Our study shows that ceilings with an insecticide treated netting window can substantially reduce human exposure to malaria vectors. It is likely that the greatest effect on clinical malaria would be seen in areas of moderate and high transmission where a reduction in exposure to malaria parasites would lead to a proportional reduction in morbidity. Based on results from our study we recommend that intervention trials that measure epidemiological outcomes should be conducted in areas of moderate to high transmission to determine the protective efficacy of ceilings against clinical malaria.Tobacco control advocacy in Montana in 2005 is led by a strong coalition of health groups and individual tobacco control advocates. However, this was not always the case. Up until the late 1990’s there were rarely any organized efforts to push tobacco control policies forward. The first organized tobacco control effort on the state level came in 1990, when a group of health professionals made a failed attempt against a much more organized and well financed tobacco industry to pass a state initiative for a cigarette tax increase. Starting in 1999, local communities began passing smoke-free ordinances and, despite sophisticated opposition coordinated by the tobacco industry, succeeded in increasing local protection against secondhand smoke. With the introduction of the Master Settlement Agreement settlement payments in 1999 and the creation of the Montana Tobacco Use Prevention Program, tobacco control efforts in Montana became much more organized,vertical farming shelves though they still lacked the political power held by the tobacco industry and it allies in the state. Health and tobacco control advocates in 1999 were unable to prevent most of the MSA money from being diverted by legislators to the state’s general fund, which was then dispersed to non-health related programs.

Furthermore, the state’s tobacco use prevention program did not have the political support needed to defend itself against an extremely pro-tobacco industry governor, Judy Martz , who severely cut the state’s tobacco use prevention resources. Since 1999, health groups and tobacco control advocates have developed strategies, such as ballot initiatives, that won them more public support and political power. By 2005, tobacco control advocates had more influence than ever before. Even with this new level of political influence, however, tobacco control advocates in 2005 still find themselves fighting the tobacco industry and its ally groups, which have themselves evolved into using strategies of seemingly reasonable compromise in order to advance pro-tobacco industry policies. In particular, the tobacco industry ally group, the Montana Tavern Association , negotiated with health groups to pass a compromised Montana Clean Indoor Air Act of 2005, which permanently preempted local smoke-free ordinances, and allowed for bar and casino exemptions for at least four years. Thus, by negotiating with state health groups, the MTA successfully eliminated stronger local ordinances and, being one of the parties that created the bill, gained the power to influence the implementation and interpretation of the 2005 clean indoor air law. The Montana Clean Indoor Act of 1979, introduced as House Bill 235, came at a time when such laws were relatively novel. In 1973, Arizona passed a limited clean indoor air law that established designated smoking areas in most public places.In 1975, Minnesota passed the first comprehensive clean indoor air act of its kind in the United States, prohibiting smoking in all public places with the exception of designated smoking sections. While designated smoking section laws seem modest in 2005, it was a big step at the time, and the Minnesota law became model legislation for future states. Although smoking section laws had also been passed in other states around this time, none were as comprehensive or effective as the Minnesota act. North Dakota passed a law in 1975 authorizing the creation of smoking and nonsmoking section,and Nebraska passed a law in 1974 that made locations nonsmoking unless specifically designated a smoking area .

As early as 1973, the tobacco industry recognized that the public’s knowledge about the dangers of smoking was increasing, and that smoking was starting to lose its status as a socially accepted habit.A review of the status of smoking and health issues found in an incomplete internal document from the Brown and Williamson tobacco company dated March 15, 1975 made several observations that were not favorable for the tobacco industry.Among the topics discussed in the review were the Surgeon’s General Report which made progress in “closing off scientific debate on the smoking and health issue,” the vast number of U.S. doctors who were advising their patients about the dangers of smoking, and the growing belief that secondhand smoke was harmful to one’s health.The first tobacco control legislation in Montana was passed in 1979, when two bills proposed in the House of Representatives attempted to require designated smoking sections: House Bill 304 and House Bill 235. House Bill 304, which was tabled by the House Committee on Human Services was introduced by Rep. Joe Kanduch , and would have prohibited smoking in restaurants unless signs were posted that designated smoking areas.House Bill 235, which was passed in amended form, was introduced by Rep. Robert Ellerd . As originally written, HB 235 would have required the designation of nonsmoking areas in enclosed public places, with a $50 fine for violations, though the bill was eventually softened to only facilitate the optional creation of smoke-free sections.When the two bills came before the House Committee on Human Services for a hearing on February 7, 1979, testimony was presented simultaneously because of “similar intent on both bills” and “for time factors involved.”Rep. Kanduch, in presenting HB 304 at the hearing, stated that the intent of the “smoking section bill” was to create areas for people to smoke “without infringing upon a non-smoker’s rights to breath clean air.”The bulk of the testimony, however, addressed House Bill 235. Several doctors and concerned citizens spoke as HB 235 proponents, citing health concerns and the high cost of treating smoking related illnesses.

