If we want more evidence-based practice, we need more practice-based evidence.*


If we want more evidence-based practice, we need more practice-based evidence.*


APPENDIX A: TOBACCO CONTROL [Under reconstruction]

This Appendix follows a single issue, tobacco control, through the phases of the Precede-Proceed Model, corresponding to the first 7 chapters. It also contains current applications of tobacco research, planning, implementation, and evaluation in each of the settings corresponding to Chapters 8-12. The purpose of this appendix is to permit the user to examine aspects of a single issue from all angles related to the Precede-Proceed model.

Chapter 1 - Health Promotion and a Framework for Planning

Chapter 2 - Social Assessment and Participation

Chapter 3 - Epidemiological Assessment

Chapter 4 - Behavioral and Environmental Assessment

Chapter 5 - Educational and Ecological Assessment

Chapter 6 - Administrative and Policy Assesssment

Chapter 7 - Evaluation and the Accountable Practitioner

Chapter 8 - Applications in Community Settings

Chapter 9 - Applications in Occupational Settings

Chapter 10 - Applications in School Settings

Chapter 11 - Applications in Health-Care Settings

Chapter 12 - Applications in New Technology



Hong Kong children rate smoking as most revolting of parents' acts (Hong Kong Council on Smoking and Health, June 20, 1999) - According to the findings of a student survey released on the Father's Day, 20 June 1999, "smoking" was rated top of the list of disliked acts the children in Hong Kong would expect from their parents. They survey, conducted by the Hong Kong Federation of Youth Groups in this May, interviewed 1,311 Primary 4 to Secondary 3 students (age between 9-15) in 12 schools. The respondents were asked to choose the top 10 acts they liked and disliked most from a list of 30.
The top 10 most disliked acts, as rated by the children, are:
1. Smoking (58.9%)
2. scolding over a minor mistake (56.3%)
3. use of violence (54.9%)
4. bullying, being unreasonable (51.9%)
5. comparing them with others (47.8%)
6. hiring sex services (45.2%)
7. having extra-marital relations (43.8%)
8. imposing too many restrictions on them (41.3%)
9. intruding into their private affairs (41.3%)
10. not keeping their promises (40.4%)

Britain To Ban Most Tobacco Ads
Tobacco advertisements will be banned from all billboards, newspapers and magazines in Britain beginning December 10, 1999, according to the country's Department of Health. The new rule will take effect 18 months before a similar European Union ban is implemented. In addition to banning tobacco ads, the department's goal is to phase out the vast majority of tobacco sponsorships by 2003. The extension of three years was given to global sports such as Formula One racing, snooker, darts and perhaps fishing, provided they reduce tobacco sponsorship and advertising by one-fifth in each year of the extension. These sports were cited as having to rely heavily on tobacco funds in order to remain in existence. The tobacco industry claimed the new ban will result in thousands of lost jobs. Clive Bates, director of Action on Smoking and Health, said, "If the cigarette companies are unhappy then we can be sure that it is a good day for long life and healthy living."
    (Sources: Lucy Fardon, "British Agency To Ban Majority Of Tobacco Ads," WALL STREET JOURNAL, June 18, 1999, p. A19 <http://www.wsj.com>; Edna Fernandes, "UK Moves To Stub Out Tobacco Advertising," REUTERS, June 17, 1999; Alan Cowell, "Tobacco Ads Banned," NEW YORK TIMES, June 18, 1999, p. C3 http://www.nyt.com .)

Knighthoods for cancer pioneers. (LONDON, Ian Murray, Times writer). A leading cancer researcher received a knighthoods. One is Professor Richard Peto, who worked closely with Sir Richard Doll on showing the link between tobacco and lung cancer. He has since devised a series of statistical methods that are in use worldwide to analyze randomized clinical trials and he was closely involved in setting up the worldwide trials that showed the benefits of breast cancer treatments, including tamoxifen. Professor Peto, director of the Imperial Cancer Research Fund clinical trial unit at Oxford University, once said: "Smoking kills as many people a year in the UK as a jumbo jet crashing every day of the year killing all the passengers."

