Carrie Morton
camnch@netzero.com
Employer Contribution to Health Benefits:
If Employers Put Employees In
Summary
of Proposal
Employers can no longer claim that they are unaware of the risks of environmental tobacco smoke. When an employer permits smoking in the workplace, he knowingly and willfully disregards the health of his employees, and he is responsible for his employees’ increased health costs due to secondhand smoke. Because the employer’s smoking policy causes the harm, the states should require the business to pay a larger percentage of the employees’ health benefits. This burden should not lie with the employee who does not control the work environment or with the taxpayers through public services, but rather, the burden of added health care costs should lie on the business that controls the employee’s work area and the employee’s exposure to secondhand smoke.
Although for most employers, health benefits are optional, the incentives to offer employees health insurance are so great that this proposal would not encourage employers to forgo offering benefits. Studies show that most businesses offer benefits to employees, and the larger the company, the more likely it is to offer benefits. Further, the incentives for employers to offer benefits include: attracting and retaining quality employees, possible tax deductions on plan contributions, employees may accept benefits in place of a higher salary, it can save the employer on personal insurance costs, improve employee health and morale, and it has been shown to decrease absenteeism.
Once an employer chooses to offer health benefits to employees, she is regulated by state and federal laws. The states can mandate certain medical coverage, regulate discriminatory practices, and regulate the plans. Further, federal laws regulate the hiring practice and discrimination to ensure the employee’s rights are protected. States can enact a law that will require businesses to contribute a larger percentage to an employee’s health benefits, if the employer exposes the employee to environmental tobacco smoke. An objective of this legislation is to encourage employers to voluntarily ban smoking in their establishments. However, if an employer continues in his current policy of endangering employees’ health, then he will be required to pay the higher health care costs. This will shift more of the burden to one of the three groups (others being tobacco companies and smokers) that can prevent the harm, and away from employees and taxpayers.
The positive results from prohibiting smoking in the workplace greatly
outweigh any perceived or inaccurate benefits from allowing smoking. A main reason to ban smoking in the workplace
is employee health. The
This exposure is not without consequence. Each year 60,000 adult nonsmokers die from
heart, lung, and other secondhand smoke related diseases. Environmental tobacco smoke is the third
leading cause of preventable deaths each year in the
Additionally, there are financial incentives for an employer to ban smoking in the workplace. Employees who smoke may cost the employer up to $5,000 more than a nonsmoker. The EPA concluded that smoking restrictions in workplaces would reduce employer costs between $4 to $8 billion each year. Additionally, smokers get sick 50% more than nonsmokers, will visit a doctor up to 50% more, incur more hospitalization, and use more medical services. This creates a higher rate of absenteeism for employee smokers, and in turn, costs the employer revenues. Employees who smoke in the workplace are also twice as likely to be injured on the job than a nonsmoker. Smoking also causes high levels of carbon monoxide, which may lower alertness and reflex speed.
In addition to health related costs, environmental tobacco smoke damages property and increases cleaning and maintenance costs. There is also an added risk of fires or explosions in establishments that allow smoking. Additionally, the cost of workers’ compensation that is borne by the employer is higher for a smoker than a nonsmoker. A smoke-free environment has been shown to raise employee morale, have a positive impact on the health of employees, and make it easier for smokers to reduce or quit smoking.
Another incentive for employers to ban smoking in their establishments is to reduce the risk of litigation. Employees exposed to environmental tobacco smoke are increasingly taking their employers to court over harm incurred in the workplace. This can be very time consuming and costly to employers. Furthermore, these cases have been met with varying degrees of success, and this success will likely increase as more courts are willing to recognize causes of actions relating to secondhand smoke and the workplace.
The main argument put forth by employers is that a smoking ban would reduce revenues. However, research has shown this to be inaccurate. In nationwide studies, sales tax data has shown that there has been no negative effect on restaurants and bars after no smoking bans were put in place. Further, some studies have shown that sales have actually increased due to nonsmokers frequenting the establishments more and smokers adjusting to new laws. However, the arguments against banning smoking, even if accurate, do not outweigh the benefits in providing a smoke-free work environment. Even so, if an employer refuses to ban smoking in the establishment, he should be required to pay the added health care cost of the employees.
