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Since flight attendants won the battle for smoke free airplanes in 1987, the debate on the effects of secondhand smoke have waged on, but according to the Surgeon General's report last year, "The Health Consequences of Involuntary Exposure to Tobacco Smoke," the debate is over.

Scientific evidence proves that secondhand smoke causes disease and death in nonsmoking adults and children. The report showed 3,000 adults die annually of lung cancer caused by secondhand smoke and 300,000 children develop respiratory infections.

While Tennessee has a poor record of tobacco prevention and control, last year a bill was passed to prohibit smoking in all state buildings. Keeping with the trend, Gov. Phil Bredesen introduced legislation this year with a smoke free workplaces bill. The proposed Tennessee Smokefree Air Law (HB 2336 and S 2255) will prohibit smoking in all workplaces, including restaurants and bars. In addition the bill would make it illegal to smoke within 25 feet of entrances and windows of smoke free establishments. Under the bill, smoking in a nonsmoking area would be punishable by fines both to individuals and noncompliant business owners.

"We don't stay at home all the time," said Shelby County Mayor A.C. Wharton at a Memphis press conference in April. "We recognize people have a right to control their inner environment, their own space. I see this as an important public health campaign. I join the governor in supporting this."

In 1999, Tennessee was one of a handful of tobacco-growing states that received a settlement from the massive tobacco industry, which allocated up to $140 million per year for the state. The Centers for Disease Control and Prevention recommend the state of Tennessee spend between $32 and $89 million annually to have an effective, comprehensive tobacco prevention program. To date, Tennessee has spent no money on tobacco prevention programs, instead funneling the dollars into general funds to address other budget concerns. According to the Campaign for Tobacco-Free Kids, Tennessee generates $265 million annually from tobacco settlement payments and tobacco taxes, which increased in 2002. Annual smoking-related healthcare costs in the state exceed $2 billion.

"In a typical pulmonologist's practice, about two-thirds of the patients are smokers," said Dr. Vince Viscomi, pulmonologist and president-elect of the Chattanooga-Hamilton County Medical Society. "(Lung cancer) has become a disease of the poor and there is no real advocacy (here) for smoking cessation. More people die from lung cancer than breast cancer."

Furthermore, the tobacco industry in Tennessee is no longer a major source of revenue for the state. The Tennessee Department of Agriculture reports $93 million in revenue for 2006, which is only one-third of the profit tobacco earned just five years ago. The disparity between tobacco revenue and tobacco healthcare costs was a driving force behind the bill.

"We learned about the surgeon general's report last summer and (noticed) an article about the decline of tobacco crops in Tennessee," explained Robert Gowan, senior policy advisor to Bredesen. "The article compared how little money Tennessee receives from tobacco versus the cost of smoking. That was the first time I ever saw figures that close together. It put things in perspective."

Partnered with the Tennessee Department of Health, Bredesen allotted $15 million for smoking prevention programs across the state with the workplaces bill as the flagship legislation. Where past bills have lacked support from legislators and lobbyist groups, this bill has succeeded. The distinction this time around has been to make tobacco control a public health and employee rights issue. Plus, the bill encompasses all workplaces rather than singling out restaurants and bars.

This level playing field approach has garnered endorsements from major healthcare organizations, the Tennessee AFL-CIO Labor Council and for the first time, the Tennessee Restaurant Association (TRA). Legislators have said TRA's involvement is key to the bill's success.

"The difference is we're taking a science-based approach. It's clear secondhand smoke is dangerous," explained Tennessee Department of Health Commissioner Susan R. Cooper, MSN, RN. "We are stewards of the state's money and improving the healthcare of Tennesseans is a return on our investment."

The surgeon general's report said the only way to protect nonsmokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors. Even brief exposure can cause immediate harm.

"As a physician who takes care of children with asthma, cystic fibrosis and other (respiratory conditions), I see the effect of secondhand smoke," added Dr. Paul E. Moore, assistant professor of pediatrics and pharmacology at Vanderbilt Children's Hospital. "The ones exposed to tobacco smoke do worse."

Julie Griffin, assistant director for government affairs for the Tennessee Medical Association, said smoking related healthcare costs continue to rise because the state has yet to develop tobacco prevention and control programs.

"We're very pleased the governor has put $15 million in his budget to address tobacco prevention and control programs, which are desperately needed in this state," Griffin said.

Legislators across the state have polled constituents with resounding feedback in support of smoke free legislation. In addition, an October 2006 survey conducted by the American Cancer Society indicated more than 73 percent of Tennessee voters would support a law that makes all workplaces smoke free. Studies have shown that tobacco control programs have a positive effect on health and increase smoking cessation efforts.

"It's time Tennessee takes a stand and we have a governor willing to take a stand," concluded Griffin. "We hope the General Assembly will follow his lead."


May 2007

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