The following item illustrate the impact of policies aimed at restricting manufacturers' use of advertising media channels:
    Consumers can expect to see more high-end direct mail as a result of tobacco giants' narrowing advertising options
(New York, DM News, May 3, 1999, Volume 21, No. 17, The Weekly Newspaper of Record for Direct Marketers, by Grant Lukenbill). American cigarette manufacturers have begun direct mail efforts and sophisticated database management as they find themselves weaned from the general advertising marketplace. After a nationwide ban on outdoor billboards for smoking-related products took effect last month, and as the firms face growing resistance from newspapers and magazines, they are left with little choice.
    Steve Kottack, a spokesman for Brown and Williamson, said the company will expand its direct mail and will place its toll-free number on all packages so consumers can contact the company with questions. Kottack said the company will focus on "building a database of consumers [it] can communicate with."
    Brendan McCormick, a spokesman for Philip Morris, told DM News that direct mail will definitely be increased for the company's products. "Direct mail is one of the options open us, including direct marketing through event sponsorship." McCormick would not disclose the amount of money going into current direct mail campaigns, but according to a direct marketing specialist in New York, many of the pieces of direct mail that tobacco companies are beginning to mail cost more than $1 each and may be as high as $2 for packages with tipped-on on coupons and multiple insertions. Both companies are sending out their mailings this month, but neither would reveal specifics of their campaigns.
    According to Priya Narang, senior vice president and media director at Dewitt Media, New York, it's difficult for the companies. "Building awareness and growing a market by trying to reach out to a young audience through direct mail alone is very hard," she said.
    The move toward direct mail comes at a time when general advertising is closing its doors. Last week, the New York Times joined a growing list of major publications and announced it will no longer accept tobacco advertising as of May 1.
    Some analysts suggest that the Times' announcement could only mean one thing: Most other newspaper publishers will follow suit, ultimately leaving tobacco companies with only glossy magazines to turn to as their key venue for marketplace messaging.
    And some analysts say that increased tobacco advertising in magazines will likely be short term. Many publishers are now facing increased scrutiny by anti-smoking activists who are already taking a hard look at circulation audit reports for indications of young adult readers. And though magazine publishers are not legally required to refuse tobacco advertising, the eventual erosion of that venue, as any astute direct marketing analyst knows, leaves only one logical alternative: direct mail.
    But Martin Feldman, a tobacco analyst at Salomon Smith Barney, New York, said in published reports that he believed the decision by the New York Times to ban cigarette advertising would have no effect on the rest of the industry. "I don't see cigarette advertising in newspapers particularly meaningful anyhow," he said. "But the tobacco companies will go there because they have too few options," Narang said.

    Last November, 46 states settled the cases they had filed against the tobacco companies. When the states filed suit against the tobacco companies, elected officials from each of the states said that they were doing so to prevent another generation of children from becoming addicted to tobacco and to reduce the amount of money their citizens were spending to treat tobacco-caused disease.
When the states settled their cases, they promised that the settlement was just the first step in their efforts to reduce tobacco use, particularly among children. Through their Attorneys General, the states pledged that the funds from the settlement created an historic opportunity to use the tobacco companies own money to reduce tobacco use, even though the agreement they had just signed did not dictate how to spend the money.
    In mid-1999, the state legislatures are debating the best use of the settlement funds. While many state legislatures are still in session and others have deferred action on how to spend the settlement money until next year, it is not too early to draw some preliminary conclusions. If current trends continue, the vast majority of the states will spend little or none of the tobacco settlement money on programs intended to prevent children from starting to smoke or on helping current tobacco users to quit. Without the extraordinary efforts of tobacco control advocates and key public officials, the results would be even worse.
    To find out more about how your state plans to use the settlement money or for more general information visit: http://tobaccofreekids.org/reports/settlements/.