TEXT:
Health
Benefits and Businesses
Health insurance is primarily regulated by the state. Statutes vary widely on whether health insurance is optional, the percentage to be paid by the employer, and the areas of coverage. Although the law does not require most employers to offer health benefits to their employees, once an employer chooses to provide benefits he must comply with state and federal regulations.[1] States can mandate certain medical conditions be covered under the insurance policy and prohibit discrimination in policies.[2] In addition to each state’s mandates, the federal government also places requirements on hiring practices, discrimination, and policy areas. The employer must adhere to federal anti-discrimination laws and health plan enforcement if he is offering benefits to employees.[3] The federal standards, which are designed to protect the employee and her beneficiaries, are set out in the Employee Retirement Income Security Act (ERISA) and federal handicap discrimination laws.[4]
Employer
Incentives to Offer Health Benefits
Although providing health benefits to employees is optional, there are many
incentives to offer benefits, and in turn, most businesses choose to provide
health benefits. A survey from
Offering benefits is another way for a business to stay competitive in recruiting and retaining employees. A nationwide survey conducted by the Employee Benefit Research Institute found that 60% of employees would accept a reduction in the business contributing to the pension plan in exchange for increased health benefits.[9] The survey also found that 13% of respondents said they or a family member declined a job solely because of health benefits, and 58% of this group, did so because the employer did not provide any health benefits.[10]
Employees demand benefits and most employers meet these demands. This is particularly true for businesses that depend on quality employees to stay competitive in their market. Therefore, the majority of businesses will offer benefits, and once an employer chooses to do so, he will be required to adhere to state and federal regulations concerning the coverage and implementation. This proposal would be a state regulation that would require a business that allows smoking in its establishment to pay a larger percentage of its employees’ health benefits. It would need to be enacted through the state’s legislature and can be tailored to fit the state’s needs. (See Sample Proposal Appendix A)
This proposal is necessary because the business has complete control over its policy to allow or ban smoking in its establishment. The burden should lie with the business to pay the extra health costs because it is directly responsible for endangering the health of its employees and creating the added health care costs. This burden rightly lies with the employer, who controls the employees work environment and the policies, rather than with the employee. Furthermore, this burden should not be allowed to fall on the taxpayers or public services, which are not profiting from or implementing the businesses’ policies. Furthermore, employers that allow smoking in their establishment knowingly and willingly expose their employees to the risk of environmental tobacco smoke; and therefore, are liable to pay for this increased risk.
Consequences
of Secondhand Smoke in the Workplace
The grave risks of exposure to secondhand smoke cannot be denied. Secondhand smoke is the third leading cause of
preventable deaths in the
Secondhand smoke can affect many functions of the body. It causes irritation to the throat, nose, and eyes. It also may affect the cardiovascular system, irritate and reduce lung function, create chest discomfort, affect asthma, lead to coughing, and excess phlegm.[16] The chemicals in environmental tobacco smoke also interfere with the blood vessels ability to control blood pressure and flow, causes injury to the heart muscle, and increases blood vessel blockage, which causes heart attacks.[17] As many as 60,000 adult nonsmokers die each year from heart, lung and other diseases caused by exposure to environmental tobacco smoke. [18] Of that number, 3,000 nonsmokers die each year from lung cancer.[19] The EPA predicates that the majority of these deaths were the result of workplace smoking.[20]
Since 1980, the leading occupational health hazard has been secondhand smoke.[21] Secondhand smoke in the workplace causes more death and disease than all other toxins combined.[22] That is more deaths per year from secondhand smoke than all the regulated chemical work hazards combined.[23] Additionally, employees exposed to secondhand smoke in the workplace are 34% more likely to get lung cancer.[24] Secondhand smoke also increases workers’ deaths from heart disease.[25] One study showed that 59.2% of nonsmoking employees suffer discomfort in workplaces that permit smoking, and even 15% of smokers report a degree a discomfort as well.[26] Furthermore, research has shown that a smoke-filled room can have up to six times more air pollution than a busy highway.[27]
The home and the workplace are the two main sources of secondhand smoke. The average person spends 88% of their day at work and in their home.[28] However, exposure to secondhand smoke at work is often more dangerous than exposure in the home. Restaurant employees are exposed to secondhand smoke 1.5 times more than a person living with a smoker, and employees in bars are exposed up to 4.5 times more than living with a smoker in the home.[29] This equates to actively smoking one to two packs of cigarettes per shift.[30] Furthermore, the carcinogens and toxins are absorbed into the building surfaces, and continue to expose the employee to the dangers of these chemicals even after the cigarette is out.[31]
Employer-Employee:
A Special Relationship
Employers who allow this preventable harm to their employees should be required to contribute more to the employee’s health benefits than employers that do not tolerate this harm. The employer-employee relationship creates special rights and obligations for both sides. An important employee right is the right to a safe work environment, one that is free from toxic substances, dangerous conditions, and other safety hazards.[32] The United States Occupational Safety and Heath Act (OSH Act) mandates each employer to provide a workplace “free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”[33] The National Research Council (NRC) of the National Academy of Sciences has proclaimed that secondhand smoke exposure increases lung cancer in nonsmokers.[34] The EPA estimates that a person is fifty-seven times more likely to develop cancer from exposure to secondhand smoke than from all other outdoor contaminants that are regulated by federal environmental law.[35] Additionally, the National Institute for Occupational Safety and Health (NIOSH) has said that secondhand smoke is a potential occupational carcinogen, and the EPA has declared it a known human carcinogen.[36] Nonetheless, it is still permitted in many workplaces. Even so, an employer still has a duty to provide a safe work environment for her employee, clearly the employer is failing in her duty if she allows the employee to be exposed to environmental tobacco smoke.
