Texas Case Study
Local Comprehensive Clean Indoor Air Ordinance in Texas
|Healthy People 2010 Objectives||Establish smoke-free indoor air laws that prohibit smoking or limit it to separately ventilated areas in public places and worksites in every state and the District of Columbia. Increase the proportion of worksites with formal smoking policies that prohibit smoking or limit it to separately ventilated areas. Reduce the proportion of nonsmokers exposed to environmental tobacco smoke (ETS).|
|OSH Indicator||Proportion of jurisdictions with public policies for smoke-free workplaces, including smoke-free restaurants, bars, and other public places.|
|Goals||Eliminate Exposure to Secondhand Smoke|
|Components||Community Policy and/or Program
|Areas of Policy and/or Program Intervention||Clean Indoor Air Policies
Policy/Program Objectives of the Intervention
Enact a comprehensive smoke-free ordinance covering workplaces and public places in the city of El Paso.
Description of the Intervention
The El Paso ordinance is designed to protect nonsmoking employees and patrons from the health effects of secondhand smoke in workplaces and public places. The ordinance covers all workplaces and public places, including restaurants, bars, bingo facilities, and bowling alleys.
Personnel/Key Players/Resources Required for Conducting the Intervention
The A Smoke-Free Paso del Norte Coalition includes a wide array of representatives from public agencies, voluntary health agencies, community-based and youth-serving organizations, and the faith community. Key members include the American Cancer Society (which provided the campaign coordinator) and the American Heart and American Lung Associations, Community Voices Tobacco Control Program (a project funded by the WK Kellogg Foundation and the American Legacy Foundation), the state and local health departments, local law enforcement, local hospitals and community clinics, Planned Parenthood, the Independent School Districts and the Region 19 Education Center, a coalition of churches, and faculty from the University Health Sciences Center. The Coalition also recruited people harmed by their exposure to secondhand smoke in public places and workplaces.
Place Where the Intervention was Conducted
El Paso, Texas, is the largest border city in the United States; on the other side of the Rio Grande River is El Paso's sister city, the booming metropolis of Ciudad Juarez, Mexico (fifth largest city in Mexico). With a population of 679,000, El Paso is the fifth largest city in Texas. It is a relatively poor city (10th poorest in the United States), with the highest percentage of residents without health insurance in the nation (37%). Seventy-eight percent (78%) of El Paso's residents are Hispanic/Latino.
The Fort Bliss Army base and the University of Texas at El Paso are two important institutions that play a large role in the life of the community.
In 1995, Las Cruces, New Mexico, passed a smoke-free workplace restaurant ordinance. Located 35 miles from El Paso, the Las Cruces ordinance created a supportive environment for smoke-free policies, further solidified when Las Cruces strengthened its ordinance again in 1997. The Tobacco-Free Las Cruces Coalition provided invaluable assistance to the El Paso Coalition as it began its own campaign.
Approximate Time Frame for Conducting the Intervention
The El Paso smoke-free ordinance effort began in November 1994, when the El Paso Tabaco/Smoke Free Coalition presented a proposal to strengthen the city smoking ordinance to the El Paso City-County Health and Environmental District. Although the Health and Environmental District approved the proposal, this initial ordinance campaign faltered in the City Council (Health and Environmental District policies must be approved by the City Council). In March of 1996 the City tabled the proposed ordinance indefinitely.
The coalition did not abandon its goal of passing a comprehensive smoke-free ordinance. With funding for a four year comprehensive tobacco control project from the Paso del Norte Health Foundation, the coalition formed as the A Smoke-Free Paso del Norte Coalition in April 2000. The coalition planned to organize a 2-year public education and grassroots campaign with the goal of passing an ordinance in 2003. However, the coalition's hand was forced when the El Paso City-County Health and Environmental District announced in September 2000 its intention to introduce an ordinance in October. The coalition prevailed upon the Health and Environmental District to slow the process down, to allow the coalition more time to educate and organize. The Health and Environmental District eventually held its public hearing in April of 2001, sending the ordinance to the city council for approval. After a preliminary discussion of the ordinance in April, the city council delayed formal action on the ordinance, because the city council election season began to heat up. The ordinance was passed after city elections, including a run-off for Mayor, on June 26, 2001. In all, the ordinance campaign took about 10 months.
