Street events, including fairs, festivals, arts and crafts, live music, dance, food, games, and educational exhibits and workshops are a fact of life in San Francisco. In 2010, over 350 street events took place in the City – more than one per day! Street events are by their nature open to the public and can result in exposing many people to secondhand smoke. Knowing that secondhand smoke kills as many as 46,000 nonsmokers each year in the United States, the City and County of San Francisco is aware that exposure to secondhand smoke presents an immediate danger to the health and well-being of the public. While San Francisco has an ordinance that prohibits smoking in enclosed areas and certain unenclosed areas, such as public parks, sports stadiums and golf courses, the law does not cover street events where nonsmokers can find themselves in close proximity to persons who are smoking. Despite being outdoors, and contrary to popular opinion, exposure to secondhand smoke can reach toxicity levels similar to those attained indoors depending on direction and amount of wind and the number and proximity of smokers.

For over 100 years, Breathe California has been dedicated to fighting lung disease, advocating for clean air and promoting public health in local communities through grassroots programs. Under contract to the San Francisco Tobacco-Free Project, San Francisco Department of Public Health, Breathe California undertook a project with a diverse group of eight San Francisco State University student advocates who decided to work towards getting a citywide policy making street events smoke free passed by the Board of Supervisors.

“As an asthma sufferer, this project is important to me because I believe that participants of street events should not have to suffer to simply breathe. Before this project, I never really knew the impact that policies had and how necessary they were in order to keep people healthy.”

The eight Breathe California advocates, who chose the problem of secondhand smoke in street events, range in age from 20 to 35 and represented many different cultures, including Mexican/Italian American, Chinese, African American, Latina, Italian, Portuguese/ Spanish, Laotian, and Mexican/Portuguese, and Chumash American Indian. Two are bilingual, one in Spanish and one in Laotian. Seven of the original eight advocates stayed with the project until the end, even though one got pregnant and others graduated from college during the course of the project (the one who left got a full-time job). An eighth advocate was hired in the second year of the project.

The advocates believed that working to get a policy that would ban smoking for street events would generate considerable support and further, that there would be little resistance in the face of the compelling supporting data they compiled:

• According to the U.S. Surgeon General, there is no safe level of exposure to secondhand smoke.

Although the advocates had approached and secured a sponsor in November 2011, it took three months to get the first draft back from the city attorney due to a series of staffing changes. A second draft, reflecting the meeting with the event producers, was then sent back to the city attorney to be modified, taking another three months. When the ordinance was finally introduced, the 2012 election dominated political activity as members of the Board of Supervisors (including their sponsor) were focusing their attention on getting re-elected.

The advocates had no control over these events, yet continued to try to do what they could to move the policy forward and ensure that the ball did not get dropped or lost. This might be the most valuable lesson the advocates learned from their involvement in the process to get a new policy passed: that no matter how much advance planning is done there can still be a considerable amount of waiting time because of circumstances outside the control of the project.

By the end of the year, on December 10, 2012, the Land Use Committee of the Board of Supervisors voted to approve and send to the full Board the ordinance making outdoor events held on city/county property smoke-free and requiring the city license permitting agency to ensure that event producers issued permits for these outdoor events inform the public that the events are smoke-free. The ordinance was scheduled to be heard before the full Board of Supervisors on January 15, 2013 and at that time received full unanimous support. The same day as the Board meeting, the advocates held another media event that raised awareness in the community. The law was signed by Mayor Ed Lee in February 6, 2013 and took effect March 6, 2013. Advocates met after the passage with producers to provide appropriate signage models that can be used at all community events. The Tobacco-Free Project provides continuing support to ISCOTT and individual event producers to ensure capacity to comply with Health Code Article 19L for the health and safety of all San Franciscans.

