SLO smoke: the anatomy of a powerful local anti-tobacco law.

Many recent success stories of anti-tobacco legislation are occurring in California, where funding from Proposition 99, a referendum increasing the tobacco taxes which was passed by the electorate in 1988, fueled local activities and increased awareness and political advocacy in controlling tobacco.

It is well known that since smoking became a popular pastime, the tobacco industry has had a free rein in controlling most federal legislation relating to smoking. Their money and skills have rolled up an impressive list of legislative and political victories in the past (1).

However, the tobacco industry has had several recent setbacks in dealing with the dynamics of grassroots activities in local communities and their governments. Cities cannot prevent citizens from smoking, but they can enact powerful ordinances that will prevent adverse health impacts to those exposed to smoke.

In California, local public health laws are being enacted by many courageous elected officials to protect their constituents, particularly the young. More than 200 California cities now have tobacco control laws ranging from limits on smoking in all city-owned facilities to restricting smoking in all enclosed public places. More California cities and counties are now considering strengthening their present ordinances (2).

An example of strong successful local legislation is in the small city of San Luis Obispo (SLO). In August 1990, this environmentally-conscious community, on the central coast of California, enacted the strictest anti-smoking ordinance in the nation. The ordinance restricts smoking in all enclosed areas used by the public, including all restaurants and bars. This no-smoking legislation has been an example for other local governments and has been thrust in the forefront of health promotion models dealing with tobacco.

A chronology of the events leading up to the ordinance passage, local political and business responses, and ongoing issues of enforcement and acceptance are elements examined in this paper. The San Luis Obispo City model provides a case study that should be considered by health professionals and other governmental/community officials as they rethink their responsibility to protect the public from the dangers of passive smoke. This example shows that health professionals can be major players in local community anti-tobacco control legislation. Their credibility and expertise suggest an active role in assisting concerned citizens and groups.

Second-hand smoke and social issues

Reports issued by the U.S. Surgeon General clearly outline the health risks involved with the use of tobacco (3). During the early 1990s the U.S. Environmental Protection Agency (EPA) has deliberated over passive smoke dangers (4). The official release of the EPA's much-awaited report on the hazards of second-hand and passive smoke in February 1993 increased the impact of media attention and public awareness about potential dangers and increased the call to action. Academic researchers and other Federal agencies also have released research information impacting local debates about second-hand smoke (5).

Because the health hazards of secondhand smoke is now well-documented, the general population is more widely knowledgeable of the health impacts. This is especially true in California, where health education efforts were funded by increasing cigarette tax revenues in 1988. When passed by referendum vote, Proposition 99 empowered the collection of an additional 25 cents a pack to provide major funding for tobacco educational activities at the state and local level. The programs are administered by the State Department of Health Services through funding to local health departments and grants for innovative programs.

Although smokers' and nonsmokers' rights groups have been in existence for several years, the recent research and educational information relating the dangers of smoke to health have caused "battle lines" to be drawn. According to a Chicago newspaper article published in the San Luis Obispo Telegram/Tribune dated April 11, 1990, 90% of nonsmokers consider secondhand smoke harmful, but just five percent would ask people to put out their cigarettes. Half of these smokers expressed their right to light up indoors without asking, "Does anyone mind?"

Two out of three Americans who have never smoked regularly worry that exposure to second-hand cigarette smoke could cause serious health problems, according to an Associated Press poll published in March 1992. This poll found that 54% favor a complete ban on smoking in all public places, and points out the current knowledge and interest this issue has for the American public. In California, the non-smoking majority are beginning to speak up, individually and in groups, to control smoking hazards in their environment.

SLO County demographics

San Luis Obispo is located on California's central coast, midway between Los Angeles and San Francisco. The county boasts a population of about 213,700 (1990 census) and is expected to grow rapidly, surpassing 300,000 by the year 2000. Racially, the county is predominantly white (82%), followed by Hispanic (15%) with smaller ethnic groups of Blacks, Filipino and Asian.

