cigarettes, metabolic activation was rea. demonstrate mute
genic activity for most of the CSC studied. ° =e

Several short-term tests have been rf in eukeryotic
systems. A solution of the gas phase of mainstrean, cigarette mea
dissolved in a phosphate buffer induced reciprocal mitotic recombi
nation in Saccharomyces cerevisiae D3 and petite mutants in an
isolate of strain D3 (Izard et al. 1980). Whole mainstream cigarette
smoke induced mitotic Bene conversion, reverse mutation, and
io mitotic recombination in strain D7 of S. cerevisiae (Gairola
1 .

Transformation of mammalian cells was also induced in several
cell systems using the CSC from mainstream Cigarette smoke
(Lasnitzki 1968; Inui and Takayama 1971; Rhim and Huebner 1973;
Benedict et al. 1975; Takayama et al. 1978; Rivedal and Sanner
1980). Transplacental exposure to mainstream CSC was reported to
transform Syrian hamster foetal cells (Rasmussen et al. 1981).
Transforming activity was reported in the acidic and basic fractions
as well as the neutral fractions of CSC. Studies on subfractions of
CSC have shown that the basic fraction and some of the acidic
fractions are the most active in cell transformation (Benedict et al
1975). The neutral fraction of CSC was also reported to inhibit DNA
repair in normal human lymphocytes (Gaudin et al. 1972). Transfor-
mation of mammalian cells with SS or ETS has not been reported.

Summary of Carcinogenicity

At present, the scientific literature offers some information on the
physicochemical nature of the sidestream smoke from tobacco
products and of environmental tobacco smoke. Chemical analytical
studies have already demonstrated that SS and ETS contain a wide
spectrum of carcinogens such as polynuclear aromatic hydrocarbons,

251
volatile and tobacco-specific N-nitrosamines, and polonium-210. To
date, only one study has demonstrated the carcinogenic activity of
the particulate matter of sidestream smoke and a few isolated
reports have dealt with the genotoxicity of SS and ETS. Therefore,
bioassay studies with the mainstream smoke and the environmental
tobacco smoke of cigarettes are needed. Although the resulting
bioassay data will derive from tests of concentrations of environmen-
tal smoke that do not realistically occur in the human setting, these
results will provide information about the relative carcinogenic
potential of sidestream smoke in comparison with the mainstream
smoke of the same cigarettes. In a comprehensive analytical
approach, data should be generated to systematically determine the
concentrations of toxic and tumorigenic agents in the ETS samples
and to simultaneously measure the uptake of tobacco-specific agents
by the body fluids of nonsmokers exposed to ETS.

Conclusions

1. The main effects of the irritants present in ETS occur in the
conjunctiva of the eyes and the mucous membranes of the nose,
throat, and lower respiratory tract. These irritant effects are a
frequent cause of complaints about poor air quality due to
environmental tobacco smoke.

2. Active cigarette smoking is associated with prominent changes
in the number, type, and function of respiratory epithelial and
inflammatory cells; the potential for environmental tobacco
smoke exposure to produce similar changes should be investi-
gated.

3. Animal models have demonstrated the carcinogencity of ciga-
rette smoke, and the limited data that exist suggest that more
carcinogenic activity per milligram of cigarette smoke concen-
trate may be contained in sidestream smoke than in main-
stream cigarette smoke.

252
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260
CHAPTER 6

POLICIES RESTRICTING
SMOKING IN PUBLIC PLACES
AND THE WORKPLACE
CONTENTS

Introduction

 

 

Current Status of Restrictions on Smoking in Public
Places —
Legislative Approaches
Federal Legislation
State Legislation
Local Legislation
Regulatory Approaches
Smoking Regulation in Specific Public Places
Public Transportation
Retail Stores
Restaurants
Hotels and Motels
Schools
Health Care Facilities

 

