The Smoke-Free Arizona Act
“It’s a Benefit, Not a Ban!”

2009 Annual Report

Arizona Department of Health Services

Janice K. Brewer, Governor
State of Arizona

Will Humble
Interim Director, Arizona Department of Health Services

ARIZONA DEPARTMENT OF HEALTH SERVICES
Bureau of Epidemiology and Disease Control
Office of Environmental Health
Smoke-Free Arizona Program
150 N. 18th Avenue, Suite 430
Phoenix, Arizona 85007-3245
(602) 364-3122

This publication can be made available in alternative format.
Please contact the number listed above.

Permission to quote from or reproduce materials from this publication
is granted when due acknowledgment is made.

“Equal Opportunity/Reasonable Accommodation Employer”

Table of Contents
Annual Report 2009
“It’s a Benefit, Not a Ban”
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.0

Smoke-Free Arizona Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.2 Roles and Responsibilities of ADHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 Roles and Responsibilities of County Health Departments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.3.1 Building on County Health Departments Strengths for Education and Compliance . .. . . . . . . . 4
1.3.2 Empowering the Counties for Successful Enforcement of the Law . . . . . . . . . . . . . . . . . . . . . . . 6

2.0

Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1 Enhancing the Website smokefreearizona.org . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.2 Answering the Information Line 1-877-AZ-STOPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.3 Maintaining smokefreearizona@azdhs.gov and nosmokingarizona@azdhs.gov . . . . . . . . . . . . . . . . 9
2.4 Complimentary “No Smoking” Signs. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.5 Smoke-Free Arizona Brochures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.6 Keeping Education and Compliance Cleared of Mixed Messages . . . ... . . . .. . . . . . . . . . . . . . . . . . 11

3.0

Outreach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 12
3.1 Public Places and Places of Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3.2 In the Community: Success Stories . . . . . . . . . . . . . . . . . .. . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . 12

4.0

Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1 Verifying Compliance through Complaint Response and Routine Inspections. . . . . . . . . . . . . . . . .
4.2 Complaint Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3 Complaint Numbers Stabilize with Increased Compliance throughout Arizona. . . . . . . . . . . . . . . .

15
15
15
15

5.0

Enforcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.1 Initiating Legal Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2 Achieving Compliance through Legal Proceedings . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.3 Update on the Retail Tobacco Store Exemption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19
19
19
20

6.0

Protecting Arizonans Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 21
6.1 2008 State of Tobacco Control Report Card. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
6.2 Arizona’s Smoking Rate Improves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
6.3 Creating a Smoke-Free Environment on Hospital Grounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
6.4 Achieving Smoke-Free Compliance at Sky Harbor International Airport . . . . . . . . . . .. . . . . . . . . . . 22

7.0

Economic Impact Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

8.0

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Smoke-Free Arizona Annual Report – June 2009

Executive Summary
On November 7, 2006, Arizona voters approved Proposition 201, the Smoke-Free Arizona Act, A.R.S. § 36601.01 (“the Act” or “the Law”). The Law went into effect on May 1, 2007, and prohibits smoking inside and
within 20 feet of entrances of most enclosed public places and places of employment, with a few exemptions.
Also included in the Proposition was a two-cent tax per pack of cigarettes to be deposited in the Smoke-Free
Arizona Fund, which must be used to enforce the provisions of the Law. If a proprietor of an establishment does
not correct violations as requested, demonstrates willful violations, or a pattern of noncompliance with the Act,
they are subject to enforcement action. They may receive a Notice of Violation (“NOV”) or an assessment of
civil penalty fines between $100 and $500 for each violation. If injunctive relief is requested, the Superior Court
may impose appropriate injunctive relief and civil penalty fines up to $5,000 per violation.
Arizona Department of Health Services (“ADHS”) and the county health departments work diligently to protect
Arizonans from secondhand smoke exposure and to ensure uniform compliance with the Law throughout the
State. Delegation agreements have been signed with all but one of the State’s fifteen counties to assist ADHS
with education and compliance activities. Funding is provided to these counties using money from the SmokeFree Arizona Fund.
The county health departments have conducted consultations and on-site visits at local businesses, bars, and
restaurants to provide education and to ensure continued compliance with the Smoke-Free Arizona Act. Between
May 1, 2008 and April 30, 2009, a total of 66,576 educational visits, consultations, and on-site visits were
conducted. Many business proprietors have made steps to go above and beyond the requirements of the SmokeFree Arizona Act. In addition to making the necessary changes to comply with the Act, such as posting the
required “No Smoking” signs and moving ashtrays, proprietors have also built outdoor patios, provided
designated smoking areas, and established in-house policies that are more strict than the Act to accommodate their
employees and customers.
During the second year after the Law went into effect, between May 1, 2008 and April 30, 2009, a total of 1,776
complaints alleging violations of the Smoke-Free Arizona Act were filed statewide. Most of the complaints
consisted of people smoking outside within twenty feet of an entrance and the presence ashtrays located outside
within twenty feet of an entrance.
A total of 40 NOV’s were issued statewide between May 1, 2008 and April 30, 2009, 17 of which were issued by
the ADHS Smoke-Free Arizona Program. The majority of the NOV’s were issued to proprietors that permitted
employees, customers, or visitors to smoke inside enclosed public places and places of employment. The
proprietors that were issued these NOV’s faced a total of $54,800 in civil penalty fines. Numerous settlements
were reached with the said recipients and a total of $14,500 in civil penalty fines were collected.
To attain consistent statewide enforcement of the Act, a toolkit detailing the enforcement routes, administrative or
judicial, was given to each county health department by the ADHS Smoke-Free Arizona Program. The toolkit
provides guidance to the counties that have the delegated authority to enforce the Act and offers general
information to the counties that do not.
In 2008, Arizona earned an A grade on the American Lung Association State of Tobacco Control Report for
maintaining a strong and comprehensive enforcement program of the Smoke-Free Arizona Act. The report states
that the hard-fought efforts of the Smoke-Free Arizona campaign continue to make Arizona a leader in protecting
the health of its citizens.

