Rendez-vous with . . . Cynthia Hallett, MPH
Americans for Nonsmokers' Rights/American Nonsmokers' Rights Foundation
Berkeley, California, USA
By Philippe Boucher
Tuesday, August 7 2001
PB : Thank you Cynthia for accepting our rendez-vous.
May I ask you to introduce yourself ?
Cynthia Hallett: I am Executive Director of Americans for Nonsmokers' Rights (ANR) and the sister organization American Nonsmokers' Rights Foundation. ANR is a national advocacy organization that promotes legislative, regulatory and voluntary policies to protect nonsmokers from secondhand smoke. The ANR Foundation develops educational programs and strategies to reinforce nonsmoking as the norm in our society. Our education programs help youth make a genuine choice to remain nonsmokers for life, and encourage youth advocacy.
Before joining ANR, I worked at the Los Angeles County Department of Health Services as the Head of Program Operations for the Planning and Policy Development Division where I worked closely with grassroots coalitions and elected officials to develop and support smokefree environments. In addition to my experience in tobacco policy at the local and state levels, I have extensive experience providing training and technical assistance on tobacco control policy and advocacy to groups throughout the nation and internationally. My early training was in cancer control and I worked at the UCLA Comprehensive Cancer Center and the National Cancer Institute.
I completed my Bachelors and Masters of Public Health at UCLA.
Q1. The fight for smoke-free environments is very often a local battle. Do you have any tips, any advice to share about the best way to proceed? Can you also explain how the smoke-free advocates were able to get where they are now, how it started, how long it took?
CH: Tobacco control advocates stumbled accidentally onto the best strategy to encourage society to view tobacco use as undesirable behavior. The nonsmokers' rights movement was born in the 1970's because average citizens were tired of breathing secondhand smoke. A 1978 poll of public attitudes conducted by the Roper Organization for the Tobacco Institute concluded that the nonsmokers' rights movement "is the single greatest threat to the viability of the tobacco industry." The industry knew then that the key ingredient in the recipe for a smokefree society is the social unacceptability of tobacco.
After Minnesota passed its Clean Indoor Air Act in 1975, nonsmokers' rights activists attempted twice to enact state laws in California. The tobacco industry used their economic clout and succeeded in defeating both initiative attempts. The tobacco industry's victory helped activists stumble onto the single most potent formula for both protecting nonsmokers and creating a society that rejects tobacco use: the implementation of local smoking control ordinances.
The following steps outline very generally the basic components of a successful local ordinance campaign.
a) Establish a coalition and lay the groundwork before going public with a smokefree proposal. Spend an adequate amount of time on a public education campaign so that members of the community understand the problem of secondhand smoke and potential solutions. Many coalitions undertake public opinion surveys, asking residents how they feel about secondhand smoke and smokefree policies.Visit ANR's website ( www.no-smoke.org) for more information on planning a successful smokefree policy campaign, as well as model ordinance language.
b) If there is strong community support in favor of smokefree policies, then move forward by sharing all of this information with elected officials. Give your coalition an important strategic advantage by letting these representatives know in advance what to expect from the tobacco industry, its allies and front groups during the campaign.
c) At the same time, educate the local business community about the health effects of secondhand smoke exposure, and their potential legal liability-before the tobacco industry shows up to spread misinformation based on unfounded fears. Also share with them the extensive research findings that prove that smokefree ordinances have no negative economic impact on businesses in communities that have already enacted them.
d) Once the coalition is ready to move forward with the smokefree policy campaign, find a local legislator to sponsor the ordinance. Ideally, sponsors should be committed to the issue, have a good relationship with their colleagues, and listen to the coalition.
Q2. There is a lot of talk about new drugs to help smokers quit but Stanton Glantz reminds us constantly that smoke-free workplaces are the most effective way to make people quit. He says several studies prove this point. Can you elaborate on this claim?
CH: There is scientific evidence that smokefree workplaces help smokers to reduce consumption or to quit smoking entirely. Several studies have examined the effects of local clean indoor air ordinances in California and nationally on the impact of workplace smoking policies on secondhand smoke exposure in the workplace and on consumption/cessation. Findings suggest that local smoking laws increase voluntary workplace smoking policies, result in fewer workers exposed to secondhand smoke, decrease consumption and increase smoking cessation among employed smokers (2, 3, 4, 5). Also, bar workers showed remarkable improvements in health after the implementation of California's smokefree bar provisions in 1998. According to a study in the Journal of the American Medical Association, working in smokefree bars was associated with a rapid improvement in respiratory health among the bartenders studied (6).