In implementing its action, Breathe California utilized the Community Action Model (CAM), a process that builds on the strengths or capacity of a community to create change from within and mobilizes community members and agencies to change environmental factors promoting economic and environmental inequalities. CAM steps include:

Train participants to develop skills, increase knowledge and build capacity.
Do a community diagnosis to find the root causes of a community concern or issue and discovering resources to overcome it.
Choose an action to address the issue of concern. The action should be achievable, have the potential for sustainability, and compel change for the wellbeing of all.
Develop/implement an action plan which may include an outreach plan, media advocacy, developing and advocating for a model policy, presentations, and evaluation.
Enforce/maintain the action after it is successfully completed to maintain it over the long term with enforcement by appropriate bodies.
Levels of secondhand smoke exposure outdoors can reach the same level as indoors, depending on number and proximity of smokers.

• A smoke-free policy in outdoor events will protect the health of the 88.4% of San Franciscans who do not smoke.
• Results from the advocates’ opinion survey conducted at public street events in San Francisco show that 67% of respondents favor making all SF street events smoke-free and 59% reported being bothered by secondhand smoke at street events.

To begin, the advocates were trained in tobacco issues, media, advocacy, policy development, strategic planning, and local and global tobacco control issues before beginning their extensive community research. This included conducting a public opinion survey and key informant interviews; conducting research and a literature review about existing policies related to outdoor smoking and what has been done by other groups working on similar policies; compiling information about known annual street events in San Francisco; and learning about the permit process for street events in San Francisco.

Public opinion survey. The advocates researched street events for logistical information, including date, description and location of event. Using a simple tool in English and Chinese, 596 street event participants were surveyed at seven outdoor events throughout San Francisco from August through October of 2011. Each event that was chosen represented a different geographic location in the City, was open to the public and varied in size and popularity. People were randomly approached and invited to complete the survey, regardless of their smoking status or residency. Of those surveyed, 86% self-identified as non-smokers and 14% said they “smoke” or “sometimes smoke.” Two-thirds, or 67% of survey respondents favored making ALL street events in San Francisco smoke-free; 59% reported having been bothered by secondhand smoke at street events; and 81% would support a designated smoking area or a stricter 100% smoke-free event.

Key informant interviews. The advocates conducted eight key informant interviews. Four key informants work in tobacco control, three organize or produce street events, and one works with the street event permit process. Interviewees who had experience in tobacco control stressed the importance of effective data, obtaining community support and building relationships as key steps in tobacco control policy. They said that challenges included getting “buy-in,” feeling sympathy for the smoker, possible arguments from those who might oppose the policy, and acknowledging the realities of nicotine addiction. Interviewees with other groups advocating for similar policies mentioned many different types of organizations that helped with their campaign, including the health department, advocacy groups, youth leadership groups, coalitions, community centers, school districts and colleges. Interviewees stressed the importance of talking to event producers to better understand the process and reveal potential problems. When asked what they would “like” and “dislike” about a citywide smoke-free policy for street events, event producers stated that reducing secondhand smoke exposure specifically for youth, children, teens or kids would be beneficial. They were, however, all concerned about losing attendance, and two expressed concern about how the policy would be enforced.

Of the interviews with groups advocating for similar policies, the advocates learned about different key things to consider in getting their policy passed, e.g. who is needed

Research and literature review. The advocates researched tobacco related policies that could be transferable to smoke-free events and found that in 2008, 187 California cities and counties had local laws restricting smoking in at least one outdoor area. San Francisco already had a smoke-free policy in public areas such as parks and sports stadiums. A few cities also had policies that extend smoke free policies to outdoor public street events, including Union City, Alameda, City of Carpinteria, California, and unincorporated areas in Sonoma County. Outside California, cities and towns in Utah, and the South Carolina city of Easely and the town of Pendleton prohibit smoking at street events.

San Francisco street events. The advocates collected data from 7 annual public street events in various parts of the City that are open to the public, charge no entrance fees, and occur between August and October. The data included date, location, organizer contacts, brief description of events, and number of attendees. The advocates also researched how permits are obtained for events requiring street closure in San Francisco.