1

Smoke-Free Arizona Annual Report – June 2009

1.0 Smoke-Free Arizona Program
1.1 Background

S

econdhand smoke is defined as the combination of smoke exhaled by a
smoker and the smoke generated by the burning end of a cigarette (or other
tobacco product). Secondhand smoke is a mixture a 4,000 chemical
compounds that are released into the air as gases and particles. Of these
4,000 compounds, 69 have been identified as carcinogens or cancer-causing
agents, 11 of which have been specifically identified as human carcinogens.
Exposure to secondhand smoke is a health concern for people of all ages. In
1992, the U.S. Environmental Protection Agency (EPA) officially listed
secondhand smoke as a Class A carcinogen. In 2006, the U.S. Surgeon General’s
report stated that there is no risk-free level of exposure to secondhand smoke.
Breathing even a little secondhand smoke can be harmful to your health.

The Smoke-Free Arizona
Act prohibits smoking
inside most enclosed public
places and places of
employment and within
twenty feet of entrances,
open windows, and
ventilation systems.

In November of 2006, the citizens of Arizona made their voices heard by passing
the Smoke-Free Arizona Act, A.R.S. § 36-601.01 (“the Act” or “the Law”). The
Act protects all Arizonans from the harmful effects of secondhand smoke
exposure in most enclosed public places and places of employment and within 20
feet of entrances, open windows, and ventilation systems. Also included in the
Act, is a two-cent tax per pack of cigarettes to be deposited in the Smoke-Free
Arizona Fund, which must be used to enforce the provisions of the Law. The Act
went into effect on May 1, 2007.
The Act prohibits smoking inside enclosed public places and places of
employment with a few exemptions:
1) Private residences, except when used as a licensed child care, adult day care,
or health care facility;
2) Hotel and motel rooms that are rented to guests and are designated as smoking
rooms; provided however that not more than fifty percent of rooms rented to
guests in a hotel or motel are so designated;
3) Retail tobacco stores that are physically separated so that smoke from retail
tobacco stores does not infiltrate into areas where smoking is prohibited under
the provisions of this section;
4) Veterans and fraternal clubs when they are not open to the general public;
5) Smoking when associated with a religious ceremony practiced pursuant to the
American Indian Religious Freedom Act of 1978;
6) Outdoor patios so long as tobacco smoke does not enter areas where smoking
is prohibited through entrances, windows, ventilation systems, or other means;
and
7) A theatrical performance upon a stage or in the course of a film or television
production
For each exemption to the Act, there are specific requirements that must be met
to qualify. These criteria are defined in the Act and in the Arizona
Administrative Code, Title 9, Chapter 2, Article 1.

2

Smoke-Free Arizona Annual Report – June 2009

Under the Act, the proprietor of a public place or a place of employment is
responsible for:
• Removing all indoor ashtrays and smoking receptacles and moving all
outdoors ashtrays and smoking receptacles at least 20 feet away of
entrances
• Posting the required “No Smoking” signs at every entrance into the
establishment
• Educating their employees about the Act
• Prohibiting anyone, such as employees, vendors, visitors, and customers
from smoking within 20 feet of all entrances and inside the establishment
• Informing violators by politely requesting that they extinguish their lit
tobacco product or that they move at least 20 feet away from the entrance
to smoke
If a proprietor of an establishment does not correct violations as requested,
demonstrates willful violations, or a pattern of noncompliance with the Act, they
are subject to enforcement action. They may receive a Notice of Violation
(“NOV”) or an assessment of civil penalty fines between $100 and $500 for each
violation. If injunctive relief is requested, the Superior Court may impose
appropriate injunctive relief and civil penalty fines up to $5,000 per violation.
1.2 Roles and Responsibilities of ADHS
The provisions of the Act assign implementation and enforcement of the Law to
ADHS. In order to accomplish this, the Office of Environmental Health, due to
its extensive experience with education, inspections, investigations, and
enforcement, oversees the Smoke-Free Arizona Program.
The Smoke- Free Arizona Program is responsible for:
• Providing free signage to businesses
• Maintaining the Smoke-Free Arizona website: www.smokefreearizona.org
• Answering inquiries coming via the information line: 1-877-AZSTOPS
(1-877-297-8677
• Taking complaints coming from the complaint line: 1-877-4AZNOSMOKE
(1-877-429-6676), or from the nosmokingarizona@azdhs.gov mailbox
• Answering inquiries from the smokefreearizona@azdhs.gov mailbox
• Conducting on-site advisory visits
• Maintaining a statewide database used by the county health departments for
complaint investigations and referrals
• Providing training to new and existing health educators and environmental
health inspectors
• Providing educational materials to county health departments
• Assisting county health departments during complaint investigations or
advisory visits by riding along with the health educators or the environmental
health inspectors
• Providing guidance to the county health departments with regards to
education, compliance, and enforcement
• Initiating enforcement procedures for cases referred by Maricopa, Gila,
Pinal, Yavapai, Cochise, and Santa Cruz counties
• Conducting education and compliance activities in Santa Cruz County

3

Smoke-Free Arizona Annual Report – June 2009

1.3 Roles and Responsibilities of the County Health Departments
1.3.1 Building on County Health Departments Strengths for Education and
Compliance
ADHS and the county health departments work diligently to protect all
Arizonans from secondhand smoke exposure and to ensure uniform compliance
with the Law throughout the State. Delegation agreements have been signed
with all but one of the State’s fifteen counties to assist ADHS with education and
compliance assistance. Funding is provided to these counties using money from
the Smoke-Free Arizona Fund.
Depending on the infrastructure of the county health department, education and
compliance assistance are performed by either health educators from their
Tobacco Education and Prevention Program or by environmental health
inspectors from their Environmental Services Division. The map below
represents the lead program for each county:
Map 1.1 Lead Program Responsible for Education and Compliance for Each
County Health Department
ADHS and the county
health departments work
diligently to protect all
Arizonans from secondhand
smoke exposure and to
ensure uniform compliance
with the Law throughout
the State.