The tobacco industry is also aware that smokefree workplace policies decrease tobacco consumption. A 1993 Philip Morris internal budget projection report quantified the financial effect of clean indoor air legislation on cigarette sales in that year alone to be $40 million.
Other studies have examined the impact of long-term exposure in workplaces and concluded that workers have an increased risk of disease and disability compared to employees who work in a smokefree environment. The most recent study, published in the International Journal of Cancer, indicates a lung cancer risk three times higher among restaurant and bar employees who work in smoke-filled environments. The tobacco industry contests these findings, but as more scientific evidence mounts, I predict more communities will demand smokefree ordinances.
Q3. What about airports? Can you tell us about your initiatives concerning airports, in the US and worldwide? Are smokefree efforts gaining ground?
CH: The tobacco industry claims they want to protect a smokers' right to "enjoy a legal product" and have, therefore, created the "Accommodation Program" or "Options" that allow for smoking sections and/or ventilation standards. The reality is the industry wants to preserve smoking indoors because smokefree environments reduce consumption and affect its bottom line.
According to a once-secret internal Philip Morris document, "Financial impact of smoking bans will be tremendous - three to five fewer cigarettes per day per smoker will reduce annual manufacturer profits a billion dollars plus per year."
According to other internal tobacco industry documents, Big Tobacco has targeted airports across the country to prevent smokefree policies by lobbying airport boards, city councils, and others to consider accommodation policies instead of remaining smokefree. For instance, the Tobacco Institute lobbyists urged Lambert Field (St. Louis, MO) airport officials to consider accommodation in lieu of going smokefree, and arranged for consultation with the ventilation firm Healthy Buildings International, a firm with ties to Philip Morris. R.J. Reynolds and Philip Morris poured millions of dollars into a campaign to establish smoking lounges at the Denver International Airport (DIA) in Colorado. In exchange for paying for ventilation systems, Philip Morris received free advertising of Marlboro cigarettes in the smoking lounges. Philip Morris made an initial payment of $77,000 for the HVAC (ventilation systems) at DIA. And the list goes on. It may seem insurmountable to achieve smokefree airports, but who would have thought we could achieve smokefree flights. At this time, ANR's campaign for smokefree airports relies on individuals to communicate directly with airport officials. On our website, we highlight the ten busiest airports and encourage individuals to share their gratitude for smokefree airports or disappointment with smoke-filled sites directly to the appropriate airport officials. Direct communication from airport patrons is extremely effective. The good news is we have experienced successes in the effort to eliminate existing smoking lounges or prevent the establishment of them. San Francisco International Airport closed the glass-enclosed lounges in 2000 and the Utah Legislature is considering a bill that would cease further construction of smoking lounges at the Salt Lake City International Airport and eventually close the existing lounges. I'm hopeful this trend will continue.
Q4. Can you tell us about your Hollywood On Tobacco (HOT) project ? is it still alive ? what do you think about the proposals to show anti-tobacco trailers before the feature film?
CH: The Hollywood on Tobacco Project was completed in July 2000. It was comprised mainly of three components:
Ethnographic Study: Over 50 qualitative in-depth interviews were conducted to determine how people in the California-based entertainment industry think about the portrayal of tobacco use in movies and on television. The paper, " Hollywood on Tobacco: How the Entertainment Industry Understands Tobacco Portrayal" was published in Tobacco Control, December 1999. You can find a copy of the article online at http://tc.bmjjournals.com/cgi/content/full/8/4/378I support showing anti-tobacco trailers before feature films. Running anti-tobacco trailers before films helps educate and inoculate the audience against positive portrayals of tobacco use in films. A 1994 study by Pechman and Ratneshwar (1) indicates that youth who watch anti-smoking counter advertisements view smoking in a less favorable light than those who only view cigarette advertisements.
Documentary: The next phase of the project was to complete a video documentary. The final version, "Hollywood on Tobacco," was completed in March 2000.