As a result of this failed duty, the employer must bear the burden of increased health care costs for his employees. Several states have taken action and have sued tobacco companies to recover costs of tobacco-related health care.[37] Likewise, the states should require employers to pay their share of liability for tobacco related health care costs, because these businesses are a causal link in permitting the harm that increases the cost of health care. Employers who expose their employees to hazardous conditions pay a larger wage referred to as hazard pay. Comparable to this notion, an employer who allows his employees to be exposed to a substance that kills more people every year than all the hazardous jobs combined, should compensate the employees for their increased health risk.
Additionally, this proposal would also serve as awareness to employees that they are facing increased risk to their health. Under the Employment Retirement Income Security Act (ERISA), the employer is required to notify the employees of eligibility standards, rights, changes to the plan, claim procedures, and managing and investing plan funds.[38] If this proposal is enacted, states may be able use ERISA to require the employer to explain to the employee why the company is contributing a larger percentage to the cost of her health benefits. As a result, employees may take additional steps to limit exposure to environment tobacco smoke, and even apply pressure to the business to establish a smoke-free policy in the workplace.
The extra cost of health care rightly falls on an employer who allows his employees to be exposed to environmental tobacco smoke. It is estimated that direct medical cost for secondhand smoke each year is 180 million and loss of life costs another 19 million.[39] Although many employees and even states have rightly sought compensation from the tobacco companies for health costs related to smoking, the employer makes the critical choice of allowing smoking in her establishment, which is the number one source of exposure to secondhand smoke. For the health of the employees and the patrons, the employer must provide a smoke-free establishment, and those who refuse should pay the added costs of an increased health risk to employees.
As one quasi-solution, many establishments have created smoking and nonsmoking sections in their buildings to “satisfy” both smokers and nonsmokers. However, these sections do not provide enough protection from secondhand smoke. Furthermore, it increases the exposure to employees working within the smoking section. Other establishments may use a half partition wall to separate sections, which still allows the smoke to diffuse throughout the air.[40] This offers little, if any, protection to nonsmoking patrons, and no protection to employees working in the smoking or nonsmoking sections. These employees will have a greater amount of secondhand smoke exposure because typically the smoke particles increase and the space decreases, which results in a greater absorption rate of these harmful chemicals.[41] Furthermore, these sections are on the same ventilation system that is designed to control the carbon dioxide exhaled from humans, not the carcinogens and respiratory toxins from environmental tobacco smoke.[42]
Partitions and separate sections for smokers and nonsmokers is not a solution. Concentrating smokers in one section only creates a higher risk to employees and the patrons in that section. The only solution is to create a smoke-free work environment. This policy is beneficial to nonsmokers as well as smokers. A smoker’s exposure to another’s secondhand smoke drastically increases their risk of cancer.[43] Smokers who cohabitate with one other smoker increase their risk of cancer by 40%. Those who cohabitate with two other smokers increase the risk by 120%, while those who cohabitate with three or more other smokers increase the risk by 140%.[44] As mentioned previously, the workplace is the number one source of secondhand smoke; hence, an employee who smokes and is exposed to environmental tobacco smoke in the workplace faces a substantial increase in the risk of developing cancer over a nonsmoking employee.
