, however, came only after the industry embraced the concept of mass marketing. Before the invention of the cigarette manufacturing machine, smokers in the United States consumed an average of 40 cigarettes per year. By 1973, the peak of consumption in the United States, smokers in the United States were consuming an average of 12,8541 cigarettes per year." Marketing of cigarette products over the past 100 years has contributed greatly to the success of the tobacco industry in the United States; per capita consumption remains about 2,800 cigarettes per year. The tobacco industry reaps huge profits from a product which is the known leading preventable cause of death and whose byproduct, environmental tobacco smoke (I?7'S), is the third leading preventable cause of death in the United States.'4 THE DANGERS OF ENVIRONMENTAL TOBACCO SMOKE Smoking cigarettes without question poses a serious and dangerous health risk. 1?ach year 430,000 Americans die as a direct result ofsmoking."'1'he economic losses incurred by U.S. businesses as a direct result of smokers is a staggering $52 billion each year 3c But the danger is not limited to smokers. I?nvironrnental tobacco smoke which includes both exhaled smoke and the sidestream smoke from a burning cigarette causes the death of 53,000 nonsmoking Americans each year.14 I3nvironmental tobacco smoke is one of the most widespread and harmful indoor air pollutants-and the state Air Resources Board estimates Californians spend roughly 86 percent of their time indoors.' '1'he Board's Scientific Review Panel 5 rs m

0 ® 0 CHART I - SUMMARY OF ORDINANCE PROVISIONS City- Restau- Enclosed Vending Machines; C'" Population Cou t Date Enacted Owned Facilities rants/ Bars Work- ly aces Public Places Advertising; SamnlinQ Redlands 62,940 San Bernardino 2/89 yes yes yes yes no Redwood City 63,193 San Mateo 7/88 no yes yes yes no Rialto 70,335 San Bernardino 8/90 no no yes no no Richmond 84,344 Contra Costa 12/87 yes yes yes yes no Ridgecrest 30,365 Kern 1/90 yes no no no no Rio Vista 3,469 Solano 1 /91 yes yes yes yes no Ripon 7,436 San Joaquin 9/90 yes no no no no Riverside 218,499 Riverside 5/85 no yes yes yes no Rohnert Park 84,878 Sonoma 2/89 yes yes yes yes no Roseville 40,981 Placer 8/91 yes yes yes yes no Ross 2,801 Marin 12/89 yes yes no yes no Sacramento 346,586 Sacramento 10/90 yes yes yes yes no Salinas 104,102 Monterey 6/88 yes yes yes yes no San Anselmo 12,117 Marin 10/76 no no no yes no San Bernardino 159,923 San Bernardino 4/88 yes yes yes yes no San Bruno 35,760 San Mateo 3/87 yes yes yes yes no San Carlos 27,490 San Mateo 12/89 no yes yes yes no San Clemente 40,381 Orange 2/88 no yes yes yes no San Diego 1,118,282 San Diego 4/91 no yes yes yes no San Dimas 33,072 Los Angeles 1/86 yes no no no no San Francisco 742,681 San Francisco 6/91 yes yes yes yes VM San Jose 749,820 Santa Clara 1/85 no yes yes yes no San Juan Bautista 1,653 San Benito 3/90 yes no no no no San Juan Capistrano 25,268 Orange 9/87 yes no no no no San Leandro 67,454 Alameda 8/88 no yes yes yes no San Luis Obispo 42,136 San Luis Obispo 7/90 yes yes yes yes no San Marcos 37,020 San Diego 3/77 no no no no VM San Mateo 85,576 San Mateo 11/86 yes yes yes yes no San Pablo 21,687 Contra Costa 10/85 no yes yes yes no San Rafael 47,116 Marin 5/81 yes yes no yes no Enforcement P~ city manager fine infraction city administrator fine city manager infraction fine city manager fine fine infraction city manager fine code enforcement offcr fine police chief fine county env. hlth. div. fine health officer infraction infraction dir., planning & bldg. infraction fine city manager fine dir. public health fine health officer city manager fine city admin. officer fine fine city manager fine 9pE0 £ZVTS

0 C HART IV WORKPLACE S EXPLANATORY NOTES 1. COMMON AREAS: This column indicates whether common areas such as meeting rooms, hallways, employee lounge areas, elevators, restrooms, lobbies, vestibules, entryways, waiting rooms, and service lines are expressly covered in the ordinance. Some ordinances specify certain common areas (specified), or refer to common areas generally (non- specified), and some do not regulate smoking explicitly in common areas (none). 2. DESIGNATE OWN AREA: Indicates whether an ordinance contains a provision which allows employees to designate their own immediate work areas as nonsmok- ing. 3. NONSMOKERS' PREFERENCE: This column indicates whether an ordi- nance contains a provision which states that in any dispute arising under the smoking policy, the concerns of nonsmokers will be given precedence. 4. EXEMPTIONS: The symbol "#" or a number indicates that workplaces employing fewer than a specified number are exempt. "OSA" indicates that specified areas are designated as optional smoking areas. Many workplace ordinances state that employers are not required to make structural modifications in order to provide smoke-free work areas. Such a provision in an ordinance which provides a total ban on workplace smoking is considered an exemption here. 5. NONRETALIATION CLAUSE: Indicates whether an ordinance prohibits retaliation against an employee who exercises rights provided under the ordinance. Ln ~ ~ N ~ W 01 N 119

CHART I - SUMMARY OF ORDINANCE PROVISIONS City- Restau- Enclosed Vending Machines; Ci~t Population Countv Date Enacted Owned Facilities rants/ Bars Work- vlaces Public Places Advertising; Samplin¢ San Ramon 35,966 Contra Costa 11/85 yes yes yes yes no Santa Ana 237,348 Orange 3/80 yes no no no no Santa Barbara 80,361 Santa Barbara 8/89 yes yes yes yes no Santa Clara 92,191 Santa Clara 7/85 no yes yes yes no Santa Cruz 51,082 Santa Cruz 10/85 no yes yes yes no Santa Maria 55,223 Santa Barbara 11/88 yes yes yes yes no Santa Monica 97,212 Los Angeles 2/91 yes yes yes yes VM Santa Rosa 112,551 Sonoma 8/88 yes yes yes yes no Santee 59,787 San Diego 3/83 no yes yes yes no Saratoga 30,710 Santa Clara 10/87 no yes yes yes no Sausalito 7,587 Marin 2/75 yes no no no no Scotts Valley 9,460 Santa Cruz 3/86 no yes yes yes no Sebastopol 38,509 Sonoma 5/88 yes yes yes yes no Simi Valley 101,523 Ventura 6/87 yes yes yes yes no Solana Beach 24,132 San Diego 10/87 no yes yes yes no Soledad 13,386 Monterey 0/86 no no no yes no Solvang 6,999 Santa Barbara 5/88 yes yes yes yes no Sonoma 8,334 Sonoma 5/88 yes yes yes yes no South El Monte 18,878 Los Angeles 4/91 yes no no no no South Pasadena 24,689 Los Angeles 2/88 no yes no yes no South San Francisco 52,938 San Mateo 10/87 yes yes yes yes no Stockton 195,223 San Joaquin 4/89 yes yes yes yes no Sunnyvale 117,331 Santa Clara 9/86 no yes yes yes no Thousand Oaks 106,381 Ventura 5/88 yes yes yes yes no Tiburon 8,844 Marin 2/89 yes yes yes yes no Torrance 142,545 Los Angeles 12/87 yes yes yes yes no Tracy 32,701 San Joaquin 2/87 yes yes yes yes no Turlock 42,217 Stanislaus 3/87 yes yes yes yes no Tustin 49,409 Orange 12/85 no yes yes yes no Ukiah 14,220 Mendocino 9/81 yes yes yes yes no Enforcement city manager city administrator city manager code enforcement offcr city manager city manager county health officer chief of police city administrator police chief city manager city manager city manager city manager city manager town manager city manager city manager c.mgr/cnty.dir.env.hith dir. comm. services city manager Pe -i O fine a m infraction fine ~ fine 0 fine fine n fine 0 fine ~ .. ~ fine 0 fine fine fine ~ fine c') infraction m fine infraction fine ~ 0 fine t fine 0 infraction fine m fine fine ~ fine fine CD fine N LK0 EZVtS

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s 37.05 through 37.19 and other Public Places similarly situated, including but not limited to the following Enclosed Areas: a. Common work areas occupied by employees performing clerical, technical, administrative or other business or work functions; b. Merchandise display areas, checkout stations, and counters and other pay stations; c. Hallways; d. Restrooms; e. Escalators, elevators and stairways; f. Lobbies; g. Reception areas; h. Waiting rooms; i. Service lines; j. Classrooms, meeting or conference rooms, or lecture halls; and k. Other places in which Members of the General Public congregate for service or otherwise frequent. § 37.05 Stores. The prohibitions contained in section 37.04 above shall be applicable to: (i) the enclosed common areas of Shopping Malls; (ii) automobile dealerships, furniture or other showrooms for the display of merchandise offered for sale at retail; (iii) grocery, specialty, department and other stores which sell goods or merchandise at retail, and (iv) service stations, stores or shops for the repair or maintenance of appliances, shoes, or motor vehicles, barbershops, beauty shops, cleaners and laundromats, video game, pool hall and other amusement centers, and other similar establishments offering services or products to Members of the General Public. § 37.06 Banks. The prohibitions contained in section 37.04 shall be applicable to banks, including savings and loan associations, credit unions and other similar institutions which offer financial services to Members of the General Public. • • • 138

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s ORDINANCE NO. 386 N.S. AN ORDINANCE OF THE TOWN COUNCIL OF THE TOWN OF TIBURON REPEALING THE EXISTING CHAPTER 28 OF THE TIBURON MUNICIPAL CODE AND ADDING A NEW CHAPTER 28 PROHIBITING TOBACCO SMOKING IN PUBLIC PLACES AND PLACES OF EMPLOYMENT AND REGULATING THE SALE OF TOBACCO PRODUCTS THE TOWN COUNCIL OF THE TOWN OF TIBURON DOES ORDAIN AS FOLLOWS: SECTION 1. The existing Chapter 28 of the Tiburon Municipal Code (Ordinance No. 340 N.S.) entitled "Smoking in Public Places is hereby repealed. This repeal shall not affect or prevent the prosecution or punishment of any person for any act done or omitted in violation of these chapters or sections prior to the effective date of this ordinance. SECTION 2. A new Chapter 28 entitled "Smoking and Tobacco Regulations" is hereby added to the Tiburon Municipal Code to read as follows: CHAPTER 28 SMOKING AND TOBACCO REGULATIONS Sections 28-1 Findings and Purpose 28-2 Definitions 28-3 Application to Town-Owned Vehicles and Facilities 28-4 Prohibition of Smoking in Public Places 28-5 Regulation of Smoking in Places of Employment 28-6 Smoking Optional Areas 28-7 Posting of Signs 28-8 Regulating the Sale of Tobacco Products 146

• Air pollution caused by smoking is an offensive annoyance and irritant. Smoking results in serious and significant physical discomfort of nonsmokers and constitutes a public nuisance in public places and workplaces. § 37.02 Authority. This chapter is enacted pursuant to the provisions of Section 25946 of the Health and Safety Code for the purpose of restricting and regulating smoking in public places and in places of work in order to reduce the hazards and nuisance which smoking causes to those who are involuntarily exposed. § 37.03 Definitions. As used in this chapter, those terms identified in this section shall, unless the context indicates otherwise, be ascribed the meaning contained herein. (a) Bar. • The term "Bar" means an area which is devoted to the serving of alcoholic beverages for consumption on the premises, in which the serving of food, if any, is incidental to the consumption of alcoholic drinks. The dining area of a restaurant utilized primarily for the serving and consumption of food shall not constitute a Bar, even though alcoholic beverages may be served therein. (b) Commercial Enterprise - Non-profit Entity - Person. [Operators of Public Places] The term "Commercial Enterprise" means any business entity formed for profit making purposes, including professional corporations and other entities under which legal, medical, dental, engineering, architectural, or other professional services are delivered, and also any person charged with the responsibility of controlling conduct in behalf of the Enterprise upon any premises regulated by this chapter. The term "Non-Profit Entity" shall mean any corporation, unincorporated association or other entity created for charitable, philanthropic, educational, character building, political, social or other similar purposes, the net proceeds from operations of which are committed to promotion of the objects or purposes of the organization and not to private gain, together with any person charged with the responsibility of controlling conduct in behalf of the Entity upon any premises regulated by the provisions of this chapter. A public agency is not a "Non-Profit Entity" within the meaning of this Section. The term "Person" means any natural person, partnership, corporation, unincorporated association, joint venture, business trust, joint stock company, club, or other organization of any kind, except the City of Sacramento or any other public agency. o, ~ N • ~ W t9 W J 135 Q0

• b. Reduce such complaints to writing, and analyze the frequency and volume thereof in relation to alleged violations of this chapter by or at particular establishments or facilities; c. Conduct an on-site inspection of any establishment or facility with respect to which the nature and volume of complaints suggests long-standing and pronounced violations of any of the provisions of this chapter; d. Provide to the owner, operator or manager of any such establishment or facility a copy of the provisions of this chapter and such advisory assistance to rectify future violations as may be necessary to achieve compliance with the provisions of this chapter; e. Follow up such investigation and advice with a written directive explaining in detail the steps required in order to achieve future compliance with the provisions of this chapter; and f. If the violations do not cease following the expiration of a reasonable period of time, commence civil actions for the recovery of infraction fines pursuant to the provisions of section 37.25 or request commencement of a civil proceeding by the County Counsel pursuant to the provisions of section 37.26 as may be appropriate. 0 The Environmental Health Division shall affirmatively seek the support and cooperation of other local public agencies, such as Fire Protection Districts, to provide information, assistance and advice in the enforcement of the provisions of this chapter, during the conduct by any of such agencies of on-site inspections of establishments or facilities. The provisions of section 37.24 shall not be remedied by either the Chief of Environmental Health or any other County or City official. Any Member of the General Public, an employee or applicant for employment may, pursuant to the provisions of section 37.26, commence in his or her name a civil action for injunctive relief, monetary damages or other appropriate relief against a person who violates section 37.24 pursuant to the provisions of section 37.26. A Member of the General Public or employee shall also be authorized to individually commence a civil action pursuant to the provisions of section 37.26 for injunctive relief, monetary damages or other appropriate relief for the purpose of remedying any other violation of the provisions of this chapter. Ln N 06 • N W m W 00 CO 145

• (g) Smoking. The term "Smoking" means lighting, inhaling, exhaling or burning any pipe, cigar, cigarette, weed or plant, or carrying any lighted pipe, lighted cigar, lighted cigarette, lighted weed, lighted plant or other ignited combustible substance in any manner or in any form. (h) Tobacco Store. The term "Tobacco Store" means a place utilized primarily for the sale to Members of the General Public at retail of tobacco products or accessories and in which the sale of any other products is merely incidental. (i) Workplace. The term "Workplace" means any enclosed area which is occupied by two or more employees of a Commercial Enterprise, Non-Profit Entity or the City of Sacramento including but not limited to places: is (1) Utilized for: (i) the manufacturing, processing, assembly, maintenance or repair of any products, goods, equipment, tools, appliances, furnishings or other object; or (ii) the physical storage for purposes of wholesaling, future utilization for operational purposes, or future transfer preceding consumption or other utilization of any products, goods, merchandise, materials, supplies, equipment, tools, appliances or furnishings; (2) Utilized or operated for a purpose described by sections 37.05 through 37.19 and from which Members of the General Public are excluded; (3) Utilized as a union hall, cafeteria, lounge, lunchroom, restroom, conference room, training room, lecture room or classroom primarily for the use or benefit of employees. Notwithstanding the provisions of this definition, a private residence including either an attached or detached garage shall not constitute a workplace, except when the residence serves as a licensed day care facility for children. § 37.04 Smoking Prohibitions, Public Places. Except as otherwise provided in this chapter, it is unlawful for any Member of the General Public or any other person including an employee to smoke in the Public Places named and described in sections v, • N W ~ W 00 m 137

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T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s Motion picture theaters shall show upon the movie or live action screens for at least five seconds prior to the showing of each feature motion picture the message that smoking is prohibited within the audience seating and other areas as specified. Hotels and Motels will prominently post in the lobby a sign notifying patrons of the availability of nonsmoking accommodations. The rooms so designated will be posted as nonsmoking rooms and ashtrays removed. § 37.24 Retaliation Prohibited. It shall be unlawful for a Commercial Enterprise, Non-Profit Entity or City to retaliate against any Member of the General Public or an employee or applicant for employment of the enterprise, entity or City because such Member of the General Public, employee or applicant seeks enforcement of the provisions of this chapter or otherwise protests smoking by others. § 37.25 Violation - Smoking or Posting. Any person who violates the prohibitions contained in sections 37.05 through 37.19 and any person who violates section 37.23 by failing to post the signs or take the other actions required by this section shall be guilty of an infraction, punishable in the manner hereinafter prescribed. Fines for the crimes made infractions by this section shall be levied in the amounts prescribed by Section 36900(b) of the Government Code, as that section may hereafter be amended or renumbered. § 37.26 Retaliation Remedies. Violation of any of the provisions of section 37.24 or 37.26 shall be remedied through civil action filed in a court of competent jurisdiction for injunctive or other appropriate relief. § 37.27 Enforcement. It shall be the responsibility of the Chief of the Environmental Health Division, Sacramento County Department of Environmental Management to enforce, in behalf of the City, the provisions of this chapter. The Chief shall be authorized to prosecute, in the name of the City, pursuant to the provisions of Sections 25132 and 39600 of the Government Code, civil actions for the recovery of fines for violations of this chapter made infractions by section 37.25 for violations of sections 37.05 through 37.23. In the performance of the enforcement responsibilities assigned by this chapter, the Chief of the Environmental Health Division shall: a. Establish a telephone number through which all complaints by citizens relating to violations of this chapter may be directed or referred; 144

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s (c) Enclosed Area. The term "Enclosed Area" means all space between a floor and ceiling which is served by a common heating, ventilating and air conditioning system and is enclosed on all sides by solid walls or windows (exclusive of door or passageways) which extend from the floor to the ceiling, including all space therein screened by partitions which do not extend to the ceiling or are not solid, "office landscaping," or similar structures. (d) Members of the General Public. The term "Members of the General Public" means shoppers, customers, patrons, patients, students, clients and other similar invitees of a Commercial Enterprise or Non- Profit Entity; and excludes employees thereof, sales representatives, service repair persons and persons delivering goods, merchandise or services to a Commercial Enterprise, Non-Profit Entity or the City of Sacramento. (e) Office. The term "office" means an area enclosed by walls containing a desk, table or similar furnishings for clerical, administrative or supervisory work, a complex of such enclosures and a building containing such enclosures, whether or not the building is utilized primarily for other purposes such as retailing, wholesaling or storage, or manufacturing, together with all hallways, stairways, elevators, escalators, restrooms, lobbies, waiting rooms, reception areas, entry areas, and conference rooms within or associated with the complex of such enclosures, including: (i) legal, medical, dental, engineering, accounting, counseling and other professional offices; (ii) insurance, real estate, ticket, collection agency, and other offices where business services are offered to or goods or services are offered to or may be ordered by or may be paid for by Members of the General Public; and (iii) offices to which Members of the General Public are admitted in order to promote the objects or purposes of the Non-Profit Entities. (f) Restaurant. The term "Restaurant" means any coffee shop, cafeteria, luncheonette, soda fountain, fast food service and other establishment where cooked or otherwise prepared food is sold to Members of the General Public for consumption on the premises. The term does not include a cafeteria or lunchroom defined as a "workplace" by subparagraph (3) of subsection (i), whether or not Members of the General Public incidentally frequent the facility. B W J l0 • • 136

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• • § 37.07 Hotels/Motels. The prohibitions contained in Section 37.04 shall be applicable to hotels and motels in which guests typically rent lodging for continuous periods less than thirty days. Smoking is permissible in rental rooms and in on-premise restaurants, bars and other areas as provided in Sections 37.13, 37.21(b) and 37.21(e). The availability of nonsmoking rooms will be prominently posted in the lobby sign-in area. The rooms so designated will be posted as smoking prohibited and ash trays removed. Customers seeking accommodations will be routinely advised of the availability of nonsmoking rooms. § 37.08 Terminals. The prohibitions contained in section 37.04 shall be applicable to depots and other terminals utilized by Members of the General Public for the purpose of being transported upon or departing from airplanes, trains, buses and taxis. § 37.09 Buses and Taxis. Smoking by either passengers or operators shall be prohibited within buses, taxicabs and all public transit conveyances operated by or licensed by the City. § 37.10 Theaters. The prohibitions contained in section 37.04 shall be applicable to theaters, including motion picture theaters, meeting halls and auditoriums where motion pictures or live theatrical musical or dramatic productions are made to an audience consisting of Members of the General Public assembled for the purpose of witnessing the performance or presentation; provided that neither this section nor section 37.04 shall be construed to prevent smoking by performers in connection with a stage production or by persons making a presentation concerning addiction to tobacco or other drugs. § 37.11 Recreational Facilities. The prohibitions contained in Section 37.04 shall be applicable to enclosed areas of sports pavilions, gymnasiums, exercise rooms, health spas, boxing arenas, swimming pools, roller and ice skating rinks, bowling alleys and other similar places where Members of the General Public assemble to either engage in physical exercise, participate in athletic competition or witness sports events. Smoking is prohibited at all times within the seating areas of an enclosed arena and in the surrounding open concourses where food and beverages are dispensed. Smoking may be allowed in enclosed on-site Restaurants, subject to the provisions of Section 37.13, and in enclosed on-site Bars. u, N ~ W m W OD IV 139

CHART I - SUMMARY OF ORDINANCE PROVISIONS City- Restau- Enclosed Vending Machines; Cit Pooulation County Date Enacted Owned Facilities rants/ Bars Work- laces Public Places Advectising; Sali Garden Grove 135,286 Orange 8/90 no yes yes yes no Gardena 51,170 Los Angeles 7/77 no no no yes no Gilroy 29,997 Santa Clara 9/86 no yes yes yes no Grand Terrace 11,418 San Bernardino 11/85 no yes yes yes no Grass Valley 9,393 Nevada 10/90 yes yes yes yes no Gridley 4,445 Butte 8/90 yes yes yes yes no Hayward 105,504 Alameda 8/88 yes yes yes yes no Healdsburg 9,325 Sonoma 11/88 yes yes yes yes no Hemet 35,660 Riverside 5/85 no yes yes yes no Hercules 16,892 Contra Costa 10/85 yes yes yes yes no Hermosa Beach 19,764 Los Angeles 9/86 yes no no yes no Hollister 18,702 San Benito 10/86 no yes yes yes no Huntington Beach 191,630 Orange 3/86 no yes yes yes no Indian Wells 2,720 Riverside 5/90 no yes yes yes no Irvine 102,418 Orange 10/85 yes yes yes yes no La Canada Flintridge 20,828 Los Angeles 8/90 yes yes yes yes no La Mesa 53,976 San Diego 2/84 no yes yes yes no Lafayette 25,838 Contra Costa 10/85 yes yes yes yes no Laguna Beach 24,599 Orange 2/85 no yes yes yes no Laguna Niguel 71,244 Orange 12/89 yes yes yes yes no Lakewood 76,974 Los Angeles 9/88 yes yes yes no no Iancaster 88,732 Los Angeles 1/88 yes yes yes yes no Lawndale 27,639 Los Angeles 2/88 yes no no no no Lemon Grove 23,379 San Diego 4/91 no yes yes yes no Live Oak 4,302 Sutter 6/86 yes yes yes yes no Livermore 58,419 Alameda 7/85 no yes yes yes no Livingston 7,216 Merced 8/87 yes yes yes yes no Lodi 50,328 San Joaquin 6/90 no yes yes yes no Loma Linda 15,557 San Bernardino 11/86 yes yes yes yes no Lompoc 33,844 Santa Barbara 5/90 yes yes yes yes no EVEO EZfiiIS Enfon:ement city administrator city administrator county health dept city manager police city manager public safety director city manager city manager city manager community safety dept city manager health dept city manager public safety officer fire marshal city manager city administrator Penaltv ~ 0 fine as 0 infraction 0 infraction ~ fine 0 fine fine 0 fine 0 fine ~ ~ fine 0 fine fine infraction infraction ~ fine ~ fine m fine fine fine ~ 0 fine ~ fine 0 fine fine m fine n fine fine ~. fine fine CD infraction H

