To: in Tennessee with some exceptions (Tennessee Department

To: Senior Policy Maker

From: Shirley Kyere

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Subject: Tennessee’s Non-Smoker
Protection Act

Date: December 8, 2017

                                                                                                                                     

Policy Background

In 2007,
Tennessee, one of the largest tobacco-producing states in the United States,
endorsed the Non-Smoker Protection Act (NSPA), which banned smoking in enclosed
areas in Tennessee with some exceptions (Tennessee Department of Health, n.d.).

The law went into effect on June 11, 2007, and municipalities had to observe it
no later than October 1, 2007. This law is enforced by the Tennessee Department
of Health. 24.3%
of adults in Tennessee were current smokers, ranking the state fifth highest in
percentage of current smokers among the 50 states in 2006 (Bauer & Li,
2008). Smoking in public places was recognized as a public health problem by
Tennessee legislature which opened the policy window, and therefore, it enacted
this statute to provide Tennesseans a smoke-free environment to improve health
(University of Tennessee,
Institute for Public Service, n.d.).

The tools used in
the NSPA are funding, taxation, and requirement. The mechanisms used to promote
this new law include employers and business owners posting “no smoking” signs
at the entrances of employment spaces and at the entrances of every public
place. Customers who are seen smoking are to be notified that smoking is
prohibited on the site. Individuals with a first-time violation receive a
written warning, and a second and third violation within a year lead to a fine
of $100 and $500, respectively (Non-Smoker Protection Act, 2007). A $0.43 tax
increment was also placed on tobacco products, and a $10 million fund was put
in place to help end smoking (Langille, 2007).

In 1897, Tennessee
was one of the 12 states that banned the sale of cigarettes to the public as a way
of controlling tobacco usage. However,
in 1921, the tobacco prohibition was repealed in Tennessee because of opposing
stakeholders. Thus, prior to the NSPA, there was no existing restrictions on
smoking in public places in Tennessee. Therefore, Tennessee was one was one of
the first states that acknowledged tobacco use as public health issue that must
be tackled through policy interventions (Mamudu, Dadkar, Veeranki, & He,
2011). The purpose of this policy brief is to recommend whether the NSPA should
be maintained or repealed.

 

The Effects

Costs

Intended
costs—lowering of health care costs

Various studies have suggested
that implementing smoke-free laws can cause a decrease in the smoking
prevalence in a population (Centers for Disease Control CDC (n.d., b).

Raising taxes on tobacco products and implementing smoking cessation
legislation can reduce the prevalence of smoking by up to 80% over a 50-year period
(Ekpu & Brown, 2015). In 2009, NBC news stated that if Kansas, one
of the states considering banning smoking in enclosed areas, banned smoking in
restaurants, the state would save almost $20 million in health-care costs
(Associated Press, 2009).

Unintended
costs

In Tennessee, the percentage of
adults who smoke increased from 23% in 2011 to 24.3% in 2015. However,
Tennessee’s smoking ban was recently enacted, and this 1% increase is not very
significant considering the fact that it was over a period of only 4 years
(Fletcher, 2016). The annual health-care cost in Tennessee attributed to
smoking increased from $2.16 billion in 2004 to $2.67 billion in 2017
(Campaign for Tobacco-Free Kids (2017b). The increase in health-care costs could potentially be
due to the number of smokers who are getting treatment for tobacco-related
diseases such as lung cancer.

Population
health

Secondhand smoking
is a health threat that causes more than 41,000 deaths per year (CDC, n.d., b).

It is a cause of lung cancer, respiratory infections, and asthma in people of
all ages. The health of workers exposed to secondhand smoke at work is at
increased risk (CDC, n.d., b). A report from the US Surgeon General concluded
that between 1964 and 2014, 2.5 million people died from exposure to secondhand
smoke. In infants and children under 18 months, secondhand smoke is responsible
for 300,000 lower respiratory tract infections annually (Dunbar, Gotsis, &
Frishman, 2013). In 2010, a report by the Institute of Medicine stated that
there is a causal relationship between smoke-free policies and a decrease in
acute coronary diseases (CDC, n.d., b). In Minnesota, for instance, the cotinine
levels in urine among nonsmoker adults decreased by 80% within the first two
months of the state implementing a smoking ban in public places (CDC, n.d., b).

Interest Groups

Campaign for Healthy and
Responsible Tennessee (CHART)

CHART is an organization that
strives to improve the quality of life for all Tennesseans and lower health
costs by significantly minimizing the incidence of diseases caused by tobacco
use (Business Wire, n.d.; Mamudu et al., 2014). When the NSPA policy was
introduced, CHART used this opportunity to push for the law to be passed
because it was an opportunity to effectively lower the rate of tobacco-related
diseases. CHART conducted a survey in 2006 that showed 78% of the population
supported smoke-free environments and wanted policies made to require such
environments. The results of that survey helped pass the law (Mamudu et al.,
2014).

Tennessee Restaurant Association
(TRA)

In addition to the
smoke-free movements led by CHART, the involvement of the TRA was what shaped
legislators’ opinions. For years, the TRA resisted smoke-free policies because
they targeted only restaurants.

In 2007, when the NSPA bill was filed, the TRA board voted in support of it
because it included all workplaces and not solely restaurants. Another major
reason why the TRA supported the NSPA was that it focused on employees’ health
(Mamudu et al., 2014).

Philip Morris International
(PHICC) and R. J. Reynolds Cigarette Companies

These tobacco companies did not
try to derail the NSPA however, they relied on individual restaurants to get
exceptions to the law so that they were not put out of business. PHICC
continues to be one of the most influential tobacco companies in the United
States, and it was not in support of the smoke-free policy. PHICC thought
having strict restrictions on smoking areas would affect tobacco sales (Mamudu
et al., 2014). This was one of the intended effects of the law. Other tobacco
companies like R. J. Reynolds favored the law because it was certain the bill
was going to pass. However, it pushed to have some exemptions put into the bill
such as allowing individuals to smoke in private bars that are 21 and up (Mamudu
et al., 2014).

The Farm Bureau

The Farm Bureau,
the third largest tobacco producer in the country, did not state a position on
the NSPA policy because it focuses on smoking and health. Also, there was limited data to authenticate the negative effect
smoke-free policies had on tobacco production (Mamudu et al., 2014). The Farm Bureau was also
certain that the NSPA was going to pass because the bill was framed as an
employee and population health protection bill (Mamudu et al., 2014).

Media

Media advocacy can be used as an approach
to develop policy in tobacco control. Between the proposal of the policy in June
2006 and the enactment in June 2007, 40 out of 77 newspaper reports failed to
express opinions on the process, 36 supported the SFP, and 1 newspaper opposed it.

Thus, the media did not show strong support for SFP, however it did not oppose
it; it just reported the news. (Mamudu et al., 2014).

Recommended Actions

The
NSPA policy should be maintained because of the strong evidence studies have
shown suggesting that smoke-free policies can improve the health of a
population over a period of time (CDC, n.d., a). The NSPA should also be maintained because of
stakeholders’ strong support for the law as a result of its positive effects on
the health of the population.

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