Trend
Towards Smoke-Free Policies
Pressure from employees, patrons, and other smoke-free establishments will encourage employers to provide smoke-free environments. A national survey shows the trend towards instituting a no smoking policy in the workplace. In 1986, only 2% of workplaces had some type of smoking policy and only six years later, that number had jumped to 81.6% of workplaces.[45] In addition to an employer not being required to pay a larger portion of an employee’s health benefits, there are other incentives in having a smoke-free establishment. Studies have shown that once a workplace becomes smoke-free it produces quit rates of up to 20% among smokers, which is beneficial for both the employer and employees.[46] In turn, this reduces the employer’s health cost and reduces the amount of environmental tobacco smoke in other establishments.[47]
Employer’s
Financial Costs and Employees’ Health Costs with Secondhand Smoke
Although, employers traditionally
implemented smoking bans out of concern for potential fires, that concern has
evolved into health care and other costs related to environmental tobacco
smoke. Exposing employees to secondhand
smoke results in increased health problems; and therefore, increased health
care costs. Health problems from active
or passive smoking costs $50 billion every year.[48] Additionally a smoker will visit a doctor up
to 50% more than a nonsmoker, incur more hospitalization, and use more medical
services.[49] Smokers are also sick 50% more often than nonsmokers.[50] This creates a higher rate of absenteeism for
employee smokers, and results in lost revenues for the employer. A
Additionally, an employee who smokes may cost the employer up to $5,000 more than a nonsmoking employee. [53] This creates an economic incentive for employers to encourage their employees to quit smoking, or at least limit the environmental tobacco smoke exposure to employees. The EPA concluded that smoking restrictions in workplaces would reduce employer costs between $4 to $8 billion each year.[54] Employees who smoke in the workplace are twice as more likely to be injured on the job than a nonsmoker; this is due to distractions, eye irritation, coughing, and loss of attention. [55] Smoking also causes higher levels of carbon monoxide, which may lower alertness and reflex speed.[56] There is an additional cost of lost productivity and work time to employers when employees take cigarette breaks throughout the workday.[57]
In addition to health related costs, environmental tobacco smoke damages property and increases cleaning and maintenance costs. One survey of 2,000 workplaces showed that of the companies reporting smoking restrictions, 23.3% had reduced their maintenance costs by implementing smoking restrictions. [58] A smoke-free environment reduces the strain on the heating and cooling systems by filtering fewer smoke particles and other toxic chemicals, which saves the employer money.[59] There is also an added risk of fires or explosions in establishments that allow smoking.[60] This is especially true in workplaces where explosive and flammable chemicals are used.[61] Furthermore, it is estimated that 2,500 people die each year from accidental fires started from a burning cigarette. [62] Theses fires also cause substantial property damage each year. Additionally, the cost of workers’ compensation that is borne by the employer is higher for a smoker than a nonsmoker. [63] Creating a smoke-free environment has also been shown to increase employee morale, have a positive impact on the health of employees, and make it easier for smokers to reduce or quit smoking.[64]
Furthermore, there is even greater concern when smoking is allowed in certain workplaces. Workplaces in which an employee handles or is exposed to other dangerous chemicals increases the harmful affect of these chemicals when the employee is smoking or is around environmental tobacco smoke.[65] These interactions increase the employee’s risk of diminished lung function, emphysema, developing chronic bronchitis, and bronchogenic carcinoma.[66] The most dangerous combination of exposure is smoking and asbestos. A smoker in this job who is exposed to asbestos and smokes one or more packs of cigarettes a day has up to a 90 times greater chance of dying from lung cancer than a person who falls in neither category.[67] Another dangerous combination that produces the same risk factor is tobacco smoke and chloromethyl ether.[68]
Additionally, there are also many commonplace substances found in the workplace and in environmental tobacco smoke which combine to increase the exposure and the risk to employees. A cigarette may be one instrument in carrying other toxic substances into the body. For example, a person smoking a cigarette can take toxic substances in by inhaling through the cigarette, as well as in through mouth and skin absorption.[69] Other chemical that can enter the body through contaminated cigarettes include dust, lead, mercury, and formaldehyde.[70] Burning tobacco can also transform chemicals found in the workplace into a more toxic substance. For instance, Polymer Fume Fever is a disease caused by breathing fumes from heated teflon.[71] This disease causes permanent lung damage. When an employee smokes a cigarette contaminated by the employee’s hands or through the work process, these fumes can enter the lungs through the burning cigarette. [72]
Another risk in allowing smoking in the workplace is litigation. An employer faces an expensive and time consuming risk of an employee suing over being harmed by environmental tobacco smoke in the workplace. As more employees go to the courts to demand a smoke-free workplace, more employers will be forced to come into compliance with smoking-related policies. A variety of legal theories have been advanced by employees and some have been met with a great deal of success.[73] This success will likely continue in litigation as more courts are willing to recognize the causes of actions employees are suing on.
