The Voice Box

Purple Megaphone

Voice from Tobacco Prevention and Control in N.C.

December 2006

Inside this Issue

NCGA Makes its Own Worksite Smoke-free

N.C. State Health Director Calls for Smoke-free Worksites

Sustain Advocates - Build Strong, Human Movements

Sustaining Ourselves for Social Justice

Report Finds Record Number of N.C. Teens Have Never Smoked

Featured Website: N.C. Healthy Hospitals

Restaurant Heart Health Survey Update

N.C. Department of Health and Human Services
Division of Public Health
Tobacco Prevention and Control Branch

1932 Mail Service Center
Raleigh, N.C. 27699-1932
(919) 733-1881 phone
(919) 715-4410 fax


Anti-smoking advertisement in a smoking room in Mumbai, India, by Everest Brand Solutions

NCGA Makes its Own Worksite Smoke-free; Allows Community Colleges to do the Same

During its short session 2006, the North Carolina General Assembly passed two measures related to secondhand smoke.

House Bill 133, Designate General Assembly Buildings Nonsmoking, was also signed into law. The new law prohibits smoking in any legislative building.

This historic measure was spearheaded by the N.C. Alliance for Health.

House Bill 448, entitled Community Colleges Exempt from Smoking Laws, was signed into law. It adds community colleges to the list of state-controlled buildings that may be designated as completely nonsmoking.

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N.C. State Health Director Calls for Smoke-free Worksites

In response to the new U.S. Surgeon General's Report, which raises new concerns about the dangers of involuntary exposure to tobacco smoke, State Health Director Leah Devlin warned North Carolinians to avoid indoor exposure to secondhand smoke and called for all North Carolina workplaces to become smoke-free.

"The health effects of involuntary exposure to smoking are more widespread than previously thought," said Devlin, speaking from the N.C. Division of Public Health's office complex on Six Forks Road in Raleigh. "The new Surgeon General's Report makes it clearer than ever that no one should be exposed to secondhand smoke on the job or in places they go to eat, play or relax."

On June 16, U.S. Surgeon General Richard H. Carmona issued a comprehensive scientific report, The Health Consequences of Involuntary exposure to Tobacco Smoke, which concludes that there is no risk-free level of exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent, the report says. The finding is a major public health concern due to the fact that nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke.

Six main findings of the report are that:

  • Secondhand smoke causes premature death and disease in children and in adults who do not smoke.
  • Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
  • Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
  • The scientific evidence indicated that there is no risk-free level of exposure to secondhand smoke.
  • Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.
  • Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Simply separating smokers from nonsmokers, cleaning the air and ventilating buildings can not eliminate exposures of nonsmokers to secondhand smoke.

Devlin saluted the progress made in North Carolina in recent years. "Thanks to the hard work of the North Carolina Health and Wellness Trust Fund and its chair, Lt. Governor Beverly Perdue, 75 of the state's 115 school systems have banned all tobacco use on all their property," she said. "And the North Carolina Hospital Association and N.C. Prevention Partners report that 39 of our hospitals are now 100 percent tobacco-free."

Many restaurants are voluntarily going smoke-free across North Carolina, Devlin said. Lexington Barbecue in Davidson County, well-known throughout the region, went smoke-free in September of 2005. In a letter to Dr. Devlin, owner Wayne Monk shared that it was an easy transition with no negative impact on sales. "People are still shaking my hand and thanking me for the smoke-free environment. Families love it," wrote Mr. Monk.

However, Devlin expressed concern that exposure to secondhand smoke remains high among adults. While the majority of white-collar workers (73.4 percent) in North Carolina work in smoke-free environments, fewer blue-collar workers (55.6 percent) and service workers (61.2 percent) - especially males - are protected by policies eliminating secondhand smoke at work.

"It's an unfair truth that North Carolina residents least likely to be protected from secondhand smoke on the job are those with lower-paying jobs and the lease amount of power to change their work situation to protect their health," Devlin said. "Smoke-free environments are both good for health and good for the bottom line. We know what works."

"I challenge all North Carolina employers to take immediate steps to make all of the workplaces in North Carolina smoke-free," Devlin said.