Current Status of Smoking Regulations in the Workplace
Smoking Policies
Prevalence of Smoking Policies
Reasons for Adopting Smoking Policies
Barriers to Adopting Smoking Policies
Types of Smoking Policies
The “Individual Solution” Approach
Environmental Alterations
Restrictions on Employee Smoking
Banning Smoking at the Workplace
Preferential Hiring of Nonsmokers
Implementation of Smoking Policies

 

Impact of Policies Restricting Smoking in Public Places
and in the Workplace
Potential Impacts of Smoking Policies
Policy Implementation and Approval
Direct Effects: Air Quality and Smoking Behav-
ior
Indirect Effects: Knowledge, Attitudes, Social
Norms, and Smoking Behavior
Methodologic Considerations in Policy Evaluation

263
Study Design
Assessing the Effects of Smoking Policies

Review of Current Evidence on Impact

Workplace Smoking Policies

Policy Implementation

Air Quality

Policy Approval

Smoking Behavior

Attitudes About Smoking

Management Issues

Legislation Restricting Smoking in Public Places
Policy Implementation and Enforcement
Policy Approval

Attitudes and Social Norms

Smoking Behavior

 

Recommendations for Future Research

 

Conclusions

 

Appendix: The Comprehensiveness Index of State Laws

 

References

264
introduction

workplace (Feldman et al. 1978; Eriksen, in Press; Walsh and Gordon
1986). Private sector initiatives have gained momentum in the 1980s.
Businesses in a wide variety of industries have adopted smoking
policies to protect employee health. Other private initiatives include
no-smoking sections in restaurants, no-smoking rooms in hotels and
motels, and smoking restrictions in hospitals.

Though this trend was fueled by growing evidence about the
health effects of involuntary smoking, it also reflects the changing
public attitudes about smoking since 1964, when public attention
was focused on the health hazards of cigarette smoking by the

portation vehicles and motels, restaurants, stores, schools, health
care facilities, and the workplace are addressed. The effects of
smoking policies on air quality, attitudes, and smoking behavior are
considered.

Current Status of Restrictions on Smoking in Public Places

Smoking regulations in public places represent a mix of public and
private actions, A public place may be defined as any enclosed area
in which the public is permitted or to which the public is invited.

265
and the methods by which new smoking restrictions have been
proposed and adopted.

Smoking in Federal, State, and local government facilities has
been addressed by legislative and regulatory action. These facilities
include government offices, public schools and libraries, and publicly
owned transportation, health care, cultural, and sports facilities. In
public facilities under private ownership, smoking restrictions are a
mixture of government-sponsored regulation and private initiative.
These facilities include retail stores, restaurants and bars, hotels and
motels, and privately owned transportation, health care, cultural,
and sports facilities.

The extent and acceptability of smoking restrictions in public
places is influenced by (1) whether ownership is public or private; (2)
the historical acceptance of smoking in the facility; (3) the degree to
which nonsmokers are exposed to involuntary smoking, determined
by the facility’s size, degree of ventilation, and ease of separating
smokers and nonsmokers; and (4) the degree of inconvenience that
smoking restrictions pose to smokers. Smoking restrictions are still
most widespread and least controversial in facilities where smoking
has traditionally been prohibited by fire codes, such as theaters or
libraries, or where smoking is negatively associated with the activity
taking place, such as gyms or health care facilities (Feldman et al.
1978). Small crowded areas with poor ventilation, such as elevators
and public transit vehicles, are also frequently regulated. On the
other hand, the strong association of smoking with eating and
drinking contributes to the controversial nature of smoking restric-
tions in restaurants and bars.

Legislative Approaches
Federal Legislation

Congress has enacted no Federal legislation restricting smoking in
public places, although bills have been introduced in Congress
several times since 1973 (Feldman et al. 1978).

State Legislation

Most legislation restricting smoking has been enacted at the State
level. Although legislation regulating smoking for health reasons is
largely a phenomenon of the past decade, cigarette smoking has been
the subject of restrictive legislation for nearly a century. Early
legislation had two different rationales. The first, a relatively
noncontroversial rationale, was the protection of the public from fire
or other safety hazards, largely in the workplace (Warner 1981b).

