The state of California has long been regarded as a pioneer in the tobacco control movement in the United States. It was the first to develop a comprehensive tobacco control program in 1988 [1
] and the first to enact a smoke-free workplace law in 1994 (i.e. Assembly Bill 13). The latter occurred in the wake of dozens of smoke-free restaurant ordinances that were passed in local communities throughout the state [2
]. The smoke-free laws in California were opposed by the tobacco industry and its sponsored organizations (e.g., Beverly Hills Restaurant Association) who argued that such laws would cause economic loss for bars and restaurants in California [3
]. However, no such long-term economic loss occurred following enactment of the indoor smoking ban in California [4
]. As a likely consequence of California's commitment to tobacco control, the State's smoking prevalence has been less than the overall smoking prevalence in the U.S. for many years (e.g., 15.2% vs. 20.9%, respectively, in 2005 [5
]). Outside of California, diminished revenue from smoke-free policies was also a concern for the gambling industry [6
] due to the co-occurrence of gambling and cigarette smoking [7
]. The tobacco industry collaborated with the gambling industry in financing economic studies, ventilation projects and lobbying activities against the smoke-free policies [9
]. Loss of gaming revenue from enactment of smoke-free laws was reported in Victoria, Australia [10
], but not in the U.S. states of Massachusetts [11
] and Delaware [12
Passage of the 1988 Indian Gaming Regulatory Act, based on the sovereignty of federally recognized Indian reservations, led to the establishment of numerous Indian casinos throughout California. Sovereignty also enabled Indian tribes to permit smoking in casinos despite passage of California's Assembly Bill 13. Aside from loopholes in the law allowing smoking in certain indoor settings (e.g., banquet facilities), Indian casinos represent the last vestige of indoor smoking where Californians are exposed to hazardous secondhand smoke. One recent study, which measured airborne fine particles in 36 of 58 California casinos [13
], reported considerable variability in fine particle concentrations by level of separation between the non-smoking and smoking areas; for the casinos that had complete physical separation, fine particle levels were comparable to levels measured in the outdoor samples.
No study in the academic literature, to our knowledge, has assessed perceptions of secondhand smoke among casino patrons, a likely function of the difficulty in obtaining a representative sample. Analysis of one such representative sample from the 2008 California Tobacco Survey (CTS) is a unique opportunity to research secondhand smoke among patrons of tribal casinos in California. This also has international implications because of the provisions set forth in the World Health Organization's Framework Convention on Tobacco Control (FCTC). Article 8 of the Convention declares that public places and workplaces be free of secondhand smoke [14
]. Yet, even in the countries that have ratified the FCTC, non-smokers continue to be exposed to secondhand smoke in public indoor settings (e.g., in Santiago, Chile [15
]). Many countries have enacted a weak smoke-free policy that reflects the tobacco industry's "Courtesy of Choice" Program [16
]. This program supports the designation of smoking and non-smoking sections in indoor public settings, similar to what is observed in the California tribal casinos. An examination of patrons' perceptions of secondhand smoke in the casinos, therefore, may be informative for policymakers as well as casino and hospitality industries in California and abroad.
Using data from the 2008 California Tobacco Survey, we aimed to assess smoking prevalence by casino visitation, predictors of casino visitation, avoidance of secondhand smoke among casino patrons, and willingness to extend one's stay and visit again if smoking were prohibited. It is hypothesized that such willingness was expressed by a significant proportion of never smokers who visited a California Indian casino in the year prior to the 2008 survey.