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, Nonsmokers Rights Foundation 2054 University Avenue, Suite 500 perkeley, CA 94704 (415) 841-3032 i J ee

'1'tll'~Al;(JU .[N~3'`i'lTU'I'[i'. LLRRARY Legislative Approaches to a Smoke Free Society Peter Hanauer Glenn Barr Stanton A. Glantz with a foreword by Jesse L. Steinfeld AMERICAN NONSMOKERS' RIGHTS FOUNDATION Berkeley, California REC'D t; iA Y 6) j:11 Il Ia

ii Copyright © 1986 by American Nonsmokers' Rights Foundation 2054 University Ave., Suite 500, Berkeley, California 94704 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, includ- ing photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. ISBN 0-9616473-0-2 987654321 This book is dedicated to the volunteers and contribu- . tors who stayed with the nonsmokers' rights movement in the early years when the cause was not always pop- ular and the tobacco companies seemed to be winning. Thanks to their hard work and loyalty, smoke-free air is fast becoming a reality. iii

w iv "I don't think the kind of thing they're doing [in Califor- nia] is exportable." Walker Merriman Vice President, the Tobacco Institute Los Angeles Times, February 17, 1986 Foreword v It was lonely in the early 1950's in the National Cancer Institute to be a nonsmoker and to be even modestly or moderately militant about that stance. While evidence was accumulating that the epi- demic of lung cancer among adult American males was under way and that 90 percent of victims of lung cancer were inveterate cigarette smokers, the issue had not yet been tied together by evidence from retrospective and prospective epidemiologic studies, pathologic stud- ies of human lungs and experimental animal studies. The early ret, rospective epidemiologic studies compared current cigarette smokers with those who were no longer smokers or who had never been smok- ers. The first necessary goal was to show that, there was a higher in- cidence of and mortality from lung cancer among cigarette smokers as compared with the nonsmokers. In my own mind in the 1950's I felt that there were no true nonsmokers in our society, unless a per- son were a nonsmoking hermit, who disdained all contact with other members of the human species. During the early 1950's just about all of my c.hiefs in t.he Na- tional Cancer Institute smoked and in later years a series of directors of the National Cancer Institute smoked cigarettes, cigars or pipes. It is small wonder that my requests for "no smoking" in meetings, conferences and poorly ventilated areas were quickly, laughingly and overwhelmingly rejected. Further, during the 1950's and 1960's I had the temerity or lack of intelligence to approach the leadership of the American Associa- tion for Cancer Research, the American College of Physicians, the American Medical Association and the American Cancer Society and

vi to suggest the desirability of a "no smoking" rule during meetings of those organizations as a standard for the rest of the medical profes- sion and of society. I was not successful. Scientific information on smoking and disease continued to accu- mulate and by the time I became Surgeon General in 1969, it was clear that, even with all the other problems facing the country, smok- ing was the number one public health problem in the United States and I so indicated in numerous speeches. That position in 1969 was still unpopular. In fact, the Clearinghouse on Smoking and Health under Dr. Daniel Horn's leadership, was faced with extinction each year from 1969 to 1973 as a result of vigorous lobbying by tobacco in- terests. I am pleased that we were successful each year in saving the Clearinghouse from total destruction and, in its current form, the Of- fice on Smoking and Health provides world-wide reference standards, on which public health and other programs are based. It was during my first year as Surgeon General that I realized that the tobacco interests were perfectly willing and content for physicians and scientists to do more and more research on identifying the exact chemicals, radiation, viruses and oncogenes that cause the neoplastic process, and were not opposed to physicians and scientists educating each other about the latest discoveries. Discussions among scientists about methylcholanthene or dibenzanthracene resulted in very little change in the American public's habits. It became clear to me that this nation, while it can always use scientific research, needed more than scientific research: It needed social action. It was at that point that I made a national plea for citizens to take up the nonsmokers' rights movement. The tobacco industry became incensed! As I review the fifteen years since then, the major progress that has been made came from those groups who initiated social actions, including legislation for nonsmokers' rights. It is not possible to mention all of the pioneers, but there were many who placed their personal, professional or political careers on the line to spearhead the movement. A small group, or even a single dedicated individual, can make a profound difference in the health of his fellow men and women. Most of us who have been involved early have been called for advice from Vll around the United States by groups in states, cities or towns when a legislative issue was about to be voted on. The advice was informal and probably incomplete. Until now, there has been no compendium on how to conduct a campaign to achieve maximum effects utilizing minimum resources. (Minimum resources will always be the lot of the nonsmokers' rights movement. ) Americans for Nonsmokers' Rights (formerly Californians for Nonsmokers' Rights) has more legislative experience in success- fully combatting the tobacco industry than any other group. Peter Hanauer, Glenn Barr and Stanton Glantz have documented that ex- perience in this book. While every chapter and every suggestion will not be applicable in every political subdivision, there is much of merit and value here. New activist organizations will save time, effort and money and will move more rapidly toward having smoke-free air in public places in their communities through use of this book. I congratulate Americans for Nonsmokers' Rights on its many accomplishments. I trust that as you read, study and use this book, you will be rewarded by the satisfaction of helping to clear the air for everyone. Jesse L. Steinfeld, M.D. Augusta, Georgia March, 1986

