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OBJECTIVE: To measure the level of compliance among businesses with legislation prohibiting smoking in public places. DESIGN: A representative sample of businesses in the Australian Capital Territory (ACT) was selected. A two-phase survey design was used: in phase 1, interviewers observed business premises to evaluate their compliance with the legislation, observing the display of no-smoking signs and noting any evidence of smoking in smoking-prohibited areas; in phase 2, a short questionnaire was completed by the business owner or manager. SETTING: Observations of business premises and self-completion interviews with owners or managers of those premises. SUBJECTS: 938 respondents who were either owners, managers, or employees of ACT businesses. MAIN OUTCOME MEASURES: Compliance with legislation prohibiting smoking in the public areas of business premises; businesses' own perceptions of the extent of their compliance; and the factors affecting the discrepancy between actual and perceived compliance. RESULTS: A total of 22% of the businesses complied fully with the legislation, whereas 56% partially complied by displaying external or internal signage. Most respondents (84%) believed that they were complying fully with the legislation. Only 21% of the businesses complied and correctly assessed their compliance. Evidence of smoking was detected in only 5% of no-smoking premises. The type of business and the smoking policy of the establishment at the time the legislation came into force were important influences on compliance, followed by whether the premises were free-standing or located within shopping malls. The mass media was identified as the main source of information about the legislation. CONCLUSIONS: Ensuring the successful implementation of non-smoking legislation is facilitated by (a) widespread publicity to make business proprietors and their customers and clients aware of the legislation; (b) first implementing legislation in premises where there is strong public support for such measures; and (c) targeting information to premises that have pre- existing policies prohibiting smoking on their premises. 




Objective

To determine whether Lexington, Kentucky's smoke‐free law affected employment and business closures in restaurants and bars. On 27 April 2004, Lexington‐Fayette County implemented a comprehensive ordinance prohibiting smoking in all public buildings, including bars and restaurants. Lexington is located in a major tobacco‐growing state that has the highest smoking rate in the US and was the first Kentucky community to become smoke‐free.

Design

A fixed‐effects time series design to estimate the effect of the smoke‐free law on employment and ordinary least squares to estimate the effect on business openings and closings.

Subjects and settings

All restaurants and bars in Lexington‐Fayette County, Kentucky and the six contiguous counties.

Main outcome measures

ES‐202 employment data from the Kentucky Workforce Cabinet; Business opening/closings data from the Lexington‐Fayette County Health Department, Environmental Division.

Results

A positive and significant relationship was observed between the smoke‐free legislation and restaurant employment, but no significant relationship was observed with bar employment. No relationship was observed between the law's implementation and employment in contiguous counties nor between the smoke‐free law and business openings or closures in alcohol‐serving and or non‐alcohol‐serving businesses.

Conclusions

No important economic harm stemmed from the smoke‐free legislation over the period studied, despite the fact that Lexington is located in a tobacco‐producing state with higher‐than‐average smoking rates.

OBJECTIVES—To determine compliance with a voluntary code of practice (VCP) for restricting smoking in restaurants and to canvass the attitudes of restaurateurs towards tougher smoking restrictions.
DESIGN—Cross-sectional survey conducted in 1996 using a telephone questionnaire.
SETTING—Metropolitan restaurants and cafés in Adelaide, South Australia.
PARTICIPANTS—276 (86.8%) of a sample of randomly selected owners and managers.
MAIN OUTCOME MEASURES—Restaurant non-smoking policies, reported and anticipated change in business, and restaurateurs' attitudes towards smoking restrictions.
RESULTS—26.8% of restaurants had a total smoking ban; 40.6% restricted smoking some other way; and 32.6% permitted unrestricted smoking. Only 15.1% of restaurants with a ban or restrictions had used the VCP to guide the development of their policy, and only half of these were complying with it. Although 78.4% of those with bans and 84.4% of those with restrictions reported that their non-smoking policy had been associated with either no change or a gain in business, only 33.3% of those allowing unrestricted smoking expected that this would be the case, if they were to limit smoking. A total of 50.4% of restaurateurs, including 45.3% of those with no restrictions, agreed that the government should ban smoking in all restaurants.
CONCLUSIONS—The VCP made an insignificant contribution to adoption of non-smoking policies, and compliance with the code was poor. Despite concerns about loss of business, there was considerable support for legislation which would ban smoking in all dining establishments.


