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

Annual Report 2011
Arizona Department of Health Services

Janice K. Brewer, Governor
State of Arizona

Will Humble
Director, Arizona Department of Health Services

ARIZONA DEPARTMENT OF HEALTH SERVICES
Bureau of Epidemiology and Disease Control
Office of Inspection and Compliance
Smoke-Free Arizona Program
150 N. 18th Avenue, Suite 130
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 2011
“It’s a Benefit, Not a Ban”
Executive Summary ___________________________________________________________ 1
1.0

Smoke-Free Arizona Program_____________________________________________ 2
1.1
1.2
1.3
1.3.1
1.3.2
1.4

2.0

Education _____________________________________________________________ 8
2.1
2.2
2.3
2.4
2.5

3.0

Initiating Legal Procedures _________________________________________________________ 24
Achieving Compliance through Legal Proceedings ______________________________________ 24

Protecting Arizonans Health _____________________________________________ 26
6.1
6.2

7.0

Verifying Compliance through Complaint Response and Routine Inspections _________________ 20
Complaint Investigation ___________________________________________________________ 20
Complaint Numbers Stabilize With Increased Compliance throughout Arizona ________________ 21

Enforcement __________________________________________________________ 24
5.1
5.2

6.0

Reaching Out to Public Places and Places of Employment ________________________________ 14
Reaching Out to the Community: Success Stories _______________________________________ 15
Educational Newsletter ____________________________________________________________ 17
Working with Smoke-Free Arizona Partners ___________________________________________ 19

Compliance ___________________________________________________________ 20
4.1
4.2
4.3

5.0

Enhancing the Website: www.smokefreearizona.org ______________________________________ 8
Answering the Information Hotline: 1-877-AZ-STOPS (1-877-297-8677) _____________________ 9
Maintaining the Email Addresses: ___________________________________________________ 11
“No Smoking” Signs______________________________________________________________ 12
Advisory Visits __________________________________________________________________ 13

Outreach _____________________________________________________________ 14
3.1
3.2
3.3
3.4

4.0

Background ______________________________________________________________________ 2
Roles and Responsibilities of ADHS __________________________________________________ 3
Roles and Responsibilities of the County Health Departments ______________________________ 4
Education and Compliance _______________________________________________________ 4
Enforcement of the Law __________________________________________________________ 6
Amount and Source of Program Funding _______________________________________________ 7

State of Tobacco Control Report Card: Smoke-Free Arizona Scores a Grade A ________________ 26
American Journal of Public Health Herman and Walsh Second Hand Smoke Research Study _____ 26

Conclusion ___________________________________________________________ 28

Smoke-Free Arizona Annual Report – June 2011

Executive Summary
On November 7, 2006, Arizona voters approved Proposition 201, the Smoke-Free Arizona Act, A.R.S. §
36-601.01 (“the Act” or “the Law”). The Law went into effect on May 1, 2007, prohibiting smoking
inside and within 20 feet of entrances, open windows, and ventilation systems of most enclosed public
places and places of employment, with a few exemptions.
While the Act prohibits smoking inside most enclosed public places and places of employment in
Arizona, smoking is allowed in establishments that meet specific exemption criteria. There are seven
exemptions of the Act, including private residences, designated smoking rooms in hotels and motels,
retail tobacco stores, Veterans and fraternal clubs, smoking when associated with a religious ceremony
practiced pursuant to the American Indian Religious Freedom Act of 1978, outdoor patios, and theatrical
performances upon a stage or in the course of a film or television production.
Also included in Proposition 201, was the imposition of a two-cent tax per pack of cigarettes to be
deposited into 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 exhibits 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.
The Arizona Department of Health Services (“ADHS”) and all but one of Arizona’s fifteen counties work
together, through delegation agreements, to ensure that Arizonan’s are protected from secondhand smoke
exposure in most enclosed public places and places of employment. This is accomplished through the
combined efforts of ADHS and the county health departments.
The county health departments conduct 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, 2010 and April 30, 2011, a total of 63,882 educational visits, consultations, and on-site
visits were conducted. 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 continued to build outdoor patios, provide designated smoking areas, and establish in-house policies
that are more strict than the Act to accommodate their employees and customers.
During the fourth year after the Law went into effect, between May 1, 2010 and April 30, 2011, a total of
1,450 complaints alleging violations of the Smoke-Free Arizona Act were filed statewide. 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.
A total of 18 NOV’s were issued statewide between May 1, 2010 and April 30, 2011, 2 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. A total of $9,150.00 in civil penalty fines was collected statewide.
In 2010, 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. For the third year in a row, the report has awarded a grade “A” recognizing the continued success of
the Smoke-Free Arizona Act.

