U.S. Tobacco Control Laws Database©: Research Applications

www.no-smoke.org @ANR_Smokefree

History of the Database

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• Collection started in early 1980’s

• Database created in 1985

• Database includes records back to 1914

– the earliest smoking control ordinance is a 1936 Milwaukee, WI law prohibiting smoking on buses, and the earliest Youth Access ordinance is a 1914 Houston, MO law prohibiting sales to minors

What’s in the Database?

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• Clean Air laws, Local and State – Including e-cigarettes, marijuana, and housing

• Sales/Distribution laws, Local and State – Including pharmacies, and Tobacco 21

• Youth Access laws, Local and State

• Advertising laws, Local

• Excise Taxes laws, Local

• Conditional Use Permits (CUP’s), Local

The Database is a repository of close to 14,500 laws in over 5000 municipalities, with 370 fields in each record.

Process of Collecting Laws

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• Mail Solicitations – ANR Foundation’s own

– Partnership mailings with others

• Monitoring news services – Daily updates from Information Specialists

– Newsletters and websites

• Advocates, Colleagues, and Elected Officials

• Our Members

Analysis & Data Entry

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Standardized system designed to ensure objectivity and consistency across all records in the database

– Checked in to our system

– Simultaneous analysis by two members of Analysis staff, using standardized analysis tool and guidelines/protocol

– Discrepancies to Senior staff for final decisions

– Data entry by Analysis staff

– Data entry is checked by policy/administrative staff

– Laws are scanned as well as filed in hard files

Comprehensiveness of Collection

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• 98% rate of coverage among cities with a population of 75,000 or more.

• Used National League of Cities mailing list of places with populations of less than 25,000 to vastly increase small cities’ representation.

Data Uses

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• Media Relations & Advocacy

• Community education

• Surveillance

• Evaluation

Earned Media

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From Huston, C., "The 16 states that still allow smoking in bars and restaurants," MarketWatch, February 4, 2015.

Earned Media

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Earned Media

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Earned Media

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Annual Trends

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Trends Over Time

0 2 3 6 7 9 16 23 26 35 49 74 95 125 183

266

352 399

494 544

607 663

743

830 892

942

2 1 3 1 2 7 7 3 9 14 25

21 30

58

83

86

47

95

50

63

56

80

87

62

50 3

0

100

200

300

400

500

600

700

800

900

199

3 (2

)

199

4 (3

)

199

5 (6

)

199

6 (7

)

199

7 (9

)

199

8 (1

6)

199

9 (2

3)

200

0 (2

6)

200

1 (3

5)

200

2 (4

9)

200

3 (7

4)

200

4 (9

5)

200

5 (1

25

)

200

6 (1

83

)

200

7 (2

66

)

200

8 (3

52

)

200

9 (3

99

)

2010 (4

94)

201

1 (5

44

)

201

2 (6

07

)

201

3 (6

63

)

201

4 (7

43

)

201

5 (8

30

)

201

6 (8

92

)

201

7 (9

42

)

201

8 (9

45

)Total Number of Laws Effective By Year

New Ordinances Per Year

Cumulative Total of Ordinances - AllPrior Years

Local 100% Smokefree Laws in all Workplaces,* Restaurants,** and Bars: Effective by Year January 2, 2018

Population Coverage Figures

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U.S. Population Covered by 100% Smokefree Air Laws

In Non-Hospitality Workplaces (W), Restaurants (R), and Bars (B): 2003-2017

69% 65%

60%

50%

41%

32% 30%

22% 21% 19% 19% 19% 19% 19% 19%

21% 23%

24%

27%

29%

32% 30%

32% 32% 33% 33% 33% 32%

24% 24%

10% 13% 15% 23%

29% 36%

40% 47% 47% 48% 48% 48% 49%

58% 58%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

No 100% Smokefree W or R or B Coverage

Some 100% W or R or B Coverage

Total 100% Smokefree W and R and B Coverage

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Peer Reviewed Publications

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• 6 National Cancer Institute (NCI) Monographs

• 5 Surgeons General’s Reports

• Close to 400 studies and journal articles, including Journal of the American Medical Association, American Journal of Public Health, Tobacco Control, National Bureau of Economic Research, Annual Review of Public Health, Journal of Social Issues, and British Medical Journal on economic impact, youth smoking prevalence, low birth weight, resale value of restaurants or cars, etc.

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Sample of Research Articles

• Cheng, K.W.; Liu, F.; Gonzalez, M.; Glantz, S., "The effects of workplace clean indoor air law coverage on workers' smoking-related outcomes," Health Economics 26(2): 226-242, Feb. 2017.

• Gentzke, A.S.; Hyland, A.; Kiviniemi, M.; Travers, M.J., "Attitudes and experiences with secondhand smoke and smoke-free policies among subsidised and market-rate multiunit housing residents living in six diverse communities in the USA," Tobacco Control [Epub ahead of print], March, 2017.

• Landers, G.M.; Ketsche, P.; Diana, M.L.; Campbell, C., "County smoke-free laws and asthma discharges: evidence from 17 US states," Canadian Respiratory Journal [Epub ahead of print], 2017.

• American Cancer Society, "Cancer prevention & early detection facts & figures: 2017-2018," Atlanta, GA: American Cancer Society (ACS), 2017.

• Stevens, V.L.; Diver, W.R.; Stoklosa, M.; et. al., "A prospective cohort study of cigarette prices and smoking cessation in older smokers," Cancer Epidemiology, Biomarkers & Prevention [Epub ahead of print], March, 2017.