• • 28-9 Enforcement 28-10 Violations and Penalties 28-11 Non-retaliation 28-12 Public Education 28-13 Governmental Agency Cooperation 28-14 Other Applicable Laws Section 28-1. Findings and Purpose The Town Council of the Town of Tiburon does hereby find that: 1. Numerous scientific studies have found that tobacco smoke is a major contributor to indoor air pollution; 2. Reliable scientific studies, including studies by the Surgeon General of the United States and studies commissioned and assessed by the U.S. Environmental Protection Agency, have shown that breathing sidestream or secondhand smoke is a significant health hazard to nonsmokers; particularly to children and teens, elderly people, individuals with cardiovascular disease, and individuals with impaired respiratory function, including asthmatics and those with obstructive airway disease; 3. Health hazards induced by exposure to environmental tobacco smoke include lung and other forms of cancer, respiratory infection, decreased respiratory function, decreased exercise tolerance, broncho-constriction and broncho-spasm, and that the most common cause of premature death from environmental tobacco smoke is heart disease; 4. Reliable scientific studies assessed by the U.S. Environmental Protection Agency have found that sidestream and secondhand tobacco smoke causes the death of at least 53,000 non-smokers annually and is a leading cause of premature death and disability among non-smokers; 5. Non-smokers with allergies, respiratory diseases and those who suffer other ill effects of breathing sidestream or secondhand tobacco smoke may experience a loss of job productivity or may be forced to take periodic sick leave because of adverse reactions to same; 6. Persons, particularly employees, have a right to a smoke-free environment if they desire; 7. Tobacco smoking is a leading cause of fires, and cigarette and cigar burns L„ and ash stains on merchandise and fixtures cause economic losses to businesses; ~; N w w ~ m 147

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s employees, as well as kitchens in which food is prepared on the premises for serving elsewhere, including catering facilities, except that the term "restaurant" shall not include a cocktail lounge or tavern if said cocktail lounge or tavern is a "bar" as defined in this section. 12. "Retail Tobacco Store" means a retail store utilized primarily for the sale of tobacco products and accessories and in which the sale of other products is merely incidental. 13. "Self-service Displays" means open display of tobacco products and point- of-sale tobacco promotional products that the public has access to without the intervention of an employee. 14. "Separate Ventilation System" means a system which is exhausted to the outside and negatively pressurized. 15. "Service Line" means any indoor line at which one (1) or more persons are waiting for or receiving service of any kind, whether or not such service involves the exchange of money. 16. "Smoking" means inhaling, exhaling, burning or carrying any lighted cigar, cigarette, weed, plant or other combustible substance in any manner or in any form. 17. "Sports Arena" means enclosed or unenclosed sports pavilions, gymnasiums, health spas, swimming pools, roller and ice rinks, bowling alleys and other similar places where members of the general public assemble either to engage in physical exercise, participate in athletic competition, or witness sports events. 18. "Tobacco Product" means any tobacco cigarette, cigar, pipe tobacco, smokeless tobacco, snuff or any other form of tobacco which may be utilized for smoking, chewing, inhalation or other manner of ingestion. 19. "Tobacco Vending Machine" means any electronic or mechanical device or appliance the operation of which depends upon the insertion of money, whether in coin or paper currency, or other things representative of value, which dispenses or releases a tobacco product. 20. "Town" shall mean the Town of Tiburon. 21. "Vendor-assisted" means only a store employee has access to the tobacco product and assists the customer by supplying the product. The customer does not take possession of the product until it is purchased. Section 28-3. Application to Town-Owned Vehicles and Facilities. All Town-owned vehicles, including jitneys and buses and other means of public transit under the authority of the Town, and all enclosed facilities owned and controlled 150

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T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s 12. Every room, chamber, place of meeting or public assembly, including school buildings under the control of any board, council, commission, committee including joint committees, or agencies of the Town or any political subdivision of the State during such time as a public meeting is in progress, to the extent such place is subject to the jurisdiction of the Town. 13. Waiting rooms, hallways, wards and rooms of health facilities, including, but not limited to, hospitals, clinics, physical therapy, mental health, and drug and alcohol treatment facilities, doctors' and dentists' offices. 14. Lobbies, hallways, and other common areas in apartment buildings, condominiums, senior citizen residences, nursing homes, and other multiple-unit residential facilities. 15. Lobbies, hallways, and other common areas in multiple- unit commercial facilities. 16. Polling places. B. Notwithstanding any other provisions of this section, any owner, operator, manager or other person who controls any establishment or facility may declare that entire establishment or facility as a nonsmoking establishment. Section 28-5. Regulation of Smoking in Places of Employment. A. Within 90 days of the effective date of this article, each employer having an enclosed place of employment located within the Town shall adopt, implement, make known and maintain a written smoking policy which shall contain the following requirements: Smoking shall be prohibited in all enclosed facilities within a place of employment without exception. This includes common work areas, auditoriums, classrooms, conference and meeting rooms, private offices, elevators, hallways, medical facilities, cafeterias, employee lounges, stairs, restrooms, vehicles and all other enclosed facilities. B. The smoking policy shall be communicated to all employees within three weeks of its adoption, and at least annually thereafter. C. All employers shall comply with these non-smoking provisions and shall be responsible for their implementation in their places of employment. D. "No Smoking" signs shall be conspicuously posted at building entrances and in employee lounges, cafeterias and lunchrooms. E. All employers shall supply a written copy of the smoking policy to any existing or prospective employee. cn N ~ N W m W 152

• by the Town, including jails, and any council, board, commission and agency of the Town shall be subject to the provisions of this ordinance. Section 28-4. Prohibition of SmokinE in Public Places A. Except as otherwise provided, smoking shall be prohibited in all enclosed public places within the Town of Ttiburon, including, but not limited to, the following places: 1. 2. 3. 4. 5. 6. 0 7. Elevators. Buses, taxicabs, and other means of public transit under the authority of the Town of Tiburon and ticket, boarding, and waiting areas of public transit depots. Restrooms. Service lines. Retail stores. All areas available to and customarily used by the general public in all business and non-profit entities patronized by the public, including but not limited to offices (such as attorneys, doctors, and other professionals), banks, laundromats, malls, hotels and motels. Restaurants, provided: (a) Cocktail lounge areas within restaurants that sell alcoholic beverages shall be exempted. Within one year of the passage of this Section, such areas must meet the standards of "cocktail lounge" as defined herein. (b) A maximum of 50% of contiguous seating in outdoor food area seating 30 or more persons, clearly posted, may be exempted. 8. Bars. 9. Public areas of aquariums, galleries, libraries or museums when open to the public. 10. Any facility which is primarily used for exhibiting motion pictures, stage productions, lectures, musical recitals or other similar performances, except when smoking is part of such production. 11. Sports arenas and convention halls. m f~ ~ • N W ~ W 151

• • writing of any violations on the standard health inspection report. Further, such violations shall be reported in writing by the County Health Department, on a quarterly basis, to the Town Manager where such violations occur. F. Notwithstanding any other provision of this ordinance, a private citizen may bring legal action to enforce this ordinance. Section 28-10. Violations and Penalties. A. It shall be unlawful for any person who owns, manages, operates or otherwise controls the use of any premises subject to regulation under Section 28-4 of this ordinance to fail to comply with any of its provisions. B. It shall be unlawful for any person to smoke in any area where smoking is prohibited under Section 28-4 by the provisions of this article. C. Any person, business, tobacco retailer, or owner, manager or operator of any establishment subject to this ordinance who violates any provision of this chapter, other than Section 28-8, shall be deemed guilty of an infraction and upon conviction shall be subject to payment of a fine not to exceed the limits set forth in Government Code Section 36900. Section 28-11. N_on-retaliation. No person or employer shall discharge, refuse to hire or in any manner retaliate against any employee or applicant for employment because such employee or applicant exercises any right to a smoke-free environment afforded by this article. Section 28-12. Public Education. The Town Manager, in conjunction with the County Department of Health, shall engage in a continuing program to explain and clarify the purposes and requirements of this ordinance to citizens affected by it, and to guide owners, operators and managers in their compliance with it. Such program may include publication of a brochure for affected business and individuals explaining the provisions of this ordinance. Section 28-13. Governmental Agency Cooperation. The Town Manager shall annually request other governmental and educational agencies having facilities within the Town to establish local operating procedures in cooperation and compliance with this ordinance. This includes urging all Federal, State, County and school district agencies to update their existing smoking control regulations to be consistent with current health findings regarding environmental tobacco smoke. u, N N W m W ~ CO 155

T o b a c c o C o n t r o I i n C a 1 i f o r n i a C i t i e s Section 28-8. Regulating the Sale of Tobacco Products A. Any person, business, tobacco retailer or other establishment subject to this ordinance shall post plainly visible signs at the point of purchase of tobacco products which state "THE SALE OF TOBACCO PRODUCTS TO PERSONS UNDER EIGHTEEN YEARS OF AGE IS PROHIBITED BY LAW. PHOTO ID REQUIRED. The letters of said signs should be at least one-quarter inch (1/4") high. B. No person, business, tobacco retailer, or owner, manager or operator of any establishment subject to this ordinance shall sell, offer to sell or permit to be sold any tobacco product to an individual without requesting and examining identification establishing the purchaser's age as eighteen years or greater unless the seller has some reasonable basis for determining the buyer's age. C. It shall be unlawful for any person, business, or tobacco retailer to sell, permit to be sold, or offer for sale any tobacco product by means of self-service displays or by any other means other than vendor-assisted sales. D. No person, business, tobacco retailer or other establishment subject to this ordinance shall locate, install, keep, maintain or use, or permit the location, installation, keeping, maintenance or use on his, her or its premises any vending machine for the purpose of selling or distributing any tobacco product. Any tobacco vending machine in use on the effective date of this ordinance shall be removed within thirty (30) days after the effective date of this ordinance. E. Any person, business, tobacco retailer, or owner, manager or operator of any establishment subject to this ordinance who violates any provision of this section shall be deemed guilty of a misdemeanor and upon conviction shall be subject to a fine as provided for in Penal Code Section 308(a). Section 28-9. Enforcement. A. Notice of these regulations shall be given to all applicants for a business license. B. Enforcement of this ordinance shall be implemented by the Town Manager or his/her designee. C. Any citizen who desires to register a complaint under this ordinance may initiate enforcement with the Town Manager or his/her designee. D. The Fire District or the County Health Department shall require, while an establishment is undergoing otherwise mandated inspections, certification from the owner, manager, operator or other person having control of such establishment that all requirements of this ordinance have been complied with. E. County Health Inspectors, on their regular restaurant inspections, shall check for compliance with sign posting requirements. Restaurants shall be notified in 154

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T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s 8. Substantial scientific evidence exists that the direct use of tobacco products causes cancer, heart disease, and various other medical diseases. The Surgeon General of the U.S. has found that tobacco-caused diseaseS are the leading cause of premature, preventable death and disability in the U.S.; 9. The National Centers for Disease Control have found that at least four- hundred-thirty-four thousand (434,000) Americans die each year from tobacco-caused diseases. The Surgeon General of the U.S. and U.S. Department of Health and Human Services have found that a majority of those Americans who die of tobacco-caused diseases became addicted to nicotine in tobacco products as adolescents before the age of legal consent; 10. The National Institute on Drug Abuse has concluded that the nicotine in tobacco products is a powerful addictive drug and identifies nicotine addiction as the most widespread example of drug dependence in the U.S.; 11. The Surgeon General of the U.S. has found that nicotine in tobacco products is as addictive as cocaine and heroine; Accordingly, the Town Council finds and declares that the purposes of this ordinance are: to protect public health, safety and general welfare by prohibiting tobacco smoking in public places and places of employment; to guarantee the right of nonsmokers to breathe tobacco smoke-free air, and to recognize that the need to breathe tobacco smoke-free air has priority over the desire to smoke; The Town Council further finds it is within its basic police power to implement and enforce the provisions of this ordinance. Section 28-2. Definitions. The following words and phrases, whenever used in this article, shall be construed as defined in this section: 1. "Bar" means an area which is devoted to the serving of alcoholic beverages for consumption by patrons on the premises and in which the serving of food is only incidental to the consumption of such beverages. Although a restaurant may contain a bar, the term "bar" shall not include the restaurant dining area. A "bar" for the purpose of this definition does not include any bar where smoke can filter into a restaurant through a passageway, ventilation system, or any other means. 2. "Business" means any sole proprietorship, joint venture, corporation or other business entity formed for profit-making purposes, including retail establishments where goods or services are sold as well as professional corporations and other entities • • N 148

• • who worked in worksites that ban smoking in the work area are less likely to be cigarette smokers, and male smokers who worked where there was a ban on smoking in the work area were more likely to be successful when they attempted to quit. Social pressure not to smoke, as manifest by the reluctance of smokers to smoke when they were the only smoker, was associated with an increased frequency of quit attempts by smokers, particularly female smokers. Tobacco advertising, particularly the Camel cigarette advertising campaign using cartoon characters, was differentially recognized by younger adolescents. The recognition of cigarette brand advertising was closely related to the brand of cigarettes purchased by adoles- cent smokers, suggesting that tobacco advertising may promote smoking initiation among adolescents. Over 60 percent of adults and two-thirds of adolescents reported exposure to some anti-smoking media message in the seven days prior to their survey interview. Those who reported exposure to the television spots funded by the tobacco tax revenues were more likely to support anti-tobacco education in schools. Adolescents reported that tobacco products were readily available, even among those aged 12-14. Small stores were the most common site of purchase of cigarettes for adolescents of all ages, but there was a suggestion that purchases from vending machines were relatively more common among younger adolescents than among older adolescents. Only 40.4 percent of those smokers who saw a physician in the last year were advised to quit on the last visit. Advice to quit on the last visit appeared to be associated with both an increased interest in quitting and an increased number of quit attempts. There was widespread support for taxation of tobacco products. The support for increasing the tax was lower among smokers, but Hispanic smokers were more supportive of increasing the tax than were California smokers as a whole. Black and Hispanic smokers were more strongly supportive of efforts to ban advertising and promotion of tobacco products as well as to resist access of children to tobacco products. This picture is consistent with a substantial level of concern in the Black and Hispanic communities about the targeting of their communities by the tobacco advertisers. Ln F~ IPb N W m W 165

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CHART I - SUMMARY OF ORDINANCE PROVISIONS City- Restau- Enclosed Vending Machines; City Populafion Coun Date Enacted Owned Facilities ranta/ Bars Work- ly aces Public Places Advertising; SamplinB Cloverdale 4,856 Sonoma 1/89 yes yes yes yes no Coachella 14,969 Riverside 3/88 no yes yes yes no Colfax 1,056 Placer 8/91 yes yes yes yes no Compton 93,352 Los Angeles 11/90 yes no no no no Corona 69,908 Riverside 1/90 yes no no no no Coronado 26,934 San Diego 9/84 no yes yes yes no Corte Madera 8,771 Matin 0/81 no yes no yes no Cotati 5,736 Sonoma 6/89 yes yes yes yes no Crescent City 3,577 Del Norte 4/89 yes no no no no Culver City 41,197 Los Angeles 8/87 yes yes yes yes no Cupertino 40,580 Santa Clara 2/85 yes yes yes yes no Cypress 45,703 Orange 7/87 no yes yes yes no Danville 51,228 Contra Costa 11/85 yes yes yes yes no Davis 45,310 Yolo 6/87 no yes yes yes no Del Mar 5,215 San Diego 3/76 no yes yes yes no Delano 21,848 Kern 10/86 yes no no no no Desert Hot Springs 11,221 Riverside 3/86 no yes yes yes no Dixon 10,979 Solano 10/87 yes yes yes yes no Downey 87,194 Los Angeles 5/89 no yes yes yes no Duarte 21,528 Los Angeles 1/89 no yes yes yes VM El Cerrito 23,460 Contra Costa 10/87 yes yes yes yes no El Segttndo 16,003 Los Angeles 5/89 yes yes yes yes no Escalon 4,247 San Joaquin 3/90 yes no no no no Escondido 104,213 San Diego 4/91 no yes yes yes no Eureka 25,418 Humboldt 12/85 no yes yes yes no Fairfield 80,803 Solano 11/88 no yes no yes no Fontana 87,381 San Bernardino 12/86 yes yes yes yes no Fortuna 9,273 Humboldt 4/88 no yes yes yes no Fremont 173,116 Alameda 9/86 yes yes yes yes no Fresno 333,564 Fresno 2/89 yes yes yes yes no Enforcement owner/proprietor owner/proprietor city manager city manager city manager city manager city manager city manager city manager city manager Pem fine misdemeanor fine fine infraction fine infraction fine fine fine fine fine citation/warning various city officials infraction city manager city manager city manager city manager city manager fine fine infraction fine fine city manager city manager city manager city manager fine fine fine fine ZV£0 E ZvTS

• • 0 § 37.15 County Courthouse. The prohibitions contained in section 37.04 shall be applicable to the County Courthouse including Jury Lounges and Jury Deliberation Rooms. , § 37.16 Places of Exhibition. The prohibitions contained in section 37.04 shall be applicable to libraries, museums, aquariums, galleries, convention halls and similar facilities where Members of the General Public assemble for the purpose of viewing the exhibition of art, artifacts, objects of historical or cultural significance, products, merchandise, equipment, appliances or services. § 37.17 Hospitals. The prohibitions contained in section 37.04 shall be applicable to hospitals, rest and convalescent homes, medical clinics, physical therapy facilities and other places where medical, dental, psychiatric or counseling services are delivered to Members of the General Public. Operators of facilities treating psychiatric or chemically impaired patients may permit smoking by patients in designated areas provided the medical director of such facility has determined in writing that the practice is beneficial for the recovery or treatment of such patients and that the practice will not interfere with the recovery and treatment of nonsmoking patients, and provided that adequate nonsmoking areas are made available for nonsmoking patients. Neither this section nor section 37.04 shall be construed to prevent smoking in locations or otherwise under conditions in which smoking is expressly authorized by or under statutes or administrative regulations applicable to such licensed facilities. § 37.18 Schools. The prohibitions contained in section 37.04 shall be applicable to any school or educational institution operated by a Commercial Enterprise or Non-Profit Entity for the purpose of providing academic classroom instruction, trade, craft, computer or other technical training, or instruction in dancing, artistic, musical or other cultural skills. The prohibitions contained in section 37.04 shall be applicable to public school facilities when school district management authorizes their use by Members of the General Public other than students. § 37.19 Day Care Facilities. The prohibitions contained in section 37.04 shall be applicable to private residences during the time when such residences are operated as licensed day care facilities for children. 141

CHART I - SUMMARY OF ORDINANCE PROVISIONS City- Restau- Enclosed Vending Machines; Ct Ponulation County Date Enacted Owned Facilities rants/ Bars Work- ]y aces Public Places Adveetising; Samvlin¢ Long Beach 424,772 Los Angeles 7/85 no yes yes yes no Los Altos 28,669 Santa Clara 12/79 no yes yes yes no Los Angeles 3,433,561 Los Angeles 12/87 no yes yes yes no Los Gatos 28,224 Santa Clara 0/80 no yes yes yes no Manhattan Beach 35,294 Los Angeles 6/87 no yes yes yes no ~ o Manteca 40 914 San Joaquin 12/76 no no no no VM ~ , Marina 32,293 Monterey 6/85 yes no no no no Martinez 30,999 Contra Costa 10/85 yes yes yes yes no Marysville 12,232 Yuba 12/86 yes yes yes yes - no Menlo Park 28,506 San Mateo 2/86 no yes no yes no Merced 55,608 Merced 8/87 yes yes yes yes no Mill Valley 13,426 Marin 12/90 yes yes no yes no Millbrae 21,136 San Mateo 7/88 yes yes no yes no Milpitas 48,115 Santa Clara 8/85 yes yes yes yes no Modesto 161,261 Stanislaus 4/87 yes yes yes yes no Monrovia 34,876 Los Angeles 4/90 yes no no no no Monterey 32,247 Monterey 6/87 yes yes yes yes no Monterey Park 65,834 Los Angeles 6/83 yes no no no no Moorpark 26,059 Ventura 12/88 yes yes yes yes no Moraga 16,373 Contra Costa 1/86 yes yes yes yes no Moreno Valley 114,903 Riverside 11/90 yes yes yes yes no Morgan Hill 25,188 Santa Clara 11/87 no yes yes yes no Morro Bay 10,377 San Luis Obispo 4/90 yes yes yes yes no Mountain View 64,962 Santa Clara 6/84 yes yes yes yes no Napa 59,523 Napa 9/78 no yes no yes no National City 56,649 San Diego 5/84 no yes yes yes no Needles 5,777 San Bernardino 4/89 yes no no no no Newark 39,842 Alameda 3/89 yes yes yes yes no Newport Beach 70,202 Orange 6/85 no yes yes yes no Novato 48,741 Marin 9/88 yes no no no no Enforcement Penalty health dept fine fine fine county env.hlth.serv. misdemeanor fine fine health services dept fine county health dept fine code infraction city manager infraction dir., planning & bldg. fine fine fine health officer fine fine city manager infraction town manager fine city manager infraction city manager fine city administrator infraction city manager fine fine city manager fine city manager city manager infraction fine infraction VV£0 EZVtS

• • where legal, medical, dental, engineering, architectural or other professional services are delivered. 3. "Cocktail Lounge" means a bar within a restaurant which is not the sole means of public access to the dining areas, is not the sole waiting area for dining patrons, prohibits minors, has a separate ventilation system and is enclosed. 4. "Employee" means any person who is employed by any employer in consideration for direct or indirect monetary wages or profit, and any person who volunteers his or her services for a non-profit entity. 5. "Employer" means any person, partnership, corporation, including a municipal corporation, or non-profit entity, who employs the services of one or more individual persons. 6. "Enclosed Area" means all space between a floor and ceiling which is enclosed on all sides by solid walls or windows (exclusive of door or passage ways) which extend from the floor to the ceiling, including all space therein screened by portions which do not extend to the ceiling or are not solid, such as "office landscaping" or similar structures. 7. "Non-profit Entity" means any corporation, unincorporated association or other entity created for charitable, philanthropic, educational, character-building, political, social or other similar purposes, the net proceeds from the operations of which are committed to the promotion of the objectives or purposes of the entity and not to private gain. A public agency is not a "non-profit entity" within the meaning of this section. 8. "Person" shall mean any individual, partnership, cooperative association, private corporation, personal representative, receiver, trustee, assignee, or any other legal entity. 9. "Place of Employment" means any enclosed area under the control of a public or private employer which employees normally frequent during the course of employment, including, but not limited to, work areas, employee lounges and restrooms, conference and class rooms, employee cafeterias and hallways. A private residence is not a "place of employment" unless it is used as a child care or health care facility. 10. "Public Place" means any enclosed area to which the public is invited or in which the public is permitted, including but not limited to, banks, educational facilities, health facilities, shopping malls, laundromats, public transportation facilities, reception areas, restaurants, retail food production and marketing establishments, retail service establishments, retail stores, hotels and motels, theaters and waiting rooms. A private residence is not a "public place". 11. "Restaurant" means any coffee shop, cafeteria, sandwich stand, private and public school cafeteria, including any associated outdoor eating area, and any other eating establishment which gives or offers for sale food to the public, guests, or ~ N 149