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Smoke-Free Arizona Annual Report – June 2011

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 of 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.
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

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Smoke-Free Arizona Annual Report – June 2011

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.
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, open
windows, and ventilation systems, and inside the establishment
• Informing violators by politely requesting that they extinguish
their lit tobacco product or that they smoke outside at least 20
feet away from the entrance, open window, or ventilation system
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 Inspection and
Compliance, 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: 1-877AZSTOPS
(1-877-297-8677), or from the smokefreearizona@azdhs.gov
mailbox
• Taking complaints coming through the complaint line: 1-8774AZNOSMOKE (1-877-429-6676), or from the
nosmokingarizona@azdhs.gov mailbox
• Conducting on-site advisory visits
• Maintaining a statewide database used by the county health
departments for complaint investigations and referrals
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Smoke-Free Arizona Annual Report – June 2011

•
•
•
•
•
•

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

1.3

Roles and Responsibilities of the County Health Departments

1.3.1

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

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Smoke-Free Arizona Annual Report – June 2011

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.
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 3,817,117, 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.

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Smoke-Free Arizona Annual Report – June 2011

Environmental health inspectors and health educators are using the same
approach with regards to education and compliance. The strategy taken
in Maricopa County has proven 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, conducting on-site inspections, and
educating the community about the Law and its
requirements.

1.3.2

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

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.
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

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Smoke-Free Arizona Annual Report – June 2011

case to ADHS for enforcement. The enforcement procedures are
explained in Section 5.0 of this report.
1.4

Amount and Source of Program Funding

The Smoke-Free Arizona Act includes a two-cent tax that is imposed on
each pack of cigarettes. The money collected from this tax is deposited
into the Smoke-Free Arizona Fund and used to enforce the Act. Any
money remaining in the Smoke-Free Arizona Fund, after ADHS and its
delegates have met enforcement obligations for the fiscal year, is
deposited into the Tobacco Products Tax Fund and used for education
programs to reduce and eliminate tobacco use.
The graph below shows the amount of money received monthly in the
Smoke-Free Arizona Fund since November 2006.

Graph 1.1 Smoke-Free Arizona Fund Monthly Tax Revenue

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Smoke-Free Arizona Annual Report – June 2011

2.0

Education

A

s we cross the threshold of the fourth year after implementation
of the Smoke-Free Arizona Act, major strides have been made to
improve the education disseminated and the communication with
the public and businesses of Arizona about the Act.

2.1

Enhancing the Website: www.smokefreearizona.org

As the main channel of communication with the public, business owners,
and other partners throughout Arizona, the Smoke-Free Arizona website
is an essential part of the education outreach of the Smoke-Free Arizona
Program. 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
Act. Useful information on the dangers of secondhand smoke, news,
tips, updates, answers to frequently asked questions about the Law, and
links to valuable resources are also available.
To date, the most popular features of the website are still 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. This year, the sign order page was updated to add our brand
new 4 by 6 inch bilingual stickers. This new sign is not only a benefit to
our Spanish speaking communities, but the new and improved design
makes the signs more clearly visible especially the signs with the 20 foot
rule. A new element, a capcha, was also added to the sign order page this
year. A capcha is a verification feature that prevents automatic or
computer generated submission of sign orders.
In addition, concerned citizens can report violations of the Act by filing a
complaint form online in three easy steps. Allowing concerned citizens
to file complaints alleging violations of the Law is not only mandated by
the Act, but it is also a good tool to aid in education and compliance
assistance.

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Smoke-Free Arizona Annual Report – June 2011

The image below is a print screen of the Smoke-Free Arizona Program
website.