A news item about renovation of a pagoda in Myanmar (formerly Burma) provides an example of cigarettes being offered to deities and holy statues. Is this a ploy of the tobacco companies moving into developing countries, or is it a simple mistaken historical connection? Obviously a 17th century monk in Myanmar could not have been a cigarette smoker. YANGON, Myanmar (June 13, 1999). http://www.nandotimes.com ). Layman Min Gyi mans a shrine dedicated to a 17th century holy man. For a fee of 200 kyats (60 cents), he lights a cigarette and holds it to the statue's lips, reciting prayers to bring good luck.


    Journal References

Glantz, S. A., & Charlesworth, A. (1999). Tourism and hotel revenues before and after passage of smoke-free restaurant ordinances. JAMA – JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 281: 1911-1918.
    ABSTRACT: http://jama.ama-assn.org/issues/v281n20/abs/joc81586.html.

    Books and Reviews

Smoking increases fire mortality. A common scenario is of elderly, debilitated, sometimes bed-bound persons accidentally igniting themselves and/or innocent bystanders with cigarette or cigarette lighter ignited fires. Much of US, and probably, increasingly China, fire mortality is made up of the elderly burned in cigarette smoking fires. Much of that data is at FIRE IN THE UNITED STATES 1985 - 1994 (NINTH EDITION)  http://www.nfpa.org .

    Other References

Green, L.W., Frankish, C.J., McGowan, P., Ratner, P., Bottorff, J., Lovato, C.Y., Shoveller, J., Johnson, J., Williamson, D. (1999). SMOKING CESSATION: A SYNTHESIS OF THE LITERATURE ON PROGRAM EFFECTIVENESS. Vancouver: University of British Columbia, Institute of Health Promotion Research, for the BC Ministry of Health.
    A systematic review of the research literature on smoking cessation.

The US Department of Agriculture's Tobacco: World Markets and Trade (FT-8-98, August 1998) and the Wordwatch Institute (Lester Brown et al. Vital Signs 1999, Worldwatch Institute. New York: Norton, 1999) published the following estimates for world cigarette production:
1950 - 1,686 billion cigarettes
1960 - 2,150 billion
1970 - 3,112 billion
1980 - 4,388 billion
1990 - 5,419 billion
1991 - 5,351 billion
1992 - 5,363 billion
1993 - 5,300 billion
1994 - 5,478 billion
1995 - 5,599 billion
1996 - 5,681 billion peak
1997 - 5,643 billion
1998 - 5,609 billion
1999 - 5,797 billion projected
2000 - 5,859 billion projected
2004 - 6,102 billion projected
    The recent decrease from 5,681 billion to 5,609 billion cigarettes is probably not a downward trend. The production decreased in the period 1990-1993 from 5,419 to 5,300 billion but increased to 5,478 billion in 1994. It seems difficult to explain these changes. They have nearly as much to do with inventory as with consumption. The reality is that the production of cigarettes was only 2,150 billion cigarettes in 1960 and that the US department of agriculture predicts that the world production of cigarettes will be more than 6,000 billion cigarettes in 2003. In other words, the industry is selling more cigarettes world-wide. In 1998 the world population was 5.919 billion meaning that each man, woman, child and baby in the world consumed an average of 2.6 cigarettes per day. The world population has increased by 1 billion over the lifetime of today's 14-year olds - that means the tobacco companies have a large, fresh market of kids in the pipeline ready to become the 'young adults' whom the industry is so fond of exploiting. Cigarette production in China is down from 1.74 trillion (nearly a third of the world production) in 1995 (peak) to 1.68 trillion in 1998. But some of this decline is attributed to the growth of illegal production and sale of cigarettes in China. US cigarette consumption has dropped from 2,940 per person in 1981 to 1,739 per person in 1998 - a drop of 41%. As well as reduced smoking in the US, exports are in decline too – total production was down from 758 million in 1996 to 716 million in1998 – a 6% decline.