A P P E N D I X E SAMPLE ORDINANCES AN ORDINANCE AMENDING CHAPTER 37 OF THE SACRAMENTO CITY CODE, RELATING TO SMOKING CONTROL BE IT ENACTED BY THE COUNCIL OF THE CITY OF SACRAMENTO: SECTION 1. Chapter 37 of the Sacramento City Code is hereby amended to read as follows: CHAPTER 37 Clean Indoor Air and Health Protection Ordinance § 37.01 Purposes. The City Council hereby finds as follows: The U.S. Environmental Protection Agency (EPA) has determined that tobacco smoke is a major source of indoor air pollution, and the Surgeon General's 1986 report on the Health Consequences of Involuntary Smoking concludes that exposure to tobacco smoke places healthy nonsmokers at increased risk for developing lung cancer. Other health hazards of involuntary smoking include respiratory infection, bronchoconstriction, and bronchospasm. While all members of the population are truly at increased risk due to exposure to sidestream tobacco smoke, it constitutes a special health hazard for children, the elderly and people with chronic lung disorders. The Surgeon General labels smoking "the largest single preventable cause of death and disability for the U.S. population." Employees subject to prolonged exposure to sidestream smoke in the workplace have been found in scientifically conducted studies to experience a loss of job productivity and some have been forced to take periodic sick leave because of reactions to second hand smoke. Furthermore, studies have shown higher costs to the employer are associated with smoking in the workplace due to increases in absenteeism, accidents, costs of medical care, loss of productivity, and cleaning and maintenance requirements. A recent scientific study has reported that sidestream smoke from tobacco may cause a significant amount of cardiovascular disease in the United States and that the number of deaths from this cause may exceed the deaths caused by lung disease associated with sidestream smoke. Smoking in public places and workplaces is a major cause of fires and damage to merchandise and equipment as well as costly maintenance and repairs to furniture and fixtures. The health care costs produced by smoking-related ailments and diseases constitute a heavy and avoidable financial drain on our community. More than three-quarters of Sacramento residents are nonsmokers and the number of nonsmokers is steadily increasing. Opinion surveys show that a-majority of both nonsmokers and smokers favor restrictions on smoking in public places and places of employment. • • . 134

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s § 37.12 Recreation Halls. The prohibitions contained in Section 37.04 shall be applicable to those areas of recreation halls and other similar facilities where Members of the General Public play bingo or cards, dance or engage in recreational, character-building or cultural activities which are designated as nonsmoking. An owner, manager or operator of a recreation hall shall designate not less than 50 percent of the main activities area of such facility not including restrooms, lounges and kitchens as nonsmoking. Commencing August 9, 1991, an owner, manager or operator of a recreation hall shall designate not less than 75 percent of the main activities area of such facility not including restrooms, lounges and kitchens as nonsmoking. Commencing May 9, 1992, the owner, manager or operator of a recreation hall shall designate the entire premises of such facility including restrooms, lounges and kitchens as nonsmoking. Signs shall be posted in the manner prescribed by Section 37.23. It shall not constitute a violation of this chapter to smoke in a location where smoking has been authorized by this chapter. The provisions of this section shall not be construed to in any manner restrict or otherwise impair the authority of an owner, manager or operator to increase the non-smoking area of a recreation hall. § 37.13 Restaurants. Within all restaurants, the prohibitions contained in Section 37.04 shall be applicable to lobbies, waiting areas, restrooms and those dining seating areas which are designated as nonsmoking. The owner, manager or operator of a restaurant shall designate not less than 50 percent of the available customer seating as nonsmoking. Commencing August 9, 1991, the owner, manager or operator of a restaurant shall designate not less than 75 percent of the available customer seating as nonsmoking. Commencing May 9, 1992, the owner, manager or operator of a restaurant shall designate all available customer seating as nonsmoking. The owner, manager or operator of the restaurant shall post signs as prescribed by Section 37.23 and remove all ashtrays from tables located in the nonsmoking areas. Where a bar shares the same Enclosed Area with the restaurant, the Bar seats must be counted with the restaurant seats in determining the total number of nonsmoking restaurant seats. The owner, manager or operator shall post a notice at the restaurant entrance that a nonsmoking section is available. It shall not constitute a violation of this chapter to smoke in a location where smoking has been authorized by this chapter. The provisions of this section shall not be construed to in any manner restrict or otherwise impair the authority of an owner, manager or operator to increase the nonsmoking seating in a restaurant or bar. § 37.14 City Buildings. Smoking is prohibited in all City buildings. 140

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s Section 28-14. Other Applicable Laws. This article shall not be interpreted or construed to permit smoking where it is otherwise restricted by other applicable laws. SECTION 3. SEVERABILITY. If any section or portion of this Ordinance is for any reason held to be invalid or unconstitutional by a decision of a Court of competent jurisdiction, that section or portion shall be deemed severable and shall not affect the validity of the remaining portions of the Ordinance. The Town Council of the Town of Tiburon hereby declares that it would have passed this Ordinance, or any sections or portions thereof, irrespective of the fact that any one or more section or portion may be declared invalid or unconstitutional. SECTION 4. EFFECTIVE DATE. This Ordinance shall take effect and be in force thirty (30) days after the date of passage. Pursuant to the provisions of Government Code Section 36933, a summary of this ordinance shall be prepared by the Town Attorney. At least five (5) days prior to the Council meeting at which adoption of the ordinance is scheduled, the Town Clerk shall (1) publish the summary, and (2) post in the office of the Town Clerk a certified copy of this ordinance. Within fifteen (15) days after adoption of this ordinance, the Town Clerk shall 1) publish the summary, and 2) post in the office of the Town Clerk a certified copy of the full text of the ordinance along with the names of those Council members voting for and against the ordinance. PASSED AND ADOPTED at a regular meeting of the Town Council of the Town of Tiburon on November 4, 1992, by the following vote: AYES: COUNCILMEMBERS: Nygren, Friedman, Thayer, Thompson, Kuhn NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None ALVIN R. KUHN, MAYOR TOWN OF TIBURON ATTEST: THERESE M. HENNESSY, TOWN CLERK 156

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s § 37.20 Smoking Prohibitions, Workplace. Smoking is prohibited in enclosed Workplaces of Commercial Enterprises, Non-Profit Entities and all City owned and managed buildings including but not limited to open office areas, shared offices, private offices, hallways, restrooms, escalators, elevators, stairways, lobbies, reception areas, and waiting rooms, classrooms, meeting or conference rooms, and auditoriums. On-site cafeterias, lunchrooms and lounges shall be deemed workplaces and smoking prohibited therein, whether or not such facilities are open to Members of the General Public. Each Commercial Enterprise, Non-Profit Entity and the City shall comply with these smoking prohibitions and be responsible for their implementation in the workplace, and "No smoking" signs shall be posted in the manner prescribed by section 37.23. § 37.21 Places Where Smoking Permissible. Smoking may be permitted in all locations where smoking is not prohibited by this Chapter, including the following locations: a. A private residence, including an attached or detached garage, whether or not the residence is utilized for office or other business purposes, except when such residence is operated as a licensed day care facility for children. b. Bars. c. Tobacco stores, whether operated as a separate business entity or as a physically separated facility within a department store or other business entity. d. Private clubs during events attended exclusively by members of the organization and their invited guests and from which Members of the General Public are excluded. e. Within conference/meeting rooms, public and private assembly rooms, banquet rooms, dining rooms or areas of restaurants, hotels and motels, while these places are occupied for private functions to which only persons specially invited are entitled to attend and from which Members of the General Public are excluded. f. In any enclosed place wherein this ordinance specifically permits smoking, notwithstanding the fact that such location is a workplace. It shall not constitute a violation of section 37.04 for a person to smoke in a location where smoking has been authorized in the manner prescribed by this section. The foregoing places are not considered workplaces subject to the provisions of section 37.20. Employers will, however, attempt to find a reasonable alternative accommodation where feasible for nonsmoking employees who do not wish to be assigned to work in a smoking permissible area. 142

T o b a c c o C o n t r o I i n C a 1 i f o r n i a C i t i e s Sec.1010. Nonretaliation No person or employer shall discharge, refuse to hire or in any manner retaliate against any employee or applicant for employment because such employee or applicant exercises any right to a smokefree environ- ment afforded by this article. Sec. 1011. Public Education The Department of Health [or City Manager] shall engage in a continuing program to explain and clarify the purposes and requirements of this ordinance to citizens affected by it, and to guide owners, operators and managers in their compliance with it. Such program may include publication of a brochure for affected businesses and individuals explaining the provisions of this ordinance. Dther Anc This article shall not be interpreted or construed to permit smoking where it is otherwise restricted by other applicable laws. Sec. 1013. SPverabilitv If any provision, clause, sentence or paragraph of this article or the application thereof to any person or circumstances shall be held invalid, such invalidity shall not affect the other provisions of this article which can be given effect without the invalid provision or application, and to this end the provisions of this article are declared to be severable. Sec. 1014. .ff tiv Dat This article shall be effective thirty (30) days from and after the date of its adoption, and shall be reviewed within one year of its effective date. 162

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s Table 11 Percentage of Nonsmokers Exposed to Environmental Tobacco Smoke at Worksites With Different Policies Restricting Smoking by the Strength of the Local Ordinance Restricting Smoking in the Workplace Ordinance Class Total Strong Ordinance Weak Ordinance No Ordinance Total Ban Work Area Ban Lesser Restrictions No Restrictions Percent Exposed 10.0 24.2 50.1 52.3 8.2 16.7 48.9 50.9 10.9 29.0 45.5 46.1 12.2 29.2 53.1 61.1 Even in worksites with a total ban on smoking, the exposure of a nonsmoker to cigarette smoke within the two weeks prior to the interview increased from 8.2% in those areas with a strong ordinance to 12.2% in those areas with no ordinance. Conversely, in those worksites where there was no policy restricting smoking, the rate of exposure declined from 61.6% in those areas where there was no ordinance to 50.9% in those areas with a strong ordinance. It is clear that the more powerful influence on exposure of the nonsmoker was the presence or absence of a recognized policy in the worksite. There was, however, an additional benefit to having a strong ordinance even in those worksites with a total ban on smoking. These data demonstrate that simply enacting an ordinance to protect nonsmokers in the workplace is not enough; a program to implement and enforce the ordinance is necessary to ensure compliance. However, changes in attitudes and norms that accompany a strong ordinance probably make an independent contribution to the compliance of individual smokers with a policy that restricts smoking in the workplace. It is likely that the effect of worksite policies on preventing relapse, at least in males, will be enhanced as compliance with these worksite restrictions improves. • • • 176

• F. Places of employment exempt from the prohibition on smoking in other sections of this ordinance shall also be exempt from this section. Section 28-6. Smoking Optional Areas. A. Not withstanding any other provision of this article to the contrary, the following areas shall not be subject to the smoking restrictions of this article: 1. Private residences, except when used as a child care or health care facility. 2. Retail tobacco stores. 3. A maximum of 50% of hotel/motel rooms. 4. Restaurants, hotel and motel conference or meeting rooms and public and private assembly rooms, which are equipped with a ventilation system which conducts air to the outside, while these places are being used for private functions. However, 50% of these areas will be designated nonsmoking. • 5. An enclosed place of employment which employs only the owner and no other employee, provided that: (a) The place of employment is not a public place, and (b) The enclosed area containing the place of employment does not share a ventilation system with any other enclosed place of employment or public place. B. Not withstanding any other provision of this section, any owner, operator, manager or other person who controls any establishment described in this section may declare that entire establishment as a nonsmoking establishment. Section 28-7. Posting of Signs. A. "No-Smoking" signs or the international "No Smoking" symbol (consisting of a pictorial representation of a burning cigarette enclosed in a red circle with a red bar across it) shall be clearly, sufficiently and conspicuously posted in every building, as well as on entrances at eye level, or other place where smoking is regulated by this article, by the owner, operator, manager or other person having control of such building or other place. B. Every restaurant shall have posted at every entrance a conspicuous sign clearly stating that smoking is prohibited. m ~-A Ob N m W l0 ON 153

0 • • 60 50 ~ ~ ~ 40 ~ 30 a 20 10 0 Fraction of Nonsmokers Who are Exposed to Tobacco Smoke at Work Age Figure 37 ~ Males  Females Fraction of Nonsmokers Who are Exposed to Tobacco Smoke at Work <12 12 13-15 16+ Years of Education Males  Females Figure 38 169

CHART II - C1TY-OWNED FACILITIES Total City Cit Ban Workplaces El Segundo no not specified Escalon no not specified Fontana no not specified Fremont no not specified Fresno no not specified Grass Valley no not specified Gridley no not specified Hayward no not specified Healdsburg no not specified Hercules no not specified Hermosa Beach no specified Irvine no not specified La Canada Flintridge no not specified Lafayette no not specified Laguna Niguel no not specified Lakewood no not specified Lancaster no not specified Lawndale no specified Live Oak no not specified Livingston no not specified Loma Linda no not specified Lompoc no not specified Marina no not specified Martinez no not specified Marysville no none Merced no not specified Mill Valley no none Millbrae no not specified Milpitas no not specified Modesto no not specified Miscellaneous Signage or Other City-Owned Common City-Owned Public Transooetation Areas Facilities Exemptions Information not specified specified not specified specified O yes Cr none specified not specified specified yes m specified specified not specified specified yes C7 specified specified specified specified yes C7 not specified specified not specified specified yes 0 not specified specified specified specified specified specified not specified not specified not specified specified specified specified yes yes yes 0 specified specified not specified specified yes 0 specified specified not specified specified yes .. ~ none specified specified none yes 0 specified specified specified none specified specified specified specified specified not specified not specified not specified specified specified specified specified yes yes yes yes 0 not specified none not specified none - n specified specified not specified specified yes o~ none none specified none yes - specified specified not specified specified yes -• none specified not specified specified yes ~` 0 specified specified specified specified yes ~ specified specified not specified specified - ~ specified none none none no - specified specified not specified specified yes m specified specified specified specified yes none none not specified specified cl) yes none specified specified specified yes .. none specified none specified yes specified specified specified specified yes eo not specified specified specified specified yes N ZSEO EZfiiZS

• quit. It appears that the impact of ordinances that restrict smoking on the individual smoker may be largely to get them to think about quitting rather than to actually make an attempt. Table I Effect of Local Ordinances Restricting Smoking in the Workplace on the Reported Extent of Workplace Policies Restricting Smoking is Strength of Ordinance by Worksite Total Strong Ordinance Weak Ordinance No Ordinance Workplace Policy Total Work Lesser No Ban Area Ban Restrictions Restrictions 30.1 16.9 15.6 37.4 38.2 19.2 16.8 25.8 34.7 18.9 15.3 31.2 29.5 18.4 15.3 36.8 Local ordinances may have a greater impact on the exposure of nonsmokers to environmental tobacco smoke through a combination of increasing the likelihood that worksites would have a ban on smoking at least in the work area and increasing the likelihood that individual smokers would obey the restrictions that are present in the worksite. Table I presents the influence of local ordinances on the likelihood that an individual working in that jurisdiction would be working in a worksite that had a policy restricting smoking. Even in those areas where there were strong ordinances, that is, ones that would require that the work area be smoke free, only 57.4% of workers reported that they were working in worksites that have policies that ban smoking at least in the work area. However, the presence of a strong ordinance did substantially increase the chance that the worksite would have a total ban on smoking and reduced the chance that the worker would be working in an environment where there were no restrictions on smoking. Clearly the presence of a strong ordinance appears to facilitate the adoption of workplace policies that protect the nonsmoker. There appears to be an interaction between the presence of a policy protecting the worker in a worksite and the existence of a local ordinance that restricts smoking for reducing the exposure of nonsmokers to cigarette smoke in the work environment. Table II presents the influences of local ordinances and worksite policies on the percentage of nonsmokers who reported being exposed to cigarette smoke in their workplace during the 2 weeks prior to the survey interview. 175

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T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • 4, ~ 4, °a ~ ~ ~ ~ ~ I ~ 6, 0, a° E °a °a E E E E E E E E E °a E E E 79 19 ~ ~ ~~~~~ ~~~~*~~ ~ ~~~~1W ~ v p ~~~ ~,~ ~,~ ~~ ~uwl t~ It ~ I I I p iC' ~ '8 V ~~~~3! 11 ~ 0 ~~~t i ~t ~~ a a ul- 1H I I ~ I ~ I I lk HIR ~ ~ !; Y Y Y Y ~~ Y Y Y a Y M 5y{~~ Y ~~ Y Y Y Y L L Y a O O O d q q q rn q q q~ q q q r"i,' b n1- Q a p q p q q q q(a~ q q q q q q Q q Q Q Q Q Q Q Q q q q q q q q q a A Q Q q q q q a Q ~; O O "' ~ ~ .~,.~ • 110

• • Notwithstanding any provision in this Ordinance which permits smoking in a place of employment, any nonsmoking employee may object to his or her employer about smoke in his or her workplace. The employer shall attempt to reach a reasonable accommodation, insofar as possible. If an accommodation which is satisfactory to all affected nonsmoking employees cannot be reached within a particular workplace, the commercial enterprise, nonprofit entity or city who employs the nonsmoking employees shall formulate, promulgate and implement restrictions or prohibitions upon smoking in a manner which accommodates the reasonable preferences and needs of the nonsmoking employees in relation to the nuisance and health impacts of the smoking upon the nonsmokers. The area in which smoking is prohibited shall be posted by "No Smoking" signs in the manner prescribed by the provisions of section 37.23. § 37.22 Exemption Procedures. Any owner or manager of a business or other establishment subject to this chapter may apply to the Chief of the Environmental Health Division for an exemption or modification to its provisions. Exemptions may only be granted on (1) a showing by the petitioner of significant financial hardship due to compliance, or (2) the proposed implementation of an alternative approach or technology which would provide equivalent protection from the health hazards of sidestream smoke. An application for exemption will be accompanied by a reasonable fee to cover the cost of preparation for the hearing, and the application will include any data required by the Division. The Division will review the application and submit it, with recommendations, for hearing by the Sacramento Environmental Commission. The applicant will be entitled to present evidence at the hearing, which will be scheduled within sixty (60) days of the receipt of the application. The Commission will, after taking into consideration the testimony received at the hearing, issue its findings and recommendations within twenty (20) days of the completion of the hearing. The Division will complete procedural action on the application and notify interested parties within twenty (20) days of its receipt from the Commission. The applicant may appeal the Commission's decision to the City Council within thirty (30) days of receipt of the action notification by the Division. Upon appeal, the City Council will set a hearing within sixty (60) days and make a final determination at that hearing. § 37.23 Posting Requirements. Each owner, operator, manager or other person having control of an establishment or facility within which smoking is regulated by this chapter shall conspicuously post in every place where smoking is prohibited "No Smoking" signs with letters not less than one inch in height (or the international "No Smoking" symbol consisting of a pictorial representation of a burning cigarette enclosed in a red circle with a red bar across it). An owner, operator, or manager of a building wherein, pursuant to these regulations, there is no smoking permitted in any space in the building may limit the "No Smoking" postings to first floor entrances and exits and to the elevator lobby areas of all other floors. • (A r ~ N W m W 143 ~

• • • The major reason for restrictions on smoking at work is protection of nonsmokers from exposure to environmental tobacco smoke. However, an influence of restrictions on smoking in the worksite on prevalence of smoking would also be of public health importance. Figure 43 shows the distribution of current, former and never smokers who worked in worksites with different types of worksite restrictions. The prevalence of smoking was related to the extent of restriction in the worksite and the relationship was somewhat stronger for men than it was for women. The difference in the prevalence of smoking by level of worksite restriction was largely due to differences among daily smokers, with no clear difference noted for occasional smokers. The difference in current smoking prevalence was primarily due to the larger fraction of never smokers working in those areas where there were greater restrictions, rather than to the number of smokers who had quit. This suggests that either worksites with restrictions on smoking tend to attract nonsmokers, or restrictions are easier to implement in those worksites with fewer smokers (see Appendix Table 22). A more direct way of examining the question of whether restrictions on smoking in the worksite influence smoking cessation is to look at the cessation behavior of those who were smoking one year prior to the survey to see whether those who work in worksites with greater restrictions are more likely to have attempted to quit. Perhaps even more important than the rate of quit attempts may be the rate of long-term success. Restricting the opportunity to smoke at work may reduce the chance of smokers' relapsing when they try to quit. Figure 44 presents the fraction of smokers who have made a quit attempt (the total height of the bar) for males and females who were smoking one year prior to the survey. When worksites with different levels of smoking restriction were examined, there was little consistent difference in the fraction of workers who attempted to quit. However, when the fraction of those smoking one year ago who are currently not smoking was examined, it appears that males who work in those environments where smoking is restricted were more likely to be currently successful in their attempts to quit. When long-term success was examined, 8.1 % and 7.8% of those men who were smoking one year ago had quit for 3+ months in worksites where there was a total ban or a ban in the work area, compared with 4.9% and 6.3% of those who work where there were lesser restrictions or no restrictions. There did not appear to be a similar effect for women either for quit attempts or for successful cessation (see Appendix Table 26). Ordinances Ordinances that restrict the locations where smoking is allowed cover the entire population living or working in the jurisdiction that enacts the ordinance. Ordinances may mandate policies in worksites, but they frequently also cover restaurants and other public locations, and often reflect the social attitudes toward smoking. When smokers who live in areas where there were strong ordinances were compared to smokers who live in areas where there were no ordinances, there was a slightly greater readiness to quit among those who lived in areas with strong ordinances; there were fewer smokers who are in the precontemplation stage and more smokers in the preparation stage. This difference in readiness to quit did not translate into a greater frequency of quit attempts or an improvement in the rate of long-term cessation in those who attempted to 173

CHART III - RESTAURANTS Non-Smoking Small Signage Section Non-Smoking Restaurant Contiguous or Other Ci~t Total Ban Minimum Size (%) 'Phase-1n' Period Outdoor Section Size Exemption Bar Exempfion Other Exemptions Public Information -1 0 Scotts Valley no - no no - yes none yes Cr Sebastopol no 50% no no 45 yes specified yes Simi Valley no 50% no no - yes specified m yes 0 Solana Beach no none no no 20 yes specified yes 0 Solvang no - no no - yes specified yes 0 Sonoma no 50% no no - yes specified yes South Pasadena no 50 % no no 30 yes none - South San Francisco no 60 % no yes 50 yes specified yes 0 Stockton no 70% no no -- yes specified yes 0 Sunnyvale no 60% no yes 50 yes specified yes .. ~ Thousand Oaks no 50 % no no - yes specified yes 0 Tiburon no 50 % no no 50 yes specified yes Torrance no - no no 50 yes specified yes Tracy no 70 % no no - yes specified yes Turlock no 50% no no - yes specified yes o Tustin no - no no 20 yes specified yes n Ukiah no - no no - yes specified yes m Union City no 40% no no 50 yes specified yes _ Vacaville no 40% no no 50 yes specified yes _. Vallejo no 50% no no 50 yes specified yes ~, 0 Ventura no 50% no no - yes specified yes ~ Victorville no 50% no no 40 yes specified yes o Vista no - no no 20 yes specified yes _. Walnut no 25 % no no 50 - none - m Walnut Creek yes 100% yes no -- yes specified yes West Hollywood no 40% no no 35 yes specified yes c') Woodside no 50 % no no - - specified yes „ Yorba Linda no 33.3% no no 40 yes specified yes _. Yountville no 80% no no - yes specified yes tD Yuba City no 50% no no 50 yes specified yes y FOOTNOTES 1. Alhambra - Smoking prohibited in restaurants seating 40 or fewer. 2. Benicia - Smoking prohibited in restaurants seating 50 or fewer. 3. Grass Valley - 100% by _ 4. Sacramento - 100% by May 1992 • 5. San Luis Obispo is the only California city which bans smoking in all bars, conti* and free-standing.