An approximate combined
total of 1,770 calls were
received between May 1,
2010 and April 30, 2011.
ADHS received a total of
1,018 calls during business
hours.

2.2

Answering the Information Hotline: 1-877-AZ-STOPS (1877-297-8677)

As required by the Smoke-Free Arizona Act, ADHS provides a 24/7 tollfree 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 return calls from people requesting further
assistance during the next business day. An approximate combined total
of 1,770 calls were received between May 1, 2010 and April 30, 2011.
ADHS received a total of 1,018 calls during business hours. More than
half of the calls received were inquiries about the Smoke-Free Arizona
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Smoke-Free Arizona Annual Report – June 2011

Act, while the remaining calls were either requests for free signage or
from individuals reporting violations of the Act.
The graph below shows the number of calls received during and after
business hours.
Graph 2.1 Number of Calls Received by ADHS and by the After Hours Answering
Service between May 1, 2010 and April 30, 2011

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,
2010 and April 30, 2011

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Smoke-Free Arizona Annual Report – June 2011

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”),
2. Smoking in multi-family housing,
3. Outdoor patios,
4. Complaint follow-up, and
5. “No Smoking” signage requirements.
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,
2010 and April 30, 2011 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.
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Smoke-Free Arizona Annual Report – June 2011

The nosmokingarizona@azdhs.gov email address is used to process
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.

2.4

“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. All entrances should have signs posted except for
doors leading to an outdoor patio and doors used as an emergency exit.
Signs should include all the required information and be clearly and
conspicuously posted.
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 no longer offers 8 ½ x 11 inch
cardstock signs for businesses and places of employment. Due to the
warm Arizona weather, many signs were fading as time passed by.
Businesses had to replace their “No Smoking” signs more frequently to
keep the signs clearly visible for the public visiting their establishment as
per the requirements of the Act. The Smoke-Free Arizona Program now
offers the more convenient “No Smoking” stickers that can attach to any
surface in four different designs. The 4 by 6 sticker is the most popular
sign with an adhesive on the back and a UV coating on the front to
protect the sign from fading in the Arizona sun.
The Smoke-Free Arizona Program provides the following types of signs:
• 3 x 5 inch vehicle sticker
• 4 x 6 inch English sticker (with or without the 20 Foot Rule
disclosure)
• 4 x 6 inch Bilingual sticker (with or without the 20 Foot Rule
disclosure)
The demand for free signs has remained steady over the last year. A
total of 1,381 sign orders were placed by businesses. In addition, signs
are distributed to businesses during complaint inspections, advisory
visits, educational visits, and routine inspections conducted by county
health educators and health inspectors. A total of 46,575 signs were
distributed statewide.

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Smoke-Free Arizona Annual Report – June 2011

The images below are the bilingual 4 by 6 “No-Smoking” sticker

2.5

Advisory Visits

Smoke-Free Arizona staff provide compliance assistance to proprietors
by performing advisory visits at their place of business. Upon request,
county environmental health inspectors, county health educators, and
ADHS Smoke-Free Arizona Program Specialists visit public places and
places of employment to clarify any questions that the proprietor may
have about a specific area of concern. Most advisory visits are requested
by proprietors that have questions about outdoor patios and/or designated
smoking areas. For this reason, the Smoke-Free Arizona Program
created an Outdoor Patio Advisory Form. The purpose of this advisory
form is to provide guidance about the requirements of outdoor patios as
defined by Arizona Administrative Code R9-2-108. This advisory form
also defines the 20 Foot Rule and further clarifies how it applies to
outdoor patios.
County environmental health inspectors, county health educators, and
Smoke-Free Arizona Program Specialists do not perform plan review for
outdoor patios; however, they can ensure that proprietors understand the
requirements of the outdoor patio exemption. The Outdoor Patio
Advisory Form informs proprietors that the advisory visit does not
indicate compliance with any other code, law, or regulation that may be
required - federal, state, or local - and that it does not constitute
endorsement or acceptance of the current or proposed patio.