The second, more controversial motivation for early legislative
action was a moral crusade against cigarettes similar in tone and
coincident with the moral crusade against alcohol that emerged at

266
enforcing the regulations Proved controversial. As part of the strong

reaction to alcohol prohibition, all State laws banning smoking were
repealed by 1927.

In the early 1970s, a new wave of smoking legislation emerged. It
covered smoking in a larger number of Places and extended for the
first time to privately owned facilities. The language became more

Annual 1985). It covered restaurants, private worksites, and a large
number of public places, and soon became the model for other State
legislation. Within the next 5 years, Utah, Montana, and Nebraska
enacted similar comprehensive legislation (US DHHS 1985b). The

267
45 -

|| Extensive

40 Moderate
Basic
Nominal

 
 
 
   

35

30

25

 

15 &

Number of States with laws in effect

10 &

Yj
|

 

FIGURE 1.—Prevalence and restrictiveness of State laws
regulating smoking in public places, 1960-1985

NOTE: See appendix for definitions of reatrictiveness of laws.
SOURCE: ASH (1986); OTA (1986); Tri-Agency Tobacco Free Project (1986); US DHHS (1985b).

The rate of enactment of State legislation increased throughout
the seventies (Figure 1, Table 1). The pace of new legislation
continues in the 1980s, with 23 new laws enacted by 16 States
between 1980 and 1985 (Table 1). As of 1986, 41 States and the
District of Columbia have enacted laws regulating smoking in at
least one public place (Figure 1). Eighty percent of the US.
population currently resides in States with some smoking restric-
tion, compared with 8 percent in 1971 (Warner 1981b). Most of the
nine States with no smoking legislation are concentrated in the
southeast United States and include three of the six major tobacco-
producing States (North Carolina, Virginia, and Tennessee) (Figure
2).

Current State legislation varies in comprehensiveness and lan-
guage. The number of public places in which smoking is regulated by
State law ranges from 1 (Delaware, Mississippi, and South Carolina
regulate smoking on public transportation only) to 16 (Minnesota
and Florida) (US DHHS 1985b, Tri-Agency Tobacco Free Project

268
TABLE 1.—State laws restricting smoking, 1970-1985

Number of Cumulative number
newly enacted of States with _Reatrictiveneas of Average

 

 

Year laws laws in effect newly enacted laws! of laws in effect
1892-1969 - 14 ~ 250
1970 0 i ~ 250
1971 2 16 250 20
1972 1 WW 20 20
1973 3 2 30 383
1974 3 22 ALT 296
1975 12 27 419 339
1976 5 30 563 425
1977 6 33 542 462
1978 2 34 625 478
1979 4 37 688 507
1980 1 a7 - ‘or
1981 6 39 500 513
1982 1 39 - on
1983 4 40 688 538
1984 3 41 ‘867 548
— 8 42 m9 619
‘ Index of Restrictivenessa

O = None; no statewide restrictions.
0.25 = Nominal; State regulates smoking in one to three public places, excluding restaurants and private
worksites.
0.50 = Basic; State regulates smoking in four or more Public places, excluding restaurants and Private
worksites.
0.75 = Moderate; State regulates smoking in restaurants but not Private worksites,
1.00 = Extensive; State regulates smoking in private worksites.
* New California laws in 1980 and 1982 extended smoking restrictions to additional public places, but did not
alter the restrictiveness of the State law (moderate). /

1986). State laws most often restrict smoking in public transporta-
tion (85 States), hospitals (33 States), elevators (31 States), indoor
cultural or recreational facilities (29 States), schools (27 States),
public meeting rooms (21 States), and libraries (19 States) (Table 2).
Other public places specifically mentioned in State smoking legisla-
tion are public restrooms and waiting rooms, jury rooms, polling
places, prisons, hallways, stairwells, and stables. Most laws restrict
smoking in these places to designated areas, thereby making
nonsmoking the norm; in a few States smoking is banned entirely in
these places. For example, smoking on public transportation is
banned entirely in four States (Florida, Georgia, Massachusetts, and
Washington) and one (Washington) bans smoking in theaters,
museums, auditoriums, and indoor sports arenas. Smoking restric-