Summary of Implementation of the Intervention
In November 2000, the coalition formed a Clean Indoor Air Ordinance Task Force to serve as the core team, responsible for day-to-day campaign operations (approximately 10 – 15 members). The Task Force spent a couple of months educating itself on secondhand smoke issues and city council politics. In the spring of 2001, Task Force members attended two trainings on organizing local ordinance campaigns. Based on their research and training learnings, the coalition developed a strategic plan to guide their campaign. Because of the short time frame, community education and grassroots mobilization activities were virtually simultaneous.
Task Force members made community presentations to educate the public and recruit new supporters, and identified a strong champion on the city council. The Task Force developed a youth smoke-free coalition, whose efforts were deemed vital to the success of the ordinance. Youth were recruited via the independent school districts.
Grassroots activities included a letter writing campaign to the El Paso Times (more than 7,000 letters were sent), a petition gathering effort, multiple meetings with City Council members, and (once the election season was in motion) attending candidate forums. The coalition also conducted a proactive media advocacy campaign, including a youth rally the day of the council's vote. The coalition produced an educational TV spot on secondhand smoke, and ran one paid print lobbying advertisement shortly before the vote. Although the coalition had planned to conduct a poll, this was rendered moot when the local media (the El Paso Times and the ABC affiliate) ran their own poll.
On June 26, 2001, the El Paso City Council voted 7 to 1 in support of the proposed ordinance.
After the ordinance passed, the coalition worked with the Health and Environmental District to develop an educational packet to be sent to 18,000 El Paso businesses.
Summary of Evaluation/Outcome of Intervention
In February 2002, one month after the ordinance went into effect, the El Paso Times and the ABC affiliate (KVIA) sponsored an opinion poll. The poll found solid support for the new ordinance; 93 percent indicated that they would go out to restaurants and bars the same (49%) or more (44%) as a result of the ordinance.
In December 2002, 11 months after the ordinance went into effect, the Paso del Norte Health Foundation sponsored a household telephone survey which also found strong support for the ordinance; after a full year of implementation 78.5 percent indicated they supported the ordinance, and only 10.9 percent opposed it (the rest reported no opinion). Although general knowledge about the existence of the ordinance was high, familiarity with the specifics was spotty.
In March 2003, the mayor's office conducted an analysis of the economic impact of the ordinance on the city's hospitality industry, using sales tax receipts reported to the Texas State Comptroller and Texas Workforce Commission data. Data for the first two quarters of 2002 indicated that total sales subject to state sales tax in eating and drinking establishments continued to grow at a steady pace compared to that period in previous years (despite a sluggish national economy). The number of persons employed as waiters or waitresses also increased by 300 people, from 2001 to 2002 (Texas Workforce Commission).
Intervention's Applicability/Replicability/Recommendations for Other Sites
The El Paso campaign is an excellent example of a grassroots campaign. It relied on direct organizing to identify, recruit and mobilize supporters, and involved relatively little paid media or paid advocacy efforts. The broad lessons from this campaign are transferable to other communities. In addition, the El Paso Coalition serves as a model for developing a diverse, representative coalition in a predominantly Mexican American community.
The only caution to coalitions considering the El Paso experience is that the time frame to educate the community and organize grassroots support was considerably compressed because of factors outside the coalition's control. Ideally, coalitions will have more time to educate the public and decision makers, and recruit and mobilize grassroots supporters.
This case study was written by Robin Hobart, an Office on Smoking and Health Consultant, in November of 2003.
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