Clean Indoor Air Ordinances Research Articles

A Multi-Year Study of Tobacco Control in Newspaper Editorials Using Community Characteristic Data and Content Analysis Findings

ABSTRACTWe content analyzed 1,473 newspaper editorials for topic, tone, and slant, and connected the results to community characteristic data: clean indoor air ordinance status for cities, and official smoking rates for counties. The analysis occurred during a multi-year project aimed at prompting communities to adopt clean indoor air policies. The results showed that most editorials were about tobacco restrictions or ordinances, were neutral in tone, and provided factual information about tobacco control. More editorials were negatively slanted vs. positively slanted toward tobacco control. Most editorials with positive tones were published in newspapers in towns that already had clean indoor air policies. We concluded that editorials might hold increased weight in spurring change, as the percentage of smokers in a city is unrelated to the town enacting a clean indoor air ordinance.

Association between local indoor smoking ordinances in Massachusetts and cigarette smoking during pregnancy: a multilevel analysis

ObjectiveTo estimate the association between local clean indoor air ordinances and prenatal maternal smoking across 351 municipalities in Massachusetts before the 2004 statewide ban and to test the effect of...

LOCAL SMOKE-FREE ORDINANCES ARE PASSING IN TOBACCO-GROWING STATES

Ferketich et al. studied demographic factors associated with the passage of clean indoor air ordinances in Appalachian communities.1 Based on reported lack of progress at the local level despite strong public support for clean indoor air laws, they recommended that efforts be focused on the state level instead. This conclusion goes beyond the data that they present and does not consider the power of the tobacco industry in state-level politics.2–6 Additionally, recent experience in South Carolina,7 a state Ferketich et al. included in their research, shows that strong progress on local clean indoor air ordinances is possible even in an Appalachian, tobacco-growing state. South Carolina's weak state clean indoor air ordinances passed in 1996 with an assumed preemption clause pushed by cigarette manufacturer lobbyists and hospitality industry allies that halted clean indoor ordinance progress for a decade. However, between May 2006 and January 2008, local advocates, supported by national tobacco control technical assistance and funding, challenged this presumed preemption by passing clean indoor air ordinances in 12 localities, two of which were sued under claims that state preemption did not allow local clean air ordinances. In March 2008, the state Supreme Court ruled that local clean indoor air ordinances were not preempted; since then, advocates have passed 21 more local clean indoor air ordinances. The passage of these local clean indoor air ordinances as of May 2010 has been recognized as the highest number of strong local ordinances passed in any US state for two years in a row.8 Cigarette manufacturing interests responded with an effort to pass explicit state preemption. During the 2007 and 2008 legislative session, 11 neutral to strong clean indoor air bills were introduced; three were co-opted to include weak clean indoor air provisions and preemptive language as a result of tobacco manufacturer lobbying. Tobacco control advocates stopped all weak bills with preemption and convinced legislators to delay state laws, which could become vehicles for preemption.7 The trajectory of South Carolina clean indoor air ordinance progress provides a strong counterpoint to Ferketich et al.'s conclusion that there is a lack of motivation among tobacco control advocates at the local level in tobacco-growing states and that clean indoor air ordinance efforts should focus at the state level. Developing clean indoor air laws at the state level without strong local support provides an opportunity for cigarette manufacturers to preempt more comprehensive local activity, where tobacco manufacturers have less sway.3,9 In contrast, developing the capacity of local advocates can result in a strong smoke-free movement through local smoke-free ordinance adoption.

SMOKE-FREE LEGISLATION IN APPALACHIAN COUNTIES

In the article “Clean Indoor Air Ordinance Coverage in the Appalachian Region of the United States,” Ferketich et al. recommend that clean indoor air laws in certain Appalachian states “should be statewide, because, clearly, leaving the effort to local communities does not result in a large number of strong local CIA ordinances.”1(p1317) The authors make a monumental leap in their conclusion that efforts to pass strong statewide smoke-free laws should take priority over local laws in Appalachian states. Their study does not analyze the effectiveness of statewide laws; rather, it only reviews the existence and strength of municipal smoke-free ordinances in six selected Appalachian states. In drawing this conclusion, Ferketich et al. do not consider the many political, societal, and contextual factors affecting tobacco control policy in Appalachia and the tobacco-growing states.2–5 Nor do the authors consider the risks associated with enacting smoke-free legislation before there is capacity at the local level for adequate implementation and enforcement.6,7 Only three of the 13 Appalachian states have enacted comprehensive smoke-free workplace legislation, and they are all located in northern, nontobacco growing states.8 Further, Georgia, which has a weak state law without explicit preemption, had very few municipal laws, indicating that local officials in Georgia may have lacked the political will to enact stronger local laws, resulting in implicit preemption.9 The fact that Appalachia is plagued by low socioeconomic status and high unemployment puts these states at risk for enacting weak, preemptive statewide smoke-free legislation, which their study findings support. Mothers participate in a regular physical exercise and social support program titled Caminando Con Fe (Walking With Faith) in a child-friendly place at The Most Precious Blood Church in Chula Vista. The group partnered with the Healthy Eating, Active Communities program to refurbish a nearby park for community use. Photo by Tim Wagner for Partnership for Public's Health. Available at http://www.twagnerimages.com. Printed with permission. The observation that so few Appalachian communities have comprehensive state or municipal smoke-free laws and regulations is not surprising given that these communities are disproportionately affected by high smoking rates, weak tobacco control laws, and lack of funding for comprehensive tobacco control. 2,10 Their study design focused solely on the most affected Appalachian communities, further underscoring the disparities that exist. The authors should have concluded that a crucial first step in smoke-free policy development is to foster capacity and demand at the local level for strong smoke-free laws by creating a mass of local elected officials who will together advocate for the ultimate goal: a comprehensive anti-preemptive statewide smoke-free law that covers all workers.11