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Smoke-Free Arizona Annual Report – June 2011

3.0

Outreach

3.1

Reaching Out to Public Places and Places of Employment

A

rizona county health departments conduct consultations and onsite visits at local businesses, bars, and restaurants and provide
education to ensure continued compliance with the Smoke-Free
Arizona Act. Between May 1, 2010 and April 30, 2011, a total of 63,882
educational visits and consultations were conducted.
Between May 1 2010 and April 30, 2011, the ADHS Smoke-Free
Arizona Program Specialists as well as county health educators and
county environmental health specialists conducted 238 educational
presentations to large employers and community partners such as
hospitals, educational facilities, multi-family housing complexes, car
auction establishments, and merchant associations. Combined, an
estimated 13,230 people attended these educational presentations.
ADHS Smoke-Free Arizona Program Specialists and county health
educators used health fairs as an effective forum to provide education to
the public regarding the requirements of the Smoke-Free Arizona Act.
Some of the health fairs attended by program specialists and health
educators included: large businesses, hospitals, educational facilities,
sporting goods manufacturer(s), and the American Indian Nations and
Tribes Legislative Day.
Car Dealership Outreach Project
Due to an increased volume of inquires and complaints about smoking at
car dealerships, the Smoke-Free Arizona Program Specialists worked to
provide assistance to car dealerships throughout the State. In December
2010, letters were mailed to 1,256 car dealerships explaining the
requirements of the Act and how it applies to the dealerships. Most car
dealerships have bay areas where cars are stored or receive maintenance.
Bay areas were the cause of many questions and concerns, specifically
whether employees are allowed to smoke in these areas or if bay doors
are considered “entrances” under the Act. This letter was the perfect
opportunity to clarify that bay areas are enclosed places of employment
where smoking is prohibited. Additionally, bay doors are entrances into
places of employment and therefore require “No Smoking” signs. In
addition to the letters, proprietors received one of the required “No
Smoking” signs and were encouraged to order or make additional signs
as needed.

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Smoke-Free Arizona Annual Report – June 2011

3.2

Reaching Out to the Community: Success Stories

Coconino County: Encouraging Movement Towards Smoke-Free
Multi-Unit Housing
In 2008-2009 while performing inspections for the Smoke-Free Arizona
Act, the Coconino County Health Department, Tobacco Use Prevention
Program, first sought to educate Flagstaff apartment communities on the
benefits of smoke-free policies and to see whether any had such a policy.
They found none.
In 2009-2010 with the help of other professionals in several different
states, the Coconino County Health Department worked with some
proactive apartment communities in Flagstaff to develop plans for
voluntary smoke-free policies. Some apartment communities designated
select units as smoke-free, while others designated entire building. Other
communities designated all units as smoke-free, one of which went even
further to make all units and the entire grounds smoke-free.

Coconino County leading
the way for Smoke-Free
policies in Multi-Unit
Housing

Come 2010-2011 with a brand new name, the Coconino County Public
Health Services District, Tobacco and Chronic Disease Prevention
Program, went back into the field to re-educate property managers and
hoping to renew interest in voluntary smoke-free policies in multi-unit
housing. The time must have been just right as they found several
property managers dealing with issues relating to smoking.
The Coconino County Public Health Services District found that some of
the communities that had taken smaller steps in years prior were now
moving forward. Two properties that had designated a single building as
smoke-free were already working on making the change for a second
building in response to finding that people were still seeking smoke-free
housing.. The Coconino County Public Health Services District is still
working with communities that are interested in making or enhancing
smoke-free policies. New and renewed interest stems mostly from tenant
complaints about secondhand smoke infiltrating into their apartments.
For those that have made voluntary policies, the Coconino County
Health Department has encouraged them to advertise that smoke-free
units are available at their properties. Through a lot of education and
pavement pounding, the Coconino County Health Department has seen
this idea sprout from a seedling of an idea into a pretty nice blossom of
reality that will hopefully continue to grow.
The Tobacco and Chronic Disease Prevention Program has also been
working very hard to educate the Flagstaff Housing Authority about the
health and monetary benefits that smoke-free policies bring. Nationally,
at least 230 Housing Authorities have adopted some form of smoke-free
policy. Arizona does not have any, but the Coconino County Health
Department has high hopes that the Flagstaff Housing Authority will be
the first. They have presented to the mayor and to the housing authority
and have attended many meetings in regards to this issue. The Tobacco
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Smoke-Free Arizona Annual Report – June 2011