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s ADDITIONAL INFORMATION For more information on topics discussed in this Fact Sheet, contact your state or local health department, non-profit agency such as your local American Lung Association, or the following: Indoor Air Division U.S. Environmental Protection Agency, Mail Code ANR-445 401 M Street, SW Washington, D.C. 20460 National Institute for Occupational Safety and Health U.S. Department of Health and Human Services 4676 Columbia Parkway (Mail Drop R2) Cincinnati, Ohio 45226 Office of Building and Community Systems U.S. Department of Energy CE-13, MS GH-068 1000 Independence Avenue SW Washington, D.C. 20585 Public Relations Office American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) 1791 Tullie Circle NE Atlanta, Georgia 30329 Building Owners and Managers Association International 1250 Eye Street NW Washington, D.C. 20005 Copies of this Fact Sheet and others in the Indoor Air series are available from: Public Information Center, U.S. Environmental Protection Agency, Mail Code PM-211 B, 401 M Street SW, Washington, D.C. 20460. 188

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• • • ORDINANCE NO. 488 AN ORDINANCE OF THE CITY OF RANCHO MIRAGE MUNICIPAL CODE DISALLOWING THE BALE OF CIGARETTES THROUGH VENDING MACHINES AND ESTABLISHING THE FEE FOR BALE OF CIGARETTES. The City Council of the City of Rancho Mirage does ordain as follows: Section I. CIGARETTES; LICENSE REOUIRED. APPLICATION. ISSUANCE. No person shall keep for retail sale, sell at retail or otherwise dispose of any cigarette or any tobacco product or cigarette paper or cigarette wrapper at any place in the City without a license. Application for a license shall be made to the City of Rancho Mirage on a form supplied by the City. The application shall state the full name and address of the applicant, the location of the building and part intended to be used by the applicant under the license, the kind of business conducted at such location and such other information as shall be required by the application form. Upon the filing of an application with the Rancho Mirage Department of Economic Development, it shall be presented to the department head for consideration. If granted by the department head, a license shall be issued by the City upon payment of the required fee. Section II. CIGARETTES; LICENSE FEE. The annual license fee for a cigarette vending license shall be $25.00. Section III. CIGARETTES; PROHIBITED SALES. No person shall sell or give away any cigarette or any tobacco product, cigarette paper or cigarette wrapper to any person under the age of eighteen (18) years. No person shall sell or dispense any cigarettes or tobacco product, cigarette paper or cigarette wrapper through the use of a vending machine. Section IV. CEOA. The passage of this Ordinance is not a project nor will it have a significant impact on the environment. Section V. Severability. If any section, subsection, sentence, clause or phrase of this ordinance is for any reason held to be invalid or unconstitutional by the decision of a court of competent jurisdiction, such decision shall not affect the validity of the remaining portions of the ordinance. The City Council of the City of Rancho Mirage hereby declares that it would have passed this ordinance, and each section, subsection, clause, sentence or phrase thereof, irrespective of the fact that any one or more other sections, subsections, clauses, sentences or phrases may be declared invalid or unconstitutional. Section VI. Savinas Clause. Neither the adoption of this ordinance nor the repeal of any other ordinance of this city shall in any manner affect the prosecution for violations of the ordinances, which violations were committed prior to the effective date hereof, nor be construed as a waiver of any license or penalty or the penalty provisions application to any violation thereof. The provisions of this ordinance, insofar as they are substantially the same as ordinance provisions previously adopted by the City relating to the same subject matter, shall be construed as restatements and continuations, and not as new enactments. Section VII. The City Clerk shall certify to the passage hereof and cause the same to be posted as required by law. This ordinance shall take effect on the 30th day following the date of its adoption. 157

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s 3. Smoking at the workplace is regulated by a combination of government action and private initiative. Legislation in 12 states regulated smoking by government employees, and 9 states and more than 70 communities regulate smoke in the private sector workplace. Approximately 35 percent of businesses have adopted smoking policies. The increase in workplace smoking policies has been a trend of the 1980's. 4. Smoking policies may have multiple effects. In addition to reducing environ- mental tobacco smoke exposure, they may alter smoking behavior and public attitudes about tobacco use. Over time, this may contribute to a reduction in smoking in the United States. To the present, there has been relatively little systematic evaluation of policies restricting smoking in public places or at the workplace. 5. On the basis of case reports and a small number of systematic studies, it appears that workplace smoking policies improve air quality, are met with good compliance, and are well accepted by both smokers and nonsmokers. Policies appear to be followed by a decrease in smokers' cigarette consumption at work and an increase in enrollment in company- sponsored smoking cessation programs. 6. Laws restricting smoking in public places have been implemented with few problems and at little cost to state and local government. Their impact on smoking behavior and attitudes has not been evaluated. 7. Public opinion polls document strong and growing support for restricting or banning smoking in a wide range of public places. Changes in attitudes about smoking in public appear to have preceded legislation, but the interrelationship of smoking attitudes, behavior, and legislation are complex. 184

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A P P E N D I X G • (EXCERPTS FROM) THE HEALTH CONSECZUENCES OF INVOLUNTARY SMOKING A REPORT OF THE SURGEON GENERAL SUMMARY AND CONCLUSIONS OF THE 1986 REPORT 0 The three major conclusions of this report are the following: 1. Involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers. 2. The children of parents who smoke compared with the children of nonsmoking parents have an increased frequency of respiratory infections, increased respiratory symptoms, and slightly smaller rates of increase in lung function as the lung matures. 3. 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. Individual chapter summaries and conclusions follow. HEALTH EFFECTS OF ENVIRONMENTAL TOBACCO SMOKE EXPOSURE • 1. Involuntary smoking can cause lung cancer in nonsmokers. 2. Although a substantial number of the lung cancers that occur in nonsmokers can be attributed to involuntary smoking, more data on the dose and distribution of ETS exposure in the population are needed in order to accurately estimate the magnitude of risk in the U.S. population. 3. The children of parents who smoke have an increased frequency of hospitaliza- tion for bronchitis and pneumonia during the first year of life when compared with the children of nonsmokers. 4. The children of parents who smoke have an increased frequency of a variety of acute respiratory illnesses and infections, including chest illnesses before two years of age and physician diagnosed bronchitis, tracheitis, and laryngitis, when compared with the children of nonsmokers. 181

• 0 B. Notwithstandinganyotherprovisionofthissection,anyowner,operator,managerorotherpersonwho controls any establishment described in this section may declare that entire establishment as a nonsmoking establishment. Sec. 1007. Posting of Signs A. "No Smoking" signs or the international "No Smoking" symbol (consisting of a pictorial representation of a burning cigarette enclosed in a red circle with a red bar across it) shall be clearly, sufficiently and conspicuously posted in every building or other place where smoking is regulated by this article, by the owner, operator, manager or other person having control of such building or other place. B. Every restaurant shall have posted at every entrance a conspicuous sign clearly stating that smoking is prohibited. SQC. 1008. Enforcement A. Enforcement of this article shall be implemented by the Department of Health [or the City Manager]. B. Any citizen who desires to register a complaint under this chapter may initiate enforcement with the Department of Health [or the City Manager]. C. The Fire Department or the Health Department shall require, while an establishment is undergoing otherwise mandated inspections, a "self-certification" from the owner, manager, operator or other person having control of such establishment that all requirements of this article have been complied with. D. Any owner, manager, operator or employee of any establishment regulated by this article may inform persons violating this article of the appropriate provisions thereof. E. Notwithstanding any other provision of this article, a private citizen may bring legal action to enforce this article. Sec. 1009. Violations and P naltiPc A. It shall be unlawful for any person who owns, manages, operates or otherwise controls the use of any premises subject to regulation under this article to fail to comply with any of its provisions. B. It shall be unlawful for any person to smoke in any area of this article. where smoking is prohibited by the provisions C. Any person who violates any provision of this article shall be guilty of an infraction, punishable by: 1. A fine not exceeding one hundred dollars ($100) for a first violation. 2. A fine not exceeding two hundred dollars ($200) for a second violation of this article within one (1) year. 3. A fine not exceeding five hundred dollars ($500) for each additional violation of this article within one (1) year. 161

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s Americans for Nonsmokers' Rights 2530 San Pablo Avenue, Suite J Berkeley, California 94702 (510) 841-3032 MODEL ORDINANCE ELIMINATING SMOKING IN WORKPLACES AND ENCLOSED PUBLIC PLACES Sec.1000. Title This article shall be known as the Smoking Pollution Control Ordinance. Sec. 1001. . Findings and Purpose The City Council does hereby find that: Numerous studies have found that tobacco smoke is a major contributor to indoor air pollution, and that breathing secondhand smoke is a cause of disease, including lung cancer, in nonsmokers. At special risk are elderly people, individuals with cardiovascular disease, and individuals with impaired respiratory function, including asthmatics and those with obstructive airway disease; and Health Hazards induced by breathing second-hand smoke include lung cancer, heart disease, respiratory infection, decreased respiratory function, bronchoconstriction, and broncho-spasm. Accordingly, the City Council finds and declares that the purposes of this ordinance are (1) to protect the public health and welfare by prohibiting smoking in public places and places of employment; and (2) to guarantee the right of nonsmokers to breathe smoke-free air, and to recognize that theneed tobreathe smoke- free air shall have priority over the desire to smoke. Sec. 1002. Definitions The following words and phrases, whenever used in this article, shall be construed as defined in this section: 1. "Bar" means an area which 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. Although a restaurant may contain a bar, the term "bar" shall not include the restaurant dining area. 2. "Business" means any sole proprietorship, partnership, joint venture, corporation or other business entity formed for profit-making purposes, including retail establishments where goods or services are sold as well as professional corporations and other entities where legal, medical, dental, engineering, architectural or other professional services are delivered. 3. "Employee" means any person who is employed by any employer in the consideration for direct or indirect monetary wages or profit, and any person who volunteers his or her services for a non-profit entity. 4. "Employer" means any person, partnership, corporation, including a municipal corporation, or non- profit entity, who employs the services of one or more individual persons. 5. "Enclosed Area" means all spacebetween a floor and ceiling which is enclosed on all sides by solid walls or windows (exclusive of door or passage ways) which extend from the floor to the ceiling, including all space therein screened by partitions which do not extend to the ceiling or are not solid, "office landscaping" or similar structures. 6. "Place of Employment" means any enclosed area under the control of a public or private employer 158

• • • Americans for Nonsmokers' Rights 2530 San Pablo Avenue, Suite J Berkeley, CA 94702 (510) 841-3032 TOBACCO VENDING MACHINE ORDINANCE FOR CALIFORNIA JURISDICTIONS Sec. 1000. Title This ordinance shall be known as the Tobacco Vending Machine Ordinance. Sec. 1001. Findings and Purpose The City Council does hereby find that: Smoking is responsible for the premature deaths of 434,000 Americans each year from lung cancer, heart disease, respiratory illlness, and other diseases; secondhand smoke is responsible for an additiona153,000 deaths among nonsmokers; and The U.S. Surgeon General has declared that nicotine is as addictive as cocaine or heroin; no other addictive product or drug, or cancer-causing product or drug is sold through vending machines; and The U.S. Secretary of Health, the U.S. Surgeon General, and the leading voluntary health organizations all recommend the elimination of cigarette vending machines for health reasons; Accordingly, the City Council finds that prohibiting the sale of cigarettes through vending machines is essential to protect the health and welfare of the public. Sec. 1002. Definitions "Tobacco Vending Machine" means any machine or device designated for or used for the vending of cigarettes, cigars, tobacco, or tobacco products upon the insertion of coins, bills, trade checks or slugs. Sec. 1003. Tobacco Vending Machines Prohibited No cigarette or other tobacco product may be sold, offered for sale, or distributed by or from a vending machine or other appliance, or any other device designed or used for vending purposes. Sec. 1004. Enforcement Violations of this ordinance are subject to a fine of $1000 per day for each violation. The City Manager and City Attorney shall enforce this ordinance. Sec. 1005. Severability If any provision, clause, sentence or paragraph of this article or the application thereof to any person or circumstances shall be held invalid, such invalidity shall not affect the provisions of this article which can be given effect without the invalid provision or application, and to this end the provisions are declared to be severable. Sec. 1006. Effective Date This article shall be effective thirty (30) days after the date of its adoption. Americans jor Nonsmokers' Rights, 3/92 163

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s 8. Public areas of aquariums, galleries, libraries and museums when open to the public. 9. Anyfacilitywhichisprimarilyusedforexhibitinganymotionpicture,stage,drama,lecture,musical recital or other similar performance, except when smoking is part of a stage production. 10. Sports arenas and convention halls. 11. Every room, chamber, place of meeting or public assembly, including school buildings under the control of any board, council, commission, committee, including joint committees, or agencies of the City or any political subdivision of the State during such time as a public meeting is in progress, to the extent such place is subject to the jurisdiction of the city. 12 Waiting rooms, hallways, wards and semiprivate rooms of health facilities, including, but not limited to, hospitals, clinics, physical therapy facilities, doctors' offices, and dentists' offices. 13 Lobbies, hallways, and other common areas in apartment buildings, condominiums, retirement facilities, nursing homes, and other multiple-unit residential facilities. 14. Lobbies, hallways, and other common areas in multiple-unit commercial facilities. 15. Polling places. B. Notwithstanding any other provision of this section, any owner, operator, manager or other person who controls any establishment or facility may declare that entire establishment or facility as a nonsmoking establishment. Sx.1005. Regulation of Smoking in Places of Employment A. It shall be the responsibility of employers to provide a smoke-free workplace for all employees, but employers are not required to incur any expense to make structural or other physical modifications. B. Within 90 days of the effective date of this article, each employer having an enclosed place of employment located within the city shall adopt, implement, make known and maintain a written smoking policy which shall contain the following requirements: Smoking shall be prohibited in all enclosed facilities within a place of employment without exception. This includes common work areas, auditoriums, classrooms, conference and meeting rooms, private offices, elevators, hallways, medical facilities, cafeterias, employee lounges, stairs, restrooms, vehicles, and all other enclosed facilities. C. The smoking policy shall be communicated to all employees within three (3) weeks of its adoption. D. All employers shall supply a written copy of the smoking policy upon request to any existing or prospective employee. D06. Where Smoking Not Regula A. Notwithstanding any other provision of this article to the contrary, the following areas shall not be subject to the smoking restrictions of this article: 1. Bars. 2. Private residences, except when used as a child care or health care facility. 3. Retail tobacco stores. 4. Restaurants, hotel and motel conference or meeting rooms and public and private assembly rooms while these places are being used for private functions. 160

• • which employees normally frequent during the course of employment, including, but not limited to, work areas, employee lounges and restrooms, conference and class rooms, employee cafeterias and hallways. A private residence is not a "place of employment" unless it is used as a child care or health care facility. 7. "Public Place" means any enclosed area to which the public is invited or inwhich the public is permitted, including but not limited to, banks, educational facilities, health facilities, laundromats, public transportation facilities, reception areas, restaurants, retail food production and marketing establish- ments, retail service establishments, retail stores, theatres and waiting rooms. A private residence is not a "public place." 8. "Restaurant" means any coffee shop, cafeteria, sandwich stand, private and public school cafeteria, and any other eating establishment which gives or offers for sale food to the public, guests, or employees, as well as kitchens in which food is prepared on the premises for serving elsewhere, including catering facilities, except that the term "restaurant" shall not include a cocktail lounge or tavern if said cocktail lounge or tavern is a"bar' as defined in Section 1002 (1). 9. "Retail Tobacco Store" means a retail store utilized primarily for the sale of tobacco products.and accessories and in which the sale of other products is merely incidental. 10. "Service Line" means any indoor line at which one (1) or more persons are waiting for or receiving service of any kind, whether or not such service involves the exchange of money. 11. "Smoking" means inhaling, exhaling, burning or carrying any lighted cigar, cigarette, weed, plant or other combustible substance in any manner or in any form. 12. "Sports Arena" means sports pavilions, gymnasiums, health spas, boxing arenas, swimming polls, roller and ice rinks, bowling alleys and other similar places where members of the general public assemble either to engage in physical exercise, participate in athletic competition, or witness sports events. iec. 1003. Anolication of Article to tv-Owned All enclosed facilities owned by the City of shall be subject to the provisions of this article. iec. 1004. Prohibition of Smoking in A. Smoking shall be prohibited in all enclosed public places within the City of , including, but not limited to, the following places, and with the following exceptions: 1. Elevators 2. Buses, taxicabs, and other means of public transit under the authority of the City of . and ticket, boarding, and waiting areas of public transit depots. 3. Restrooms. 4. Service lines. 5. Retail stores. 6. All areas available to and customarily used by the general public in all businesses and non-profit entities patronized by the public, including but not limited to, attorneys offices and other offices, Ln banks, laundromats, hotels and motels. I-' 7. Restaurants. 0 N w 159

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • Types of Worksite Restrictions Total Ban No Restrictions (30.1%) (37.4%)- ; (16.9%) (15.6%) Work Lesser Area Ban Restrictions Figure 41 Nonsmoker Exposure to Smoke in the Workplace by Level of Restriction 60 50 40 30 20 10 0 Total Ban Work Lesser No Area Ban Restrictions Restrictions Level of Ban Figure 42 172 • •

• THE RESULTS DO NOT APPLY TO OUR CITY BECAUSE OF ITS UNIQUE CHARACTERISTICS. This is the first argument that the tobacco industry used. It is a clever criticism because no two communities are precisely identical. They say: the results do not apply to San Francisco because it has lots of foreign tourists; the results do not apply to Oakland because of the large African-American community; the results do not apply to Walnut Creek because it is a bedroom community; the results do not apply to Madison because winters are cold in Wisconsin. The fact is that the four communities studied in the report are quite different from each other: Beverly Hills is a well-to-do urban community; Bellflower is a middle class bedroom community; San Luis Obispo is a college town; Lodi is a rural center. Examination of the detailed tables in the appendix of the report shows differences between these communi- ties, with more people eating in more expensive "full service" restaurants in richer communi- ties. The fact that there was no adverse effect on business in any of these communities supports the conclusion that the results do generalize. • 201

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s 5. Chronic cough and phlegm are more frequent in children whose parents smoke compared with children of nonsmokers. The implications of chronic respiratory symptoms for respiratory health as an adult are unknown and deserve further study. 6. The children of parents who smoke have small differences in tests of pulmonary function when compared with the children of nonsmokers. Although this decrement is insufficient to cause symptoms, the possibility that it may increase susceptibility to chronic obstructive pulmonary disease with exposure to other agents in adult life, e.g., active smoking or occupational exposures, needs investigation. 7. Healthy adults exposed to environmental tobacco smoke may have small changes on pulmonary function testing, but are unlikely to experience clinically significant deficits in pulmonary function as a result of exposure to environmental tobacco smoke alone. 8. A number of studies report that chronic middle ear effusions are more common in young children whose parents smoke than in children of nonsmoking parents. 9. Validated questionnaires are needed for the assessment of recent and remote exposure to environmental tobacco smoke in the home, workplace, and other environments. 10. The associations between cancers, other than cancer of the lung, and involun- tary smoking require further investigation before a determination can be made about the relations of involuntary smoking to these cancers. 11. Further studies on the relationship between involuntary smoking and cardiovas- cular disease are needed in order to determine whether involuntary smoking increases the risk of cardiovascular disease. ENVIRONMENTAL TOBACCO SMOKE CHEMISTRY AND EXPOSURES OF NONSMOKERS 1. Undiluted sidestream smoke is characterized by significantly higher concentra- tions of many of the toxic and carcinogenic compounds found in mainstream smoke, including ammonia, volatile amines, volatile nitrosamines, certain nicotine decomposition products, and aromatic amines. 2. Environmental tobacco smoke can be a substantial contributor to the level of indoor air pollution concentrations of respirable particles, benzene, acrolein, N-nitrosamine, pyrene, and carbon monoxide. ETS is the only source of nicotine and some N-nitrosamine compounds in the general environment. 3. Measured exposures to respirable suspended particulates are higher for nonsmok- ers who report exposure to environmental tobacco smoke. Exposures to ETS occur widely in the nonsmoking population. 4. The small particle size of environmental tobacco smoke place it in the diffusion- controlled regime of movement in air for deposition and removal mechanisms. Because these submicron particles will follow air streams, convective currents will dominate and the distribution of ETS will occur rapidly through the volume of a room. As a result, the simple separation of smokers and nonsmokers within the same airspace may reduce, but will not eliminate, exposure to ETS. 5. It has been demonstrated that ETS has resulted in elevated respirable suspended particulate levels in enclosed places. 182

. In 1989, 42,407 Californians died due to smoking-related diseases, resulting in 643,000 years of potential life lost based on life expectancy at death, and $4.4 billion lost to the economy of California (based on a 4 percent discount rate) or $104,484 per death.  One of five deaths in California is attributable to smoking.  Men account for 63 percent of the smoking-related deaths in California, 61 percent of years of potential life lost, and 72 percent of the productivity losses. • TOBACCO USE IN CALIFORNIA The prevalence of smoking among adults in the United States decreased from 40.3 percent in 1965 to 25.4 percent in 1990 (National Center for Health Statistics, 1992). Nearly half of all living adults who have ever smoked have quit. Nevertheless, smoking rates remain high in certain population groups. For example, in 1990, 32.2 percent of Blacks and 36.7 percent of persons with less than 12 years of education still smoked. Among U.S. young people, more than half of 8th graders and nearly two-thirds of 10th graders report having smoked during the preceding month and nearly one in five reports smoking a pack of cigarettes or more in the previous month (U.S. DHHS, 1991). A continuing decline in tobacco use in California follows the national pattern, although smoking rates are lower than for the United States. In 1987, 26.8 percent of adults smoked; by 1990, the smoking rate declined to 21.6 percent (Burns & Pierce, 1992). The smoking rate among adolescents was 9.3 percent. Using prevalence estimates slightly underes- timates the number of current smokers because some former smokers will resume smoking. Ln N ~ N m W W 195

• • • Table 21 Nonsmokers' Exposure to Environmental Tobacco Smoke in the Workplace by Strength of Smoking Policy Overall Smokin olic Total ban Work area ban Lesser restrictions N o restrictions Exposed (%) Population Size (N) Sample Size (N) Exposed (%a) Population Size (N) Sample Size (N) Exposed (%) Population Size (N) Sample Size (N) Exposed (%) Population Size (N) Sample Size (N) Total 10.0 3,172,165 3,634 24.2 1,662,685 1,795 50.1 1,333,218 1,408 52.3 2,618,146 2,608 Sex Male 13.1 1,526,642 1,535 30.0 795,810 837 56.6 797,026 797 58.4 1,506,656 1,430 Female 7.1 1,645,523 2,099 18.8 866,875 958 40.4 536,192 611 44.0 1,111,490 1,178 Age 18-24 12.3 415,536 465 39.5 284,346 313 59.1 231,956 222 59.2 536,959 551 25-44 10.7 1,873,057 2,146 22.8 919,687 1,030 51.0 767,739 828 53.0 1,419,001 1,377 45-64 7.8 815,816 969 18.3 435,431 429 43.5 296,790 343 47.5 588,318 617 65+ 2.0 67,756 54 1.3 23,221 23 27.7 36,733 15 27.2 73,868 63 Hispanic Hispanic 17.8 516,644 392 36.0 389,782 236 59.1 246,435 176 58.3 734,451 424 Origin Non-Hispanic 8.4 2,655,521 3,242 20.6 1,272,903 1,559 48.0 1,086,783 1,232 50.0 1,883,695 2,1 84 Race White 9.6 2,564,128 2,709 24.7 1,336,968 1,278 51.9 1,029,122 1,033 53.2 2,179,437 1,930 Black 12.6 249,555- 181 20.9 105,031 91 46.5 108,673 70 48.2 113,062 88 Asian or PI 10.6 320,443 694 21.2 191,278 391 40.6 149,658 270 47.4 264,277 536 Other 13.9 38,039 50 33.7 29,408 35 47.7 45,765 35 49.9 61,370 54 Education <12 Years 17.4 263,452 115 47.8 215,453 84 52.9 133,160 61 62.0 537,590 228 12 Years 12.0 793,350 719 23.9 491,317 440 60.3 430,761 357 55.4 821,484 726 13-15 Years 9.5 862,787 1,221 25.8 449,028 581 50.6 365,414 468 52.9 696,279 911 16+ Years 7.7 1,322,019 1,627 12.5 535,135 717 37.3 441,342 562 38.3 674,595 868 eZbO EZVIS

