Evaluate the effectiveness of laws on smoking in your home state. Determine if your state’s standpoint on smokerfree bars is adequate, in your opinion. Provide support for your rationale.EXHIBIT 2–3 Case Study: Using Epidemiologic Methods to Conduct a Policy Evaluation of the Smokefree Bars Law

Smokefree

Evaluate the effectiveness of laws on smoking in your home state. Determine if your state’s standpoint on smokerfree bars is adequate, in your opinion. Provide support for your rationale.EXHIBIT 2–3 Case Study: Using Epidemiologic Methods to Conduct a Policy Evaluation of the Smokefree Bars Law

This research project investigated a community’s response to the California Smokefree Bars (SFB) Law, a change in tobacco control policy that was implemented as Assembly Bill (AB) 3037 on January 1, 1998. The SFB Law removed the exemption for bars, taverns, and lounges that had been included in AB 13, the 1995 Workplace Safety Law. AB13/3037 banned smoking in all bars throughout the state (with some exemptions for bars with no employees). For our epidemio-logic research, the SFB Law was viewed as a natural experiment, with its scope and timing under the control of the California State Legislature.

Tobacco control policy in the form of laws and local ordinances is occurring with increasing frequency as part of the antitobacco efforts to reduce the deleterious first- and secondhand health effects of cigarette smoke. Evidence suggests that secondhand smoke has harmful health consequences from which customers and workers in alcohol-serving establishments need protection.

These adverse effects include cancer, emphysema and other lung disorders, and heart disease. Policies to reduce exposure to secondhand smoke need to be investigated to understand their potential to effect health-related changes in population groups and to suggest recommendations regarding their efficacy.

Our policy analysis of the response to the SFB Law was conducted within Long Beach, which is the fifth-largest city (population, 460,000) in the state of California and the second largest in Los Angeles County, the county in which Long Beach is located.

Noteworthy is the fact that Long Beach has a distinguished record of local tobacco control. In September 1994, Long Beach was one of 22 cities in the state recognized for protecting the health of its residents through strong tobacco control policies.

The Long Beach Smoking Ordinance, enacted in 1991, prohibited smoking in all enclosed work-places and public places. In 1993, the Long Beach City Council strengthened the ordinance by prohibiting smoking in all restaurants and restaurant/bar combinations.

Additionally, Long Beach is one of the few cities in the state with its own health department, a key factor for the positive community response to both local and statewide tobacco control. Over the years, a very active Tobacco Education Program within the city’s health department has worked closely with the city to educate the citizens regarding antitobacco concerns and also to implement various tobacco control policies.

In order to determine the response to the California SFB Law, we directed our efforts to gathering data from five different perspectives: bar personnel, residents, economic data from the restaurant business, compliance at the bars, and print media. The study was conducted over a 4-year period (July 1998–June 2002). Trained interviewers were sent to a sample of alcohol-serving establishments, such as restaurant bars and stand-alone bars.

Observations of compliance at Long Beach bars showed a continuing decrease in the proportion of bars with inside ashtrays; no restaurant bars in the sample had ashtrays during fall 2000 or spring 2001. Inside smoking increased only for stand-alone bars during fall 2000, and then decreased in spring 2001. No inside smoking was observed in any restaurant bars in either fall 2000 or spring 2001. Outside smoking continued to increase during the third year.

The extent of the smell of smoke was significantly higher in stand-alone bars than in restaurant-bars, whether measured during daytime or early evening hours during fall 2000 and spring 2001. Based upon the odor of smoke, we concluded that compliance with the law was higher within restaurant-bars than stand-alone bars, although smoking continued in some restaurant-bars.

In year 1 (with a follow-up in year 3), a telephone survey of a cross-sectional sample of Long Beach residents was conducted with over 1,500 respondents. A key result was that approval for the SFB Law increased from 66% in year 1 to 73% in year 3.

Other results demonstrated that 68% approved a ban on smoking on a nearby, wooden ocean pier; 75% approved of a cigarette tax to fund early childhood development programs; and 83% approved of smokefree zones in parks frequented by children. In conclusion, this case study demonstrated how epidemiologic methods (e.g., cross-sectional surveys and other analyses of population-based data) could be used in public health policy evaluation.

Supported by Grant 7RT-0185, University of California Tobacco-Related Disease Research Program.

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