The aims of this study were to determine the effectiveness of Philadelphia’s no-smoking policy diffusion to the city’s Chinese business community, to assess perceptions of and attitudes toward implementation and adoption of the law and formulate suggestions for improved policy dissemination in a predominantly Asian business community that serves the public at large. Results have indicated that while a significant percentage of business owners and their respective employees were aware of the law, most lacked in-depth knowledge of relevant details suggesting poor diffusion.
A significant majority of respondents believed the law applied to all businesses without exceptions. Most were unaware of the specific details of the no-smoking ordinance such as the provision that bans smoking within 20 feet of business entrances. Although the high level of awareness (92%) of the law may indicate a high level of diffusion, data have revealed that the extent of diffusion is limited. Specifically, some information known to businesses about the law is inaccurate, for example, which businesses were included in the ordinance. Mainstream media may be partly responsible for improper diffusion of the law. Public attention may have been focused on restaurants to the exclusion of other businesses (e.g., food markets, retail store, and offices), leading to some misperceptions of the intent of the law. Most Chinese businesses (and other Asian businesses) in the study target area are small- or medium-sized businesses, located proximal to the communities they serve. Due to their relative invisibility, these businesses tend to be given little or no attention by the mainstream media.
This study has provided a number of insights into the diffusion and enforcement of public policy in Chinese business establishments. While previous studies have shown the high prevalence of smoking in Chinese and other Asian-American communities, other studies have shown that business establishments and their respective employees in Chinatown have higher rates of smoking and higher tolerance for secondhand smoke than the general Asian population (Fu et al., 2003
; Ma et al., 2002
; Ma et al., 2005a
). Our study corroborated these findings. The study, however, did not stratify smokers according to gender, which would likely have shown significantly higher rates in males as has previously been demonstrated (Ma et al., 2002
One specific aim of our study was to understand attitudes and perceptions toward sustainable enforcement of the law. Data revealed some ambivalence about implementation despite the fact that the majority of respondents were cognizant of its merits. This ambivalence may be attributed to fears associated with the law’s negative impact on business income and a perceived conflict between social norms -- namely smoking -- and an ordinance that bans smoking, or between serving customers’ needs and enforcement of the law. For example, while most respondents indicated a relatively strong confidence regarding implementation of the law, there was a discrepancy with actual enforcement because observed smoking levels did not decrease as significantly as anticipated due to implementation of the law. Furthermore, businesses that had been in operation for only a few years may be operated by more recent immigrants who are more likely to consider smoking as a social norm. In combination with low levels of diffused information, this conflict between confidence and enforcement may continue despite high levels of expressed favorability for the law.
While previous studies have suggested that smoking bans are easily implemented, self-enforcing, and have a beneficial health impact (Albers et al., 2004
; Hyland & Cummings, 1999a
; Hyland, Cummings, & Nauenberg, 1999
; Siegel et al., 2004
; Skeer et al., 2004
), these studies were not implemented in an ethnic community of different cultural and social context from that of the mainstream (Fu et al., 2003
; Ma et al., 2002
). Despite the presence of no-smoking signs, study administrators and observers witnessed forms of smoke in at least 5 businesses including an instance of a worker attempting to hide cigarettes in a cardboard box, a clear hazard. In Asian-American communities, smoking bans should not automatically be considered self-enforcing as behaviors may not always match the law’s requirements.
Our findings clearly indicate that only a small percentage of respondents were aware of important details of the law, suggesting that combined television and ethnic print media efforts were insufficient to diffuse policy to the Chinese business community. The low ranking of the Internet and the high ranking of word of mouth diffusion of the tobacco policy suggest vertical transmission of information within the Chinese community. This type of transmission is vulnerable to misinterpretation of messages, especially legal jargon. In addition, as there were no significantly varied attitudes or perceptions across positions within businesses or levels of English, the law diffused relatively evenly across these subgroups. Philadelphia authorities in the future should consider more direct means of communication with Chinese businesses in order to improve policy diffusion.