Environmental Services Division (ESD)
Tobacco Education and Prevention (TEP)
ESD and TEP
Arizona Department of Health Services

Environmental Services Division
The Environmental Services Division is the lead program for education and
compliance in Cochise, Gila, Graham, Greenlee, Mohave, Navajo, and Pinal
counties. Environmental health inspectors verify compliance and provide
education about the Act during routine food safety and environmental health
inspections. Smoke-Free Arizona violations have been included on inspection
checklists to monitor compliance with the Act. In addition, environmental health
inspectors carry “No Smoking” signs and educational brochures for distribution
during routine inspections and complaint investigations.
Tobacco Education and Prevention Program
The Tobacco Education and Prevention Program is responsible for compliance
and education in Apache, Coconino, La Paz, Pima, Yavapai, and Yuma counties.
Health educators have been actively working with businesses in their
communities by providing education about the Smoke-Free Arizona Act and
explaining the benefits of smoke-free environments.

4

Smoke-Free Arizona Annual Report – June 2009

In these counties, a solid partnership exists between the Tobacco Education and
Prevention Program and the Environmental Services Division. For example if an
environmental health inspector observes a smoking violation during a routine
inspection in a food establishment, he or she will notify the health educator about
their observation(s). The health educator will follow-up with the person in
charge of the food establishment to ensure compliance with the Law.
Dual Lead Programs – Environmental Services Division & Tobacco Education
and Prevention Program

With a population of 3,880,181, Maricopa County is by far
Arizona's most populous county, encompassing more than
half of the State's residents. Joining efforts of health
educators from the Tobacco Education and Prevention
Program and environmental health inspectors from the
Environmental Health Services Division is the key to
ensuring compliance in Maricopa County.
For establishments permitted under the Maricopa County Health Code, such as
restaurants, bars, grocery stores, hotels/motels, and public accommodations,
education and complaint investigations are conducted by environmental health
inspectors. For non-permitted establishments such as retail stores, repair shops,
business offices, and shopping centers, education and complaint investigations
are conducted by health educators from the Tobacco Education and Prevention
Program.
Environmental health inspectors and health educators are using the same
approach with regards to education and compliance. The strategy taken in
Maricopa County revealed to be a great success.
ADHS – Santa Cruz County
The ADHS Smoke-Free Arizona Program is responsible for
education and compliance in Santa Cruz County. This
includes investigating complaints and conducting on-site
inspections. In addition, surveys have been conducted by
visiting business complexes, shopping centers, and major
public places in the Nogales area in order to assess
compliance with the Act. Following the assessment,
education was provided to the business owners that were
found out of compliance.
1.3.2 Empowering the Counties for Successful Enforcement of the Law
Nine county health departments have the delegated authority for enforcement
activities such as issuing NOV’s, assessing civil penalty fines, attending
administrative hearings, and seeking injunctive relief.

5

Smoke-Free Arizona Annual Report – June 2009

The map below illustrates who is responsible for enforcement in each county.
Map 1.2 Enforcement Responsibilities for each County Health Department

Arizona Department of Health Services
County Enforcement

The counties conducting their own enforcement activities are Apache, Coconino,
Graham, Greenlee, La Paz, Mohave, Navajo, Pima and Yuma. For these counties,
the delegation agreement delineates the enforcement duties and additional
funding is provided.
Nine counties have the
delegated authority for
enforcement; ADHS
provides assistance for
enforcement for the
remaining six counties.

For the remaining six counties, Maricopa, Gila, Cochise, Yavapai, Pinal, and
Santa Cruz, ADHS provides assistance for enforcement. This means that once a
pattern of noncompliance is documented, or there is evidence of willful
violations of the Act, the county health department refers the case to ADHS for
enforcement. The enforcement procedures are explained in Section 5.0 of this
report.

6

Smoke-Free Arizona Annual Report – June 2009

2.0 Education

T

he second year after implementation of the Smoke-Free Arizona Act
consisted of advancements and changes in education and outreach to
better serve the public and businesses of Arizona.

2.1 Enhancing the Website: www.smokefreearizona.org
The Smoke-Free Arizona website is the main form of communication with the
public, business owners, and other partners throughout Arizona. This website
explains the benefits of smoke-free enclosed public places and places of
employment, and provides information about the requirements of the Act,
resulting in a better understanding of the requirements of the Act. The website
was updated throughout the second year to better answer the most frequently
asked questions received via the toll-free information line and recommendations
from statewide partners.
The most popular features of the website are the sign order page and the online
reporting system. Since the Law went into effect, business owners have been able
to order signage free of charge from the website. In addition, concerned citizens
can report violations of the Act by filing a complaint form online in three easy
steps.

7

Smoke-Free Arizona Annual Report – June 2009

2.2 Answering the Information Line: 1-877-AZ-STOPS (1-877-297-8677)

Nearly half of the calls
received by the 24/7 toll-free
information line were
inquiries about the
requirements of the SmokeFree Arizona Act, while the
remaining calls are either
requests for free signage or
reports of violations

As required by the Smoke-Free Arizona Act, ADHS provides a 24/7 toll-free
information line to answer inquiries from the general public and business owners.
During business hours, ADHS Smoke-Free Arizona Program staff answer the
calls. After business hours, live assistance is provided by an answering service
agency. The answering service agency staff is trained to answer general
questions about the Act, fulfill requests for free signage, and document reports of
violations. ADHS Smoke-Free Arizona Program staff returns calls from people
requesting further assistance during the next business day. An approximate
combined total of 3100 calls have been received between May 1, 2008 and April
30, 2009.
ADHS received a total of 1,680 calls during business hours. Nearly half of the
calls were inquiries about the Smoke-Free Arizona Act, while the remaining calls
were either requests for free signage or from individuals reporting violations of
the Act.
The pie chart below shows the categories of calls (by percentage) received during
business hours by ADHS.

