enacting strong smoke-free laws: the advocate’s guide …...enacting strong smoke-free laws: the...

ENACTING Strong SMOKE-FREE Laws:The Advocate’s Guide to

Legislative Strategies

American Cancer Society/UICC Tobacco Control Strategy Planning Guide #3

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The Next Stage in the Global Tobacco Control Movement

We have focused our strategies for global tobacco control advocacy over the last 40 years on the passage of strong laws. Through the initiative of the World Health Organization (WHO) and the collaborationof national and international tobacco control advocates on the landmarkFramework Convention Alliance (FCA), the majority of the world’s countrieshave now ratified WHO’s Framework Convention on Tobacco Control (FCTC), and have takensteps to implement the FCTC by enacting the required laws.

When we came together in Helsinki for the 2003 World Conference on Tobacco OR Health, whoamong us would have dreamed that workplaces and public places – including pubs and cafes –in Davao City, Philippines; Dublin, Ireland; Cape Town, South Africa; New York City, New York;and Milan, Italy would be virtually smoke free by 2007?

Our efforts all around the world have set in motion a global wave of change. More and morecities, regions, and countries are now enacting and implementing effective, practical, and popularrules and laws that set a new standard in protecting people from the harms of secondhandsmoke. Through our experiences, we have learned what wise and experienced advocates haveknown all along: The keys to smoke-free air are comprehensive legislation and effective enforcement.Even the best-written laws and the tightest regulations are sometimes poorly enforced or ignoredaltogether by authorities.

That is why, for the past two years, a team of volunteers led by the American Cancer Society, theInternational Union Against Cancer, and the Campaign for Tobacco Free Kids has reached out toour most creative and resourceful colleagues around the world to gather guidance, case studies,and stories of successful advocacy strategies for the enactment and enforcement of effectivesmoke-free laws and regulations. Team members joined together from diverse organizations,including the Framework Convention Alliance, Essential Action, and the Pan-American HealthOrganization. Members of the pharmaceutical companies GlaxoSmithKline and Pfizer have alsojoined the effort, providing both strategic and financial support. What we have found to ourdelight is that what holds true for most human endeavors also holds true in the worldwide enactment and enforcement of smoke-free laws: Success breeds success.

Drawing on the most culturally and politically adaptable strategies field-tested by advocatesaround the world, two guides have been developed that examine specific barriers to the enactmentand enforcement of smoke-free laws and regulations and that offer proven advocacy strategiesfor overcoming these barriers.

As an additional resource, these guides will serve as cornerstones in a new global effort coordinatedby the International Union Against Cancer Global Smokefree Partnership. This multi-partner initiative provides resources and support to advocates and others, with the aim of realizing best-practice smoke-free environments throughout the world.

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The guides, simultaneously with their publication at the 13th World Conference on Tobacco ORHealth, will be available through both Globalink [globalink.org] and the Smoke-free Partnership’sWeb site [strategyguides.globalink.org/shs.htm], where their content will be updated regularlyand linked to complementary smoke-free advocacy resources and a range of support services.

Because the nearly half-century struggle to enact and enforce strong tobacco control lawsreminded the guides’ development team of the cooperative effort of climbers who, on reachingthe top of one mountain, were presented with a view of the next challenging peak, the developersnamed themselves the “Climbing the Next Mountain Team.”

Welcome to the team. Lace up your boots, pick up your pitons, and let’s start climbing the nextmountain together toward a smoke-free world.

John R. Seffrin, PhDCEO, American Cancer SocietyPresident, International Union Against CancerJuly 2006

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American Cancer Society/International Union Against Cancer (UICC)Tobacco Control Strategy Planning

Introduction to the Series

Tobacco Control Strategy Planning is a series of guides developed by the American CancerSociety (ACS) and the International Union Against Cancer (UICC). Each guide in this seriestakes readers through a set of strategic planning questions that address specific challenges in tobacco control advocacy. The guides answer those questions, based on the wisdom and experience of tobacco control advocates throughout the world.

Enacting Strong Smoke-Free Laws: The Advocate’s Guide to Legislative Strategies and EnforcingStrong Smoke-Free Laws: The Advocate’s Guide to Enforcement Strategies are the most recentguides in the series. They are intended to be used together by tobacco control advocates lookingspecifically to enact and enforce smoke-free air laws.

Other guides in the Tobacco Control Strategy Planning series include the following:

Strategy Planning for Tobacco Control Advocacy takes NGO (nongovernmental organization)planners through the process of developing long- and short-term national strategic plans, withan emphasis on media advocacy.

Strategy Planning for Tobacco Control Movement Building helps planners identify the kinds ofpeople and allied organizations that can be the most helpful to them in putting together andimplementing national plans.

Engaging Doctors in Tobacco Control responds to the concern of tobacco control advocates thatfar too few doctors – who should be among the leaders of every tobacco control movement – areactively engaged in tobacco control.

Building Public Awareness of Passive Smoking Hazards responds to the evidence in many countries of little or no public awareness of the serious, proven health hazards of secondhandsmoke. This lack of awareness severely hampers advocates who try to persuade governments to decree or enforce smoke-free public places or work sites.

Each guide is designed to help advocates develop practical strategies to overcome specific barriers to effective tobacco control policies. As advocates continue to learn valuable lessonsabout tobacco control advocacy, we encourage them to share their experiences. We will continually update these guides and the related Web site [strategyguides.globalink.org] so that advocates always have access to the most current strategies and resources.

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Part II. Smoke-free Tool Kit . . . . . . . . . . . . . 37Developing a Campaign Plan . . . . . . . . . . . . . 39

Putting the Campaign Plan in Writing . . . . 39Evaluating Campaign Objectives : How SMART Are You? . . . . . . . . . . . . . . . . . 40Involving Others in the Campaign . . . . . . . 40Resources for Planning a Campaign . . . . . . 41

Media Advocacy: A Short How-to Guide . . . 43Working with the Media . . . . . . . . . . . . . . . 43Getting the Message Heard through Public Events . . . . . . . . . . . . . . . . . . . . . . . . . 46Tailoring Messages to Specific Audiences . . . . . . . . . . . . . . . . . . . . . 48Resources for Conducting Media Advocacy . . . . . . . . . . . . . . . . . . . . . . . 51

Countering the Tobacco Industry . . . . . . . . . 53Myths and Realities of Smoke-Free Policies . . . . . . . . . . . . . . . . . . . . 53Economic Impacts of Going Smoke-Free . . . . . . . . . . . . . . . . . . . . . . . . . . 55Tobacco Industry Efforts to Fight Secondhand Smoke Legislation . . . . . . . . . . 56

Smoke-Free Air: The Essential Facts . . . . . . . . 59Essential Facts . . . . . . . . . . . . . . . . . . . . . . . . 59Useful Fact Sheets on Secondhand Smoke . . . . . . . . . . . . . . . . . . . 60Terminology Matters . . . . . . . . . . . . . . . . . . 61

Climbing the Next Mountain . . . . . . . . . . . . . 61

Stop the Presses! A Final Word of Encouragement . . . . . . . . . . . . . . . 63

Acknowledgments . . . . . . . . . . . . . . . . . . . . . 65

Contents

IntroductionPart I. Strategic Planning Guide . . . . . . . . . . 5

Question 1. What Do We Want Now? . . . . . . 5Plotting Initial Steps . . . . . . . . . . . . . . . . . . . . 6Setting Long-Term Objectives . . . . . . . . . . . . .7Setting Short-Term Objectives . . . . . . . . . . . . 9Hiring a Lawyer . . . . . . . . . . . . . . . . . . . . . . . . 9Use the FCTC to Your Advantage . . . . . . . . 10

Question 2. Who Has The Authority To Make It Happen? (Who Is Our TargetAudience?) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Question 3. What Messages Do TheseAuthorities Need To Hear To Motivate Them To Act? . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Emphasizing a Public Health Frame . . . . . . 12Understanding Core vs. Tailored Messages . . . . . . . . . . . . . . . . . . . . . 12Outflanking the Opposition with Fact-Based Messages . . . . . . . . . . . . . . . . . . . 17Focusing on the Health Effects of Secondhand Smoke . . . . . . . . . . . . . . . . . . . .19A Precampaign Trial Run . . . . . . . . . . . . . . . 22

Question 4. Who Are The Most EffectiveMessengers To Deliver Those Messages? . . . 22

The Difference the Messenger Can Make . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Choosing a Messenger . . . . . . . . . . . . . . . . . 22

Question 5. How Can We Get Our TargetAudiences To Hear Our Messages? . . . . . . . . 27Lobbying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Media Advocacy . . . . . . . . . . . . . . . . . . . . . . . 27Reports and Studies . . . . . . . . . . . . . . . . . . . . . 34Public Demonstrations . . . . . . . . . . . . . . . . . . 35

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3Enacting Strong Smoke-Free Laws: The Advocate’s Guide to Legislative Strategies

Introduction

Scope and OrganizationThis guide is designed primarily for nongovernmental advocates, especially in developing nations,who are working to achieve strong and enforceable smoke-free laws. The guide is divided into twoparts: the Strategic Planning Guide and the Smoke-free Tool Kit.

Like earlier guides in the series, the Strategic Planning Guide in Part I looks at five key questionstobacco control advocates need to answer as we develop our advocacy strategies and campaigns:What do we want? Who has the authority tomake it happen? (Who is our target audience?)What messages do these authorities need tohear to motivate them to act? Who are themost effective messengers to deliver thosemessages? How can we get our targetaudiences to hear our messages?

The Smoke-free Tool Kit in Part II is filled with hard-learned advocacy lessons and techniques drawn from the experiences of our colleagues across the globe in their campaigns to enact and implement stronglaws over the past 30 years.

Poster used in Norwegian mass media campaign welcoming visitors tosmoke-free Norway. All workplaces in

Norway – including restaurant and bars –went smoke-free on 1 June 2004.

Credit: Virtual Garden (Ad Agency), Rune Kongsro (Photographer)

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Part I: Strategic Planning Guide

Question 1. What Do We Want Now?

Our long-term objective, of course, is to protect people from the dangers of secondhand smoke by passing strong smoke-free laws. But to plan strategically, to guide our actions over the nextsix months or the next year, we need to ask ourselves, what exactly do we want now? Here weneed to ask how far toward that ultimate goal we can aggressively, but realistically, hope to go.

You may have heard the expression: “People don’t plan to fail. Instead, they fail to plan.” Becauseadvocacy usually involves going up against powerful vested interests, it is critical that we take thetime to plan properly before launching a campaign. Planning helps us identify beforehand anymajor problems that may lie ahead. We need to clearly spell out our objectives and figure out the steps we need to take to achieve them. And we need to write these down!

In this guide you’ll find the term objectives rather than the term goals. Objectives are the ultimateaim of our advocacy work – what we are hoping to achieve, such as comprehensive smoke-freeworkplace legislation. Strategies are broad categories of activities we use to achieve an advocacyobjective. Tactics are the action steps we take to implement a strategy.

The bottom line, more important than the terminology, is that a strategic plan is simply a formalway of figuring out where we want to go and how we are going to get there.

Objectives, Strategies, & TacticsObjectives are the ultimate aim of advocacy work, such as comprehensive smoke-freeworkplace legislation.

Strategies are the activities we use to achieve an objective – for example, lobbying,media advocacy, and coalition building are strategies. We can evaluate a strategy by asking whether it:

• Helps reach the objective

• Appeals to current and potential supporters

• Minimizes the level of opposition

Tactics are the action steps we take to implement a strategy, from letter-writing campaigns to public demonstrations, from issuing reports to meeting with public officials. To evaluate a tactic, we ask whether it helps carry out a strategy and thus helps achieve the objective. As we plan each specific tactic, we need to know the answers to these questions:

• Who is responsible for carrying this tactic out?

• Do they have the resources (financial and human) to make it a success?

• Who else should be involved?

• What is the timeline?

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American Cancer Society/UICC Tobacco Control Strategy Planning6

This guide proceeds step-by-step through an advocacy campaign whose objective is to pass effective and comprehensive smoke-free laws and policies.

Plotting Initial Steps

At different stages of a campaign, advocates may face barriers ranging from public ignorance ofthe health risks of secondhand smoke to confusion caused by tobacco-industry propaganda. Theill-founded fear of an adverse impact from smoke-free laws, particularly on businesses, oftenclouds reason. As we define our objectives, we need to identify the specific barriers we face anddesign our strategies and tactics to address the most immediate of these barriers.

Tobacco control advocates usually have limited human or financial resources, especially in countrieswhere the tobacco control movement is just getting started. These circumstances make priority-setting and planning critical. We must choose the most effective strategies and focus on the mostimmediate obstacles and opportunities.

The first steps are to develop an advocacy campaign plan and to find campaign partners. A goodway to start is by reviewing the Strategy Planning for Tobacco Control Movement Building guide.The guide describes the kinds of people that you will want in an initial planning group. 1 Oncethat group comes together, the next steps are to

• Determine campaign objectives (long-term andshort-term)

• Identify the target of advocacy activities

• Collect information on the attitudes and opinions of the public, media, and decisionmakers on smoke-free legislation

• Collect information on the process and politics of passing (or amending) legislation(e.g., government or parliamentary decision,attitudes of the minister or influential members of the Parliament)

• Identify resistance and barriers

• Decide on the strategies and tactics you will employ in order to achieve your objectives,both short-term and long-term

• Know your issue; Become a smoke-free air expert; Learn all you can about the latestsmoke-free facts, studies, polls, etc.

• Know what resources you currently have – both financial and human – and develop plansto use them to achieve campaign objectives

• Prepare for opposition from the tobacco industry by doing research – learn as much aspossible about your opposition and what they will do to fight campaign efforts

• Assess the strengths and weaknesses of the campaign organization, including key staffand volunteers

• Determine how much support exists for and against the campaign

Identifying potential allies and opponents may not be easy. The dictum “Politics makes strangebedfellows” often applies – people and organizations that might seem obvious opponents canturn out to be supporters under specific circumstances, and vice-versa.

Credit: Bob Baker, The Phoenix

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Planning is critical, but campaigns also need to be flexible so they can adapt to changing circumstances. For example, after the smoke-free coalition in El Paso, Texas mapped out a four-year plan to achieve a comprehensive smoke-free law, the city health department unexpectedlysubmitted a smoke-free bill to the city council. The coalition had to radically change its plans andspring into action at once. Within eight months, a comprehensive law was on the books. 2

Setting Long-Term ObjectivesWhere do we want to be at the end of our advocacy campaign? At first glance, the answer lookssimple: We want effective, comprehensive smoke-free laws and policies that protect the health ofall workers and patrons. Sinead Jones, head of Tobacco Control at International Union AgainstCancer (UICC), defines the objective this way:

We envision a world in which no one is forced to breathe tobacco smoke anywhere they havethe right to be, including every place the public is welcome – all health-care facilities, allworkplaces, all schools, all transportation facilities, all restaurants and pubs, all theatres, allsports facilities. 3

But what at first seems a straightforward question becomes one of the most difficult to answer.And it is also probably the most important question to get right, because it points the way for thenext steps. Some issues to consider:

1. Should we push for comprehensive national legislation, or should we try to pass aseries of state, provincial, territorial, and/or local smoke-free laws?

There is no right answer to this question. The answer depends on a host of factors:

• What is the relative power of the tobacco industry (and tobacco control advocates) at thenational versus the local level?

• Has the country ratified the FCTC? If it has, we have the power of an international treatyto back up our campaign!

• In our country, can national or regional law preempt or override local government laws onthe same subject? In the United States, for example, preemption provisions in state and/orfederal law prevent some localities from enacting bans on smoking in public places.

• Is the level of understanding of, and public support for, smoke-free areas so low that anational law right now is unrealistic? Instead, local laws could serve as models that couldbe replicated in other areas and at the national level.

• Is the country is a member of the European Union or any other regional regulatory body, or does it have aspirations to become a member? This is important because there may betobacco-related legislation that the country needs or will need to comply with, regardlessof the planned smoke-free campaign.

2. Is it possible to use existing laws and regulations to advance smoke-free policies?

In some countries, there may be ways to protect people from secondhand smoke asidefrom new legislation. Depending on the structure of regulatory authorities, for example,existing worker health and safety regulations might apply, which would protect workersfrom secondhand smoke. Unfortunately, employers rarely, if ever voluntarily make significant moves to protect workers’ health; this means legislation or regulation isnecessary. Still, this approach can be a tactic that increases pressure for a smoke-free law.

It may prove easier to pass general worker-safety laws that include protection from secondhand smoke than to pass legislation specific to tobacco. The advantage to thisapproach is that workers get protected without our having to confront the tobacco industry head-on.

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3. Should the objective be to cover all workplaces and public places, or to begin with a more limited set of facilities?

Developments in the last few years – most notably the passage and successful implementationof smoke-free legislation in Ireland (including bars), the passage of smoke-free laws inUruguay and England, and the ratification of the FCTC by many countries – have radicallyshifted the terms of debate regarding what is politically feasible. Yet in many countries,the tobacco industry remains extremely powerful, and the signature and ratification ofthe FCTC have just begun to result in concrete changes in national legislation.

It is a maxim of advocacy that we must choose our battles. After analyzing the situation– looking at our strengths and weaknesses as a movement – we may decide that the time

is simply not yet right for comprehensive smoke-free legislation. We might first push for alimited set of work and public places to be smoke-free and then work to expand smoke-free policies to other facilities over time. Remember, no political climate is static – if ours is not currently favorable to smoke-free laws, we need to remember that we have the power to change that climate.

Most countries that have comprehensive smoke-free legislation practiced this incrementalapproach. There are some recent exceptions in the last few years, for example, England,Northern Ireland, Scotland, and Uruguay. And in some countries, danger lurks in the gradual

approach, as Tanith Muller, director of the Tobacco Control Resource Centre of the British Medical Association, has pointed out, for it “becomes an excuse to take ineffectiveaction, and leave many thousands of people exposed.” 4 If there is a favorable climatefor a comprehensive law, advocates should go for it. After all, we have far more evidenceand international precedent available now on our side than we did even ten years ago, soit may be possible to make big leaps.

If the decision is to take an incremental approach, it is important to create steppingstones for further action down the road. That is, advocates must ensure that the legislationwe are promoting does not unintentionally create roadblocks to progress. According toU.S. advocate Judith Wilkenfeld, 5 legislation can hamper progress when it

• Allows or mandates separate smoking areas

• Endorses the use of discredited ventilation technology as a way of dealing with secondhand smoke

• Gives enforcement authority to the wrong agency

• Accepts government-endorsed voluntary agreements

• Includes excessively complicated and unenforceable regulations and solutions

• Includes a “sunset clause” whereby the legislation expires after a set amount of time (thereby forcing advocates to refight the same battle)

• Specifically exempts certain populations (such as laws that apply to “adults only” or areasthat are smoke-free only “when minors are present”)

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Setting Short-Term Objectives Mapping out a long-term objective does not automatically lead to an effective advocacy strategy.Advocacy planners also need to set ambitious but realistic short-term objectives. These intermediateobjectives represent concrete building blocks for achieving long-term objectives, and they give the organization and/or coalition a sense of accomplishment. They also provide benchmarks bywhich to measure our progress. This is important for keeping everyone’s spirits up in what may be a multi-year battle.

In setting these objectives, it is helpful to understand

• The current political environment

• The extent of public awareness of the hazards of secondhand smoke

• The degree of public support for strong smoke-free laws

Short-term objectives could include

• Publishing an editorial in support of your smoke-free campaign in the major newspaper

• Identifying a powerful Member of Parliament to sponsor your smoke-free legislation

• Gaining the support of the major unions in your community

The more specific and well-defined these objectives, the more concrete and effective advocates’ strategic planning will be.

Hiring a LawyerAs advocacy efforts move forward, the exact wording of proposedlaws and regulations will become incredibly important. This is thetime to call on legal experts for help – to make sure the wordingtruly protects people from secondhand smoke. The tobaccoindustry employs an army of lawyers trained in the nuances oftobacco control law. In many instances, these lawyers have managedto insert into drafts of bills seemingly innocuous language that endsup undermining the intent of the laws. So it’s worth taking sometime to research the law firms that work for the tobacco industry in the country where we are conducting our campaign.

