June 21, 1999

To:Board of Health

From:Dr. Sheela Basrur, Medical Officer of Health

Subject:Ventilation and ETS

Purpose:

To report on the appropriateness of including a ventilation option in a harmonized ETS by-law as an alternative to being smoke-free.

Financial Implications:

None, if a ventilation option is rejected. If a ventilation option is approved, additional staffing and expenses for system approvals, inspection, laboratory analysis and enforcement will be required.

Recommendations:

It is recommended that:

(1) a ventilation option not be included in the proposed ETS by-law.

However, if Toronto Council decides to consider ventilation systems as an alternative to being smoke-free in the future:

(2)(a) such systems must be designed, installed, and maintained in a manner that will control ETS so as to meet or exceed standards for ETS and/or its components, that may become established in Canada by federal and/or provincial government bodies for health protection purposes; and

(b)problems with enforceability combined with the additional workload and costs to the City for ventilation system approvals, inspections and enforcement must be taken into consideration.

Background:

On May 6, 1999 the Board of Health passed a resolution requesting the Ontario Restaurant Association to provide the Medical Officer of Health with Aspecific details on the ventilation technology which they believe to be an effective alternative to 100% smoke-free status for hospitality establishments, along with independent scientific evidence supporting the effectiveness of this technology@. No such information was received by the Board=s May 31, 1999 deadline, although by that point an upcoming demonstration of an Aair quality solution@ had been announced by the Ontario Restaurant Association. On June 3, 1999, the Board of Health passed a further resolution that the Medical Officer of Health report back to the Board with Adetails of a health-based evaluation protocol that could be used to assess any ventilation system put forth by the hospitality industry to achieve the equivalent of a smoke-free indoor environment@. This report responds to that request and comments on the Ontario Restaurant Association=s ventilation system demonstration - Appendix (a).

Discussion:

The following issues must be taken into account in assessing the effectiveness of ventilation as an alternative to being smoke-free:

(1)Air quality standards for ETS exposure.

The effectiveness of a ventilation system can only be assessed in relation to an appropriate standard for ETS exposure, either for workers or the general public. No such standard has been set in any North American jurisdiction despite consideration of this matter by a number of regulatory bodies in both Canada and the United States. However, the National Institute of Public Health in Norway has established guidelines for indoor air quality which are not legally binding. Exposure standards for air pollutants (such as ETS) are normally set by the federal and/or provincial governments, not by local municipalities. It is strongly recommended that the City not attempt to set an arbitrary standard for ETS in the proposed by-law because:

(a)Scientific consensus has not determined a safe level of exposure to ETS; and

(b)Scientific regulatory bodies B on which the City normally relies for standard setting Bhave themselves been unable to establish an air quality standard for ETS.

Exposure to harmful components should be eliminated as a first choice in protection strategies whenever possible, especially in indoor environments. Only when a health risk cannot be eliminated must it be managed. For example, when the health risk associated with asbestos was confirmed, governments took action to eliminate the risk of exposure to asbestos wherever possible. It was removed from public places and controls were put in place to ensure that people are not exposed to asbestos fibres. Asbestos wasn't banned completely because it continues to be essential as a heat resistant material and insulator. However, when asbestos is used there are restrictions put in place to protect workers and the general public. In contrast, ETS has no useful functions.

(2)Factors that affect the concentration and measurement of ETS within an indoor environment.

ETS is a complex mix of gaseous compounds and particulates which may be measured using a variety of markers, none of which are ideal. ETS levels are influenced by many factors in addition to the type of ventilation system, including:

the number of cigarettes being smoked per unit time

the degree of absorption of ETS components to furniture and other surfaces

room occupancy and physical configuration

air exchange rates

whether other ventilation systems are in operation elsewhere in the building

how often windows and doors are opened.

The complexities of ETS measurement make it difficult to incorporate ventilation standards into the by-law as any guarantee of effectiveness in removing ETS from all portions of a given indoor space. The mechanical specifications of a proposed system, along with the maintenance procedures and associated costs that are required to ensure that it operates to the manufacturer=s specifications, must also be taken into account.

(3)The requirements for inspection and enforcement to ensure such systems are operating effectively.

If an air quality standard is developed by an appropriate body along with engineering requirements by which to achieve this standard, there are still substantial issues related to operational feasibility that must be taken into account. While the manufacturer=s specifications regarding installation, operation and maintenance must be complied with if a system is to be effective, there are many potential areas for Ashort-cuts@ to be taken either by contractors, proprietors or their designates in order to reduce costs. This may limit the effectiveness of the system. Hence, a strong set of checks and balances by the City is required to ensure the by-law is enforced and that the public and workers are protected from ETS. These include:

Inspection of ventilation systems prior to their approval by a duly qualified engineer, at the expense of either the applicant or the City.

(b)Collection of maintenance records by the proprietor (including operation of vents, cleaning and exchange of filters, etc.) and inspection of these records on a regular basis by the City.

(c)Collection, analysis and interpretation of airborne ETS levels (assuming agreement could be found on the appropriate markers and collection methods), with the associated expense for laboratory analysis to be borne either by the proprietor or the City.

Enforcement of non-compliance, including collection of sufficient evidence to mount a successful case, since the onus would fall on the City to prove non-compliance - given the technical complexities of ETS measurement, overall enforceability and the associated costs are a major consideration.

(e)Given the large number of restaurants in the City, even a 10% uptake on ventilation systems as an alternative to smoke-free would mean an additional 700 premises requiring detailed inspections, many of which would likely proceed to enforcement given the inadequacies of current ventilation technologies in removing ETS from indoor air. As ventilation companies produce ever-increasing and cheaper systems that they claim to be satisfactory, uptake by restaurants could increase substantially while the onus of disproving claims will invariably fall onto the City.

(f)While some proprietors will make a genuine attempt to install, operate and maintain an appropriate system, others may claim their system works and tie up the City=s resources in having to prove the contrary. This scenario could be exacerbated with the aid of tobacco companies, which would benefit greatly if a municipality of Toronto=s stature makes smoking permissible in public places, with a possible influx of Aconsultants@ claiming to have better and cheaper systems, etc. Problems with enforceability would only add to the negative public relations that could result from this situation.

Comments on the ORA Demonstration

On June 8, 1999 the Ontario Restaurant Association held a demonstration for the Board of Health, Toronto Councillors and the media, of a newly installed ventilation system at the Black Dog Pub in the east end of Scarborough. As part of their presentation, a consultant in toxicology and environmental health stated that the components of tobacco smoke can arise from other sources and therefore that exposure to these substances cannot be avoided. It should be noted that the ORA did not describe their ventilation solution as being able to eliminate ETS.

The visual demonstration involved a single smoker seated in one room which connected through an open doorway to an adjacent Asmoke-free@ room. While smoke from the burning cigarette was clearly flowing away from the direction of the Asmoke-free@ room towards the vents in the smoking room, this scenario failed to simulate the conditions more typical of a bar on a weekend night, in which many more smokers would be present and in which air movement may be much more complex. A ventilation system that appears to clear the air when one cigarette is burning may fail entirely to be effective when many cigarettes are burning.

The technology presented was an energy recovery ventilator, also known as a heat recovery ventilator (HRV). These systems are designed to remove a portion of stale or contaminated air and replace it with fresh air from the outside. The main concept behind this technology is that heating or cooling (depending on the season) is transferred from the exhausted air to the fresh air. This allows for more air exchanges while controlling increases in energy costs. However, these types of systems are not designed to be health protecting systems, since their primary function is to save energy costs while exchanging some percentage of the indoor air in a certain period of time.

At the presentation, the ORA presented a series of charts describing the air quality results at the Black Dog Pub before and after implementation of the ventilation system and compared these results with those obtained in a smoke-free food court. Their study results showed that ETS levels in the Asmoke-free@ food court which, according to their findings, exceeded those at the Black Dog Pub with ventilation in effect. It must be noted, however, that this food court shares an airspace with two restaurants in an adjacent building which do allow smoking. This situation would be rectified in the proposed by-law by prohibiting smoking in non-enclosed restaurants that are adjacent to food courts and other public areas.

Finally, while ORA has not provided Public Health with any of the information needed to properly interpret their study=s methodology or results, including such basic facts as the number of cigarettes that were burned during the test, how samples were collected or how the data were analyzed (see attachment for list of questions posed to the ORA). As such, their results are considered uninterpretable at this time.