Indoor smoking ordinances in workplaces and public places in Kansas

The purpose of this study was to investigate the preferences of elected city officials regarding the need for a statewide clean indoor air law and to analyze the content of local smoking ordinances. A survey of elected officials in 57 larger Kansas cities obtained information on the perceived need for statewide legislation, venues to be covered, and motivating factors. Clean indoor air ordinances from all Kansas cities were analyzed by venue. The survey response rate was 190 out of 377 (50.4%) for elected officials. Over 70% of the respondents favored or strongly favored greater restrictions on indoor smoking. Sixty percent favored statewide legislation. Among these, over 80% favored restrictions in health care facilities, theaters, indoor sports arenas (including bowling alleys), restaurants, shopping malls, lobbies, enclosed spaces in outdoor arenas, and hotel/motel rooms. Officials who had never smoked favored a more restrictive approach. Employee and public health concerns were cited as influential by 76%-79% of respondents. Thirty-eight ordinances, covering over half of the state's population, were examined. They varied considerably in their exemptions. Official's attitudes toward smoking regulations were associated with their smoking status. The examination of existing ordinances revealed a piecemeal approach to smoking regulations.

Clean Indoor Air Ordinance Coverage in the Appalachian Region of the United States

We sought to quantitatively examine the pattern of, and socioeconomic factors associated with, adoption of clean indoor air ordinances in Appalachia. We collected and reviewed clean indoor air ordinances in Appalachian communities in 6 states and rated the ordinances for completeness of coverage in workplaces, restaurants, and bars. Additionally, we computed a strength score to measure coverage in 7 locations. We fit mixed-effects models to determine whether the presence of a comprehensive ordinance and the ordinance strength were related to community socioeconomic disadvantage. Of the 332 communities included in the analysis, fewer than 20% had adopted a comprehensive workplace, restaurant, or bar ordinance. Most ordinances were weak, achieving on average only 43% of the total possible points. Communities with a higher unemployment rate were less likely and those with a higher education level were more likely to have a strong ordinance. The majority of residents in these communities are not protected from secondhand smoke. Efforts to pass strong statewide clean indoor air laws should take priority over local initiatives in these states.

Youth Participation in a Community Campaign to Pass a Clean Indoor Air Ordinance

Because of the harmful effects of secondhand smoke, communities are organizing to pass clean indoor air policies. With youth being considered one of the most vulnerable populations to this health hazard, it can be strategic to campaigns and beneficial to the youth's development to involve them in efforts to control this toxin. However, youth participation in health campaigns is limited because of barriers inherent in these initiatives. This article presents lessons learned from a qualitative case study on the youth involvement in a successful local clean indoor air campaign. Through the analysis of semistructured interviews with the adult members of the campaign, group interviews and questionnaire completion by the youth members of the campaign, and additional insight made possible by participant observation, recommendations are provided to engage and sustain youth involvement in local public health initiatives.

But Will I Be Re-Elected? What Happens to Local Level Policy Makers Who Support Clean Indoor Air Laws?

This research was conducted to determine the impact of voting for clean indoor air ordinance on a local-level policy maker's re-election status. Secondary data were used to identify local tobacco ordinances in Arizona proposed between 2001 and 2005, score ordinance content for comprehensiveness, identify policy makers who voted and how they voted, and determine if the measure passed or failed. Participation in and outcomes of subsequent elections were documented from public records. Ninety-two local-level policy makers in 15 local jurisdictions considered clean indoor air laws between 2001 and 2005. Policy makers who voted for these ordinances were more likely to be re-elected than those who voted against them. Structured interviews revealed that policy makers did not believe the issue had an impact on re-election results and believed that although the issue may have been contentious, it was no longer salient in the community.