Keywords: smoking restrictions; restaurants; environmental tobacco smoke; Australia

Noncompliance with labor and occupational health and safety laws contributes to economic and health inequities. Environmental health agencies are well positioned to monitor workplace conditions in many industries and support enhanced enforcement by responsible regulatory agencies. In collaboration with university and community partners, the San Francisco Department of Public Health used an observational checklist to assess preventable occupational injury hazards and compliance with employee notification requirements in 106 restaurants in San Francisco's Chinatown. Sixty-five percent of restaurants had not posted required minimum wage, paid sick leave, or workers' compensation notifications; 82% of restaurants lacked fully stocked first-aid kits; 52% lacked antislip mats; 37% lacked adequate ventilation; and 28% lacked adequate lighting. Supported by a larger community-based participatory research process, this pilot project helped to spur additional innovative health department collaborations to promote healthier workplaces.

SYNOPSIS

Objective

We developed and assessed a program designed to help small business owners/managers conduct short training sessions with their employees, involve employees in identifying and addressing workplace hazards, and make workplace changes (including physical and work practice changes) to improve workplace safety.

Methods

During 2006, in partnership with a major workers' compensation insurance carrier and a restaurant trade association, university-based trainers conducted workshops for more than 200 restaurant and food service -owners/managers. Workshop participants completed posttests to assess their knowledge, attitudes, and intentions to implement health and safety changes. On-site follow-up interviews with 10 participants were conducted three to six months after the training to assess the extent to which program components were used and worksite changes were made.

Results

Post-training assessments demonstrated that attendees increased their understanding and commitment to health and safety, and felt prepared to provide health and safety training to their employees. Follow-up interviews indicated that participants incorporated core program concepts into their training and supervision practices. Participants conducted training, discussed workplace hazards and solutions with employees, and made changes in the workplace and work practices to improve workers' health and safety.

Conclusions

This program demonstrated that owners of small businesses can adopt a philosophy of employee involvement in their health and safety programs if provided with simple, easy-to-use materials and a training demonstration. Attending a workshop where they can interact with other owners/managers of small restaurants was also a key to the program's success.

Background

Clean indoor air (CIA) policies that include free-standing bars and restaurants have been adopted by communities to protect employees in all workplaces from exposure to environmental tobacco smoke, most notably employees working in restaurants and free-standing bars. However, due to the perception of negative economic effects on alcohol-licensed hospitality businesses, partial CIA policies (those that provide an exemption for free-standing bars) have been proposed as a means to reduce the risk of economic effects of comprehensive CIA policies applied to all worksites.

Objective

To determine if partial CIA produce differential economic effects compared to comprehensive CIA policies using bar and restaurant employment per capita.

Design, setting, and subjects

Ten cities in the state of Minnesota were studied from 2003 to 2006. Economic data were drawn from monthly employment in bars and restaurants, and a pooled time-series was completed to evaluate three types of local CIA policies: Comprehensive, partial, or none beyond the state law.

Results

Communities with a comprehensive CIA policy had a decrease of 9 employees per 10,000 residents compared with communities with a partial CIA policies (p=0.10). Communities with any type of CIA policy (partial or comprehensive) had an increase of 3 employees per 10,000 residents compared to communities without any CIA policies (p=0.36).

Conclusion

There were no significant differential economic effects by CIA policy type in Minnesota cities. These findings support the adoption of comprehensive CIA policies to provide all employees protection from environmental tobacco smoke exposure.

OBJECTIVE—To learn how the tobacco industry reacted to businesses' voluntarily enacting policies to discourage tobacco use and minimise exposure of employees and patrons to secondhand smoke.
DATA SOURCES—Internal tobacco industry documents discovered among those posted on the internet. Approximately 24 million documents have been posted as of this writing. Information in this article was culled from among these documents, which have been made public as a unique requirement of the state of Minnesota's settlement with the industry.
STUDY SELECTION—Those documents were used that offered insight into, and which gave a perspective on, the industry's attitudes and reactions toward other businesses as they adopted tobacco-free policies.
CONCLUSIONS—In the wake of widespread acceptance that tobacco use causes illness and death, many individual businesses (and even entire industries) took positive steps to eliminate employees', customers', and facilities' exposure to tobacco smoke. Steps were also taken to discourage tobacco use among employees. Internal tobacco industry documents show that the industry reacted with aggression, and in some cases with retribution, against businesses that voluntarily adopted policies to discourage tobacco use. The intent of these actions appears to be to reverse these policies, with a broader goal of neutralising large scale public and private trends that reflect the decreasing social acceptability of tobacco use.