For free help in quitting smoking, people can call a quit coach at the N.C. Tobacco Use Cessation Quitline at 1-800-QUIT-NOW or can go to the website at

The Heart Disease and Stroke Prevention Task Force educates North Carolinians about the relationship between secondhand smoke and heart disease on its "Get the Buzz" Web site at

A detailed summary of the Surgeon General's report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, and other related information can be found on the Centers for Disease Control and Prevention (CDC) Web site at

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Sustain Advocates - Build Strong, Human Movements

(This article is from The Advocacy Institute's newsletter, For more information, visit

By David Cohen, co-founder of The Advocacy Institute

It is easier to destroy a movement than to build one.

Advocacy requires many qualities - innovation, hope, stamina, drive, grit, determination, resolve, commitment. When an effort is clearly winning, it is easy to sustain these, as individuals and organizations. But when an issue suffers a setback or fades from public view, an organization's leadership faces its greatest challenges.

Leaders need to create strong organizations that motivate, energize and support people engaged in the effort. Strong organizations must also buffer members against both external and internal tensions.

In the early 1980s, Byron Kennard, an organizer and leader in the U.S. environmental movement, wrote of "ten ways to kill a movement." Former Advocacy Institute Co-Director Michael Pertschuk created a contemporary list based on his experiences with public health and tobacco control advocates. Pertschuk called his list "eight ways to lead a movement to oblivion":

  1. Fight! Fight! Fight! or Talk! Talk! Talk!, but never balance struggle efforts with negotiation.
  2. Use your grassroots; then lose them.
  3. Lose track of your goals.
  4. Get drunk on your successes.
  5. Let a tender bruised ego destroy your strategic judgment.
  6. Undermine all efforts at open and honest debate.
  7. Find a scapegoat and move on unenlightened.
  8. Keep doing what you are doing no matter how much the world changes.

Any one of these behaviors can be damaging to advocates and movements. When looked at in the reverse, they stand as a powerful reminder of the care that must be given to sustain advocates. Sustenance is particularly important when an effort does not successfully reach a short-term objective and frustrated advocates are tempted to find faults and lay blame in each other. The negative behaviors are noted here so advocates can avoid them.

In any advocacy effort, positive models of behavior deserve to be followed. Kennard’s "ten ways to kill a movement" are reframed here as ten positive, proactive steps that an organization, coalition, or movement and its leadership can take to build a movement. I have tried these behavior models out on experienced practitioners. They invariably respond enthusiastically.

  1. Remember where you come from, that you are part of something larger. Celebrate your origins and roots.
  2. Listen to the insights and experience of people who are affected by the issues and participate in the efforts. They are the real experts - amplify their voices. Keep professional experts "on tap, not on top."
  3. Keep balance in your work and personal life. Work hard, yes. Meet responsibilities, yes. Make an extra effort, yes. But also add humor and rest. Avoid pessimism and martyrdom.
  4. Recognize human frailty and accept it. Set the example by not holding yourself - or others - to rigid or impossible standards that drain the organization's energy.
  5. Motivate others by sharing responsibility, paying attention to others, and encouraging those who make the extra effort. Give praise when it is merited.
  6. Model behavior, or set a good example, by fostering cooperation, sharing information with others, and encouraging others' leadership. Don't dominate. Leave space for others to share their knowledge and skills.
  7. Insist on a calm approach to solving problems. Set real deadlines. Avoid a crisis mentality.
  8. Share credit generously within the organization, sector, and among allies.
  9. Be equally civil to those who share your views or tactics, and those who do not. Agree to disagree and do so without personalizing disagreements.
  10. Recognize that there are incremental steps in the advocacy journey. Celebrate how far a group has come and what it means to the lives of people. New experiences - like meeting with a bureaucrat, politician, or editor - are as much a success as winning a favorable policy. They build confidence and empowerment that, in many ways, are the most profound and lasting changes. Savor them.

Information on this page came from Advocacy for Social Justice: A Global Action and Reflection Guide, now available in English and Spanish from Kumarian Press.

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Sustaining Ourselves for Social Justice

(This article comes from, the newsletter of The Advocacy Institute. For more information, visit

By Gita Gulati-Partee, OpenSource Leadership Strategies, Inc.

Pause what you’re doing for a moment. Take a deep breath. In. And out. Now, take an honest and loving look at yourself. How are you? How are you feeling - literally, how is your body feeling? Are you well rested and energized, or tired, drained, stressed out? Take another breath. In this moment, do you feel creative, connected to others, and powerful, or isolated, perhaps even a little angry?

Are you living the life you intend, the life that will truly change the world? Or are you slowly destroying yourself in the name of doing good? Are you feeding yourself to the system that you seek to dismantle?

