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Update on Smoke-Free States

Introduction

At the beginning of the 2003-2004 Governing Council term, six goals were selected to focus the efforts of the MSS. This report will provide an update on one of those goals: smoke-free workplaces. The purpose of this report is to make our members aware of those states that are active in smoke-free workplace reform, and hopefully inspire other states to get motivated and join coalitions in their home states to further such efforts. Another goal of this report is to update our members on the original states to pass smoke-free legislation, as well as some of our international neighbors who have passed smoke-free legislation in the past few years.

Background

When the 2003-2004 Governing Council took office, only five states (California, New York, Delaware, Maine and Connecticut) had established laws protecting employees and consumers from the deleterious effects of secondhand tobacco smoke. Most notably seen in New York, medical students began to take an active role in talking with legislators and working with state anti-tobacco coalitions to make progress in the fight. The challenge for this term is to make people more cognizant of this preventable source of morbidity and mortality and to get them more involved in the fight for smoke-free workplaces.

The plan for this year was to get the other forty-five states without smoke-free workplace legislative to become more active. The Smokeless States Initiative was promoted to chapters throughout the year. The hope was that students would use this resource to find the coalitions in their states that were already active and then use their numbers to aid in the effort. The Smokeless States Initiative is sponsored by a grant from the Robert Wood Johnson Foundation that is administered through the American Medical Association.

Seeing as that New York has the best experience in the marriage of medical students to smoke-free workplace reform, medical students from NY made a presentation at the National Projects Forum at the 2004 Annual Meeting. This allowed for NY to take on a mentor relationship with students from other states that are eager to join the fight for smoke-free workplaces throughout our nation. As more states become smoke-free, it is our hope that the mentoring network will expand.

Although the MSS has taken a strong stance against tobacco, we still look to our parent organization, the AMA, to support our efforts. This includes AMA support of any policy which will lead to smoke-free workplaces and a healthier environment for our constituents. The MSS will continue to seek the support of the AMA in the smoke-free workplaces campaign.

Finally, the MSS will keep the membership aware of activities on the international scene. As more and more countries become smoke-free, it should serve as an inspiration not just to medical students in the United States, but to our politicians and our constituents as well. People’s eyes must be opened to the dangers of cigarette smoking.

Action on the Part of MSS Chapters

Alabama: The University of Alabama-Birmingham Hospital is banning smoking on its property. Anyone caught smoking will be fined. There was a previous ban in place at the hospital, but that ban only covered the inside of the facility. The ban does not apply only to UAB hospital employees, but to patients and other visitors and guests as well.

Arkansas: The University of Arkansas for Medical Sciences, which is home to the state’s only medical school, also includes the college of public health, college of nursing, and pharmacy. The center is also home to one of the largest hospitals in the state. The University of Arkansas recently voted to make its entire campus totally smoke-free. The ban went into effect on July 4, 2004.

Kansas: The Kansas University chapter of the AMA-MSS formed a committee of ten students, which is dedicated to the smoke-free workplaces effort in Kansas. These students have combined forces with a member of the Kansas City Board of Health. The committee has signed up a group of people who are interested in smoke-free workplaces in and around the city, and those people will be featured in a directory of those who support smoke-free workplaces. The political phase of the campaign is in its infancy at this time, but the committee and the chapter is committed to educating local citizens about the dangers of tobacco use. Members of the committee have also attended several County Health Committee meetings and have spoken on behalf of the medical students in the area.

Massachusetts: Students from the University of Massachusetts Medical School, Harvard Medical School, Tufts University School of Medicine, and Boston University School of Medicine have been working closely with the Massachusetts Medical Society in their effort to make Massachusetts smoke-free. Their efforts have not gone in vain. A bill to support smoke-free workplaces was passed by both the Massachusetts state senate and the Massachusetts House of Representatives. In early May, this bill was voted out of conference committee and Governor Mitt Romney has promised to sign the bill as soon as it crosses his desk. The student section of the Massachusetts Medical Society has been an active member of a coalition of organizations that has been working to get this bill passed. There is also a medical student on the coalition leadership board.