Conclusions:

I have considered at great length the appropriateness of including a ventilation option in a harmonized ETS By-law as an alternative to being smoke-free. My recommendation against such an option is based on the current state of scientific consensus which has not determined a safe level of exposure to ETS. Further, no Canadian jurisdiction has set an air quality standard for ETS exposure, either for workers or for the general public. Regulation of air pollutants (such as ETS) is a federal/provincial responsibility and should not be undertaken by one municipality acting in isolation. Methods to assess the effectiveness of ventilation in meeting air quality standards, should one be established in the future, would also be the responsibility of the federal and/or provincial government which sets the standard.

Should such a standard be developed and ventilation systems be designed that are capable of achieving this standard, the associated installation and maintenance costs to proprietors and the inspection and enforcement costs to the City would have to be taken into account when considering the appropriateness of this approach at a future point in time.

A protocol to critically assess a study of ventilation system effectiveness in achieving the equivalent of a smoke-free indoor environment was developed in consultation with a ventilation engineer with ETS expertise. The results of the Ontario Restaurant Association=s demonstration of its Aair quality solution@ are uninterpretable at this time, due to the continuing unavailability of such basic information as the number of cigarettes being smoked during the testing period. Further, their results must be subjected to independent scientific analysis to assess their replicability not just in this setting but also in a variety of others.

In summary, the ORA has not provided any supporting evidence to confirm their claim that ventilation technology can provide an acceptable alternative to removing the source of contamination, that is, smoking.

Contact Name:

Dr. Sheela Basrur

Medical Officer of Health

Tel:392-7402

Fax:392-0713

Dr. Sheela V. Basrur

Medical Officer of Health

A Harmonized Environmental Tobacco Smoke

(ETS) By-law for the City of Toronto

Policy Options and Recommendations

For Public Discussion

Toronto Public Health

April 6, 1999

Introduction:

The purpose of this report is to describe the outcome of stakeholder consultations and to outline policy options with recommendations from Toronto Public Health for a harmonized Environmental Tobacco Smoke (ETS) by-law and strategies to achieve smoke-free workplaces and public places.

Recommendations:

(1)That workplaces in the City of Toronto be smoke-free, except in fully enclosed, separately ventilated designated smoking rooms (DSRs) that make up no more than 25% of the work space, and which no employee is required to enter;

(2)That the six existing municipal by-laws respecting smoking in public places be replaced with one ETS by-law from one of the two following options:

(i)That public places be smoke-free, except for restaurants, bars, bowling centres, casinos and bingo and billiard halls, which may have unenclosed smoking in 25% of space until April 30, 2001 when they become smoke-free;

OR

(ii)That public places be smoke-free, except for restaurants, bars, bowling centres, casinos, billiard and bingo halls, which may have 25% of their space for unenclosed smoking for a time limited period, such that:

(a)Restaurants and bowling centres become smoke-free April 30, 2001, and

(b)Casinos, bars, billiard and bingo halls become smoke-free May 3, 2004, with the distinction between bars and restaurants being that a bar is where alcohol is served and where admittance is restricted to persons 19 years of age and older at all times.

(3)That one of the following options be selected regarding designated smoking rooms (DSRs) in public places:

(i)No DSRs, except where permitted in the Tobacco Control Act, 1994, (e.g. Homes for the Aged);

(ii)DSRs up to 25% of space; OR

(iii)DSRs up to 50% of space.

(4)That the Corporation of the City of Toronto develop a corporate policy to prohibit smoking in all municipal facilities including workplaces, whether located in municipal or commercial buildings, except in such cases where this space is reserved for a private function such as a wedding. Where exemptions apply, they should be time limited until April 30, 2001.

(5)That the Commissioner of Urban Planning and Development Services be requested to consult with the Medical Officer of Health regarding revisions to the Licensing By-law to ensure these revisions have regard for the ETS By-law.

(6)That the new harmonized by-law be implemented three months following its enactment by City Council.

Background:

At its meeting January 26, 1998, the Board of Health requested the then Acting Medical Officer of Health to report back on the status of ETS by-laws in the new City along with suggestions for next steps towards reaching smoke-free workplaces and public places in the amalgamated City of Toronto.

At its meeting February 4 to 6, 1998, City Council referred a motion to the Board of Health for recommendations and public hearings on phasing in a harmonized smoke-free by-law for the entire City which would be protective of health .

The Medical Officer of Health reported to the Board of Health at the April 21, 1998 meeting on the status of ETS by-laws and recommended that stakeholders be consulted regarding the components of a uniform by-law and strategies to achieve the goal of smoke-free public places.

Upon the request of the Board of Health, the Medical Officer of Health made a presentation on a Stakeholder Consultation Plan for an ETS by-law at the June 23, 1998 Board meeting.

The changes proposed by Toronto Public Health for a harmonized ETS by-law and the eventual attainment of smoke-free public places are highlighted in Section 8. The rationale for the proposed changes is summarized below.

Discussion:

(1)GOVERNMENT RESPONSE TO ENVIRONMENTAL TOBACCO SMOKE (ETS)

During the past 20 years, governments across North America have moved steadily toward ensuring that residents, workers and visitors are fully protected from ETS by implementing legislation that prohibits smoking in the workplace and in public places. Currently 76 per cent of Toronto residents do not smoke tobacco, but are exposed to ETS in a variety of public places, such as restaurants, bars, bowling centres, billiard and bingo halls and other entertainment centres, or at work if they are employed in the hospitality industry. Each of the six former municipalities has a by-law requiring employees to be protected from ETS, with the exception of employees in the hospitality industry. This report focuses on harmonizing the six ETS by-laws as a first step to providing full protection for all employees, as well as for the non-smokers who visit these public places.

The omission of restaurants, bars and other entertainment facilities from ETS by-laws is being addressed in jurisdictions across North America. In the State of California all public places and workplaces, including restaurants and bars, are smoke-free. The Capital Region of British Columbia introduced smoke-free restaurants and bars Jan 1, 1999. The City of Vancouver prohibits smoking in restaurants that allow children. Closer to home, municipalities that have passed progressive ETS by-laws include Vaughan, Guelph, Windsor, London and Waterloo. (See Appendix V for a detailed outline).

(2)HEALTH HAZARDS OF ENVIRONMENTAL TOBACCO SMOKE (ETS)

The move to full employee and public protection is a direct result of increasing scientific evidence that links regular exposure to ETS to a variety of illnesses in non-smokers, including lung and heart disease, asthma, and numerous childhood conditions. The full impact of ETS on health is not yet known, but the direct link to ill health is not surprising given that ETS contains 4,000 chemicals; among them benzene, formaldehyde and arsenic. More than 43 of these chemicals are known to cause cancer in humans.

The most immediate effects of exposure to ETS occur in children and in people with chronic lung and heart conditions. They range from itchy eyes, runny nose, coughing, wheezing and sore throat to exacerbated asthma attacks. Children, whose developing bodies are especially susceptible to poisonous fumes inhaled at home, in restaurants, and in other places with open smoking (Glantz, 1995), because they breathe in more air compared to their body weight than an adult and absorb more harmful chemicals than an adult. With 11% of children affected by asthma, any exposure to ETS is of significant concern. Other common childhood illnesses linked to ETS include ear infections and pneumonia. The more insidious long term effects of ETS can emerge later in life as full blown cancers or heart disease. It is estimated, for example, that 3000 non-smokers die each year in Canada from preventable heart disease attributed to exposure to ETS. Another 330 die from preventable lung cancer. The health effects experienced by individuals depend upon such factors as personal sensitivity and frequency of exposure. As with some other cancer causing agents, such as asbestos, health experts generally agree that there is no safe level of exposure to ETS.

As the scientific evidence on ETS has increased so has public awareness of its dangers. More than 90 per cent of Toronto residents now believe ETS harms health (Smaller World Communications, 1998, Appendix VIII), and one third of all Ontario residents avoid certain bars and restaurants because they are too smoky (OTRU, 1997/1998). Given that non-smokers are protected from ETS at work and in many public places, there is public demand for smoke-free places, including restaurants and entertainment facilities, such as bowling centres, casinos, billiard and bingo halls and bars. It should be noted that the provision of separate but unenclosed spaces for smoking in public places is not health protective to non-smokers, or to employees, since ETS travels freely through the air. Full protection is achieved only in a smoke-free environment, or where there is a fully enclosed and separately ventilated DSR.