Draft smoke-free legislation produced by the International Unionfor Health Promotion and Education (IUHPE) is a good place tostart. 6 And the World Health Organization’s report Tobacco ControlLegislation: An Introductory Guide has a section on smoke-free legislation that includes a draft law. 7 But as Professor Mark Levin ofthe University of Hawai‘i suggests, it is important not just to findthe best wording but also to get technical assistance from someonefluent in the local language. Smoke-free campaigns usually needtwo kinds of legal expertise: (1) in local law and (2) in secondhand-smoke law and policy. “Trained legal professionals can help catch loopholes or understand implications of legalese,” Levin explains, since “expert groups are familiar with the industry’s ‘bag of tricks’ and may recognize hidden problems.” 8

Attorney Phillip Karugaba, spokespersonfor The Environmental

Action Network, and Dr.Margaret Mungherera,

President of the UgandaMedical Association in a

march in Kampala,Uganda to mark World No Tobacco Day 2001.

Credit: The Environmental Action Network and theUganda Medical Association (Kampala, Uganda)

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Take advantage of lessons from similar campaigns. For example, veterans of smoke-freeair campaigns in Europe met in Limassol, Cyprus, in 2005 and drafted a set of campaignprinciples and strategy guidance for similar campaigns in their region. The resulting“Limassol Recommendations to Obtain Comprehensive Smoke Free Legislation” provide valuable planning guidance to advocates in Europe and beyond. The Limassol Recommendations are available online at:http://www.tabakkontrolle.de/pdf/Limassol_Recommendations.pdf.

To sum up, advocate Luk Joossens advises:

Drafting clear legislation is essential, as poorly drafted legislation is difficult to enforce. Thismeans a legal text without ambiguity, with a clear date of enforcement, clear visible signs,clear fines, and clear responsibility for enforcement.

Avoid legislation with smoking areas or zones. A smoking area is an unclear concept which is difficult to enforce. In addition, it provides no health protection, as the air in the smoking and nonsmoking areas will mix.

A total ban is the best option. There is evidence that a total ban is easier to enforce thansmoking restrictions. Restriction means that smoking is allowed in some areas and bannedin other areas. This leads to confusion and disputes between smokers and nonsmokers.Compliance with the legislation in Ireland and Norway improved when a total ban wasintroduced in 2004. 9

Because effective enforcement of even a well-written law will rely, to a great extent, on self-policing, we also need to plan an awareness and education campaign on the reasons for the law and on its provisions.

Use the FCTC to Your AdvantageArticle 8 of the FCTC, which was adopted unanimously by 192 countries in May 2003, specificallyobligates all ratifying nations to implement “effective” measures to protect people from exposureto secondhand smoke. 10 A good-faith interpretation of the term effective would require a countryto implement comprehensive smoke-freeair policies. The FCTC is a powerfultool available to advocates in all countries. The strength of Article 8grows with every new study that confirms the effectiveness and success of comprehensive policies and the failure of partial bans and tobacco industry-backed ventilation “solutions.”

Article 8 goes on to state that “scientificevidence has unequivocally establishedthat exposure to tobacco smoke causes death, disease, and disability.” 11 As Laurent Huber, executive director of the Framework Convention Alliance, explains:

This is important because all 192 member countries of the World Health Organization havenow unanimously agreed that secondhand smoke is deadly. This puts to rest the bogus claimsmade by the tobacco companies and their allies that asserted the opposite and that even suggested that science from one region of the world could not be applied to other regions. 12

World Health Assemblymeets in Geneva,

Switzerland.

Credit: World Health Organization (Geneva Switzerland)

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The verdict is in on the danger of secondhand smoke; increasingly, countries publicly recognizethat the science is clear. Of course, this will not prevent the tobacco industry from continuing totry to foment debate on the science. But it does mean that citing the FCTC over and over again in our advocacy work can bolster our efforts to achieve smoke-free laws and regulations. AsProfessor Monica McWilliams, chief commissioner of the Northern Ireland Human RightsCommission, has stated, the Commission “recognizes as a human right the right of all bar workersin Northern Ireland to protection from exposure to smoke. The government has ratified aninternational treaty on this topic and so is obliged to adopt and implement legislative or othermeasures providing effective protection.” 13

Question 2. Who Has The Authority To Make It Happen? (Who Is Our Target Audience?)

Asking the question “Who has the authority to make it happen?” helps narrow the focus of ouradvocacy activities by clarifying which person or institution ultimately has the authority to grantus our long-term objective. We must know exactly who has the power to pass the law, becausethis official or government body is the ultimate target of our advocacy efforts.

Public support for smoke-free laws and awareness of the dangers of exposure to secondhandsmoke is enormously important for passage and enforcement. But we need to be strategic insending our advocacy messages. A major strategy would be to educate the segments of the publicthat can influence the ultimate target of our advocacy efforts.

The target will differ depending on whether our long-term objective is passing a local, regional, or national law. At the local level, the target may be the city council or the mayor; at the nationallevel, the target audience may be the prime minister or every member of the cabinet, who mustdecide whether to go forward with a law proposed by the health minister. The target might beeven broader: every undecided member of parliament or a subset of that body, such as the HealthCommittee. The target audience may well differ from country to country and even among citiesand states within one country.

We must take care to figure out exactly who or what is the target of our efforts, and then focuslike a laser beam on getting that target to give us what we want!

Question 3. What Messages Do These Authorities Need To Hear To Motivate Them ToAct?

The best public issue campaigns are based on hopes and dreams, rather than fears and problems. If you want to involve people, you must inspire them and generate enthusiasm for the campaign. They must feel that something will improve if they support your campaign.Negative approaches that exploit emotions like fear or anger can sometimes mobilise peoplefor a short period but are much harder to use to build organisations or transform society.Campaigns will only succeed if you can make your target audience identify with your issue….

Every successful campaign needs a clear identity and a message that the public understands.This means you need logos and slogans that people identify with the campaign. You also mustbe clear about the message that you want to get across in all the speeches you make or mediayou produce. The message sums up the key things that you want the public to understandabout your issue.

Once your target audience identifies with the issue, you have to move them to take action. Todo this, you need a mobilising and organising strategy. A successful campaign never moves offits message. Do not get diverted by other issues, especially by opposition attacks. Stick to thepositive message you want to get across, regardless of what other people say. This enables youto set the agenda.

—The Millennium Campaign 14

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As advocates, we are eager to develop strong messages to persuade the public that action mustbe taken to control tobacco use. Indeed, we might be so eager to create such messages that wefail to pause long enough to ask the question that will make our messages the most strategicallyeffective – not “What do we want to say?” but “What must we say to empower our target audience to act?”

The language we choose is critical. It takes just a few words to frame an issue, but these fewwords often determine how effectively we are able to draw popular or political support. 15

Emphasizing a Public Health Frame When people view tobacco primarily as a personal issue, they tend to “blame the victim.” Theysee the individual smoker as responsible both for causing the problem and for finding a remedy.In this view, people who use tobacco have made a bad decision and have no willpower, so they aremorally responsible for the result. Advocates often run up against such attitudes, which absolvetobacco executives and government regulators of all responsibility.

In contrast, putting the issue in a public health context – framing secondhand smoke as a publichealth issue – shifts it from the personal to the social and political arena, from the behavior ofsmokers to the behavior of the tobacco companies that fight smoke-free legislation and of thepolicy makers who refuse to act. A statement like “Everyone has the right to breathe smoke-freeair” can engage and unite both nonsmokers and smokers who care about the health of thosearound them. The right of nonsmokers to breathe smoke-free air is an issue that appeals to anylogical thinker.

The purpose of putting our message in the framework of public health is to highlight governmentaland corporate accountability; this approach builds support for reaching our objective –smoke-free air for all – via policy change.

Understanding Core vs. Tailored MessagesIn advocacy, we distinguish between core messages and tailoredmessages. Core messages speak to all our target audiences. They include the fundamental arguments for the laws. For the enactmentof smoke-free legislation, our core messages might be:

• Exposure to secondhand smoke causes serious health problems.

• Everyone has the right to breathe smoke-free air.

• Secondhand smoke is a public health hazard that requiresresponsive public health protection, laws, and regulations.

• All employees have the right to a safe work environment,free from the hazards of tobacco smoke.

• No one should have to risk getting lung cancer to make a living.

In an ideal world, these core messages would convince governmentauthorities to pass strong smoke-free laws simply to protect thepublic health. But in the real world, government officials haveconcerns unrelated to health that get in the way of enacting suchlaws. Often these concerns result from false or deceptive propagandaby tobacco industry lobbyists and their allies. To counteract thefear and doubt this propaganda produces, we need to address officials’ concerns directly.

School girl in asmoke-free march

by the UgandaMedical Associationin Kampala, Uganda

marks World NoTobacco Day 2001.

Credit: The Environmental Action Network and theUganda Medical Association (Kampala, Uganda)

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That’s where tailored messages come in. Tailored messages address the self-interest and specialconcerns of a particular target audience. For example, a city council member up for reelection is worried about whether the public supports smoke-free laws. This person needs to hear:“Smoke-free laws are popular. They are supported by the majority of smokers and nonsmokers.”

Tailored messages can often be more persuasive than core messages in motivating our target audience.And the more political intelligence we gather about the concerns and motives of key decision makers,the more effectively we can tailor the messages they need to hear to support our advocacy objectives.

Assume that one of our targets is the prime minister. We want this influential leader to support alaw that will ban all smoking in public places – a national smoke-free law. So we need to developmessages that resonate with the prime minister’s specific interests and concerns.

For example, the prime minister and the cabinet may be impressed by our core health message butfeel no urgent need to act. To persuade them to move now, we can send them a tailored message:“Important political constituents such as labor unions support workplace smoke-free laws” is agreat example.

The prime minister, the finance minister, and the commerce minister may also need to heartailored messages that calm their economic fears. They need to know that restrictions on smokingin public places, including restaurants, have not caused economic harm to businesses and havenot created a sudden drop in tax revenues in countries where these policies have been implemented.Indeed, the evidence is often that these laws are good for business. The prime minister wouldprobably be impressed to learn that reliable polls show that enacting and enforcing smoke-freelaws in public places would be politically popular with voters (if such poll information is available).

Depending on the stage of our advocacy campaign, we need to tailor our messages to differenttarget audiences. Even the best-educated public officials may not see smoking as a public healthissue, especially in countries where other health concerns seem more critical. And even if theyunderstand that smoking is harmful, public officials may believe the solution lies not in governmentregulation, but in individual “free choice” – just as the tobacco industry has always argued. Thesepublic officials need to hear the message that exposure to secondhand smoke is not just a personalhealth problem, but a major public health catastrophe that demands government action.

Designing Effective MessagesExperienced tobacco control advocates and other communication experts have built a tool kit oftechniques to help them design effective messages. We list some of those tools here, along withreferences and links to more extensive guidance. For more information, see Part II of this guide.

On 15 October 2003 the Irish Congress of Trade Unions (ICTU) came outin the Irish Times newspaper in support of Ireland’s proposed smoke-

free law. In the article, ICTU “claimed 150 Irish pub workers diedannually from the effects of ‘second-hand’, and accused employers in

the hospitality sector of putting profit before the heath of employees.”The ICTU said its grounds for supporting the law were simple:

“passive smoking was a killer, it was the biggest health hazard in the workplace, and there could be no ‘so-called compromise’ on health

and safety of Irish workers.”

Credit: Reproduced with permission from the Irish Times

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Composing Simple, Catchy PhrasesSusan Bales, director of the Frameworks Institute in Washington, D.C., applies communicationsresearch to advocacy. An effective advocacy message, she finds, must both capture the essence ofa scientific concept and be simple and catchy enough to appeal to nonexperts. Examples fromother issues are the “ozone hole” and “greenhouse gases.” 16

Tobacco control advocates have developed several simple phrases along these lines with greatsuccess. An excellent example is “fairness to workers.” As advocates in the United States developedmessages to support smoke-free restaurants and bars, they had difficulty countering messagesfrom the tobacco companies. The companies argued that smoke-free laws were “unfair” to smokers.Nonsmokers, the industry argued, could simply avoid bars and restaurants whose patrons chooseto smoke. But tobacco control advocates gained strong support, including that of labor unionsand ethnic minorities, by reversing the message and shifting focus. Instead of fairness to restaurantand bar patrons who wanted to smoke, they argued for fairness to restaurant workers. The simplermessage was not “smoke-free restaurants” or “smoke-free bars,” but “smoke-free workplaces.”

The “fairness to workers” message carries strong moral authority. Restaurant and bar patrons canchoose not to go to restaurants or bars that allow smoking, the tobacco companies argue. Butworkers do not have that choice. In these workplaces, they must accept involuntary exposure tosmoke to earn a living.

Laws against smoking in the workplace in cities like New York were already in place to protectmost workers from having to perform their jobs in a smoke-filled environment. Why shouldworkers in restaurants and bars be treated unequally? As advocate Joe Cherner argues: “Lawsshould treat the health of all workers equally. No one should have to breathe tobacco smoke pollution to hold a job, because it causes cancer, heart disease, and respiratory disease.” 17

The message that all workers deserved equal and fair treatment was quick to arouse public passion.This support sped the passing of stronger laws much more effectively than would messages thatraised concerns for the health of restaurant or bar patrons.

Appealing to the Brain and the HeartIn advocacy campaigns, a message needs to do much more than persuade or present an argument.Ethel Klein is a leading scholar and practitioner of political communications – something inwhich tobacco control advocates are unavoidably engaged. She cautions that an effective advocacymessage must be “at the same time logically persuasive, morally authoritative, and capable of

evoking passion. A campaign message must speak at oneand the same time to the brain and to the heart.” 18

The Bangladesh Anti-Tobacco Alliance (BATA) hasdeveloped public education materials on secondhandsmoke, including posters and stickers, that aim tospeak both to the heart and the head. The messagesfocus on raising public awareness of the problemscaused by secondhand smoke by illustrating its impacton the most vulnerable populations.

A Bangladesh Anti-TobaccoAlliance (BATA) poster (basedon one originally created byASH Thailand) warns of the

effects of secondhand smokeon children. The poster lists

diseases caused by secondhandsmoke along with the slogan,

"We want clean air, not cigarette smoke.”

Credit: Reproduced with permission from Bangladesh Anti-Tobacco Alliance

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A sticker highlighting the dangers of secondhand smoke for women states: “Passive smokingreduces women’s fertility, harms fetuses, and causes lung and breast cancer.” A poster, based onone originally created by the Action for Smoking and Health (ASH) Thailand, warns people of theeffects of secondhand smoke on children. The poster lists diseases caused by secondhand smokealong with the slogan, “We want clean air, not cigarette smoke.”

Using Numbers That SingTobacco control advocates can develop motivating messagesby presenting statistics in ways that convey scientific truthsand also move an audience emotionally. This technique hasbeen called “creative epidemiology” or “social math” – math-ematics applied for a social purpose.

In Bangladesh, activists used “social math” to highlight theeffect that tobacco has on poverty. By comparing tobaccoexpenditures with expenditures on basics such as food andeducation, they established an emotional connection between tobacco and poverty.

“In both urban and rural areas of Bangladesh, per capita spending on tobacco is higher than on milk.” 19

“Researchers estimate that 10.5 million people are going hungry and 350 children are dying each day due to diversion of money from food to tobacco.” 20

Developing Responsive-Chord MessagesAdvocate Tony Schwartz uses a message-development technique he calls “responsive-chord” communication: The message strikes a responsive chord in its audience. 21

In a smoke-free campaign, for instance, the issue of workers’ right to a safe and healthy workplacecan hit a responsive chord with audiences, especially union workers. In Canada, waitress HeatherCrowe became a national symbol of the effects of secondhand smoke and an important player inthe effort to have smoke-free legislation passed. In a series of television and print ads, Heathertold her story directly to the Canadian people of how she had never smoked a day in her life. Yetafter 40 years of working as a waitress in a smoke-filled restaurant she was diagnosed with inoperable

lung cancer. Public health groups sponsoreda “You Can Make a Difference” speakingtour where she traveled the country tellingher story to the media, policymakers andthe public. “My goal is to be the last personto die from secondhand smoke”, Heather stated. “You can help make it happen. You can make a difference.” 22 By putting a human face on the deadly effects ofsecondhand smoke, Heather Crowe struck a responsive chord among the Canadianpublic and thus played a major role in thedrive to have smokefree workplaces.

Food that could be bought for one pack of Marlboro

cigarettes in Bangladesh, 2000

Heather Crowe never smoked a day in her life, but she worked asa waitress for 40 years. In May of2006, Heather died of lung cancer.She was 61 years old. Crowe was

featured in a mass media campaignby Health Canada that began in2002 to build awareness about

the dangers of secondhand smokeand to protect the health of

workers everywhere.

Credit: Health Canada

Efroymson, D.; and Ahmed, S., Hungry for Tobacco: An analysis of the economic impact of tobaccoon the poor in Bangladesh, PATH Canada, Work for a Better Bangladesh, October 2001.

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Respecting the Cultural and Political EnvironmentAn effective message is attuned to the social, religious, and political cultures of its audience.Messages that resonate with one society may alienate people from other cultures or people with different political veiws. For instance, messages that assume negative feelings about tobaccocompanies may prove effective in countries where, thanks in large part to aggressive mediareporting, the public views these companies as evil and incapable of a positive act. But in countrieswhere the public sees the tobacco industry as just another business, the same messages wouldprobably fall flat. (In such countries, messages need to target decision makers, spelling out thedevastating economic cost of tobacco and the marginal contribution the industry makes to thecountry’s economy.)

According to Dr. Hussein Gezairy of WHO’s Tobacco Free Initiative (TFI): “All religions call uponpeople to look after their health, to avoid health hazards and risks and to raise their standards ofhygiene.” 23 But advocates need to be cautious about designing messages that emphasize religiousvalues in support of laws and regulations; sentiments that prove persuasive in religiously homogeneoussocieties may come across as offensive or inappropriate in secular and pluralistic societies.

In countries or areas of the world where advocates can safely tap into religious values to gainpopular support for tobacco control, they have developed messages such as these that call onMuslim and Christian perspectives:

Recently, physicians and university professors have presented shocking statistics on thedeath toll and fatal diseases resulting from tobacco consumption and now it is [one]

hundred percent clear that using tobacco is dangerous. Even the children of those whosmoke cigarettes and the people near them are not immune from the dangers of smoking.

Therefore, now I have issued an absolute decree banning smoking. I want God Almighty tohelp protect the youth who are the primary victims of smoking.

—Ayatollah Nasser Makarem-Shirazi, senior Iranian cleric in the city of Qom 24

I think Christianity – particularly Orthodoxy – can welcome the Tobacco Free Initiative of theWorld Health Organization in the hope that it can eventually tackle it as part of the holisticproblem of the need to cure the human person, that frame full of dust (see Psalms 103:14),and the importance of making it shine as a dynamic reflection at the heart of a reasonable nature.

—Rev. Professor Athanasios Hatzopoulos, Greek Orthodox Church 25

Smoking [by] whichever form and whichever means, causes extensive health and financialdamage to smokers. It is also a cause of [a] variety of diseases. Consequently on this

evidence smoking would be forbidden and should in no way be practiced by the Muslims.

—Sheikh Gadul Haq Ali Gadul Ha, a grand Imam of Al-Azhar, Cairo 26

When we face things that destroy man’s health and ruin his well-being and stability, such astobacco, we remember the teachings of the Bible that make clear that while "all things arelawful, not all things are constructive.” Hence, when we say that everything is lawful, it isimportant to remember our duty not to allow anything to hold us in slavery. Since smokingis an addiction, it certainly enslaves the smoker. The Bible states: "Whoever perpetrates a sinis a slave of that sin.” Today we see how smoking holds every smoker in slavery, whether ayoung person, a man or a woman, youth or adult. This is clear in the fact that every smokerfinds it very hard to quit.

—Father Wissa Gurguis Marcus 27

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(For more information on how various religions view tobacco, refer to the World HealthOrganization’s report on the Meeting on Tobacco and Religion, held in Geneva in May 3, 1999.) 28

Cultural differences can also influence which messengers can most effectively spread the advocacymessage. For example, the public, the media, and politicians (in some countries) might admirethe idealism of young people who openly criticize political leaders for accepting gifts from tobaccocompanies. Other societies consider outspoken criticism by young people rude and disrespectful;messages they deliver will meet with disfavor.

