Tag Archive for: tobacco prevention

Group of community advocates banning together

Creating a Prevention Campaign That Works

Lessons learned from tobacco control hold value for future efforts

In 1880, James Albert Bonsack filed a patent on an invention that would eventually pit industrial growth against public health.

Bonstack’s invention could roll hundreds of cigarettes a minute, revolutionizing the tobacco industry and creating a product that would see thousands of percentages of increases in use over just a few short decades.

Tobacco industrialists saw tremendous potential for profit in this new, portable and cheap cigarette. This signaled the beginning of what would become almost a century-long campaign to sell consumers a highly addictive, highly carcinogenic product. And it worked!

Over 100 years since Bonsack filed his original patent, communities everywhere are still subjected to the fallout of the “smoking boom” of the 1900s, and new smokers are created every day through products like flavored tobacco and e-cigarettes/vaporizers.

But all hope is not lost. In the decades since, public health professionals have advanced policy and enforcement measures around tobacco, and have learned important lessons in the process.

Many early attempts to create tobacco prevention campaigns framed much of the issue as one of personal choice. Most of those campaigns regarded the individual smoker as the important unit of change, believing that if you can change the thinking of an individual through education and appeals to reason, then you can halt a behavior in an entire population. However, we have since learned this narrow focus has a very limited effect.

Instead, modern prevention strategies have shifted the focus from individual knowledge, behavior and attitudes as the “unit of change” to acknowledging the role of policy, systems and “environmental factors” in shaping individual behavior. In this context, environmental factors include factors like the way a neighborhood is built, the types of businesses that exist there, the amenities and spaces available to residents and even transportation. In tobacco prevention, it also includes the devious marketing tactics of Big Tobacco.

When focusing on these environmental factors, modern prevention campaigns focus on influencing policy to produce community-level change. Democracy at any level, from the local city council all the way to state and federal jurisdictions, plays a role. Focusing on policy, rather than individuals, provides resources for enforcement and maintenance of policies.

Despite the understanding that smoking was already a population-level health hazard, smoking prevention in the 1970’s and 80’s approached it as an individual choice; something for people to stop doing on their own.

It wasn’t until studies began showing the effects of second and even thirdhand smoke exposure (especially on children) that conversations about prevention began to elevate on a national level. In 1990 the federal government instituted its ban on smoking in airplanes for U.S. domestic flights, a policy which expanded worldwide thereafter. In the early 2000s, many cities and local jurisdictions in the U.S. began implementing indoor smoking bans, and as of 2018 nearly 30 states had totally banned the smoking of cigarettes indoors. These broad policy changes reflect efforts at the federal, state and local levels by public health professionals and advocates to create evidence-informed changes that promote healthy decisions and reduce access and exposure to harmful substances like tobacco.

Even now, initiatives like IPS’ Smoke-Free Multi-Unit Housing (MUH) project aim to implement smoking restrictions in residential spaces where secondhand tobacco exposure can impact people’s health, with a goal to implement transformative, equitable policy strategies that keep residences free of harmful tobacco smoke and other carcinogens.

As prevention efforts continue to hone in on effective strategies, one element remains consistent: community. Involving community members and welcoming their input instantly elevates any campaign, and is absolutely vital to creating sustainable change after a campaign’s conclusion. Prevention professionals have learned that it is important to work with community members to develop a plan that meets them where they are, to create a shared language with residents that embraces policy and systems change, and to invest in the capacity of the communities so that residents can continue this important work.

Efforts to reduce smoking-related problems are far from over. Despite successes like California’s recent successful ballot measure that will ban flavored tobacco products, issues with nicotine and tobacco will persist. Youth access and second-hand exposure are likely issues that will take decades of work to address. However, through the efforts of dedicated public health professionals—and with a lot of patience—we can learn from our successes and failures to bring strong, coherent campaigns that truly influence population-level change.

Let’s not let those lessons go up in smoke.


IPS Expands Tobacco Prevention Efforts

Agency awarded two new grants from the Los Angeles County Department of Public Health

LOS ANGELES, December 2022 – The Institute for Public Strategies (IPS) announced it has been awarded two grants from the County of Los Angeles Department of Public Health to develop and implement comprehensive smoke-free policies for outdoor areas and in multi-unit housing. These grants from the Division of Chronic Disease and Injury Prevention, Tobacco Control and Prevention Program will be implemented in four cities within LA County – Whittier, Pico Rivera, Montebello, and Alhambra. Since 2020, IPS has also led a multi-unit housing tobacco prevention project in the City of Los Angeles.

“We are excited to expand our tobacco prevention work in LA with these initiatives, as we increase the wellbeing of residents in these additional communities,” IPS Director of Tobacco Programs Maurina Cintron said. “We will also rely on the help from community members to achieve these goals.”

One of the new contracts will focus on advancing policy solutions that address drifting secondhand smoke in outdoor communal areas in Montebello and Whittier. The primary focus will be on preventing smoking at bus stops, ticket lines, ATMs, taxi stands and within 25 feet of where smoking is currently outlawed. These areas will also include outdoor dining areas, public events like farmers markets, fairs, swap meets and concerts, recreational areas, golf courses, playgrounds, parks, sidewalks, parking lots, bike lanes, alleys and work sites. Smoking is defined as inhaling, exhaling or burning tobacco, cannabis or any other plant product including synthetics, whether by burning or vaping.