(a)Exposure to ETS in Restaurants, Bars and Entertainment Facilities

It is troubling that the least protected employees in the new City of Toronto, are those working in places with the highest levels of ETS (See Appendix I). A 1994 review of many studies on indoor air quality concluded that, on average, ETS levels in restaurants were 1.6 to 2.0 times higher than in other workplaces that permit smoking, and 1.5 times higher than in homes where at least one person smokes (Siegel, 1993). ETS levels in bars were found to be 3.9 to 6.1 times higher than in workplaces that allow smoking, and 4.4 to 4.5 times higher than in homes where at least one person smokes (Siegel, 1993). The same review concluded that the increased risk of lung cancer among food service workers may be as high as 50% compared with the general population. In a recent study, San Francisco bartenders reported a substantial reduction in ETS exposure after the State of California made bars smoke-free. The study concluded that implementation of smoke-free legislation has an immediate beneficial effect on the respiratory health of employees (Eisner et al, 1998). The exposure of employees, children and susceptible adults to the high levels of ETS in restaurants, bars, bowling centres and bingo and billiard halls is a serious health concern. It is important to note in this regard that youth are exposed to ETS not only as patrons of these places, but also as workers since youth make up a significant percentage of food service workers.

(3)STAKEHOLDER CONSULTATION

Not surprisingly, moves to protect non-smoking employees and the non-smoking public from exposure to ETS in the workplace have been welcomed by the majority of non-smokers and health experts, and resisted by those who believe such laws are unworkable, or will have a negative impact on business. The introduction of the workplace by-law in 1979 in the former City of Toronto, for example, engendered many complaints in its initial stages, including some from individuals who felt it was an unnecessary infringement of their "right" to smoke.

To guide development of the by-law, Public Health consulted with the public and with stakeholders from the hospitality and health sectors, including health agencies, hospitality organizations and operators of food premises, bowling centres and bingo and billiard halls. The hospitality industry was asked for advice on the development of a consultation plan that would be used to gather information from interested parties in the hospitality/entertainment sector on the components of a uniform by-law for the city, as well as on strategies to achieve smoke free public places. The consultation included a public opinion survey, focus group discussions, and meetings. As well, stakeholders were invited to provide written submissions to the Board of Health, or to depute to the Board during future public hearings on the proposed by-law. Results from the community consultation were similar to those found during extensive consultations carried out by the six former municipalities of Toronto in past years. The following is a summary of the results.

(a)Public opinion survey

An independent research firm was contracted to conduct a public opinion survey to gauge the level of support regarding details of a harmonized ETS by-law for the city, and to provide ideas on how to move forward to smoke-free public places. The survey of a random selection of 1,000 Toronto residents was done by telephone in October 1998. Survey results show that more than 90% of people believe ETS is harmful to non-smokers. This is in line with Health Canada's National Population Health (Cycle 2, 1996/97) which found that 77% of current smokers and 88% of non-smokers believe ETS can cause health problems in non-smokers. The majority of respondents in the public opinion survey believe the best way to reach smoke-free status is by increasing the percentage of non-smoking space each year and that fully enclosed and separately ventilated designated smoking rooms should be permitted. Support for non-smoking space was higher among non-smokers and among individuals who believe ETS is harmful to non-smokers. These individuals support a significantly greater percentage of space for non-smoking patrons across all public places. (See Appendix VIII for detailed results). This highlights the need for comprehensive education campaigns with regard to the health risks of ETS With respect to the harmonized by-law, the survey showed that 78% of residents believe restaurants should be at least 75% non-smoking.

(b)Health agencies

Health agencies were consulted by phone and/or invited to meetings. Not surprisingly there is a high level of support among agencies for achieving smoke-free public places as soon as possible, particularly given the increased smoking rates in young people and the epidemic of lung cancer in women. While ETS by-laws are primarily aimed at protecting non-smokers and children from ETS they also help reduce direct smoking rates by reducing the number of places where people can smoke. Health agencies are particularly cognizant of studies that show that youth who do not take up smoking in their early and mid teens are much less likely to become regular smokers later in life. Some agencies believe that although DSRs with separate ventilation may be a necessary step for restaurants, bars and entertainment facilities to become completely smoke free, no worker should be required to enter a DSR as part of their job. The majority of agencies said that where public places are not already smoke-free, a harmonized by-law should require a minimum non-smoking area of 75% as a step towards becoming smoke-free.

(c)Hospitality organizations and food premise operators

During the past decade public health departments in the six former municipalities have worked with representatives of the hospitality industry and owner/operators to obtain input on various public health issues, including ETS by-laws. In past consultations with staff, the Ontario Restaurant Association (ORA) has suggested: allowing smoking in bars and bar areas, in "smoke rooms"; increasing non-smoking areas incrementally, rather than going directly to smoke-free; and allowing individual operators to designate their establishments a "smoke house". Since the beginning of this current consultation and research process, various approaches have been used to solicit input on a harmonized by-law, including letters, telephone conversations and meetings. Staff met with the ORA and the Ontario Hotel and Motel Association (OHMA) to plan the consultation process. Both organizations recommended focus groups as the best way to get direct input from operators of food premises. A total of 38 operators from six former municipalities attended the focus group discussions. The executive summary of the report is attached as Appendix VII. In March 1998, Ryerson Polytechnic University conducted a random survey of 200 food premise operators on ETS by-laws in the former city of Toronto. (Sly, 1998). The survey found that about half of the respondents wanted either no change in current by-laws, or a more restrictive by-law. The other half preferred a less restrictive by-law. The survey found that operator attitudes towards ETS by-laws are highly associated with whether smoking is allowed in their premises (i.e. operators of a smoke-free premises are more likely to call for a more restricted by-law than operators of premises which allow smoking).

In general, hospitality organizations and food premise operators are sympathetic to health concerns related to ETS with some operators preferring a smoke-free environment for themselves and their families. However they are more concerned about any potential for lost business. They believe that the cost of providing fully enclosed and separately ventilated DSRs is prohibitive and not structurally feasible for many establishments. They believe the level of non-smoking seating should be market driven. The ORA suggested a multi-faceted approach to a by-law amendment should be considered to address the uniqueness of establishments within the food-service industry. There is strong advocacy for ventilation systems as a way to deal with ETS.

(d)Bowling centre operators and bingo hall operators

Telephone consultations were conducted with a random sample of bowling centre and bingo hall operators; 17 of 34 bowling centres and 12 of 22 bingo halls were included for consultation. Because of the similarity in responses, the results have been combined. In general, these operators believe they attract a larger percentage of smokers than found in the general population and have strong concerns about the economic impact of ETS by-laws. The majority of operators support a harmonized standard of 60% non-smoking space, reflective of the current average across the former municipalities. There is mixed support for DSRs and the eventual achievement of smoke-free. Responses ranged from no support for smoke-free, to support if required province-wide. Some operators did identify an interest in ideally operating smoke-free establishments.

(e)Billiard hall operators

Telephone consultations were conducted with a systematic sample of 21 billiard hall operators. Respondents recommended a harmonized smoking standard ranging from completely open smoking to 50% non-smoking, less than the current average of 60%. There was no general support for smoke-free and only five operators indicated the years 2001-2005 as a target for being smoke-free. Economic concerns were most commonly stated as the reason for the low level of support. There was general support for DSRs. The majority of operators said their clientele is largely composed of smokers.

(4)ISSUES RELATED TO BY-LAW DEVELOPMENT

(a)Economic hardship

There is considerable concern about any possible economic loss resulting from ETS by-laws. During this consultation, many members of the hospitality industry said they would prefer to be smoke-free but fear they will lose business if a smoke-free by-law is implemented. A review of many studies indicates that over the long term there is no overall negative impact on business and that the effects of such by-laws are either neutral or result in positive economic gain as non-smokers replace smokers. It should be noted that 700 Toronto restaurants are voluntarily smoke-free. However, there may be an initial negative impact in some establishments where the majority of patrons are smokers. Some jurisdictions in the United States have included a hardship clause in smoke-free legislation, also known as a variance or waiver, which exempts restaurants from smoke-free by-laws if they can demonstrate financial hardship in complying with the law. The burden of proof is placed on the applicant to demonstrate both a loss of business, and that the law is the cause of that loss. (See Appendix II for detailed information)

(b)Differentiating between restaurants and bars

There are more than 6,000 restaurants in the City, about half of which are in the former city of Toronto. They vary from family type establishments serving no alcohol, to cafes, pubs and establishments which cater mainly to adults and offer a variety of food and entertainment, including dancing, billiards and live music. For some of these establishments, the sale of food is incidental to the sale of alcohol and provision of entertainment. During past public consultation on smoke-free public places, some industry advocates have requested that bars be treated differently than restaurants, as is the case in some other municipalities, especially outside Ontario. As well, recent surveys (Appendix VII and VIII) suggest somewhat lower levels of public support for smoke-free bars. The concept of differentiating between restaurants and bars has been extensively researched by City staff now and in the former municipalities, and has been found to contain numerous problems. These problems arise primarily because the Ontario Liquor Licence Act does not distinguish between restaurants and bars for licensing purposes. Instead it provides a single class of liquor licence for all establishments that serve alcohol and, in an attempt to reduce public harm associated with alcohol use, establishments that serve alcohol must also serve food.