The Alberta Tobacco Control Centre has completed a publication entitled, "The economic impact of smoke-free restaurant bylaws." This resource binder brings together all relevant and available published research on the effects of smoke-free bylaws on the economic effects of smoke-free ordinances on restaurant business, as well as several items of cited background literature. It is divided into four sections:
- Journal Articles (18 items);
- Editorials/Opinion Pieces (2 items);
- Reports/Monographs (7 items); and
- Cited Secondary Literature (9 items).
A summary of the compilation in PDF format is available on the ATCC website, at http://www.tobaccocentre.ab.ca/publications/binders , as well as similar summaries for two other ATCC publications on workplace and youth issues.


Tobacco Law Compendium - http://www.tobaccolaw.org - A comprehensive site for all Canadian tobacco control legislation from local, provincial and federal levels of government.

Calculations by Susan Lantos of toxic emissions from cigarettes (sidestream only – not including mainstream) from the over 50 billion cigarettes smoked per year in Canada and compared to major industrial polluters. The full list and explanation is available in PDF format at http://www.smoke-free.ca/factsheets/Chemicals.htm. These calculations were made possible because of new regulations by the government of British Columbia which forced tobacco companies to test and report emissions from the leading Canadian cigarette brands.

Status of smoking bans on international flights, June 1999.
    Japan, one of the last countries to resist the bans, has banned smoking on all of its domestic and international flights. In the USA, smoking has been banned on all domestic and international flights, as well. Now that Tower Air, the last hold out announced smoking bans on all its flights, some 95 percent of all international passenger flights are now smoke-free and it now appears realistic to expect a complete ban world-wide. Some up-to-date statistics on the status of the implementation of the International Civil Aviation Organization (ICAO) Resolution:

CDC's Office on Smoking and Health announced in June 1999 that its STATE System (State Tobacco Activities Tracking and Evaluation System) is now active on the internet. This system has been years in development and is a one-stop electronic source for state-specific tobacco data. Go to: http://www2.cdc.gov/nccdphp/osh/state/


Chapter 1 - Health Promotion and a Framework for Planning


Koh, H. K. (1999). The End of the "Tobacco and Cancer" Century. JOURNAL OF NATIONAL CANCER INSTITUTE 91: 660-661.
    FULL-TEXT: http://jncicancerspectrum.oupjournals.org/cgi/content/full/jnic;91/8/660

Wingo, P. A., Ries, L. A. G., Giovino, G. A., Miller, D. S., Rosenberg, H. M., Shopland, D. R., Thun, M. J., & Edwards, B. K. (1999). Annual Report to the Nation on the Status of Cancer, 1973-1996, With a Special Section on Lung Cancer and Tobacco. JOURNAL OF NATIONAL CANCER INSTITUTE 91: 675-690.

Ecological Approach and Best Practices Applied in Tobacco Control

1-3 Powerful role played by the ecosystem and its subsystems (such as family, organizations, community, culture, and physical environment): Goodman, Wandersman, Chinman, Imm, & Morrisey, 1996; Institute of Medicine, 2003; Karpati, Galea, Awerbuch, & Levins, 2002; Kickbusch, 1989; McLeroy, Bibeau, Steckler, & Glanz, 1988; Powell, Mercy, Crosby, Dahlberg, & Simon, 1999; Rainey & Carson, 2001; Richard, Gauvin, Potvin, Denis, Kishchuk, 2002; Simons-Morton, B., Brink, Simons-Morton, et al., 1989.

Institute of Medicine (2003). The Future of Public Health in the 21st Century. Washington, DC: The National Academy Press.

Karpati, A., Galea, S., Awerbuch, T., & Levins, R. (2002). Variability and vulnerability at the ecological level: Implications for understanding the social determinants of health. American Journal of Public Health 92, 1768-1772.

