Tobacco Education Advocacy Members The Policy Leadership “TEAM” Approach For Creating and Protecting Smoke-Free Workplaces Including Bars and Restaurants

Dian Kiser, M.S., C.F.R.E., and Theresa Boschert, J.D.
BREATH-California’s Smoke-Free Bar Program
Sacramento, CA

Abstract

On January 1, 1998, California implemented the final phase of the California Smoke-Free Workplace Law, mandating that bars (both stand-alone bars and those attached to restaurants), along with casinos and bingo parlors become the newest workplaces to eliminate smoking indoors. With this final phase of the law in place, over 95% of California's workforce was now protected from environmental tobacco smoke (ETS) at work. After the first year, overall compliance rates were unexpectedly high at 85.7%. Yet, evidence still existed of less effective enforcement in some communities. Realizing that gaps in enforcement were closely tied to the will of local policy makers to enforce the law, BREATH--The California Smoke-Free Bar Program, a statewide project of the American Lung Association funded by the California Department of Health Services, initiated a grassroots policy leadership training program to recruit, create and train community Tobacco Education Advocacy Members (TEAM). The goal of the TEAM approach was to voice the broad public support for the smoke-free bar law by galvanizing existing tobacco control coalitions in each community into action and equipping them to advocate for full and effective enforcement. In addition to improving enforcement of the smoke-free workplace law in key communities around California, the relationships created between TEAM groups and policy leaders were subsequently used to advance other tobacco control issues including Attorney General Settlement requests, stronger local tobacco control ordinances and continued outreach to a full variety of policy leaders such as school board members, newspaper editors, law enforcement agencies and congressional members.

Diagnosing A Community’s Readiness

As part of the journey to smoke-free workplaces in California made during the decade from 1988 to 1998, Anne Klink and Dr. Carol D’Onorfrio developed a tool they called the “Social Will Index”. It was used to study “variations in local response to the state [smoke-free workplace] law”. In other words, it indicated which communities or regions were ready on their own to comply with the law and which ones needed assistance to activate the will to implement the law. Indicators of “social given community included factors such as 1) the existence of local tobacco control ordinances, 2) voting record of this community’s state legislators on tobacco measures and 3) popular votes on tobacco ballot issues. BREATH gratefully used the Index and the concept of “social will” to prioritize and customize advocacy on behalf of smoke-free bars in diverse communities around the state. We soon learned that community diagnosis was useful in virtually all tobacco control advocacy and indeed for advancing public health imperatives of many kinds.

A primary way to discover a community’s “social will” was to conduct a survey of elected policymaking bodies such as city councils, county commissions and state legislatures to understand their members’ positions on public health and rights issues. Making changes to public policy was a process of building. This analysis answered the question, “what have we got to build with?”. At the outset, community health advocates - such as volunteers for the American Lung Association, American Heart Association and American Cancer Society (also known as the tri-agencies) were asked by public health agency personnel to answer the following diagnostic questions:

- Who do you personally know among policy makers, community leaders, local media members?

- Where is the resistance to tobacco control policy, who is blocking public health progress in our community, region or state -- the chamber of commerce, the National Smokers Alliance (NSA)?

Beyond the “social will” index, tobacco control advocates, including local health department personnel, asked themselves: “Who are friends of public health - our potential allies? Have they formed coalitions? Specifically, do we have good relationships with non-profit health organizations like the tri-agencies and other health-related groups such as HMO's, health-conscious religious groups, state colleges and universities?”

When these questions were answered, health advocates made a list of allied groups and individuals, including supportive policy-makers, the voluntary health agencies and public health personnel where possible. This list was prioritized, based upon each player’s potential to help achieve change. Thus, Tobacco Education Advocacy Members (the TEAM) were initially identified. An equally important part of this initial step was identifying community media resources such as newspapers, cable television and radio that would be needed eventually to reach the public and policy makers. By diagnosing their community, tobacco control advocates identified the level of tobacco control action their community was ready for and how much tobacco control education was still needed to prepare it for action.