Connecting with Underlying Value Systems A leading scholar in the field of cognitive linguistics, George Lakoff has an important lesson foradvocacy: People generally do not come to their feelings about political issues by analyzing themin the context of a political philosophy. Instead, they form these preferences unconsciously. Theyrelate political issues to familiar words and images that carry imbedded values and feelings. 29

For instance, Lakoff observes that we almost all speak – and unconsciously, think – of our countryand our government as our “family.” As a result, we apply the same moral standard to questions ofgovernance that we apply to the raising of children. The Department of Health in South Africacaptured this connection when it stated: “As custodian of health services and standards, theDepartment has a moral obligation to the population to protect them from hazardous effects of tobacco products.” 30

Similarly, as we have seen, advocates in some countries call upon religious values to draw popularsupport for tobacco control.

Outflanking the Opposition with Fact-Based Messages

Tobacco Industry Interference

Tobacco use is unlike other threats to global health. Infectious diseases donot employ multinational public relations firms. There are no front groups

to promote the spread of cholera. Mosquitoes have no lobbyists….Reversing [tobacco’s] burden on global health will be not only about understanding addiction and curing disease, but, just as importantly,

about overcoming a determined and powerful industry.

– World Health Organization, 2000 31

Tobacco is a unique public health problem because the main vector of the disease– the tobacco industry – has a financial stake in high smoking rates. Thismeans that advocates for comprehensive smoke-free legislation must be wellprepared to counter the tobacco industry’s efforts to mislead and misinformpolicy makers and the public.

The tobacco industry has long recognized that public smoking restrictions are one of the mosteffective ways of reducing tobacco consumption, confidentially acknowledging that comprehensivelaws that protect against secondhand smoke pose a serious threat to Big Tobacco. In fact, as thefollowing examples from the now defunct U.S. Tobacco Institute show, the internal files of thetobacco industry can themselves be useful messages in our advocacy efforts:

Credit: Reproduced with permission from Jerry King

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Blowing Smoke: BAT’s Air Filtration SchemeInternal British American Tobacco documents reveal the company knew that air filtrationor ventilation systems were ineffective yet still promoted the technology as a viableoption to smoking bans.

In BAT’s own words, the company’s interest in ventilation systems was primarily “to negate the need for indoor smoking bans around the world.”

– “Blowing Smoke: British American’s Tobacco Air Filtration Scheme,” British Medical Journal 332 (2006): 227–228.

• “What the smoker does to himself may be his business, but what the smoker does to the nonsmoker is quite a different matter…. This we see as the most dangerous development yet to the viability of the tobacco industry that has…. occurred.” 32

• “The logical appeal of smoke-free air is irresistible to politicians, commentators, even somesmokers. It is the most effective way to reduce smoking.” 33

Since the evidence (and the tobacco industry’s owncomments!) shows that smoke-free policies are one of

the most effective ways of lowering smokingrates, we can expect fierce resistance from thetobacco industry. Usually this will come throughproxies, such as industry-funded scientists, businessassociations, labor unions, “smokers’ rights”groups, and think tanks. “Myths and Realities of Smoke-Free Policies” in Part II of this guidecontains useful rebuttals to some of the mostcommon tobacco industry arguments againstsmoke-free legislation. 34

Economic Arguments“It is secondhand smoke, not efforts to protect people from it, that harms the economy,” the Smoke Free Europe Partnership reminds us. 35

As many advocates have learned, no matter how much data we present on the health impacts of secondhand smoke, some government officials are reluctant to press for smoke-free laws out of concern about the potential economic impact of such laws. In our campaigns, we need to persuade government authorities that strong smoke-free laws will not harm the economy. In particular, officials who have responsibility for the funding of health care need to hear that limiting exposure to secondhand smoke can reduce health-care costs.

As mentioned earlier, “social math” refers to using statistics to convey powerful messages. An effectivesocial math strategy is to estimate the annual health-care and other costs attributed to secondhandsmoke in a country or city. For example, researchers and advocates in the U.S. state of Indianapublished such an estimate in the Indianapolis Star newspaper to illustrate for the public theeconomic costs of secondhand smoke. According to the article:

Credit: Reproduced with permission from Martyn Turner and the Irish Times

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• “The cost of disease and deaths related to passive smoking was estimated at $56 million in Marion County in 2000, according to a report being released today by the county Health Department.”

• “It is estimated that $25 million was spent for adults suffering from ailments related topassive smoking, such as lung cancer and heart disease, and $31 million was spent fortreating children for diseases, such as asthma and other respiratory conditions, caused by secondhand smoke.” 36

Similarly, with help from economic researchers we might be able to devise a statement like the following:

“It is estimated that $XXX million is spent annually in our country on adults who sufferfrom ailments related to secondhand smoke, such as lung cancer and heart disease, and$XXX million is spent on treating children for illness caused by secondhand smoke, such asasthma and other respiratory conditions.”

Focusing on the Health Effects of Secondhand Smoke

There is no safe level of exposure to secondhand smoke, which is recognized as a publichealth hazard – not just as a mere discomfort for nonsmokers. It is well known that tobaccoand secondhand smoke undermine our health and physical performance and we need to acton that knowledge.

– Harri Holkeri, UN General Assembly president 37

In many countries, public awareness of the health hazards of secondhand smoke is still low. Inthese cases, we need to focus on how secondhand smoke affects nonsmokers. The message is that secondhand smoke is a scientifically proven health risk to nonsmokers; that they should notbe exposed to it involuntarily; and that smoke-free laws spare people from disease and death,both by protecting nonsmokers directly and by encouraging smokers to quit. Nonsmokers needto hear that they are seriously at risk if they don’t speak up to the smokers who ignore smoke-freerules. The focus is not smokers versus nonsmokers or getting rid of smokers. The focus is gettingrid of smoke.

Effective messages combine sound science and emotive language in a way that provokes an emotional response in almost any listener. An effective message on secondhand smoke has several key components:

• It conveys the fact that even short periods of exposure are harmful and have immediate effects.

• It is based on sound research.

• It uses startling and memorable images to evoke an emotional reaction.

• It links secondhand smoke to grave health conditions such as heart attacks and strokes.

Messages on the Short-Term Health Effects of Secondhand SmokeBreathing secondhand smoke causes immediate and substantial effects. For example, breathingsecondhand smoke for just 30 minutes activates blood platelets as much as those of pack-a-daysmokers. These activated platelets damage the lining of arteries, which leads to heart disease.They can form a blood clot that lodges in a coronary artery and causes a heart attack. They canlodge in the brain and cause a stroke. 38

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Secondhand smoke can trigger an asthma attack in anyone who suffers from asthma. 39 Most asthma sufferers report symptoms ranging from discomfort to acute attacks when exposed to secondhand smoke. 40

Messages on the Long-Term Health Effects of Secondhand SmokeIndividuals who regularly breathe secondhand smoke are at increased risk for a range of smoking-related diseases. Many studies have shown that secondhand smoke is a cause of lungcancer, ischemic heart disease, and eye and nasal irritation in adult nonsmokers; a cause of respiratory disease (e.g., bronchitis, pneumonia), low birth weight, cot death (also known as cribdeath or sudden infant death syndrome), and middle ear infections in children; and a cause ofasthma attacks, coughs, and croup in both adults and children. 41

Multiple studies have linked exposure to secondhand smoke to heart disease. For instance, nonsmokers who breathe secondhand smoke at home have a 30% increased risk of heart disease. Just as for active smokers, what causes much of the cardiovascular effect for nonsmokers is acute poisoning. 42

A critical message for advocates to communicate is that secondhand smoke is a proven healththreat at home, at work, at school, in restaurants, in theatres, and in bars. Secondhand smokecauses serious long-term health problems to all people, in all countries. To convey the gravity of the threat, we need to cite the concrete scientific evidence that proves it.

Another message we need to send is that “studies” showing that secondhand smoke is not harmfulare generally funded by the tobacco industry and are sometimes not even conducted by scientists. 43

Messages on Secondhand Smoke as a Toxic Pollutant Appreciation for the natural environment is on the upswing in many countries today, along withawareness of the increasing presence of the toxic chemicals that make people ill. So messagesthat highlight the presence of hazardous chemicals in secondhand smoke can be effective.

The World Health Organization’s International Agency for Research on Cancer has identified secondhand smoke as a cause of lung cancer and classifies secondhand smoke as a human carcinogen. The U.S. Environmental Protection; Agency has also classified environmental tobacco smoke as a Class A (known human) carcinogen other Class A carcinogens are asbestos,arsenic, benzene, and radon gas. For Class A carcinogens, there is no safe level of exposure; anyexposure is dangerous. 44

In 2005, the California Environmental Protection Agency identified environmental tobaccosmoke as a “toxic air contaminant.” 45 Tobacco smoke contains more than 4,000 chemicals in theform of particles and gases. Some of these have strong irritant properties, and at least 60 of themare known or suspected carcinogens. They include nitrosamines, which cause cancer of the lung,respiratory system, and other organs; aromatic amines, which cause bladder and breast cancer;formaldehyde, which causes nasal cancer; and benzene, which causes leukemia. 46 Tobacco smokealso contains large quantities of carbon monoxide, a gas that inhibits the blood’s ability to carryoxygen to body tissues, including vital organs such as the heart and brain, as well as other substances that contribute to heart disease and stroke. 47

Part II includes some helpful messages aimed specifically at teachers, workers, business owners,parents, and women to convince them to support smoke-free legislation.

Messages on the Advantages of Smoke-Free PoliciesIn addition to presenting the hazards of secondhand smoke, it is important to offer the solution –messages that express the benefits of smoke-free laws, particularly those related to health and politics.

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Immediate Benefits to Public HealthA great example we can point to that vividly conveys the benefits of smoke-free laws to publichealth is the 2002 case study conducted in Helena, Montana (USA). The researchers found that, inthe six months following the enactment of a new smoke-free workplace law, heart attack admissionsto hospitals declined by 40%, while no corresponding decrease occurred in neighboring towns.When the law was preempted by a weaker state law, heart attacks went up again. 48

A year after a smoke-free law made every workplace smoke-free in March 2004 in the Republic of Ireland, the southern half of the country, the lung health of bar workers in the Republic hadimproved significantly. The lung health of their colleagues in Northern Ireland, where smokingwas still permitted in bars, remained the same. 49

A 2005 study found that since New York’s workplace smoke-free law had gone into place, bar andrestaurant workers were suffering less from sore throats, runny noses, and irritated eyes. 50

We can point to the Montana, Ireland, and New York study findings to encourage our own community to take action to protect the health of citizens. Specifically, these studies

• Demonstrate that the health benefits of smoke-free ordinances are virtually immediate;

• Provide more scientific evidence that smoke-free workplace policies improve health and save lives

Global Leadership in Smoke-Free PolicyAll policy makers want to be seen as leaders – not as people who hesitate to do the right thing.National or state leaders often spend considerable time looking over their shoulders to make surethey’re keeping up with – or surpassing – their close neighbors. And the media thrive on lettingthe public know how the national scorecard reads.

An example of how we can influence leaders in our country by playing on this anxiety is a statementby Heather Monteverde, Macmillan Cancer Relief ’s General Manager for Northern Ireland, quotedin the country’s major newspaper: “With the success of the legislation in the Republic becomingever more evident, and a ban likely to come into effect in Scotland next spring, Northern Irelandis in danger of looking increasingly isolated in its lack of commitment to taking the necessarymeasures to improve the health of our people. Every delay in introducing legislation, is delayingthe time, that when Northern Ireland can be a healthier place to live and work.” 51 She is saying, inessence “All progressive countries are passing these laws; our government doesn’t want to be seen as backward.”

Popular SupportAs strong as elected officials’ concern for the public welfare, and sometimes stronger, is theirdesire to be reelected. A message that speaks to both of these concerns can be especially persuasive:A majority of the public supports smoke-free policies. In most countries, the percentage of adultsmokers is under 50%. Where that is true, we can also mention in our communications materialsthat the majority of people don’t smoke. In addition, recent evidence from a number of countriesshows that even a majority of smokers supports smoke-free legislation.

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A Pre-campaign Trial Run Even advocates’ judgment can go off track. Let’s go back to the question we need to ask: “Whatmessages do these authorities need to hear to motivate them to act?” What we as advocates maydeem effective and clever messages may not resonate at all with the people we want to inspire.Veteran advocates have learned the wisdom of giving messages a trial run before launching acampaign and of continuing to test them periodically to make sure they are still effective.

Focus GroupsOne way to test our message is to gauge the focus groups’ reactions to it. Most tobacco controladvocacy groups cannot afford to hire a specialized firm to organize such a group. But we caneasily reach out to colleagues in target institutions to try out different messages informally. Or if raising public awareness is the goal, we can invite some friends and neighbors who are notinvolved in tobacco control to come together to sit and talk for a few hours (perhaps over a goodmeal). Such groups commonly harbor contradictory feelings about issues that we consider self-evident. Their conversation gives us a sense of how the public thinks and talks about particularissues and what messages they are most likely to respond to.

If our funding covers hiring specialized firms to supply focus groups, they can bring together randomly selected members of our target audiences; this can include elite opinion and decisionmakers and citizens who have not thought much (or systematically) about political issues.

Further information on using focus groups is available in Blowing Away the Smoke,Advisory 3, “Getting the Message Right: Using Formative Research.” 52

Question #4. Who Are The Most Effective Messengers To Deliver Those Messages?

The Difference the Messenger Can MakeTobacco control advocacy groups often spend a great deal of time and care developing their messages but little time considering who can best deliver them. We may assume that our groupleader or the chair of the organized tobacco control coalition will deliver the messages. Buttobacco control leaders are not always the best spokespeople for every setting. And self-awareleaders are willing to suppress their egos enough to recognize and admit, for example, “I’m notthe right one to lobby Parliament (or to go on TV for this interview). Someone else can do this better.”

Depending on who delivers it, the same message can vary in its credibility, power, and effect on a particular audience. What we are looking for in a messenger is a combination of individualcredibility, eloquence, and, most importantly, the ability to influence the targets of our advocacyefforts. Only a strategic analysis will tell us for sure who the best messenger is in each case.

Choosing a MessengerIn the process of deciding who will be the most effective messenger, we need to answer some keyquestions, (several of which might elicit the same answer):

• Who is most likely to influence our target audience favorably?

• To whom is our target audience politically responsive?

• Whom does that audience most want to please?

• To whom is that audience politically (or financially) obligated?

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• Whom does it honor? Trust? Respect? Fear? Like? Perhaps even love?

• Whom among our possible messengers does our target audience dislike? Scorn? Not takeseriously? Distrust?

An Example of the Process: Choosing Messengers Persuading a target audience depends as much on the messenger as the message.Parliamentarians are likely to give a great deal of weight to the political advice of their peers. Forexample, suppose a respected member of parliament who is also a doctor makes a scientific andpolitical case on the floor of parliament for a smoke-free law. His statement will carry a great dealof weight. Or imagine that a prominent political columnist who has the ear of government leaders– or is feared by them – raises questions about the corrupt influence of tobacco lobbyists. His columnwill be far more influential than a letter to the editor from an unknown tobacco control advocate.

Whatever person or institution is the target, the process of figuring out whom they will listen to is the same. Since many advocates will be trying to pass national smoke-free legislation, here weprovide examples of the kinds of messengers who might influence a prime minister.

In this case, our short-term objective is: To persuade a prime minister to support a comprehensivesmoke-free law.

We begin by answering the key questions on this issue: Who is most likely to influence a primeminister favorably? To whom is a prime minister politically or financially responsive or obligated?Whom does a prime minister trust? Respect? Honor? We conclude that on the issue of supportinga comprehensive smoke-free law, a prime minister is likely to listen to:

• Trusted aides

• Former aides the prime minister respects

• Cabinet members, including the minister of health

• Political leaders of the prime minister’s party

• Campaign supporters and financial contributors

• Leaders of important constituent groups – labor leaders, teachers, or business leaders, for example

• Media owners, powerful political columnists, and other prominent media figures

• Nationally known medical and scientific leaders

• Doctors from the prime minister’s party who are Members of Parliament

• Nationally respected religious leaders

• Leading business people and business associations

• The prime minister’s personal physician

• The prime minister’s spouse or another family member

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To sum up, politicians – including prime ministers – are most influenced by people they know,respect, and rely on for advice. Therefore, the most effective messengers will be their trusted advisors,family members, and colleagues. In addition, politicians may be persuaded by some combinationof respected scientists, doctors, and others in positions of authority – teachers, priests, nurses,doctors, professors of medicine, presidents of national medical societies, or scientific stars suchas Nobel Prize winners. Celebrities, sports figures, television and movie stars (including actorswho play doctors), musicians, and political figures can also serve as excellent messengers to helpmotivate and educate policymakers on the hazards of secondhand smoke.

Roles and Influence of Specific MessengersThe qualifications of each type of messenger guide what role they can play, carrying our primarymessage either to a prime minister, other government officials, the media or other audiences.

Ministers of HealthAlthough heads of government do often turn to their health ministers for advice, health ministersare too often seen as the politically weaker members of a cabinet. However, a strongly committedstate or provincial health minister can still rally the entire government to back strong tobaccocontrol measures. Simon Chapman, professor in public health at the University of Sydney,recounts the impact of such a health minister, newly appointed in the Australian state of Victoria:

Few politicians get thrown in the deep end of politics and given a ministry and seat in cabinet on their first week in Parliament. Frank Sartor broke the mold and was entrusted to pursue a personal crusade he had long been lobbying the [Carr] government to fund: aministry unique in the world that would be dedicated to doing all that was possible toreduce the burden of cancer in the community. Like so many, the former Sydney OlympicsLord Mayor has deeply personal experience with cancer. His mother had died of melanomawhen he was 16 and his partner, former ballerina Hephzibah Tintner, died of throat canceraged just 30.

Everyone who meets Sartor or receives one of his [expletive deleted] 50-minute late eveningphone monologues knows immediately that he is personally driven. He seems to know thishimself, quoting the late Christopher Reeve in his maiden speech to Parliament, “I oftenwonder why it takes a direct emotional connection for our elected officials and prominentmembers of society before they are willing to help us.”

Sartor takes to a brief like a hungry dog cleans a bone. Any question elicits a Niagara of statistics, which are invariably correct. He has rapidly acquired a reputation among healthprofessionals as being among the most informed politicians to have dealt with health issues.Famously described as an “acquired taste,” he can be impatient, irritable and stubborn, and hemakes enemies. But if you want someone on your side, he is a peerless operator. 53

Former health ministers, even from neighboring countries, can have a telling impact on debatesover smoke-free legislation. In Scotland, First Minister Jack McConnell’s smoke-free-environmentsinitiative was aided when former English health secretary Frank Dobson was quoted as saying:“Strength to your arm, Jack, get on with it. It will be popular, it will work and it will save lives,particularly here in Scotland where the general level of health, among a large part of thepopulation, is poor.” 54

It may also be useful to encourage officials from our country to visit or talk to their counterpartsin places like Ireland, where successful smoke-free policies have been enacted. The Guardianreports that “Scottish ministers were initially sceptical that a comprehensive ban would work.But are said to have been convinced of the idea after a fact-finding visit to Ireland.” 55

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Other Government Ministries or Key Officials While health ministers are important messengers, other administration officials may be evenmore powerful – especially finance and commerce ministers. Given the economic concern thetobacco industry has stirred up over smoke-free legislation, it was particularly important inIreland to hear Finance Minister Brian Cowen welcome the large decrease in cigarette consumptionthat followed the country’s strong ban on pub smoking. The finance minister announced that thedrop in consumption proved that the government’s “brave” decision on the smoke-free law was agood public health initiative. 56

DoctorsDr. Thomas Glynn, director of cancer science and trends at the American Cancer Society, hasnoted that few countries in the world have made “significant progress in curbing the tobacco epidemic without its doctors understanding that their professional responsibilities require that

they take a leadership role in advocating for comprehensive tobacco control laws.” 57

If too few doctors in our country are activelyengaged in tobacco control advocacy, then doctors can become one of our first target audiences. For more information please see Guide #2: Engaging Doctors in Tobacco Control. 58

As the skilled and determined Czech physician-advocate Eva Kralikova points out: “Most peoplein most societies know that doctors are well educated and probably best informed about thehealth risks of tobacco smoke. That’s why doctorscould easily be good advocates for tobacco control– credible, and respected.” 59

Doctors have special credibility with policy makersand the media. In the UK, doctors delivered agiant cigarette pack full of letters to the residence

of Prime Minister Tony Blair. The letters, written by fellow doctors, told of the ways secondhandsmoke had affected patients under their care and called on Blair to make the UK smoke-free. 60

Those letters were later collated and published to counter the opponents of smoke-free legislationwho were contending that no one was seriously harmed by secondhand smoke.