Retail trade, government, agriculture, tourism and commercial fishing are major industries in the county. The four largest employers in the county are county government, California Polytechnic State University, California Men's Colony, and Pacific Gas & Electric (with nuclear power plant at Diablo Canyon). While local employment in the major industries increased during the last four years, there were county-wide employment declines in construction, mining and agriculture. San Luis Obispo County's unemployment rate is consistently lower than state and national averages.

The county's health department is a small comprehensive agency that attempts to meet a variety of public health service demands. Programs and services that directly apply to clean air are disease prevention, environmental surveillance and regulation, air pollution and control, and health promotion and wellness. Deaths attributed to lung cancer each year in San Luis Obispo County number approximately 150 (6).

SLO city description

The City of San Luis Obispo is the county seat, the location of California Polytechnic State University, and the largest and most centrally located of the incorporated cities. With a population of more than 45,000 residents, San Luis Obispo claims 20% of the total county population. While the median age in San Luis Obispo is near the state and national averages, there are more people over the age of 65 and under 19 than either the state or national average. This is probably due to the retirement at traction of the area and the 15,000 student population attending colleges.

In their Guide to San Luis Obispo, the chamber of commerce says, "The people of San Luis Obispo were fortunate enough to inherit a spectacular, beautiful, bountiful, and natural environment and have been sensitive enough to preserve, protect and enhance it." The publication also boasts that "...the people who settled here saw a unique opportunity...their choice to settle here was easy...(but)...keeping the environment beautiful and maintaining the city as a special place to live and visit over the years has not been so simple. It's taken time, energy and patience."

Perhaps this is the legacy that inspired the community to press forward to become a community having the toughest no-smoking ordinance in the world. Having two basic requirements certainly helped: 1) a strong local community interest in environmental issues, and 2) sympathetic support from elected officials.

Health data for San Luis Obispo city in the areas of smoking and heart disease were reported in a 10-year study by Stanford University (7). The study was completed in 1988 and gathered information from 2,600 residents, aged 12 to 74 years. Current smokers in the resident population of San Luis Obispo city were reported to be 15%, versus the statewide average of 27% for the same period. Male smokers composed 18%, while females composed 12% of the population. These rates were reportedly lower than any of the other four California cities studied in this project. Here, then, is a setting for strong concern for health and environmental issues and a small minority of active smokers.

Ordinance background

In late 1989, revisions to the city's no-smoking ordinance began when a city council member concerned about the effects of public smoking was inspired to proceed with a proposal for the city. He consulted with a local physician, a long-time anti-tobacco advocate and member of the California Medical Society. The supporting medical evidence was enough to encourage revisions to the ordinance to be placed on the agenda for discussion in May of 1990.

Concurrently, implementation of the first stages of state legislation which established anti-smoking health education programs was taking place. County health departments were beginning to anticipate receipt of the funds from cigarette tax revenues for local programs. Part of the state health department's plan for distributing these funds to local agencies was the formation of local community coalitions to plan appropriate programs. To support this effort and implement programs in San Luis Obispo County, the County Health Officer created the Tobacco Control Program as a unit of the department's Disease Prevention Services.

Spearheaded by health and community leaders, informal meetings were held to discuss tobacco issues in the county. This group was formally organized into the Tobacco Control Coalition for San Luis Obispo County, an advisory group to the health department's program. These community volunteers are strong local anti-tobacco advocates and represent a broad base of support. The group draws on experiences from their associations with the medical and dental societies, alcohol and child health programs, business and government, prison and law enforcement officials, local colleges, the American Lung Association, American Cancer Society, American Heart Association, YMCA and other youth organizations, senior citizen groups, and those providing outreach health services to minorities, plus local marketing and media liaisons.

Political and public climate

Coalition members were present when the ordinance revisions were first introduced in May of 1990. The first draft prepared by the city legal staff was not, in the opinion of the council, satisfactory. They requested the city attorney strengthen the provisions of the law. As the council was stepping into a new area of controversy, legal staff were cautious of challenges, but redrafted the ordinance as requested.