and Chronic Disease Prevention Program hope to be involved in the
implementation of such a policy if they do decide to proceed.
Graham County: Keeping in Touch with the Community Through
Health Fairs
The Graham County Environmental Health Program operated a booth at
the 2011 Mt. Graham Regional Medical Center community health fair.
The health fair was held at the activities’ center at Eastern Arizona
College in Thatcher Arizona on February 25th and 26th. The main
objective for the health fair was to raise awareness about the Smoke-Free
Arizona Act and to provide information about it. The Graham County
Environmental Health Department distributed brochures and spoke with
citizens about the Law and how individuals can submit a complaint if
they feel that the Law is being violated. The Graham County
Environmental Health Program even distributed a few signs to business
owners who needed a sign or additional signs for their buildings. The
Graham County Environmental Health Department feels that the
community health fair was a good avenue for providing education and
outreach to the community to aid in compliance with the Law and the
reporting of violations.

Smoke-Free Arizona
Program Specialists work
towards compliance
through advisory visits in
Santa Cruz County.

Santa Cruz County: Working Towards Compliance Through
Partnerships and Educational Advisory Visits
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 communities. A
continuing partnership with the Nogales Chamber of Commerce is an
effective 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 and to
business proprietors that are members of this organization.
This year’s compliance efforts focused on advisory visits in the Tubac
Area in Santa Cruz County. As previously mentioned, Smoke-Free
Arizona staff provide compliance assistance and education to businesses
and proprietors throughout the State. During the month of March, 56
advisory visits were conducted in Tubac. Proprietors received the
required “No Smoking” signs to post at all business entrances and also a
general brochure that explains the basic information about the
requirements of the Smoke-Free Arizona Act. In addition, as a tool to
both document compliance efforts and provide information to business
proprietors, a new Advisory Form was created and used for these
educational visits. The form provides for the documentation about an
establishment and the visit, but it also includes a list of requirements
from the Act that proprietors must comply with. The Smoke-Free
Arizona Program hopes to see increased compliance as a result of
conducting proactive advisory visits.

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Smoke-Free Arizona Annual Report – June 2011

Yuma County: A Successful Enforcement Case
Although a high level of compliance is still being achieved in Yuma
County, for the first time since the inception of the Smoke-Free Arizona
Act, the Yuma County Tobacco Use Prevention Program was compelled
to use enforcement during this fiscal year. The business had received a
number of complaints against it, the first in August of 2007, with four
subsequent complaints. Through complaint investigations, along with a
number of routine inspections, every effort was made to work with the
manager and staff to bring the establishment into compliance, but it
teetered between compliance and violations. Two written warnings were
issued before finally moving to penalties. The last inspection conducted
in response to a complaint revealed violations, and in view of the history,
penalties were then assessed. The manager was informed of his right to
request a hearing. A hearing was held on March 1, 2010 in the presence
of the hearing officer, who after examining all evidence and listening to
both sides, made a determination to place the business under a
probationary period of six months, during which time inspections would
be conducted. Any violations found during this time period would
require the payment of the original fines along with any new fines
assessed.
The manager vowed to maintain smoke-free standards henceforth, and a
routine inspection conducted shortly after the hearing found the business
to be in compliance. However, in August 2010, near the end of the
probation period, another routine inspection was conducted and
violations were found requiring The Yuma County Tobacco Use
Prevention Program to move forward with the enforcement process;
therefore, assessing civil penalties for the total amount of $2000.00. On
November 9th, 2010 the program received a check from the owner for the
full amount bringing this case to close with the stipulation of future
inspections to be conducted. This case provided the Yuma County
Tobacco Use Prevention Program with the opportunity to experience the
Smoke-Free Arizona Program in its entirety to include the enforcement,
hearing process, and assessing of fines resulting in their most important
success and accomplishment this fiscal year.