Communicating With Local Elected Officials: Lessons Learned From Clean Indoor Air Ordinance Campaigns

This article describes a study of the effectiveness of communication strategies used to influence policy makers to support local smoke-free laws in the Minneapolis-St. Paul metropolitan region. Twenty-seven of 41 members of three city councils and two county boards of commissioners were individually interviewed as were seven advocates who campaigned for the bans. Officials valued public health and economic data, public opinion polls, personally written e-mails, and dialogue with constituents. Phone banking messages indicated public support but were a nuisance. Officials felt that media ads were a waste of money and leafleting and other personal targeting were unacceptable. Advocates tended not to critically examine their own efforts for strengths and weaknesses and seemed unconcerned by public officials' negative reception to some strategies. This case study suggests the need for reflection on the pros and cons of well-funded, highly orchestrated campaigns for public health policy, as these strategies may clash with the political process of building relationships.

The impact of a smoking ban on hospital admissions for coronary heart disease

Objective. In March 2002, the city of Bowling Green, Ohio, implemented a clean indoor air ordinance banning smoking in workplaces and public places. This study evaluates the effect of this ordinance on hospital admissions for smoking-related diseases. Methods. A quasi-experimental design with interrupted time-series was used including a matched control city (Kent, Ohio) with no clean indoor air ordinance. Data on hospital admissions during the period of January 1999 to June 2005 were analyzed using Autoregressive Integrated Moving Average (ARIMA) models. Results. A reduction in admission rates for smoking-related diseases was achieved in Bowling Green compared to the control city. The largest reduction was for coronary heart disease, where rates were decreased significantly by 39% after 1 year and by 47% after 3 years following the implementation of the ordinance. ARIMA models revealed a statistically significant downward trend in monthly admission rates for coronary heart disease (Bowling Green, ω = − 1.69, p = 0.036 vs. Kent, ω = − 1.14, p = 0.183) and support the hypothesis that the ordinance had a significant impact on admission rates for coronary heart disease. Conclusion. The findings of this study suggest that clean indoor air ordinances lead to a reduction in hospital admissions for coronary heart disease, thus reducing health care costs.

Indoor Air Quality in Restaurants With and Without Designated Smoking Rooms

Indoor air quality in restaurants was studied in two cities in northwest Ohio after clean indoor air ordinances had been enacted. Carbon dioxide and ultrafine particles were measured in two restaurants in Toledo and two restaurants in Bowling Green. One restaurant in each city was smoke free, and one restaurant in each city contained a dedicated smoking room. A smoke free office space was also assessed as a reference site. Measurements were collected with datalogging instrumentation simultaneously in both the designated smoking room, if present, and in the nonsmoking section. For smoke free establishments, datalogging instrumentation was also used. Carbon dioxide levels were elevated in all four restaurants, with only 32% of the measurements meeting the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) criterion level of 1000 ppm. Ultrafine particles currently do not have any formal standard or guideline. Statistically significant differences were evident between all four restaurants and the reference site. The largest differences were found between the two designated smoking rooms and the reference site (p < 0.001), with the mean levels in the smoking rooms up to 43 times higher than in the reference site. The results from this study indicate inadequate fresh air supply in all four restaurants, particularly in the designated smoking rooms, and the possibility that the designated smoking rooms were not containing the environment tobacco smoke, based on the ultrafine particle concentrations measured in the nonsmoking areas of the smoking restaurants.

Diffusion of Clean Indoor Air Ordinances in the Southwestern United States

The authors investigate the process through which clean indoor air ordinances were considered in 10 communities in the southwestern United States and key factors that influenced diffusion and adoption. Clean indoor air ordinances, which ban smoking in public places, were adopted in approximately 1,409 U.S. communities from 1986 to April 2004. The authors gathered data from 10 communities in New Mexico and Texas by means of face-to-face interview, e-mail, and telephone interviews and by analyzing archival materials. Important influences on the adoption or rejection of clean indoor air ordinances were (a) personal experiences of policy champions, (b) local framing of the ordinance as a public health issue versus as an economic/ business or an individual rights issue, and (c) interpersonal networks connecting a community to previously adopting communities. The policies that were adopted ranged in comprehensiveness, with each community of study reinventing model policies obtained from other communities.

Development of a social will for tobacco control index.

To design a valid and reliable questionnaire to assess community support for controlling tobacco. Four samples were obtained to test the psychometric properties of the Social Will for Tobacco Control Instrument. Principal components analysis found 2 factors accounted for 42.8% (personal support) and 9.7% (agency support) of the variance, respectively. Sensitivity was 93.7%, specificity was 90.6%, and validity was 92.3%. The instrument predicted, within 1%, the actual vote regarding a local clean indoor air ordinance. Stability reliability was .84 and .77 respectively for the 2 factors. The SWTCI can help policy makers predict whether communities are supportive of clean indoor air ordinances.