Andrew Pipe, a well-known heart physician in Canada and a frequent witness in front of parliamentary committees, would look members of parliament in the eye and say, “You can save more lives with one stroke of your pen than I can in my entire career as a doctor.” 61

In some countries, leading physicians have access to the mass media. Usually they appear as guestexperts on news programs and talk shows, but some have their own regularly scheduled healthguidance programs. Such media access may give them the opportunity to target messages to policymakers about the importance of supporting smoke-free legislation.

As helpful as doctors can be to an advocacy campaign, we need to remember that no single group – other than policy makers – is critical for success. Countries have achieved tobacco control policy in many different ways, and some have achieved such policies without the activeinvolvement of doctors.

Dr. Steve Bruner, fromLawrence, Kansas, hasinspired others in themedical community toget involved in tobaccocontrol. On 1 July 2004,

the Lawrence city commission approved

a comprehensivesmoke-free air law.

Credit: K. Burner (Kansas, United States)

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NursesAs the people with the most day-to-day contact with patients, nurses know all too well the devastating impact of tobacco use. The Royal College of Nursing in the UK has come out strongly to make all public places smoke-free.

In the United States, nurses have formed a group, the Nightingales, using their experience ashealth-care providers to hold Philip Morris and other tobacco companies accountable for theiregregious marketing strategies. Nightingales, often nurses caring for those dying from lung canceror other smoking-related illnesses, have attended Philip Morris shareholder meetings to spreadtheir message. Because of their special credibility with the public, their tobacco-control advocacyhas attracted good media coverage.

Scientists and Other Experts The strongest tobacco control advocacy is firmly grounded in good science. And no messengerson the science that supports tobacco control are more persuasive than the scientists themselves.

Government officials, like the general public, often have great respect for scientists and “experts”that goes beyond their scientific credibility. People with extensive professional credentials canthus usefully lend their support to our advocacy efforts, particularly in combatting the supposedlyscientific arguments of the tobacco industry.

Bernard Lown, MD, is an example. Dr. Lown is a professor of cardiology emeritus at HarvardUniversity, a senior physician at Brigham and Women’s Hospital, and founder and chairmanemeritus of the Lown Cardiovascular Research Foundation. He is also a recipient of the NobelPeace Prize. Dr. Lown has published articles and lectured about the hazards of secondhandsmoke. At the First Virtual Congress of Cardiology, he stated: “The problem of passive smokingglobally is of enormous dimension and is growing. The wide prevalence of smoking in the home,the workplace, and spaces of public assemblage, provides no oasis free from toxic tobacco pollutantsfor the nonsmoker.” Dr. Lown’s recognition of secondhand smoke as a major problem, backed byhis own research on its detrimental effects, lends great credibility to advocacy efforts.

EconomistsThe World Bank, which many government officials and others view as a highly credible source,has come down strongly on the side of tobacco control with the publication of Curbing theEpidemic: Governments and the Economics of Tobacco Control. 63 This book contains economic as well as other arguments for a range of actions on tobacco control. As we try to convince government officials or other policy makers of the need to pass legislation, citing the World Bank may be a useful strategy.

Economic arguments put forward by the World Bank and other economists can also be helpful in deflating the arguments of the tobacco industry that tobacco control measures such as smoke-free environments will harm the economy.

Victims and Surviving Family MembersFamily members of victims of exposure to secondhand smoke or the victims themselves can bepowerful messengers because they can speak from the heart about their personal experiences.Simon Chapman recounts the emotional impact of the words of a tobacco victim’s widow at ameeting convened by the New South Wales, Australia health minister. The audience includedhospitality-industry representatives opposed to smoke-free laws; for smoke-free advocates, writes Chapman, it was “a largely hostile lion’s den.”

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Joy McKean, widow of country music icon Slim Dusty, had offered her support to the NSWCancer Council after Slim’s death from cancer. We spoke to the Committee high up in Governor Macquarie Tower in February. I watched their faces while she talked of the decades of smoke-choked rooms they’d played in. Joy quietly begged the meeting to think of the health of younger musicians who could avoid what Slim went through. When she finished, there waspin-drop silence in the room. No one would meet her eye or ask a question.” 64

Question #5. How Can We Get Our Target Audiences To Hear Our Messages?

One of the most effective ways to get officials to listen to our messages is to have advocates theytrust speak with them directly – a strategy we sometimes call lobbying. But this opportunity israre. More likely, it will take a different effort to get the attention of these officials – a strategytermed media advocacy. For instance, we might influence the local newspaper to publicize pollingresults that show that majorities of nonsmokers and smokers are in favor of smoke-free laws, orhave a Sunday supplement run a human-interest story that highlights the plight of people workingin smoky environments.

Lobbying If we are fortunate enough to enlist one of the powerful messengers discussed in Question #4,then our most effective medium may be direct lobbying. For example, if we are trying to influencea particular member of parliament, lobbying can range from a formal scheduled visit to the parliamentarian to a heartfelt plea from the parliamentarian’s wife over breakfast to a seeminglycasual conversation among parliamentarians passing in the corridor or at a reception.

Sometimes, tobacco control advocates can gain personal access to decision makers. Doors mayopen because they are highly respected members of society or because they represent noteworthyNGOs; sometimes doors open because they have worked hard to build relationships of trust andconfidence with key individuals.

We need to be creative in deciding who is “powerful.” Sometimes it’s simply someone who understands the issue. Politicians in general welcome information from any trusted source sothey can increase their knowledge base and speak with authority in meetings on the subject.Advocates in Bangladesh have noticed that they do not need to hold advanced degrees or highpositions to get the ear of officials. They must simply provide basic information in a factual manner and be helpful wherever possible. (The World Health Organization’s Tobacco ControlLegislation: An Introductory Guide, Chapter 8, “Passing Legislation,” offers suggestions for effective communication throughout the stages of the legislative process, including direct communication with parliamentarians.) 66

But when the doors to high-ranking offices – like the minds of their occupants – are closed totobacco control advocates, we must find the right medium to deliver our messages.

Media AdvocacyWe cannot expect policy makers to solve a problem unless they know the problem exists. This iswhere media advocacy – using the media to deliver our messages in news stories and editorials –comes in. Somehow we must convince the media to herald the news that secondhand smoke willultimately result in disease and death and that smoke-free laws protect people’s health withoutbeing ruinous to the economy. And we must persuade them to get these facts to the public asoften as possible and as dramatically as possible.

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As Shoba John reports from India, media advocacy can prove useful no matter how large theadvocacy effort: “Our coalition is a small group, but by getting attention in the media, the coalitioncomes to seem larger and more powerful.” 67 In South Africa, Yussuf Saloojee of the NationalCouncil Against Smoking, South Africa, writes “we focused essentially on media advocacy….≥We made sure that we put our own positions forward in the media, and nothing that the tobaccoindustry said went unchallenged. So media advocacy was one of our most important strategies.” 68

Polish advocate Witold Zatonski found a particular form of media advocacy, the press conference, highly successful:

Very quickly I understood that the best way to influence Parliament is not necessarily to goto Parliament, but to have press conferences. I learned how to speak with journalists. Thecampaign to create legislation – and the controversy – was very interesting to the mediaand the media began to educate the public. It became a topic for people to discuss. It beganto change the attitude of the Polish population. It became the fashion for politicians to tell themedia they would like to stop smoking. 69

The bottom line is this, according to media advocacy expert Lori Dorfman, author of BlowingAway the Smoke, Media Advocacy Advisories 5 and 6:

The news media sets the public agenda. The more often an issue is reported in the news, themore people are concerned about it. If we want to keep tobacco issues on people’s minds,you have to make sure those issues are regularly discussed in the news. You have to get the journalists’ attention. 70

How to Get the Media to Pay AttentionTo convince the news media to discuss the effects of secondhand smoke and the necessity forgovernment to enact smoke-free laws and policies, we first need to get the media’s attention.

Being a media advocate means being pragmatic about how the news works. Weneed to learn to think like journalists, to look for good stories, and to bring themto journalists’ attention. Here we can draw on strategies honed by successfultobacco control media advocates.

The main way to attract journalists’ attention is to make our stories newsworthy.Journalists cannot cover every important story. They must communicatethe news of the day within limits: a brief TV news segment, a short newspaperitem, or a few minutes on the radio. To get journalists’ attention, we haveto emphasize what makes our stories more interesting than the othersbefore them. Tobacco control media advocates should not think, “Here isan important health issue this journalist has an obligation to writeabout!” but rather, “How can I give this journalist a good, newsworthystory?” And health issues on their own are not always major news. Themedia likes controversy, so, for example, issues of rights, law, corruption,and industry influence related to secondhand smoke may be far morenewsworthy than a straight story about the dangers of exposure to secondhand smoke.

We need to remember that usually a story must grab the interest andattention of at least two people to become news: the reporter and thereporter’s editor (or TV or radio news producer). Even a journalist eager towork with us has to convince the editor that the story deserves to be partof the day’s news. The more newsworthy information we give a journalist,the better the chances we will read our story in the newspaper or see it on TV.

On 29 March 2004 the Irish Examiner heralded in

Ireland’s smoke-free law. Thefirst line of the article stated,“It’s HERE. From today Irelandleads the world in becomingthe first country to place anoutright ban on smoking in

the workplace.”

Credit: Reproduced with permission from the Irish Examiner

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Apart from celebrities, what subjects appeal to journalists? What are creative ways to maketobacco control stories newsworthy? How do we make sure the media communicates our advocacy messages effectively? The rest of this section offers answers to these questions.

How to Frame the IssueAn advocate’s ability to frame the issue in the media from a public health perspective can makethe difference between winning or losing a smoke-free-air campaign. This makes the concept offraming a critical tool for advocates to understand and use.

Frames are the boundaries around a news story – the context in which an issue is presented. Justas we decide what to include when we take a photograph, journalists decide what to include in astory. Framing describes the journalist’s selection process: which issues, ideas, and images shouldappear in a news story? The news frame draws attention to specific parts of the picture, relegatesother elements to the background, and leaves out some aspects entirely.

Framing can also refer to the attitude or perspective the writer takes toward what is included inthe story. This is often referred to as the angle or spin on the story. Symbols, metaphors, or visualaids that evoke particular feelings are what give a story its angle or spin. We need to pay attention tothe use of these images to understand how writers frame stories – and to frame stories ourselves.

News frames are important to advocates for one overriding reason:

How the news media frames an issue not only helps informed readers, viewers, and listenersdecide who is responsible for the cause and solution of a problem but also influences theopinions of many citizens who are less engaged in the issues than tobacco control advocates are.

Media-effects research shows that viewers of TV news typically place responsibility for fixing a problem on the people that news reports depict as having that problem. This is aconcern for public health advocates, because usually TV news frames emphasize isolatedevents or people and minimize the larger social and physical context.

How to Promote a Public Health Perspective Advocates can take several concrete steps to make the public health perspective resonate in their news stories.

Translate the Individual Problem into a Social IssueA public health frame emphasizes social determinants and the policies that can change themrather than individual choices. This means talking about policies, not behavior. So, for example,we should talk about “protecting people from secondhand smoke in public places.”

Our words must always demonstrate that there is a larger environment in which people are tryingto make healthy decisions. What barriers limit their options related to health? What elements ofthe environment could support them? Illustrating the answers to these questions helps journalistsand their audiences understand the importance of addressing systemic solutions.

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Assign Primary ResponsibilityWithout information from advocates, most news consumers might assume that the nonsmokeror business owner is the person with the problem and is thus responsible for solving it. (“If somebodydoesn’t like smoke, they shouldn’t be working in a bar.”) If we want audiences to understand thepublic health perspective, we must constantly assert governmental responsibility for the lack ofprotection from secondhand smoke. We need to name the individual or body whom we holdresponsible for taking action.

Suppose, for example, we want to convey the issue of fairness. We can first develop a story thatpersonalizes the injustice occurring, such as the story of a nonsmoking restaurant worker whohas developed lung cancer as a result of constant exposure to secondhand smoke. Then we canprovide a clear picture of who benefits from the status quo – the tobacco industry. Now we have a story about an exploiter and the exploited. The key to advancing the social justice and fairnessissue is to create a story that leads people to say: “That just isn’t right. There ought to be a law.”

Present a SolutionIf someone asks us what needs to be done about secondhand smoke, we need to be prepared togive a simple, effective answer. For example: “We need to establish smoke-free workplaces.” Wekeep it brief and simple so that the average TV viewer or newspaper reader knows what we want.This means knowing in advance what we want to say and being able to say it simply. We canpractice with colleagues until the answers roll off our tongue.

Make a Practical AppealPolicy changes behavior more effectively than education alone. The good news is that publichealth solutions are usually winners from a practical as well as a moral perspective. A successfulpolicy change is cost-effective. It eliminates the need for costly remedial measures and brings certainty and a level playing field to businesses. So we want to talk about how smoke-free workplaces will save money, enhance productivity, save lives, shield children, and/or protectworkers. We have at our fingertips examples of how our policy will benefit the entire community– not just those who suffer from the problem.

How to Use Media Bites The successful media bite is one of the most challenging and creative tools for framing a newsstory to get our point across effectively. A media bite is a short (bite-sized) quote that reportersfind so appealing and tasty that they want to give it a prominent place in their stories.

To be truly effective, the media bite must combine the art of the poet with the soundness of science and the conciseness required by the media. The best media bites meet three of the mediaadvocate’s greatest challenges:

• Communicates an effective simplifying concept for our policy objective

• Grabs the attention of a journalist and gains access in a news story

• Helps frame the issue in a way that points toward our policy objective

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To get a story in the news, we must work within the constraints of news time. Reporters usuallydevelop their stories by conducting interviews with known sources – people familiar to them. As they begin to gather information, reporters may talk to us for background on an issue. Thesediscussions may provide the reporter with direct quotes for their story. But usually reportersselect quotes later, after they better understand the issue and know which of our words best represents a particular aspect of the story. At that point, media bites become extremely important.Generally speaking, we can expect to be heard for 15 seconds in a TV story or to appear for a fewsentences in a print story. Despite the complexity of our issue, we must make it come alive fornews consumers in short bites.

How do we come up with media bites? We practice with colleagues. Try out different ways todescribe the problem and convey our solution. Get ideas from tobacco control advocates in othercountries. Try to speak to the shared values of our society. Stress themes such as fairness, commonsense, or protecting children. Take a stand. Talk about what is at stake. Who is affected? Whatwill this mean to people’s lives?

Successful media bites often convey some irony, sometimes comparing the public health problemto another issue people feel strongly about. For instance: “Having smoking and nonsmokingsections in the same enclosed space is like having urinating and nonurinating sections in a swimming pool.” This widely used media bite explains why smoke-free laws are necessary. Theanalogy clearly illustrates why no-smoking sections are not enough to protect people’s health.

TobaccoScam, a project of University of California professor Stan Glantz that seeks to expose thetobacco industry’s use of the hospitality industry, nicely sums up the health arguments againstsecondhand smoke in some tasty bite-sized portions:

1. A burning cigarette is a little toxic waste dump on fire, emitting benzene, formaldehyde,ammonia, cyanide, arsenic, and many of the same chemicals in diesel exhaust.

2. Secondhand smoke causes the same diseases in nonsmokers as smokers: heart attacks,asthma attacks and other breathing problems (particularly in children), lung andother cancers.

3. There is no safe level of secondhand smoke exposure. Restaurant, bar, and casinoworkers involuntarily inhale enough secondhand smoke every day to suffer some of thesame health effects observed in pack-a-day smokers. 71

How to Use Media Advocacy in the Advanced Stages of a Campaign: NarrowcastingAt a certain stage in our campaign, we may decide that we need to concentrate on the media thatreach and influence decision makers, even if much of the public does not pay attention to thesemedia. Such media advocacy is sometimes called narrowcasting (as opposed to broadcasting).Narrowcasting requires us to look at the media in terms of specific, limited audiences.

Parliamentarians are likely to read the news and editorial pages of their nation’s most widelycirculated newspapers, especially papers published in the nation’s capital city. They also readnewspapers from the region whose voters elect them to office. They may watch the evening news on national television.

Tobacco control advocates need to learn as much as possible about precisely which media aremost likely to influence the key decision makers who need to hear our message. We must thenapproach those media outlets strategically, deciding how to utilize them in the best possible way.

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How to Work with the Media Now that we have developed and refined our messages, we still need to get them into public discourse. The most clever and well-thought-out messages will do little good if only a fewcolleagues see or hear them. The media can play a crucial role in bringing much-needed publicityto our issue. It is our job not only to get them to cover our issue but to do so in a way that achievesour advocacy goals. Although the prospect of working with the media may seem intimidating at first,

the payoff is incredible. If we are successful, we will be able to reachhundreds or thousands of people with a single newspaper article ornews telecast. Part II of this guide provides some practical tips on how to reach the media effectively.

Opinion Polls and SurveysPublic opinion polls can be useful to show – when it is the case –that tobacco control laws will be well accepted among both smokersand nonsmokers. This can ease concerns about the unpopularity ofsuch actions and thus greatly increase the chances that politicianswill support such measures. If the public is not supportive, then itmay be our task to educate people about the importance of tobaccocontrol policies so that they will support their passage and obey thelaws when they are passed.

Work for a Better Bangladesh (WBB Trust) surveyed 1,073 passengersof an inter-city bus service. Less than half (41%) of the passengerssurveyed said they ever smoked on buses; even among those whodid, 67% said it would be good to have smoke-free buses, and a mere23% said it would not be a problem for them. Only 9% of the smokersobjected. The reaction from nonsmokers was stronger, with 99% saying buses should be smoke-free. WBB used the results to convince two bus companies to introduce a smoke-free bus service and to fight successfully for a law that prohibits smokingin public transport. 72

In the Czech Republic, students in epidemiology at the First Facultyof Medicine, Charles University of Prague, polled workers at Praguepubs on their opinions of secondhand smoke and then called a pressconference to publicize their findings. Advocate Eva Kralikova reports:

They asked the personnel about secondhand smoke. There was no effective ban of smokingin restaurants at this time in the Czech Republic. Surprisingly, 60 percent of the personnel,including smokers, would prefer no-smoking workplaces: They did not like tobacco smoke in their restaurant. But they did not want to lose their jobs and this is why they did not asktheir chief for a nonsmoking environment. Medical students presented those findings at apress conference, saying to journalists that 6 of 10 waitresses who told guests that they don’tmind their smoking were lying. This was a powerful argument for public discussion aboutnonsmoking public places in the society. 73

Even other countries’ public opinion polls that show support for smoke-free legislation can beuseful in our advocacy efforts. For example, the Framework Convention Alliance helped its members around the world publicize a poll in Ireland that showed that 83% of smokers thoughtthe new smoke-free law was a “good” or “very good” policy. This helped its member organizationscounter the fears of decision makers in their countries that passing smoke-free legislation wouldlead to massive protest by smokers. As Ireland's minister of state at the Department of Healthand Children, Seán Power, put it:

On 9 September 2003 the Irish Times reported that amajority of voters supportedthe government’s proposedsmoke-free ban. The Timesreported “coming after a

sustained campaign againstthe ban by publicans, the solidsupport shown by the poll will

encourage the Minister ofHealth, Mr. Martin, in his

determination to go aheadwith the ban.”