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s Restricting Exposure to Environmental Tobacco Smoke Exposure of Children One of the most important groups to be protected from exposure to environmental tobacco smoke are young children because their developing lungs are particularly vulnerable to damage caused by environmental tobacco smoke. Most of the regulation of tobacco smoking is directed at environments where adults live and work. Regulation of day care centers and schools is an important step forward in protecting children, as is sensitizing parents to the injury that their smoke is causing their children, but the best solution to the problem remains in influencing smokers to quit for their own good as well as that of their children. From 26% to 40% of children under the age of 5 years live in homes where there are one or more smokers, and the exposure of these children varied substantially across the geographic Regions of the state (see Figure 36). These children will be major beneficiaries of the tobacco control effort in California (see Appendix Table 18). Worksite Restricting the locations where smoking is allowed is an important part of a tobacco control program because it limits exposure for the nonsmoker, creates an environment where smokers are encouraged to quit, and; once they have quit, makes it more likely that they will be successful. Exposure to environmental tobacco smoke can occur either at home or in the workplace. This survey examines exposure in the workplace by asking those nonsmokers who work outside the home in an indoor work setting whether anyone had smoked in their immediate work environment within the last 2 weeks. Overall, 31.3% of those nonsmoking Californians who work indoors were exposed to environmental tobacco smoke with a higher percentage of men (38.3%) than women (23.6%) reporting exposure. Exposure was much higher among Hispanic nonsmokers (42.3%). Blacks tended to report slightly less exposure (27.5%). The largest differences in reported exposures occurred with age and level of education. Younger nonsmokers and those with less education were much more likely to be exposed to tobacco smoke at work (Figure 37 and Figure 38), possibly because they are also less likely to have control over their immediate work environment. It is these groups that are most likely to benefit from efforts to restrict smoking in the workplace. The increased exposure of those who are younger and have less education was more pronounced in males than in females (see Appendix Table 19). Exposure to smoke at the worksite also varied substantially among the different Counties and Regions in this survey, from a low of 18.1 % for nonsmoking workers exposed in Sacramento County to a high of 38.5% in Riverside County (see Figure 39). This marked variation among Counties in the percentage of workers exposed to cigarette smoke suggests there can be substantial progress achieved by disseminating the voluntary and regulatory approaches already enacted in those Counties with the lowest rates of workplace exposure. • . 51423 0409 166

A P P E N D I X I • • (ExCEaP,,.aoM) NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AN D HEALTH, CURRENT INTELLIGENCE BULLETIN 54 ENVIRONMENTAL TOBACCO SMOKE IN THE WORKPLACE LUNG CANCER AND OTHER HEALTH EFFECTS JUNE, 1991 • AB STRACT The National Institute for Occupational Safety and Health (NIOSH) has deter- mined that environmental tobacco smoke (ETS) is potentially carcinogenic to occupationally exposed workers. In 1964, the Surgeon General issued the first report on smoking and health, which concluded that cigarette smoke causes lung cancer. Since then, research on the toxicity and carcinogenicity of tobacco smoke has demonstrated that the health risk from inhaling tobacco smoke is not limited to the smoker, but also includes those who inhale ETS. ETS contains many of the toxic agents and carcinogens that are present in mainstream smoke, but in diluted form. Recent epidemiologic studies support and reinforce earlier published reviews by the Surgeon General and the National Research Council demonstrating that exposure to ETS can cause lung cancer. These reviews estimated the relative risk of lung cancer to be approximately 1.3 for a nonsmoker living with a smoker compared with a nonsmoker living with a nonsmoker. In addition, recent evidence suggests a possible association between exposure of nonsmokers to ETS and an increased risk of heart disease. Although these data were not gathered in an occupational setting, ETS meets the criteria of the Occupational Safety and Health Administration (OSHA) for classifying substances as potential occupational carcinogens (Title 29 of the Code ofFederal Regulations, Part 1990). NIOSH therefore recommends that ETS be regarded as a potential occupational 189

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s SOURCES OF INDOOR AIR POLLUTION Indoor air pollution is caused by an accumulation of contaminants that come primarily from inside the building, although some originate outdoors. These pollutants may be generated by a specific, limited source or several sources over a wide area, either at certain times or continuously. Common sources of indoor air pollution in commercial buildings include tobacco smoke, biological organisms, building materials and furnishings, cleaning agents, copy machines, and pesticides. HEALTH PROBLEMS AND VENTILATION Harmful pollutants from a variety of sources can contribute to building-related illnesses, which have clearly identifiable causes, such as Legionnaire's disease. HVAC systems that are improperly operated or maintained can contribute to sick building syndrome (SBS); SBS has physical symptoms without clearly identifiable causes. Some of these symptoms include dry mucous membranes and eye, nose, and throat irritation. These disorders lead to increased employee sick days and reduced work efficiency. A committee of the World Health Organization estimates that as many as 30 percent of new or remodelled buildings may have unusually high rates of sick building complaints. While this is often temporary, some buildings have long-term problems which linger, even after corrective action. The National Institute for Occupational Safety and Health reports that poor ventilation is an important contributing factor in many sick building cases. CONTROLLING INDOOR AIR POLLUTION Control of pollutants at the source is an obvious and effective strategy for maintain- ing clean indoor air. Control or mitigation of all sources, however, is not always possible or practical. Ventilation, either natural or mechanical, is the second most effective approach to providing acceptable indoor air. In the past, most buildings had windows that opened; airing out a stuffy room was common practice. In addition, indoor-outdoor air pressure differences provided ventilation by movement of air through leaks in the building shell. Today however, most newer office buildings are constructed without operable windows, and mechanical ventilation systems are used to exchange indoor air with a supply of relatively cleaner outdoor air. The rate at which outdoor air is supplied to a building is specified by the building code. Supply rates are based primarily on the need to control odors and carbon dioxide levels; carbon dioxide is a component of outdoor air, but its excessive accumulation indoors can indicate inadequate ventilation. Supply rates, hereafter referred to as ventilation rates, are commonly expressed in units of cubic feet per minute per person (cfm/person). 186

• E • DEPOSITION AND ABSORPTION OF TOBACCO SMOKE CONSTITUENTS 1. Absorption of tobacco-specific smoke constituents (i.e. nicotine) from environ- mental tobacco smoke exposures has been documented in a number of samples of the general population of developed countries, suggesting that measurable exposure to environmental tobacco smoke is common. 2. Mean levels of nicotine and continine in body fluids increase with self-reported ETS exposure. 3. Because of the stability of continine levels measure at different times during exposure and the availability of noninvasive sampling techniques, continine appears to be the short-term marker of choice in epidemiological studies. 4. Both mathematical modeling techniques and experimental data suggest that 10 to 20 percent of the particulate fraction of sidestream smoke would be deposited in the airway. 5. The development of specific chemical assays for human exposure to the compo- nents of cigarette tar is an important research goal. TOXICITY, ACUTE IRRITANT EFFECTS, AND CARCINOGENICITY OF ENVIRONMENTAL TOBACCO SMOKE 1. The main effects of the irritants present in ETS occur in the conjunctiva of the eyes and the mucous membranes of the nose, throat, and lower respiratory tract. These irritant effects are a frequent cause of complaints about poor air quality due to environmental tobacco smoke. 2. Active cigarette smoking is associated with prominent changes in the number, type, and function of respiratory epithelial and inflammatory cells; the potential for environ- mental tobacco smoke exposure to produce similar changes should be investigated. 3. Animal models have demonstrated the carcinogenicity of cigarette smoke, and the limited data that exist suggest that more carcinogenic activity per milligram of cigarette smoke concentrate may be contained in sidestream smoke than in mainstream cigarette smoke. POLICIES RESTRICTING SMOKING IN PUBLIC PLACES AND THE WORKPLACE 1. Beginning in the 1970's an increasing number of public and private sector institutions have adopted policies to protect individuals from environmental tobacco smoke exposure by restricting the circumstance in which smoking is permitted. 2. Smoking in public places has been regulated primarily by government actions, which have occurred at Federal, State, and local levels. All but nine states have enacted laws regulating smoking in at least one public place. Since the mid-1970's, there has been an increase in the rate of enactment and in the comprehensiveness of state legislation. Local governments have enacted smoking ordinances at an increasing rate since 1980; more than 80 cities and counties have smoking laws in effect. 183

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• RESOLVING AIR QUALITY PROBLEMS IN OFFICE BUILDINGS Building managers and tenants should work together to improve air quality; areas to address include: HVAC system operation and maintenance: Operate the ventilation system in a manner consistent with its design. Perform maintenance and inspections on a regular basis, as prescribed by the manufacturer. Record keeping: Maintain records of all HVAC system problems, as well as routime maintenance and inspection activities. Document the nature of complaints concerning the indoor air environment, as well as steps taken to remedy each complaint. These records may be useful in solving future problems. Pollution control: Identify pollution sources. Implement source removal or special ventilation techniques (including restrictions on smoking.) Occupant activities: Eliminate practices which may restrict air movement (e.g., furniture placement relative to air vents). Building maintenance activities: Increase ventilation rates during periods of in- creased pollution, e.g., during painting, renovation, and pesticides use; schedule use of pollutant sources to minimize the impact on indoor air quality. • Ventilation standards and codes: Keep abreast of revisions to ventilation standards and building codes affected by those standards. Energy Conservation: Reexamine energy conservation practices with regard to indoor air quality considerations, employee health, and productivity costs. Identify areas for followup. SUMMARY  An HVAC system that is properly designed, installed, maintained, and operated is essential to providing healthful indoor air; a poorly maintained system can generate and disperse air pollutants.  Control of pollutants at the source is the most effective means of promoting indoor air quality.  An adequate supply of outdoor air is essential to diluting indoor pollutants.  In the absence of adequate ventilation, irritating or harmful contaminants can build up, causing worker discomfort, health problems and reduced performance levels.  Ventilation rates specified in most local building codes are design standards only, and therefore are not enforceable for insuring healthful indoor air quality after the system begins to operate.  Air cleaning is an important part of an HVAC system, but is not a substitute for cn source control or ventilation. All air cleaners must be properly sized and maintained to be ~ effective.  An objective evaluation of indoor air quality, employee health, and productivity ~ costs should be included when considering energy costs and energy-saving strategies. w m 187

A P P E N D I X K (exc FROM) THE COST OF SMOKING IN CALIFORNIA, 1989 BY DOROTHY P. RICE AND WENDY 1\/lAX HIGHLIGHTS  Smoking annually imposes a multi-billion dollar burden on Californians -- $7.6 billion in 1989.  The cost of the adverse health effects of smoking annually amounts to $256 per Californian or $1,543 per smoker.  Considerable variation in smoking cost per resident (based on statistically signifi- cant estimates) occurs among the 58 counties in California, ranging from $172 in Lassen County to $377 in Inyo County.  Almost 5 million people in California smoke cigarettes, including 220,000 adolescents and 4.7 million adults.  More men than women currently smoke -- 2.7 million men, 2.1 million women, 118,000 adolescent boys, and 102,000 adolescent girls.  Annual cigarette sales in California amount to $4.5 billion compared with $7.6 billion for the cost of the adverse health effects of smoking.  Charging California smokers for smoking-related medical costs and productivity losses would add $3.43 to the price of each pack of cigarettes. If smokers were taxed to cover these costs, every smoker would pay $1,543 a year.  The cost of smoking for men is more than twice that for women -- $5.4 billion compared with $2.3 billion. The significantly higher cost for men reflects their higher rate of smoking and illness, greater number of deaths, and higher earnings.  Direct medical costs amounts to $2.4 billion and comprises 31 percent of the total cost of smoking in California; the value of lost productivity due to smoking-related illness amounts to $860 million, 11 percent of the total; and productivity losses for people who die prematurely amount to $4.4 billion (based on a 4 percent discount rate) or 58 percent of the total.  Expenditures for hospital care of current and former smokers amount to $1.6 billion or 69 percent of the total direct medical cost; physician services amount to $427 million; nursing home care, $147 million; medications, $129 million; and other professional services, $22 million. 194

.  restaurant sales in cities with smoke-free restaurant ordinances versus a comparison city that had no such ordinance This analysis showed:  the presence of a 100 percent smoke-free restaurant ordinance had no significant effect on total restaurant sales in any community  the presence of a 100 percent smoke-free restaurant ordinance was associated with a small, but statistically significant, increase in the fraction of total retail sales that went to restaurants. (Restaurant sales increase from about 13 percent to about 14 percent of total retail sales when a smoke-free restaurant ordinance was in force)  the presence of a 100 percent smoke-free restaurant ordinance had no significant effect on the ratio of restaurant sales in communities with such an ordinance compared with matched control communities which had no such restrictions  the effects of a 100 percent smoke-free ordinance were similar on all categories of restaurants, defined by the kind of alcoholic beverages (if any) were served There is no evidence to support the common claim, first made in Beverly Hills, that smoke-free restaurant ordinances reduce business by 30 percent. The overall conclusion from these data is that 100 percent smoke-free restaurant ordinances do not adversely affect restaurant sales within a community or lead to a shift in patronage to restaurants in commu- nities with no such ordinances. If anything, 100 percent smoke-free restaurant ordinances make restaurants more competitive for retail sales dollars. 197

A P P E N D I X L (cxc FROM) THE EFFECT OF ORDINANCES REQJJIRING SMOKEFREE -RESTAURANTS ON RESTAURANT SALES IN CALIFORNIA BY STANTON A. GLANTZ, PH.D. AND LISA R.A. SMITH, B.A. INSTITUTE FOR HEALTH POLICY STUDIES, SCHOOL OF MEDICINE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO MARCH, 1992 EXECUTIVE SUMMARY The potential effect of local ordinances requiring smoke-free restaurants on restau- rants revenues is an important consideration for restauranteurs themselves and cities which depend on sales tax revenues to provide city services. To assess the effects of such ordinances on restaurants, we obtained data from the California State Board of Equalization on taxable restaurant sales from January 1, 1986, through June 30, 1991, for the communities of Bellflower, Beverly Hills, Lodi, and San Luis Obispo, where 100 percent smoke-free restaurant ordinances were in force, as well as similar communities (Lakewood, Los Angeles, Woodland, and Atascadero) where no such ordi- nances were in effect. These data were analyzed using a multiple linear regression econometric model, including year (for the underlying time trend), quarter (for seasonal adjustment) and a variable to indicate whether or not an ordinance was in force at the time. We analyzed:  total restaurant sales  restaurant sales as a fraction of total retail sales 196

7 o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s Distribution of Cigarette Use by Level of Worksite Restriction 100 80 60 40 ~ ~ 20 0 Total Work Lesser No Ban Area Restrictions Ban Males Females  Current Smokers Former Smokers Figure 43 Never Smokers Fraction of Smokers Making a Quit Attempt by Level of Ban ~ ~ ~ 60 50 40 ~ 30 aa 20 10 0 Total Work Lesser No Ban Area Restrictions Ban Males Females 0 Quit 3+ months Quit 0-3 months Figure 44 Total Work Lesser No Ban Area Restrictions Ban Total Work Lesser No Ban Area Restrictions Ban Relapsed 174

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s carcinogen in conformance with the OSHA carcinogen policy, and that exposures to ETS be reduced to the lowest feasible concentration. Employers should minimize occupational exposure to ETS by using all available preventive measures. INTRODUCTION The Surgeon General has concluded that tobacco smoke is a carcinogen and an important risk factor for heart disease. The purpose of this bulletin is to disseminate informa- tion about the potential carcinogenicity of environmental tobacco smoke' (ETS) in the workplace. Evidence is now clear that the health risk from inhaling tobacco smoke is not limited to the smoker, but also includes those who inhale ETS. Recent epidemiologic studies of nonsmokers exposed to ETS have shown an increased relative risk for lung cancer com- pared with unexposed nonsmokers. In addition, recent evidence suggests that exposure of nonsmokers to ETS may be associated with an increased risk of heart disease. This bulletin describes the results and implications of these studies. The conclusions and recommendations in this Current Intelligence Bulletin are based on the following:  Reports of the Surgeon General on the health effects of tobacco smoke  Comparison of the chemical compositon of ETS with that of mainstream smoke 2(MS)  Results from recent epidemiologic studies of nonsmokers exposed to ETS Methods for controlling involuntary exposures to ETS in the workplace are also discus.sed. REPORTS OF THE SURGEON GENERAL ON THE HEALTH EFFECTS OF TOBACCO SMOKE In 1964, the Surgeon General issued the first report on smoking and health, which concluded that cigarette smoke causes cancer: "Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect cigarette smoking far outweighs all other factors. The data for women, though less extensive, point in the same direction... The risk of developing lung cancer increases with duration of smoking and the number of cigarettes smoked per day, and is diminished by discontinuing smoking." Since 1964, evidence has continued to support the causal relationship between exposure to cigarette smoke and lung cancer, demonstrating that risk increases with amount and duration of smoking. Subsequent research has increased our knowledge about the toxicity and carcinogenicity of tobacco smoke and the risks of exposure. Additional support for the Surgeon General's conclusion has come from (1) animal studies that demonstrated the carcinogenicity of tobacco smoke condensate, and (2) analytical studies demonstrating that tobacco smoke contains carcinogens. Cigarette smoking is the major cause of lung cancer (87 percent of lung cancer deaths) and is estimated to account for 30 percent of all cancer deaths. The 1964 Surgeon General's report also pointed out that male cigarette smokers have higher death rates from heart disease than nonsmokers. Subsequent reports have concluded that cigarette smoking is a major cause of heart disease and that smoking is a major independent risk factor for heart attack. 190

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s S ~ E I ~ E ~ E 1>11 1>11 E E ~ E E E E U I U E E E E E E E E E E ~ ~ ~ ~ ~oooo oI ooo I oI oo 0 0I oI o 0 0 0~ 1 o o11 3l. 1"3~ ~1 1~~I ~ u ~ E E E E E 13 1 6 1 is . E 2 , v % E E ~. ~ 6 1 T E E 13 N E E E E E E E E E E x~w °a~Oaa°~ °a~~~Oa ~Oaa°~Oa °aaoaoaoa aooa a$aa~ w ~ xw a° °a ;11 ;81 °a °a a° ;"°a °a ~ °a °a ~ a °a ~ °a °a ~ Ma E E a° E °a >6, ~ E E E E E E E E E E E E E E E E E E O E E E E E E E E E E .~' v~i ~I a a a a a ~ a a a a a a a a a a a a a a a a a a a a a a a a k E E a C7 E E E E E E E E a E N 7y ~~y d) y ~ 0 .~y .~ .~ ~ ~ ~~ G U Q C7 22222 /~ !-~ Zi F. F~.~"' V V V •V~ V V V P4 P4 WQQ P. P4 Qa a 130

• FRACTION OF TEENS RECEIVING ANTI-TOBACCO EDUCATION 0 %4 • Percent 61.0%to71.3% 71.3% to 74.2% F~ 74.2%to 76.9% 0 76.9%to 78.4% 167 Appendix F -2

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A P P E N D I X J • (EXCERPTS FROM) SMOKING AND RESTAURANTS: A GUIDE FOR POLIcYMAKE - RS BY MICHAEL SIEGEL, M.D., M.P.H. (FROM THE) EXECUTIVE SUMMARY • • ENVIRONMENTAL TOBACCO SMOKE EXPOSURE IN RESTAURANTS  Restaurant environmental tobacco smoke (ETS) exposure is about 3-5 times higher than typical workplace exposure.  Restaurant employees' ETS exposure is about 8-20 times higher than domestic exposure.  The most heavily exposed restaurant workers inhale the benzo(a)pyrene equivalent of actively smoking 1-1/2 to 2 packs of cigarettes per day.  Restaurant air causes gene mutations at a rate 10-100 times higher than previously measured urban outdoor and indoor air.  The mutagenic potency of restaurant air is 5-10 times that of "high-risk" indus- trial workplace air.  Heavily exposed restaurant workers have levels of carcinogens in their blood 2-3 times higher than persons with typical ETS exposure, and have higher levels of mutagenicity in their urine.  Restaurant employees are therefore the occupational group most heavily exposed to ETS and most likely to suffer adverse health effects due to ETS exposure. HEALTH EFFECTS OF ETS EXPOSURE IN RESTAURANTS  In California, waitresses have the highest mortality of any female occupational group. Compared to all other women, they have almost four times the expected lung cancer mortality and 2-1/2 times the expected heart disease mortality rate.  Preliminary evidence suggests that waiters and waitresses have about a 50-90 percent increased risk of lung cancer than is most likely attributable to restaurant tobacco smoke exposure. Thus, exposure to ETS at work makes restaurant workers 1-1 /2 to 2 times as likely to die from lung cancer as they would otherwise be.  Although not yet studied, the morbidity and mortality of restaurant workers from heart disease attributable to restaurant ETS exposure is expected to be even more significant than for lung cancer. 193

T o b a c c o C o n t r o 1 i n C a I i f o r n i a C i t i e s  Offer smoking-cessation classes to all workers  Establish incentives to encourage workers to stop smoking Further information regarding workplace smoking policies and smoking cessation programs can be found in No Smoking: A Decision Maker's Guide to Reducing Smoking at the Worksite (American Cancer Society etal. 1985) ISOLATING SMOKERS The 1986 Surgeon General's report on involuntary smoking concluded that, "the simple separation of smokers and nonsmokers within the same airspace may reduce, but does not eliminate, the exposure of nonsmokers to ETS. "In indoor workplaces where smoking is permitted, ETS can spreak throughout the airspace of all workers. The most direct and effective method of eliminating ETS from the workplace is to prohibit smoking in the work- place. Until that is achieved, employers can designate separate, enclosed areas for smoking, with separate ventiliation. Air from this area should be exhausted directly outside and not recirculated within the building or mixed with the general dilution ventilation for the building. Ventilation of the smoking area should meet general ventilation standards, and the smoking area should have slight negative pressure to ensure airflow into the area rather than back into the airspace of the workplace (ASHRAE 1989). Guidance for designing local exhaust ventilation systems can be found in Recommended Industrial Ventilation Guidelines (Hagopian and Bastress 1976), Industrial Ventilation A Manual of Recommended Practice (ACGIA 1986), and Fundamental,r Governing the Design and Operation ofLocal Exhaust Systems (ANSI 1979). Warning signs should be posted at the entrances to the workplace in both English and the predominant language of non-English-reading workers. These signs should state that smoking is prohibited or permitted only in designated smoking areas. If designated smoking areas are provided, they should be clearly identified by signs. 'tobacco smoke in the ambient atmosphere composed of sidestream smoke and exhaled mainstream smoke Zsmoke drawn through the tobacco and into the smoker's mouth 3"`Potential occupational carcinogen' means any substance, or combination or mixture of substances, which causes an increased incidence of benign and/or malignant neoplasms, or a substantial decrease in the latancy period between exposure and onset of neoplasms in humans or in one or more experimental mammalian species as the result of any oral, respiratory or dermal exposure, or any other exposure which results in the induction of tumors at a site other than the site of administration. This definition also includes any substance which is metabolized into one or more potential occupational carcinogens by mammals" (29 CFR 1990.103). 192