Agenda Setting and the Albuquerque Clean Indoor Air Ordinance

Health education professionals must continuously address health promotion issues using the latest strategies and research. Agenda setting uses interrelationships of the media, public, and policy agendas to explore how issues move to the forefront of policymakers' actions. The relative importance of an issue influences the policy agenda and is determined by how often an issue appears in the media. The Albuquerque Clean Indoor Air Ordinance is an example of agenda setting applied to a health promotion issue.

Adolescent Exposure to and Perceptions of Environmental Tobacco Smoke

Environmental tobacco smoke (ETS) poses an underappreciated risk to adolescent health. This study examined perceptions of adolescents (n = 574) regarding ETS. About one half (54%) were exposed to ETS the previous week, and one third (30%) were exposed to 3 or more hours of ETS the past week. Concurrently, 29% believed that breathing someone else's cigarette smoke had little or no effect on their health. Most adolescents (56%) believed that smoking should not be allowed in restaurants without bars but were less supportive of prohibiting smoking in restaurants with bars (20%) or in bars (14%). Two thirds (69%) of adolescents believed that the government should be involved in making laws that protect the health of people who work in bars and restaurants. Almost one half (49%) believed that the government should be involved in passing laws that make it illegal for people to smoke in public places. Odds ratios revealed that females, nonwhites, younger students, nonsmoking students, and students who believed that ETS exposure had a moderate or major effect on health were statistically significantly more likely to support clean indoor air ordinances in select locations compared to males, whites, older students, students who smoke, and students who perceived that ETS exposure has little to no effect on health.

Effectiveness of Clean Indoor Air Ordinances in Controlling Environmental Tobacco Smoke in Restaurants

Clean indoor air (CIA) ordinances in Toledo, Ohio, and Bowling Green, Ohio, regulate smoking in restaurants to protect patrons and employees. Yet complete protection is questionable because the ordinances allow for smoking in certain dining sections. Two restaurants were studied in each city, one smoking and one nonsmoking. Levels of contaminants related to environmental tobacco smoke (ETS)--determined by personal and area air monitoring-in the nonsmoking restaurants were comparable to levels in a control environment. However, levels of ETS-related contaminants in the smoking restaurants, including designated nonsmoking sections, were significantly higher than levels in the control environment. ETS-related contamination of the nonsmoking sections in the smoking restaurants is attributable to direct openings between the smoking and nonsmoking sections. Reasonable protection of employees and patrons against ETS-related contaminants requires strict enforcement of CIA ordinances. Full protection is achievable only with 100% smoke-free policies.

The Nuts and Bolts of the Passage of a Clean Indoor Air Ordinance in Toledo, Ohio

In many communities across the country various clean indoor air policies (smoking bans) are being put into effect. Implementation occurs in various ways, making each policy unique regarding its components, the processes involved in getting it passed, and the timetable in which it happens. The following article outlines one city's quest for a clean indoor air policy.

Survey of Smoking in Food Service Establishments

Survey of Smoking in Food Service Establishments

The Duluth Clean Indoor Air Ordinance: Problems and Success in Fighting the Tobacco Industry at the Local Level in the 21st Century

Case study methodology was used to investigate the tobacco industry's strategies to fight local tobacco control efforts in Duluth, Minn. The industry opposed the clean indoor air ordinance indirectly through allies and front groups and directly in a referendum. Health groups failed to win a strong ordinance because they framed it as a youth issue rather than a workplace issue and failed to engage the industry's economic claims. Opponents' overexploitation of weaknesses in the ordinance allowed health advocates to construct a stronger version. Health advocates should assume that the tobacco industry will oppose all local tobacco control measures indirectly, directly, or both. Clean indoor air ordinances should be framed as workplace safety issues.

Tobacco Control and Direct Democracy in Dade County, Florida: Future Implications for Health Advocates

In 1979 and 1980 in Dade County, Florida, a small grassroots advocacy group, Group Against Smoking Pollution (GASP), attempted to enact a clean indoor air ordinance through the initiative process. The tobacco industry's successful efforts to defeat the initiatives were expensive high-tech media-centered campaigns. Even though GASP's electoral resources were extremely limited for both initiatives, GASP utilized similar media-centered tactics. This approach attempted to defeat the tobacco industry in its own venue, in spite of the tobacco industry's vastly greater resources. Nevertheless, the industry defeated these ordinances by narrow margins because of broad voter support for the initiatives before the industry started its campaigns. Health advocates will never have the resources to match the tobacco industry in expensive high-tech media-centered initiative campaigns. Rather, their power lies in the general popularity of tobacco control legislation and their ability to mobilize broad grassroots efforts combined with an adequately funded media campaign.