Credit: Reprinted with permission from the Irish Times

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The Irish public’s overwhelming acceptance of this historic public health measure sends avery clear message to legislators around the world who are considering the introduction of similar smoke-free workplace legislation. Not alone is it very possible to implement suchlegislation but citizens fundamentally accept its validity and necessity in order to protecttheir health. 74

Similarly, in Australia, health groups rallied to generate public support for a regulation that wouldmake pubs smoke-free. Their efforts paid off, and online polls revealed tremendous support forthe smoke-free pubs. Simon Chapman, professor in public health at the University of Sydney,describes the experience:

Health groups in Australia saw their main hope in surfing the momentum of massive publicsupport and positioning the pub anomaly as a political issue that demanded leadership.While the Australian Hotels Association (AHA) was intent on spraying its apocalyptic economic fantasies around, health groups ridiculed this with overseas data and admissionsfrom internal tobacco industry documents. (“The economic arguments often used by theindustry to scare off smoking ban activity…. had no credibility with the public, which isn’tsurprising when we consider that our dire predictions in the past rarely came true.”) Theystuck to the core, touchstone issue of it being un-Australian to give all workers protectionfrom secondhand smoke, except those who are most exposed. It resonated. Several onlinemedia opinion polls saw some of the largest voting numbers ever seen since the polls began,with typically 80% supporting a ban. 75

The publicity of these polls, in addition to other advocacy efforts happening simultaneously, ledto the passage of the smoke-free-pubs law in New South Wales and Victoria, Australia.

Public opinion polls are simple and can be fairly inexpensive to conduct. If we do choose to conductan opinion poll, we need to be careful when we phrase our question. For example, “Do we thinkall public places including barsshould ban smoking?” is far lesslikely to gain support than “Dowe think all workers have theright to protection from thedangers of secondhand smoke?” It may be possible to get other organizationsand/or volunteers to help uscollect and analyze data; thiswould make the study basicallyfree. This is a powerful tool inour advocacy campaign andshould not be neglected.

On 20 August 2005 activists in Bahia Blanca, Argentina conducted their own informal poll on public

support for smoke-free policies. A majority of respondentswere bothered by secondhand smoke and supported

smoke-free shopping centers and public places.

Credit: Essential Action and Healthy Environments (Bahia Blanca, Argentina)

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Reports and StudiesIn many countries, journalists and their editors commonly treat the publication of reports andstudies as news. Advocates for smoke-free rules have used this opportunity skillfully. For example,BBC News Online carried this news on 2 March 2005:

A British Medical Journal study concludes that secondhand smoke kills more than 11,000 a year in the UK. This figure is much higher than had previously been estimated. The studyalso for the first time includes a figure for people dying from secondhand smoke in theworkplace (600 a year). The report’s author, Konrad Jamrozik, stated, “It is clear that adoption of smoke free policies in all workplaces in the UK might prevent several hundred premature deaths each year.” 76

Fenton Communications, a well-known public interest public relations firm in the United States,has published a useful guide on how to make the most of our reports. They point out that whilegroups often spend a great deal of time researching and writing reports, they do not spendenough time thinking about how the report can make the most impact on their policy objectives.All the hard work that goes into preparing a report is thus wasted. Before we sit down to write areport, we should be asking the following questions:

• What is our goal and how will our report move us closer to that goal? Is our goal to shapepolicy? If our goal is to raise public awareness, what is the ultimate purpose?

• Who are our target audiences? If we’re thinking “general public,” we need to think morestrategically. We should be clear about which people we want to influence and who canhelp build our power base.

• What’s groundbreaking about our report? How would we finish this sentence: “This report is the first to….”? In other words, what does our research do that has never been done before? 77

Every report, fact sheet, and press release we prepare should keep those questions in mind. AsPATH Canada points out:

What distinguishes research for advocacy from other types of research is its focus on changing laws and policies. The research is conducted with specific policy aims in mind, as part of an overall strategy to obtain the passage of tobacco control laws and policies.While other research contributes to the overall understanding of tobacco, research for advocacy has very narrow and specific aims.

Rather than simply seeing where research leads us, they suggest: “Your advocacy objectivesshould guide your research. Start with what information you need to press for a certain policychange; then plan your research.” PATH Canada’s publication Low Cost Research for Advocacyremains one the most helpful guides for advocates who want to make sure that their next reportdoes not simply end up on people’s shelves collecting dust. 78

Another good example of using research for advocacy is the recent collaboration between theFCA and the International Tobacco Control Policy Evaluation Project (ITC), an internationalorganization of researchers studying the impact of tobacco control policies throughout theworld. 79 The FCA produces press releases and fact sheets summarizing the ITC’s research findings. It then distributes the information to its worldwide network of tobacco control advocates. The advocates, in turn, tailor the information to reflect the circumstances in theirown communities and then disseminate it to local media and policy makers. In their first formal collaboration, the FCA publicized research findings showing that even smokers in Ireland supported having pubs become smoke-free.

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Advocates sometimes use handheld smoke monitors to show just how unhealthy smoking environments can be. The rapidly collected data from these monitors can be very helpful in gainingthe attention of lawmakers and the media. In 2005, the American Cancer Society and a groupcalled NJ GASP (New Jersey Group Against Smoking Pollution) released data that indicated thatNew Jersey workplaces where smoking is allowed are 15 times more polluted than smoke-freesites. 80 The data were collected by NJ GASP members who took handheld monitors into morethan 50 diners, bars, restaurants, bowling alleys, and casinos to collect and measure the pollutantsin the air. This effort gained extensive coverage in the local media. 81

Public DemonstrationsLobbying and advocacy can take more aggressive or creative direct forms, such as picket lines,demonstrations, sit-ins, and street theatre. The PATH Canada guide Using the Media for TobaccoControl provides practical guidance on how to use demonstrations, events, and stunts to attractthe attention of the media.

Here’s an example of how a creative event can stimulate effective news coverage for the passage ofsmoke-free laws: In 2002, with the support of the Romanian National TV, tobacco control advocates

both outside and within the government persuaded Bucharest cityofficials to declare the center city a smoke-free zone in celebration of thefirst Romanian National No-Tobacco Day. The event drew considerable

public and media attention, partly as the result of a dramatic visualmessage: the release of a cloud of black, helium-filled balloons, eachrepresenting a nonsmoking Romanian citizen who will die eachyear as the direct result of secondhand smoke. 82

Another example comes from Bangladesh, where advocates celebrated the passage of their tobacco control law (including a banon smoking in public transport and other public places) with a colorfuldemonstration, complete with balloons, banners, and face paint.Photojournalists loved the face paint (No-Smoking signs and aBangladeshi flag), and the demonstration made big news. 83

Celebration of NationalNo Tobacco Day inBelgrade, Serbia

Credit: Dr Milan Jovanovic Batut, Institute of Public Health (Belgrade, Serbia)

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Part II: Smoke-free Tool Kit

Developing a Campaign Plan

• Putting the Campaign Plan in Writing

• Evaluating Campaign Objectives: How SMART Are You?

• Involving Others in the Campaign

• Resources for Planning a Campaign

Media Advocacy: A Short How-to Guide

• Working with the Media Press releases, interviews, letters to the editor, and op-eds

• Getting the Message Heard through Public Events

• Tailoring Messages to Different Audiences: Messages for workers, managers of governmentand private workplaces, parents, and women

• Resources for Conducting Media Advocacy

Countering the Tobacco Industry

• Myths and Realities of Smoke-free Policies

• Economic Impact of Going Smoke-free

• Tobacco Industry Efforts to Fight Secondhand Smoke Legislation

Smoke-Free Air: The Essential Facts

• Essential Facts

• Useful Fact Sheets on Secondhand Smoke

• Terminology Matters

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Developing a Campaign Plan

Putting the Campaign Plan in Writing

Many advocates find that the process of writing down their objectives, strategies, and tacticshelps clarify their thinking, visually illustrates the relationship between the three, and helps keeppeople on track. The staff at the Work Group on Health Promotion and Community Developmentat the University of Kansas in the United States has developed a very useful outline for running anadvocacy campaign. Here’s a modified version:

Outline for Advocating for Change

State the objectives of the advocacy campaign, including

• The mission (i.e., what the campaign is about and why, e.g., to protect people from secondhand smoke by passing strong smoke-free workplace laws)

• The policy changes (i.e., new or modified laws or regulations) our group hopes to bring about

• The action steps required (i.e., who will do what by when to bring about the specificdesired changes)

Identify resources and assets to be used, including

• The number and kinds of people who are available and committed

• The financial resources available

• Written materials that already exist and those that need to be developed

• Other human and material assets that can be used to support the effort

Identify potential allies

• What other individuals or groups can help us influence the target of our advocacy efforts?Think strategically – it’s not always how many allies we have, but how effective the ones wedo have can be.

• Identify likely allies and figure out how they will support the effort.

Identify likely opponents

• Identify likely opponents and how they might resist or oppose the effort.

• Outline tactics and arguments that may be used by the opposition, and the ways in whichthose can be countered.

• Figure out how to set the agenda or reframe the issue (e.g., not the smoker’s rights, but the right to breathe clean air).

• Learn from the past; for example, understand the response to the proposed change elsewhere.

Identify targets and agents of change (in the light of anticipated allies and opponents)

• List the target(s) of our advocacy (i.e., those whose behavior we want to influence).

State the strategies and tactics of the campaign

• Identify strategies that will be used. Based on the particular situation/context, state thespecific tactics that will be used.

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• Review whether the planned strategies and tactics meet the group’s criteria and situation.Consider whether the strategies and tactics:

• Fit the group’s style (i.e., are group members comfortable with the approach?)

• Use available resources and allies (i.e., do they take advantage of the group’s strengths?Engage its allies? Deter opponents?)

• Are flexible (i.e., do they permit adjustments to changing situations?)

• Are likely to work (i.e., Do they bring about the desired effect with the issue and with opponents?)

Describe the evaluation of the advocacy campaign

• Clearly state what indicators will signify “success” (e.g., bringing about a change in laws or regulations).

Describe how the information will be used to improve the effort (e.g., feedback will be provided toleadership and membership; review progress and make adjustments.) 84

Evaluating Campaign Objectives : How SMART Are You?A helpful way to evaluate a campaign’s objectives is to decide whether they meet the SMARTcriteria – whether they are Specific, Measurable, Achievable, Relevant, and Time Bound. 85

Specific – How specific is our objective? “Convincing Parliament to pass smoke-free legislationcovering all workplaces” is specific. “Raising public awareness” is not.

Measurable – Is our objective measurable? The more precise we can be about what we want toachieve, the easier it will be to see how our campaign is progressing and what we may need tochange in order to be successful.

Achievable – Advocates are always walking a fine line between being too ambitious and beingtoo cautious. We want to think big – but not so big that our supporters become discouraged if we fail (or become intimidated by the size of our dreams!).

Relevant – Is the campaign relevant to the concerns of our fellow citizens?

Time Bound – It is critical to set a date by which we hope to achieve our campaign objective.The same applies to tactics. Even if we have to modify it later, setting a firm deadline will help usplan, determine the dates by which intermediate objectives need to be achieved, and evaluatethe success of our campaign along the way.

Involving Others in the CampaignOne of the qualities of great leaders is the ability to get others involved and engaged in an issue.An effective campaign leader needs to keep every colleague and supporter motivated.

Maintaining a positive attitude benefits everyone in the movement. Every accomplishment, goodidea, helpful suggestion, deserves recognition – publicly. It is surprising how a little positivereinforcement can inspire and motivate people to continue volunteering their time.

Small wins count. Campaigns for smoke-free legislation can take years of hard work. It’s important that we achieve – and celebrate – intermediate victories. If our volunteers don’t seeany progress after dedicating a lot of time and energy, they will start to drift away, and our effortwill lose momentum.

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Some useful resources on how to be an effective leader and keep our volunteers motivated:

Top 10 Leadership Tips

http://www.commonpurpose.org.uk/home/public/civilsociety/skills/planning/managing/top-ten-leadership-tips.aspx

How to Involve Others in Our Campaign

http://www.commonpurpose.org.uk/home/public/civilsociety/skills/planning/managing/involving-others.aspx

Top 10 Tips for Motivating People

http://www.commonpurpose.org.uk/home/public/civilsociety/skills/planning/managing/motivating-people.aspx

Resources for Planning a CampaignCampaign groups that work on issues aside from tobacco have put together excellent guides onthe nuts and bolts of activism. Some links are below:

Planning a Campaign

http://www.millenniumcampaign.org/site/pp.asp?c=grKVL2NLE&b=475853

Building a Coalition


Lobbying and Advocacy


Action Research


Using Formal Political Processes


Public Speaking

http://members.shaw.ca/toasted/steps.htm

Using the Internet as an Organizing Tool

http://www.netaction.org/training/

Activist Tool Box

http://ctb.ku.edu/

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Media Advocacy: A Short How-to Guide

Working with the Media

Press ReleasesWriting a Press Release

Many media outlets receive dozens, even hundreds, of press releases every day. Your job is toprepare something that will catch someone’s eye. A catchy headline that sums up the message ofthe release can make the difference between getting our message read and having it consigned tothe reporter’s trash bin. The next hurdle in the competition with other releases that survive thecut is the first paragraph: Does it explain the headline and highlight the main points clearly? Is itnewsworthy: Does it say something important? New? Of interest to readers or listeners?

A good press release is short, to the point, and written in the active voice. It includes enoughbackground information on the subject to spark interest (e.g., “Secondhand smoke has beenclassified as a Class A carcinogen”) and only the most compelling facts, figures, and arguments.Interested reporters can always follow up with the writer or the group. A writer of successfulpress releases avoids jargon and complicated scientific terms at all costs! Make sure we can backup everything we say so that over time, journalists look to us as a credible source.

Media professionals suggest that a press release should resemble an inverted pyramid, with themain points at the top. Important information placed near the end of the release may never beread. The International Campaign to Ban Landmines suggests that a good test is to cover the finalparagraph with a sheet of paper and see whether critical facts are missing. The visible text shouldmake sense on its own. 86

Structuring the ReleaseThe first two paragraphs of our press release should answer five questions, what journalists callthe “5 Ws” – Who? What? When? Where? and Why?

Who: Our organization and what it stands for

What: Concise information on the newsworthy event, including calling on our city council to passa smoke-free law, releasing a new survey or report, and so on

When and Where: The exact location, date, day, and time of the event, including the streetaddress or intersection for a protest, press conference, or other public happenings

Why: The reason for this action or event

Concise, colorful quotes from our designated spokespeople (including first and last names andtheir positions in the organization) bring a story to life. Well-chosen quotes often end up in newsstories, as many reporters do not have time to conduct in-depth interviews. A good example is aquote from ASH-UK exposing a right-wing columnist on the payroll of Big Tobacco: “Scrutonpasses himself off as the leading intellectual of the right, but it seems he's just a grimy hack for thetobacco industry.” 87

The press release should be written on our group’s letterhead and should include at least onetelephone number for journalists to call, including a contact number for off-hours, and our Website URL. If online news services pick up the story, it may be possible to have our press releaselinked to their account. We need to make sure someone proofreads the release for spelling,grammar, and content. The writer may not see the mistakes that a fresh pair of eyes will.

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Some newspapers may run our entire press release verbatim, so we want to be sure it is interestingand convincing, and communicates not just the problem but also the solution we support.

For further tips on writing a release, the International Campaign to Banish Landmines Web siteoffers excellent advice: http://www.icbl.org/resources/campaignkit/publicise/pressrel.html.

Sending Out the Release The best-written press release in the world won’t make a difference unless it gets into the righthands. An important tool in our kit is a list of reporters and editors whom we think our issuemight interest. Most media outlets have a reporter who covers health issues at least part-time.We can also look at who has written stories in the last few years on health or tobacco issues.

Since passing smoke-free laws will involve convincing politicians and businesspeople, we shouldadd the main political and business journalists to our list. In fact, an important goal of mediaadvocacy should be to bring the issue from the obscurity of the back health pages to the prominenceof the front news pages. For newspapers, we need the names of the news and health editors. Andwe need the name of assignment editors at television and radio stations; they help decide whatstories their reporters will cover.

Next, we can collect contact information for these journalists and editors (phone and fax numbersas well as e-mail addresses). If we have no contact person at a media outlet we wish to reach, wecan call and ask to whom we should send our materials. Remember, journalists come and go; thelist needs to be kept up-to-date.

Respecting DeadlinesAll journalists work on deadlines – for morning newspapers, it’s usually in the late afternoon. We should not try to get reporters’ attention when they are trying to finish a story for the nextday’s newspaper. Early in the day is the best time to call – the earlier we connect with thereporters, the more time they have to convince the editor that they need our story and to actually write or produce the piece.

It is critical to return calls from reporters immediately. We can be enthusiastic over the phonewhile still maintaining our professionalism.

Following UpFinally, we need to follow up with the journalists we have sent our release to (at least the mostimportant ones) to make sure they have received it and have all the information they need. Weneed to be courteous and respect the fact that they, like we, are overworked. And we need to bejudicious about making these calls – there is a fine line between being persistent and beingannoying. If we send out press releases and call reporters every week, some will get tired of us,making it difficult for us to get our stories into the news.

It’s a good idea to get to know the journalists who cover health issues – ask them to go to lunchor grab a cup of coffee. Often these activities set the stage for more open communication in the future.

CIVICUS, an international alliance dedicated to strengthening citizen action and civil societythroughout the world, suggests this checklist for our release:

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• Is it new?

• Are the main points at the top?

• Is it short, sharp, and simple?

• Does it include direct quotes?

• Does it provide a contact name and number for more information?

• Have we avoided jargon, flowery language, and generalisations that cannot be supported?

• Have we circulated a copy to everyone from the campaign whom the media might contact?

• Have we made follow-up calls to journalists we know? 88

InterviewsThe first rules of thumb for advocates facing an interview are: to be informed, to make sure toread all the relevant material, and to be prepared. It is wise to anticipate the questions – especiallyhostile questions – likely to be asked. And we should always be honest; if we do not know theanswer to a question, we don’t make one up. Inaccuracy will only hurt our cause. If reportersknow we are reliable and honest, they will be more likely to turn to us in the future. From veteranadvocates, here are some additional tips for success when being interviewed:

• It’s a good idea to write down the key points we want to make during the interview, andrehearse until the answers roll off our tongue. It’s best to use simple language, and toimagine we are talking to a friend or family member.

• If more than one person in the same campaign is being interviewed, they need to coordinatetheir messages in advance.

• Calm and polite are our watchwords during the interview. Although passion is important,we should never let our emotions get the best of us. Sometimes it’s necessary to take adeep breath before answering a question.

• Answers should be short, understandable, and memorable. We can learn to talk in soundbites by imagining what we would want to be quoted as saying, and then saying that. Wedon’t try to make too many points, and we avoid jargon.

• It’s the answers that make the news, not the questions. A skillful technique is to use aquestion to make the points we want to make.

• Bullying by the interviewer is best ignored – if the interviewer tries to interrupt us, we simplykeep on talking until we have made our point. At the same time, we don’t pontificate; wegive the reporter an opportunity to ask questions. Assertiveness on our part works;rudeness is counterproductive.

• For tricky questions, a useful strategy is to try to agree with a part of the question and thenpoint out that there’s more to the story. (“Yes, some business owners have been concernedover the economic impact of smoke-free policies, but in places where smoke-free laws havebeen enacted, those fears have turned out to be unfounded.”) But if the interviewerpresents information we know to be false (“Secondhand smoke is annoying but notharmful”), we can calmly correct it.

• In a television interview, it’s important to address the viewers, not the interviewer. Beforeour first interview, we can practice with friends or with a video camera – better to makemistakes in front of them than in front of millions of TV viewers. On both radio and television,we come across most effectively when we speak up and put more emphasis into our voicethan we would in a regular conversation. Otherwise we risk sounding flat.

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Letters to the EditorIn many countries, the Letters to the Editor section of the newspaper is one of the most widelyread sections. This makes a letter to the editor of local papers an excellent – and underutilized –way of getting out our viewpoint about events in the news in a relatively unfiltered way.Advocates can write to the editor to correct inaccuracies or biases in an article that has recently appeared or to comment on a topic in the news.

Here are some tips:

• Be timely. A letter sent about an article that appeared a week ago is unlikely to be published.