Claudia Horwitz of stone circles, a nonprofit that sustains activists and strengthens the work of justice through spiritual practice and principles, declares, "Personal sustainability is an act of resistance." She notes that by replicating unhealthy life patterns, social justice activists have taken on aspects of the dominant culture. It's time to reclaim our birthright to a healthy, balanced life that embodies the change we seek in the world.

Not doing so results in dire consequences — stress-related illnesses, addiction, limited creativity and energy, burning out, and ultimately dropping out — for ourselves as well as our organizations and our movements. The results of investing in our own sustainability are equally powerful — renewed creativity, energy, authenticity, connectedness, resilience, and integrity. Being mentally, emotionally, and physically healthy also leads to practical benefits for our organizations, like lower absenteeism and turnover.

The good news is that we have the responsibility and the capacity to change unhealthy patterns for our own sake and for those who follow us. In their book Resonant Leadership, Richard Boyatzis and Annie McKee write, "Today's leaders face unprecedented challenges that result in a vicious cycle of stress and sacrifice, with little or no recovery time built in....To counter the inevitable 'power stress' of the leadership role, leaders must consciously [step] out of destructive patterns and [renew] themselves physically, mentally, and emotionally."

The possibilities for self-care are as varied as we are. Find the ones that best suit your needs and personality. But remember, self-care is not a competitive sport. You don't have to do it all or do it all perfectly. Intentionally try on a healthy, balanced mix including some things that push you outside of your comfort zone, that allow you to experience truly different aspects of yourself. For example:

  • Physical movement or other non-competitive exercise
  • Regular rest and uninterrupted sleep
  • Deep breathing, meditation, or prayer
  • Vacations - non-working ones!
  • Maintaining an aesthetically pleasing physical environment
  • Developing mutually supportive networks with colleagues and friends
  • Regularly (weekly or monthly) prioritizing goals and focusing time on those things that are most important
  • Arts or crafts
  • Writing, journaling
  • Intentional, structured reflection
  • Periodically working with a coach
  • Eating healthy foods and not skipping meals
  • Reading books just for fun
  • Scheduling regular "dates" with your partner or a good friend
  • Organizations can support individuals by providing resources and making space for individual and collective self-care — for example:
    • Hosting a weekly potluck lunch or monthly reading group
    • Beginning staff meetings with personal check-ins and including time for reflection and learning
    • Celebrating personal occasions and group accomplishments
    • Organizing periodic office clean-ups
    • Offering personal and professional development funds for art or exercise classes, coaching, and time management help

In addition to having a healthy mix of activities that nurture our bodies, minds, and spirits, Horwitz encourages social justice leaders and activists to develop a daily practice. As social activists, we are always called upon to engage. Developing a "practice" allows us to engage from a place of authentic and compassionate wisdom. Practice, at its best, helps to move us from burnout to balance, from isolation to connection, and from despair to possibility.

What's a "practice"? Horwitz defines it as something:

  • Done on a regular (perhaps daily) basis,
  • In a context where it is uninterrupted,
  • Allowing for deep awareness and presence.

Use a combination of research and intuition to find your practice. Reflect on the recent past and identify five times when you felt a sense of wholeness or balance. Think of an image or story that caught your interest. Pay attention to these past experiences and follow the thread to your practice.

Once you find your practice, you can strengthen it through:

  • Practicing with a group for support and focus
  • Guidance from others who are further down the path
  • Periods of more intense practice (for example, a writing retreat)

Another key practice is reflecting on and expressing gratitude for all the things that you do to care for and sustain yourself. At the end of each day or week, take time to notice whatever embodied the life you want to lead. Don't worry how long the list is or about what's not on the list. Focus on and appreciate the positive. Valuing and taking care of ourselves is truly an act of social justice.

You must have a room, or a certain hour or so a day, when you don't know what was in the newspapers that morning, you don't know who your friends are, you don't know what you owe anybody, you don't know what anybody owes you. This is a place where you can simply experience and bring forth what you are and what you might be. This is the place of creative incubation. At first, you may find that nothing happens there. But if you have such a sacred place and use it, something eventually will happen.

Joseph Campbell

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Report Finds Record Number of N.C. Teens Have Never Smoked

Smoking No Longer “Rite of Passage”; 100% Tobacco-Free Schools Policies Big Reason Why

On September 5, in one of the state’s newest Tobacco-Free School districts, N.C. Health and Wellness Trust Fund (HWTF) Chair Lt. Governor Beverly Perdue announced that the number of N.C. middle and high school students who have never tried smoking has increased significantly. These results show that more and more teens across the state are forgoing their first cigarette as a rite of passage into young adulthood.