Pie Chart 2.1 Percentage of Calls by Category Received by ADHS between May 1, 2008 and
April 30, 2009

Of these calls, the top five types of inquiries received during business hours were
regarding:
1. The reasonable distance from entrances where smoking is prohibited (the “20
Foot Rule”),

8

Smoke-Free Arizona Annual Report – June 2009

2. Issues in multi-family housing with regards to smoke from the neighboring
apartment infiltrating their own apartment,
3. “No Smoking” signage requirements,
4. Outdoor patios, and
5. How complaints are investigated.
The pie chart below illustrates the types of calls received and the most frequent
questions received.
Pie Chart 2.2 Percentage of Calls by Category Received by ADHS between May 1, 2008 and
April 30, 2009 including the Top Five Inquiries

2.3 Maintaining the Email Addresses:
smokefreearizona@azdhs.gov and nosmokingarizona@azdhs.gov
The smokefreearizona@azdhs.gov email address is solely dedicated to answering
questions and providing information to the general public and business owners
about the requirements of the Smoke-Free Arizona Act. The ADHS Smoke-Free
Arizona Program specialists are responsible for replying to all inquiries received
in this email mailbox.
The nosmokingarizona@azdhs.gov email address is used to process all reports of
violations. Occasionally this email mailbox will receive general questions from
citizens and business owners, which are answered by an ADHS Smoke-Free
Arizona Program specialist.

9

Smoke-Free Arizona Annual Report – June 2009

2.4 Complimentary “No Smoking” Signs
The Smoke-Free Arizona Act requires that most enclosed public places and
places of employment in Arizona have a “No Smoking” sign posted at every
entrance. To meet the required information, the sign must include:
• The international “No Smoking” symbol or the words “no smoking”;
• A citation to A.R.S. § 36-601.01;
• The telephone number (1-877-4-AZNOSMOKE) for making complaints;
and
• The website address (smokefreearizona.org) for making complaints.
Business owners have the option to order “No Smoking” signs free of charge
from the Smoke-Free Arizona Program or they may choose to create their own
signs as long as the required information is included. The Smoke-Free Arizona
Program provides the following types of signs:
• 3 X 5 inch vehicle sticker
• 8 ½ X 11 inch cardstock (an optional 20 Foot Rule add-on is available)
• 4 X 6 inch sticker (with or without the 20 Foot Rule disclosure)
The demand for free signs has remained steady over the last year.
Approximately 1,800 sign orders were placed by businesses. In addition, signs
are distributed to businesses during complaint inspections, advisory visits,
educational visits, and routine food safety inspections conducted by county
health educators and health inspectors. A total of 65,737 signs were distributed
statewide.

4 X 6 inch sticker with the
20 Foot Rule

4 X 6 inch sticker without the
20 Foot Rule

The most popular sign is the 4 by 6 inch sticker with an adhesive on the back and
a UV coating on the front. Most businesses requested signs that could be affixed
outside tinted windows and are resistant to the extreme heat and sun exposure.
The 4 by 6 inch stickers can be ordered both with and without the 20 Foot Rule
disclosure.

10

Smoke-Free Arizona Annual Report – June 2009

2.5 Smoke-Free Arizona Brochures
The “Clearing the Air about the Smoke-Free Arizona Act” brochure provides
general information about the requirements of the Smoke-Free Arizona Act to
employers and the general public. Additional brochures will become available
soon to answer the most frequently asked questions and concerns from the public
and business owners, including:
• “Clearing the Air for Employers”
• “Clearing the Air About Outdoor Areas”
• “Clearing the Air About Private Residences and Multi-Family Housing”

2.6 Keeping Education and Compliance Clear of Mixed Messages
Information provided to the general public and business owners focuses on the
benefits of smoke-free enclosed public places and places of employment for all
Arizonans. Smoke-Free Arizona Program officials’ role is to increase awareness
of the Smoke-Free Arizona Act and the benefits of smoke-free environments, not
promote cessation. This approach is taken due to the passionate nature of the
Law and to reduce perceived infringement on smokers’ rights. This keeps the
education and compliance efforts clear of mixed messages.
Brochures and educational materials clearly focus on the requirements of the
Law, rather than encouraging tobacco users to quit. The Arizona’s Smokers
Helpline phone number and website are provided as a reference only for
individuals looking for free counseling or information about cessation programs
in their area.

11

Smoke-Free Arizona Annual Report – June 2009

3.0 Outreach
3.1 Reaching Out to Public Places and Places of Employment

A

rizona county health departments have conducted consultations and onsite visits at local businesses, bars, and restaurants to provide education
and to ensure continued compliance with the Smoke-Free Arizona Act.
Between May 1, 2008 and April 30, 2009, a total of 66,576 educational visits and
consultations were conducted.
In addition, the ADHS Smoke-Free Arizona Program specialists as well as
county health educators and county environmental health specialists conducted
365 educational presentations to large employers and community partners such as
colleges, national fraternal organizations, and multiple city departments between
May 1, 2008 and April 30, 2009. Combined an estimated 13,995 people attended
theses educational presentations.
Health fairs were also an opportunity to provide education regarding the
requirements of the Smoke-Free Arizona Act. Some of the health fairs attended
by ADHS Smoke-Free Arizona Program specialists and county health educators
include but are not limited to: large manufacturing plants, chain food
headquarters, and county fairs.
3.2 Reaching Out to the Community: Success Stories
Yuma County: Fostering Compliance with the Act
Bordered by California on the West and Mexico to the South, Yuma County
faces many education and compliance challenges. The city of Yuma is a
temporary home to field laborers, farming companies from California and winter
visitors from other states.
Some of the challenges in dealing with the farming companies is that much of
their transportation vehicles are coming from California, where there is no
requirements for No Smoking signage on vehicles. Another challenge is that a
large number of field workers are smokers and having to be in a transport bus for
sometimes up to 2 hours at a time without lighting up is quite difficult. To
resolve the issue, Yuma County has reached out with educational efforts to
companies involved in the farming business to assist them in complying with the
Act as it applies to “vehicle as places of employment.” The county health
educators provide the businesses with a simple flyer that can be distributed to
their workers with information containing the requirements of the Law. As for
the posting of the no-smoking signs on their vehicles, Yuma County encourage
them to use the No Smoking stickers in a temporary fashion while they are doing
business in Arizona, such as hanging the No Smoking sign inside the bus. These
companies have been very cooperative in enforcing the Smoke Free Act and are
taking it very seriously.
Health educators were also able to contact smaller privately owned taxi services,
and provide education about the Act. “We want to ensure that these companies
are in compliance and that those using these transportation venues have the