Keywords: tobacco industry; tobacco-free policies; aggression

Despite an increase in policies regulating smoking at the workplace, little research has been conducted on organizational factors that may be associated with the adoption of those policies. In November 1986, a survey assessing tobacco use habits was sent to 3,432 employees of 68 auto dealerships in western New York. Managers at the worksites were surveyed by telephone in 1986 and 1 year later to assess their attitudes about smoking by employees and changes in smoking policy implementation. At the time of the initial survey, 21 percent (N = 14) of businesses had smoking restrictions. Among the 54 worksites with no smoking restrictions, 14 (26 percent) adopted smoking policies within a year. The strongest predictor of policy adoption was an interaction between the presence of floating smoking restrictions (not tied to a specific area) and the manager's willingness to impose smoking restrictions on employees. Adoption of policies was also more likely to occur among worksites with younger employees. That adoption of smoking policies was more likely to occur among worksites with floating smoking policies underscores the idea that focusing efforts at the managerial level within an organization can accelerate the diffusion process. In addition, the presence of unions and employee concerns about smoking policies are likely to impact upon management's decisions regarding implementation of policies. Given the potential of smoking prohibitions to influence the smoking habits of employees, future studies should begin to focus on ways to facilitate the adoption of smoking policies in worksites.

Background

In March 2005, Armenia enacted legislation protecting employees from secondhand smoke. This research was the first attempt to understand the attitudes, beliefs and practices of managers of public and private enterprises regarding smoke-free worksite policies.

Methods

Mixed methods were used. The study team conducted focus group discussions with worksite administrators to explore their beliefs, attitudes and practices related to worksite smoking. These findings guided development of a quantitative instrument to collect more representative data on the same issues. Using stratified random sampling, 243 worksites were interviewed from June-July 2005, representing state/municipal, health, educational, culture and business institutions in three of Armenia's largest cities.

Results/Discussion

Smoking-related practices differed significantly across institutions. More than half of the managers (55.6%) reported having smoking restrictions at worksites, including 37.0% who reported smoke-free workplaces; however, smoking or the presence of ashtrays was observed in 27.8% of workplaces reported to be smoke-free. A substantial proportion of the administrators favored both banning indoor smoking and allowing smoking in special areas. Only 38.0% of managers were aware of employees' existing legal protections from exposure to secondhand smoke. Knowledge of these regulations was not related to adherence to smoke-free worksite policies. The research also revealed widespread confusion between the concepts of worksite smoking restrictions and smoke-free workplaces. Public awareness campaigns that promote promulgation and enforcement of worksite smoking regulations could increase employee demand for smoke-free worksites.

Conclusion

As one of the first studies to investigate smoking-related worksite practices, attitudes and beliefs in former Soviet countries, these findings provide insight into law enforcement processes in economies in transition.

Objective

To evaluate the effect of a total ban on smoking indoors in restaurants and other hospitality business premises in Norway, on respiratory symptoms among workers in the industry.

Methods

Phone interviews with 1525 employees in the hospitality business were conducted immediately before the enacting of the law. In a follow‐up study five months later, 906 of the workers from the baseline sample participated. Questions were asked on demographic variables, passive smoking exposure, personal smoking, attitudes towards the law, and five respiratory symptoms. Change in symptom prevalence was analysed with McNemar's test and with analysis of variance (ANOVA) for repeated measures.

Results

The prevalence of all five symptoms declined after the ban; for morning cough from 20.6% to 16.2% (p < 0.01); for daytime cough from 23.2% to 20.9%; for phlegm cough from 15.3% to 11.8% (p < 0.05); for dyspnoea from 19.2% to 13.0% (p < 0.01); and for wheezing from 9.0% to 7.8%. ANOVA showed that the largest decline in symptom prevalence was seen among workers who themselves gave up smoking, and subjects with a positive attitude towards the law before it took effect.

Conclusion

A significant decrease in respiratory symptoms among service industry workers was found five months after the enacting of a public smoking ban.

Purpose

To explore the feasibility of engaging community businesses in HIV prevention.

Design

Randomly selected business owners/managers were asked to display discreetly wrapped condoms and brochures provided free-of-charge for 3 months. Assessments were conducted at baseline, mid-, and post-program. Customer feedback was obtained through an online survey.