Without this distinction, the City must develop its own method of deciding what is a restaurant and what is a bar. There is no easy way to do this because restaurants often change their services and primary mode of business depending on the time of day, or day of the week, so that an establishment may function primarily as a restaurant during the day and as a bar at night. City staff have considered distinctions based on an establishment's percentage of alcohol sales and the age of its patrons; e.g. exclusion of children and youth under 19 years of age, from premises that allow unenclosed smoking. Recommendation 2 (ii), which contains an age exclusion, is designed to help protect children from the effects of ETS and is in keeping with other health protective provincial legislation aimed at youth that prohibits the sale of cigarettes to those under 19.

Only the former city of Scarborough ETS by-law defines restaurants separately from bars, essentially categorizing bars as establishments that derive at least 75% of revenues from the sale of alcohol. Although the by-law exempts bars from any smoking restrictions, it also permits any eating establishment to have smoking in up to 100% of the premises, based on customer demand. In practice therefore it has not been necessary for an establishment to identify itself as a bar to be exempt from smoking restrictions. Therefore it is recommended that in the by-law for the new City of Toronto, bars be distinguished from restaurants based on the existence of a liquor licence combined with a restriction on the age of patrons to 19 years and over. Nineteen is selected as the age limit as this is the minimum legal age for purchasing tobacco products and the minimum age for legal alcohol consumption. However, it should be noted that youth age 18 would remain eligible to work in bars.

Although some jurisdictions have differentiated between bars and restaurants, the fact that there is an increased ETS exposure risk in bars (Siegel, 1993) should be considered sufficient health grounds to make all such premises smoke-free. However, should the City wish to phase in the elimination of smoking in bars, Recommendation 2, Option (ii) is recommended. The administrative procedures for implementation must clearly differentiate these establishments and minimize any burden placed on the City and the hospitality industry.

(c)Ventilation

Ventilation technology is often proposed as an alternative to smoke-free by-laws by the hospitality industry. While some ventilation systems have been utilized to improve air quality, the improvement is purely aesthetic. The concept that ETS could be reduced to "acceptable levels" is also flawed as there is no safe level of ETS. Studies conducted in the former city of Toronto and elsewhere clearly indicate that non-smoking areas in restaurants that are not physically separated from the smoking area and not separately ventilated offer little or no protection from exposure to ETS (Abernathy & O'Grady, 1996; see Appendix II for descriptions of ventilation systems currently available.) Decreasing the concentration of ETS through exhaust or dilution offers less protection than restricting smoking to a percentage of the premises.

In order for a ventilation system to be considered effective it must be capable of removing ETS in both the gas and the particulate phase. According to ventilation experts such a system does not exist. In order to achieve a de-minimus risk (1 death/million) for lung cancer the ventilation rate in a hospitality establishment with unenclosed smoking would have to be increased 40,000 times, creating wind speed similar to that of a severe tornado. Accordingly, many experts advise that the most appropriate use for ventilation is to remove ETS from fully enclosed designated smoking rooms.

At a meeting Nov. 24, 1998 to discuss ventilation technology, one expert in ventilation engineering proposed a scenario in which an establishment could have an open passage way between the smoking and non-smoking rooms, provided that the opening was constructed with a tunnel that protruded at least eight feet into the non-smoking area. However, other experts at the meeting were skeptical of this theory, feeling that complete structural separation of smoking from non-smoking areas is essential. A recent article in a hospitality industry publication also concluded that "in the majority of conventional forced air heating/ventilation/air-conditioning systems, air is typically recirculated with generally only 10 to 15 percent fresh air added per hour. Therefore, even when the best efforts are made to physically isolate smokers from non-smokers, a single ventilation system will distribute some smoky air throughout a restaurant." (LaRiviere, Feb. 98)

If an effective ventilation system becomes available, there are still practical issues to consider. Ventilation systems can be expensive to design and install and there are physical limitations as to the type of buildings that can be retrofitted. As well, heating and cooling costs would rise with the required increase of air flow. Without regular maintenance the effectiveness of these systems declines very quickly, which presents particular difficulties for enforcement. While the system design and installation would require approval from the building department, the responsibility to monitor the operation, maintenance and overall effectiveness would be passed on to other enforcement staff. Even if one assumed the system was on and operating, the task of checking the filters, measuring air flow and grading effectiveness could be onerous.

Without the possibility of removing ETS from the air, the most logical option is to remove the source of the ETS. If at some point in the future a ventilation system is developed that could provide air quality equivalent in health terms to that in a smoke-free environment it could be considered as an alternative to a ban on smoking.

The ASHRAE standard:

In 1989, the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) developed a ventilation standard applicable to all indoor or enclosed spaces that people may occupy. The current edition is entitled ANSI/ASHRAE 62-1989 Ventilation for Acceptable Indoor Air Quality. This standard is the basis for almost all ventilation requirements contained in North American building codes. The purpose of the standard is to specify minimum ventilation rates and indoor air quality that will be acceptable to human occupants with the intent of minimizing the potential for adverse health effects. However, the standard does not ensure protection from ETS.

(d)Designated Smoking Rooms (DSRs)

Most of the existing ETS by-laws in the city permit DSRs in workplaces. This is because employees are not required to enter these rooms as part of their work duties. DSRs are not recommended for public places on health grounds because employees in public places should be provided with the same protection from ETS, and it would be impractical to expect them not to have to enter DSRs in the course of their work. (See Appendix IV for discussion of DSRs). Nonetheless, DSRs may be considered as a means of easing the impact of the by-law on smoking patrons. In the former city of Toronto, DSRs have been approved for fewer than 20 restaurants. The Board of Health/City Council will have to decide what to do about these existing DSRs. The Provincial Tobacco Control Act currently permits DSR's in certain public places, including homes for the aged and hospitals. For consistency, this policy should remain in effect for the present time.

(e)Enforcement

As with many municipal by-laws, ETS by-laws are largely self-regulating through voluntary compliance by owners/operators, employers, staff, and public over an introductory period of 6-12 months. Public Health staff will be responsible for enforcing the ETS by-law, primarily through education of operators and ticketing, if necessary. To make a new ETS by-law as understandable and as easily enforceable as possible, it must apply equally across the city and have clear standards for the size and location of smoking and non-smoking space. Education of all parties, including the public, employers, owners, operators and staff, is essential prior to and during implementation to ensure everyone understands the reason for the by-law, and their responsibilities under it. The hospitality industry feels strongly that the public must receive clear information about where they can and can't smoke. In general, the greater and more restrictive the change, the greater the need for education and enforcement. As with other by-laws to protect health, the owner/operator should be responsible for complying with the by-law, removing ashtrays from non-smoking areas, posting No Smoking and Health Warning signs to ensure patrons are aware of the by-law and the health risks of ETS, providing legal seating space and operating a smoke-free establishment where applicable. Penalties for non-compliance range from $205 for a ticket to a maximum $5,000 for a prosecution and conviction in Court.

(5)BY-LAW INTERPRETATIONS

The by-law will set out classes of establishment by which to define public places. These will include public places that serve food whether or not they serve alcohol, bowling centres, billiard halls, and gaming halls (e.g. bingo). By-law requirements will be interpreted and applied to these and other public places as outlined below.

(6)PUBLIC PLACES COVERED BY OTHER LEGISLATION

In Ontario, the Tobacco Control Act, 1994 (TCA) regulates smoking in some public places as well as the sale of tobacco to minors. The TCA also gives municipalities the authority to pass more restrictive no-smoking legislation. The TCA also states that where a more restrictive law exists, that law will prevail. The public places that will be covered under the TCA for Toronto are outlined in the following table.