12

Smoke-Free Arizona Annual Report – June 2009

benefit of smoke-free environments as they travel”, said Suzanne Cooper, Yuma
County Health Educator.
La Paz County: Measuring the Public Support of the Law
La Paz County Public Health Education & Prevention Program conducted a
Smoke-Free Arizona public opinion survey in the fall of 2008. The survey was
conducted using professional online software that enables the target audience to
respond in a quick and easy manner. The purpose of the survey was to measure
public support of the Law, community compliance, public knowledge of the
dangers of secondhand smoke, and also to educate the community on how to file
smoking complaints.
The results of the survey revealed that public support of the Smoke-Free Arizona
Act is at a staggering 75%. Based on the survey findings, La Paz County will
continue outreach to the public, specifically on how to file complaints, continue
issuing public service announcements, and will continue routine educational
visits. “I was really pleased with the volume of participation. I have a clearer
picture of how the Smoke-free Arizona Act is perceived in our county, and the
feedback had helped me pinpoint areas where extra technical assistance and
education may be needed,” Janan Vences, La Paz County, Smoke-Free Arizona
Coordinator.
“Thank you for helping
make our dining, shopping,
and entertainment
experiences more
breathable!”
La Paz County Citizen,
Opinion Poll 2008

Coconino County: Helping with Smoke-Free Housing
Coconino County, like most other counties, received a substantial number of
complaints involving secondhand tobacco smoke in apartments. Most complaints
were associated with secondhand smoke seepage into individual private units,
balconies and patios.
Although private residences are exempt from the Act, compliance inspections of
the enclosed common areas of the apartment complexes took place. During the
inspections, education on secondhand smoke was presented along with a fact
sheet. Apartment tenants and managers alike had questions and concerns
regarding smoking, secondhand smoke and apartments.
Moreover, there was a continuing interest in smoke free housing. Health
educators decided to provide education about the Smoke-Free Arizona Act to
major apartment complexes in Flagstaff. During the educational visits, managers
were asked if they had a smoking policy in place. Only two of the 51 multifamily housing complexes visited had any sort of existing policy established.
Overwhelmingly, most apartment managers’ main concerns were keeping their
units rented and legality questions concerning smoke free policies. In response a
fact sheet was created addressing the requirements of the Act, health and
financial benefits of smoke free multi unit housing, and legal concerns for the
landlord.
Several apartment complexes expressed interest in exploring the idea of smoke
free multi unit housing. As of this writing, Flagstaff has three apartment
communities that have some degree of a smoke free policy; one where all
buildings are smoke free, one of which will be entirely smoke free by summer’s
end and another with some select units smoke free. A fourth community is
contemplating how far they want to go with a new policy.

13

Smoke-Free Arizona Annual Report – June 2009

The bottom line for most apartment complexes is keeping their units occupied. A
goal of the Coconino County Health Department is that through secondhand
smoke education, more multi unit housing complexes will see the health benefits
for their tenants and thus adopt smoke-free policies on a voluntary basis. A list
of smoke-free apartments is posted on the county website in order to help those
relocating to Flagstaff, find smoke free housing.
Santa Cruz County: Partnering with Resources Involved in the Community
Reaching out to businesses located in Santa Cruz County has been successful
despite the distance between the ADHS Smoke-Free Arizona Program located in
Phoenix and the Santa Cruz County community. Efforts are focused on
networking with agencies involved in the county. For example, one complaint
inspection resulted in establishing contact with the Nogales Fire Department. An
educational presentation explaining the basics of the Smoke-Free Arizona Act
was presented to approximately 15 firemen and administrators who in turn
passed the information along to those who were not able to attend the
presentation. Partnering with the Nogales Chamber of Commerce is another
channel used to stay in touch with business owners. The Chamber of Commerce
provides Smoke-Free Arizona “No Smoking” signs and educational brochures to
the community of Nogales.

14

Smoke-Free Arizona Annual Report – June 2009

4.0 Compliance
4.1 Verifying Compliance through Complaint Response and Routine
Inspections

C

ompliance with the Smoke-Free Arizona Act is continuing to increase
throughout the State. Compliance is monitored through complaint
response inspections at enclosed public places and places of employment.
Additionally, compliance is verified during routine food safety inspections
conducted at foodservice establishments, such as bars and restaurants.
Many business proprietors have made steps to go above and beyond the
requirements of the Smoke-Free Arizona Act. In addition to making the
necessary changes to comply with the Act, such as posting the required “No
Smoking” signs and moving ashtrays, proprietors have also built outdoor patios,
provided designated smoking areas, and established in-house smoking policies
that are more strict than the Act to accommodate their employees and customers.
4.2 Complaint Investigation

Compliance is monitored
through complaint
investigations and during
routine food safety
inspections.