With the council requesting a stronger ordinance, the Tobacco Control Coalition went into action to support the restrictions on smoking in all public places. Health department staff provided medical and environmental research, model legislation, and available pertinent facts to city staff, council members and the public.

On May 9, 1990, during the SLO city council discussions, the Los Angeles Times broke a story revealing that a draft study of the U.S. Environmental Protection Agency listed environmental tobacco smoke (ETS) with radon and benzene as a Class A carcinogen. At that time it was also reported that the tobacco industry initiated a major campaign of harassment against the report in an attempt to weaken or kill this information (8). However, on June 25, 1990, the EPA did release for public comment two draft reports on environmental tobacco smoke that added fuel to the controversy. One document recommended that government and private sector employers eliminate involuntary exposure to ETS while the other concluded that ETS causes 3,800 adult lung cancer deaths a year and increased prevalence of childhood respiratory illness in the United States (9).

During these same months, close on the heels of the EPA story, the University of California, San Francisco, released a new study strongly linking involuntary smoking with heart disease. This study, conducted by UCSF Professors Stanton Glantz and Williams W. Parmley, found that 30,000 to 40,000 persons die from passive smoking-caused heart disease each year. Dr. Glantz estimated that passive smoking kills 50,000 Americans a year, from both cancer and heart disease. Dr. Glantz continues to gather and release research findings, adding to public awareness and information about second-hand smoke.

The ordinance debate

In June and July, 1990, the SLO city council held public hearings and received testimony on the ordinance to ban smoking in all enclosed public areas of San Luis Obispo city. This total ban concept seemed to take some citizens by surprise and launched a fury of last minute debate within the council chambers as well as with the community. As the hearings continued over several weeks, formal and informal groups began to organize in support and opposition of the ordinance.

The public hearings involved many hours of public testimony from citizens, and from professional, medical and business speakers. Speakers expounded about their businesses and individual rights. Others spoke of relatives who died of lung cancer. Print and broadcast news coverage was constant and continuous. Letters to the editor with strong support or opposition appeared daily. The press, in editorials and reports, seemed neutral: however, the increased furor gave the media ample story opportunities.

The Chamber of Commerce maintained a neutral stand; however, the local Business Improvement Association, an arm of the Chamber of Commerce, expressed concern that the ban would have an adverse economic impact and suggested that a county-wide ban should be phased in, as this would "not be so punitive."

The Chamber of Commerce executive director suggested that 70 percent of public areas be smoke free and that 30 percent be designated as smoking areas, in order to protect local businesses who were afraid that tourists would go elsewhere. The council felt this would create an enforcement problem and declined to change its direction.

In early June, the tobacco industry entered the local scene. R.J. Reynolds sent 200 to 300 letters to local people urging them to contact city council members in protest of the ordinance. The letter, called "Choice, an Action Alert," used the headline "Urgent -- your rights in danger." According to industry reports, these letters were sent to people on the tobacco company's huge database of smokers (usually names of those who redeem cigarette coupons). Council members' names and phone numbers were listed in the letter, with a tear-off sheet to reply to the company about action taken. This move by R.J. Reynolds may have backfired when a front page article appeared in the San Luis Obispo Telegram-Tribune on June 11, headlined "Tobacco Firm Tries to Halt SLO Ban." The attempt by the industry to garner local support caused what appeared to be an expression of outrage from local residents against outside influence.

The strongest local opposition to the ordinance came from the owners of restaurants and bars. Bar owners in particular were opposed. The president of the local restaurant association, representing some 12 to 15 members, spoke against the ordinance, arguing that rights were being taken away and that the city could become a nonsmoking island. He asked for a compromise, suggesting there be a voluntary ban.

Several speakers, representing civil libertarians who opposed any proposed government regulations, spoke at length during each hearing, citing the U.S. Constitution and Bill of Rights. The council received this testimony with courtesy, but continued the stance that this was not a constitutional issue. During the two hearings 36 citizens spoke, with 12 speaking against and 24 in support of the ordinance.