Powell, K. E., Mercy, J. A., Crosby, A. E., Dahlberg, L. L. and Simon, T. R. (1999) Public health models of violence and violence prevention. Encyclopaedia of Violence, Peace and Conflict. Vol 3. Academic Press, Washington, DC.

Rainey CJ, Carson KL (2001). Nutrition interventions for low-income, elderly women. American Journal of Health Behavior, 25, 245-51.

Richard L, Gauvin L, Potvin L, Denis JL, Kishchuk N (2002). Making youth tobacco control programs more ecological: organizational and professional profiles. American Journal of Health Promotion, 16, 267-79

1-12 Example of drawing on "best practices" from previous research and statewide experiences

Centers for Disease Control and Prevention, Best Practices for Comprehensive Tobacco Control Programs - August 1999. Atlanta, GA:  U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, August 1999.

1-13 Limitations of, and possibilities for "best practices" when applied in different populations

Green, L.W. (2001). From research to “best practices” in other settings and populations (Research Laureate address). American Journal of Health Behavior 25:165-178. Full text online at http://www.ajhb.org/2001/number3/25-3-2.htm.

Applications of the PRECEDE-PROCEED Model in tobacco control

1-25 Applications of the Model in developing or reviewing national policies in health promotion and disease prevention. Mercer et al., 2003.

Mercer, S. L., Green, L. W., Rosenthal, A. C., Husten, C. G., Khan, L. K., Dietz, W. H. (2003). Possible lessons from the tobacco experience for obesity control. American Journal of Clinical Nutrition, 77 (4): 1073S-1082S Suppl. S Apr.


Chapter 2 - Social Assessment and Participation

Values as they determine national preferences and debates on health issues such as tobacco:

Cohen, J.E., de Guia, N.A., Ashley, M.J., Ferrence, R., Northrup, D.A., Studlar D.T. (2002). Predictors of Canadian legislators' support for tobacco control policies. Social Science & Medicine 55: 1069-1076.

Cohen JE, de Guia NA, Ashley MJ, Ferrence R, Studlar DT, Northrup DA. (2001). Predictors of Canadian legislators' support for public health policy interventions. Canadian Journal of Public Health 92: 188-189.

Pertchuck, M. (2000). Smoke in their eyes: Lessons in movement leadership from the tobacco wars.  Nashville: Vanderbilt University Press.

Studlar, D.T. (2002). Tobacco Control: Comparative Politics in the United States and Canada. New York: Broadview.

Values expressed in preferences and economics of smoke-free restaurants:

Oct 20, 2003.  ZAGAT Survey Finds Smokefree Air Popular With Diners
96% of restaurant goers eating out the same amount or more often

A new Zagat survey of 29,361 diners finds that 96% are eating out the same
amount or more often as a result of New York's smokefree restaurant law.
Specifically, 23% said they were eating out more often because of the law.
73% said they were eating out the same.  Only 4% said they were eating out
less often.
"The Zagat survey, like those done by Global Strategy, Zogby International,
and Quinnipiac University, shows that the vast majority of New Yorkers
prefer smokefree dining," says Joe Cherner, Founder of BREATHE-- Bar and
Restaurant Employees Advocating Together for a Healthy Environment.  "Most
diners simply don't want to breathe dirty air while they are eating."
In other Zagat findings, restaurant openings outnumbered closings by nearly
2-1, with 174 new restaurants opening and 91 closing.  "The number of major
openings occurring now and scheduled for early next year is amazing," said
Tim Zagat, who publishes the survey with his wife, Nina.
Tobacco interests still claim that New York's smokefree workplace law is
killing business, causing layoffs, and destroying New York's economy,
despite all of the surveys and data showing an increase in employment,
food/beverage sales, and tourism.  "Tobacco interests have lied, lie, and
will always lie," adds Cherner.  "Fortunately, fewer and fewer people
believe them."