Complaints alleging violations of the Smoke-Free Arizona Act are investigated
by all but one of the State’s fifteen counties (See Map 1.2). Once a complaint is
received and it is determined that the allegations are valid violations of the Act,
an unannounced inspection will take place and/or the business proprietor is
notified within 15 days of the complaint. When necessary, investigations are
performed in pairs, for example, during night inspections and for cases where the
evidence may be difficult to find. If a violation of the Act is observed during an
inspection, the proprietor is requested to correct the violation at the time of the
inspection. If the violation is not corrected at that time, a re-inspection will take
place to verify that a corrective action has been made. Re-inspections have
shown to be an effective approach in achieving compliance.
Complainants may follow-up on their complaints by calling the ADHS SmokeFree Arizona Program or their county health department. Complaint
investigation findings are entered into a database that can be accessed by SmokeFree Arizona Program officials only. Complaints can be located with a
complaint identification number that is issued when a complaint is filed, the
complainants’ last name (if provided), the business name, address, or cross
streets.
4.3 Complaint Numbers Stabilize With Increased Compliance throughout
Arizona
The ADHS Smoke-Free Arizona Program continues to encourage members of
the public to report violations of the Smoke-Free Arizona Act. Complaints can
be filed by one of the following:
• Filling out an online complaint form at www.smokefreearizona.org,
• Calling the toll-free Smoke-Free Arizona hotline at 877-4-AZNOSMOKE (877-429-6676), or
• Sending an e-mail to nosmokingarizona@azdhs.gov.

15

Smoke-Free Arizona Annual Report – June 2009

During the second year after the Law went into effect, between May 1, 2008 and
April 30, 2009, a total of 1,776 complaints alleging violations of the Smoke-Free
Arizona Act were filed statewide. The number of complaints stabilized as
compliance improved throughout the State. Most of the complaints were
regarding people smoking outside within twenty feet of an entrance and the
presence of ashtrays located outside within twenty feet of an entrance.
The table below illustrates the number of complaints filed monthly statewide
between May 1, 2008 and April 30, 2009.
Graph 4.1 Total Complaints Filed Statewide from May 1, 2008 to April 30, 2009

The counties that received the highest number of complaints are: Maricopa
(60%), Pima (15%), Mohave (6%), Yavapai (5%), and Pinal (3%). Of the 1,776
complaints received, 1,564 complaints reporting violations of the Act were for
public places and places of employment located in these five counties.

16

Smoke-Free Arizona Annual Report – June 2009

The top five counties that received the highest percentage of complaints between
May 1, 2008 and April 30, 2009 are shown in the map below.
Map 4.1 Top Five Counties with the Highest Percentage of Complaints

The number of complaints received for each county between May 1, 2008 and
April 30, 2009 is shown in the map below.
Map 4.2 Number of Complaints for Each County between May 1, 2008 and
April 30, 2009

The complaints received during the second year after the Law went into effect
transitioned off in comparison to the first year. A total of 4,803 complaints were
filed during the first year. During the second year, the number of complaints
dropped significantly to a total 1,776 complaints filed statewide. Efforts to
educate business owners and incorporating compliance checks during routine
food safety inspections resulted in a decline in the number of complaints and thus
achieving a higher level of compliance.

17

Smoke-Free Arizona Annual Report – June 2009

The line graph below illustrates the comparison between the number of
complaints received during the first and second year after the Law went into
effect.
Graph 4.2 Comparison of Complaints Filed Monthly Statewide between May 1, 2007 and April 30,
2008 and Between May 1, 2008 and April 30, 2009

18

Smoke-Free Arizona Annual Report – June 2009

5.0 Enforcement
5.1 Initiating Legal Procedures

N

ine of the fifteen Arizona county health departments have the delegated
authority to enforce the provisions of the Smoke-Free Arizona Act.
These include Apache, Coconino, Graham, Greenlee, La Paz, Mohave,
Navajo, Pima, and Yuma counties. The ADHS Smoke-Free Arizona Program is
responsible for enforcement in the remaining six counties, including Cochise,
Gila, Maricopa, Pinal, Santa Cruz, and Yavapai (See Map 1.2).
If a proprietor of an establishment does not correct violations as requested,
demonstrates willful violations, or a pattern of noncompliance with the Act, he or
she is subject to enforcement action and may receive a NOV or an assessment of
civil penalty fines between $100 and $500 for each violation. If injunctive relief
is requested, the Superior Court may impose appropriate injunctive relief and
civil penalty fines up to $5,000 per violation.

Enforcement actions take
place when educational
efforts fail to result in
compliance with the SmokeFree Arizona Act in a timely
manner.

To attain consistent statewide enforcement of the Act, a toolkit detailing the
enforcement routes, administrative or judicial, was given to each county health
department by the ADHS Smoke-Free Arizona Program. The toolkit provides
guidance to the counties that have the delegated authority to enforce the Act and
offers general information to the counties that do not.
5.2 Achieving Compliance through Legal Proceedings
Enforcement actions take place when educational efforts fail to result in
compliance with the Smoke-Free Arizona Act in a timely manner. The ADHS
Smoke-Free Arizona Program has had tremendous support from the Education &
Health Section attorneys from the Office of the Arizona Attorney General and
from the Office of Administrative Rules at ADHS. This support, combined with
an effective enforcement protocol, allows ADHS to better serve the county health
departments when cases are referred to the ADHS Smoke-Free Arizona Program
for enforcement.
Notices of Violation are issued in response to a pattern of noncompliance or
willful violations of the Law. A NOV details violations that have been observed
and documented during complaint investigations. A total of 40 NOV’s were
issued statewide between May 1, 2008 and April 30, 2009, 17 of which were
issued by the ADHS Smoke-Free Arizona Program. The majority of the NOV’s
were issued to proprietors that permitted employees, customers, or visitors to
smoke inside enclosed public places and places of employment. The proprietors
that were issued these NOV’s faced a total of $54,800 in civil penalty fines.
Numerous settlements were reached with the said recipients. A total of $14,500
in civil penalty fines were collected. No cases were brought before the Superior
Court for injunctive relief this year.
The majority of the NOV’s were issued to proprietors of public buildings and
places of employment, rather than retail food establishments. 22 NOV’s were
issued to proprietors of places of employment and public places, such as pest
control companies, law offices, collection agencies, auto repair businesses and