In the midst of public hearings, two surprise events took place. Members of the restaurant association announced that they would not oppose the proposal as long as it continued to include bars. They seemed to believe that if the law applied to bars along with restaurants, no one business would be favored by the smokers. In making this announcement to the council, the president of the restaurant association said he was personally in favor of non-smoking restaurants and within the week he was making his own restaurant smoke-free. Not to be outdone, a second owner of a large restaurant spoke of his plan to voluntarily go smoke-free.

The second event that occurred to impact the hearings was the collection of powerful messages that the council and community heard during the final hearing. A "speak out," well-coordinated by the coalition and community, took place. Speakers included:

* a respiratory therapist, who spoke for a patient, "who has lung cancer and will die soon," and for another, "who cannot walk out of her house because of smoking-related disease;"

* a surgeon, who spoke of how many patients he operates on weekly for debilitating tobacco-related diseases; and

* a college student, who related how she has to wait tables in a smoke-filled restaurant, and who suffers afterwards from severe asthma attacks aggravated by the smoke.

When public testimony concluded, individual council members spoke about their own experiences and feelings. Two members related stories about family members lost to lung cancer. One council member gave personal testimony as a current smoker but proclaimed support for the ordinance.

On July 3, 1990, SLO City Ordinance 1172 was adopted as law, prohibiting smoking in any indoor place open to the public. This was the first municipal ordinance that excludes smoking in all bars as well as restaurants.

Enforcement

Enforcement issues, when discussed at council level, seemed to indicate the ordinance would be self-enforcing. The media and street gossip had fun with the idea of "Smoke Cops." After the required 30-day waiting period, the ordinance went into effect August 3, with little fanfare except for local public opinion articles in the newspaper and on television, which generally echoed an earlier local newspaper article heralding "Non-smokers in SLO can breathe a little easier today."

The city provided businesses with signs reminding the public of the news ordinance. In addition, a small pamphlet was produced and distributed, upon request from city hall, to explain the law and answer questions.

Initial complaints most often expressed views such as "I would never shop or eat again in San Luis Obispo." One caller said her husband drove her to Santa Maria, 30 miles south in Santa Barbara county, to shop because he was "mad at the city." Two elderly people were irate that they could no longer smoke at a Denny's restaurant where they frequently met with a group of seniors for breakfast.

In a Los Angeles Times article in July, the SLO Chamber of Commerce related that there was little economic change noted, and that the ordinance had not hurt business as first thought. As one council member noted, "implementation has gone very smoothly."

By December, 1990, the local newspaper was running articles with headlines such as "SLO smoking rule brings few gripes." According to the city, 45 letters were received during these first few months, with opinion running 20 to 1 in favor of the ordinance. Many positive responses were received from tourists who visited from out of state. Numerous requests for information about the law and its implementation were received by city and county officials. People who heard about the SLO ordinance on television networks CNN and CBS wanted to know more. Inquiries from the Dallas Morning News, San Francisco Bay-area papers, the Los Angeles Times and British public television were received. Reporters came from out of town and asked questions of officials and citizens, who were quoted and re-quoted.

Penalties for individuals cited for smoking (or those who allow it) range from $100 for the first offense to $500 for the third offense during a one-year period. Five enforcement complaints were received by the city within the first few months after the smoking ban went into effect. Because of the small number of complaints received, the city's staff assigned to manage this ordinance was given other tasks.

However, in March and April 1991, three citations were issued to two employees of a local tavern. The citations were heard in court, resulting in two fines, and a third charge was dismissed on procedural technicalities because of legal language. This incident again stirred up a "smoker's rights" group, which gathered to launch another petition drive. Active signature gathering for a referendum was evident in May, June and July 1991, but by that fall all signs of signature gathering had disappeared.

Social impact

As businesses began to address the social changes to accommodate smokers and non-smokers, small outdoor spots became new smoking areas with groups of smokers near doorways. Complaints were registered by non-smokers who had to walk through these smoke-filled entries or along sidewalks where the smokers huddled. In response, some night spots that required cover charges or reservations began providing smokers with separate entrance/exit areas.