Chapter 3 - Epidemiological Assessment

Breast Cancer Victims More Likely to Die if They Smoke
Women who smoke are 2.5 times more likely to die from their breast cancer
Excerpted from a press release by the American Society for Therapeutic
Radiology and Oncology

WASHINGTON, Oct. 20, 2003 /U.S. Newswire/ -- For women undergoing treatment for
early breast cancer, those who smoke are more than twice as likely to die
from their cancer than others, according to a new study presented today at
the Annual Meeting of the American Society for Therapeutic Radiology and
Oncology, the largest radiation oncology society in the world.

The study, the first to examine the effect of smoking on long-term outcomes
of breast cancer patients treated with conservative surgery and radiation,
finds that women who continue to smoke during therapy are 2.5 times more
likely to die from the cancer than are women with no smoking history.

The study examined 1,039 non-smokers and 861 smokers from March 1970 to
December 2002 who underwent conservation therapy for breast cancer. The
median follow-up of the patients was 65 months. Local control, distant
metastases, deaths from breast cancer and overall survival were compared.

"Even after we adjusted for different prognostic factors, those who
continued to smoke during treatment did not live as long," said Dr. Khahn
Nguyen. "Our study suggests that smoking cessation remains an integral
component in the comprehensive management of breast cancer."

Chapter 4 - Behavioral and Environmental Assessment

Boffetta, P., Pershagen, G., Jockel, K. H., Forastiere, F., Gaborieau, V., Heinrich, J., Jahn, i., Kreuzer, M., Merletti, F., Nyberg, F., Rosch, F., & Simonato, L. (1999). Cigar and Pipe Smoking and Lung Cancer Risk: a Multicenter Study From Europe. JOURNAL OF NATIONAL CANCER INSTITUTE 91: 697-701.

Frisch, M., Glimelius, B., Wohlfahrt, J., Adami, H-O., Melbye, M. (1999). Tobacco Smoking as a Risk Factor in Anal Carcinoma: an Antiestrogenic Mechanism? JOURNAL OF NATIONAL CANCER INSTITUTE 91: 708-715.

Lam, S., leRiche, J. C., Zheng, Y., Coldman, A., MacAulay, C., Hawk, E., Kelloff, G., & Gazdar, A. F. (1999). Sex-Related Differences in Bronchial Epithelial Changes Associated With Tobacco Smoking. JOURNAL OF NATIONAL CANCER INSTITUTE 91: 691-696.

The British Columbia Ministry of Health required tobacco companies to provide the chemical ingredients of their cigarettes. The Ministry released its "Reports on Cigarette Additives and Ingredients and Smoke Constituents" on December 16, 1998.
    The release of the reports on smoke chemistry will assist in better understanding how cigarette smoke harms those who smoke and those who breathe second-hand smoke. Knowing the levels of specific compounds that are released in cigarette smoke will also aid in developing an understanding of how cigarette smoke and other pollution sources combine to harm human health. As the first jurisdiction in the world to require tobacco companies to both reveal the additives and ingredients in each brand of cigarettes, and to provide a detailed chemical analysis of the smoke of each brand of cigarettes, the BC Ministry acted on the strength of a law passed by the BC legislature. See: http://www.legis.gov.bc.ca/bills/3rd_read/gov28-3.htm
    For additional chemical detail and the hidden ingredients of tobacco, see the American Council on Science and Health (ASCH) book, CIGARETTES: What The Warning Label Doesn't Tell You, at: http://www.pbs.org/wgbh/nova/cigarette/anatomy.html 


Chapter 5 - Educational and Ecological Assessment


Chapter 6 - Administrative and Policy Assesssment

The jury in the world's first class action against the tobacco industry has returned a GUILTY verdict on July 7, 1999. Damages at over $200 billion are expected. See http://www.tobacco.neu.edu/