The second new contract will concentrate on policy solutions that prevent exposure to tobacco and cannabis smoke in multi-unit residences in Alhambra and Pico Rivera. In these two cities, IPS will help reduce and eliminate drifting secondhand and thirdhand smoke in individual units, balconies, patios, porches, decks, common areas, hallways and laundry rooms.

Smoking is the leading preventable cause of disease and disability in the United States, resulting in over 480,000 deaths each year, including deaths from secondhand smoke. In LA County, smoking causes one in every seven deaths, and approximately $4.3 billion dollars are lost due to smoking-related diseases and deaths each year. The leading causes of smoking related deaths are lung cancer, coronary heart disease (CHD) and chronic airway obstruction.

IPS works alongside communities to build power, challenge systems of inequity, protect health and improve quality of life. IPS has a vision for safe, secure, vibrant and healthy communities where everyone can thrive.

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Tobacco Prevention 2.0: Integrating Equity into Smoke-Free Multi-Unit Housing

Protecting the health and safety of everyone requires a new approach to policy

When it comes to housing vulnerable populations, tobacco prevention is essential. Tens of millions of Americans live in multi-unit housing (apartment buildings, condominiums, and other tightly-clustered living arrangements). A significant percentage of this housing is subsidized by the government.

Smoke-free building policies, which cover roughly one-third of multi-unit housing residences in the U.S., are intended to protect tenants from exposure to secondhand smoke, which can travel through open windows and under doors, seep in between shared walls, and blow through shared ventilation systems. Owners and managers of smoke-free housing also benefit from reduced fire risk and legal liability safeguards, lower maintenance costs, and maintenance of property value.

Research shows there is no level of safe exposure to secondhand smoke. In adults, health impacts range from mild nasal irritation to more severe health risks to the coronary, pulmonary, and reproductive systems.

In children, secondhand smoke can cause middle ear disease, compromise respiratory function, and even result in sudden infant death syndrome (SIDS). Secondhand smoke is also responsible for triggering asthma. About 1 in 20 children suffer from asthma, and of those, about 1 in 6 are treated at emergency departments or hospitalized, resulting in high medical bills, missed school (and work) days, and decreased quality of life.

The lack of policy around secondhand smoke is particularly harmful to children, people with lower income, people with less education, residents of rental and multi-unit housing, people who live with someone who smokes inside the home, and people in traditionally “blue collar” occupations. The Black population, in particular, is exposed to more secondhand smoke than other racial and ethnic groups. According to the Centers for Disease Control and Prevention:

As of June 2021, of the ten U.S. states with the highest proportion of Black residents, only three of those states have comprehensive smoke-free laws that prohibit smoking in all workplaces and public places. Of the seven states that do not have comprehensive laws, two also prevent local communities from adopting comprehensive smoke-free laws.

Smoke-free multi-unit housing policies have therefore been well-intentioned efforts to protect tenants from unwanted tobacco smoke. They have also, however, forced building managers to grapple with serious issues of equity: While it is not fair or right to expose tenants to someone else’s tobacco smoke, it is also ethically unsound to evict smokers with no other housing options available, particularly considering the U.S.’s current housing crisis.

Demand for housing that is in short supply for both homeowners and renters is sharply driving up the cost of homeownership and rent. The consequences are dire: billions of dollars in lost earnings, increased debt, overcrowded homeless shelters, more people living in their car or on the streets, and physical and emotional distress. It is neither a prudent public health nor ethical policy to force people out of their homes.

These dynamics have recently inspired a new take on smoke-free building policies. Cities in California, for example, have created equity-forward solutions that are less punitive toward the tenant while holding the HOA and/or landlord accountable for enforcing the policy before more extreme measures like tenant fines and eviction are implemented.

Berkeley’s Municipal Code 12.70 is one such example. Importantly, Berkeley’s policy is specifically framed to protect smokers, and eviction is not the preferred form of regulation and enforcement. Tenants who smoke are provided with adequate notice, education, access to comprehensive cessation resources, and reasonable accommodations.

Community groups advocating for smoke-free MUH policies, too, are adopting an equity-forward approach, ensuring affected tenants, and even smokers themselves, are involved in the process by sharing lived experiences, advising on policy details, and meeting with elected officials.

Solutions like the Smoke-Free Multi-Unit Housing Initiative are vital to preserving the health and well-being of tenants, property managers/owners, and community members without contributing to the housing insecurity crisis. The project advocates for eliminating extreme remedial measures such as massive fines or eviction in favor of a graduated, multi-step process that doesn’t shame or further threaten the health and well-being of smokers while also protecting non-smokers.

The tension between the needs and wants of smokers and non-smokers has plagued housing units for decades, and there are no easy solutions. These new, equity-forward approaches recognize the complexity of the problem and attempt to do a better job ensuring everybody – smokers and non-smokers alike – can live in housing that is healthy and safe.