269
   

a)
ay
Uy

WB Extensive

 
   
    

 

 

 

 

 

 

 

. — EE] Moderate
& Basic
Nominal

(C) No restrictions

FIGURE 2.—Geographic variability of State laws regulating
smoking in public places, 1986

NOTE: See appendix for definitions of restrictiveness of laws.
SOURCE: ASH (1986); OTA (1986), Tri-Agency Tobacco Free Project (1986); US DHHS (1985b).

tions extend to restaurants and retail stores, which are largely
privately owned, in 18 States.

Smoking at the workplace is restricted for public sector employees
in 22 States and for private sector employees in 9 States. The
provisions of worksite smoking legislation vary widely, making
direct comparisons of their comprehensiveness difficult.

Currently enacted workplace smoking laws contain provisions to
(1) require a written policy (5 States); (2) limit smoking to designated
areas (8 States); (3) require the posting of signs (10 States); and (4)
give preference to nonsmokers in resolving conflicts over the
designation of a work area (2 States) (OTA 1986). Public or private
worksites are included in the definition of public places in some
States where worksites are subject to the general provisions for
public places. Other States have written separate guidelines for the
worksite, which are usually more stringent. Laws in four States
apply only to State and local government employees; restrictions
apply to the private worksite in an additional nine States.

270
TLE

State AL AK AZ AR CA co CT DE pC FL GA HI ID IL_ IN IA KS KY

1971,76 1973 1925
Year(s) legislation 1975 1973 1977 1980,81 1977 1974 1983 1975
enacted — 1984 1981 1985 1982 1985' 1983 1960 1979 1985 1975 1976 1985 — 1978 1975 1972

 

PUBLIC PLACES WHERE SMOKING IS PROHIBITED (EXCEPT IN DESIGNATED AREAS)

 

 

 

Public transportation xX xX (X)? X34 x x: x xX X35 xX® xX xX xX X
Elevators xs xX xX xX* xX xs x* x xX xX xX
Indoor recreational or
cultural facilities * X xX xX xX xX xX xX xX x
Retail stores (X)" (X)? xX xX xX xX xX
Restaurants x* x? X x" X* xX
Schools x x xX xX xX xX xX xX xX x
Health care facilities
Hospitals x x x xX xX x X xX x xX xX xX
Nursing homes xX x Xx x x X Xx x X
Public meeting rooms xX xX x xX xX x xX xX x
Libraries x xX x xX x
Restrooms xs x xX xX xX
Waiting rooms xX X xX xX xX »«
Other X27 X27 X26.27.30
WORKSITE SMOKING RESTRICTIONS **
Public worksites Dp" B D! B B B,D‘? B! B D
Private worksites A B B,D
IMPLEMENTATION PROVISIONS
Nonsmokers prevail
in disputes x
No discrimination
against nonsmokers
ENFORCEMENT
Penalties for violations xX x xX xX x xX xX xX xX X xX x x xX
Smoking X23 X23p X2e X2e X23 X23 X23e X23 X23e X23 X2ad X23 Z23 X230
Failure to post signs XMh Kh

 

Overall State law
restrictiveness: ** 0 3 2 1 3 3 4 1 2 4 1 2 3 0 0 2 2 1

 
Glo

TABLE 2.—Continued

 

 

 

 

State LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH
1954 1924 =. 1967 1955 1921
Year(s) legislation 1981,83 1957 1947-1968 = 1971 1911 1979 1975 1981
enacted - 1985 1975 «61975 1978 1975 1942 — 1979 1979 1975 1981 1985 1985 1976 — 1977 1984
PUBLIC PLACES WHERE SMOKING JS PROHIBITED (EXCEPT IN DESIGNATED AREAS)
Public transportation x xé (Xx)? x x x x x x x x x x x
Elevators Xx xs x x x x x x x x x x
Indoor recreational or
cultural facilities * xX x x x x x x x x x
Retail stores x )" xX x xX x xX x
Restaurants xX x" xX xX x" x" x
Schools x xX x x x x x x x
Health care facilities
Hospitals x x x x x x xX x x x x xX x
Nursing homes xX x xX x x x xX x xX xX x x x
Public meeting rooms x x xX x x x x x x
Libraries x x xX Xx x x x x
Restrooms x x x x x
Waiting rooms x x x x x x x
Other x 50 x 48 X%27 xX av xX a x 2s
WORKSITE SMOKING. RESTRICTIONS '*
Public worksites BD Dp" p D" p* BC" BC c c
Private worksites B,D p72 pb” pial As Bc” A™
IMPLEMENTATION PROVISIONS
Nonsmokers prevail .
in disputes x xX
No discrimination
against nonsmokers x

 

ENFORCEMENT
ELS

 

State OK OR PA he sc SD TN TX UT VT VA WA WV WI WY

1973,75 1927 1913 Total
Year(s) legislation 1977 1947 1976 1976 1919 N  (%)
enacted 1975 1981 1977 1977 1997 1974 — 1975 1979 1892 — 1983 1985 1984 — 51 (100)

 

PUBLIC PLACES WHER SMOKING IS PROHIBITED (EXCEPT IN DESIGNATED AREAS)

 

 

 

Public transportation xX x (Xx)? xX xX xX xs xX xX 35 (68.6)
Elevators xX xX xX xX xX xX x* xX 31 (60.8)
Indoor recreational or

cultural facilities * xX x xX x x xX xX x® xX 29 (59.6)
Retail stores xX xX xX xX x* xX 18 (35.3)
Restaurants xX xX Xx x x 18 (35.3)
Schools xX xX xX xX xX x® xX x 27 (52.9)
Health care facilities

Hospitals xX xX xX xX xX xX xX x 33 (64.7)
Nursing homes xX xX x x x x x 29 (56.9)
Public meeting rooms xX xX xs 21 (41.2)
Libraries xX xX xX xX xX xX 19 (37.2)
Restrooms X 11 (21.6)
Waiting rooms xX X x 16 (31.4)
Other xs x7 x's 12 (23.5)
WORKSITE SMOKING RESTRICTIONS "°
Public worksites D D" D D'* 22 (43.1)
Private worksites Dizzz A D A” 9 (17.6)
IMPLEMENTATION PROVISIONS

Nonsmokers prevail

in disputes xX 4 (78)
No discrimination

against nonsmokers x 2 (3.9)
ENFORCEMENT

Penalties for violations X xX xX xX x x x X xX xX Xx 40 (78.4)

Smoking X23 X23b X2ie X23 X23p X230 X230 X23a X25f 0 X23e X2% 39 (76.5)

Failure to post signs X24e Xz Xzc 9 (17.6)

 

Overall State law
restrictiveness: *® 2 3 2 3 1 2 0 2 4 1 0 4 1 3 0

 
a
op

TABLE 2.—Continued (Footnotes)

 

‘ Executive order.

1 School buses only.

‘Including school buses.

* California stipulates that at least 50 percent of all passenger seats must be in nonsmoking areas on trains, airplanes, and street railroad cars departing from the State.

* Smoking never permitted in this area.

“Indoor recreational and cultural facilities: museums, auditoriums, theaters, and sports arenas.

7 Grocery stores only.

* Restaurants seating 50 or more persons must have a no-smoking section.

* Restaurants seating 50 or more persons must have a no-smoking section if the restaurant is in a publicly owned building.

‘© Restaurants seating 75 or more persons must have a no-smoking section.

» Restaurants must designate at least 30 percent of their seats as a no-smoking area.

'? Restaurants are encouraged to establish no-smoking areas.

‘3 Restaurants must designate at least 50 percent of their seats as a no-smoking area.

'«(Deleted).

‘* No place other than a bar may be designated a smoking area in its entirety.

‘* Worksite (only B, C, and D count as having a worksite policy in caculation of totals): A - Employer must post a sign prohibiting smoking at the worksite; B ~ Employer must have a (written)
smoking policy; C - Employer must have policy that provides a nonsmoking area; D - No smoking except in designated areas.