The Philadelphia Chinatown, like Chinatowns in other U.S. cities, is a business hub and contributes substantially to the tax base of the city. Where there is a large business community in which English is not the primary language, one would assume greater sensitivity by the local government to language barriers, particularly to diffusion of policies that affect the population at large. Many of these businesses have limited longevity (<5 years) and are operated by low-income, relatively recent immigrants with low levels of acculturation. Given the socio-cultural and economic context of owners and employees of these businesses, one cannot assume that policy information that diffuses in mainstream establishments will, in fact, diffuse in Chinese or other Asian American businesses. For example, a month after enforcement of the no-smoking ordinance, the Philadelphia Department of Public Health (PDPH) mailed an English language letter in which it informed business owners of the law and listed an Internet Web site as a source of further information (Paris, 2007
; PDPH, 2007
). Active efforts to alert businesses about the ban are courtesies to the relevant parties as well as a benefit to the local public health department to improve policy implementation. Lack of personal communication with business owners may have reinforced gaps in knowledge dissemination to Chinese businesses.
Improvements in no-smoking policy should address effective dissemination to all communities affected, particularly ethnic communities that face communication barriers, be they technological, linguistic or cultural. A multifaceted diffusion strategy that includes direct mailings in appropriate languages, televised news on frequently accessed channels, translated and adapted literature that addresses important aspects of the policy, radio announcements on popular Asian stations, print media articles in appropriate languages, and official face-to-face meetings with affected businesses would ensure proper diffusion, hence wider compliance with the law. Countering social norms in the interest of public health requires extra effort to reach business and other community leaders and engage them as change-agents in the overall implementation strategy. The high levels of success in implementation models adopted by both Boston and New York City can be largely attributed to multidimensional educational programs targeted at businesses and patrons (Frieden et al., 2005
; Hyland et al., 1999
; Skeer et al., 2004
; Weber et al., 2003
). No-smoking policies are generally assumed to be enforced through the actions of businesses and little attention is given toward the responsibilities of customers to refrain from smoking. Business patrons who receive no formal notification of laws should therefore not be expected to automatically comply. Much smoking witnessed by administrators and observers, for example, was from patrons and bystanders suggesting that bans should not automatically be considered self-enforcing on the behaviors of those with limited knowledge of the law.
Several limitations to this study should be noted. First, the self-reporting nature of the study and social norms of ‘saving face’ may have led participants to provide some socially desired responses. Second, smoking behavior observations were limited by the random collection times during the study period. Third, the sample of businesses approached did not include all businesses in Chinatown, but did constitute the majority. Fourth, there is no data available for comparison before the ban was enacted. Fifth, the sample size was small, limiting generalizability beyond Chinatown Philadelphia. Sixth, owners/managers may have differences in law knowledge in comparison to employees. Seventh, there may be some recall bias since the study was conducted a month after the law was implemented. Eighth, because diffusion data for Philadelphia at large as well as for specific racial and ethnic groups are unavailable, Chinese businesses may not be the only group to have experienced low levels of diffusion. There may also be variations according to the specific group assessed. Finally, the Chinese community as noted earlier has exceptionally high rates of smoking. Full and effective implementation of a smoking policy may not necessarily alter smoking behaviors or if it does then may not to the extent of other communities with a lower prevalence of smoking.
This study contributes to the growing amount of literature on the effectiveness of smoking bans. To the best of our knowledge, this is the first study to consider diffusion of policies to an Asian-American ethnic subpopulation and community. Based on our findings, we have concluded that the Philadelphia’s no-smoking law has not effectively diffused to the Chinese business community in Philadelphia’s Chinatown. In order to reach a wider segment of this community, dissemination efforts should take into consideration language barriers, social acceptability of smoking, effective diffusion streams for the target community, and implementation of an anti-smoking campaign to outreach to both businesses and patrons alike. Future studies may utilize such methods as physiological measures or particulate sensors to gauge the levels of compliance and investigate top-down mechanisms of communication to businesses, explore dissemination streams to a larger population that includes business patrons, and assess whether bans affect smoking behaviors in Asian communities at large.