3.3

Educational Newsletter

In a continued effort to disseminate information about the Act, the
Smoke-Free Arizona Newsletter was created. The first issue of the
second volume of the newsletter was designed with the intent of
reviewing what every citizen should know about the 20 Foot Rule and
how it applies to outdoor patios. This issue also informed proprietors
that the Act allows them to declare an area under their control, such as an
outdoor patio, as nonsmoking. More importantly, this newsletter advised
proprietors to contact their local county health department, Department

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Smoke-Free Arizona Annual Report – June 2011

of Liquor Licenses and Control, their local building department, and any
other applicable authority before building or modifying an outdoor patio.
The most recent newsletter was distributed electronically to more than
12,500 business proprietors throughout Arizona by email. The
distribution of the Smoke-Free Arizona Newsletter was a successful and
cost efficient educational outreach effort.
The image below is a copy of the Smoke-Free Arizona Newsletter,
Volume 2 Issue 1.

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Smoke-Free Arizona Annual Report – June 2011

3.4

Working with Smoke-Free Arizona Partners

One of the most important and constant partnerships the Smoke-Free
Arizona Program has is with the county health departments. Through
delegation agreements, county health departments play a major role in
providing education, compliance, and in some instances enforcement of
the Smoke-Free Arizona Act. Each year, an annual training session is
arranged to provide standard and consistent information to county health
educators and county health inspectors. In previous years, the SmokeFree Arizona Program Specialists have traveled to each individual
county to provide these training presentations. In other instances, two or
three counties have come together to be part of the annual training and
thus minimizing travel.

Annual trainings for new
and existing Smoke-Free
Arizona employees help to
achieve consistent statewide
implementation of the
Smoke-Free Arizona Act.

As technology advances, the Smoke-Free Arizona Program is always
looking for new ways to provide continuing education to county health
educators and county health inspectors. Last year, for the first time, the
training was presented using i-linc. This system enabled users from their
computer to log in to i-linc and follow the PowerPoint training
presentation. This system also allows the user to join a conference call to
listen first hand to the presentation in a true webinar style. Users were
able to post questions directly into i-linc at any time without any
reservation or fear of interruption.
For those counties in which county health inspectors play a major role in
the Smoke-Free Arizona Program, there is also one more chance at
continuing education about the Smoke-Free Arizona Program during the
year. Each county health inspector who is a Registered Sanitarian is
required to have at least 12 hours of continuing education units (CEUs).
Towards the end of the year, in November, the ADHS and the Arizona
Sanitarians’ Council put together a conference to help those inspectors
who have not yet fulfilled this requirement. For the past four years, the
Smoke-Free Arizona Program has been requested to present relevant
information about the Act.

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Smoke-Free Arizona Annual Report – June 2011

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.
During the fourth year of the Smoke-Free Arizona Act business
proprietors have continued 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 continue to build
outdoor patios, provide designated smoking areas, and establish in-house
smoking policies that are more strict than the Act to accommodate their
employees and customers.
4.2

Complaint Investigation

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 reinspection 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
Smoke-Free Arizona Program or their county health department.
Complaint investigation findings are entered into a database that can be
accessed by Smoke-Free 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.

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Smoke-Free Arizona Annual Report – June 2011

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.
During the fourth year after the Law went into effect, between May 1,
2010 and April 30, 2011, a total of 1,450 complaints alleging violations
of the Smoke-Free Arizona Act were filed statewide. The numbers of
complaints have continued to level off this year when compared to last
year’s total of 1,389 complaints filed statewide. This is best illustrated
on Graph 4.2. 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 graph below illustrates the number of complaints filed monthly
statewide between May 1, 2010 and April 30, 2011.

Graph 4.1 Total Complaints Filed Statewide from May 1, 2010 to April 30, 2011

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Smoke-Free Arizona Annual Report – June 2011

The counties that received the highest number of complaints are:
Maricopa (61%), Pima (15%), Yavapai (12%), Mohave (3%), and Pinal
(2%). Of the 1,450 complaints received, 1,352 complaints reporting
violations of the Act were located in these five counties. UPDATE
The top five counties that received the highest percentage of complaints
between May 1, 2010 and April 30, 2011 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,
2010 and April 30, 2011 is shown in the map below.