Michigan: The AMA-MSS chapter at the University of Michigan would like to see Ann Arbor's restaurants and bars become smoke-free. The students believe that an important first step towards this goal would be to have a smoke-free night to show students and residents the benefits of smoke-free venues. If this event is successful, it can be used as an example in future efforts to make Ann Arbor completely smoke-free. The chapter leadership has chosen a popular campus sports bar and restaurant for their smoke-free event. On an average night, approximately 500 patrons visit the venue. There will also be approximately 10 student volunteers and coordinators available to run the event. The students plan on advertising this event as an advancement of the AMA, and will cite the AMA as a sponsor on all publicity materials. The chapter will also have a large AMA banner in the venue. The plan is to publicize this event in local and campus newspapers, as well as within the medical community. Furthermore, the students will be using this event as a recruitment tool for the incoming medical class. The event occurs on August 9, 2004.

Minnesota: The Mayo Medical School chapter of the AMA-MSS was heavily involved in an effort to make Olmsted County, Minnesota, smoke-free. The students worked with the Zumbro Valley Medical Society (ZVMS) to make this effort a success. The effort initially began in Rochester, Minnesota where Mayo Medical School is located. However, the motion was voted down. The medical students, with the help of the Zumbro Valley Medical Society, took the fight to the county level. Members of the ZVMS encouraged students to speak at local town and county meetings to supply a fresh perspective. The ordinance passed at the county level, and was one of the first efforts to be led by members of the medical establishment!

Nebraska: Members of the AMA-MSS chapter at the University of Nebraska Medical Center have begun working with PrideOmaha, an organization in Omaha, Nebraska that is working to increase knowledge about the dangers of tobacco use. The coalition is also involved in smoke-free workplaces efforts. The students, along with members of PrideOmaha, participated in World No Tobacco Day in late May by distributing educational handouts to bar patrons on the dangers of secondhand smoke. The students are also working closely with the coalition to gather signatures and support for a smoking ban in Omaha before the issue reaches the City Council in August 2004.

Texas: The Baylor College of Medicine AMA-MSS chapter, with the assistance of an AMA-MSS Policy Promotion Grant, hosted a lecture on Secondhand Smoke and Advocacy by Dr. Joel Dunnington, of MD Anderson Cancer Center. He spoke to a crowd of 90 first- and second-year students about why smoke-free workplaces should be an important health issue. Students were able to learn how to get involved in the Smoke-free Houston Coalition to make Houston restaurants smoke-free. The attendees signed petitions for the Coalition, and signed students up for follow-up events in the community. At the end of May, the chapter had a petition drive. A group of students brought petitions and informational brochures to busy lunch locations in the medical center to spread information about the issue. The students hope to continue to plan educational events about smoke-free workplaces, as well as plan letter-writing events to their city council members as the issue is taken to the table in our city government.

Update on the Original Five States to Go Smoke-Free

California: California’s smoking law, which was fully enacted in 1998, prohibited smoking in all indoor places of employment, which deemed it unnecessary for local governments to create laws of the same type. The intent of the law was to reduce the exposure of employees to secondhand smoke. There were certain provisions for which smoking could be allowed, such as that for research.[1] How has California done since the ban was enacted? In 2002, a law was passed that created a buffer zone around playgrounds. Patrons are not allowed to smoke or throw away their butts within 25 feet of a playground. Many praised this move because it was one that reduced the amount of secondhand smoke to which children were exposed.[2] The fight did not stop at the playgrounds. It has now moved to California’s beaches. Solana Beach in San Diego County was the first beach in California to become smoke-free in October, 2003. Since that time, San Clemente beach in Orange County and thirteen miles of beach in Los Angeles County, which includes Santa Monica, are also smoke-free. Violators are slapped with heavy fines if caught. The premise behind this effort is the same as the original ban from 1998: beachgoers have a right to be protected from exposure to secondhand smoke.[3] California truly remains the nation’s leader in clean air ordinances both indoors and outdoors.

Connecticut: Connecticut joined the pentad of states that are smoke-free in 2003. Like the California law, the Connecticut law mainly focused on reducing the danger of environmental smoke exposure to restaurant and bar patrons and employees. The ban also outlawed smoking in all workplaces with five or greater employees, including buildings owned, operated, or leased by a state agency, including state university dormitories, again much like the California law. At the time the law was passed, certain establishments were exempted, including private clubs that existed before the ban was enacted, as well as some cigar bars and outdoor patios of restaurants and bars.[4] The law was fully enacted on April 1, 2004, and many will be waiting to see how Connecticut performs, especially with successful neighbor New York to the south.