I t vnl P refac e 0 ix The tobacco industry's money and political clout are legendary. Yet, in recent years, small groups of political activists, operating on a shoestring, have repeatedly defeated the industry and passed strong legislation protecting nonsmokers from the thousands of toxic chemicals in second-hand tobacco smoke. You can pass such legislation if You know the issues and how to deal with the tobacco industry. That knowledge, combinecl with a little money and a lot of hard work, will produce success. This book tells you how to pass nonsmokers' rights laws. Before starting to read it, you should learn the following basic principles, which will guide you in your work: • Tobacco smoke is a serious form of indoor air pollution more serious, in fact, than outdoor air pollution. • The vast majority of the population, both smokers and non- smokers, supports restrictions on smoking in public places and workplaces. • Although some business organizations will oppose nonsmokers' rights legislation, the only real opposition will come froni the tobacco industry, which fears loss of sales as smoking becomes socially unacceptable. . No one likes the tobacco industry; the industry has no credi- bility with the public.

xi x Acknowledgements • Nonsmokers' rights laws have been on the books for years in California and throughout the country. They have worked well and have had broad public support. • The central strategy in passing nonsmokers' rights laws is to isolate the big (out-of-town) tobacco industry as the only op- ponent to a reasonable measure to protect the public health. This book is organized into two volumes. The first volume is a narrative that describes the issues and how to go about passing a law. Every key person in your organization should read it carefully before you begin a legislative campaign. The second volume is a collection of appendices containing important documents of a; technical nature as well as samples of brochures, press releases, action letters and other materials you will need. Different people in your organization will find different parts of the appendix useful as your campaign progresses. ln planning these volumes, we were convinced that they would be useful only if they were comprehensive in every sense of the term. We believed that anyone making a serious attempt to pass legislation must have at his or her fingertips all the relevant information that we could assemble based on our many years' experience in the field. The time you invest in reading and absorbing this material will save you time, money and, possibly, defeat once you lock horns with the tobacco industry. You should treat these volumes as resource materials which can be constantly referred to rather than something to be read through once and put aside. We are confident that you will find them useful and we wish you every success in using them. The authors wish to acknowledge with grateful thanks the many valuable contributions to this book by other persons. Charles Mawson, former Legislative Director of Americans for Nonsmokers' Rights, put together much of the raw material on which the text is based and compiled much of the appendix. In a very real sense, he created a need for this book by successfully lobbying for non- smokers' rights legislation throughout California over a four-year pe- riod. Walt Bilofsky, Jay Matchett and Robert Stern, members of the Board of Directors of the American Nonsmokers' Rights Foundation, and Karen Krzanowski, Program Director of the American Lung As- sociation of Michigan, made numerous suggestions to improve the scope and wording of the book and provided materials for the Ap- pendix. Dr. Paul Magnus, Medical Associate to the Director of the National Heart Foundation of Australia, kindly permitted us to use his summary of the adverse health effects of second-hand smoke as the basis for Chapter 2. Michael Pertschuk, former Chairman of the Federal Trade Commission, kindly permitted us to use various ideas he had developed in preparing an organizing guide for anti-smoking groups in Latin America. John Finnegan, Jr., Director of Media at the Minnesota Heart Health Program, University of Minnesota, vol- unteered his time to do a final edit of the manuscript, and in the process offered several important suggestions for improving the text. The staff of the American Nonsmokers' Rights Foundation, Denise Kivlen, Mark Pertschuk, Julia Carol and Len Casey, spent many hours reviewing and preparing the text and appendix. The authors also wish to thank William Bloomfield, Sr., Joli Peter Hanauer Glenn Barr Stanton A. Glantz Berkeley, California March, 1986

xii Table of Contents xiii Quentin Kansil, Michael Parker, Joseph Shane and the Wallace A. Gerbode Foundation, whose generous financial assistance made pub- lication of this book possible. We also thank the American Cancer Society, California Division, which for years stood alone among the major voluntary health agencies in embracing the goals and methods of the nonsmokers' rights movement, and whose financial support and cooperation made it possible to develop the winning strategies this book documents. Finally, we wish to thank Paul Loveday, whose early leadership and tireless devotion to the cause laid the foundation for the success- ful nonsmokers' rights movement in California. P.H. G.B. S.G. Foreword v Preface ix Acknowledgements xi 1. A Short History of the Nonsmokers' Rights Movement I 2. The Health Hazards of Second-Hand Smoke 8 • What's in the Smoke that Nonsmokers Breathe? 11 • How Much Exposure do Nonsmokers Get? 12 • What are the Health Hazards of Passive Smoking? 14 • How Big is the Risk? Where is it Encountered Most? 18 • Physical Irritation and Discomfort: Who Wants it? 18 • How Strong is the Evidence? 18 3. Supporters and Opponents of Nonsmokers' Rights Legislation 23 • Natural Constituencies 24 • Potential Allies 25 • Certain Opponents 26 • Probable Opponents 27 • What About Smokers? 29 • Role of the Media 29