19

Smoke-Free Arizona Annual Report – June 2009

barber shops. 18 NOV’s were issued to proprietors of retail food establishments,
such as bars and grocery stores.
5.3 Update on the Retail Tobacco Store Exemption
In March 2008, the Maricopa County Superior Court ruled that cigar bars are
subject to the Act and thus smoking is prohibited in cigars bars. The owner of a
cigar bar appealed the decision, alleging that his establishment meets the
exemption for retail tobacco store. On September 30, 2008 the Court of Appeals
reverted and remanded the decision of the Maricopa County Superior Court.
ADHS filed a petition with the Arizona Supreme Court to review the Court of
Appeals decision with regards to a cigar bar using the exemption for retail
tobacco stores in order to allow smoking inside the premises. The Arizona
Supreme Court denied the petition.
At this time, the Court of Appeals’ decision remains in effect. In summary, the
Court of Appeals held that a business/facility which satisfies the definition of a
“retail tobacco store” under A.R.S. § 36-601.01(A)(10) qualifies for the statutory
tobacco store exemption to the smoking ban, even if the business/facility is
otherwise prohibited from smoking. The Maricopa County Superior Court will
prepare, in late summer 2009, a final order based on the Court of Appeals’ ruling.

20

Smoke-Free Arizona Annual Report – June 2009

6.0 Protecting Arizonans Health
6.1 State of Tobacco Control Report Card: Smoke-Free Arizona Scores a
Grade A

T

he American Lung Association State of Tobacco Control 2008 report
tracks progress on key tobacco control policies at the state and federal
level and assigns grades to tobacco control laws and regulations enacted.
Arizona is one of 23 states that have passed
comprehensive smoke-free workplace laws protecting the
public and workers from the dangers of secondhand
smoke.

In 2008, Arizona earned a grade A for maintaining a
strong and comprehensive enforcement program of the
Smoke-Free Arizona Act. The report states that the hardfought efforts of the Smoke-Free Arizona campaign continue to make Arizona a
leader in protecting the health of its citizens.
6.2 Arizona’s Smoking Rate Improves
The 2008 Behavioral Risk Factor Survey shows that Arizona’s smoking rate
among adults improved from 19.7% in 2007 to 15.7% in 2008. This is a 20%
drop in the number of Arizonans that smoke. These new figures state that
Arizona has the seventh-lowest rate in the nation in terms of smoking prevalence,
a significant decline from a year earlier when Arizona was 25th-lowest. This data
is coming from the 2008 Behavioral Risk Factor Surveillance System, which is
the U.S. Centers for Disease Control and Prevention’s annual survey of the
nation’s health.
6.3 Creating Smoke-Free Environments on Hospitals Grounds
The Arizona State Hospital became a smoke-free environment on July 1, 2008,
an historic move designed to benefit patients, staff, and visitors. Smoking is no
longer permitted on the grounds of the State's only publicly owned and operated
psychiatric hospital.
"While approximately 23 percent of the general population smokes, the
prevalence is three times higher in persons with other addictions or mental
illness," said John Cooper, Arizona State Hospital CEO. "The heavy rate of
smoking in our patient populations puts them at higher risk of developing
medical consequences from long-term tobacco use, such as emphysema, heart
disease, and cancer."
Besides reducing health care costs for patients, the smoke-free campus policy has
other benefits. Other states with smoke-free policies in their psychiatric hospitals
have observed a reduction in the use of restraints and psychiatric medications,
improved patient supervision, and better participation in therapy sessions.

21

Smoke-Free Arizona Annual Report – June 2009

The Arizona State Hospital is not the only facility that has implemented a smokefree campus policy in Arizona. In 2007, St. Joseph’s Hospital in Phoenix, AT
Still University and Kingman Regional Medical Center developed a tobacco-free
campus policy. In 2008, Banner Heart Hospital, Banner Baywood Medical
Center, Mountain Park Health Center and Phoenix Indian Medical Center also
adopted a tobacco-free campus policy. Carondelet Health Network previously
launched a tobacco-free initiative at all three of its hospitals and most of its
facilities. Carondelet’s hospitals, including St. Mary’s and St. Joseph’s in
Tucson, and Holy Cross Hospital in Nogales, all became tobacco free in March
2006, and it’s newest affiliate, Tucson Heart Hospital, became officially tobacco
free in 2007.
Momentum for smoke-free hospital grounds policies is increasing across the U.S.
More than 1,600 U.S. hospitals and nursing homes have already implemented
smoke-free environment policies.
6.4 Achieving Smoke-Free Compliance at Sky Harbor International Airport
Phoenix Sky Harbor International Airport is one of the top ten busiest airports in
the nation. It served nearly 40 million passengers in 2008. 100,000 people pass
through Sky Harbor everyday. Sky Harbor has 33,000 employees and more than
75 food and beverage locations, and more than 60 retail shops.

“We worked closely with all
of our stakeholders and our
staff to ensure that the
regulations associated with
the Smoke-Free Arizona
Act were understood,
communicated and
enforced,” Becky Gawin,
Deputy Aviation Director

“The City of Phoenix Aviation Department has taken its compliance of the
Smoke-Free Arizona Act very seriously. We went to great lengths to ensure that
we comply with the Law, while facilitating the needs of non-smokers and smokers
alike,” Paul Blue, Assistant Aviation Director.