Delaware: Delaware was the second state to enact a clear indoor air law. Policy was passed in May 2002 (on World No Tobacco Day), which again protected both employees and patrons from the dangers of secondhand smoke. Delaware’s law was one of the nation’s harshest, banning smoking in restaurants, bars, and even casinos (the two casinos in Connecticut are exempt from the law there).[5] How has Delaware done? In early 2003, the House passed a bill that would have allowed patrons to smoke in bars and taprooms that did not serve food, and casinos. That bill was struck down by the state senate in April, 2003.[6] Many critics of the law fear that its passage will hurt Delaware financially and only time will tell.

Maine: Maine’s Clean Indoor Air Act was passed in 2003, and was enacted on January 1, 2004. This act, like the four others that came before it, was structured to protect employees and patrons from the dangers of secondhand smoke. It, like the Delaware law, was one of the tougher laws passed. Restaurants in Maine had been smoke-free since 1999. Bars and bingo halls were included in the new law.[7] Like the law in Connecticut, the Maine law is very new and only time will tell if bars and bingo halls truly lose business over their patrons no longer being allowed to light up indoors.

New York: New York was the third state to adopt clean indoor air legislation. New York City enacted its law in March 2003 while the state senate and house passed a bill that was signed into law by Governor George Pataki. The statewide law went into effect in July 2003. Like the laws of other states, the basic tenet was to make indoor areas safer for patrons and employees by eliminating exposure to secondhand smoke. The victory in New York was also impressive in large part by the medical student support that was put forward to make the law possible, and their work serves as a model for medical students across the country. In the year since New York City went smoke-free, patrons are singing the city’s praises. The number of employees in bars and restaurants has increased. 97% of New York City bars and restaurants were in compliance with the law. Business tax receipts are up in NYC bars, and restaurants are up by 8.7%. In addition, air quality in bars and restaurants has improved.[8] One must not forget, however, that while there are fantastic economic results from the ban, the more important statistics are those where health parameters have been improved.

Each of the five states with comprehensive Clean Indoor Air Acts is in different stages of their passage and enactment. However, none of the five states with these laws have been able to repeal them once they have been passed. It appears that Massachusetts and Rhode Island may soon join these five. These states should serve as an inspiration to the MSS, and that with hard work and determination, a difference truly can be made in the lives and the health of the patients we see!

Smoke-Free Workplaces on the International Front

In an attempt to educate out membership on the importance of smoke-free workplaces in our nation, it is important to examine some of the successes of other nations on the war against tobacco. Ireland, Uganda, and Tanzania will be examined here.

Ireland: Ireland’s Clean Air Act began in late March 2004. Like the Clean Air Acts in the United States, Ireland’s law prohibited tobacco use in all indoor workplaces, including the country’s bars and pubs. The idea was to protect employees and non-smoking patrons against the dangers of secondhand smoke exposure. Ireland is the first European nation to have such a law.[9]

Uganda: Uganda passed its smoking ban in late 2003, and the law was enacted in March 2004. The law covers restaurants, bars, and educational institutions. Violators can be arrested and fined for violating the law.[10] Uganda has since created a smoking ban task force to determine the best ways to implement the ban.[11]

Tanzania: Tanzania’s Tobacco Products Act was signed into law in April 2003 and went into effect on July 1, 2003. Under this act, it was deemed illegal to smoke inside schools, hospitals, and many other public places. Furthermore, tobacco advertising on TV, print, and on the radio has been banned. The country’s health ministry stated that the ban was enacted to reduce the amount of smoking in the country, which would in turn decrease the incidence of smoking related diseases.[12] As of yet, no report has been released indicating the economic effects of the ban, as tobacco is a major crop of Tanzania. Only time will tell if any long-term adverse economic effects will occur due to the smoking ban.

Conclusion

Tobacco use is an issue that many people are concerned about. Regardless of the angle that is spun, one thing does stand out: people are serious about removing this environmental hazard from as many places as possible. As research shows that tobacco has deleterious effects on nearly every body system, it stands to reason that something must be done to reduce exposure. As medical students, we have great power to make an impact on this battle, and in this regard, we also have great responsibility. We must educate our patients about the dangers not just of their own tobacco use, but the danger they face by the tobacco use of others.

Last updated: Mar 14, 2006
Content provided by: Medical Student Section

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