Setting

San Diego, California neighborhood with a high rate of AIDS.

Subjects

Fifty-one business owners/managers representing 10 retail categories, and 52 customers.

Measures

Participation rates, descriptive characteristics, number of condoms and brochures distributed, customer feedback, business owners'/managers' program satisfaction and willingness to provide future support for HIV prevention.

Analysis

Kruskal-Wallis, Mann-Whitney U, Fisher's exact, and McNemar's tests were used to analyze data.

Results

The 20 business owners/managers (39%) who agreed to distribute condoms and brochures reported fewer years in business and more employees than those who agreed only to distribute brochures (20%) or refused to participate (41%), p <.05. Bars were the easiest of ten retail categories to recruit. Businesses with more employees and customers distributed more condoms and brochures, p < .05. More than 90% of customers supported distributing condoms and brochures in businesses and 96% of business owners/managers described their program experience as “positive.”

Conclusion

Businesses are willing to distribute condoms and brochures to prevent HIV. Policies to increase business participation in HIV prevention should be developed and tested.

Hospital policies regarding cigarette smoking can affect the smoking habits of employees, patients, and visitors. Successful smoking policy development and impact have been reported in a number of hospitals. These reports have been from financially secure or university hospitals. This article reports on the policy experience at Interfaith Medical Center, a public hospital serving an economically disadvantaged black inner-city community. Policy implementation and smoking cessation efforts were directed by a broad-based hospital committee. An employee survey demonstrated support for a policy restricting but not banning smoking (89% of nonsmokers, and 80.2% of smokers). Among smoking employees, 87.6% wanted to quit. A policy restricting smoking to designated areas in the cafeteria and coffee shop was enacted. Health fairs and smokeout contests were enthusiastically received and resulted in short-term cessation verified by exhaled carbon monoxide levels. Assemblies where ex-smokers were given "Hall of Fame" certificates, "stop smoking" art contests, and a "stop smoking hotline" generated further cessation activity. The department of medicine, in cooperation with the National Heart, Lung, and Blood Institute's Smoking Education Program, set up a training program for residents on how to help patients quit. Overall, the smoking prevalence, attitudes, and enthusiasm to quit were similar to previous reports in financially secure hospitals. Unfortunately, lack of resources and staff turnover led to dissolution of the program. Institutional stability and a funding source are critical for the long-term success of hospital smoking cessation programs.

Study objective

Multiple studies have found that, compared with employees in other settings, workers in bars and restaurants have been exposed to high levels of secondhand smoke, putting them at increased risk for health complications. Among these bar employees are many women of low socioeconomic status (SES). Smoke free workplace ordinances have been extended to bars and restaurants in cities and states throughout the USA; some bars, however, continue to be out of compliance with these laws. The objective of this study is to assess the relation between bartender gender and smoke free workplace compliance in bars.

Design

This paper reports on analyses of observational data on compliance with smoke free workplace policy in 121 randomly selected bars together with qualitative data from semi‐structured interviews with bartenders and patrons in bars.

Setting

San Francisco County bars.

Main results

Findings from this research showed that smoke free policy non‐compliance was associated with bars in which women were bartenders, increasing their tobacco exposure compared with male bartenders. In interviews, although some female bartenders expressed ambivalence toward the smoke free ordinance, many others described experiencing positive health and social consequences when the bars in which they worked could eliminate interior smoking.

Conclusions

The analyses presented here shed light on the benefits of improving the workplace environment for low SES female bartenders through the extension of strong smoke free workplace policies to all workplaces, including bars.

For reasons of health and economics, the business community is displaying a growing interest in providing smoking cessation programs for employees. An examination of the current research on smoking cessation methods has revealed a number of promising directions that smoking cessation programs can take, for example, aversive smoking approaches combined with self-control strategies. A review of current smoking cessation programs in occupational settings revealed some emphasis on physician counseling, but a relatively greater emphasis on use of consultants (especially in proprietary programs) or of contingency programs to encourage nonsmoking.

The smoking cessation programs in businesses can move in a number of innovative directions, including (a) increased use of inhouse programs with a variety of smoking cessation strategies; (b) greater emphasis on the training of program participants in nonsmoking behavioral skills, combined with contingency or incentive programs for smoking control; (c) vastly improved research methods, including complete followup assessments of program participants and chemical tests to validate their self-reported abstinence; (d) greater concern about the need for empirically tested procedures for recruitment of participants for the programs; and (e) expanded interchange among behavioral scientists (especially behavioral psychologists), health professionals in occupational health and medicine, union and employee groups, and management.