• Wang, T.W.; Marynak, K.L.; Agaku, I.T.; King, B.A., "Secondhand exposure to electronic cigarette aerosol among US youths," JAMA Pediatrics [Epub ahead of print], March, 2017.

• Lowrie, C.; Pearson, A.L.; Thomson, G., "Inequities in coverage of smokefree space policies within the United States," BMC Public Health 17: 456, 2017.

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Applications to Related Issues

• Tracking acute and chronic disease rates

– Pediatric clinics: asthma, ear infections, bronchitis, etc.

– AMI admissions

– Cancer rates and trends over time • Fewer “cancer clusters” as cities go smokefree?

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Possible Model for Other Policy Tracking

• Are there other potential applications of this type of database?

– Obesity and nutrition policies

– Other areas?

• Opportunity to share lessons learned and technical issues from our experience.

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Current Status of Smokefree Protections

• More than 40% of the U.S. population is NOT protected by a 100%

Smokefree Workplace, Restaurant, and Bar law.

• For states without these minimal protections, we should strongly advocate for Smokefree Laws before other types of laws.

– Caveat: Preemption states (repeal Preemption!)

– Laws must include casinos

• 90% of Commercial Gaming Employees work in Smoke-Filled casinos, including Dealers, Janitors, Technicians, Security, Hosts & Hostesses, Entertainer, and more.

– Top gaming states (NV, NJ, PA, MS, IN, LA, IA) are NOT Smokefree in casinos (exceptions: laws in New Orleans and East Baton Rouge).

• Good news: there are over 800 commercial and tribal gambling facilities across the U.S.; however, these tend to be smaller gaming states.

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Some of the factors influencing health and contributing to health disparities:

• Root causes or social determinants of health such as poverty, lack of education, racism, discrimination, and stigma. • Environment and community conditions such as how a community looks (e.g., property neglect), what residents are exposed to (e.g., advertising, violence), and what resources are available there (e.g., transportation, grocery stores). • Behavioral factors such as diet, tobacco use, and engagement in physical activity. • Medical services such as the availability and quality of medical services.

cdc.gov/healthequityguide

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Health Equity means that every person has an opportunity to achieve optimal health regardless of: • The Color of their Skin • Level of Education • Gender Identity • Sexual Orientation • The Job they have • The Neighborhood they live in • Whether or not they have a Disability

Endorse a paradigm shift in how to look at equity. For example:

• Supporting and building communities’ ability to engage in reducing inequities at the state/local level;

• Identifying creative ways to eliminate inequities; and

• Measuring equity differently (e.g., city report cards).

We cannot address health equity without addressing tobacco use and exposure to secondhand smoke in workplaces and public places, and in multi-unit housing.

Population Protected,

57.9%

Texas, 5.3% Georgia, 3.1%

Midwest States: IN, MO, 2.8%

Southern States: AL, AR, KY, LA, MS,

SC, WV, 6.5%

Western States: AK, CO, ID, NM, NV, WY,

3.6%

Preemption States: CT, FL, NC, NH, OK, PA, TN,

VA), 20.8%

POPULATION PROTECTED VS. POPULATIONS NOT YET FULLY PROTECTED BY SMOKEFREE LAW, AS A PERCENTAGE OF THE U.S. POPULATION

As of January 2, 2017

Population Not Fully Protected

42.1%

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Smokefree workplace laws were associated with significantly lower odds of initiating smoking and curbed tobacco usage among current smokers. “The effect of smokefree workplace laws on smoking initiation is equivalent to a $1.57 (in 2007 dollars) tax increase. Smokefree bar laws are associated with lower rates of current smoking, as well as a decrease in the number of days reported smoking among current smokers.” (Association of Smoke-Free Laws With Lower Percentages of New and Current Smokers Among Adolescents and Young Adults: An 11-Year Longitudinal Study JAMA Pediatr. 2015;169(9):e152285. doi:10.1001/jamapediatrics.2015.2285)

Smokefree Policies are a Youth and Young Adult Smoking Prevention Strategy

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Moving Forward: Closing Gaps • Goal: Securing 100% smokefree Workplace, Restaurant,

Bar, and Gaming laws in places without protections.

• Challenges: – States with Preemption – Combatting Tobacco and Casino Industry interference, as well as

e-cigarette industry & proponents – Overcoming perception that the problem is solved – Lack of media around harms of Secondhand Smoke Exposure

and Benefits of Smokefree Workplaces – Competing Policy Interests, in tobacco and other issues – Reduced or absent tobacco control infrastructure in many states

as a result of reduced funding – Legalization and Commercialization of Marijuana

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Timeline of State Preemption of Smokefree Air Laws

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Wisconsin

Nebraska

Rhode Island

Montana

New Hampshire

Washington

Oregon

Michigan

New Jersey

South Carolina

South Dakota

Utah

Delaware

Kentucky

Tennessee

Louisiana

Nevada

North Carolina

Connecticut

Iowa

Virginia

Illinois

Pennsylvania

Oklahoma

Florida

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How Can We Close the 42% Gap in Smokefree Protections?

• Strategically focus and plan for local smokefree workplace campaigns that include all workplaces; no exemptions.

• Engage all partners and affected populations in the process to increase community understanding and buy-in.

• Repeal Preemption (and prevent the adoption of preemptive state laws).

• In states with smokefree W,R,B and G laws, consider other areas such as smokefree multi-unit housing.

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For More Information:

Maggie Hopkins Director, Data Management and Analysis

Maggie.Hopkins@no-smoke.org

Cynthia Hallett, MPH President and CEO

Cynthia.Hallett@no-smoke.org

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Twitter and Facebook: @ANR_Smokefree