• Keep it short, ideally under 250 words. (Many newspapers provide guidelines on length.)Make specific reference to the article or news event at issue in the first sentence.

• If the letter is written on behalf of an organization, it needs to include the writer’s positionwithin that organization and all relevant contact information.

• Keep trying. Even if the letter is not accepted, it may pave the way for a future letter to be published.

• Be accurate. Make sure to get the facts correct so the letter doesn’t damage the writer’s ororganization’s credibility.

Opinion Editorials (Op-Eds)Decision makers read the opinion pages of newspapers. Advocates can take advantage of thisavenue to reach them.

Here are some tips:

• Keep it short, usually between 500 and 750 words. Most newspapers publish guidelines forsubmitting op-eds – we need to follow them. Write in short paragraphs and sentences,avoid jargon, and use the active voice.

• Keep it focused. Too many arguments diffuse the point. Identify a problem (e.g., secondhand smoke in the workplace) and provide a solution to it.

• Include a cover note that summarizes why the op-ed is timely and of interest to readers.

• Think about authorship. Often it makes sense to ghost-write an op-ed for someone else –an advocate does the writing but the piece is submitted and published, with permission,under someone else’s name, usually that of a well-known and respected figure. The key tofinding the best person is to think about the target of our message and the people thatperson or group listens to. The right name on the piece can influence the op-ed editor’sdecision to publish the article or to toss it. A one-paragraph bio of the author shouldaccompany the submitted piece.

• Check facts carefully and include only the information that can be supported.

• Stay optimistic. This hard work will pay off. Soon the op-ed editor will be calling us!

Getting the Message Heard through Public EventsPublic events offer exceptional opportunities to focus broad public attention on the health dangersof secondhand smoke. Such events include the annual WHO World No Tobacco Day, regional andnational smokeout days, health fairs, and annual celebrations. Romanian tobacco controladvocates developed a list of creative plans for raising public awareness about the health hazardsof secondhand smoke during their Great National Smokeout; other advocates may be able toadapt them.

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• Issue a press release and hold a press conference featuring:

• Prominent doctors or health scientists, especially those who have quit smoking in theirworkplaces and homes

• Nonsmoking spouses suffering from smoking-related illnesses

• Nonsmoking coworkers suffering from smoking-related diseases

• A child who suffers from asthma

• Initiate a letter-writing campaign to elected officials and newspaper editors to make sure they know the health risks caused by secondhand smoke and the solution: smoke-free environments.

• Meet with the editors of local newspapers and with reporters to educate them about thedangers of secondhand smoke and the need for smoke-free environments.

• Prepare and distribute an editorial memorandum to newspaper and magazine editorsdescribing the scientific evidence that secondhand smoke is harmful to nonsmokers. Urgethat editorials alert readers to these hazards. (Meeting with the editors to give them thematerial and to establish a relationship is most effective.)

• Release helium-filled black balloons during the press conference, with each balloon representing 100 nonsmokers who will die from smoking-related diseases each year.

• Unveil at the press conference a “passive smoking death clock,” a prominently displayedbillboard that will digitally add each day the projected number of nonsmokers who will diethat day from secondhand smoke.

• Contact popular television and radio talk shows to schedule a program on secondhandsmoke, and provide the names of prominent doctors or health scientists willing to serve as resources.

• Write letters to ministers of health, asking that cigarette warning labels include informationon the dangers of secondhand smoke. (Brazil, Canada, and Thailand all have warninglabels that could be used as models.)

• Distribute 30- to 60-second public service announcements to local radio and TV stationsillustrating the hazards of secondhand smoke.

• Work with government and business leaders to place public service announcements aboutsecondhand smoke on bus and train tickets, telephone cards, and Web site banners.

• Question politicians and leaders (via radio phone-ins, TV shows with audiences, campaignmeetings) when they have public meetings or make public appearances. Challenge them:What are they going to do about secondhand smoke?

• Distribute a short video news release – a prepackaged “news” piece – to television andradio stations illustrating the health dangers of secondhand smoke.

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Tailoring Messages to Specific Audiences

Messages for WorkersWorkers need to hear that in their workplace, other people’s smoking threatens their health andlives. They are most likely to respond to messages that stress the real health dangers they facefrom secondhand smoke. For many adults, the workplace is a greater source of exposure to secondhand smoke than the home.

• A review of involuntary smoking at work concluded that both bar and restaurant workersare exposed to levels of secondhand smoke that are higher than those seen in nonsmokerswho are exposed in the home. 89

• Secondhand smoke, with its toxic chemicals, poses a serious health threat in the workplace because this is where many adults spend most of their time. 90

• People who are routinely exposed to secondhand smoke have a much higher risk of getting lung cancer than workers in smoke-free environments. 91

• Studies of levels of secondhand smoke show that exposure levels in restaurants areapproximately 1.6 to 2.0 times higher than in office workplaces or other businesses. Levelsin bars are 3.9 to 6.1 times higher than in offices. The epidemiological evidence suggestthat there may be a 50% increase in lung-cancer risk among food-service workers, in partbecause of tobacco smoke exposure in the workplace. 92

• Pub, casino, and restaurant workers and their labor unions are in “the group mostexposed to and at risk of disease” and “the last to be protected.”

Messages for Managers of Government and Private Workplaces

The economic arguments often used by the industry to scare off smoking ban activity were no longer working, if indeed they ever did. These arguments simply had no credibility with the public, which isn’t surprising when we consider our dire predictions in the past rarely came true.

– Philip Morris document, 1994 93

An October 2004 editorial in the British trade publication Caterer and Hotelkeeper provides oneof the best arguments for businesses to back comprehensive smoke-free policies:

We have long lobbied for industry self-regulation over smoking. But, faced with such agroundswell of feeling among our readership, we feel we can no longer sit on the fence. The “courtesy of choice” approach adopted by many bars and restaurants may allowcustomers to choose whether or not to sit in a designated smoking area; but it doesnothing to save hospitality workers from breathing in harmful smoke.

It's not only employees who would benefit from a ban. Operators currently spend precioustime and money introducing nonsmoking areas and installing air-purifying systems. A banwould make such efforts unnecessary, and create a level playing field for doing business. Itwould guard them against the potential threat of litigation from employees claiming theyhave become sick as a result of passive smoking. And, our survey suggests, it would evenhelp ease the skills problem in hospitality. (Three-quarters of respondents said a company’santi-smoking policy would make it a more attractive employer.) 94

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Dan Rosenthal, owner of the Sopraffina restaurant chain in Chicago, further emphasized thehealth perspective when he asked, “Why in the devil would we want to be so inhospitable to ourworkers and to our guests as to bring them into one of our restaurants and create a health hazardfor them? We might as well be serving them E. coli.” 95

Specifically, managers need to hear that:

• Their nonsmoking workers want smoke-free workplaces.

• Their smoking workers will not resist smoke-free rules in the workplace if advance information and support is provided.

• If their workers are represented by labor unions, the unions often will either support orwill not resist smoke-free workplaces.

• Workplace smoking increases costs to employees, decreases worker efficiency, and resultsin lost days of work due to smoke-caused illnesses.

• Reducing the time lost by workers who get sick from tobacco smoke and cannot workbrings economic benefits to employers. Employers who allow smoking in the workplaceleave themselves vulnerable to lawsuits in some countries from workers forced to breathetobacco smoke.

• Eliminating the time wasted by employees on workplace smoking breaks brings employers economic benefit, especially since there is evidence that smoke-free officescause many smokers to smoke less or to quit smoking altogether, resulting in healthier,more reliable workers.

• Employers benefit from lower costs for ventilation and cleaning.

The economic interests of bar and restaurant owners and operators make them open to hearingmessages like these:

• The tobacco-industry trade publication Tobacco Journal International quotes Irish barowner Tom Ericksen: “The bar industry was not destroyed in New York and California, why should it be here? I think that once this transitional period is over, it’s going to be likesmoking on aeroplanes. People are going to think that it’s really weird that people eversmoked in pubs!” 96

• Smoking costs employers money. Employers bear direct and indirect costs as a result ofemployees’ smoking. According to the World Bank, these costs include

• More employee absenteeism

• Decreased on-the-job productivity

• Increased early retirement due to ill health

• Higher annual health-care costs for smokers and higher health insurance costs

• Higher life insurance premiums

• Higher maintenance and cleaning costs

• Higher risk of fire damage, explosions, and other accidents related to smoking

• Higher fire insurance premiums 97

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Messages for ParentsExpecting and new parents may be the audience most open to hearing (and taking seriously)messages about the harm secondhand smoke causes to children. Evidence suggests that interventions by children’s health professionals with parents who smoke leads to more quitattempts by the parents.

Approaching the leadership of medical societies for obstetricians, midwives, pediatric nurses,and pediatricians can bring effective new voices to an advocacy campaign. We can encouragethese leaders to speak at conferences and in the mass media about the dangers of secondhandsmoke, to focus on secondhand smoke in newsletter articles, and to distribute brochures aboutthe ill health effects secondhand smoke has on infants and small children. Brochures can also beplaced in doctors’ offices and in maternity wards, where pregnant women and new parents willsee them.

Tobacco control advocates and health authorities can encourage the publishers and producers ofmagazines, television shows, and radio programs for parents to include program segments andannouncements on the hazards of secondhand smoke. They can also distribute leaflets outliningthe risks of secondhand smoke to parents and coaches at children’s football matches and othersporting events.

Parents are most likely to respond to messages that stress the risks that secondhand smoke posesto their children. For example,

• The World Health Organization currently “estimates that nearly 700 million, or almost halfof the world’s children, breathe air polluted by tobacco smoke, particularly at home.” 98

• Infants and young children subjected to secondhand smoke experience:

• Increased rates of lower respiratory tract infections, such as bronchitis and pneumonia

• Increased rates of ear infections

• Exacerbated chronic respiratory symptoms (such as asthma)

• A four-fold increase in the risk of death from sudden infant death syndrome (SIDS) 99

• Childhood exposure to secondhand smoke may also contribute to heart disease in adulthood and to behavioral problems. 100

• Cotinine levels in the blood indicate the extent of one’s exposure to secondhand smoke. Arecent study shows that, on average, the higher the levels of cotinine children have in theirbodies, the lower their reading, math, and reasoning test scores, even after accounting fortheir education and the income levels of their parents. 101

• A British study indicates that in households where both parents smoke, young childrenhave a 72% increased risk of respiratory illnesses. 102

Messages for Women Women need to hear that tobacco smoke significantly increases the risks of coronary heart disease. 103

Women need to know that exposure to secondhand smoke during pregnancy may severely harmtheir fetus. Pregnant women exposed to other people’s secondhand smoke are about 20% morelikely to have a low birth-weight baby. 104

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Resources for Conducting Media Advocacy Smoke Signals, the original ACS/UICC media guidehttp://www.strategyguides.globalink.org/guide10.htm

Blowing Away the Smoke series, Advanced Media Advocacy, Advisory #5, written by Lori Dorfmanfor the Advocacy Institute http://www.strategyguides.globalink.org/guide06.htm

The SPIN Project’s online tutorial: helpful checklists for groups who want to engage in advocacy communications http://www.spinproject.org/resources/spinworks.php3

PATH Canada’s guide Using the Media for Tobacco Control: tips for tobacco control advocates whohave little or no experience working with the mediahttp://www.pathcanada.org/public/Media_Guide.PDF

Now Hear This: The Nine Laws of Successful Advocacy Communications: useful lessons from someof the leading practitioners of public interest communicationshttp://www.fenton.com/pages/5_resources/pdf/Packard_Brochure.pdf

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Countering the Tobacco Industry

Myths and Realities of Smoke-Free Policies

As tobacco control advocates who are building support for smoke-freeair, we must overcome more than the preconceptions of journalists

and policy makers. We must also contend with the active propagandaefforts of the tobacco industry to reframe smoke-free issues tosupport their negative advocacy. Usually this reframing comesvia proxies, such as business associations, the Chamber ofCommerce, “smokers’ rights” groups, and think tanks. Forexample, a study by researchers at the University of California,San Francisco, found that the tobacco industry “recruited andmanaged an international network of more than 80 scientificand medical experts in Europe, Asia, and elsewhere in a bid toavoid regulation on secondhand smoke.” 105

To combat the myths created or supported by the tobaccocompanies and their allies, advocates need to be armed with the facts about smoke-free policies – just in case we’re fired on.

Myth: Secondhand smoke is an unproven health hazard.

Reality: Every scientific body in the world, including the World Health Organization and theInternational Agency for Research on Cancer, has reached the same conclusion: Secondhandsmoke is harmful, causes many diseases, and can lead to death. 106

Reality: The International Agency for Research on Cancer has reviewed all the available evidenceon secondhand smoke and cancer. This independent panel of international scientists from 12countries, convened by the World Health Organization, concluded that secondhand smoke iscarcinogenic to humans, and that exposure to other people’s smoke increases the risk of lungcancer in nonsmokers by 20 to 30% and coronary heart disease by 25 to 35%. 107

Reality: The only studies that do not show a correlation between secondhand smoke and disease are those funded by the tobacco industry. 108

Myth: There is only a small chance that a nonsmoker could develop cancer as a consequence of breathing secondhand smoke.

Reality: There is no safe level of exposure to secondhand smoke. Sir Richard Doll, formerRegius Professor of Medicine at Oxford University, offered this comparison: “An hour a day ina room with a smoker is nearly 100 times more likely to cause lung cancer in a nonsmokerthan 20 years spent in a building containing asbestos.”

Reality: Nonsmokers who work in the smokiest bars are around 20 times more likely to getlung cancer than the average nonsmoker. 109

Reality: The impact of secondhand smoke on the heart can be measured after as little as halfan hour of exposure. 110 In addition to causing cancer and heart disease, exposure to second-hand tobacco smoke causes and aggravates asthma and other respiratory conditions in adultsand is known to cause middle ear and respiratory infections in children. 111

Myth: A prohibition on smoking in enclosed public places is a violation of an individual’sfreedom of choice.

Credit: Reproduce with permission from The Mercury (Hobart, Australia)

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Reality: The right of a person to breathe clean air takes precedence over any possible right ofsmokers to pollute the air other people breathe. Under the current system, nonsmokers aredenied the freedom to go about their business in smoke-free environments. The failure toprovide smoke-free public places and workplaces puts lives at risk from exposure to thedeadly effects of secondhand smoke. This is not about whether smokers smoke; it is aboutwhere they smoke.

Reality: We cannot respect human rights without respecting workers’ rights. Employees whowork in enclosed public places and workplaces currently have no choice but to breathe inother people’s smoke. If all public places and workplaces were smoke-free, everyone wouldhave the freedom to breathe air free of secondhand smoke.

Reality: We don’t consider other worker safety measures (e.g., wearing helmets at constructionsites, safety equipment for window cleaners, etc.) as puritanical or anti-free market, eventhough they restrict the actions of employers and employees. The same principles apply toprotecting workers from tobacco smoke.

Myth: There should be separate rooms in restaurants and pubs for smokers.

Reality: Half measures, such as designated smoking areas, do not adequately protect people’shealth and are difficult to enforce. 112

Myth: Ventilation is a solution to secondhand smoke.

Reality: Ventilation systems do not work, and the tobacco industry knows it. Internal BritishAmerican Tobacco documents reveal that the company knew that air filtration or ventilationsystems were ineffective, yet still promoted the technology as a viable option to smokingrestrictions. In BAT’s own words, the company’s interest in ventilation systems was primarily“to negate the need for indoor smoking bans around the world.” 113

Reality: In 2005, The American Society of Heating, Refrigerating, and Air ConditioningEngineers (ASHRAE), the international standard-setting body for indoor air quality, unanimously adopted an important new position on secondhand smoke, stating:

• There is no safe level of exposure to secondhand smoke.

• Ventilation and other air filtration technologies cannot eliminate all the health riskscaused by secondhand smoke exposure.

• Tobacco smoke does not belong in indoor areas. 114

Reality: Not only do ventilation systems fail to protect people from secondhand smoke, butthey are also too expensive for most businesses to install. We cannot force high costs on businesses, particularly small businesses, for equipment that serves no public health benefit. 115

Myth: The smoke-free law will result in more smokers smoking in the home and will thereforeexpose more children to the dangers of secondhand smoke.

Reality: International evidence suggests that smoke-free laws result in less exposure in thehome. After smoke-free workplaces were introduced in Australia, the proportion of familyhomes with smoking restrictions more than doubled, from 25% to 59%. In households whereone adult smoked, the proportion of family homes with smoking restrictions rose from 17%to 53%; among those where all adults smoked, it increased from 2% to 32%. 116

Myth: Smoking restrictions will ruin the economy.

Reality: The tobacco industry’s dire predictions about “ruined” economies have not cometrue – not in Ireland, not in New York, not in Norway, and not in any other major city orcountry that has gone smoke-free. 117

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Reality: Not only have hospitality industries in smoke-free countries or cities not lost money,but some, such as those in New York City, have found business improving because the majorityof the population, including tourists, prefer smoke-free dining and entertainment. 118

Myth: Smoking restrictions are not appropriate for our country.

Reality: No one is immune to the health risks from secondhand smoke. It is appropriate to protect all people from illness and death caused by secondhand smoke, no matter whatcountry they live in.

Reality: Our citizens have the same right to health and worker safety as those of X (a country that has passed a ban). How would we feel if someone said that seatbelt laws (or any other law that is now widely accepted) are inappropriate in our country, because we’re somehow “different?”

Myth: Smoking restrictions will harm the poor.

Reality: The burden of exposure to secondhand smoke falls hardest onthe poor. Workers in lower-paidpositions, such as those in the serviceindustry, are more likely to beexposed to secondhand smoke onthe job. No person should be forcedto make a decision between beinghealthy and making a living.

Economic Impacts of GoingSmoke-FreeA favorite weapon in the arsenal of thetobacco industry’s arguments, as wehave seen, is the ominous warning that any locale that restricts smoking will soon see its economyin ruins, especially its hospitality industry – its bars, restaurants, hotels, and pubs. Lending theirvoices to this doomsday scenario, some bar and restaurant owners cite anecdotal evidence to claim that smoke-free legislation has led to a business sag and threatens the viability of their establishments.

As always, advocates need to have the facts ready to counter these arguments and allay economic fears.

Research in leading journals has consistently proved such claims wrong. Studies indicate thatdips in business after an establishment goes smoke-free are temporary and that the closing of afew bars or restaurants does not indicate an overall negative economic effect of the policies.Smoke-free laws have been shown to have no adverse effects on the hospitality industry and, infact, can actually be good for business. 119

In March of 2003, for instance, New York City passed one of the strongest smoke-free ordinancesin the country. One year after the law went into effect, the city’s bars and restaurants were booming.According to the New York City Department of Finance, tax receipts grew by 8.7%, or approximately$1.4 million. Moreover, the New York State Department of Labor found no evidence that restaurantswere closing as a result of the smoke-free law. 120 In fact, statistics showed that bar and restaurantemployment increased and more licenses were issued for such places in 2003 than during thesame period in 2002, before the ban. 121

Credit: Bob Baker, The Phoenix

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In Ireland, representatives of the hospitality industry attributed losses in pub sales to smoke-freelegislation; however, the decrease in alcohol sales was actually in line with declines that started in2002, well before the smoke-free law was introduced. These declines follow a Europe-wide trendtoward consuming more alcohol at home. In Ireland, the estimated share of beer sales consumedin private homes increased from 12% in 2000 to 23% in 2003. In the UK, the estimated share of beersales consumed in private homes increased from 12% in 1980 to 33% in 2000 to 39% in 2003. 122

Findings from cases like these are consistent with research led by Michelle Scollo and Anita Lalof the VicHealth Centre for Tobacco Control in Australia. Scollo and Lal analyzed more than 100studies on the economic impact of smoke-free policies in the hospitality industry. They concludedthat all the studies that met the highest scientific criteria that bars and restaurants experience nonegative sales or showed bad employment effects from smoke-free regulations.