(7)GUIDING PRINCIPLES FOR A HARMONIZED BY-LAW

At the beginning of this process Public Health developed guiding principles for the development of an ETS by-law for the new City of Toronto. These principles are that a new by-law should:

(a)achieve a maximum level of protection from ETS exposure;

(b)continue to make progress overall towards smoke-free status;

(c)be implemented three months after it is passed by Council;

(d)include future dates upon which public places become smoke-free;

(e)be supported by continuing city initiatives that encourage restaurants to go smoke-free voluntarily; and

(f)be accompanied by a comprehensive education campaign.

(8)OPTIONS FOR A HARMONIZED ETS BY-LAW

To protect health, a new ETS by-law should prohibit smoking in all workplaces and public places as soon as possible. Four of the six former municipalities (the exceptions being York and Scarborough) have by-laws committing to smoke-free workplaces and public places by 2000. To make the transition to a smoke-free standard for Toronto and to provide the most health protective environment possible, it is recommended that the City adopt Recommendation 1 and 2 (i). Recommendation 2 (ii) is provided for consideration, in the event the City decides to increase the amount of time operators and the public have to adjust to smoke-free premises. Appendix III describes other possible options along with their pros and cons. Once fully implemented, the by-law would protect the public and workers from ETS in all public places. If the Board of Health and/or Council decide to adopt a by-law that reduces current restrictions in some former municipalities in order to have a single standard across the city, it should encourage owners/operators to maintain their existing higher standard as a natural progression to being fully smoke-free (see Appendix I for current standards). A chart outlining these recommendations follows.

OPTION 1: Recommendation 2(i)

ESTABLISHMENT	RECOMMENDATION
Workplaces	maintain 100% smoke-free permit designated smoking rooms to be used for no other purpose than smoking
Public Places Not Already Smoke-free: restaurants bars banquet halls bowling centres bingo halls billiard halls casinos	public places not already smoke-free become 75% non-smoking three months after by-law is passed by City Council
	100% smoke-free April 30, 2001

OPTION 2: Recommendation 2 (ii)

ESTABLISHMENT	RECOMMENDATION
Workplaces	maintain 100% smoke-free permit designated smoking rooms to be used for no other purpose than smoking
All Public Places Not Already Smoke-free: restaurants banquet halls bars bowling centres bingo halls casinos billiard halls	public places not already smoke-free become 75% non-smoking three months after by-law is passed by City Council
Transition of Public Places to Smoke-free: restaurants bowling centres banquet halls	100% smoke-free April 30, 2001
bars bingo halls billiard halls casinos	100% smoke-free May 3, 2004

(9)PUBLIC COMMUNICATION PLAN

To successfully implement a harmonized ETS by-law for the City of Toronto and prepare for smoke-free public places, it is necessary to implement a communications plan (Appendix VI) that will inform and assist owners, operators and employees in the hospitality and entertainment industry, as well as the patrons of these establishments. All parties need clear, effective targeted information on the reasons for the by-law and their obligations under it. A subsequent campaign is needed to implement smoke-free public places when the time-limited exemption for certain establishments ends. The campaign should include up-to-date information on the health risks associated with ETS as well as a continuation of the successful Go for the Green smoke-free dining campaign, which encourages restaurants to go smoke free voluntarily. Past experience in the former municipalities and elsewhere has shown that ETS by-laws engender significant debate as employers, the public and media try to come to terms with restrictions on the places in which this addictive and harmful substance may be used.

(10)CITY OF TORONTO CORPORATE SMOKING POLICY

At the current time there are inconsistencies with regard to workplace corporate smoking policies across the amalgamated City. City workplace policies are consistent with the current smoking by-laws for the respective former municipality. That is, smoking is prohibited in the areas of municipal facilities considered workplaces. There are inconsistencies in areas such as workplace cafeterias and underground garages. The City should set a positive example and adopt the most restrictive policy possible to protect all City employees and the public visiting City facilities: to prohibit smoking in all municipal facilities whether located in municipal or commercial buildings. In cases where space is rented or leased for a private function such as a wedding, the City could permit smoking for the time limited period of that function. Should the City choose to allow this exception, it should be time limited until April 30, 2001.

Conclusion:

The majority of employees in the City of Toronto are protected from ETS at work. The continued exposure of workers and the visiting public in restaurants, bars and entertainment facilities is an unacceptable health risk given the current knowledge of the effects of ETS. The Board of Health must address the significant risk to public health in these establishments. A new ETS by-law is required for the city and there is a need to develop and implement a communications strategy to make the transition toward the goal of smoke-free public places.

Appendix I

COMPARISON OF SMOKING BY-LAWS IN THE

SIX FORMER MUNICIPALITIES IN THE NEW CITY OF TORONTO * (February 1999)

Type of Establishment	East York	Etobicoke	North York	Scarborough	Toronto	York
Workplaces	Smoke-free. DSRs permitted up to 25%.	Smoke-free. DSRs permitted up to 25%.	Smoke-free. DSRs permitted. No maximum stated.	Smoke-free, DSR option (fully enclosed ventilation system, at a minimum ventilation rate of 15 litres/sec.pp., exhausted to exterior at a rate of 110% of supply). Room used only for smoking. (No room size requirement). Includes vehicles, and eating areas (may include cafeterias), lounge and lunch rooms.	Smoke-free. DSR permitted up to 25%.	Smoke-free.
Food Courts	Smoke-free.	Smoke-free.	Smoke-free.	Smoke-free (included in the definition of "Common Area").	Smoke-free.	Smoke-free.
Restaurants, including Bars	As of December 2, 1996, new establishments smoke-free. Existing establishments 65% non-smoking.	75% non-smoking.	75% non-smoking.	Restaurants with more than 40 seats - 20% smoke-free seating. Restaurants with less than 40 seats are exempt. May be increased or decreased based on customer demand. Bars exempt.	Establishments larger than 100 square metres - 90% non-smoking. Establishment less than 100 square metres - 75% non-smoking (or a 10 square metres smoking section, whichever is less). DSR permitted up to 50%.	40% non-smoking if over 40 seats.
Bingo Hall, Gaming Facilities & Casinos	Bingo Halls & Casinos (in banquet halls) smoke-free.	75% non-smoking in bingo halls, gaming facilities and casinos.	60% non-smoking in bingo halls.	60% of the total floor areas must be a non-smoking area.	50% non-smoking in bingo halls.	40% non-smoking.
Bowling Centres & Billiard Halls	65% non-smoking.	Bowling centres: Smoke- free in playing areas which include bowling lanes and scoring tables, and in service counters, food take-out and line-up areas. Spectator Areas: 75% non-smoking. Billiard Halls: 75% non-smoking.	60% non-smoking.	60% of the total floor area must be a non-smoking area.	These establishments are not specifically included in the by-law, but are subject to the restaurant requirements if food is served.	40% non-smoking.
Multiple Residential/ Commercial & Public Building	All common areas are smoke-free.	All common areas are smoke-free.	All common areas are smoke-free.	Defined as "common area" and "public place" - smoke-free. Senior citizen residential facility may allow up to 25% of the recreational room space for smoking.	Public washrooms, stairwells, lobbies, reception areas, elevators & escalators are smoke-free.	All common areas are smoke-free.
Public Places & Places of Public Assembly	Smoke-free.	75% non-smoking.	Smoke-free; DSRs permitted.	Smoke-free (definition does not include restaurants, bars, gaming premises, billiard halls, bowling alleys or health care facilities, places rented or leased or otherwise used for private functions). Includes transit shelters, and public transit vehicles (including taxis).	Smoke-free, DSRs permitted up to 25% (definition includes shopping malls, cinemas, theatres, public washrooms and sports facilities, whether covered by a roof or not).	Smoke-free
Others	Common areas in banquet halls are smoke-free.	Woodbine Racetrack - 75% non-smoking in indoor spectator areas - 50% non-smoking in outdoor spectator areas.			School bus, escalators, elevators smoke-free.
Commitment to be Smoke-free by 2000	Jan.1, 2000 Smoking will only be permitted in workplace DSRs.	Yes.	Yes.	Support for all remaining sites going smoke-free contingent upon surrounding municipalities becoming smoke-free at the same time.	Yes.	No.

Notes:DSR - Designated Smoking Room

*This chart represents a summary of the by-laws. For details and definitions please refer to original by-laws.