Map 4.2 Number of Complaints for Each County between May 1,
2010 and April 30, 2011

The complaints received during the fourth year after the Law went into
effect remained consistent in comparison to the previous year May 1,
2009 to April 30, 2010. A total of 4,803 complaints were filed during
the first year and a total of 1,776 complaints were filed during the second
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Smoke-Free Arizona Annual Report – June 2011

year. During the third year, the number of complaints continued to
decline to a total of 1,389 complaints filed statewide. The current year,
saw the number of complaints remained consistent with the previous
year. Efforts to educate business owners and incorporating compliance
checks during routine food safety inspections continue to result in
maintaining a steady number of complaints and thus continuing to
achieve compliance statewide.
The line graph below illustrates the comparison between the number of
complaints received during the first, second, third, and fourth year after
the Law went into effect.

Graph 4.2 Comparison of Complaints Filed Monthly Statewide between May 1, 2007 and
April 30, 2011

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Smoke-Free Arizona Annual Report – June 2011

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 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.

A total of 18 NOV’s were
issued statewide between
May 1, 2010 and April 30,
2011, 2 of which were
issued by the ADHS SmokeFree Arizona Program.

To attain consistent statewide enforcement of the Act, a 3rd annual
training was given by ADHS to each county health department. The
annual training provides an opportunity for all existing and new
inspectors to receive uniform training to ensure all inspectors are
implementing the Smoke-Free Arizona Act consistently throughout the
State. The annual training also gives inspectors a chance to ask
enforcement questions specific to their County.

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. An NOV details violations that have
been observed and documented during complaint investigations. A total
of 18 NOV’s were issued statewide between May 1, 2010 and April 30,
2011, 2 of which were issued by the ADHS Smoke-Free Arizona
Program. A total of $9,150.00 in civil penalty fines was collected
statewide. The majority of the NOV’s were issued to proprietors that
permitted employees, customers, or visitors to smoke inside enclosed

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Smoke-Free Arizona Annual Report – June 2011

public places and places of employment. No new cases were brought
before the Superior Court for injunctive relief this year.
The number of NOV’s issued to proprietors of public buildings and
places of employment were greater than the number of NOV’s issued to
retail food establishments. 14 NOV’s were issued to proprietors of
places of employment and public places, such as real estate offices, law
offices, insurance services, and trucking companies. 4 NOV’s were
issued to proprietors of retail food establishments, such as bars,
restaurants, and grocery stores.
Of the 2 NOV’s issued by the ADHS Smoke-Free Arizona Program, 1
case was closed out and 1 has been settled and is currently pending
monthly civil penalty payments. A total of $2,900.00 in possible civil
penalty fines was assessed. Settlement agreements were not reached
with either business proprietor. A total of $1,950.00 in fines were
collected in time to be included in this annual report, as noted above one
case is pending monthly payments.
In previous annual reports, ADHS indicated that settlement agreements
have been met which included a lesser fine; however, the remainder of
the original fine was deferred, as long as the business is not found in
violation of the Act at any time in the future. Should a business be found
in violation after signing a settlement agreement, the deferred amount
must be paid and additional fines may be assessed. Between May 1,
2010 and April 30, 2011 ADHS had 2 cases in which the establishment
violated the consent agreement and thus were subject to the previously
deferred amount, totaling $2,100.00. ADHS notified both establishment
proprietors at least 3 times and were requested to make payment of the
deferred amount. Both proprietors chose not to respond to ADHS as a
result both were referred to Arizona Attorney General’s Collection
Department. Additionally, when combining all enforcement cases issued
since May 1, 2007 that have been referred to collections for non-payment
of civil penalties this totals $21,000.00. One request for injunction and
two NOV’s issued by ADHS between May ’09 and April ’10 were not
resolved during that year and were subsequently resolved during the
current year. The proprietors faced a total of $8,000.00 in civil penalties.
The total civil penalty amount collected by ADHS was $4,800.00. The
remaining $3,200.00 has been referred to collections for non-payment
and is included in the above reported collections referral total.
During the fourth year 4 administrative hearings were held to determine
the outcome of 4 enforcement cases statewide. 2 administrative hearings
were held between May ’09 and April ’10. The outcome for all 6
hearing decisions were issued in favor of ADHS and found the
proprietors to be in violation of the Smoke-Free Arizona Act.

