To: Senior Policy MakerFrom: Shirley KyereSubject: Tennessee’s Non-SmokerProtection ActDate: December 8, 2017 Policy BackgroundIn 2007,Tennessee, one of the largest tobacco-producing states in the United States,endorsed the Non-Smoker Protection Act (NSPA), which banned smoking in enclosedareas 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 itno later than October 1, 2007. This law is enforced by the Tennessee Departmentof Health. 24.
3%of adults in Tennessee were current smokers, ranking the state fifth highest inpercentage of current smokers among the 50 states in 2006 (Bauer & Li,2008). Smoking in public places was recognized as a public health problem byTennessee legislature which opened the policy window, and therefore, it enactedthis statute to provide Tennesseans a smoke-free environment to improve health(University of Tennessee,Institute for Public Service, n.d.).The tools used inthe NSPA are funding, taxation, and requirement.
The mechanisms used to promotethis new law include employers and business owners posting “no smoking” signsat the entrances of employment spaces and at the entrances of every publicplace. Customers who are seen smoking are to be notified that smoking isprohibited on the site. Individuals with a first-time violation receive awritten warning, and a second and third violation within a year lead to a fineof $100 and $500, respectively (Non-Smoker Protection Act, 2007). A $0.43 taxincrement was also placed on tobacco products, and a $10 million fund was putin place to help end smoking (Langille, 2007). In 1897, Tennesseewas one of the 12 states that banned the sale of cigarettes to the public as a wayof controlling tobacco usage. However,in 1921, the tobacco prohibition was repealed in Tennessee because of opposingstakeholders. Thus, prior to the NSPA, there was no existing restrictions onsmoking in public places in Tennessee.
Therefore, Tennessee was one was one ofthe first states that acknowledged tobacco use as public health issue that mustbe tackled through policy interventions (Mamudu, Dadkar, Veeranki, & He,2011). The purpose of this policy brief is to recommend whether the NSPA shouldbe maintained or repealed. The EffectsCostsIntendedcosts—lowering of health care costsVarious studies have suggestedthat implementing smoke-free laws can cause a decrease in the smokingprevalence in a population (Centers for Disease Control CDC (n.d., b).Raising taxes on tobacco products and implementing smoking cessationlegislation 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, oneof the states considering banning smoking in enclosed areas, banned smoking inrestaurants, the state would save almost $20 million in health-care costs(Associated Press, 2009). Unintendedcosts In Tennessee, the percentage ofadults 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 verysignificant considering the fact that it was over a period of only 4 years(Fletcher, 2016). The annual health-care cost in Tennessee attributed tosmoking 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 bedue to the number of smokers who are getting treatment for tobacco-relateddiseases such as lung cancer.PopulationhealthSecondhand smokingis 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 ofall ages. The health of workers exposed to secondhand smoke at work is atincreased risk (CDC, n.d., b). A report from the US Surgeon General concludedthat between 1964 and 2014, 2.5 million people died from exposure to secondhandsmoke.
In infants and children under 18 months, secondhand smoke is responsiblefor 300,000 lower respiratory tract infections annually (Dunbar, Gotsis, &Frishman, 2013). In 2010, a report by the Institute of Medicine stated thatthere is a causal relationship between smoke-free policies and a decrease inacute coronary diseases (CDC, n.d., b). In Minnesota, for instance, the cotininelevels in urine among nonsmoker adults decreased by 80% within the first twomonths of the state implementing a smoking ban in public places (CDC, n.
d., b).Interest GroupsCampaign for Healthy andResponsible Tennessee (CHART)CHART is an organization thatstrives to improve the quality of life for all Tennesseans and lower healthcosts by significantly minimizing the incidence of diseases caused by tobaccouse (Business Wire, n.d.
; Mamudu et al., 2014). When the NSPA policy wasintroduced, CHART used this opportunity to push for the law to be passedbecause it was an opportunity to effectively lower the rate of tobacco-relateddiseases. CHART conducted a survey in 2006 that showed 78% of the populationsupported smoke-free environments and wanted policies made to require suchenvironments. The results of that survey helped pass the law (Mamudu et al.,2014).Tennessee Restaurant Association(TRA)In addition to thesmoke-free movements led by CHART, the involvement of the TRA was what shapedlegislators’ opinions.
For years, the TRA resisted smoke-free policies becausethey targeted only restaurants.In 2007, when the NSPA bill was filed, the TRA board voted in support of itbecause it included all workplaces and not solely restaurants. Another majorreason 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 CompaniesThese tobacco companies did nottry to derail the NSPA however, they relied on individual restaurants to getexceptions to the law so that they were not put out of business. PHICCcontinues to be one of the most influential tobacco companies in the UnitedStates, and it was not in support of the smoke-free policy.
PHICC thoughthaving strict restrictions on smoking areas would affect tobacco sales (Mamuduet al., 2014). This was one of the intended effects of the law. Other tobaccocompanies like R. J.
Reynolds favored the law because it was certain the billwas going to pass. However, it pushed to have some exemptions put into the billsuch as allowing individuals to smoke in private bars that are 21 and up (Mamuduet al., 2014).
The Farm BureauThe Farm Bureau,the third largest tobacco producer in the country, did not state a position onthe NSPA policy because it focuses on smoking and health. Also, there was limited data to authenticate the negative effectsmoke-free policies had on tobacco production (Mamudu et al., 2014).
The Farm Bureau was alsocertain that the NSPA was going to pass because the bill was framed as anemployee and population health protection bill (Mamudu et al., 2014).MediaMedia advocacy can be used as an approachto develop policy in tobacco control. Between the proposal of the policy in June2006 and the enactment in June 2007, 40 out of 77 newspaper reports failed toexpress 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 opposeit; it just reported the news.
(Mamudu et al., 2014).Recommended ActionsTheNSPA policy should be maintained because of the strong evidence studies haveshown suggesting that smoke-free policies can improve the health of apopulation over a period of time (CDC, n.d., a).
The NSPA should also be maintained because ofstakeholders’ strong support for the law as a result of its positive effects onthe health of the population.