New Jersey's role as a leader in tobacco control dates back to the 1970s, when public health advocacy groups and New Jersey State government began acting to protect the health of its residents against the dangers of tobacco use. Given the very limited resources available, DHSS is proud of its accomplishments in the areas of age-of-sale enforcement, community mobilization and education. However, without a significant increase in support, program benefits will continue to reach only a small number individuals in a few communities. A well-financed and sustained program is needed to affect long-term, systemic change.

In 1976 Shimp v. New Jersey Bell Telephone Company achieved national attention as a precedent-setting case in the nation; it was the first case to show that freedom from the danger of "secondhand" tobacco smoke should be a right for employees. In that case the Superior Court of New Jersey ruled that under common law, Donna Shimp had a right to a safe workplace, that the smoke from cigarette smoking was harmful to her health, and that her place of business had to restrict smoking in many areas.²⁷ This case increased public awareness of the danger of secondhand smoke and set a precedent for other employers in New Jersey and elsewhere to provide smoke-free work areas.

Following the Shimp ruling, the New Jersey Public Health Council revised the New Jersey sanitary code to include restrictions on smoking in most public places, including workplaces and restaurants. Due to procedural flaws in the code, these revisions were not adopted. However, in the early 1980s the New Jersey Legislature passed several laws restricting or limiting smoking to certain sections in public schools, retail food stores, public transportation and other indoor public places. These laws include the following: employers of more than 50 individuals are required to develop smoking policies (1985); restaurants must post signs regarding whether smoking is allowed (1985); retail food stores and public transportation must prohibit all smoking (1985); and public schools must prohibit smoking (1982).²⁸

There has been bipartisan support for tobacco control in the Executive Branch of State government for several administrations. Under both Governor Kean and Governor Florio, the Executive Branch of State government required smoke-free workplace policies. In 1988 Governor Kean signed the State law restricting the sale of tobacco products to minors. Eight years later Governor Whitman signed legislation to provide the Commissioner of Health and Senior Services with authority to enforce this law. And in 1998 this Governor signed into law an increase in the State's tobacco excise tax, raising the tax on cigarettes from $0.40 to $0.80 per pack. Governor Whitman's decision in 1996 to sue the tobacco industry for the costs associated with treating the diseases caused by tobacco and her decision in 1999 to dedicate 20% of the subsequent settlement payment for a comprehensive tobacco control plan continues this bipartisan tradition of leadership in the area of tobacco control.

In the 1990s tobacco control has been focused more at the local level than at the State level. For example, the right of a municipality to enact local ordinances restricting the sale of tobacco products was established by East Brunswick Township after it eliminated cigarette vending machines. Under the leadership of then-Mayor Jack Sinagra and with the support of the Township Council, the East Brunswick ordinance banning cigarette vending machines was successfully defended against challenges by vending machine operators. Since 1994 more then 150 local ordinances have been passed throughout the State restricting access to or use of tobacco products. These ordinances have been passed at the urging and with the assistance of advocacy groups such as the American Cancer Society, New Jersey Division, American Lung Association of New Jersey, American Heart Association, New Jersey Affiliate, the Medical Society of New Jersey, the New Jersey Group Against Smoking Pollution (NJ GASP), and local coalitions supported through New Jersey ASSIST (American Stop Smoking Intervention Study for Cancer Prevention).²⁹

The success that New Jersey has had in its passage of the tobacco control local ordinances highlights one of New Jersey's great strengths: highly dedicated and skilled public health advocates and advocacy groups willing to collaborate for the public good. In recent years, the Robert Wood Johnson Foundation has provided funding through its "Smokeless States" program to the Medical Society of New Jersey for the support of "New Jersey Breathes". New Jersey Breathes is a coalition of organizations from public, private, government and non-profit sectors interested in decreasing tobacco use in New Jersey. New Jersey Breathes has been especially effective in gaining public support for anti- tobacco initiatives. In 1998 New Jersey Breathes was able to mount a public awareness campaign which helped lead to the increase in the previously mentioned State's tobacco excise tax signed into law by Governor Whitman; this tax is collected by the Department of Treasury for the State General Fund.

New Jersey has numerous other examples of public-private partnerships working for tobacco control. For example, the American Cancer Society, New Jersey Division has partnered with the New Jersey Department of Health and Senior Services in the management of the New Jersey ASSIST Program. The grassroots organization, advocacy expertise and technical assistance of the American Cancer Society, New Jersey Division coupled with the broad policy perspective and management expertise of the Department of Health and Senior Services has helped establish a network of "Clean Air Communities" coalitions in New Jersey. These coalitions have been instrumental in the passage of local ordinances limiting tobacco use.