Slowly, more smokers started to call for help with interest in cessation and support groups. Many said they were becoming less tolerated by the social circumstances and had decided to quit smoking. Within 12 months following implementation of this law, clearly more smokers were thinking about quitting due to social and peer pressures.

A research project by two students of the political science department at California Polytechnic State University was conducted in December 1990, five months after implementation of the SLO smoking ban. The research provided a snapshot of public opinion. Two hundred randomly selected city residents over 18 years of age were polled by telephone for their opinion. The survey showed that 73.5% of those polled favored the ordinance; 23.5% were against; and 3% were undecided. Of those surveyed, 20% were smokers and 80% were not. As expected, 82% of the non-smokers were in favor of the ordinance, while a surprising 37.5% of smokers also were in favor. Fifty-three percent thought the ordinance was a good idea, and 50% supported issuance of citations for smoking violations (10).

While the city government devoted much time and effort to this ordinance during the intense period before and after its passage, following implementation the parties involved seemed to wish to move on to other issues. The Chamber of Commerce and the business community also appeared to want to ignore the ordinance, expressing concerns that publicizing a non-smoking atmosphere might drive away tourist business.

Some businesses did disappear from the scene. A few suggested that this could be attributed to the smoking ordinance, but with recessionary times there was no clear-cut reason for business failure. San Luis Obispo has more than 100 restaurants within the city limits, and during recent years there have been many start-ups and failures. A popular sports bar/night club was closed 18 months following passage of the ordinance, and the media cited smoking restrictions as one possible cause. Another dining establishment that reportedly violated the ordinance on several occasions closed its doors during January 1992, claiming lack of business due to the non-smoking ordinance.

Smoking is occasionally still reported in a few local taverns and a bowling alley. The bowling alley management reported to the press in the winter of 1991 (a year and a half after the ordinance went into effect) that immediately after adoption of the ordinance, its business was heavily impacted. However, it is noted that a new bowling establishment opened up in a community to the north, and the major highway between this community and San Luis Obispo was closed for repairs during evenings for three months in the fall of 1990. These two events likely had a significant impact on San Luis Obispo bowling leagues; and, in fact, several league members stated they were staying in their own community to bowl rather than drive to SLO.

Recent developments

It can be said that the San Luis Obispo City no-smoking ordinance is recognized as much from outside the local area as from within. In fact, the majority of calls inquiring about the impact and implementation come from outside of the county and state.

In November 1990, a national award was given to the SLO Tobacco Control Coalition by the American Cancer Society at its annual "Great American Smoke-Out" celebration in Atlanta, Georgia. In December 1991, a California Healthy Cities grant was awarded to the city for a business analysis to examine the impact of the ordinance on the business community. And in March 1992, San Luis Obispo was included as one of four cities cited in a report reviewing the effect of smoking ordinances on restaurants. According to the report, there was no effect on total sales in cities having 100% smoke-free restaurants (11). In the city of San Luis Obispo, restaurant and hotel sales tax receipts for the first two quarters of 1991 increased by 7.6%.

State tobacco tax funding for local programs, although reduced and under continuous siege, continues to have a positive impact on local anti-tobacco efforts. The passage of ordinances by other city and county governments is increasing, and the anti-tobacco climate in the state appears to be having a snowball effect. A review of other California city/county laws shows, however, that few others contain a restriction including bars. Other California cities with strong legislation are Rancho Mirage and Walnut Creek (12).

Conclusion

In government, anti-tobacco programs generally are organized by health care professionals with the goal of ensuring comprehensive physical, mental and social well-being, and not merely the absence of disease or infirmity. Specifically, health promotion includes strategies relating to individual life-style choices that have a positive influence on the quality of life, and on morbidity and mortality. Tobacco control activities in California have a high priority in the 1990s.

Environmental health programs are created to protect against environmental factors which adversely impact on human health. Since tobacco smoke is an environmental problem, it follows that those engaged in environmental health science and protection programs should lend their knowledge of issues and community dynamics to strengthen the attempt to control tobacco at the local level. The interdisciplinary backgrounds and training of environmental health scientists and protection professionals can make them particularly valuable in helping address and solve complex health protection problems (13).