Design: Analysis used a pre/post-quasi-experimental design that compared town meals tax receipts before and after the imposition of highly restrictive restaurant smoking policies in adopting versus non-adopting communities. The effect of restaurant smoking policies was estimated using a fixed effects regression model, entering a panel of 84 months of data for the 239 towns in the study. A separate model estimated the effect of restaurant smoking policies on establishments that served alcohol.

Main outcome measure: Change in the trend in meals tax revenue (adjusted for population) following the implementation of highly restrictive restaurant smoking policies.

Results: The local adoption of restrictive restaurant smoking policies did not lead to a measurable deviation from the strong positive trend in revenue between 1992 and 1998 that restaurants in Massachusetts experienced. Controlling for other less restrictive restaurant smoking policies did not change this finding. Similar results were found for only those establishments that served alcoholic beverages.

Conclusions: Highly restrictive restaurant smoking policies do not have a significant effect on a community's level of meal receipts, indicating that claims of community wide restaurant business decline under such policies are unwarranted.

One of the goals of the Centers for Disease Control's (CDC) policy on the prevention of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is to support business organizations in implementing HIV and AIDS information, education, and prevention activities. However, the response of the American business community to HIV infection and AIDS has been varied. Although company executives consider AIDS to be one of the leading problems in the country, surveys typically indicate that less than one-third of businesses have or are developing some type of AIDS policy. The workplace appears to be a valid site for AIDS information and education programs, given the weight employees attach to information received there. However, workplace education and information programs are undertaken primarily by large companies. Many small companies do not devote much time and effort to these activities, even though extensive, indepth educational programs are likely to have positive impacts on worker attitudes and behavior, whereas short programs or literature distribution may only increase workers' fears. The question of what is an effective workplace program still needs additional research. Very little is known about the magnitude of the costs of HIV infection and AIDS to business. These costs, which are affected by the changing roles of employer-based health insurance, cost shifting, and public programs, will influence how employers react to the epidemic and how they respond to CDC's prevention initiatives.

Objectives:

Exposure to second-hand smoke (SHS) is widespread in restaurants in Ulaanbaatar, the capital city of Mongolia. While a smoke-free policy is the most effective way of protecting restaurant workers and customers from SHS, this has not been well accepted in Mongolia. Furthermore, little is known about restaurants’ attitude toward the smoke-free policy.

Methods:

A cross-sectional survey directed to restaurant owners or managers was conducted in 475 representative restaurants in Ulaanbaatar. Face-to-face interviews using a questionnaire and on-site observation were performed.

Results:

Only 29.3% of the restaurants claimed to prohibit smoking; none of the remaining had any protection toward SHS, and half of the restaurants estimated that more than 20% of customers would smoke inside. None of them had visible “no smoking” signs and the majority never received complaints about SHS. Despite the generally high level of knowledge of the health effects of SHS, of the 336 restaurants that were not smoke free, only 25.9% expressed that they planned to take action in the near future. By contrast, 87.8% of restaurants would support the government if it asked all restaurants to ban smoking. Multivariate analysis identified that restaurants having menus in foreign languages, selling cigarettes and predicting business decline were less likely to support the government smoke-free policy.

Conclusions:

This survey demonstrates that restaurants owners and managers were reluctant to take action on their own, but would support government policy. The government can assume a stronger role first by revising the law on tobacco control following the Framework Convention on Tobacco Control guideline.

Background

Community-wide preparedness for pandemic influenza is an issue that has featured prominently in the recent news media, and is currently a priority for health authorities in many countries. The small and medium business sector is a major provider of private sector employment in Australia, yet we have little information about the preparedness of this sector for pandemic influenza. This study aimed to investigate the association between individual perceptions and preparedness for pandemic influenza among small and medium business owners and managers.

Methods

Semi-structured face-to-face interviews were conducted with 201 small and medium business owners or managers in New South Wales and Western Australia. Eligible small or medium businesses were defined as those that had less than 200 employees. Binomial logistic regression analysis was used to identify the predictors of having considered the impact of, having a plan for, and needing help to prepare for pandemic influenza.