Proposed Model Policy 1. Smoking shall be prohibited in outdoor events on city owned property, regardless of the number of people assembled for the event, performance, or competition. 2. Events requiring city permits must notify the public that the event is smoke-free by meeting the following conditions: a. All electronic or print promotional materials will state that this is a smoke free event per SF Health Code, Article 19L (e.g. website, electronic promotional materials, print, advertisements, radio, television, internet, newspaper, media). b. Each event shall have a “no smoking” sign. The international “No Smoking” symbol, consisting of a pictorial representation of a burning cigarette enclosed in a circle, with a diameter of at least three inches, with a bar across it. And includes a statement at the sign that reads “SF Health Code Article 19L” in font no less than 1/8 inch in height. c. Public events with amplified sound must make at least one announcement every two hours at each stage during an event.

 

When all the data was collected and analyzed, the advocates proceeded to develop the model policy and an educational packet. The proposed policy included three main requirements: 1) to have at least one “No Smoking” sign posted at each entrance or exit; 2) to have advertisements and event-related publications include the international “no smoking” symbol or state that it is a “smoke-free event;” and 3) to announce every two hours at each stage with amplified sound that the event is smoke-free. To support the policy and educate stakeholders and the community, the advocates prepared a folder that included information about Breathe California and the project, background information on street events, secondhand smoke facts, outdoor smoking policies, cities with policies for smoke-free events, and charts from the survey results.

The advocates met with a member of the Board of Supervisors very early in the process. This supervisor was strategically chosen because of his commitment to public health and his past support of secondhand smoke laws. He committed to be the lead sponsor and sent the proposed model policy to the City Attorney for review.

To deepen their understanding about street event permitting, the advocates met with staff from the Interdepartmental Staff Committee on Traffic and Transportation (ISCOTT), the city agency in charge of permitting street events, and learned that ISCOTT has a section in their applications that includes prohibitions on tobacco advertising, but not about making street events smoke-free. The staff person explained the street event permitting process. She expressed support for the idea of smoke-free street events in San Francisco but cautioned that the City would not want to create extra work for event organizers.

The advocates then convened a large meeting with several event producers to flesh out their concerns about the proposed policy. While most attendees were supportive of the concept, questions were raised in the areas of signage and enforcement. The main concerns of the event producers which focused on the signage requirements and enforcement were discussed during the first meeting with the advocates.

Signage. The original policy would have required a sign at every entrance and exit. The event producers thought that would be too much because some events are a mile long and have many entrances and exits. When the advocates learned that event producers are required to post other types of signs, they proposed integrating the “no smoking” message on the already-required signs, thereby avoiding creating extra work and duplication.

Enforcement. The event producers were also concerned about being held responsible for someone smoking at their event and wanted to know if that was something they could be ticketed or cited for. The advocates assured them that the only thing they as event producers would be responsible for is making the three requirements on signage and announcements and that they would not be punished for something happening at the event that is out of their control.

These concerns were conveyed to the city attorney who was in the process of reviewing the proposed ordinance. The adjustments that had been discussed in the meeting were made, which successfully addressed and neutralized the concerns of the event producers.

The advocates then turned their attention to publicizing the campaign and getting endorsements. A press conference was held on July 19, 2012 and received coverage by the San Francisco Chronicle and KCBS Channel 5 news, thus creating community awareness about the issue. The advocates successfully collected endorsements from 11 organizations that were presented to the Board of Supervisors, including: San Francisco Asthma Task Force, Dolores St. Community Services, Freedom From Tobacco, African American Tobacco Control Leadership Council, Health Education Students Association at San Francisco State University, Girls After School Academy, Sunset Russian Tobacco Education Project, Shape Up San Francisco Coalition, San Francisco Tobacco-Free Coalition, Filipino American Development Foundation, and Asian Americans for Community Outreach.

“All my life I have been exposed to secondhand smoke growing up in a family (and community) with a lot of smokers…I feel like it’s my responsibility to be a positive role model for the youth in my community. This project has affirmed my commitment to working in the community and my passion for advocating for health ordinances/policies to improve the quality of life for everyone.”