Studies that found a negative economic impact were predominantly based on subjective impressionsor estimates of changes rather than on objective, verified, or audited data. They were also fundedmainly by the tobacco industry or organizations allied with the tobacco industry and werealmost never peer-reviewed. 123

For more on the economic impact of smoke-free legislation, see the Web site of Americans forNonsmokers’ Rights. 124

Tobacco Industry Efforts to Fight Secondhand-Smoke LegislationTo help policymakers understand the opposition from the tobacco industry, advocates may findit useful to highlight tactics the industry has used in other parts of the world. For example, inAsia, Philip Morris put together a team of local tobacco companies from Korea, China, Thailand,and Taiwan that functioned to promote faulty science and manipulate the region’s policy makers.Through its Secondhand Smoke Scientific Consultancy Project, the regional tobacco monopoliespromoted Philip Morris’ agenda to create controversy sufficient to block smoke-free legislation.

The tobacco industry claimed that there were alternate, indigenous causes of diseases attributedto secondhand smoke and recruited local scientists to lie. They advanced the idea that air qualityin the “East” differs from that in the rest of the world and that in locations such as Hong Kong,China, and Malaysia, environmental factors, and even diet and local genetic parameters, are thetrue causes of lung cancer. 125

Similar strategies have been used in Latin America, Oceania, Europe, and North America. Here are some studies that might prove useful to advocates working with policy makers and the media:

Assunta, M.; Fields, N.; Knight, J.; and Chapman S. “Care and Feeding”: the Asian ETSConsultants Programme. Tobacco Control, (2003).http://tc.bmjjournals.com/cgi/reprint/13/suppl_2/ii4

Barnoya, J; and Glantz, S. A. Tobacco industry success in preventing regulation of secondhandsmoke in Latin America: The “Latin Project.” Tobacco Control 11 (2002): 305–314.http://tc.bmjjournals.com/cgi/content/full/11/4/305

Barnoya, J.; and Glantz, S. A. The tobacco industry’s worldwide ETS consultant’s project:European and Asian components. European Journal of Public Health, (2005). http://eurpub.oxfordjournals.org/cgi/content/abstract/cki044v1

Chapman, S.; and Penman, A. “Can’t stop the boy”: Philip Morris’ use of Healthy BuildingsInternational to prevent workplace smoking bans in Australia. Tobacco Control 12 (2003):107–112. www.tobaccocontrol.org

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Drope, J.; Bialous, S. A.; and Glantz, S. A. (2004). Tobacco industry efforts to present ventilation as an alternative to smoke-free environments in North America. TobaccoControl 13 (2004): 41–47. www.tobaccocontrol.org

Ong, E. K.; and Glantz, S. A. Tobacco industry efforts subverting International Agency forResearch on Cancer’s second-hand smoke study. Lancet 355 (2000): 1253–1259.http://www.tobaccoscam.ucsf.edu/pdf/5.1.2b-Ong&GlantzIARC.pdf

Pan American Health Organization. Profits over People: Tobacco Industry Activities toMarket Cigarettes and Undermine Public Health in Latin America and the Caribbean.(2002). http://www.paho.org/English/DD/PUB/profits_over_people.pdf

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Smoke-Free Air: The Essential Facts

Essential Facts

No matter what the occasion, the message, or the audience, no tools in an advocate’s tool kit aremore vital than facts that support our arguments on the dangers of secondhand smoke and theneed for smoke-free laws and regulations. Following is a list, with back-up support for every claim.

Health Effects of Secondhand SmokeSecondhand smoke contains a complex mixture of more than 4,000 chemicals, more than 60of which are known or probable cancer-causing agents (carcinogens) in humans. 126

Secondhand smoke is a known cause of lung cancer, heart disease, low birth weight, andchronic lung ailments such as bronchitis, as well as other serious health problems. 127

Exposure to secondhand smoke in the workplace is estimated by the International LaborOrganization to cause approximately 200,000 deaths per year worldwide. 128

Even 30 minutes of exposure to secondhand smoke can increase a nonsmoker’s risk of coronary heart disease. 129

Exposure to secondhand smoke increases the risk of coronary heart disease in nonsmokers by as much as 60%. 130

Approximately 700 million children – nearly half of all children in the world – are regularlyexposed to secondhand smoke, 131 increasing their risk of developing asthma and increasing thefrequency and severity of attacks in those with asthma. 132

A major 2005 review of recent scientific evidence confirms earlier findings regarding the healthimpact of secondhand smoke and has listed secondhand smoke as a toxic air pollutant. 133

Benefits of Smoke-free PoliciesLevels of secondhand smoke are up to eight times higher in offices without a no-smokingpolicy compared to those with such a policy. 134

From the period 1991– 1994 to the period 1999 – 2000 (when a majority of smoke-free policieswere enacted), exposure to secondhand smoke in the United States declined 58% for children,55% for adolescents, and 75% for adults. 135

Levels of cotinine, a biological measure of nicotine intake, declined by 85% among bar and restaurant workers in New York City after a smoke-free workplace law went into effect. 136

A study in the British Medical Journal documents a 40% drop in hospital admissions for heartattacks in the U.S. city of Helena, Montana during a six month period in 2002 when the city’scomprehensive smoke-free law was in effect. 137

Seven of every ten smokers want to quit smoking, and smoke-free policies provide them withenvironments free from any pressure or temptation to smoke. 138

Following the implementation of a smoke-free workplace policy in Ireland, 59% of smokersreported they had cut back because of the law, and 46% reported the law made them more likelyto quit; of those who did quit, 79% said the law had helped them succeed. 139

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EconomicsNo objective, peer-reviewed study of smoke-free laws has ever found a significant negative economic impact. 140

Smoke-free laws have been shown to have no adverse effects on the hospitality industry and,in fact, can be good for business. 141, 142

After analyzing more than 100 studies on the economic impact of smoke-free policies in the hospitality industry, researchers from VicHealth Centre for Tobacco Control in Australia concludedthat all the studies that met the highest scientific criteria found that bars and restaurantsexperience no negative sales or employment effects from smoke-free regulations. 143

Between March 2003, when the smoke-free policy for restaurants and bars was implemented inNew York City, to December 2003, employment in restaurants and bars increased by 10,600jobs and taxable receipts rose by 9%. 144

Growing Support for Smoke-Free PoliciesMomentum behind smoke-free air policies has surged in recent years. In 2004 alone, Bhutan,Ireland, Italy, New Zealand, Norway, Sweden, and Uganda all passed or implementedcomprehensive national smoke-free workplace policies, including restaurants, pubs and bars. 145

Public acceptance of smoke-free air policies increases after implementation. Six years afterCalifornia extended its smoke-free workplace law to cover all restaurants and bars, public support for the measure stood at 90%. 146

Six months after Ireland implemented its workplace smoking ban, 95% of the populationbelieved the ban was a positive health measure. 147

According to a 2002 survey, eight in ten California bar owners, managers, assistant managers,and bartenders support the state’s law prohibiting smoking in bars. In addition, 77% saidthat complying with the law had been “very” or “fairly” easy. 148

Useful Fact Sheets on Secondhand SmokeAmerican Cancer Society. “Secondhand Smoke”http://www.cancer.org/docroot/PED/content/PED_10_2X_Secondhand_SmokeClean_Indoor_Air.asp

Americans for Nonsmoker’s Rights. “Secondhand Smoke: Get the Facts”http://www.no-smoke.org/getthefacts.php?id=13

ASH-UK. “Passive Smoking: A Summary of the Evidence”www.ash.org.uk/html/passive/html/passive.html

Campaign for Tobacco Free Kids. “Secondhand SmokeFactsheets”http://www.tobaccofreekids.org/research/factsheets/index.php?CategoryID=19

Framework Convention Alliance. “Smokefree Air Resources in English and Spanish”http://www.fctc.org/tobtopics/topics.php?num=15

U.S. Centers for Disease Control and Prevention. “Clean Indoor Air Regulations – Fact Sheet”www.cdc.gov/tobacco/sgr/sgr_2000/factsheets/factsheet_clean.htm

Pan American Health Organization. Smoke-free Americas Web site http://www.smokefreeamericas.org/main_e.htm

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Terminology MattersSecondhand smoke (SHS), environmental tobacco smoke (ETS), passive smoking…. are theseterms all the same?

While such terms are often used interchangeably to describe “other people’s smoke,” they havedifferent connotations; the use of one term over another may strengthen (or weaken) our message.Here, in brief, are the terms in common use and their connotations. The article that follows, bySimon Chapman, professor in public health at the University of Sydney and editor of TobaccoControl, explores these terms in greater depth. 149

Environmental Tobacco Smoke (ETS) – “Environmental tobacco smoke” and “ETS” are termspromoted by tobacco companies because they do not convey the seriousness of the issue; indeed,these phrases mean very little to people. Dr. Jonathan Samet, from the Johns Hopkins UniversitySchool of Public Health, cautions tobacco control advocates never to use these terms. 150

Forced passive smoking – This term essentially means the same as “passive smoking” and“involuntary smoking,” but according to veteran tobacco control leader Dr. Witold Zatonski, itconveys the fact that nonsmokers, especially children, are forced to breathe the smoke of others. 151

Involuntary smoking – Exposure to secondhand smoke, also called “passive smoking.” 152

The term “involuntary smoking” may not be widely understood. 153

Passive smoking – Exposure to secondhand smoke, also called “involuntary smoking.” 154

The term “passive smoking” has been criticized as being too mild. 155

Secondhand smoke – The combination of two forms of smoke from burning tobacco products:sidestream smoke and mainstream smoke. Sidestream smoke, which makes up about half of allsecondhand smoke, comes from the burning end of a cigarette, cigar, or pipe. Mainstream smokeis the smoke exhaled by the smoker. 156

Climbing the Next MountainAs American Cancer Society president John Seffrin mentions in the introduction to this guide,the struggle to enact strong smoke-free laws is like climbing the next mountain. It takes cooperation,planning, the right tools, flexibility, and, most important, resilience.

Keep in mind that this guide is just that – a guide. Every smoke-free campaign is different, andthe objectives, strategies, and tactics change depending on our unique situation and environment.Flexibility in advocacy is key – in smoke-free campaigns, it is a must.

Launching a smoke-free campaign is often a struggle. The opposition can be fierce, the hours areusually long, and success oftentakes a while. But we mustalways remember thatthough we may stumble on a peak, we are still makingprogress up the mountain.And the payoff of reachingthe top is huge. Not only dosmoke-free laws save livesand prevent disability, butthey even have the potentialto change the way societyviews smoking.

Good luck on your smoke-free journey.

On 1 March 2006 Uruguay became the first

Latin American country to pass a comprehensive smoke-free air law. The National Tobacco Control Alliance and Ministry of Public Health ran a public relations campaign to inform the public of the new decree

with the tag-line "We arecounting on you to make

it happen.”

Credit: Reproduced with permission from the National Tobacco Control Alliance and Uruguayan Ministry of Public Health

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Stop the Presses! A Final Word of Encouragement

As these guides went to press, the long battle for comprehensive smoke-free legislation inEngland was up for a vote in Parliament. Ireland had already gone smoke-free nearly two yearsearlier, and the other members of the United Kingdom – Scotland, Northern Ireland, and Wales –had voted in their own smoke-free protection. Yet England, home of 14 million smokers (andsome of the biggest tobacco multinationals), lagged behind, held back by intense lobbying forexemptions by private clubs and a disheartening lack of government leadership. Media coverageargued strongly against the establishment of a “Nanny State” and supported protecting “people’sright to smoke.” England’s health secretary, under heavy pressure from special interests, was publicly undecided about whether she would support a comprehensive smoke-free law.

But English public health advocates never quit fighting for an uncompromised law. They not only fought passionately, they also fought skillfully – as have so many advocates whose storiescontributed so much to these guides.

Finally, in a heavily publicized 2006 Valentine’s Night vote, a massive majority of 384 MPs, with 184 against, voted in the House of Commons to give England comprehensive smoke-freelegislation without exemptions for private members’ clubs. Prime Minister Tony Blair and Health Secretary Patricia Hewitt voted to support the comprehensive smoke-free law.

This spectacular victory for public health was covered extensively the next day on the front pageof every London newspaper. Deborah Arnott, director of ASH (Action on Smoking and Health),summarized the significance of this outcome:

This vote will save thousands of lives, as non-smokers are protected from other people’ssmoke and as smokers quit in their hundreds of thousands. MPs will rarely get the chanceto cast a vote that does so much good, at such little cost, in such a short time. This is thebest news for public health for more than thirty years. 157

The example set in England should remind us all that, with determination, strategic thinking,and skill, we can overcome even the most discouraging challenges. Indeed, often the difficultyencountered during the battle is in direct proportion to the ultimate health benefits winningbrings. So take heart: Millions of people at risk from secondhand smoke are counting on us– and we can win!

We hope you find this guide useful. If you have suggestions, resources, techniques, best practices, or stories that tobacco control advocates may find useful, please send them to [email protected].

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Acknowledgments

This guide was written principally by Ross Hammond, with major research, editing, and logisticalsupport from Emily Bleimund, Jessica Corsi, Clare Dougherty, Catherine Jo, Kim-Thien Nguyen,Noila Usmanova, and Cassandra Welch. It draws heavily from earlier ACS/UICC Tobacco ControlStrategy Planning Guides.

Substantial reviews, insights, additional writing, and edits were contributed by Monika Arora,Joaquin Barnoya, John Bloom, Simon Chapman, Debra Efroymson, Joe Gitchell, Stanton Glantzand the staff at the University of California San Francisco Center for Tobacco Control Researchand Education (a WHO collaborating center), Fiona Godfrey, Francois Gouahinga, OlcottGunasekera, Karen Gutierrez, Cynthia Hallett, Sinead Jones, Luk Joossens, Katie Kemper, Brook Osterland, Yu-Chin Peng, Heather Selin, Zukhra Shaabdullaeva, Jui Shah, Anna White, and Judith Wilkenfeld.

The design and layout of the guide was provided by Edelman Public Relations, with our specialthanks to Nancy Golosman, John Lineberger, Donna Lorenson, Gillian Rubin, and the Edelmandesign team. Brady Hill of the American Cancer Society oversaw printing and production.

Finally, overall leadership in the development of these Guides was provided by MichaelPertschuk, with support from Tom Glynn and the members of the Climbing the Mountain team: Roxana Bonnell, Monica Conway, David Graham, Ross Hammond, and Peter Segall.

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Notes

1 The guide Strategy Planning for Tobacco Control Movement Building is available at: http://strategyguides.globalink.org/guide02_04.htm.

2 Heather Selin, personal communication, 8 March 2006.

3 Sinead Jones, personal communication, 21 February 2006.

4 Tanith Muller, personal communication, 4 April 2005.

5 Judith Wilkenfeld, personal communication, 14 March 2006.

6 The International Union for Health Promotion and Education: Legislation for Tobacco Control: A PolicyDevelopment and Legislative Drafting Manual, Part 6: “Protection from Tobacco Smoke,” is available at:http://www.fctc.org/modelguide/index02.html.

7 The World Health Organization (WHO), Tobacco Control Legislation: An Introductory Guide, is available at:www.who.int/tobacco/research/legislation/tobacco_cont_leg/en/index.html.

8 Michael Levin, personal communication, 9 March 2006.

9 Luk Joossens, personal communication, 7 February 2006.

10 The WHO Framework Convention on Tobacco Control, is available at: www.who.int/tobacco/framework/down-load/en/index.html.

11 Ibid., Part III, Article 8, #1, at: who.int/tobacco/framework/fctc_en.pdf..

12 Laurent Huber, personal communication, 4 March 2006.

13 Monica McWilliams qtd. in Freedom from smoke “human right.” BBC News, 12 October 2005, available at:news.bbc.co.uk/2/hi/uk_news/northern_ireland/4332804.stm.

14 The United Nations, Millennium Campaign: Voices Against Poverty, The Millennium Development GoalsCampaigning Toolkit, is available at: http://www.millenniumcampaign.org/site/pp.asp?c=grKVL2NLE&b=484815.

15 Dorfman, L; Wallack, L; and Woodruff, K. More than a message: Framing public health advocacy to change corporate practices. Health Education and Behavior 32, 3 (2005): 320–336.

16 The Frame Works Institute, Framing Public Issues. 2002, is available at www.frameworksinstitute.org/strategicanalysis/FramingPublicIssuesfinal.pdf.

17 Action on Smoking and Health, NY smokefree law takes effect on July 24, 15 July 2003, at: www.no-smoking.org/july03/07-17-03-2.html.

18 The Advocacy Institute, Getting the Message Right: Using Formative Research, Advisory No. 3, Blowing Away theSmoke: A Series of Advanced Media Advocacy Advisories for Tobacco Control Advocates, 1998, is available at:www.strategyguides.globalink.org/resources.htm.

19 Efroymson, D., Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor inBangladesh, Tobacco Control 10 (2001): 212–217.

20 Ibid.

21 Schwartz, T., The Responsive Chord (New York: Anchor/Doubleday, 1973).

22 More information on Heather Crowe is available at http://www.smoke-free.ca/heathercrowe/heathers-story.htm

23 Gezairy, H. A.; and Khayat, M. H., Religion and tobacco (World Health Organization Regional Office for the Eastern Mediterranean, Tobacco Free Initiative, 2000), at:http://www.emro.who.int/tfi/emroleads.htm#islamicview.

24 Iran’s religious authorities forbid smoking, IranMania, 25 May 2005, at:http://www.iranmania.com/News/ArticleView/Default.asp?NewsCode=32092.

25 WHO. Tobacco Free Initiative Meeting Report, Meeting on Tobacco and Religion, 1999.

26 Sheikh Gadul Haq Ali Gadul Ha qtd. in an article in Dawn Newspapers (Pakistan), 26 May 2000, at:http://www.emro.who.int/tfi/EMROleads-Pakistan.htm.

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27 Wissa Gurguis Marcus qtd. The Christian View on Smoking. At: http://www.emro.who.int/tfi/EMROleads-christianview.htm.

28 See the WHO Meeting on Tobacco and Religion.

29 Lakoff, G. Moral Politics: What Conservatives Know That Liberals Don’t (Chicago: University of Chicago Press, 1996).

30 South African Department of Health. Tobacco Legislation, 29 February 2000, at:http://www.doh.gov.za/docs/pr/2000/pr0229.html.

31 WHO, Tobacco Company Strategies to Undermine Tobacco Control Activities at the WHO, report of the Committeeof Experts on Tobacco Industry Documents, 2000, at: http://www.who.int/tobacco/resources/publications/general/who_inquiry/en.

32 Roper Organization, A Study of Public Attitudes towards Cigarette Smoking and the Tobacco Industry in 1978, vol.1, 1978, quoted in Glantz, S., et al., The Cigarette Papers (Berkeley: University of California Press, 1996).

33 Kloepfer, W. Report on Public Smoking Issue: Executive Committee, Tobacco Institute, 10 April 1985, Bates NumberTIMN0013710/3723, at: http://www.tobaccoinstitute.com/.

34 Americans for Nonsmokers’ Rights (ANR), Tobacco Industry Sound Bites and Responses, Part 1, available at:http://www.no-smoke.org/pdf/industrysoundbites.pdf; Dorfman, L. Blowing Away the Smoke, Advisory # 6,Framing for Content: Shaping the Debate on Tobacco, at: www.strategyguides.globalink.org/guide07.htm.

35 Smoke Free Europe Partnership, Smoke free Europe Makes Economic Sense: A Report on the Economic Aspects ofSmoke Free Policies, May 2005, available at:http://www.smokefreeeurope.com/assets/downloads/smoke%20free%20europe%20-%20economic%20report.pdf.

36 Williams, C, Secondhand smoke cost county $56 million, Indiana Star, 30 May 2002, at: http://www.no-smoking.org/june02/06-03-02-3.html.

37 United Nations, Saluting World No-Tobacco Day, General Assembly president warns of hazards from second-handsmoke (press release GA/SM/252OBV/216, 31 May 2001), at:http://www.un.org/News/Press/docs/2001/gasm252.doc.htm.

38 Stanton Glantz qtd. in Emerson, E., California Lessons in Clean Indoor Air; A Compilation of Campaign Stories,Implementation Tools, and Compliance Strategies (California Department of Health Services, Tobacco ControlSection, May 2001).

39 United States Environmental Protection Agency (US EPA). Respiratory Health Effects of Passive Smoking: LungCancer & Other Disorders. Washington, DC: EPA Office of Research and Development. 1992.