In agreement with OSHA, many courts have found that an employer has a duty to provide the employee with a reasonably safe work environment. Some courts have expanded this to include a workplace free from environmental tobacco smoke.[74] For most employers, the minimum they are required to do for employees is not force an employee who objects to being exposed to secondhand smoke to share an adjacent workspace with a smoker and to provide an adequately ventilated work area.[75] However, some courts have required much more from employers and some employers have had to pay significant amounts of money to the harmed employee.
Arguments
Against Implementing Smoke-Free Policies
The primary argument for an employer to allow smoking in his
establishment is economic. A view promoted
primarily by tobacco companies is that if an establishment bans smoking it will
lose significant revenues each year and some smaller businesses will be forced
to close their doors.[76] Additionally, they argue that tourism will
suffer because of the bans.[77] However, studies have shown the opposite
results in states and cities that have enacted smoke-free ordinances in
businesses. One study showed that after
Likewise, tourism has not been
negatively impacted by ordinances restricting smoking. A three-state, six-city study published in
the Journal of the American Medical Association found that the tourism volume
before and after the ordinance passage was not impacted by smoking
restrictions. [80] In fact,
Further, these ordinances have won popular support from patrons and employees.[83] (See Appendix C). These smoke-free ordinances encourage nonsmokers to frequent establishments more and smokers will adjust to the new standards, and subsequently continue patronizing these establishments. Moreover, with the added health care savings and work productivity it makes economic sense to adopt a smoke-free workplace. The perceived and inaccurate risks of implementing a smoking ban does not outweigh the positive health impact on employees and the financial savings for employers. Nevertheless, if an employer continues to allow smoking in the establishment she would be required to contribute more to the employees’ health insurance.
This proposal will not create an incentive for employers to forgo offering benefits because benefits are a much needed bargaining chip for employers. A business needs quality employees to help it run efficiently, benefits help attract and retain quality employees. Rather than forgo benefits for employees the employer will more likely pay the added cost or ban smoking in his establishment. This proposal puts the burden of health care costs on the employer who exposes the employees to environmental tobacco smoke and the added health care costs.
Appendix A
Sample
TITLE
57. INSURANCE
CHAPTER 689C. HEALTH INSURANCE FOR SMALL EMPLOYERS
HEALTH BENEFIT PLANS
NRS § 689C.125 (2004)
§ 689C.125. Rating factors for determining premiums
1. A carrier serving small employers shall apply rating
factors, including characteristics, consistently with respect to all small
employers in a class of business. Rating factors must produce premiums for
identical groups that differ only by the amounts attributable to the design of
the plans and the terms of the coverage and do not reflect differences based on
the nature of the groups that will select particular health benefit plans. As
used in this subsection, "premium" means all money paid by a small
employer and eligible employees to a carrier as a condition of receiving
coverage from a carrier, including any fees or other contributions associated
with the health benefit plan.
2. A carrier serving small employers shall treat all health benefit plans
issued or renewed in the same calendar month as having the same rating period,
if the terms of coverage provided in the plans are the same.
3. A carrier must
factor the exposure of environmental tobacco smoke into the small employers’
contribution to an employee health plan.
If the employer permits the smoking of cigarettes, cigars, pipes, or
otherwise permits any form of environmental tobacco smoke in his establishment,
he must contribute an additional 20% to the employees’ health care plan.
a.
This section solely applies to health care and does not include dental
or eye care.
b.
This section also applies if there are smoking and nonsmoking sections
in the establishment
and if the employee only works in the
nonsmoking section.
c.
This sections applies if any form of environmental tobacco smoke is
permitted in any section
of the building, regardless of separate
ventilation systems.