xiv xv 4. The Issues 31 • Telephone Trees 92 • The Need for Paid Staff 92 • The Health "Issue" 34 • Funding 93 • Is Legislation Necessary? 39 • Using External Resources 94 • Is Legislation Wanted? 42 • Scope of Legislation 43 8. Legislative Strategy 95 • Civil Liberties 44 • Knowing Your Local Political and Legislative Process 95 • Government Regulation 47 • Writing Your Legislation ; 96 • Costs 49 • Choosing Your Author 98 • Enforcement- 52 ' • Countering the Opposition s Strategy 99 onents and Opponents • Pro 53 p • Lobbying Individual Legislators 100 5. Scope and Types of Legislation 57 • Testifying and Choosing Spokespersons 102 • State vs. Local Legislation 57 • Organizing Grass Roots Pressure 103 • Comprehensive vs. Specific Legislation 58 • Second Readings: Keeping Up the Pressure 105 • Most Important Targets 59 • Lobbying the Chief Executive 105 • Ineffective Legislation 59 • Letters to the Editor 106 • Voluntary or Look-Alike Legislation 60 • Ammending Existing Legislation 106 • Legislation by Referendum 61 • A Case Study: The Los Angeles Ordinance 106 • Provisions Protecting "Rights" of Smokers 62 9. Dealing With the Media 109 • Specific Wording of Legislation: A Model Ordinance 62 • Importance of the Media 109 6. Experience With Existing Legislation: What the Record • Getting the Media to Work for You 111 Shows 83 • Press Releases 111 7. The Basics of Organizing 87 • Following Up Your Initial Contact 112 • At State or Local Level 87 • Press Conferences 114 • Leadership 88 • Media Events 117 • Forming an Organization 88 • Editorial Support 117 • Building a Coalition 89 • Editorial Replies 119 • Building Grass Roots Support 90 • Ways to Have Your Viewpoint Heard 119

xvi • Debates 120 • Keeping Records 122 • What to Tell the Media 122 About the Authors Appendix' 125 • Excerpts from "Clean Your Room! A Compendium on In- door Pollution," California Department of Constuner Af- fairs, February, 1982 • Excerpts from Indoor Pollutants, National Academy Press, 1981 J A. "A Study of'Public Attitudes Toward Cigarette Smoking and the Tobacco Industry in 1978," The Roper Organization, May, 1978; prepared for the Tobacco Institute I. Letter of support for a nonsmokers' rights ordinance from the Greater Riverside (California) Chambers of Comrnerce B. "Proposition P: Anatomy of a Nonsmokers' Rights Ordinance," Peter Hanauer, New York State Journal of Medicine, July, 1985 J. Celebrities who have supported nonsmokers' rights K. Data on smoking and fires C. Charts of California and national nonsmokers' rights laws D. "Bibliography on Involuntary Smoking," compiled by Stanton A. Glantz and Lydia Jensen E. 1986 Letter from Surgeon General C. Everett Koop to Ameri- cans for Nonsmokers' Rights summarizing the health effects of second-hand smoke • Known Causes of Residential Fires: National Figures for 1981, California Fire Incident Reporting System • Known Causes of Residential Fires: California Figures for 1981, California Fire Incident Reporting System L. "Tobacco Industry Conglomerates," Smoking and Health Re- porter, July, 1984 F. "Tobacco Smoke and the Nonsmoker" brochure M. Cost of smoking to business G. Testimony in support of nonsmokers' rights legislation before • Testimony of Professor Marvin Kristein before the United the United States Senate Subcommittee on Civil Service, Post States Senate Subcommittee on Civil Service, Post Office Office and General Services of the Committee on Governmental and General Services of the Committee on Governmental Affairs, September 30, 1985 Affairs, September 30, 1985 ~ • "How Much Can Business Expect to Profit rrom Smoking • James L. Repace Cessation?" M. Kristein, Preventive Medicine, 1983 ~ • Joseph A. Califano, Jr. • "Wanted: Smoking Policies for the Work Place," M. Kris- ~ • Alfred Munzer, M.D. tein, Business and Health, November, 1984 ~ • Stanton A. Glantz, Ph.D. • "A Smokefree Workplace," California Nonsmokers' R.ights C!1 Foundation 1985 P~+ 'The appendix is in a seperate volume. , xvll • Bill Ross H. Indoor air pollution studies