Course Curriculum: Three Discussion Guides were produced as companion pieces to the documentary and geared toward health related courses, critical thinking/media studies, and film classes at the college level.
Q5. What do you identify as the next steps for improving tobacco control in California? How do you assess the performance of Governor Gray Davis, until now?
CH: Many want to use the California law as a model for state or local legislation in their state or community. I would discourage this simply because a good deal of negotiating took place during the legislative process and the law contains loopholes. I also recommend that coalitions start with ANR's model ordinance - it is strategically wise to start fresh rather than adopt another community's negotiated policy. I would love to see an ongoing effort to protect and preserve smokefree policies in California. The tobacco industry never ceases to find opportunities to undermine, overturn, or weaken existing laws and the more we maintain public support and understanding of smokefree policies, the more likely California is to keep and improve its smokefree laws. Governor Gray Davis has been a challenge. Whereas former Governor Pete Wilson was a close friend of Big Tobacco and an obvious opponent, Davis campaigned on a tobacco control platform but only recently began to take positive, albeit small, steps on the issue. The voluntary agencies in California, ANR and the Campaign for Tobacco Free Kids had to wage an all-out war on Davis to secure a small fraction of the Master Settlement Agreement funds for tobacco prevention. The Legislative leadership is also changing which is likely present another challenge for tobacco control advocates in California.
Q6. Is there anything else you would like to add?
CH: ANR is often asked, "How long does it take to get an ordinance passed?" My answer, "Slow and steady wins the race." It takes time: time to cultivate your coalition, time to educate the masses, time to develop a relationship with business owners, the media, and your elected officials. Once that is complete, then it is time to introduce a policy. The reality is, it can take nine months or it can three years. The goal should be to successfully change social norms about smoking, not simply to pass a law.
The tobacco industry fears this social norm change, so it uses its huge coffers of money, its hordes of public relations and political consultants, researchers and other allies to spin the facts and alter reality. We've all seen the "we've changed" philanthropy ads by Philip Morris and I'm hearing that the public is feeling the industry has paid for past injustices. The only time the industry will admit responsibility is when its bad behavior is exposed. For instance, the recent release of the Czech report has put the industry on the defensive again - yet it will try endlessly to spin the findings and shirk responsibility.
It is the nonsmokers' rights movement's responsibility to work smart and cultivate the grassroots to continue to gain successes in smokefree policies.
The most effective tools this movement has are the truth and people power. Let's continue to think strategically, engage and involve the public and expose the bullying tactics of the tobacco industry and their allies. The nonsmokers' rights movement has achieved a great deal and ANR has seen many changes in smoking policies since its inception in 1976. I'm looking forward to being a part of additional significant achievements in the future.
PB: Thank you Cynthia for taking the time to be with us today.
P.S: Here are the references quoted by Cynthia:
1) Pechman, C.; Ratneshwar, S., "The effects of antismoking and cigarette advertising on young adolescents' perceptions of peers who smoke," Journal of Consumer Research 21: 236-250, September 1994.Rendez-vous is supported by a contract from the Robert Wood Johnson Foundation
2) Pierce, J.P.; Shanks, T.G.; Pertschuk, M.; Gilpin, E.; Shopland, D.; Johnson, M.; Bal, D., "Do smoking ordinances protect non-smokers from environmental tobacco smoke at work?," Tobacco Control 3: 15-20, 1994.
3) Evans, W.N.; Farrelly, M.C.; Montgomery, E., "Do workplace smoking bans reduce smoking? NBER Working Paper Series, Working Paper 5567.," Cambridge: National Bureau of Economic Research (NBER), May 1996.
4) Moskowitz, J.; Lin, Z.; Hudes, E.S., "The impact of California's smoking ordinances on worksite smoking policy and exposure to environmental tobacco smoke," American Journal of Health Promotion 13(5): 278-281, May/June, 1999.
5) Moskowitz, J.M.; Lin, Z.; Hudes, E.S., "The impact of workplace smoking ordinances in California on smoking cessation," American Journal of Public Health 90(5): 757-761, May 2000.
6) Eisner, M.D.; Smith, A.K.; Blanc, P.D., "Bartenders' respiratory health after establishment of smoke-free bars and taverns," Journal of the American Medical Association, 280(22): 1909-1914, December 9, 1998.
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