(Added material in italics)
Appendix B
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*Compiled from Smoke-Free Colorado Springs at http://www.smokefreecoloradosprings.com
Appendix C
Surveys of Popular Support and Compliance with California Smoke-Free Bar Law
Study Sponsor Major
Findings
Other Findings
|
California Smokefree Cities
(March 1995) |
64% agreed that bar employers
had a responsibility to protect bar employees. 61% agreed that bar
employers had a responsibility to protect bar patrons. |
36% reported that they
would be less likely to go to a bar that allowed smoking as opposed to 11%
reporting they would be more likely to go to a bar that allowed smoking |
|
American Lung Association,
Contra Costa-Solano (March 11, 1998) |
100% of bars in Jack London
square ( 96% of bars in Fisherman’s
Warf ( |
Both areas have significant
tourism |
|
California Department of
Health Services (October 5, 1998) |
65% of bar patrons approved
of a smoke free bar law. 68% reported that it was
important to have a smoke free environment inside a bar |
87% reported going to bars
more often or not changing the amount they frequented bars after the smoke
free law was implemented. |
|
|
96.5% of restaurant bars
visited in 100% of hotel bars visited
were in compliance |
77.8% of nightclubs visited
were in compliance 50.6% of stand-alone bars
were in compliance 57.9% of complying bars
posted no-smoking signs 76.5% of noncomplying bars
posted no-smoking signs |
|
American Cancer Society, |
61% of voters support
smoke-free bar laws 69% of voters were
concerned about the bar workers and patrons being exposed to secondhand smoke |
61% strongly agreed that
the tobacco industry spent too much on advertising and lobbying 90% agreed that secondhand
smoke is harmful to health 75% wanted a complete
smoking ban in all workplaces |
|
Los Angeles County
Department of Health (March 4, 1998) |
70% of patrons said that is
was very or somewhat important to have smoke-free bars 85% of bar of patrons said
they were more likely to go to a smoke-free bar or it made no difference |
78% of frequent bar patrons
said that the smoke free ordinance increased or had an effect on their intent
to visit bars 60% of frequent bar patrons
strongly or somewhat approved of the smoking ban. |
|
|
60% of respondents approved
of a smoke-free bar law |
25% of smokers approved of
the new law 20% of respondents were
smokers |
* Surveys from Sheryl Magzamne and Statnon Glantz, American Journal of Public Health, The New Battleground: California’s Experience with Smoke-Free Bars, Vol. 91, No.2, Febuary 2001.
[1] Employment Law, Health Insurance Overview, available
at http://smallbusiness.findlaw.com/employment-employer-benefits (last visited
[2] Mark Rothstien, Refusing to Employ Smokers: Good Public Health or Bad Public Policy?, 62
Notre Dame L. Rev. 940 (1987).
[3] Employment Law, Health Insurance Overview, available
at http://smallbusiness.findlaw.com/employment-employer-benefits (last visited
[4]
[5] California Labor Federation, Small Businesses and Health Insurance, available at
http://www.calaborfed.org/issues_politics/healthcare/SB2_Main.html (last
visited
[6] Employment Law, Pros and Cons: Offering Employee Benefits, available at
http://smallbusiness.findlaw.com/employment-employer benefits (last visited
[7]
[8]
[9] Diana Slivinska, Health Care Cost-Containment and Small Businesses: The Self-Insurance
Option, 12 J.L. & Com. 333 (1993).
[10] Diana Slivinska, Health Care Cost-Containment and Small Businesses: The Self-Insurance
Option, 12 J.L. & Com. 333 (1993).
[11] Judge William Chinnock, Translating Insights Into Policy: No Smoking Around Children, 45
[12] Louisiana Department of Environmental
Quality, Second Hand Smoke, available at
http://www.deq.state.la.us/laboratory/2ndsmoke.htm (modified
[13]
[14] Smoke-Free Colorado Springs, Secondhand Smoke, available at
http://www.smokefreecoloradosprings.com/shs.htm (last visited
[15] Smoke-Free Colorado Springs, Secondhand Smoke, available at
http://www.smokefreecoloradosprings.com/shs.htm (last visited
[16] Louisiana Department of Environmental Quality,
Second Hand Smoke, available at
http://www.deq.state.la.us/laboratory/2ndsmoke.htm (modified