40 Otsuka, R., Acute effects of passive smoking on the coronary circulation in healthy young adults, JAMA 286(2001): 436–441.

41 United Kingdom Department of Health, Report of the (British) Scientific Committee on Tobacco and Health, 1998,at: http://www.advisorybodies.doh.gov.uk/scoth/PDFS/scothnov2004.pdf; State of California Air Resources Board,Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant, 29 September 2004, at:ftp://ftp.arb.ca.gov/carbis/regact/ets2006/app3exe.pdf.

42 Barnoya, J.; and Glantz, S., Cardiovascular effects of secondhand smoke: Nearly as large as smoking, Circulation111, 20 (2005): 2684–2698

43 Scollo, M.; Lal, A.; Hyland, A.; and Glantz, S., Review of the quality of studies on the economic effects of smoke-free polices on the hospitality industry, Tobacco Control 12 (2003): 13–20.

44 US EPA. Respiratory Health Effects of Passive Smoking, EPA/600/6-90/006F, 1992.

45 State of California Air Resources Board, Proposed Identification of Environmental Tobacco Smoke 2005, available athttp://www.arb.ca.gov/toxics/ets/finalreport/finalreport.htm.

46 U.S. EPA, Respiratory Health Effects of Passive Smoking EPA/600/6-90/006F, 1992.

47 Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Health Effectsof Exposure to Environmental Tobacco Smoke, October 1997, at: http://www.oehha.org/air/environmental_tobac-co/finalets.html#download.

48 Sargent, R.; Shepard, R.; and Glantz, S. A., Reduced incidence of admissions for myocardial infarction associatedwith public smoking ban: Before and after study, British Medical Journal, 5 April 2004, at: http://bmj.bmjjournals.com/cgi/reprint/bmj.38055.715683.55v1.

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49 Allwright, S., et al., Legislation for smoke-free workplaces and health of bar workers in Ireland: Before and afterstudy, British Medical Journal 331 (12 November 2005): 1117.

50 Farrelly, M.; Nonemaker, J.; Chou, R.; Hyland, A.; Peterson, K.; and Bauer, U., Changes in hospitality workers’ exposure to secondhand smoke following the implementation of New York’s smoke-free law, Tobacco Control 14, 4(August 2005): 236–241.

51 Heather Monteverde qtd. in Pressure on for total smoking ban, Belfast Telegraph, 12 May 2005.

52 The guide Blowing Away the Smoke, Advisory 3, “Getting the Message Right: Using Formative Research,” is available at: www.strategyguides.globalink.org/guide04.htm.

53 Chapman, S., The end of pub smoking in Australia: a tribute to Frank Sartor, 10 February 2005, athttp://tobacco.health.usyd.edu.au/site/supersite/news/pdfs/pubsmoke.pdf.

54 Frank Dobson qtd. in Executive to adopt smoking ban after 54,000 speak out, Scotsman News, 25 October 2004 athttp://news.scotsman.com/health.cfm?id=1235672004.

55 Scott, K., Prison cells and care homes escape Scotland’s smoking ban, The Guardian, 11 March 2005, at:http://www.guardian.co.uk/smoking/Story/0,,1435303,00.html.

56 Ban sees cigarette sales slump, BBC News, 26 November 2004, available at:http://news.bbc.co.uk/2/hi/uk_news/northern_ireland/4044605.stm.

57 Thomas Glynn, personal communication, 27 March 2006.

58 The guide Engaging Doctors in Tobacco Control is available at:http://www.strategyguides.globalink.org/doctors.htm

59 Eva Kralikova, personal communication, 9 February 2006.

60 The photo of the event is available at: http://www.bma.org.uk/ap.nsf/Content/PassiveSmokingKills.

61 Cynthia Callard, personal communication, 10 March 2006.

62 Lown, B., Passive Smoking: Overview. Lecture to the 1st Virtual Congress of Cardiology, 2000, at:http://www.fac.org.ar/cvirtual/cvirteng/cienteng/sfeng/sfc6301i/ilown/ilown4a.htm.

63 The World Bank, Curbing the Epidemic: Governments and the Economic of Tobacco Control, 1999, is available at:http://www1.worldbank.org/tobacco/reports.htm.

64 Chapman, The end of pub smoking in Australia.

65 Debra Efroymson, personal communication, 11 February 2006.

66 WHO Tobacco Control Legislation: An Introductory Guide, Chapter 8, “Passing Legislation,” available at:http://www.who.int/tobacco/research/legislation/Tobacco%20Control%20Legislation.pdf.

67 Shoba John, personal communication, 28 February 2006.

68 Yussuf Saloojee, personal communication, 28 February 2006.

69 Witold Zatonski, personal communication, 18 February 2006.

70 Dorfman, L., Blowing Away the Smoke, Advisory 5 & 6 available at:http://www.strategyguides.globalink.org/resources.htm

71 More information can be found at TobaccoScam: http://www.tobaccoscam.ucsf.edu/index.cfm

72 Efroymson, D., Low Cost Research for Advocacy, PATH Canada Guide, 2002, at:http://www.pathcanada.org/library/docs/Eng_res_Guide.pdf.

73 Eva Kralikova, personal communication, 9 February 2006.

74 80% of smokers “support ban,” Irish Examiner, 28 March 2005, at:http://www.irishexaminer.com/breaking/story.asp?j=8995898&p=8995944&n=8995986&x.

75 Chapman, The end of pub smoking in Australia.

76 Passive smoking killing thousands, BBC News, 2 March 2005, at: http://news.bbc.co.uk/2/hi/health/4309613.stm.

77 Fenton Communications, In a Study Released Today . . . . 10 Tips to Get More Ink on Your Next Report, 2005,at:http://www.fenton.com/pages/5_resources/pdf/whitepaper_final.pdf.

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78 Efroymson, Low Cost Research for Advocacy.

79 International Tobacco Control Policy Evaluation Project, at: http://arts.uwaterloo.ca/~itc/.

80 Travers, M.; and Hyland, A., New Jersey Air Monitoring Study, Department of Health Behavior, Roswell Park CancerInstitute, November 2005, at: www.njgasp.org/11-13-05%20New%20Jersey%20Report.pdf.

81 Using the Media for Tobacco Control, PATH Canada Guide, available at:www.pathcanada.org/library/docs/Media_Guide.pdf.

82 Cornel Radu-Longhi, personal communication, 2 March 2006.

83 Debra Efroymson, personal communication, 11 February 2006.

84 KU Work Group on Health Promotion and Community Development, Outline for Advocating for Change,University of Kansas, 2006, at: http://ctb.ku.edu/tools/tk/en/tools_tk_content_page_238.jsp.

85 The objectives come from Six Sigma, at: http://www.isixsigma.com/dictionary/S.M.A.R.T.-112.htm.

86 International Campaign to Ban Landmines, So You Want To Write a Press Release, at:http://www.icbl.org/resources/campaignkit/publicise/pressrel.html.

87 Roger Scruton high priest philosopher of the libertarian right defrocked and exposed as ‘grimy hack’ for tobaccoindustry, ASH-UK Press Release, 24 January 2002, at: http://www.ash.org.uk/html/press/020124.html.

88 Boulle, J.; and Newton, D., Campaign Toolkit for Civil Society Organisations Engaged in the MillenniumDevelopment Goals, Chapter 5, Campaign Skills, at: http://www.civicus.org/mdg/5-1.htm.

89 Siegel, M., Involuntary smoking in the restaurant workplace: A review of employee exposure and health effects,JAMA 270 (1993): 490–493.

90 Takala, J., Introductory report: decent work, safe work, International Labor Organization, Geneva, September 2005,at: http://www.ilo.org/public/english/protection/safework/wdcongrs17/intrep.pdf.

91 Johnson, K.C.; Hu, J.; and Mao, J., Lifetime residential and workplace exposure to environmental tobacco smokeand lung cancer in never-smoking women, Canadian Cancer Registries Epidemiology Research GroupSurveillance and Risk Assessment Division, Center for Chronic Prevention and Control, Canada, 1994–1997,International Journal of Cancer 93, 6 (2001): 902–906.

92 Siegel, Involuntary Smoking.

93 Wells, T., CAC Presentation, Number 4, 8 July 2004, Bates Number 2041183751/3790, at http://www.pmdocs.com/.

94 Time to put an end to passive smoking, Caterer and Hotelkeeper, October 2004, at:http://www.caterersearch.com/Articles/2004/11/17/55071/Stub+out+Smoking.htm.

95 Vote on smoking ban likely this week: Aldermen work on compromise ordinance, NBC News, 28 November 2005,at: http://www.nbc5.com/politics/5419659/detail.html?z=dp&dpswid=2265994&dppid=65193.

96 Tom Ericksen qtd. in Welcome to Norway, Tobacco Journal International 28 February 2005, at: http://www.tobaccojournal.com/Welcome_to_Norway.X4256.0.html

97 World Bank, Smoke Free Workplace at a Glance: Why Should Workplaces Be Smoke Free? July 2002, at:http://www.wpro.who.int/NR/rdonlyres/347D7C4C-0B2B-4599-8A02-C9B5CABE47E3/0/smokefreeworkplaces.pdf.

98 WHO, Tobacco and the Rights of the Child, 2001, at:http://whqlibdoc.who.int/hq/2001/WHO_NMH_TFI_01.3_Rev.1.pdf.

99 Office of Environmental Health Hazard, Health Effects of Exposure.

100 Ibid.

101 Yolton, K., et al., Exposure to Environmental Tobacco Smoke and Cognitive Ability among U.S. Children, May 2002,available at: http://ehp.niehs.nih.gov/docs/2004/7210/abstract.html.

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102 Strachan, D.; and Cook, D., Parental smoking and lower respiratory illness in infancy and early childhood, Thorax52 (1997): 905–914.

103 National Cancer Institute (NCI), Health Effects of Exposure to Environmental Tobacco Smoke: The Report of theCalifornia Environmental Protection Agency, Smoking and Tobacco Control Monograph No. 10, NIH Pub. No. 99-4645, 1999, at: http://cancercontrol.cancer.gov/tcrb/nci_monographs/MONO10/`MONO10.HTM

104 Peacock, J. L., et al. Maternal cotinine level during pregnancy and birth-weight for gestational age, InternationalJournal of Epidemiology 27 (1998): 647–656.

105 Glantz, S., The truth about big tobacco in its own words, British Medical Journal 321 (August 2000): 313–314.

106 See, e.g., International Agency for Research on Cancer, Tobacco Smoke and Involuntary Smoking: Summary of DataReported and Evaluation, vol. 83, June 2002, at: http://www-cie.iarc.fr/htdocs/indexes/vol83index.html; NCI, Health Effects; Law, M. R., et al., “Environmental tobacco smoke exposure and ischaemic heart disease: Anevaluation of the evidence,” British Medical Journal 315 (18 October 1997): 973–979. See, also, He, J., et al., “Passivesmoking and the risk of coronary heart disease: A meta-analysis of epidemiologic studies, New England Journal ofMedicine 340, 12 (25 March 1999): 920–926.”

107 International Agency for Research on Cancer, Tobacco Smoke and Involuntary Smoking.

108 Barnes, D. E.; and Bero, L., “Why review articles on the health effects of passive smoking reach different conclusions,” JAMA 279, 19 (20 May 1998): 1566–1570.

109 Public Affairs Division, British Medical Association, The Human Cost of Tobacco (London: British MedicalAssociation, 2004).

110 Whincup, P. H., et al., Passive smoking and risk of coronary heart disease and stroke: Prospective study with cotinine measurement,” British Medical Journal, 30 June 2004, at:http://bmj.bmjjournals.com/cgi/reprint/bmj.38146.427188.55v1.

111 National Cancer Institute, Health Effects of Exposure.

112 City of Ottawa Public Health Branch, Secondhand smoke in public places: Why ventilation is not an option,” 25January 2001, at: http://www.smokefreeottawa.com/pdf/fs-ventilation_e.pdf.

113 Leavell, N. R.; Muggli, M. E.; Hurt, R. D.; and Repace, J., “Blowing smoke: British American Tobacco's air filtrationscheme,” British Medical Journal 332 (January 2006): 227–229.

114 American Society of Heating, Refrigeration, and Air Conditioning Engineers, Environmental tobacco smoke: position document approved by the ASHRAE Board of Directors, June 30, 2005, at: http://www.ashrae.org/content/ASHRAE/ASHRAE/ArticleAltFormat/20058211239_347.pdf.

115 Ontario Tobacco Research Unit, Protection from Second-Hand Tobacco Smoke in Ontario: A Review of the Evidence Regarding Best Practices (Toronto, Ontario: University of Toronto, Ontario Tobacco Research Unit, May 2001).

116 Borland, R.; Mullins, R.; Trotter, L.; et al. Trends in environmental tobacco smoke restrictions in the home inVictoria, Australia. Tobacco Control 8 (1999): 266–271.

117 Smoke Free Europe Partnership, Smoke free Europe Makes Economic Sense: A Report on the Economic Aspects ofSmoke Free Policies, May 2005, available at:http://www.smokefreeeurope.com/assets/downloads/smoke%20free%20europe%20-%20economic%20report.pdf.;Scollo, M.; Lal, A.; Hyland, A.; and Glantz, S., Review of the quality of studies on the economic effects of smoke-free polices on the hospitality industry, Tobacco Control 12 (2003): 13–20.

118 Department of Finance, New York City Department of Health and Mental Hygiene, The State of Smoke-Free NewYork City: A One-Year Review, New York City Department of Small Business Services and New York City EconomicDevelopment Corporation, March 2004, at: http://www.nyc.gov/html/doh/downloads/pdf/smoke/sfaa-2004report.pdf.

119 Scollo, M., et al., Review of the Quality of Studies; Scollo, M.; and Lal, A., Summary of Studies Assessing theEconomic Impact of Smoke-free Policies in the Hospitality Industry (Melbourne: VicHealth Centre for TobaccoControl), 2005, at: http://www.vctc.org.au/tc-res/Hospitalitysummary.pdf; Smoke Free Europe Partnership, SmokeFree Europe Makes Economic Sense.

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120 New York City Department of Finance, The State of Smoke-Free New York City.

121 Doyle, G.; and Wischnowsky, D., Other cities’ bans didn’t kill business. Chicago Tribune, 7 December 2005, Lexis-Nexis database.

122 Information Resource Centre. Going smoke-free does not damage profits, global report shows, Cancer ResearchUK Press Release Archive, 2 June 2005, at:http://info.cancerresearchuk.org/pressoffice/pressreleases/2005/june/74845.

123 Scollo and Lal, Summary of Studies.

124 More information on smoke-free legislation is available at Americans for Nonsmokers’ Rights, http://www.no-smoke.org/getthefacts.php?id=14.

125 Assunta M., et al., Care and feeding: The Asian environmental tobacco smoke consultants programme, TobaccoControl 13 (2004): 4–12.

126 National Cancer Institute, Risks Associated with Smoking Cigarettes with Low Machine-Measured Yields of Tarand Nicotine, Smoking and Tobacco Control Monograph No. 13 (Bethesda, Md.: U.S. Department of Health andHuman Services, National Institutes of Health, National Cancer Institute, NIH Pub. No. 02-5074, October 2001),available at: http://cancercontrol.cancer.gov/tcrb/monographs/13/m13_preface.pdf

127 National Cancer Institute, Health Effects of Exposure.

128 Takala, J., Introductory Report: Decent Work, Safe Work (Geneva: International Labor Organization, September2005), 16, available at: http://www.ilo.org/public/english/protection/safework/wdcongrs17/intrep.pdf.

129 Pechachek, T.; and Babb, S., How acute and reversible are the cardiovascular risks of secondhand smoke? BritishMedical Journal 328 (2004): 980-983, available at: http://bmj.bmjjournals.com/cgi/content/full/328/7446/980.

130 Whincup, et al., Passive smoking.

131 WHO, International Consultation on Environmental Tobacco Smoke (ETS) and Child Health, 11–14 January 1999(WHO/NCD/TFI/99.10).

132 British Medical Association, Smoking and reproductive life, February 2004, available at:http://www.bma.org.uk/ap.nsf/Content/SmokingReproductiveLife.

133 State of California Air Resources Board, Proposed Identification of Environmental Tobacco Smoke.

134 Borland, R.; Pierce, J. P.; Burns, D. M.; Gilpin, E.; Johnson, M.; and Bal, D., Protection from environmental tobaccosmoke in California: The case for a smoke-free workplace, JAMA 268, 6 (1992): 749–752.

135 National Center for Environmental Health, Second National Report on Human Exposure to EnvironmentalChemicals. (Atlanta: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services,21 July 2005).

136 New York City Department of Finance, New York City Department of Health & Mental Hygiene, New York CityDepartment of Small Business Services and New York City Economic Development Corporation. The State ofSmoke-Free New York City: A One-Year Review. March 2004 available at: http://www.tobaccofreekids.org/pressoffice/NYCReport.pdf.

137 Sargent, R.; Shepard, R.; Glantz, S., “Reduced incidence of admissions for myocardial infarction associated withpublic smoking ban: before and after study,” British Medical Journal, Vol. 328 (April 2004), p. 977-980. Note:Helena, MT’s smoke-free ordinance was in effect June 2002 through December 2002. The law has been since preempted by state law.

138 Fiore M.C.; Bailey W.C.; Cohen S.J., et al., Treating Tobacco Use and Dependence. Clinical Practice Guideline, HHSPublic Health Service, June 2000.

139 Fong, G.F.; Hyland, A.; Borland, R. et al. Changes in Exposure to Tobacco Smoke Pollution and Support for Smoke-Free Public Places Following the Implementation of Comprehensive Smoke-Free Workplace Legislation in theRepublic of Ireland. Submitted to The Lancet on 25 February 2005.

140 Scollo, M., et al., Review of the Quality of Studies.

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141 Ibid.

142 Scollo and Lal, Summary of Studies.

143 Ibid.

144 New York City Department of Finance, The State of Smoke-Free New York City.

145 Howell, F., “Smoke-Free bars in Ireland: A runaway success,” Tobacco Control 14 (2005): 73 – 74, at:http://tc.bmjjournals.com/cgi/content/full/14/2/73.

146 Field Research Corporation, California Secondhand Smoke Survey, 2004.

147 Lansdowne Market Research, survey commissioned by the Department of Health and Children, August 2004, at:http://www.news-medical.net/?id=3989.

148 Field Research Corporation, Bar Establishment Survey, conducted September – October 2002 for CaliforniaDepartment of Health Services.

149 Chapman, S., Other people’s smoke: What’s in a name? Tobacco Control 12 (2003): 113 – 114.

150 See guide Tobacco Control Strategy Planning, Companion Guide #1: Building Public Awareness about PassiveSmoking Hazards, 2003,available at:. http://strategyguides.globalink.org/shs.htm

151 Ibid.

152 National Cancer Institute, Secondhand Smoke: Questions and Answers, 2005, at: http://www.cancer.gov/cancer-topics/factsheet/Tobacco/ETS.


154 National Cancer Institute. Secondhand Smoke.


156 National Cancer Institute, Secondhand Smoke.

157 Gilliver, D., Public health community hails ‘landmark’ smoking ban, Public Health News, 24 February 2006, at:www.publichealthnews.com/news/showcontent.asp?id=%7B4130F3EC-0277-459B-9662-509B8349D6C0%7D.

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©2006, American Cancer Society, Inc.No. 007339

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American Cancer Society/UICC Advocacy Guides

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Tobacco Control Strategy Planning Guide #3Enacting Strong Smoke-Free Laws: The Advocate’s Guide to Legislative Strategies

Tobacco Control Strategy Planning Guide #4Enforcing Strong Smoke-Free Laws: The Advocate’s Guide to Enforcement Strategies

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Tobacco Control Strategy Planning Guide #1Strategy Planning for Tobacco Control Advocacy

Tobacco Control Strategy Planning Guide #2Strategy Planning for Tobacco Control Movement Building

Tobacco Control Strategy Planning, Companion Guide #1Building Public Awareness of Passive Smoking Hazards

Tobacco Control Strategy Planning, Companion Guide #2Engaging Doctors in Tobacco Control

To download the guides, please visit www.strategyguides.globalink.org

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