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T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s is, in fact, a 30 percent drop in business when smoke-free restaurant ordinances are in force. This claim is directly contradicted by the data from the State Board of Equalization in Figure 2 of the report. This document responds to several criticisms the tobacco industry has advanced. THE NUMBERS ARE WRONG; OTHER SURVEYS REVEAL THAT THERE WAS A DROP IN SALES. It is important to emphasize that the data we used on restaurant sales did not come from a survey we did. These values are from the sales figures reported to the California State Board of Equalization for purposes of paying sales taxes. The only way that these numbers could be wrong is if restaurants were lying on their tax returns. Because the data from the Board of Equalization shows no drop in sales when smoke-free restaurant ordinances were in force, the tobacco industry's claim that sales actually dropped would require all restaurants to have systematically overstated their sales while the ordinances were in force by precisely the right amount to make it look like sales fell along long term trends. The assertion is simply not credible. The Board of Equalization numbers have several advantages. First, as noted above, they are probably the most accurate values available, since it is a crime to lie in reporting the values. Second, the numbers reflect all restaurant sales in a community, not just a small sample of restaurants. Third, the numbers are objective; they were collected by an agency with no interest in the outcome of the analysis. Likewise, they could not be manipulated by selectively including information from restaurants that did well or poorly during the time an ordinance was in effect. We included all the actual sales data in an appendix in our report so that any interested individual could double check their accuracy. This situation contrasts with the tobacco industry's studies, which, if available at all, provide no details on the actual data used. SALES IN ONE OR THE OTHER COMMUNITIES DROPPED WHEN A SMOKE-FREE RESTAURANT ORDINANCE WAS IN EFFECT COMPARED TO AN EARLIER QUARTER. Sales tax data exhibit some natural fluctuation. As a result, it is possible for the tobacco industry to reach any conclusion it wants by selectively picking the "correct" two quarters. To obtain an unbiased evaluation of the effects of a smoke-free restaurant ordinance, it is important to take into account long-term (secular) trends and seasonal variation, as well as the quarter-by-quarter random variation due to things like reports coming in late (which make part of one quarter's sales appear in another quarter) and short term economic changes. To obtain an unbiased estimate of the effect of the ordinances and increase the power of the statistical analysis to detect an effect of the ordinances, we used data for a five-year period. This length of time allowed us to obtain good estimates of both secular and seasonal trends before estimating any additional effects of the ordinances. 200

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T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s EXPOSURE OF CHILDREN 5 AND UNDER TO TOBACCO SMOKE AT HOME 0. Percent El 26.5 % to 30.1 % ^ 30.1 % to 32.2 % 32.2% to 36.2% 36.2% to 40.0% Figure 36 168

• • • On July 1, 1965, Congress approved the Federal Cigarette Labeling and Advertising Act of 1965 (Public Law 89-92). This law, which becamse effective on January 1, 1966, was the first of a continuing series of Federal statutes enacting warning labels to inform the public about the health hazards of smoking and, subsequently, the use of other tobacco products. Presently, the Comprehensive Smoking Education Act (Public Law 98-474) (Title 15, § 1331 of the U.S. Code) requires cigarette companies to rotate four health warnings on all cigarette packages and in advertisements. RECOMMENDATIONS Several systems exist for classifying a substance as a carcinogen. Such classification systems have been developed by NTP (1989), IARC (1987), and OSHA (29 CFR 1990). NIOSH considers the OSHA classification system (Identification, Classification, and Regulation of Potential Occupational Carcinogens (29 CFR 1990), also known as the OSHA carcinogen policy) the most appropriate for use in identifying occupational carcinogens 3 The Surgeon General has concluded that cigarette smoke causes lung cancer as well as heart disease. ..Furthermore, a large body of evidence indicates that exposure to ETS has produced lung cancer in nonsmokers. NIOSH therefore considers ETS to be a potential occupational carcinogen in conformance with the OSHA carcinogen policy (29 CFR 1990). The risk of developing cancer should be decreased by minimizing exposure to ETS. Employers should therefore assess conditions that may result in worker exposure to ETS and take steps to reduce exposures to the lowest feasible concentration. METHODS FOR CONTROLLING INVOLUNTARY EXPOSURE TO ETS Workers should not be involuntarily exposed to tobacco smoke. To prevent worker exposures to any hazardous substance, employers should first eliminate hazardous workplace emissions at their source. If elimination is not possible, emissions should be removed from the pathway between the source and the worker (NIOSH 1983). Therefore, the best method for controlling worker exposure to ETS is to eliminate tobacco use from the workplace and to implement a smoking cessation program. Until tobacco use can be completely eliminated, employers should protect nonsmokers from ETS by isolating smokers. Methods for eliminat- ing tobacco use from the workplace and isolating smokers are described here briefly. ELIMINATING TOBACCO USE FROM THE WORKPLACE Worker exposure to ETS is most efficiently and completely controlled by simply eliminating tobacco use from the workplace. To facilitate elimination of tobacco use, employ- ers should implement smoking cessation programs. The Association of Schools of Public Health (ASPH) has recommended the following strategy for smoking cessation (NIOSH 1986). Specifically, management and labor should work together to develop appropriate nonsmoking policies that include some or all of the following:  Prohibit smoking at the workplace and provide sufficient disincentives for those who do not comply  Distribute information about health promotion and the harmful effects of smoking 191

Table 21 Nonsmokers' Exposure to Environmental Tobacco Smoke in the Workplace by Strength of Smoking Policy Overall (continued) Smokin olic Total ban Work area ban Lesser restrictions N o restrictions Population Sample Population Sample Population Sample Population Sample Exposed Size Size Exposed Size Size Exposed Size Size Exposed Size Size (%) (N) (N) (%) (N) (N) (%) (N) (N) (%) (N) (N) Region Los Angeles 11.7 770,141 748 30.1 501,074 433 54.5 400,929 303 53.7 961,249 695 San Diego 8.0 346,989 231 33.4 143,894 92 37.0 98,170 77 46.6 177,380 131 Orange 12.5 295,778 180 23.3 139,530 79 43.8 122,187 63 45.6 225,428 120 Santa Clara 6.8 207,618 194 15.8 118,543 102 56.9 87,796 77 49.5 135,667 100 San Bernardino 7.1 136,358 151 17.8 66,599 87 60.5 54,155 78 72.3 100,330 134 Alameda 10.1 147,762 164 11.1 89,557 93 33.1 74,425 85 41.9 97,044 102 Riverside 12.5 83,673 130 23.1 52,910 78 51.2 39,729 47 64.2 96,876 126 Sacramento 7.1 154,185 225 8.1 63,467 84 50.6 36,687 53 41.8 47,111 78 Contra Costa 10.5 105,728 191 15.8 58,475 104 49.9 45,801 96 48.3 59,919 115 San Francisco 10.3 93,724 151 17.8 63,126 81 48.2 43,269 66 44.8 60,841 114 San Mateo, Solano 9.8 112,950 159 13.3 53,284 82 46.1 58,036 76 69.2 102,460 122 Marin, Napa, Sonoma 6.7 81,000 159 31.9 37,395 67 48.6 31,598 53 41.2 66,622 112 Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Plumas, Shasta, Siskiyou, Tehama, Trinity, Yolo 11.2 87,017 152 28.9 30,138 60 65.3 34,980 55 53.2 73,895 113 San Luis Obispo, Santa Barbara, Ventura 5.0 166,604 204 25.3 61,148 66 44.8 54,017 65 50.1 98,650 109 Amador, Alpine, Calaveras, El Dorado, Mariposa, Nevada, Placer, San Joaquin, Sierra, Sutter, Tuolumne, Yuba 7.2 97,302 143 35.2 53,487 73 42.0 35,545 42 55.2 84,980 114 Monterey, San Benito, Santa Cruz 13.9 77,042 175 22.1 26,223 67 56.7 28,424 71 45.8 50,538 110 Fresno, Madera, Merced, Stanislaus 11.0 132,027 160 25.0 54,475 78 55.8 52,307 55 50.1 87,652 98 Imperial, Inyo, Kern, Kings, Mono, Tulare 17.9 76,267 117 22.9 49,360 69 56.7 35,163 46 54.0 91,504 115 0 CD N . • •

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A P P E N D I X N • • (EXCERPTS FROM) RESPONSE TO TOBACCO INDUSTRY CRITICIsMs OF THE EFFECT OF ORDINANCES REo,uIRING SMOKE- FREE RESTAURANTS ON RESTAURANT SALES IN CALIFORNIA BY STANTON A. GLANTZ, PH.D. AND LISA R.A. SMITH, B.A. INSTITUTE FOR HEALTH POLICY STUDIES, SCHOOI. OF MEDICINE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO JUNE 1, 1992 The tobacco industry has used the claim that ordinances requiring smoke-free restaurants have reduced restaurant sales by 30 percent in order to fight the spread of such ordinances. (These arguments are generally made by restaurants working with the tobacco industry, rather than the tobacco industry directly, since its public relations experts know that the tobacco industry has no credibility with the public.) In March, 1992, we published our study, "The Effect of Ordinances Requiring Smoke-Free Restaurants on Restaurant Sales in California" to provide an objective test of the tobacco industry's claims that such ordinances were bad for business. This study used data on restaurant sales provided by restaurants to the State of California Board of Equalization to examine the effect of the ordinances and showed that there was no such drop in business. If anything, smoke-free restaurant ordinances are slightly • good for restaurants by making them more competitive for retail dollars. Ln The tobacco industry's original response was muted, but the industry, and its N restaurant allies, are simply back to claiming that our study is "seriously flawed" and that there W ~ ~ ~ 199 N

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s SURGEONS GENERAL'S REPORTS The Health Consequences of Smoking for Women (1980). 360 pages. The Health Consequences of Smoking: Cancer and Chronic Lung Disease in the Workplace. (1985).542 pages. The Health Consequences of Involuntary Smoking (1986). Summary only available. The Health Consequences of Smoking: Nicotine Addiction (1988). Summary only available. Reducing the Health Consequences of Smoking: 25 Years of Progress (1989). Summary only available. 220

A P P E N D I X M (EXCERPTS FROM) AN UPDATE, THE EFFECT OF ORDINANCES REQJIRING SMOKEFREE -RESTAURANTS ON RESTAURANT SALES IN CALIFORNIA BY STANTON A. GLANTZ, PH.D. INSTITUTE FOR HEALTH POLICY STUDIES, SCHOOL OF MEDICINE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO JUNE 18, 1992 The California State Board of Equalization has now released the sales tax data for the third quarter of 1991, and I have used this new information to update our report on the effects of smoke-free restaurant ordinances on restaurant sales. There continues to be no evidence of any adverse effect on restaurant sales. In addition to adding another quarter of data, I have been informed by the Board of Equalization that there were two errors in the restaurant figures for San Luis Obispo for the 4th quarter of 1990 and the 1 st quarter of 1991. These two quarters are very important because they cover the period in which the ordinance went into force. The corrected figures are $13,463,000 and $14,014,000. These changes are very important because they eliminate the downward "blip" in the restaurant sales originally reported ($10,533,000 and $16,507,000) and smooth out the sales curve. Simple visual inspection of these plots shows that there was no effect of the ordinances on sales, particularly in San Luis Obispo. The updated statistical analysis is available upon request. This correction by the Board of Equalization is important because it eliminates the argument that the tobacco industry makes in "The Effects of a Ban on Smoking in Public Places in San Luis Obispo, California" by L.H. Masotti and P.A. Creticos. While this document is quite long and involved, the major point it tries to make is that the fall in restaurant sales in San Luis Obispo the quarter after the ordinance went into force (the fourth quarter of 1990) was larger than the drop in retail sales in general. This conclusion is based on the incorrect value of restaurant sales of $10,533,000; using the correct value of $13,463,000 eliminates this discrepancy, and shows comparable changes in restaurant sales and retail sales generally. 198

0 • • Percentage of Those Who Are Willing to Ask Someone Not to Smoke 100 80 ~ 60 U ~ U a 40 20 0 Hispanic  Recently Asked White Black Not Recently Asked Asian or PI ~ Not Willing to Ask Figure 40 The increased workplace smoke exposure of younger and less educated nonsmokers, as well as of Hispanic nonsmokers, was not the result of a greater tolerance of smoke exposure by these groups. Among all nonsmokers, 87.4% would be willing to ask someone not to smoke and 59.2% have asked someone to stop smoking recently. This measure of nonsmoker activism was similar among men and women and was equally strong among individuals at different educational levels. Hispanic nonsmokers were even more likely than non-Hispanics (see Figure 40) to have recently asked someone not to smoke (65.3%), and younger nonsmokers were more likely to be willing to ask and to have recently asked than older nonsmokers. These data suggest that "common courtesy" and voluntary programs to restrict smoking at the worksite are not effective in preventing exposure of nonsmokers to cigarette smoke at work. The groups who most frequently reported exposure were also the groups who were most active in asking smokers not to smoke, indicating that their activism has not been successful in protecting them from smoke exposure. This provides a strong argument for encouraging regulations to control smoking at the worksite rather than relying on voluntary programs to protect these groups of nonsmoking workers (see Appendix Table 27). The fraction of the indoor working population that is covered by different types of worksite restrictions is presented in Figure 41. Overall, 37.4% of indoor workers worked in environments that have no restrictions on smoking and 30.1 % worked where there was a total ban on smoking. The likelihood that a worksite would have restrictions on smoking was related to the size of the worksite. Worksites with 50 or more employees were more likely to have any policy that restricts smoking and it was more likely that the policy was a total ban. The percentage of nonsmokers who were exposed to environmental tobacco smoke in the worksite was also related to the level of workplace restriction. Figure 42 presents the percentage of nonsmoking workers who reported exposure to cigarette smoke at work for worksites with different levels of restriction of smoking. Restrictions less than a ban in the work area appear to have little effect on reducing workplace exposure. A ban on smoking in the work area substantially lowered the percentage of workers who reported exposure, but a total ban dropped the level of exposure to less than one-half of that which occurred where there was a ban only in the work areas. However, even with a complete ban, 10% of workers reported that they are exposed at work (see Appendix Table 21). 171

Table 25 Strength of Local Ordinance Under Which the Population Works by Region of Residence Strong Weak No Non-California No location Population Sample ordinance ordinance ordinance location information Unclassified Size Size (%) (%) (%) (%) (%) (%) (N) (N) Total 31.5 24.8 20.3 1.1 16.9 5.4 13,503,093 17,564 Re ion Los Angeles 10.2 44.3 25.6 1.1 15.0 3.7 3,989,984 3,349 San Diego 1.2 72.4 5.0 1.2 19.5 0.7 1,188,912 988 Oran e 26.4 14.5 39.9 1.8 15.1 2.4 1,147,346 817 Santa Clara 76.2 3.7 0.9 0.7 12.6 6.0 762,051 838 San Bemardino 27.1 7.6 42.7 0.7 20.4 1.5 611,701 996 Alameda 82.5 1.4 1.9 0.2 13.2 0.8 622,588 851 Riverside 39.6 9.7 25.6 1.3 22.2 1.5 481,557 881 Sacramento 58.7 0.2 6.3 1.1 14.1 19.5 451,550 836 Contra Costa 81.7 1.0 0.8 1.6 12.9 2.0 387,932 908 San Francisco 81.7 2.7 5.4 0.6 8.0 1.7 355,771 721 San Mateo, Solano 59.2 14.9 8.6 0.4 12.8 4.2 487,497 825 Marin, Napa, Sonoma 39.3 1.1 16.4 2.1 18.3 22.8 333,666 732 Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Plumas, Shasta, Siskiyou, Tehama, Trinity, Yolo 6.4 0.7 4.0 .6 5.6 .6 81,000 93 San Luis Obispo, Santa Barbara, Ventura 14.9 32.2 11.2 0.5 17.2 24.1 560,919 825 Amador, Alpine, Calaveras, El Dorado, Mariposa, Nevada, Placer, San Joaquin, Sierra, Sutter, Tuolumne, Yuba 7.1 .7 2.5 .8 1.9 .0 43,103 59 Monterey, San Benito, Santa Cruz 49.4 6.4 4.5 0.6 20.6 18.5 282,555 802 Fresno, Madera, Merced, Stanislaus 51.4 9.7 8.0 1.6 21.9 7.4 547,067 817 Imperial, Inyo, Kern, Kings, Mono, Tulare 2.3 2.6 64.6 1.2 27.8 1.6 467,894 826 0 ~ 0 ~ 0 m n 9 0 0

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s NON-SMOKER EXPOSURE TO TOBACCO SMOKE ATWORK Percent 0 18.1 % to 26.3 % 0 26.3%to30.5% 30.5% to 36.3% 36.3%to38.5% Figure 39 170

A P P E N D I X (EXCERPTS FROM) TOBACCO USE IN CALIFORNIA, 199O1991 . D. BURNS AND J.P. PIERCE CALIFORNIA DEPARTMENT OF HEALTH SERVICES, 1992 0 SUMMARY This report presents data from a survey of cigarette smoking behaviors and attitudes among Californians conducted between June 1990 and July 1991. The prevalence of current smoking among adults in California was 22.2 percent, with males (25.5 percent) smoking more than females (19.1 percent). This represents a sharp decline in smoking following the increase in the tobacco excise tax and implementation of a comprehensive tobacco control program by the State of California. The decline in prevalence is on track for reaching the goal of 75 percent reduction in smoking prevalence by the year 1999. Black Californians were more likely to be cigarette smokers than other racial or ethnic groups, and Hispanic and Asian/Pacific Islander women were less likely to be cigarette smokers. Smoking prevalence was also lower among those who have completed more years of formal education and among those who were over the age of 65 years. Current smoking prevalence among adolescents aged 12-17 years was 9.3 percent; little difference in prevalence rates was found between boys and girls. The prevalence of smoking prior to pregnancy among women who had been pregnant in the last five years was 16.1 percent, and 32.8 percent of those who did smoke quit before the pregnancy reached term. Approximately one-half of California smokers made an attempt to quit in the 12 months before the survey. The rate of quit attempts was higher among Black smokers of both sexes and among Hispanic males. However, California smokers were unable to translate their high rate of cessation attempts into successful cessation. Only 11.3 percent of those who were smokers one year ago were nonsmokers at the time of the survey. This high rate of failed cessation attempts is most evident for Black males where 60.2 percent of those who were smoking one year ago attempted to quit, but only four percent were current smokers. The status and effectiveness of several of the components of the tobacco control campaign were assessed. Among adolescents, 72.6 percent reported at least one class in school directed at tobacco education. Among nonsmoking Californians who work indoors, 31.3 percent reported recent. exposure to environmental tobacco smoke at work, but this exposure was substantially lower among the 38.7 percent of indoor workers who work where there was at least a ban on smoking in the immediate work area. Exposure was further reduced for those workers who work in jurisdictions that have strong ordinances to limit smoking in the workplace. Those 164

A P P E N D I X S (EXCERPTS FROM) PUBLICATIONS FROM THE OFFICE ON SMOKING AND HEALTH CENTERS FOR DISEASE CONTROL 1600 CLIFTON ROAD, N.E., ATLANTA, GEORGIA 30333 PUBLICATION INFORMATION FOR MORE INFORMATION, CALL: (404) 488-5705 PUBLICATIONS Smoking, Tobacco & Health: A Fact Book (1989). A booklet describing the health, social, and economic aspects of smoking and tobacco use. Includes tables and charts. 41 pages. Clearing the Air (1989). Tips on smoking cessation for those who want to quit. 44 pages. Nicotine Addiction and Cigarettes (1988). A pamphlet by the American Lung Association answering some of the most commonly asked questions about nicotine, cigarettes, and nicotine addiction. 8 pages. Youth and Smoking Fact Sheet (1990). A fact sheet answering frequently asked questions about youth and smoking. 10 pages. TECHNICAL INFORMATION Smoking and Health: A National Status Report (1988). A report to Congress discussing the status of smoking programs in the nation. Includes information on the economic impact of smoking, smoking behavior, antismoking legislation, and antismoking programs. 390 pages. (A 32-page summary of the report is also available.) Media Strategies for Smoking Control: Guidelines (1988). A manual discussing guidelines for media advocacy, based on a two-day consensus conference convened by the Advocacy Institute for the National Cancer Institute. 44 pages. Inspector General's Report on Minors' Access to Cigarettes (1990). An assessment of the enforcement of State laws prohibiting the sale of cigarettes to minors. 15 pages. Bibliography on Smoking and Health (1989). A compilation of 1989 scientific information on tobacco and tobacco use. 278 pages. 219

• • • Table 23 Percentage of Nonsmokers Exposed to Environmental Tobacco Smoke in the Workplace by Restrictiveness of Workplace Policy and Local Ordinance Smokin olic Total ban Work area ban Lesser restrictions No restr ictions Percent Exposed (%) Sample Size (N) Percent Exposed (%) Sample Size (N) Percent Exposed (%) Sample Size (N) Percent Exposed (%) Sample Size (N) Population Size (N) Sample Size (N) Total 10.0 3,634 24.2 1,795 50.1 1,408 52.3 2,608 8,786,214 9,445 Sex Male 13.1 1,535 30.0 837 56.6 797 58.4 1,430 4,626,134 4,599 Female 7.1 2,099 18.8 958 40.4 611 44.0 1,178 4,160,080 4,846 Ordinance Strong Ordinance Total 8.2 1,715 16.7 812 48.9 675 50.9 1,010 3,317,147 4,212 Class Sex Male 9.7 704 22.2 370 52.3 375 58.6 554 1,712,143 2,003 Female 6.9 1,011 12.3 442 44.6 300 39.6 456 1,605,004 2,209 Weak Ordinance Total 10.9 854 29.0 431 45.5 301 46.1 633 2,588,237 2,219 Sex Male 14.9 369 39.7 199 54.3 189 52.9 345 1,383,985 1,102 Female 6.9 485 19.1 232 30.1 112 37.2 288 1,204,252 1,117 No Ordinance Total 12.2 742 29.2 406 53.1 296 61.1 681 2,109,927 2,125 Sex Male 15.8 318 32.9 180 61.8 150 66.6 359 1,065,772 1,007 Female 9.2 424 26.0 226 40.2 146 54.7 322 1,044,155 1,118 Non-California Locati Total 33.7 24 20.9 13 49.8 17 46.7 52 106,432 106 Sex Male 54.4 14 9.4 11 76.2 11 58.3 36 66,113 72 Female 15.6 10 74.0 2 25.1 6 21.2 16 40,319 34 No Location Info Total 40.8 19 28.2 13 73.0 9 60.9 50 90,047 91 Sex Male 56.3 7 12.6 9 74.3 7 68.3 37 67,314 60 Female 26.4 12 91.6 4 61.2 2 39.6 13 22,733 31 Unclassified Total 6.2 280 28.4 120 63.5 110 48.5 182 574,424 692 Sex Male 12.5 123 32.1 68 65.6 65 47.7 99 330,807 355 Female 0.4 157 22.4 52 59.7 45 49.9 83 243,617 337 ZZfiO EZVTS

