Arizona's 2006 Smoke-Free Act and community health protection

Local Community

Local/Regional Community Health Issue: Arizona's 2006 Smoking Ban

Since the Surgeon General publicly declared a causal link between smoking and lung cancer, smoking cessation has been a part of many federal anti-drug and public health initiatives. However, some public health advocates have criticized the influence of some politician's personal financial interests in supporting tobacco production. Tobacco companies often make contributions to certain politician's campaign funds. Tobacco supports many states' economies, such as the Carolinas, and voters resist anti-smoking legislation for fear of losing their jobs. The national and international lobbying influence of corporate conglomerates such as RJR Nabisco are powerful and can block effective national anti-smoking legislation. So many local communities and states without powerful tobacco interests have attempted to fill what they see as gaps in national anti-tobacco and anti-smoking legislation, including Arizona.

Reason for Selection

As a resident of Arizona, I applauded when on May 1, 2007 my state formally implemented the voter-approved

Smoke-Free Arizona Act. This statute illustrates the power of voter-generated legislation to protect community as well as individual health interests (Hedding, 2007). The ban was an extension of policies that already existed in many cities in Arizona that had already passed smoking bans in bars and restaurants. It shows how grass-roots, voter-generated efforts in a state or a community can create a more positive health environment within a state's own borders, first on a local and then on a state level, even when federal authorities may be remiss or overly influenced by powerful special interests such as tobacco and restaurant lobbying organizations. Since the act was passed, Arizona restaurants have actually been coping quite well with the law's challenges. "Do you think people might prefer a cigarette over the finest steak in the Valley?" asked one restaurant owner (Steinberg, 2007). "You come for the food," said [a restaurant patron] as he "took a drag from a cigarette" saying "I'll go outside to smoke" (Steinberg, 2007).

Description of the Issue/Problem

The voter-generated initiative generated public support through a wide-spread state-wide advertising campaign that encompassed a variety of media, including television, print, and the Internet. The initiative was submitted to the public in November of 2006. The citizens of Arizona overwhelmingly passed Proposition 201, the Smoke-Free Arizona Act. The statute prohibited smoking in most indoor public places including (amongst the most controversial areas) restaurants, bars, gaming facilities such as bingo halls, billiard or pool halls, bowling centers, public buildings, grocery stores or any food service establishment (the Basics: Smoke Free Arizona," 2007, Smoke Free Arizona, 2007).

While New York and New Jersey have also banned smoking in such food establishments, the Smoke-Free Arizona Act extended the ban to "lobbies, elevators, restrooms, reception areas, hallways and any other common-use areas in public and private buildings, condominiums and other multiple-unit residential facilities, indoor sports arenas, gymnasiums and auditorium, health care facilities, hospitals, health care clinics, doctor's offices and child day care facilities, and common areas in hotels and motels, and no less than 50% of hotel or motel sleeping quarters rented to guests" (the Basics: Smoke Free Arizona," 2007, Smoke Free Arizona, 2007).

Private residences, tobacco shops, private clubs, theatrical productions where smoking is part of the action on stage, outdoor patios of private residences, and of course the sovereign Native American nations within Arizona's borders were exempt ("Exemptions," 2007, Smoke Free Arizona, 2007). Citizens were encouraged to report violations, to provide additional support to the public health inspectors responsible for ensuring that public safety measures are observed by restaurants. The fines are significant: "Each day a violation occurs constitutes a separate violation. If the superior court finds the violations are willful or evidence a pattern of noncompliance, the court may impose a fine up to $5,000 per violation "("Reporting," 2007, Smoke Free Arizona, 2007).

Supporting Data to Validate Existence of Problem

According to sources cited on the Smoke Free Arizona website from agencies as diverse as the U.S. Surgeon General and the American Heart Association, secondhand smoke is responsible for approximately 3,000 lung cancer deaths a year in the United States in non-smokers. Secondhand smoke has been estimated to result in at least 53,000 annual deaths in the United States. Also, in the United States, annual healthcare expenditures solely from secondhand smoke exposure total $4.98 billion. In short, although some restaurant owners are worried about the economic impact of the ban, everyone is paying for the health care costs of smoking.

Non-smokers pay for the cost of smoking in their lives and health, and even people who personally minimize their own contact with second-hand smoke by avoiding smoke-filled areas pay for the risks of smoking because the health care expenditures and loss of productivity is passed onto the American taxpayer. Smoking, restaurants, hotels, gaming establishments -- all are lucrative industries, but they are industries that cost people in the long run, because of the health damage inflicted upon workers in smoky areas.

Possible Community Health Nursing Interventions

Educating people about the reasons and the necessity of the ban is one important role for community nurses. People know that smoking is bad for them, but they may see the issue as one of personal freedom, rather than rights, and resist the ban initially. By stressing the risks and the financial costs of second hand smoke, nurses can provide a powerful educational resource for the community.

Although the initiative is specifically not designed to reduce the number of smokers, some people who have tried and failed to quit many times may use this as a motivating factor to quit. Nurses can provide cognitive strategies to help people who are used to smoking, especially when they go out for an evening of enjoyment, cope with the loss of their favorite, deadly oral pacifier. Also, nurses can use this opportunity and increased interest on the part of the media in regards to stopping smoking to educate people about the benefits of quitting and dispel some myths, like the fact that all people who quit smoking gain weight or that if you have smoked for many years the health benefits are lost to the former smoker.

Encouraging people to report violations for the sake of their health is a final service that nurses can perform to support the ban. People often do not like to report violations, because they feel like 'busybodies' but there is no way that state health inspectors alone can constantly police restaurant owners who illegally look the other way when customers light up. Nurses can remind the public that this legislation was the result of a voter-generated, rather than a politician-generated effort. It must be supported by the public to succeed.

One final criticism of the bill was that smokers will simply go across the border to smoke (Steinberg, 2007). However, proponents point out that, for smokers, there are other options, like patios, personal residences, and other places where they can smoke and not put hospitality workers' lives at risk. And once again, nurses can act as advocates, asking smokers to ask themselves if they really want to be slaves of such a deadly and expensive habit that they are willing to uproot their social lives merely to take a few deadly drags of a cigarette while eating.