Results

Approximately 6 per cent of participants reported that their business had a plan for pandemic influenza, 39 per cent reported that they had not thought at all about the impact of pandemic influenza on their business, and over 60 per cent stated that they required help to prepare for a pandemic. Beliefs about the severity of pandemic influenza and the ability to respond were significant independent predictors of having a plan for pandemic influenza, and the perception of the risk of pandemic influenza was the most important predictor of both having considered the impact of, and needing help to prepare for a pandemic.

Conclusion

Our findings suggest that small and medium businesses in Australia are not currently well prepared for pandemic influenza. We found that beliefs about the risk, severity, and the ability to respond effectively to the threat of pandemic influenza are important predictors of preparedness. Campaigns targeting small and medium businesses should emphasise the severity of the consequences to their businesses if a pandemic were to occur, and, at the same time, reassure them that there are effective strategies capable of being implemented by small and medium businesses to deal with a pandemic.

Objective

To compare air nicotine concentrations according to the smoking policy selected by bars/restaurants in Santiago, Chile before and after the enactment of partial smoking ban legislation in 2007 (establishments could be smoke free, have segregated (mixed) smoking and non-smoking areas, or allow smoking in all areas).

Methods

The study measured air nicotine concentrations over 7 days to characterise secondhand smoke exposure in 30 bars/restaurants in 2008. Owner/manager interviews and physical inspections were conducted.

Results

Median IQR air nicotine concentrations measured in all venues were 4.38 (0.61–13.62) μg/m3. Air nicotine concentrations were higher in bars (median 7.22, IQR 2.48–15.64 μg/m3) compared to restaurants (1.12, 0.15–9.22 μg/m3). By smoking status, nicotine concentrations were higher in smoking venues (13.46, 5.31–16.87 μg/m3), followed by smoking areas in mixed venues (9.22, 5.09–14.90 μg/m3) and non-smoking areas in mixed venues (0.99, 0.19–1.27 μg/m3). Air nicotine concentrations were markedly lower in smoke-free venues (0.12, 0.11–0.46 μg/m3). After adjustment for differences in volume and ventilation, air nicotine concentrations were 3.2, 35.5 and 56.2 times higher in non-smoking areas in mixed venues, smoking areas in mixed venues and smoking venues, respectively, compared to smoke-free venues.

Conclusions

Exposure to secondhand smoke remains high in bars and restaurants in Santiago, Chile. These findings demonstrate that the partial smoking ban legislation enacted in Chile in 2007 provides no protection to employees working in those venues. Enacting a comprehensive smoke-free legislation which protects all people from exposure to secondhand smoke in all public places and workplaces is urgently needed.

Introduction

Smoke-free restaurant ordinance campaigns were conducted in 15 Wisconsin cities during 1992 through 2002. Community and health coalition organizational characteristics varied with each campaign; nine campaigns were successful in enacting ordinances, and six campaigns failed.

Methods

Data on community and coalition characteristics were analyzed. Community characteristics included adjusted gross income, percentage of Democratic voters in recent elections, and county smoking prevalence. Coalition characteristics included the number of supporters identified, leadership experience, level of print news media coverage, and editorial position of local newspaper.

Results

Successful campaigns were more likely to have leadership with high levels of political experience; eight of nine successful campaigns had leadership with high levels of experience, and two of six unsuccessful campaigns had leadership with high levels of experience. Every successful campaign had high levels of newspaper coverage and strong editorial support. None of the unsuccessful campaigns had high levels of news coverage or strong editorial support.

Conclusion

Characteristics controlled or influenced by coalitions are associated with successful outcomes. Community characteristics were not associated with outcomes. These results should assist communities planning to implement smoke-free ordinances or other health policy campaigns.

State tobacco control programs provide an important laboratory for the development, implementation, and evaluation of comprehensive tobacco control interventions. Studies have demonstrated that states and municipalities with aggressive tobacco control programs have experienced more rapid decreases in per capita cigarette sales, smoking prevalence, lung cancer, and heart disease than entities without such programs. Despite strong evidence that population-level interventions are critical in achieving large and sustained reductions in tobacco use, states do not fund tobacco control efforts at levels recommended by the CDC. Research on the effectiveness and cost-effectiveness of these activities is essential to inform and strengthen tobacco control at the state-level. A workshop, co-organized by ACS, NCI, AACR, and CDC, was held in Philadelphia in December, 2007 to discuss the topic “Linking tobacco control policies and practices to early cancer endpoints: Surveillance as an agent for change”. Participants represented three different disciplines. Tobacco surveillance researchers described the data currently collected on state-level tobacco control policies, pro-tobacco countermeasures by the industry, public attitudes towards tobacco use and measures of smoking prevalence and consumption. Cancer registry experts described the geographic coverage of high quality, population-based cancer registries. Mathematical modeling experts discussed various modeling approaches that can be used to relate upstream tobacco promotion and control activities to downstream measures such as public attitudes, changes in tobacco use, and trends in tobacco-related diseases. The most important recommendation of the Workshop was a call for national leadership to enhance the collection and integration of data from multiple sources as a resource to further study and strengthen the scientific basis for tobacco control.