9
9
9
9
9
9
9
9
9

Sky Harbor’s Compliance Actions:
The Aviation Department responded to other requirements of the Smoke-Free
Arizona Act by completing the following tasks by May 1, 2007:
Removing ashtrays from areas where smoking is now prohibited.
Smoking facilities located in airport concessions and smoking lounges became
nonsmoking on May 1, 2007.
Designating specific outdoor areas for smoking to help the public comply with
the new Law and closed or relocated existing outdoor smoking areas to be
compliant with the Law.
1100 required “No Smoking” signs meeting the Smoke-Free Arizona Act
requirements were installed at all facility entrances and other areas where
smoking is not permitted.
200 additional new signs were designed and installed to improve way-finding to
designated smoking areas and remind the public not to smoke in nonsmoking
areas.
525 City of Phoenix vehicles and 98 airport buses were provided with required
signs including “No Smoking” decals in all passenger windows.
Letters were sent to all airport tenants informing them of the Smoke-Free
Arizona Act.
The Aviation Department sent out weekly emails to all airport tenants updating
them and reminding them of implementation requirements for the new Law.
Public address announcements for airport terminals and visual paging messages
play continuously to remind passengers of the Smoke-Free Arizona Act.

22

Smoke-Free Arizona Annual Report – June 2009

9 Information on Smoke-Free Arizona is located on the Sky Harbor website
phxskyharbor.com, as well as in Sky Harbor publications.
9 Smoke-Free Arizona information is announced in Rental Car Center and interterminal parking shuttle videos.
9 A letter from Aviation Director, Danny Murphy, was sent to 700 Aviation
Department employees to inform them of the Smoke-Free Arizona Act.
9 10,000 educational cards were printed for the public and employees and are
currently being distributed by customer service staff and our volunteer
Navigators.
9 Developed training material and provided staff briefings regarding the new Law
for Aviation Department employees who have enforcement or customer service
responsibilities as part of their job duties.
9 Provided training for Communications Dispatchers on how the new Law impacts
their job and how to handle potential complaints.
9 Provided update briefings to various airport tenants and stakeholders at regular
meetings including power point presentations and handouts.
9 Met with a number of airport tenants to assist with individual concerns about
smoking and nonsmoking locations.
“We worked closely with all of our stakeholders and our staff to ensure that the
regulations associated with the Smoke-Free Arizona Act were understood,
communicated and enforced. We successfully educated employees and
contractors as well as our customers and we continue this education process
through publications, our Web site, overhead announcements and signage,” says
Becky Gawin, Deputy Aviation Director.

23

Smoke-Free Arizona Annual Report – June 2009

7.0 Economic Impact Study

A

DHS contracted with the W.P. Carey School of Business at Arizona State
University to conduct an economic impact study about the effects of the
Smoke-Free Arizona Act on the restaurant and bar industry in Arizona.

In order to assess the economic effect of the statewide ban, two independent
analyses were conducted as part of this study. The first analysis consisted of a
survey of eating and drinking establishments across Arizona. The initial survey
was conducted in May 2007, before the Act went into effect. The survey was
repeated a year later. The second analysis reviewed actual aggregate bar and
restaurant sales data, comparing sales from before and after the implementation
of the Act.
The report on the economic impact study was released on September 2, 2008.
Contrary to what many opponents of the Smoke-Free Arizona Act claimed before
its passage in November of 2006, the report states that the Act did not result in
any distinguishable large-scale economic effects on the restaurant and bar
industry in Arizona. This conclusion is consistent with most studies that have
examined the effect of smoking bans by analyzing actual sales data.
“My hope is that Arizona
will now become one more
example of how the creation
of a smoke-free state can be
done without having a
serious impact on local
businesses,” Bill J. Pfeifer,
President and CEO of the
American Lung
Association of Arizona

Based on the survey, some establishments such as bars with large, well-furnished
outdoor patios indicated that they were actually benefiting from the smoking ban,
while others with only inside seating may have not.
The full report is available online at www.smokefreearizona.org.

24

Smoke-Free Arizona Annual Report – June 2009

8.0 Conclusion

T

he successful implementation of the Smoke-Free Arizona Act is due to the
tremendous efforts of county health educators and county environmental
health inspectors providing education and compliance assistance to
business owners in their community.
Many business proprietors have gone above and beyond the requirements of the
Act. In addition to making the necessary changes to comply with the Act, such
as posting the required “No Smoking” signs, and moving ashtrays, proprietors
have also provided limited designated smoking areas, and established in-house
smoking policies that are more strict than the Act to accommodate their
employees and customers. For example, numerous hospitals including the
Arizona State Hospital have declared their entire campus as “smoke-free,” and
other public places such as Sky Harbor International Airport provides only a
limited number of designated smoking areas on their premises.
The ADHS Smoke-Free Arizona Program continues to encourage members of
the public to report violations of the Act by filling out a complaint form online,
by calling the toll-free complaint line or by sending an Email. A total number of
1,776 complaints were filed between May 1, 2009 and April 30, 2009. Most of
the complaints were regarding people smoking outside, but within 20 feet of an
entrance, and the presence of an ashtray outside within 20 feet of an entrance.
Only a minimal number of complaints resulted in legal proceedings.
Enforcement took place only when educational efforts failed to gain compliance
with the Act in a timely manner.
We are proud to state that two years after the Law went into effect; a high level
of compliance has been achieved statewide. Most employers responded well in
creating smoke-free workplaces thus resulting in cleaner air for Arizona
residents.
The 2008 American Lung Association State of Tobacco Control Report gave a
grade A to the state of Arizona for maintaining a strong and comprehensive
enforcement program of the Smoke-Free Arizona Act. The report states that the
hard-fought efforts of the Smoke-Free Arizona campaign continue to make
Arizona a leader in protecting the health of its citizens.

25

Smoke-Free Arizona Annual Report – June 2009

For questions regarding this report please contact:
Harmony Duport, R.S.
Acting Program Manager, Smoke-Free Arizona
Arizona Department of Health Services
Office of Environmental Health
150 North 18th Avenue, Suite 430
Phoenix, AZ 85007
602-364-3138
duporth@azdhs.gov

26