Among the groups represented in the proponents testimony were the Montana Lung Association, the Montana Medical Association, the Montana Nurses Association, and the Montana Society of Respiratory Therapists. Testimony in opposition to HB 235 came from individual restaurant and tavern owners, as well as from the Cascade Tavern Association and from Tom Maddox, who represented the Montana Association of Tobacco and Candy Distributors. Maddox argued to the committee that the issues was a waste of time and money, that it had not been adequately proven that smoking or second-hand smoke caused cancer, that smoking laws were unpopular, and that the law would be unenforceable.The tobacco industry was well prepared for the committee hearing on HB 304 and HB 235, shown by an information bulletin distributed by the Montana Association of Tobacco and Candy Distributors, dated January 23, 1979,and a February 2, 1979 letter titled “Grass Roots Activities – Montana,” written by the Manager for State Public Affairs at R.J. Reynolds Tobacco Co, Larry Bewley. Together,commercial grow supply the documents show that the Association of Tobacco and Candy Distributors, R.J. Reynolds Tobacco Co., and the Tobacco Institute coordinated their efforts against the two bills, with the effort being managed by Tom Maddox, Executive Director of the Montana Association of Tobacco and Candy Distributors, who was also the lobbyist for the Tobacco Institute.The Montana Association for Tobacco and Candy Distributors informational bulletin reprints the proposed HB 304, and asks Montana wholesalers “will you and your people please telephone or call on your restaurant customers; advise all of this bill and HB 235? Ask all to write to their representatives and ask each to vote DO NOT PASS on both bills.” The bulletin further instructs to write “all members of the House Committee on Human Services.”The R.J. Reynolds State Public Affairs letter, “Grass Roots Activities,” was distributed to several RJR employees, including Vice President Charles A. Tucker and Assistant General Counsel Peter Ramm.The memorandum discussed the upcoming February 7, 1979 hearing on the two bills and listed the members of the House Committee holding the public hearing. The memorandum further indicated that Tom Maddox was the Tobacco Institute lobbyist in Montana and would handle the opponents phase of the hearing. The memo advised that “RJR people attending the hearing should locate Tom just prior to the hearing. Our people will not testify, but follow Tom’s instructions.”Thus, R.J. Reynolds would have a presence at the hearings without committee members knowing their affiliations. The “Grass Roots Activities – Montana” letter advised that opponents should call their representatives and indicate opposition to House Bill 304, and provided a phone number for themto call, as well as reasons they should give in opposing HB 304.This follows standard tobacco industry strategy used in several other states, including California,Minnesota,Mississippi Nebraska,and Texas. House Bill 304 was defeated with little argument.

According to the minutes from the House Committee on Human Services hearing from Feb. 7, 1979, no testimony from either proponents or opponents of the bill were heard.On February 9, 1979, Republican committee member G.C. Feda moved to table HB 304, and the House committee unanimously carried the motion. House Bill 235, on the other hand, did achieve passage, but in a weakened form. HB 235 was initially defeated by a 7 to 10 vote in the House Human Services Committee on Feb. 9, 1979, but was amended and re-introduced by the bill’s sponsor, Rep. Robert Ellerd , and committee chair Polly Holmes , thereby becoming known as substitute HB 235. On Feb. 12, 1979, the committee again voted against HB 235 in a 7 to 10 vote, but the sponsors were able to get 10 signatures from the House membership to overturn the committee on Feb. 14, 1979. Substitute HB 235 was approved by the House in a 78 to 22 vote on Feb. 19, 1972, and the bill was then moved to a hearing before the Senate.Substitute HB 235 was heard by the Senate Public Health, Welfare and Safety Committee on March 5, 1979, where the bill’s sponsor, Rep. Ellerd, introduced proposed amendments that were presumably made to increase the bill’s chances of passing, since the bill had already been defeated in the initial committee hearing.Instead of prohibiting smoking in certain areas, the bill would require that no smoking signs be posted in certain areas . None of the proponents of the bill at the March 5th hearing objected to these amendments. In fact, Rep. Holmes gave some further argument in favor of the amendments, saying that the change was made so that enforcement would be focused on sign compliance, instead of on the individual smoker.Holmes further stated that if substitute HB 235 were not passed, proponents would put a stricter version of the bill on a ballot for voter approval. Testimony was heard from many of the individuals and organizations that had spoken on the bill in the House Committee hearing. Among the witnesses in favor of HB 235 were several representative from various health organizations: the Montana Society for Respiratory Therapy, the Department of Health and Environmental Sciences, the Lewis and Clark County Health Department, the Montana Nurses’ Association, and the Montana Lung Association.Although HB 235 had been considerably weakened, the tobacco industry and it’s ally groups continued to fight against it, worried that it’s passage would be a first step for an even stronger bill.Opponents testifying at the Senate Committee hearing were individuals from the hospitality industry, the Montana Innkeeper’s Association, and Tom Maddox, who was again representing the Montana Tobacco and Candy Distributors Association. Maddox submitted a five page prepared statement to the senate committee, reiterating the arguments that HB 235 was unnecessary, unenforceable, and unpopular. Maddox also contended that the goal of reducing the harm caused by second-hand smoke could be better achieved through the use of “clean air devices,” otherwise known as ventilation devices, and claimed that such devices “clean the air amazingly in short time,”a common tobacco industry argument which has been proven to be untrue.On March 9, 1979, the senate committee voted 4-2 to advance te bill to the full senate, and on March 15, 1979, the Montana Senate approved HB 235 by a vote of 34-16.