COMPARISON OF BY-LAWS IN NEIGHBOURING MUNICIPALITIES (February, 1999)

Appendix II

Issues to be Considered for By-law Development

1.Economic Impact

Discussions with representatives of the restaurant industry showed that restaurant operators fear a smoking ban in restaurants will have a negative impact on business. In public policy debates, informal surveys of restaurateur opinion have often been presented as "evidence" of a negative impact of smoking by-laws on business. However, not all restaurant and bar operators share this opinion. More than 700 restaurants in Toronto have already chosen to voluntarily prohibit smoking. This would indicate public demand for smoke-free environments and suggests economic viability for such establishments.

A review of studies that have used a systematic, econometric analysis of restaurant sales based on sales revenues consistently shows no evidence of negative effects from smoke-free by-laws. This is true whether or not the restaurant serves alcohol. A 1994 study that analysed sales tax data for the first 15 cities in the U.S. to enact smoke-free ordinances affecting restaurants showed there is no significant effect on business when comparing restaurant sales data in cities with smoke-free restaurant ordinances with those in similar cities without ordinances (Glantz et al., 1994 & 1997). In addition, longitudinal analysis showed no significant change in business following the introduction of smoking prohibitions. This study was expanded in 1997, and confirmed the earlier study's results. A more recent analysis conducted in Flagstaff, Arizona also demonstrated that prohibiting smoking in restaurants did not affect sales (Sciacca et al., 1998).

This lack of economic impact was also documented in two communities where earlier surveys claiming significant loss of business based on less objective measures had been used to persuade municipal legislators to overturn restaurant smoking by-laws. The 15 municipalities included in this study varied widely, and included several that were part of larger contiguous urban areas. No loss of business to adjacent municipalities with less restrictive smoking legislation was documented. The only other published study using objective revenue data examined 19 U.S. cities with restaurant smoking restrictions and 87 neighbouring communities without restrictions. It showed no consistent economic impact of smoking restrictions regardless of the extent of restrictions. (Maroney et al, 1994)

Prior to New York City passing smoke-free restaurant legislation in restaurants with more than 35 seats, several restaurant operators predicted business would suffer. However, a survey by the Center for Hospitality Research at Cornell University, found non-smokers were eating out more frequently since restaurants became smoke-free. (Corsun et al., 1995). More recent surveys (Hyland et al, 1999 and Hyland and Cummings, 1999) found that taxable sales for restaurants increased by 2.1%, compared with sales two years prior to the legislation coming into effect. An 18% increase in restaurant jobs was also found. A telephone survey of 434 restaurant owners found no evidence to suggest that the smoke-free legislation had a detrimental effect on the city's restaurant business.

A report by the California State Board of Equalization compared taxable sales for 6,211 bars and bar/restaurants for the first quarters of 1997 and 1998, following the introduction of smoke-free bars Jan. 1, 1998. It found a 12% increase in taxable sales. As well, public opinion polls show that support for smoke-free bars is increasing. A 1998 statewide poll found that 85% of bar patrons go to bars as much or more than they did prior to the legislation coming into effect.

In 1996, the Conference Board of Canada published the results of case studies of 16 restaurants in Canada that voluntarily converted to smoke-free. The study included a variety of restaurants, including family, fast food, fine dining, casual, independents and franchises. Self-reported gross and net sales before and after the smoke-free policy indicated that two-thirds of the restaurants experienced a sales increase or no change in sales and 29% reported a decrease. None of the fine dining establishments reported a decline.

The scientific evidence on the economic impact of a restaurant smoking ban should be reassuring to concerned restaurateurs. It is consistent with data from the 1996 Angus Reid survey for Toronto, which suggests that smoke-free restaurants will be more attractive to consumers overall.

A recent study by the Ontario Tobacco Research Unit found no evidence that increased restrictions in the former city of Toronto, from 50% to 75%/90% designated non-smoking space, had any negative impact on taxable sales (Lothian et al, 1999).

2. Ventilation Systems

The following describes the types of ventilation systems currently available:

Negative Pressurization uses airflow to create an environment where the air pressure in the smoking area is lower than in the non-smoking area. Theoretically, this would prevent the movement of tobacco smoke from the smoking area to the non-smoking area. In reality, without physical separation the ETS can flow backward against the pressure. The difference in pressure required to make this system effective would have to be so great, the application would be totally impractical.

Heat Recovery Ventilation involves total removal of the air in a room and replacement with fresh air. The system allows heat to be recovered from the exhausted air to save on heating costs. However, if such a ventilation system were designed to sufficiently remove ETS, the ventilation rate would have to be increased to an unachievable rate.

Air Cleaning Devices include a variety of products that recycle air but in the process use different methods to filter the air. The main problem is that most of the hazardous components of ETS exist in a variety of physical states. There are solid particles of various sizes, gases, and some components that exist in both gas and particle form. Some air cleaning devices can remove gases while others can remove particles. If it were possible to develop a system that would remove both the gases and particles, it would also require the same air exchange rate as the heat recovery systems to get the ETS to the filters. The required maintenance for these systems must also be considered. If the filters are not replaced frequently, the effectiveness of the system suffers. It is also difficult to determine when the filters need to be replaced.

Included in this Appendix is a letter to Dr. Sheela Basrur from James Repace, M.Sc., physicist and ventilation expert, dated November 15, 1996, providing a more thorough analysis of these ventilation systems.

Appendix III

Options for a New ETS By-law

The following options for a new ETS by-law were considered during the research and consultation process :

Appendix V

Smoke-free Initiatives in Other Jurisdictions

The following gives detail on smoke-free by-laws in Canada and the United States; starting with those with the tightest restrictions:

CANADA

VANCOUVER, B.C. - Smoke-free workplaces and smoke-free in restaurants that allow minors

History:

March 12, 1996 Vancouver City Council approved a series of recommendations to prohibit smoking in workplaces, restaurants and common public areas in other buildings that allow access to minors, and workplaces.

By-law effective May 31, 1996; active enforcement not pursued until Dec. 1, 1996 to allow for education of the public and operators.

By-law components:

Exclusions for adult-oriented establishment including bars, cabarets, casinos, bingo halls.

By-law Effectiveness:

Vancouver Health Department indicates operator compliance is high.

Miscellaneous Information:

By-law has withstood an appeal by the B.C. Restaurant Association to the B.C. Court of Appeal.

The Province of British Columbia introduced legislation to ban smoking in all workplaces effective April 15, 1998; hospitality type establishments exempted until Jan. 1, 2000.

CAPITAL REGIONAL DISTRICT, B.C. - Smoke-free

History & By-law Components:

The Board of the Capital Regional District passed the Capital Regional District Clean Air By-law which prohibits smoking in all public places (including restaurants and bars) as of January 1, 1999. The by-law affects 12 municipalities and 4 electoral areas in and around Victoria.

By-law Effectiveness:

Early stages of implementation, with changes being made to the by-law to require owners to ensure compliance.

VAUGHAN, ONT. - Smoke-free

History & By-law Components:

Jan. 29, 1996 the City of Vaughan endorsed a draft by-law making workplaces and all public places including restaurants smoke-free May 1, 1996. As a result of a later amendment, banquet halls, bars/tavern, billiard and bingo halls and institutional-residential buildings were exempted until October 1996. A further amendment allowed restaurants, bars, banquet halls, bowling allies and billiard halls to construct DSRs of up to 25% of the floor area, and bingo halls to construct DSRs of up to 50% of their floor area.

By-law Effectiveness - Strictly enforced, operator compliance high.

WINDSOR, ONT. - Smoke-free commitment for May 1999

History& By-law Components:

On Jan. 3, 1995 the City of Windsor passed a by-law making all restaurants smoke-free by May 31, 1999. Mixed use establishments (restaurant by day, bar by night) will also be smoke-free when they are operating as restaurants.

Windsor has a licensing system that allows for the differentiation of establishments, e.g. restaurants vs adult establishments and mixed use establishments. Adult and mixed use establishments are not required to have non-smoking space, but they must prohibit minors. Failure to comply may result in non-renewal of licence.

HAMILTON-WENTWORTH, ONT. - Smoke-free commitment for 2000.

History:

During the November 1997 municipal election, Hamilton-Wentworth had a plebiscite on tobacco control. Results indicated that 73% of voters favour a model by-law to prohibit smoking in all public places and workplaces (with exceptions) by June 1, 2000.