Working relationships between environmental health personnel and restaurant owners can be used to garner input and support for legislation that will impact the business community during implementation of smoking restrictions. In addition, some environmental health programs have been designated as enforcement agencies for smoking restriction ordinances.

The successful accomplishment of these goals for community health professions, i.e., health educators, environmental health specialists and other public health leaders, strongly depends on the political climate and the community linkages already established. Coalition development, using community models in tobacco control, has proven to be a valuable approach in achieving success.

The opportunities developed through community coalitions for mutual support are enormous. For example, the Area Council on Aging became active in San Luis Obispo County by adding their senior citizen constituent weight to environmental health issues. Local medical, dental and pharmaceutical associations can lend important support.

The coalition approach works best when:

* cohesiveness is accomplished prior to the action needed;

* health and social benefits are a common goal; and

* all involved are willing to work together without question of credit or "territory."

These steps make for true progress through community cooperation. By working together, health education and environmental health professionals can use these methods to take the lead in improving the health and environment of all citizens.

Update

In January 1993 the city of San Luis Obispo received the results of a commissioned study entitled "The San Luis Obispo Smoking Ordinance -- the Economic Impacts on Restaurants and Bars." The summary states: "The smoking ban appears to have no significant effect on the profitability of the restaurants and bars. Furthermore, sales in neighboring cities did not increase when the ban was instituted. Although there is no measurable impact on total sales, significant numbers of smokers and non-smokers have changed their behavior as a result of the ban. Most notably, smokers are more often going to out-of-town restaurants and bars, while nonsmokers are more likely to go to San Luis Obispo establishments. These two shifts offset one another such that there is no net sales impact."

The report was conducted by the Taylor Consulting Group for the City of San Luis Obispo.

Barbara J. Wells, R.N., MED, CAS, Director, Health Promotion, San Luis Obispo County Health Agency, 1223 Higuera St., Suite 203, San Luis Obispo, CA 93401.

References

1. Glantz, S.A., Ph.D. and B. Samuels, (1991), "The Politics of Local Tobacco Control," J. Amer. Med. Assoc. 266(15):2110, Chicago, IL.

2. California Healthy Cities Project (1992), Tobacco Control in California Cities, Western Consortium for Public Health, Health Promotion Section, Sacramento, CA.

3. Office of the Surgeon General (1989), Reducing the Health Consequences of Smoking, U.S. Dept. of Health & Human Services, Rockville, MD.

4. U.S. Environmental Protection Agency Draft Report (1990), Occupational Safety and Health Reporter, Washington, D.C.

5. University of California--San Diego (1991), Tobacco Use in California, California Dept. of Health Services, Sacramento, CA.

6. Cancer Surveillance Section (1991), Cancer in California Study: 1988 Incidence and Mortality, California Dept. of Health Services, Sacramento, CA.

7. Stanford Center for Research and Prevention (1988), Stanford Five City Project--SFCP, Stanford University School of Medicine, Palo Alto, CA.

8. Americans for Non-Smokers Rights (1991), Update 10(2), American for Non-Smokers Rights, Berkeley, CA.

9. Bureau of National Affairs (1990), Occupational Health and Safety Reporter, U.S. Environmental Protection Agency, Washington, D.C.

10. Coleman, R and D. Stubbs (1991), Project #91-0889, Cal Poly University Political Science Dept., San Luis Obispo, CA.

11. Glantz, A., Ph.D. and L. Smith (1992), The Effect of Ordinances Requiring Smoke Free Restaurants on Restaurant Sales in California, Institute for Health Policy Studies, University of California--San Francisco, CA.

12. Americans for Non-Smokers Rights (1990), Update 19(1), Americans for Non-Smokers Rights, Berkeley, CA.

13. Gordon, L.J. (1991), Year 2000 Education Plan for Environmental health Science and Protection: Problems, Challenges, and Recommendations, Bureau of Health Professions, HRSA, U.S. Public Health Service, Washington, D.C.