11 Employer must post signs designating smoking and no-smoking areas.

18 Employer must post signs in smoking areas.

1* Employer must post either smoking or no-smoking signs, depending upon their policy.

*° Employer must post signs in no-smoking areas.

*1 State does not restrict smoking in factories, warehouses, and similar places of work not usually frequented by the general public.

1 Prohibits smoking in any mill or factory in which a no-smoking sign is posted.

*3 Persons who smoke in a prohibited area are subject to a fine or a penalty. Maximum fines or penalties, where applicable, are listed below: a = $5; b = $10; c = $25; d = $50; e = $100, f =

$100/day; g = $200; h = $300; i = $500; j = $50 or up to 10 days in jail or both; k = $50 or 90 days imprisonment; | = civil action; m = minor misdemeanor; n = petty misdemeanor; 0 =
misdemeanor; p = petty offense.

* Persons who are required to and fail to post smoking and/or no-smoking signs are subjected to a penalty. Maximum fines, where applicable, are listed in footnote 23.

*6 Reatrictiveness key: 0 = None, no statewide restrictions; 1 = Nominal, State regulates smoking in one to three public places, excluding restaurants and private worksites; 2 = Basic, State
regulates smoking in four or more public places, excluding restaurants and private worksites, 3 = Moderate, State regulates smoking in restaurants but not private worksites; 4 = Extensive,
State regulates smoking in private worksites.

** Jury rooms.

#7 Halls and stairs.

™* Stables.

»* Polling places.

9° Prisons, at prison officials’ discretion.
The least restrictive workplace laws simply empower the employer
to restrict smoking in factories by posting signs. These statutes were
enacted in the early 1900s. The weakest recent laws simply require
an employer to issue a written smoking policy and to post signs.
More restrictive laws require that employers designate no-smoking
areas at work, implying that smoking is the norm. The most
comprehensive laws prohibit smoking except in designated areas,
making nonsmoking the norm. Seven States (Florida, Maine, Minne-
sota, Montana, Nebraska, Utah, and Washington) have this type of
law. In several States, some worksites or some parts of a worksite
{usually private offices) are exempted from the regulations. To
prevent employers from complying with the letter but not the intent
of the law, some States prohibit a workplace from being designated
as entirely smoking.

State laws vary in their provisions for implementation and
enforcement. In most States, the State health department is
responsible for policy enforcement. Nearly all (39 of 42) States with
laws provide penalties for smokers who violate restrictions; the
maximum penalty is $500. In two States violators can be jailed.
Employers or others who fail to designate smoking areas can be fined
in nine States.

The comprehensiveness of State laws, as defined by the number
and nature of places where smoking is restricted or prohibited, has
increased since 1970. In 1981, Warner (1981b) classified State laws
according to their comprehensiveness (restrictiveness) and docu-
mented an increase in the average restrictiveness from 1971 to 1978.
An updated and modified index of the comprehensiveness of State
laws (described in the appendix) demonstrates that the phenomenon
reported by Warner has continued into the mid-eighties. The
comprehensiveness of newly enacted laws increased markedly dur-
ing the mid-seventies, and the average restrictiveness of State laws
in effect has increased more than twofold between 1972 and 1985
(Table 1, Figure 3). As shown in Figure 1 and Table 1, the increase in
comprehensiveness of State laws occurred in two ways. The average
comprehensiveness of first laws in additional States increased, and
existing State smoking laws were replaced with more comprehensive
legislation.

Warner also documented that both the prevalence and comprehen-
siveness of State laws enacted through 1978 varied by geographic
region (Warner 1982). This has not changed (Table 3, Figure 2). Over
90 percent of the States in the Northeast and West have enacted at
least one law regulating smoking, as have three-fourths of the North
Central States. Southern States have fewer laws than other regions,
and the laws they have are less comprehensive than laws in other
‘regions. The six major tobacco-producing States, all located in the
South, have less restrictive laws than do the other six Southern

275