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Smoke-Free Arizona Annual Report – June 2011

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 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 35 states that have passed
comprehensive smoke-free air laws that protect
the public and workers from the dangers of
secondhand smoke in workplaces and/or
restaurants and/or bars (as of April 1, 2011).

The Herman and Walsh
Research Study found a
decrease of hospital
admissions in the 13
months after the
implementation of the
Smoke-Free Arizona Act in
nonban counties.

This year once again and for the third
consecutive year, Arizona earned a grade A in
The American Lung Association State of
Tobacco Control 2010 report, for maintaining a
strong and comprehensive enforcement program of the Smoke-Free
Arizona Act. The report states that Arizona’s statewide smoke-free
workplace law, also known as Smoke-Free Arizona, has had continued
success. The American Lung Association works diligently with
organizations, state departments, and legislators to address tobacco
control issues. The Arizona Department of Health Services continues to
work in partnership with the Arizona American Lung Association to
make sure that the Law is appropriately enforced throughout the state.

6.2

American Journal of Public Health Herman and Walsh
Second Hand Smoke Research Study

In May 2010, the Hospital Admissions for Acute Myocardial Infarction,
Angina, Stroke, and Asthma After Implementation of Arizona’s
Comprehensive Statewide Smoking Ban study was published. The study
was conducted by Patricia M. Herman and Michele E. Walsh from the
Evaluation, Research, and Development Unit from the Department of
Psychology at the University of Arizona in Tucson. This study examined
the impact of the implementation of the Smoke-Free Arizona Act, a
statewide comprehensive smoking ban that became effective on May 1,
2007, on hospital admissions. This study focused on hospital admissions
due to acute myocardial infarction (AMI), angina, stroke, and asthma,
which are diagnoses closely related to exposure to secondhand smoke
(SHS), and used four diagnoses not associated with SHS as a control
(appendicitis, kidney stones, acute cholecystitis, and ulcers).

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Smoke-Free Arizona Annual Report – June 2011

The data used in the study was collected between January 2004 and May
2008 by 87 hospitals that routinely report to the Arizona Department of
Health Services. Because local smoking bans were already in effect in
some cities and counties throughout Arizona, this research study
compared these counties (“ban counties”) to counties with no official city
or county smoking ban (“non-ban counties”). The Herman and Walsh
research team found a decrease of 13% in AMI, 33% in angina, 14% in
stroke, and 22% in asthma cases in a 13 month period after the
implementation of the Smoke-Free Arizona Act. They estimated an
approximate reduction in hospital costs of $16.8 million.

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Smoke-Free Arizona Annual Report – June 2011

7.0

Conclusion

T

he fourth year of the Smoke-Free Arizona Act saw a continuous
number of inquiries from Arizona citizens and a stabilization of
complaints filed by concerned citizens. Partnerships with county
health educators and county environmental health inspectors
provided education and timely complaint assistance to citizens and
business owners throughout their communities.
Providing awareness of the Act results in higher levels of compliance.
This was achieved in multiple ways including but not limited to;
educational outreach, compliance assistance during complaint
inspections, advisory visits, health fairs, conferences and the media.
Secondhand smoke research studies such as the one published in the
American Journal of Public Health, conducted by Herman and Walsh;
demonstrate to the public the importance and benefit of smoke-free laws
such as the Smoke-Free Arizona Act. The study presented how
successful implementation with the continued cooperation from citizens
and business owners lead to a healthier community.
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 1,450 complaints were filed between
May 1, 2010 and April 30, 2011. Most of the complaints, as in years
past, 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. Compared to the number of complaints, only a minimal
number of complaints resulted in legal proceedings. Enforcement took
place only when educational efforts did not result in timely compliance.
We are pleased to report that the fourth year of implementation of the
Smoke-Free Arizona Act has continued to provide cleaner air for the
citizens of Arizona demonstrating “It’s a Benefit, Not a Ban.”

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Smoke-Free Arizona Annual Report – June 2011

For questions regarding this report please contact:
Krystal Colburn
Program Manager, Smoke-Free Arizona
Arizona Department of Health Services
Office of Inspection and Compliance
150 North 18th Avenue, Suite 130
Phoenix, AZ 85007
602-364-3449
Krystal.colburn@azdhs.gov

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