Lt. Governor Perdue was joined by N.C. State Board of Education Chair Howard Lee, Pitt County Schools Superintendent Dr. Beverly Reep, and other educators to announce new results from the 2005 N.C. Youth Tobacco Survey (YTS) at Hope Middle School in Greenville.

According to the 2005 YTS survey, 74.2 percent of middle school students and 45.7percent of high school students have never smoked a cigarette, up double-digit points from the 2001 and 2003 surveys. This fact is significant to the state’s teen tobacco movement because studies show if a teenager makes it to the age of 19 without ever smoking a cigarette, the likelihood of them starting is less than 20 percent.

The UNC School of Family Medicine cites one of the reasons for the growing number of students who haven’t taken a puff is the increasing number of N.C. school districts that have adopted the 100% TFS (Tobacco-Free Schools) policy. UNC reports that high schools with established 100% TFS policies report 40 percent fewer smokers than schools without the policy.

UNC attributes this success to the fact that from 2003 to 2005, there was rapid expansion of 100% TFS policies across the state because of HWTF funding, jumping from 15 districts at the beginning of 2003 to 78 in 2006. HWTF began funding its statewide teen tobacco use prevention and cessation initiative in 2003.

Earlier this year, Lt. Governor Perdue announced the first round of survey results, which showed that teen smoking rates have hit a historic low in North Carolina. The study’s data revealed that high school smoking rates have declined by one-third since 1999, and smoking rates among middle schoolers have dropped by two-thirds.

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Featured Website: N.C. Healthy Hospitals

N.C. Prevention Partners (NCPP), a long-time partner in tobacco control issues, has new information on their website, focused on its Healthy Hospital initiative.

The Healthy Hospital Initiative promotes tools, resources, and policies that support healthy environments for employees and patients to quit tobacco, improve nutrition, and be physically active. The Initiative is funded by The Duke Endowment.

In partnership with the N.C. Hospital Foundation, NCPP will assist all hospitals in the state interested in enacting 100% tobacco-free campus-wide policies for all patients, employees and visitors. For more information on North Carolina hospitals that have passed tobacco-free policies,

  • visit the hospital section of the Healthy County Profile, which includes searchable databases for contacts at hospitals which have passed these policies;
  • see a list of the hospitals that have passed 100% tobacco-free policies;
  • view examples of tobacco-free campus wide policies;
  • check a map showing all hospitals in the state that have, or have not, passed such policies;
  • view a Twelve-Month Timeline for hospitals going 100% tobacco-free campus-wide; and
  • view the Healthy Hospital photo gallery

If you would like to be added to the listserv of hospital representatives working on this issue, or are interested in training opportunities, please contact Melva Fager Okun, DrPH.

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Restaurant Heart Health Survey Update

The N.C. Restaurant Heart Health Survey (N.C. RHHS) provides a critical source of public health data. N.C. RHHS is a statewide county sample of more than 88 counties (78 health departments) and more than 8,000 restaurants regarding healthy food options, restaurant smoking policies and need for assistance.

Each year counties are recruited to participate and offered a small incentive to conduct a short survey with restaurant staff. In some counties, health educators and their environmental health restaurant inspectors conduct this survey together following quarterly restaurant inspections.

Eventually one-third of N.C. counties will participate each year, so that every three years a county could measure changes in smoke-free dining policies and healthy food options.

The 2005-2006 RHHS is just wrapping up; recruitment for the 2006-2007 RHHS is well under way.

The 2005-2006 RHHS had more than 40 counties participate and complete surveys in more than 2,500 restaurants across the state. A statewide report will be made available soon to participating counties and others interested in receiving a copy.

We would love to hear how you are using the RHHS data; send us an email and let us know. Or ask how we can help you use the RHHS data to make your local efforts and programs better. Contact Scott Proescholdbell (919-707-5412) or email.

County health departments interested in participating in N.C. RHHS can contact Abha Varma (919-707-5364) Scott Proescholdbell, (919-707-5400) or Rosemary Ritzman (919-707-5233).

For more information, see the N.C. Heart Disease and Stroke Prevention website:

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If you have feedback or comments please let us know, OR you can contribute your own story about tobacco prevention and control in N.C. Please send to Julie Helsabeck.