Givel, M. S., & Glantz, S. A.  (1999, July).  TOBACCO INDUSTRY POLITICAL POWER AND INFLUENCE IN FLORIDA FROM 1979 TO 1999.   Institute for Health Policy Studies, School of Medicine, University of California, San Francisco.
    The report is available at: http://www.library.ucsf.edu/tobacco/fl/

The Union Internationale Contra Cancer (UICC) released in July 1999 the 2nd UICC Cancer Management Meeting - The Team Approach to Cancer Management 14-18 April 1999, Antwerp, Belgium. It includes a session: "The Tobaccogate" 16 April 1999, co-chaired by Nigel Gray of Melbourne, Australia, and Greg Connolly of Boston, USA. Contents of the session include an interview and summary of Greg Connolly's (Massachusetts State Tobacco Control Program) remarks, prepared by N. Gray, "The way forward in Europe. What next?" by Albert Hirsch of Paris, "Global smuggling as a global problem" L. Joossens of the Netherlands, and "Regulation of tobacco smoke" by N. Gray.
    Go to: http://www3.uicc.org/publ/antwerp/tobacco.htm

Massachusetts House Passes Smokefree Workplace Legislation, 125-25
Boston, 10/22/03... By a landslide vote of 125-25, the Massachusetts House
of Representatives today approved smokefree workplace legislation.  If
passed by the Senate and signed by the Governor, Massachusetts would become
the nation's sixth smokefree state joining California, Delaware, New York,
Connecticut, and Maine.
"Smokefree workplace legislation is great for health and great for
business," says Joe Cherner, founder of BREATHE-- Bar and Restaurant
Employees Advocating Together for a Healthy Environment.  "Most people
prefer to breathe clean air.  The only loser is the tobacco cartel."

Chapter 7 - Evaluation and the Accoutable Practitioner


Chapter 8 - Applications in Community Settings

Mon Oct 06, 2003

Hey Chicken Little: The Sky Didn't Fall  by Joe Cherner
Restaurant and bar business going strong in smokefree New York

In March of this year, New York City made all of its restaurants and bars
100% smokefree.  In July, the entire state of New York did the same.
Tobacco interests claimed (as always) that restaurants and bars would go out
of business, employees would be fired, money would be lost, tourism would
suffer, and the New York economy would basically cease to exist.
Hey Chicken Little:  The sky didn't fall.  In fact, here's what really
1) From March to June, New York City created 10,000 new restaurant and bar
jobs, according to the Department of Labor.
2) Alcohol and beer tax collections went up statewide to $15.2 million in
August, compared with $14.4 million in August of last year, according to the
Department of Taxation.
3) Hotel revenues increased for the first time in three years indicating a
rebound in tourism, as reported by Crain's business news.
Polls by Global Strategy, Zogby International, and Quinnipiac University
show that New Yorkers in every political party, every ethnic group, and
every borough overwhelmingly support the new smokefree workplace law.  By a
margin of 6 to 1, New Yorkers find restaurants more enjoyable.  By a margin
of 3 to 1, New Yorkers find bars and nightclubs more enjoyable.
"Of course business is good," says Joe Cherner, president of SmokeFree
Educational Services, Inc.  "The vast majority of people prefer to breathe
clean air.  Very few people prefer to breathe dirty air."
Five entire states-- CA, DE, NY, CT, and ME-- have enacted smokefree
workplace legislation for bar and restaurant workers.  MA is expected to
join them shortly.
"Legislatures should stop letting tobacco interests intimidate them,"
advises Cherner.  "There is no downside to providing workers with a safe,
healthy, smokefree work environment.  It's good for health AND it's good for
business.  The only loser is the tobacco cartel."
To thank the New York State legislature, go to www.smokefree.net/NY
To thank the New York City legislature, go to www.smokefree.net/NYC


Chapter 9 - Applications in Occupational Settings


Chapter 10 - Applications in School Settings


Chapter 11 - Applications in Health-Care Settings


Chapter 12 - Applications in New Technology