The California smokefree workplace ordinance (AB13) has been well-received, even in bars where deeply-established traditions of smoking may exist. However, a closer investigation of bars where indoor smoking persists reveals that bar workers in some immigrant communities continue to be exposed to secondhand smoke in their workplaces. To identify sociocultural factors that may impede the adoption of AB13, 150 observations and 29 qualitative interviews were conducted in 50 California bars serving Asian patrons. Observers witnessed indoor smoking in 82% of the bars. Interviews revealed that social relationships, social interactions, and confrontation avoidance complicated the positive reception of AB13 within these bars. By understanding the implications of sociocultural factors on policy, we provide a nuanced understanding of the challenges involved in implementing tobacco control policy in diverse settings, which may help inform future policy development and implementation in other jurisdictions.

Introduction

The harmful effects of secondhand smoke are convincing more and more communities across the United States and the world to prohibit smoking in public places, especially in eating and drinking establishments. A 1993 Missouri state law allows smoking in designated areas in indoor public places such as restaurants and bars. Consequently, some Missouri communities have adopted local ordinances that prohibit smoking in all indoor workplaces, including restaurants and bars. We used an objective measure of economic activity, the taxable sales revenues of eating and drinking establishments, to empirically examine the economic effect of smoke-free ordinances.

Methods

We studied the economic effect of smoke-free ordinances in 11 Missouri cities using multivariate log-linear regression models with log-transformed taxable sales revenues of eating and drinking establishments as the dependent variable and the smoke-free ordinance as the independent variable, while controlling for seasonality, economic condition and unemployment. We used data from 20 quarters before the smoke-free ordinances and at least 10 quarters after the smoke-free ordinances for all cities. The null hypothesis of no effect of smoke-free ordinance on taxable sales of the eating and drinking establishments was tested.

Results

Eight of the 11 cities had increased taxable sales for eating and drinking establishments postordinance. The remaining 3 experienced no change.

Conclusion

The findings of our study are consistent with findings from most published economic studies that a smoke-free ordinance does not harm a local economy.

Employers are implementing workplace health promotion programs that address modifiable health risk factors such as overweight and obesity, smoking, high blood pressure, high cholesterol, physical inactivity, poor diet, and high stress. Research with large employers has found that these programs can improve workers' health and decrease the costs associated with medical care, absenteeism, and presenteeism. Despite their promise, health promotion programs are not widely embraced by small businesses, especially those in rural communities. This article reviews the barriers encountered by small and rural businesses in implementing health promotion programs. We describe an approach developed in cooperation with the New York State Department of Health's Healthy Heart Program and the Cayuga Community Health Network to engage small businesses in health promotion. We review the development and implementation of an assessment tool created to evaluate current workplace health promotion programs, policies, and practices targeting cardiovascular disease among small, rural employers in upstate New York. Potential benefits of the assessment tool are discussed, and the instrument is made available for the public.

Design: Observational surveys of retail establishments and interviews with store managers.

Setting: Demographically contrasting business districts of eastern Massachusetts.

Main outcome measures: Percentage of businesses selling tobacco, numbers and characteristics of exterior and interior tobacco advertisements per store, merchant reports of promotional allowances received from tobacco distributors.

Results: The proportion of businesses selling tobacco, and hence having storefront tobacco advertising, is strongly negatively correlated with per capita income in the census tracts where businesses are located (Spearman's ρ = -0.794, p = 0.006). Mentholated brands are marketed disproportionately in low income, urban communities. Latino merchants are highly dependent on tobacco sales, but would require relatively modest compensation to forego tobacco promotional allowances.

Conclusions: Storefront tobacco advertising is far more prevalent in predominantly minority, low income communities than in non-minority, higher income communities, principally because of the differing mix of kinds of businesses in the two types of communities, and the greater prevalence of tobacco vendors in lower income neighbourhoods. Tobacco companies obtain this advertising at little cost.