New Jersey GASP has had a "smoke-free air, everywhere" campaign for twenty-five years. As one of the best-known public health advocacy groups in New Jersey, it has helped hundreds of restaurants to adopt a smoke-free policy and assisted local coalitions in their efforts to affect tobacco-free public policies. The American Lung Association of New Jersey has supported education programs and activities encouraging youth to remain tobacco-free, along with advocacy activities. The American Heart Association, New Jersey Affiliate has been a steadfast supporter of tobacco control initiatives. In addition, the anti-tobacco movement in New Jersey has had the unfailing support of the New Jersey Public Health Association and the New Jersey Health Officers Association.

Partnerships in the public sector have also been a valued resource for tobacco control. The New Jersey Department of Education (DOE) has instituted Core Curriculum Content Standards. Under these standards, schools are required to provide content to students in each grade which teaches the nature of tobacco and its physiological, psychological, sociological and legal effects on the individual, family, and society. In addition, this year the DOE provided a Comprehensive Health and Physical Education Curriculum Framework to all school districts.

The Department of Law and Public Safety and the Governor's Council on Alcoholism and Drug Abuse (GCADA), in cooperation with the Department of Health and Senior Services, have developed the middle school peer leadership initiative, now in its third year of funding. There are 111 participating middle schools. During the school year the peer leaders are guided by adult mentors. The peer leaders teach their peers or younger students about the health effects of tobacco and industry manipulation. By December 31, 1999 it is expected that more than 890 students will have been trained as peer leaders and will be responsible for teaching over 20,000 students. Rutgers University is providing an outcome evaluation of this program, and the preliminary results are positive.

Using limited resources, DHSS has implemented a number of tobacco control initiatives. These initiatives are described below and should be incorporated, where appropriate, into the comprehensive tobacco control program:

• DHSS has dedicated $1.5 million of federal funds for a two year, anti-tobacco media and public relations campaign focusing on middle school youth which began in June 1997. The multi-media "Don't Get Sucked In" campaign includes television and radio ads, in-theater placements, billboards, print ads, and a website. This campaign focuses on the short term effects of smoking and sends the message that smoking is disgusting and dangerous. The process evaluation of the campaign has shown that this message has reached over 2.7 million teens through the radio ads alone, and it has also reached many more adults and children.

• ASSIST (American Stop Smoking Intervention Study for Cancer Prevention) was a public health demonstration project funded by the National Cancer Institute (NCI) in partnership with the American Cancer Society (ACS) that operated in New Jersey for eight years. Its purpose was to demonstrate that the wide-spread, coordinated application of the best available strategies to prevent and control tobacco use would significantly accelerate the downward trend in smoking and tobacco use. DHSS provided grants to six regional "Clean Air Coalitions," with local membership consisting of representatives from schools, workplaces, health care systems and the community at large. Program strategies included working with community groups to portray smoking as unattractive, thereby deterring children from initiating tobacco use; advocating ways to reduce ETS in local communities through volunteer groups; educating physicians and other health care workers on strategies to help patients quit smoking; and working with community leaders to develop and enforce tobacco- related policies. These strategies were directed toward the following groups: youth, blue-collar workers, women of child-bearing age, and racial/ethnic minorities. After September 29, 1999, the CDC became the federal funding source for this Division of Addiction Services Tobacco Control Program and will continue to support the six local coalitions, as well as several statewide initiatives which have been developed during the eight years of ASSIST.

• Since 1991 DHSS has supported the "Addressing Tobacco in the Treatment and Prevention of Other Addictions" project, which is now in the New Jersey School of Public Health at UMDNJ. This project works with alcohol and drug treatment providers to assist them in implementing smoke-free policies and integrating nicotine prevention and treatment into their overall treatment programs.

• DHSS oversees several programs to enforce tobacco control policies. The Tobacco Age of Sale Enforcement Program (TASE) enforces the State tobacco age of sale laws through contracts with local health departments that volunteer to work with the program. It provides education for vendors about the New Jersey tobacco laws, uses volunteer youth to ensure that vendors are following the law, and provides technical assistance to local health departments in planning and conducting compliance check inspections of licensed tobacco vendors. It also reimburses local health departments for enforcement activities. Since its inception in 1996, the rate of compliance by merchants to the tobacco age of sale laws in New Jersey has risen from 29% to 72%. However, those merchants who are not already compliant with the law are very resistant to enforcement and will need much more intensive education and monitoring so that the targeted level of compliance can be achieved statewide.

• In 1998 the federal Food and Drug Administration contracted with DHSS to enforce the federal age of sale tobacco rules relating to youth. The program uses part-time staff from schools and community organizations to recruit and train youth to help conduct compliance checks in stores.

In addition to these programs, DHSS also provides limited education and technical assistance to thousands of New Jersey residents who call the State Tobacco Control Unit.

With an appropriate level of resources, these partnerships and programs could have a significantly greater impact on New Jersey residents. Many of these programs are pilot or demonstration programs which could be expanded and integrated with other programs for great success. In addition, many programs could be funded which currently receive little or no state funding such as tobacco control youth programs which reach all youth or nicotine treatment (cessation).

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