By-law components:

Restaurants:

Five of six municipalities currently require 70% or more of seating to be non-smoking;

Four of six, require 75% non-smoking for restaurants less than 100 square metres and 90% for larger restaurants, or proprietors can have up to 50% smoking if they provide fully enclosed separately ventilated DSRs. As of June 1, 2000 smoking will only be allowed in DSRs in these four municipalities.

Bars:

Restrictions are more lenient for establishments that have a "no minors" policy, ranging from 25%-50% throughout the municipalities.

Other:

Billiard and bingo halls, bowling and gaming centres and public halls can have a maximum of 50% smoking. Most other public places, including taxi cabs and food courts, are smoke-free.

GUELPH, ONT. - Smoke-free commitment for 2000.

History & By-law Components:

July 17, 1995, the City of Guelph adopted Municipal Code amendments that make all public places, including restaurants, smoke-free in 2000.

Currently, restaurants must designate 75% of their seating as non-smoking. Workplaces became smoke-free Jan. 1, 1996.

PETERBOROUGH, ONT. - Smoke-free commitment for 2000.

History & By-law components:

Workplaces: smoke-free as of Jan. 1998; food courts, theatres and common areas of residential and municipal buildings smoke-free since 1997.

Restaurants and entertainment facilities, smoke-free in 2000. Currently; over 40 seats, 75% smoke-free until 9 p.m., 50% after 9 p.m. Bingo halls, 50% non smoking; bowling centres, 75%.

WATERLOO, ONT. - Smoke-free commitment for 2000.

History & By-law Components:

(a)Nov. 1, 1996, restaurants must designate 50% of seating area as non-smoking, and will be smoke-free in 2000. Food courts smoke-free since Nov. 1, 1996.

(b)DSRs will not be permitted.

(c)Bars may have up to 100% of their floor space as a smoking area until the year 2000, at which time they must be smoke-free;

(d)Bingo halls must be 25% smoke-free: 50% in 2000. Places of amusement (bowling alleys, billiard halls, etc) must designate 25% of their space non-smoking, and be smoke-free in 2000.

(e)Private and public facilities (hall, room or banquet area) must designate 25% of the seating area non-smoking and all public and private facilities must be smoke-free in 2000. (Note: a private facility means any hall, banquet area or room that is privately owned and actually in use which has more than 10 people in attendance for the purpose of eating and/or consuming alcohol).

PEEL REGION, ONT. - Smoke-free commitment for 2001

History:

The Region of Peel has gone through a public consultation on smoke-free public places and workplaces. Peel Regional Council has endorsed the goal of smoke-free public places and workplaces by 2001. The Health Department is currently working with the municipalities of Brampton, Caledon and Mississauga. The aim is to be consistent with the new ETS by-law in the new City of Toronto. At the current time, restaurants in each of the three municipalities are 70/30 non-smoking.

BRANTFORD, ONT. - Smoke-free commitment for 2002

History:

June 1997 City Council considered a by-law making public places smoke-free by 2000. In March 1998, a by-law was passed making public places smoke-free by 2002. Percentages of smoke-free seating will be increased gradually.

LONDON, ONT. - Smoke-free commitment for 2002

History:

Nov. 15, 1993 the City of London passed a by-law making restaurants smoke-free by January 1, 2002. The by-law was created in consultation with the Ontario Restaurant Association (ORA) and will be reviewed with the ORA in 2000.

By-law Components:

Restaurant:

Less than 25 seats, unrestricted smoking. More than 25 seats, 75% non-smoking.

Bars and Billiard Halls:

Playing area may be 100% smoking.

Bingo Halls:

60% of the total area may be smoking.

HALTON REGION, ONT.

Oakville

History & by-law components:

Workplaces are smoke-free; DSRs permitted.

Restaurants are 70% non-smoking. The percentage is reviewed each year to keep pace with current smoking rates.

Burlington

History:

In May 1998 City Council passed a by-law making restaurants 70% non-smoking. Restaurants that have DSRs or a house policy prohibiting minors under 19 may have 50% of the seating area for smoking. Bingo halls, bowling centres and billiard halls are 50/50.

PICKERING, ONT.

By-law Components:

Municipal by-law requires a minimum of 70% non-smoking seating in restaurants and bars. Bingo halls, bowling alleys and billiard halls must provide 50% of the floor area as non-smoking.

YORK REGION, ONT. - Smoke-free commitment for 2001

History:

In 1998, York Regional Council formed a committee with representatives from all nine municipalities, school boards, health associations, police and Youth Advisory Board, to develop a uniform ETS by-law for the region for public places. Each of the nine municipalities would then adopt the by-law locally. There is a desire for each municipality to maintain control over their respective ETS by-laws.

The committee wants all community centres and arenas in the region to become smoke-free, with a phased in approach for other public places until smoke-free is reached by the end of 2001. Current restrictions for smoking in restaurants vary within each of the York Region municipalities, e.g., smoke-free in the City of Vaughan, 50% non-smoking in Markham, and 20% non-smoking in Richmond Hill. The municipalities of Aurora and King City have no restrictions for smoking in public places.

DURHAM REGION, ONT.

There is no regional activity for smoke-free by-laws at this time. However, individual municipalities have been making changes to their respective by-laws in the past few years.

UNITED STATES

STATE OF CALIFORNIA - Smoke-free

By-law History and components:

Assembly Bill 13 (AB 13) prohibits smoking in all California's enclosed workplaces, including restaurants, bars, taverns and casinos. Workplace by-law came into effect Jan. 1, 1995; bars, taverns and casinos in February 1998.

Smoking prohibition in effect until the Occupational Safety and Health Standards Board or the Federal Environmental Protection Agency adopts a regulation reducing the level of employee exposure to smoke to a level that would prevent anything other than an insignificantly harmful effect to exposed employees.

In February 1998, the Legislative Assembly of California voted to suspend the ban on smoking in bars and taverns for two years. This must be confirmed by the State Senate. Reports from California Health Department and media, indicate the Senate will not support suspension. Therefore, at the current time restaurants and bars are required to be smoke-free.

VERMONT - smoke-free

Components of Legislation:

The State of Vermont prohibits smoking in all public places including restaurants and bars as of July 1, 1995. Establishments with a "cabaret" licence may permit designated smoking areas. A cabaret licence is issued to establishments providing primarily entertainment, dancing and the sale of alcoholic beverages to the public and not the service of food.

NEW YORK CITY

By-law Components:

Smoking is prohibited in dining areas of all restaurants seating more than 35 people; permitted in bars and bar areas of restaurants.

ERIE COUNTY, N.Y.

By-law Components:

Smoking is banned in open-air arenas of more than 5,000 seats; lobbies, hallways and other common areas in apartment buildings, condominiums and multiple residential facilities; all enclosed areas in places of employment; entertainment facilities, including places for lectures and music recitals; places of worship; lobbies, hallways and other common areas in multiple unit commercial facilities; polling places. Restaurants whose establishments include bars, limited smoking to 20% of seating by Jan. 1, 1997, and all dining rooms, rest rooms and waiting areas became smoke-free in 1998. Bowling centres were required to provide smoke-free areas for minors as of Jan. 1, 1998.

Appendix VI

Summary of Communication and Implementation Plan for a Harmonized ETS By-law for the City of Toronto and the progression to smoke-free public places.

Goal:

To reduce exposure to Environmental Tobacco Smoke (ETS) by supporting the implementation of a harmonized by-law and preparing operators and the public for smoke-free public places.

Overall strategy:

Former municipalities have supported ETS by-law changes with communication campaigns to inform and educate operators and the public about the health effects of exposure to ETS, and to increase acceptance of health protective by-laws. As well, during the past 10 years there have been campaigns designed to supplement, rather than implement, ETS by-laws. The most recent is the "Go for the Green" campaign, which promotes smoke-free dining and is in the process of becoming City-wide. During recent community consultations, representatives from the restaurant and hospitality industry identified the need for more education on ETS by-laws. As well, the Ontario Mandatory Health Programs and Services Guidelines requires that the proportion of smoke-free public places and workplaces be increased to 100% by the year 2005; and that tobacco-free living be promoted through ongoing use of community mass media including television, radio, print, transit/billboard ads.

Toronto Public Health will be the communications lead for the by-law, liaising with other city Divisions as appropriate and partnering with other health agencies for communications activities to avoid duplication and to enhance the acceptance of the ETS by-law.

