Andy Hyland, PhD Roswell Park Cancer Institute Stephen Babb, MPH Office on Smoking and Health

1. TM Approaches to Evaluating Smoke-free Policies Andy Hyland, PhD Roswell Park Cancer Institute Stephen Babb, MPH Office on Smoking and Health TCN Smoke-Free Policy Implementation Strategies TeleconferenceMarch 25, 2008

2. Acknowledgments • Brett Loomis • Matthew Farrelly • Joanne Pais • Andy Hyland • Paul Mowery • Natasha Jamison • Jerie Jordan • New York Program • ClearWay Minnesota Toolkit

3. Overview • Options for evaluating smoke-free policies • Focus on five key outcomes • Public support • Compliance • Air quality • Employee health • Economic impact • Factors to consider in selecting among studies • Case studies

4. Measuring Public Support • These studies use surveys to assess the level of public support for a smoke-free law • Are you personally in favor, opposed to, or indifferent to the New York State law prohibiting smoking in all public and work places, including bars and restaurants? (NY ATS) • Useful before and after law passed • Before: Determine whether support is already high or if further public education is needed; document support • After: Document support; track changes in support over time

5. Observational Studies of Compliance • These studies involve visiting relevant venues (e.g., restaurants, bars, bowling alleys, casinos) to observe whether smoking is occurring • Observations of people smoking • Presence of smoke (seen or smelled) • Presence of “No Smoking” signs • Presence of ashtrays • Useful for measuring the extent of smoking before a law is put in place and for assessing compliance once a law takes effect

6. Air Quality Monitoring Studies • Assesses air quality in restaurants, bars, and other hospitality venues • Involves using a small, portable device to measure particulate matter suspended in air • Provides an objective measure of the presence of secondhand smoke (SHS) • Quantify air quality before and after a smoke-free law takes effect

7. Employee Health Studies • Assess SHS exposure and related health outcomes among nonsmoking employees of hospitality venues • Respiratory symptoms (e.g., coughing, wheezing) • Sensory symptoms (e.g., itchy eyes) • Other outcomes (e.g., lung function, NNAL levels) • Conducting baseline and follow-up studies can document changes in employee SHS exposure and related health outcomes • These findings have cost implications for employers

8. Economic Studies • Assess potential economic impact of smoke-free laws on restaurants, bars, and other hospitality venues • Draw on existing data on employment levels and taxable sales revenues from government sources • Track employment and sales before and after smoke-free law • Account for trends and seasonal patterns • Collect at least a year’s data after the law takes effect • If possible, compare trends to a control site • Long lag time before data become available

9. Selecting Among Studies—Factors to Consider • Assessing all five outcomes may not be necessary or feasible • Need to consider several factors • Stage of policy process (proposed, passed, implemented) • Key issues of interest to policymakers, the news media, the business community, and the public • Provisions of the smoke-free law (exemptions, phase-ins) • Resources for evaluation: funding, personnel, expertise, data

10. Stage: Policy Under Consideration • Three types of studies can be particularly helpful • Public support • Air quality in hospitality venues • Hospitality workers’ SHS exposure and related health outcomes • Taken together, these studies can make a compelling case for the need for SHS protection measures • They can also provide a baseline against which to measure progress

11. Stage: Policy Implemented • If baseline data collected • Collect follow-up data within 3 months and 12 months after the law takes effect • In absence of baseline data • Assess public support soon after the law takes effect to document support • Conduct observational or air quality studies to demonstrate compliance, identify problem areas, and/or illustrate the impact of gaps in law

12. Stakeholder Considerations • Is there public support for the law? • Will hospitality venues, other workplaces, and smokers comply with the law? • Will enforcement be expensive and time-consuming? • Will enforcement divert resources from more pressing needs? • Is the air quality in hospitality venues that allow smoking unhealthy? Did it improve after the law took effect? • Are nonsmoking hospitality employees exposed to SHS at work? Is this exposure affecting their health? • Is the law having a negative economic impact on hospitality venues?

13. Exemptions • Compromises that were made during the legislative process may have resulted in exemptions • Bar areas of restaurants, stand-alone bars, private clubs, casinos • Ventilation • Adults-only venues • Hardship exemptions • Long phase-ins

14. Exemptions • Evaluations can examine how such provisions impact a law’s effectiveness • Assess air quality and employee health in exempted or phased-in hospitality venues • Assess compliance

15. Resources • It is possible to carry out credible, useful studies with minimal resources, although with limitations • Refer to objective studies from other smoke-free jurisdictions • Use an existing survey that includes public support and compliance questions, or add questions to an existing survey • Assess compliance and air quality using volunteers

16. Case Studies • New York State • Laramie, Wyoming

17. TM Approaches to Evaluating Smoke-free Policies Stephen Babb, MPH Office on Smoking and Health sbabb@cdc.gov TCN Smoke-Free Policy Implementation Strategies TeleconferenceMarch 25, 2008 The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.