Assessing Social Will and Proceeding Through the Levels of Readiness

Once potential players were identified, existing local tobacco control measures, if any, were examined. For instance, had the community mandated smoke-free school grounds or taken steps to limit youth access to tobacco? Had it regulated cigarette vending machines, or self-service tobacco displays in retail stores? How about ETS in hospitals, clinics and government buildings, had this been addressed? Had it passed an ordinance or local regulation establishing smoke-free environments in private-sector offices or enclosed workplaces in general? Had this community attempted to remove ETS from restaurants and entertainment venues? The answers to each of these questions demonstrated an advancing level of “social will” to control tobacco use and second-hand smoke. A powerful tool to jump-start the process was conducting public opinion/public awareness polls to reveal what portion of the community at large was aware of the dangers of ETS and would support formal regulations to limit employees’ and patrons’ exposure to this environmental pollutant.

At the end of this two-to-three-month fact finding stage, health advocates now knew how policy makers and the public regarded the dangers of second-hand smoke and who their potential allies would be.

Assembling the TEAM

Over the next two months, advocates in each city, county or region, selected the most promising candidates from the list of potential allies and met with each of them separately to determine their interest and possible time/staff commitment. When five individuals or agency representatives were identified, a meeting of the group was scheduled. Generally, at least five committed individuals were needed to begin a TEAM. Although five is not a magic number for the recruitment and development of the TEAM, it was found to be a manageable group with potential for representing diverse talents and contacts. Most California counties had at least one existing tobacco control coalition as a result of prior work. But where they didn’t, the TEAM approach created one. At that first meeting, it was clearly and enthusiastically acknowledged that the TEAM mission was to change community, region or state health norms by creating smoke-free indoor air environments.

Training the TEAM.

TEAM members needed a working knowledge of environmental tobacco smoke or any other tobacco-related issues about which public policy was being developed in their community. To accomplish this, BREATH used training materials and videos such as "Witches Brew--Secondhand Smoke in the Work Place", produced by the American Heart Association or "Bar Profits--Up In Smoke?", produced by BREATH of the American Lung Association . The TEAM was taught to present its message in a straight forward, “three-good-points-are-enough” framework. They were urged to be politically savvy; in other words, to know when it was O.K. to compromise. Lastly, TEAMS were encouraged to be proactive and POSITIVE, POSITIVE, POSITIVE!!!

Eliminating the Mystique

To clear away the mystique surrounding public policy change and to make people comfortable speaking their minds and hearts to elected officials and local authorities, the following themes were embraced:

Selected Principals of Advocacy

--Look for friends in unusual places

--Don't be afraid to say "I don't know"

--Never lie to or mislead a policy maker

--Never promise anything you can’t deliver

--Do Not Grab Credit!

Practicalities of Advocacy

--Plan for enough lead time

--Provide sample materials for policy makers

--Always identify a contact person from your TEAM who can be

available to answer questions and provide clarification

--Be clear about tasks and communications with your TEAM

--Thank people! ... each other and policy makers.

Taking Action

The TEAM was now ready to begin taking the following action:

Conduct a poll. If it shows low public awareness about the dangers of second hand smoke, use it internally to guide your education campaign. If it reveals high public awareness and support for tobacco control measures, publicize it! In either case, use Letters to the Editor and your most supportive policy makers to speak on your behalf. In several communities, polls were paid for by non-profit health organizations like the tri-agencies and/or health maintenance organizations.

Meet with friendly City Council Members, County Commissioners or State and Federal Legislators or their staff members. Discuss your plans for tobacco control action, provide background material and samples, seek their suggestions, advice and help. If you are a state or federal employee, check on your agency’s guidelines for allowable educational activity.

Meet with the editorial board of the local newspaper. Find out if they are supportive or need more education on your issue. They look for topics that are of current concern to the community and welcome background information. Offer to write an Opinion-Editorial (op-ed) piece.

Send Letters to the Editor. The local newspaper is a great place to demonstrate an atmosphere of support for pro-health policies. Letters should be signed by your TEAM volunteers.

Utilize university students/interns. They can be helpful in conducting surveys and focus groups.

Three to six months of these kinds of activites are the foundation of your TEAM work and will place tobacco control issues squarely on your community, regional or state public health agenda.

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