Key audiences:

(a)owners/operators of restaurants, bars, billiard halls, bingo halls, bowling alleys and casinos, and their respective employees and customers;

(b)restaurants choosing to become smoke-free;

(c)parents and care givers concerned about the health of their children, and wanting to take them to smoke-free public places;

(d)people choosing to patronize smoke-free dining establishments

(e)smokers deciding to quit smoking.

Strategic communications considerations:

Tobacco companies spend millions of dollars each year to advertise and promote their products. The Council for Tobacco Free Ontario states that in 1991 the Canadian tobacco industry spent an estimated $80 million on advertising. To try to counteract some of these messages, Public Health must deliver clear, concise messages about the health risks of ETS and on the requirements of health protective ETS by-laws.

To be effective, messages must:

(a)be consistent and from many sources (Siegel, 1998);

(b)repeated often, over a long period of time (Siegel, 1998);

(c)delivered through paid advertising since media relations and public service announcements alone will not guarantee coverage;

(d)delivered through a variety of media to generate integrated messages;

(e)reach both key stakeholders and secondary audiences;

(f)create awareness;

(g)encourage behaviour change.

In consideration of the above, the ETS communications plan attempts to be:

(a)comprehensive; i.e. communications messages and elements relate to each other to maximize impact and use budget effectively;

(b)sustained and targeted both for specific events, such as the by-law implementation date, and occur at regular intervals for maximum effect;

(c)integrated to inform and educate a variety of audience stakeholders, to continue to build support for and compliance with the harmonized by-law, to promote 100% smoke-free public places, and to change attitudes regarding second hand smoke;

(d)consistent in its messages, and using standard graphics for clarity;

(e)repetitive, that is, messages are stated many times (multiple strikes), to maximize recall and retention;

(f)timed appropriately. For example, advertising may need to be booked several months in advance in order to obtain space during peak periods, e.g. holiday season, key dining out periods, or during special promotions such as National Non-Smoking Week.

Specific communication elements:

To have multiple messaging, as outlined in the strategy, the media mix may include;

(a)dailies, including newspaper and specialty print

(b)radio, including advertising during part of the program, and event or traffic sponsorships.

(c)out of home, including street ads, exterior transit shelters, interior subway and bus cards, and subway posters.

(d)television, which delivers a powerful emotional impact and appeals to more of the viewers' senses than any other medium. There are opportunities to purchase :30 second ads on cable TV, such as the Rogers and Shaw Cable TV Guide channel, which can be less costly than producing and purchasing TV ad space. (4)

Strategy:

Informs and educates business owners and operators, food service and hospitality patrons, and the public about:

(a)the health effects of ETS;

(b)how the by-law affects them and how to comply;

(c)where to get information and assistance.

Elements include:

(a)letters to food premises and public places;

(b)signs, as required by the by-law, i.e. "No Smoking" and "Health Warning";

(c)ETS fact sheets e.g. information on the by-law and on ETS risks for restaurant workers and children;

(d)reprints of existing Public Health brochures, including "Facts About Second-Hand Smoke" and "What's the Big Attraction?" (smoke-free dining);

(e)media relations, including, media packages with releases, back grounders, fact sheets, PSAs, copies of ads, dubs of radio spots, brochures; designated spokespersons from Public Health and elsewhere, as appropriate, and tracking media coverage;

(f)telephone help line, staffed with Public Health staff;

(g)internet website, using the city's existing Public Health site, partnered with the Toronto Star's website toronto.com;

(h)employee communications, including intranet, "Inside Toronto"staff newsletter, divisional newsletters, as well as staff newsletters in health agencies, organizations and companies.

(i)promotion of restaurants that voluntarily choose to be smoke-free;

(j)encouragement of more establishments to become smoke-free prior to smoke-free coming into effect;

(k)radio advertising, including several 30 second spots, production and placement several times throughout the year during key periods, e.g. winter holiday season, Valentine's Day, Mother's and Father's Day, graduation, and special events such as World No Tobacco Day and National Non-Smoking Week;

(l)print ads for specialty food and hospitality publications such as Ontario Restaurant News and Food Service and Hospitality Magazine;

(m)interior transit cards, including development, production and placement in subway and bus cars;

(n)exterior transit in bus shelters, including development and production, and placement using the 55 free spaces provided for the city from Mediacom;

(o)promotion of smoking cessation materials and programs for smokers.

To build on the Go for the Green smoke-free dining campaign, and to produce advertising items such as radio spots, Public Health may consider contracting with an external ad agency, through a request for proposal process. The agency may help secure appropriate sponsorship funds; e.g. with a pharmaceutical company or drug store not affiliated with a tobacco company.

Agency fees have been factored in. Newspaper line rates increase each year; cable TV rates may increase. Some taxes may be extra. Translation costs are extra (at approximately 25 to 30 cents a word).

REFERENCES

Abernathy, Tom, & O'Grady, Bill. Exposure to Environmental Tobacco Smoke (ETS) in Public Places: An Exploratory Study, 1996.

Angus Reid Group. No Smoking Bylaw Survey, April 1996.

California State Board of Equalization. Taxable Sales in Restaurants and Bars Following Enactment of Smoke-free Legislation, January 1999.

Corsun, David, L., Young, Cheri, A., & Enz, Cathy, A. Should New York City's Restaurateurs "Lighten Up?": Ithaca, New York, 1995.

Council for Tobacco Free Ontario fact sheet, 1993.

Eisner, Mark D., Smith, Alexander K., & Blanc, Paul D. Bartenders' Respiratory Health After Establishment of Smoke-Free Bars and Taverns. Journal of the American Medical Association, December 9, 1998, Vol. 280, No. 22, 1909-1914.

Glantz, Stanton, A., & Parmley, William, W. Passive Smoking and Heart Disease. Journal of the American Medical Association, April 5, 1995, 1047-1053.

Glantz, Stanton, A., & Smith, Lisa, R.A. The Effects of Ordinances Requiring Smoke-free Restaurants on Restaurant Sales. American Journal of Public Health, July 1994, Vol. 84. No.7, 1081-1085.

Glantz, Stanton, A., & Smith, Lisa, R.A. The Effects of Ordinances Requiring Smoke-free Restaurants and Bars on Revenues: A Follow-Up. American Journal of Public Health, October 1997, Vol. 87, No. 10, 1687-1693.

Health Canada. Smoking Behaviour of Canadians. National Population Health Survey Highlights, January, 1999, No. 1.

Health Canada. The Effects of Tobacco Smoke and Second-Hand Smoke in the Prenatal & Postpartum Periods: A Summary of Literature, February, 1995.

Hyland, A., Cummings, M.K. & Nauenberg, E. Analysis of taxable sales receipts: Was New York City's Smoke-Free Air Act bad for restaurant business. J. Public Health Management Practice, 5(1), 14-21.

Hyland, A. & Cummings, M.K. Restaurant Employment Before and After the New York City Smoke-Free Air Act. J. Public Health Management Practice, 1999, 5(1), 22-27.

La Riviere, A. Room to Breathe, Food Service and Hospitality Magazine, February, 1998, 96-99.

Lothian S., Ferrence R., Ope M. The Impact of Increased Smoking Restrictions on Restaurant Sales in the City of Toronto. Ontario Tobacco Research Unit, February, 1999.

Makomaski-Illing, Eva, M, & Kaiserman, Murray, J. Mortality Attributable to Tobacco Use in Canada and its Regions, 1991. Canadian Journal Of Public Health, July-August, 1995, 257-265.

Maroney, Neal, Sherwood, Deborah, & Stubblebine, Wm., Craig. The Impact of Tobacco Control Ordinances on Restaurant Revenues in California. Claremont, CA, January, 1994.

Ontario Tobacco Research Unit. Monitoring the Ontario Tobacco Strategy, 1997/1998.

Sciacca, John, & Ratliff, Michael. Prohibiting Smoking in Restaurants: Effects on Restaurant Sales. American Journal of Health Promotion, January/February, 1998, Vol. 12, No. 3, 176-184.

Siegel, M. Involuntary Smoking in the Restaurant Workplace. A Review of Employee Exposure and Health Effects. Journal of the American Medical Association, 1993, 270, 490-493.

Siegel, M. Mass Media Antismoking Campaigns: A Powerful Tool for Health Promotion, Annals of Internal Medicine, Vol. 129, No. 2, July 15, 1998

Sly, Tim. Toronto's 1997 Restaurant Smoking By-law: Evaluation of Awareness and Acceptance. November, 1998.