A P P E N D I X 0 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 "smokers' 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 industry's 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. (JAMA. 1991;266:2110-2117) BEFORE the emergence of the non- smokers' rights movement, virtually 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 editorial 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 of Medicine and the I nstitute for Health Policy Studies, University of California, San Francisco. The opinions expressed in this article are those of the authors alone and do not necessarily reflect the individ- uals and organizations who graciously assisted in this research. Reprint requests to Division of Cardiology, Room 1186M, Box 0124, University of California, San Francis- co, CA 94143-0124 (Dr Glantz). ers' Rights to promote local legislation in California and elsewhere. They be- lieved that local , legislators would be more sensitive to constituents and less responsive to campaign contributions and pressure from out-of-town tobacco industry lobbyists.'•' This strategy suc- ceeded. By 1986, more than 75 ordi- nances had been enacted in California alone.' Nationwide by 1990, over 400 local ordinances had been passed.' Recent local campaigns in California illustrate the tobacco industry's 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. To 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 community 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 activity, 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 2110 JAMA, October 16, 1991-Vol 266, No. 15 Politics of Local Tobacco Control-Samuels & Glantz 202

A P P E N D I X H • (exc FROM) EPA INDOORAIR FACTS No. 3 VENTILATION AND AIR CZUALITY IN OFFICES OFFICE OF AIR AND RADIATION, WASHINGTON, D.C. 20460 REVISED JULY, 1990 • • INTRODUCTION Millions of Americans work in buildings with mechanical heating, ventilation, and air-conditioning (HVAC) systems; these systems are designed to provide air at comfortable temperature and humidity levels, free of harmful concentrations of air pollutants. While heating and air-conditioning are relatively straightforward operations, the more complex processes involved in ventilation are the most important in determining the quality of our indoor air. While many of us tend to think of ventilation as either air movement within a building or the introduction of outdoor air, ventilation is actually a combination of processes which results in the supply and removal of air from inside a building. These processes typically include bringing in outdoor air, conditioning and mixing the outdoor air with some portion of indoor air, distributing this mixed air throughout the building, and exhausting some portion of the indoor air outside. The quality of indoor air may deteriorate when one or more of these processes is inadequate. For example, carbon dioxide (a gas that is produced when people breath), may accumulate in building spaces if sufficient amounts of outdoor air are not brought into and distributed throughout the building. Carbon dioxide is a surrogate for indoor pollutants that may cause occupants to grow drowsy, get headaches, or function at lower activity levels. There are many potential sources of indoor air pollution, which may singly, or in combination, produce other adverse health effects. However, the proper design, operation and maintenance of the ventilation system is essential in providing indoor air that is free of harmful concentrations of pollutants. 185

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A P P E N D I X P (EXCERPTS FROM) POLITICAL EXPENDITURES BY THE TOBACCO INDUSTRY IN CALIFORNIA STATE POLITICS FROM 1976 TO 1991 BY IVIICHAEI, EVANS BEGAY, PH.D. AND STANTON A. GLANTZ, PH.D. SEPTEMBER, 1991 EXECUTIVE SUMMARY  In the mid-1980's, the tobacco industry became a major source of campaign contributions to legislative officeholders and candidates. In the 1975-1976 election cycle, the tobacco industry contributed only $5,500 to candidates for legislative and statewide offices. By the 1989-1990 election, this amount had increased by a factor of 102, to $563,366.  Growth in the amount of tobacco industry contributions in California has made it one of the major sources of political money in California. The tobacco industry has spent a grand total of $11,786,550 since 1975. In the 1989-1990 cycle, the industry ranked fifth among contributors to legislative and constitutional officeholders and candidates.  In the first six months of 1991, contributions of $196,000 made the tobacco industry the largest contributor to legislative and constitutional candidates in California.  Based on the trend established in the first six months of 1991, the industry may contribute over $772,000 in the 1991-1992 election cycle. It is very likely that the tobacco industry will exceed the amount contributed to legislative candidates in the 1989-1990 cycle because contributions tend to increase as the election approaches and because provisions of Propositions 68 and 73, which limited contributions to political candidates, were ruled unconstitutional by a federal district court.  The tobacco industry contributes large amounts of money to key legislative leaders of the Assembly and Senate.  Assembly Speaker Willie Brown has received a total of $225,150 from the industry since his first contribution of $200 in 1980. In the 1989-1990 cycle, the Speaker accepted a total of $62,250. In the first six months of 1991, the industry contributed $68,000 to the Speaker. If this trend is maintained for the entire 1991-1992 cycle, the Speaker may receive a total of $272,000 or more than he accepted during the ten years from 1980 to 1990. 210

A P P E N D I X Q (EXCERPTS FROM) UNDOING PROPOSITION 99: POLITICAL EXPENDITURES BY THE TOBACCO INDUSTRY IN CALIFORNIA POLITICS IN 1991 BY MICHAEL EVANS BEGAY, PH.D. AND STANTON A. GLANTZ, PH.D. INSTITUTE FOR HEALTH POLICY STUDIES, SCHOOL OF MEDICINE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO APRIL, 1992 EXECUTIVE SUMMARY  This report is the third in a series of monographs examining the political activity of the tobacco industry in California state politics to influence tobacco policymaking. The industry has become a major player in California politics at both the state and local levels in response to state tobacco education and prevention activities funded by tobacco tax revenues raised by Proposition 99.  The Legislature and the Wilson Administration have not provided 20 percent of tobacco tax revenues for health education programs as the voters required in Proposition 99 in the 1991-1992 fiscal year and in the proposed 1992-1993 fiscal year.  The Governor's revised 1991-1992 budget for the Health Education Account provides only nine percent or $60 million of total available revenues for tobacco education. This amount represents a shortfall of $68 million from the 20 percent requirement of Proposition 99 or $128 million.  The Governor's proposed 1992-1993 budget only allocates seven percent of total available revenues to tobacco education. This represents a shortfall of $73 million from the 20 Ln percent requirement of Proposition 99 or $110 million. ~ N  Medical service programs have received higher proportions of tobacco tax revenues w than allowed by Proposition 99 at the expense of health education programs. Medical service m programs now exceed the legally mandated maximum of 70 percent allowed by Proposition 99. ~ Ln 212

• •  Democratic President Pro-Tem David Roberti of the Senate has received a total of $60,328 from 1981 to 1991, Republican Senate Minority Leader Ken Maddy, a total of $61,000 for the same period.  The total amount of money the tobacco industry spends on state and local political activity in California increased sixteen-fold between the 1975-1976 cycle and the 1989-1990 cycle from $264,960 to $4,383,923. Most of the growth in tobacco political spending has occurred in lobbying expenditures, contributions to initiative campaigns, legislative contributions, and local political activity. In the first six months of 1991, the industry spent a total of $1,030,774. At this rate the industry may match the amount spent in the 1991-1992 cycle.  The tobacco industry almost exclusively supports incumbents rather than chal- lengers. In the 1989-1990 cycle, of the candidates receiving tobacco money, 97 percent were incumbents.  The tobacco industry contributes something to virtually every member of the legislature; of the 120 members of the State Senate and Assembly, all but 8 have accepted money.  The tobacco industry has developed a strategy since 1975 to gain access to key legislative leaders and legislative committees. Lobbying legislators and administration officials has also become an important element of the industry's strategy. Since the 1975-1976 cycle, the industry has spent $5,914,214 to lobby the legislative and the executive branches in Sacramento. In the first six months of 1991, the industry spent $539,137 on lobbying. If this trend is maintained, the industry may spend over $2 million, matching the amount spent on lobbying in 1989-1990, $2,212,231.  From 1975 to 1991, the tobacco industry spent a grand total of $42,034,759 on state and local political activity and to defeat non-smoking initiatives (i.e., Proposition 5 in 1978, Proposition 10 in 1980, and Proposition 99 in 1988).  In contrast to other major sources of campaign contributions in California, which are made by in-state organizations, virtually all of the money from the tobacco industry comes from outside California. Funds flow from New York (Philip Morris), North Carolina (R.J. Reynolds), and Washington, D.C. (the Tobacco Institute). SUMMARY The tobacco industry has become a major player in California politics. In the 1975- 1976 election cycle, the industry spent a modest amount of money, $264,960. By the 1989- 1990 election cycle, the industry spent a total of $4,383,923. Overall, the industry has spent a grand total of $42,034,759 on state-level and local political activity and to defeat non- smoking initiatives. The industry was the fifth largest contributor to candidates for legislative and constitutional offices in the 1989-1990 election. In the first six months of 1991, the tobacco industry became the largest contributor in California. The industry will continue to ~ be actively involved in state and local politics. ~ N w • 0 ~ ~ ~ 211

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s clearly a new fixture 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. To date, however, all attempts by the tobacco industry to overturn nonsmokers' rights legislation by referendum have failed.1e " 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 100% smoke-free require- ment for the city's 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.E' The Tobacco 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 Tobacco 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.Eb 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 was 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 experience 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 Tobacco Institute, played an important role in its success. LOS ANGELES, CALIF Three years later, the Los Angeles City Council considered an ordinance similar to the original Beverly Hills or- dinance, which would have prohibited smoking in all restaurants. In 1990, Councilman Marvin 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 firm that the To- bacco Institute, Philip Morris, and RJ Reynolds use (Ogilvy 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 company's 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 legislation." The addresses and telephone numbers of the elected offi- cials were included, as well as "talking points" that could be used in communi- cations. A toll-free telephone number was given to answer any questions. On August 13,1990, the Environmen- 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 own- 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 2112 JAMA, October 16, 1991-Vol 266, No. 15 Politics of Local Tobacco Control-Samuels & Glantz 204

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s CONCLUSION Contrary to the requirements of Proposition 99 mandated by the voters, AB 99 and the Governor's revised 1991-1992 and proposed 1992-1993 budgets do not fully fund tobacco education and prevention and tobacco research programs. AB 99 failed to provide 20 percent of tobacco tax revenues for tobacco education in 1991-1992 allocating only 14 percent. AB 99 also appropriated more funds for medical service programs than permitted by Proposition 99. Section 43 of the bill guarantees certain direct medical services programs will be protected from possible shortfalls in available revenue and receive additional funds to meet increasing caseloads. As these programs take more of the available funds, health education and other activities mandated by Proposition 99 will be eliminated entirely by the mid to late 1990s. The Governor's revised budget for the 1991-1992 fiscal year and his proposed budget for the 1992-1993 fiscal year also fails to provide 20 percent of total available tobacco tax revenues for tobacco education programs. The revised 1991-1992 budget provides only nine percent of revenues for tobacco education and the 1992-1993 budget only seven percent of funds. The Governor has also proposed a 40 percent reduction in funds available to the tobacco research program, which was mandated by Proposition 99. The Governor's proposals would allocate more funds to medical services programs beyond the 70 percent allowable by Proposition 99, 80 percent in 1991-1992, 84 percent in 1992-1993. The Governor also refused to sign the $16 million media campaign contract with the advertising firm of Livingston & Keye. This money was allocated by AB 99 for the 1991- 1992 fiscal years. In the following year, 1992-1993, the Governor proposes to redirect revenues from tobacco education and prevention programs to fund Medi-Cal perinatal services for women whose family income is between 133 percent and 185 percent of the federal poverty level. The Governor's decision to cancel the media campaign contract is inconsistent with AB 99 and Proposition 99. Governor Wilson has argued that he needs only a four-fifths vote in both houses of the Legislature in order to allocate tobacco education and prevention funds to medical services. The Legislative Counsel has ruled that the proposed use of Proposition 99 funds to the Medi-Cal program would require voter approval because the Governor's proposal extended the tobacco education account's purposes beyond those specified in the proposition. Finally, the tobacco industry appeared to have been very successful in its efforts to influence tobacco policymaking in California since Proposition 99 initiation began. The industry has accelerated the amount of money spent on political activity in California. The industry has gained more political power in state and local politics to defeat tobacco control efforts. Under trends established by AB 99 budgets and the Governor's proposed budgets, tobacco education and prevention and tobacco research programs will be eliminated by the mid-1990s. These programs will not survive into the next century. 214

• • • Table 2.-Contributions to Sacramentans for Fair Business Policy and Cigarette Market Shares Company Contribution, $' % of Total US Market Share of Company In 1989, k'° RJ Reynolds 134 434 36 29 Philip Morris 124 963 33 42 Brown and Williamson 36 327 10 12 American Brands 21 569 6 7 Lorillard 15 627 4 8 Liggett 0 0 3 Tobacco Institute 32 901 9 Capital Cigar Co 1000 0.2 Non-tobacco sources 9150 2 Total 375 971 100 100 •Data from Sacramentans for Fair Business Policy." of lobbying by the industry at the city level, Mayor Anne Rudin stated, "They probably gave up." The Referendum The tobacco industry had not given up. On October 3, 1990, the same day that the County Board of Supervisors passed the ordinance, the Tobacco In- stitute loaned $20 000 to a referendum campaign committee that had not yet been formed.a' On October 5, 1990, 3 days after the County Board of Supervi- sors vote and prior to the city council vote, Sacramentans for Fair Business Policy (SFBP) filed a statement of orga- nization to force a referendum on the smoking ordinances. Pueyo, the San Francisco political consultant for RJ Reynolds, was hired to run the cam- paign for SFBP. That same day, RJ Reynolds contributed almost half of its total contribution of $134 000. As of De- cember 31, 1990, SFBP had received $375 971 in cash, loans, and services, of which only $9150 (2%) came from non- tobacco interests (mostly restaurants) (Table 2). The tobacco industry contri- butions highly correlate with their do- mestic market shares (r=.94; P=.005). While the tobacco industry has a long history of spending large sums to op- pose nonsmokers' rights initiatives sponsored by tobacco control advo- cates,' the industry had only rarely at- tempted to overturn enacted ordi- nances by referendum. In 1983, the tobacco industry spent $1.3 million in an unsuccessful attempt to overturn by referendum a workplace ordinance en- acted in San Francisco.P° In 1984, the industry also lost at an attempt to over- turn a similar ordinance in Ft Collins, Colo. The referendum tactic then lay fallow for 6 years, until it reappeared in Sacramento. The SFBP group hired Nielsen, Merksamer, Hodgson, Parrinello, and Mueller, a politically influential law firm, to fulfill legal obligations. Vigo Nielson, of the aforementioned law firm, has been a key player for the to- bacco industry in California for over a decade. The firm also represents the Tobacco Institute, five tobacco compa- nies (Philip Morris, RJ Reynolds, Loril- lard, Brown and Williamson, and Amer- ican Tobacco), the California Association of Tobacco and Candy Dis- tributors Political Action Committee, and the California Medical Associa- tion.' This firm has been paid more than $1 million by tobacco interests for lobby- ing since 1985.' Within 2 weeks, SFBP was using the tobacco money to distribute referen- dum petitions by mail. Despite being organized and essentially fully funded by out-of-state tobacco companies, throughout the campaign SFBP claimed to be a local independent orga- nization. In an October 17, 1990, letter addressed to "Dear Neighbor," Pueyo wrote, "We're an independent coalition of smokers, nonsmokers, small business owners, restaurant workers, restau- rant owners, and other concerned Sa- cramentans." A referendum petition with instructions was enclosed in the envelope. The county required 30 433 signa- tures and the city required 19 334 to force a referendum vote. Most of the tobacco money went to a Sacramento company specializing in petition drives. The city clerk of Sacramento said that signature gatherers were being paid $3 to $5 per signature, when $1 is usually considered a competitive rate. As in San Francisco in 1983,E° SFBP employed nonresidents as signature gatherers from as far away as southern California. According to Mayor Rudin, California state law requires petition solicitors for a city referendum to reside in the same jurisdiction. Mayor Rudin publicly questioned the legality of the out-of- town solicitors,' but the district attor- ney did not take action. JAMA, October 16, 1991-Vol 266, No. 15 207 By the deadline, the county had re- ceived approximately 60 000 signa- tures. Enough were deemed valid to force a referendum at the county level. Supervisor Streng said that they could have had many of the county petitions invalidated because the person who signed the 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. Of the 31 135 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 city's ordinance went into effect on December 14, 1990. From December 14, 1990, to March 31, 1991, there were 164 complaints of noncompliance registered by the en- forcement agency, the Environmental Health Division of the Environmental Management Department. When a complaint was received, a letter was sent to the offender with a copy of the ordinance. Ken Stewart, the enforce- ment officer, says that the ordinance is largely self-enforcing; no citations have been issued. According to Stewart, "Once people become aware of the law and realize that we are not out to arrest smokers, they comply." Mayor Rudin has found that city resi- dents are supportive of the ordinance. Council Member Robie agrees; about 90% of the constituent correspondence she has received has been in support of the ordinance. She also stated that many employers are happy with the or- dinance because they have been in favor of a smoke-free workplace but have been unwilling to establish their own policy. Now if anyone complains, they can blame it on the city and county elect- ed officials. Sam Manolakas, president of the Sac- ramento Restaurant Association, said that their strategy in the referendum campaign will be to portray the ordi- nance as unfair to business. He also said that SFBP may put up its own ordi- nance for the public to vote on, with a 50% nonsmoking area in restaurants and reinstatement of the old workplace policy that required "reasonable accom- modation" between smokers and non- smokers. Using San Francisco as an ex- ample,' Sacramento could be facing a multimillion-dollar campaign. It will be difficult for the tobacco in- dustry to argue that the law is unpopu- lar or unworkable since the city ordi- nance has been working well. It is expected that a steering committee will be formed to spearhead the effort in Politics of Local Tobacco Control-Samuels & Glantz 2115

•  The Legislative Counsel has concluded that Proposition 99 does not allow the Governor to redirect funds away from tobacco education and prevention programs to medical service programs.  Under Section 43 of Assembly Bi1199 (AB 99), which established 1991-92 spending allocations, all tobacco tax revenues will go to medical service programs by the 1997-1998 fiscal year. Under the Governor's revised 1991-1992 and proposed 1992-1993 budgets all tobacco tax revenues will go to medical service programs by the 1996-1997 fiscal year. Unless changed, these major budget decisions made by the Legislature and the Wilson Administration, which ignore the mandate of Proposition 99, will eliminate tobacco educa- tion and prevention and tobacco research programs by the mid-1990s.  The tobacco industry has continued its efforts to influence tobacco policymaking in California. The industry spent a total of $2,746,124 on political activity at the state and local levels in California in 1991.  A total of $436,127 was contributed by the tobacco industry to legislative office- holders and candidates including the Democratic and Republican party committees in 1991. In 1991, the industry increased the rate of contributions to legislative officeholders and candidates by 50 percent compared to rate of industry contributions in the previous two election cycles.  Assembly Speaker Willie Brown accepted a total of $112,000 from tobacco • interests in 1991. Contributions to the Speaker in 1991 were almost double the amount he received in the 1989-1990 election cycle and almost matched the amount of all tobacco contributions he received from 1980 to 1988.  Philip Morris contributed $25,000 to Governor Wilson's inauguration committee and hosted a $5,000 a plate dinner for Governor Wilson and the Republican Party.  The tobacco industry spent a total of $1,733,566 on lobbying in 1991. The largest total amount of tobacco funds was received by the lobbying firm of Carpenter and Associates, $361,180. Other firms hired by the tobacco industry included Lang/Mansfield, Governmental Associates, Neilsen, Merksamer, A-K Associates, and Wendt-Loper.  The health education campaign funded by Proposition 99 has encouraged local jurisdictions to protect nonsmokers. In response, the tobacco industry has more than tripled its efforts to defeat local non-smoking ordinances in California in just one year. The industry spent at least $539,931 in 1991 to influence local campaigns including referenda campaigns to overturn ordinances in Sacramento County, Visalia, Oroville, and Long Beach.  In addition to sponsoring referenda campaigns against local ordinances, the tobacco industry also contributed funds to some local officeholders and candidates in 1991. For example, Los Angeles City Councilman Richard Alatorre accepted a total of $5,500. Another Los Angeles Councilman John Ferraro accepted a total of $4,500 from the tobacco industry in 1991. Los Angeles Mayor Tom Bradley accepted a total of $6,000 of tobacco funds in 1991. These were the largest contributions made to local officeholders and candi- Ln dates. ~' ~ N m • W (PI dl 213

• • • fails to make such a commitment, the tobacco industry prevails, more by de- fault than because it has superior finan- cial resources. 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- al's report on passive smoking,s 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.e 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." 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 smoking re- strictions has been reasonably good. Unfor- tunately, our record with 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- tle over smoking restrictions as decisively in bits and pieces-at the local level-as with state or federal measures [emphasis 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 "smokers' rights" move- ment. In 1990, RJ Reynolds chief execu- tive James Johnston stated, "This is something I wish we had done a decade ago."" By attempting to counter grass-roots pressure for nonsmoker protections, the tobacco industry had to confront the JAMA, October 16, 1991-Vol266, No. 15 203 fact that it had little credibility with the public. A national poll that was conduct- ed for the Tobacco Institute in 1978" highlighted the tobacco industry's prob- 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 ban on smoking in public places." Another study done for the To- 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 issue) does move a signifi- cant number of respondents into the 'yes' column [supporting a nonsmokers' rights measure]." In 1989, of nine na-. tionally recognized special interest groups, the Tobacco Institute had the lowest public credibility and the most negative ratings." As a result, the insti- tute's lobbyists 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. They just sneer us away ... so I try to work behind the scenes when- ever I can.116 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 Morris and RJ Reynolds, the two dominant US cigarette manufactur- ers, both have active programs to iden- tify smokers and mold them into a politi- cal force to counter genuine grass-roots pressure for nonsmoker protections. These programs 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 political involvement." Nei- ther company will disclose how much money it has devoted to the smokers' rights effort.Y The cigarette manufacturers use pub- lications such as Philip Morris Maga- zine and newsletters such as Smokers' Advocate (Philip 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. Toll-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 paying the participants to come, but that it was 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.19(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-Samuels & Glantz 2111

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s 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 organizaticn 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.a° 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 would 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 smoking. 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 considered. The Ordinance At the hearing before the County Board of Supervisors, the tobacco in- dustry flew 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 Gary 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 Brother' approach to government. s30 In contrast, 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 also cited the health evidence and the encouragement by the health coalition as the key factors in convincing him that they were dealing with a serious public health issue. Citing the need to protect the health of workers in the workplace, Supervisor 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 supervisors 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 was 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 Environ- 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 2114 JAMA, October 16, 1991-Vol 266, No. 15 Politics of Local Tobacco Control-Samuels & Glantz 206

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• • • 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 impact study of the proposed ordinance.p' The report was 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 $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 wasn'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.'B 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 $500 for larger restaurants. However, in a survey of restaurants listed as members of RSVP, only 13% said they had con- tributed money. Thus, even if all the restaurants that contributed to RSVP donated the $500 maximum, this would yield only $28 600.'A 7b 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, October 16, 1991-Vol 266, No. 15 205 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 with 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 (Table 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 Tobacco 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 workers 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 ordinance, did influence some votes; Councilman Zev Yaroslavsky re- ported that the ratio of his mail in sup- port of the ordinance was 20:1." 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 Angeles (Calif) City Council Mem- bers' Receipt of Tobacco Industry Money and Their Vote on the Proposed Ordinance to Prohibit Smok- Ing in All Restaurants• ouncll Members Tobacco Industry Csmpalgn Contributions, $ ote Nate Holden 1000 No Michael Woo 1000 No Gloria Molina 900 No Richard Alatorre 500 Absent Hal Bernsen 500 No Robert Farrell 500 Yes John Ferraro 500 No Joy Picus 500 Yes Ernani Bernardi 0 Yes Marvin Braude 0 Yes Joan Milke Flores 0 Absent Ruth Galanter 0 Yes Gilbert Lindsay 0 Absent Joel Wachs 0 No Zev Yaroslavsky 0 Yes •From January 1, 1989, through December 31, 1990?-"""' 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

T o b a c c o C o n t r o 1 i n C a I i f o r n i a C i t i e s authority should rest with both law en- forcement agencies and with local or state government agencies such as pub- lic health departments. Secretary Sul- livan and other tobacco control activists propose the establishment of a licensing system that would fund enforcement and tie compliance with laws to selling to- bacco products. Fifth, there is the issue of who should be culpable and for what. Some have argued that the owner or manager of a store selling tobacco products should be fined for not setting and enforcing pol- icies. The establishment of a licensing system would address this issue because stores would be punished for violations, including the loss of their license to sell any tobacco. Others have suggested that minors should be held accountable by making possession and use of tobacco illegal. The effects of these different op- tions need further evaluation. The interpretation of the findings of this study should be considered in light of several potential design limitations. First, the design did not allow a test of the independent effects of education and enforcement. Thus, it is unclear whether enforcement alone would have achieved the same outcomes. Second, a truer cross section of merchants would have been obtained if sampling occurred on sev- eral different days and times. Third, the absence of data from some stores at the three data collection points may limit the conclusions derived, although sta- tistical analysis of potential differences was not significant. The results of this study illustrate the complexity of the problem regarding ac- cess to tobacco products by underage youth. An over-the-counter sales rate of 21% still provides minors with access to tobacco, although it is possible that this level of sales may serve as an ef- fective impediment to minors who are not yet addicted or who are contemplat- ing use of tobacco or are already in the early stages of use. Unfortunately, there are virtually no data on the relationship between reductions in tobacco access and youth smoking prevalence. In the case of alcohol, however, there is a mod- erate amount of literature on the effects of raising the minimum age of purchase, alcohol availability, and prohibition of consumption.141e Although this study demonstrated that active enforcement of sales-to-minors laws is an effective and viable way to reduce sales of to- bacco products to minors, the most fun- damental question has yet to be an- swered -what effect does decreased ac- cess by underage youth have on their use of tobacco? This project was sponsored by the Solano County Cancer Prevention Program of the North Bay Health Resources Center, Petaluma, Calif, and was supported by a grant from the Henry J. Kai- ser Family Foundation, Menlo Park, Calif. References 1. Surgeon General. The Health Consequences of Snaoking.• Nicotine Addiction: A Report of the Sur- geon General. Washington, DC: US Dept of Health and Human Services; 1988. US Dept of Health and Human Services publication 88-8406. 2. Fleming R, Levanthal H, Glynn K, Ershler J. The role of cigarettes in the initiation and progres- sion of early substance abuse. Addict Rehav. 1989;14:261-272. 3. Greydanus DE. Routing the modern Pied Piper of Hamelin. JAMA. 1989;261:99-100. 4. Yamaguchi K, Kandel DR. Patterns of drug use from adolescence to young adulthood, I I: sequences of progression. Am J Public Health. 1984;74:668- 672. 5. Yamaguchi K, Kandel DB. Patterns of drug use from adolescence to young adulthood, III: predic- tors of progression. Am J Public Health. 1984;74:673-681. 6. University of California (San Diego), California Department of Health Services. Tobacco Use in California, 1990. Sacramento, Calif: Department of Health Services; 1990. 7. DiFranzaJR, TyeJB. Who profits from tobacco sales to children? JAMA. 1990;263:2784-2787. 8. kirn TF. Laws ban minors' tobacco purchases, but enforcement is another matter. JAMA. 1987;257:3323-3324. 9. Altman D, Foster V, Rasenick-Douss L, Tye JB. Reducing the illegal sale of tobacco to minors. JAMA. 1989;261:80-83. 10. DiFranza JR, Norwood BD, Garner DW, Tye JB. Legislative efforts to protect children from tobacco. JAMA. 1987;257:3387-3389. 11. Model Sale ofTobacco Products to Minors Con- trol Act: A Model Law Recommended for Adoption by States or Localities to Prevent the Sale of To- bacco Products to Minors. Washington, DC: US Department of Health and Human Services; May 24, 1990. 12. Youth Access to Cigarettes: A Report of the Office of the lnspector General, New York. New York, NY: Office of the Inspector General; 1990. 13. Altman DG, Rasenick-Douss L, Foster V, Tye JB. Sustained effects of an educational program to reduce sales of cigarettes to minors. Am J Public Health. 1991;81:891-893. 14. Ashley MJ, Rankin JG. A public health ap- proach to the prevention of alcohol-related health problems. Annu Rev Public Health. 1988;9:233- 271. 15. US Department of Health and Human Ser- vices. Surgeon General's Workshop on Drunk Driv- ing: Proceedings. Washington, DC: US Dept of Health and Human Services; 1989. 16. Holder HD. Environmental restrictions and effective prevention policy. Adv Subst Abuse. 1987;1(suppl 1):405-432. 17. Holder HD, Saltz RF. Research opportunities in environmental and community prevention strat- egies. Presented at the Institute of Medicine Panel on Opportunities for Research on Prevention of Alcohol-Related Problems; January 20,1988; Wash- ington, DC. 18. Milgram GG, Nathan PE. Efforts to prevent alcohol abuse. In: Edelstein BA, Michelson L, eds. Handbook of Prevention. New York, NY: Plenum Press; 1986:243-262. JAMA, December 11, 1991 -Vol 266, No. 22 Education and Enforcement to Reduce Tobacco Sales-Feighery et al 3171 218

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s 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 (which had become an ongoing organiza- tion) stated that the 30% figure, which was 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%."' No docu- mentary evidence has ever been provid- ed to support the 30% claim. As more cities in California 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 restaurants."' 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, 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 Creek 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 lbbac- 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. The involvement of the Manatt, Phelps, Rothenberg, and Phillips law firm and of the Ogilvy and Mather public rela- tions and advertising firm at both the national and local levels, as well as the involvement of attorneys associated with Vigo 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 successfully battle tobacco control legis- lation at the state and national'•Y s' 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 legislatures by pushing for weak state legislation with a preemption clause that overturns 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- ployment 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 minimizing 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. Furthermore, 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 without 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 2116 JAMA, October 16, 1991-Vol 266, No. 15 Politics of Local Tobacco Control-Samuels & Glantz 208

• 0 • Table 1.-Cohort of Stores Visited at Pretest and Posttest 1 to Determine Percentage of Stores Selling Tobacco to Minors ariable June 1988 Pretest, No. of Stores (%) December 1988 Posttest 1, No. of Stores (%) ' % Change Pretest to Posttest It (95 % Confidence Interval, %)$ All stores 77 (77) 77 (65) NS -12 (1,-24) Over-the-counter sales 64 (73) 64 (59) NS -14 (0,-28) Vendingmachinessales 13 (92) 13 (92) NS -0 (21,-21) •NS indicates a significance level >.05. tPercent in pretest-percent in posttest 2. $95 % confidence Interval calculated for change using sample with data at pretest and posttest 1. Table 2.-Cohort ot Stores Visited at Pretest and Posttest 2 to Determine Percentage of Stores Selling Tobacco to Minors ariable June 1988 Pretest No. of Stores (%)' May 1990 Posttest 2 No. of Stores (%) } % Change Pretest to Posttest 2$ (95 % Confidence Interval, %)§ All stores 104 (75) 104 (35) <.0001 -40 (-26,-55) Over-the-countersales 87 (71) 87 (24) <.0001 -47 (-31,-64) Vending machines sales 14 (93) 14 (93) NS 0(20,-20) •The numbers for over-the-counter sales (87) and vending machine sales (14) do not add up to the number for all stores (104) because three stores were dropped trom the analysis since tobacco was purchased differently between tests (eg, one time by over-the-counter and one time by vending machine). iNS indicates a significance level >.05. $Percent in pretest-percent in posttest 2. §95 % confidence interval calculated for change using sample with data at pretest and posltest 2. sentences, placed those cited on infor- mal probation, and imposed $50 fines as a condition of probation. One judge sus- pended the sentences of all nine persons issued citations and although they were found guilty, the individuals were not required to pay a fine. Interviews were conducted with two judges to learn why these decisions were made. Three primary reasons were given. First, the judges were reluctant to establish criminal records for citizens with no prior criminal history. Since it is a misdemeanor in California to sell tobacco to a minor, convicted violators will have lifetime criminal records. Sec- ond, the judges believed that a $200 fine placed an unfair burden on store em- ployees, many of whom worked for min- imum wage. California law states that the clerk who sold tobacco illegally, rather than the manager or store owner, is cited. Third, judges believed that vi- olations of the law on tobacco sales to minors were far less serious than most of the other cases they face daily. As a result, judges treated violators leniently, particularly first-time offenders. Unlike the California law regulating sales of alcohol to minors, judges interpreted the tobacco sales law as providing them with discretion in determining the pen- alties, if any, imposed. COMMENT This study illustrated that enforce- ment of laws regulating sales of tobacco products to minors had a significant ef- fect on over-the-counter sales above and beyond that obtained through commu- nity and merchant education alone. Given the small amount of time spent by each police department to implement the intervention, our findings suggest that enforcement is a feasible way to reduce tobacco sales to minors. While education alone yielded a rel- atively small reduction in illegal sales of tobacco products to minors, it did gar- ner broad community support and set the stage for the more punitive action of police department enforcement. Edu- cating merchants and the community at large about the law demonstrated to the police departments that a serious effort was made to obtain voluntary compli- ance with the law. When educational efforts fell short of project goals, police departments were willing to take ac- tion. Additionally, because police depart- ments are public servants and therefore sensitive to community pressure, pre- senting evidence of the problem and sup- port from the local media and commu- nity leaders influenced their decisions to enforce a law that is largely ignored throughout the state and nation. Since this project modeled its educa- tional intervention on the Santa Clara County project,9 we expected to achieve similar reductions in over-the-counter sales due to education alone. In retro- spect, there were two major differences in program implementation that may ac- count for our educational intervention not reducing tobacco sales significantly. The first difference is the type of com- munity. The four intervention cities in Solano County are small and suburban, whereas the cities in the Santa Clara 3170 JAMA, December 11, 1991-Vol 266, No. 22 County study, one of which was San Jose, the 11th largest city in the United States, were primarily urban. Second, while we used local print and radio me- dia extensively, we were generally un- able to capture the attention of the larger San Francisco Bay area television me- dia market as was accomplished in the Santa Clara study. We did, however, get some television coverage when police de- partments started issuing citations. There are several disappointing out- comes of the intervention to date. First, vending machine sales were unaffected. This provides support for the elimina- tion of all tobacco vending machines, an action called for by Department of Health and Human Services Secretary Louis Sullivan and several prohealth groups. Community experiences with partial vending machine bans (eg, vol- untary surveillance of machines by re- tailers, the use of locking devices or to- kens, or limiting machines to adult loca- tions) in limiting vending machine sales of tobacco to minors are not encouraging. The second outcome was the judges' dismissals of charges and reductions of fines when store clerks who received citations appeared in court. This was particularly disappointing in light of the broad community support and police commitment to enforcement. Continued lack of punishment would eventually act as a deterrent to police involvement and would weaken the effectiveness of po- lice enforcement efforts in the commu- nity. Additionally, merchants would again flaunt the law knowing that cita- tions would not be upheld in court. Fol- lowing this study, however, when new citations were processed through the same courts, the judges were far less lenient than they were when first con- fronted with this type of case. This sug- gests that the court system can be stim ulated to respond when repetitive vio- lations occur. Third, although it is clear that mer- chant behavior can be affected signifi- cantly by active enforcement of the law by police departments, multiple prob- lems with access laws exist. Given that the dockets of criminal courts are gen- erally overloaded, these courts are in- appropriate vehicles for the disposition of access violations. Also, judges' reluc- tance to establish criminal records for citizens with no prior convictions must be recognized. Both of these problems lend support for access laws to be con- sidered as civil rather than criminal of- fenses and processed administratively rather than through the criminal justice system. Fourth, the responsibility for enforce- ment has implications for the success of access laws. To increase enforcement, Education and Enforcement to Reduce Tobacco Sales-Feighery et al 217

• • • A P P E N D I X 0 The Effects of Combining Education and Enforcement to Reduce Tobacco Sales to Minors A Study of Four Northern California Communities Ellen Feighery, MS; David G. Altman, PhD; Gregory Shaffer, MA Objective.-To examine the effects of a community education and law en- forcement intervention on illegal tobacco sales to minors. Design.-A 2-year, before and after trial with retail stores as the unit of anal- ysis. Setting.-Implementation occurred in four suburban California communities with populations of 25000 to 100000. Participants.-AII the retail stores in one intervention community and half the retail stores, randomly selected, in the other three intervention communities (n = 169) were visited by minors aged 14 to 16 years with the intent to purchase tobacco. Intervention.-Ongoing community and merchant education and four law enforcement operations were conducted. Main Outcome Measures.-Over-the-counter and vending machine sales of tobacco to minors were the primary outcomes. Results.-Among a cohort of stores visited by minors at the pretest (n = 104) in June 1988, 71 % sold tobacco over the counter and 92% sold tobacco through vending machines. At posttest 2 in May 1990, 24% sold tobacco over the counter and 93% sold tobacco through vending machines. Of the 31 stores issued ci- tations, 16 were followed into the courts where the fines were dismissed or re- duced. Concluslons.-Education alone had a limited effect on reducing illegal tobacco sales to minors. It did promote community support for more aggressive enforcement strategies. Education plus enforcement decreased significantly over-the-counter sales; vending machine sales were unaffected by these inter- ventions. The lack of support at the judicial level may temper the effectiveness of enforcement. Legislative remedies addressing judicial obstacles and vend- ing machine sales are needed. EASY access to tobacco products by adolescents is a major public health prob- lem. Approximately 75% of current From the Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, Calif (Ms Feighery and Dr Altman) and the North Bay Health Resources Center, Petaluma, Calif (Mr Shaffer). Reprint requests to the Center for Research in Dis- ease Prevention, Stanford University School of Medi- cine, 1000 Welch Rd, Palo Alto, CA 94303 (Ms Feigh- ery). (JAMA. 1991;266:3168-3171) smokers become addicted to tobacco by the age of 18 years, generally before it is legal for them to purchase tobacco products.' The importance of prevent- ing early tobacco use is reinforced by data illustrating that tobacco is the ini- tial drug of preference for young people and that its use is associated with other drug use.'-6 A 1990 report of tobacco use in Californias found that current smok- ing status was 3.3% in 12- and 13-year- olds, 9.5% in 14- and 15-year-olds, and 19.1% in 16- and 17-year-olds. The rate for 16- and 17-year-olds is just 2% less than that of the overall California adult population. This study also identified ex- perimenters: 12.9% of 12- and 13-year- olds, 29.4% of 14- and 15-year-olds, and 40.8% of 16-and 17-year-olds. Nationally, in 1988, more than 3 million Americans under the age of 18 years consumed al- most 1 billion packs of cigarettes and 26 million containers of smokeless tobacco, accounting for approximately 3% of an- nual tobacco industry profits.' These data illustrate that minors are obtaining to- bacco readily. See also pp 3159 and 3186. Indeed, in field trials around the coun- try, minors have purchased tobacco suc- cessfully from stores and vending ma- chines 70% to 100% of the time (E.F., unpublished data,1991).&1e In May 1990, Louis Sullivan, MD, Secretary of the Department of Health and Human Ser- vices, wrote: "Access of minors to to- bacco is a major problem in every state of the nation. About three-fourths of the million outlets which sell cigarettes to adults also sell cigarettes to minors. These stores ignore the laws of their states because enforcement is almost nonexistent."" The Inspector General's Office of the Department of Health and Human Services found blatant disregard of the laws that prohibit the sale of to- bacco to minors by merchants, law en- forcement agencies, and communities at large. Specifically, they found only 11 active state and local jurisdictions where these laws were enforced.12 In one of 3168 JAMA, December 11, 1991-Vol 266, No. 22 Education and Enforcement to Reduce Tobacco Sales-Feighery et al 215

T o b a c c o C o n t r o I i n C a I i f o r n i a C i t i e s • these jurisdictions, Woodridge, 111, il- legal sales to minors in the 26 stores licensed to sell tobacco were eliminated due to a tobacco retailer licensing ordi- nance and active law enforcement. This impressive finding should be interpreted in light of the fact that in the four vil- lages contiguous to Woodridge, tobacco sales to minors occurred in 94% of the stores. Thus, tobacco is still readily ac- cessible to Woodridge minors. The cur- rent study evaluates an intervention, also cited in the Inspector General's re- port, that combined merchant and com- munity education with active enforce- ment of the California law by local police departments. The goal was to reduce tobacco sales to minors by 50%. Laws regulating sales of tobacco prod- ucts to minors differ from state to state. California law prohibits the sale and pur- chase of tobacco products to and by any- one under the age of 18 years. Retailers who break this law are subject to a mis- demeanor with a first-offense fine of $200, a second-offense fine of $500, and a third-offense fine of $1000. As of Jan- uary 1, 1989, minors caught purchasing tobacco are subject to a fine of $50 or 25 hours of community service work. METHODS In 1988, the Solano County Cancer Prevention Program embarked on a com- munity-wide efforL to reduce the illegal sale of tobacco to minors. The four tar- geted cities in Solano County, California (Benicia, Fairfield, Vacaville, and Vallejo), with populations ranging from 25000 to 100000, account for approximately 85% of the county's 340000 residents. These are suburban communities separated from each other by 8 to 24 km. Tobacco sales to minors (yes or no) was the primary outcome variable of the study. Data were collected at the pretest (June through August 1988); posttest 1, after an education-only in- tervention (December 1988); and post- test 2, after an education plus law en- forcement intervention (May 1990). Data were anahvzed using the McNemar non- parametric test. In June through August 1988 (pre- test), 20 youths ranging in age from 14 to 16 years were recruited through local community agency contacts and escorted to 169 stores in the four intervention cities to purchase tobacco. The 14- to 16-year-old age group was selected be- cause this is generally when experimen- tation and adoption of smoking behavior occurs. The stores comprised approxi- mately half of all the retail outlets in each city with the exception of Benicia where all tobacco retailers were sur- veyed. The outlets in the other three cities were selected randomly from lists JAMA, December 11, 1991-Vo1266, No. 22 generated from the telephone company yellow pages and the county health de- partment's listing of eating establish- ments. The outlets included grocery, li- quor and convenience stores, restau- rants, pharmacies, and gas stations. In September 1988, a comprehensive educational intervention directed at mer- chants, law enforcement agencies, and the community at large was begun. The intervention included widely publiciz- ing the results of the pretest through the local media; making presentations to city councils, the county board of su- pervisors, and community organizations; and mailing educational packets to all tobacco retailers in the four cities. The packets included a cover letter that de- scribed the results of the first survey and why it was important to comply with the law, a copy of the law, warning stickers for cash registers, employee ed- ucation materials, and a list of individ- uals and community organizations sup- porting the project. In December 1988, half of the stores visited at the pretest were selected ran- domly and visited by eight of the orig- ina120 minors (posttest 1). A total of 83 stores were visited. Because the results of this visit fell short of project expec- tations to reduce sales by at least 50%, face-to-face interviews were conducted with 17 merchants to discover why the educational effort did not achieve the results of a similar study in Santa Clara County, California.b•13 Merchants re- ported the following: (1) frustration that minors could purchase tobacco products easily from other local sources, making it a disincentive to change their prac- tices; (2) knowledge that the law was not enforced and a belief that without the sanctions of active enforcement, business as usual was acceptable; and (3) belief that the most effective method to stop sales to minors was by active en- forcement. The results of the store sur- veys and the merchant interviews were communicated to local police departments with requests to enforce the law. In November 1989, a law enforcement intervention was added to the ongoingg educational intervention. Four police de- partment enforcement operations (ie, "stings") were conducted by three po- lice departments. Upcoming police vis- its to stores were announced in local newspapers. A total of 90 stores were visited by underage police cadets; 34% of the stores sold tobacco products and received citations. Each enforcement ef- fort required about 8 hours of each po- lice department's time, half of which was spent visiting the stores and the other half on paperwork. The results of this police activity were reported in the local media, including the names of violators and stores. In May 1990, following police enforce- ment activities and continued education, 15 male and female minors aged 14 to 16 years who had not participated previ- ously in the project visited 145 stores in the four cities with the intent to pur- chase tobacco (posttest 2). Of the orig- inal 169 outlets visited in June through August 1988, 104 were revisited in May 1990. The 65 stores not visited in May 1990 either went out of business, did not sell tobacco products, or could not be located by project staff members. At posttest 2, 41 of the 145 stores visited had not been visited previously. To ex- amine the representatives of the 104 stores that were visited at the pretest and posttest 2, two analyses were con- ducted. The first, an analysis of pretest data, compared stores with pretest data only (n = 65) to stores with pretest and posttest 2 data (n = 104). The second, an analysis of posttest 2 data, compared stores with posttest 2 data only (n=41) to stores with pretest and posttest 2 data (n = 104). Neither of these analyses was significant, suggesting that the 104 stores visited at the pretest and post- test 2 were representative of the entire sample of 210 different stores visited over the course of the intervention (169 at the pretest, 41 at posttest 2). Because the California law was not enforced prior to the intervention, we wanted to document how judges inter- preted it. In the summer of 1990, staff members followed half ofthe store clerks cited for selling tobacco to minors through the county court system and interviewed each judge after court ses- sions to obtain explanations of their decisions. RESULTS Overall, 73% (n = 169) of stores sold tobacco to minors at the pretest, 68% (n = 83) sold tobacco at posttest 1, and 31% (n = 145) sold tobacco at posttest 2. Over-the-counter sales dropped from 72% at the pretest (n = 144), to 62% (n = 69) at posttest 1, and to 21%(n = 122) at posttest 2. Vending machine sales were 84% at the pretest (n = 25), 93% at posttest 1 (n = 14), and 83% (n = 23) at posttest 2. Table 1 presents data from the cohort sample of stores visited at both the pretest and posttest 1, and Ta- ble 2 presents data from the cohort of stores visited at both the pretest and posttest 2. Following the issuance of citations, 16 of the 31 merchants who received citations were followed through the ju- dicial system by Solano County Cancer Prevention Program staff members to track the disposition of the cases. In seven cases, the judges suspended the Education and Enforcement to Reduce Tobacco Sales-Feighery et al 3169 216 i •

• • stage of the process, even the most com- mitted 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. Raferences 1. Taylor P. The Smoke Ring. New York, NY: Pantheon Books Inc; 1984:189-207. 2. Sylvester K. The tobacco industry will walk 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- proaehes to a Smokefree Society. Berkley, Calif: Americans for Nonsmokers' Rights Foundation; 1986:1-7. 4. Glantz SA. Achieving a smoke-free society. Cir- culation.1987;76:746-762. 5. Pertachuk M, Shopland DR, eds. Major Local Smoking Ordinances in the United States. 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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 Times. May 21,1987. 25. RJ Reynolds Inc. In the news. Choice. 1987;1:4. No. 6. 26. Jacobs C. Ban on smoking in L. A. restaurants is snuffed out, for now. Los Angeles Business J. October22, 1991. 27. Laventhol & Horwath. Preliminary Analysis of the Impact of the Proposed Los Angeles Ban on Smoking in Restaurants. Los Angeles, Calif: La- venthol & Horwath; October, 1990. 28. Fitch A. Municipal Legislative Advocate Quarterly Expenses and Earnings Report. Los Angeles, Calif: City Hall; July-December 1990. Begay, PhD, Roy Brewer, Valerie Burrows, Julia Carol, Rudy Cole, Adam Dados, Jacquolyn Duerr, Kevin Goebel, Anna Hazan, PhD, Robin Hobart, Grantland Johnson, Jack Johnston, Dian Kiser, Paul Knepprath, Sam Manolakas, Rob McCray, Bob McNatt, Dave Monk, Candace Moorman, Mark Pertschuk, Tim Pueyo, Lynn Robie, Alice Reimche, Jerry Reiss, Anne Rudin, Ron Saldana, Eilleen St Yves, Randy 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. Sacramento Bee. September 12, 1990:A1. 31. Sacramentans for Fair Business Policy. Gener- al Purpose Recipient Committee Statements. Sac- ramento, Calif: City and County Clerks; January 1- December31,1990. 32. Secretary ofState. 1991-92DirectoryofLobby- ists, Lobbying Firrn.s, and Lobbyists Employers. 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