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  • U.S. Department of Health and Human Services Centers for Disease Control and Prevention

    Evaluation Toolkit for Smoke-Free Policies

  • We would like to thank the New York State Tobacco Control Program, which pioneered several of the evaluation approaches reviewed in this publication, for its generosity in sharing its evaluation strategy and its study

    protocols. We would also like to acknowledge ClearWay Minnesota’s A Toolkit for Implementing and Defending Smoke-Free Ordinances, which helped us in organizing and presenting the information in this publication.

    Ordering Information To download or order copies of this book, go to http://www.cdc.gov/tobacco to order single copies, or call toll-free

    1 (800) CDC-INFO

    1 (800) 232-4636

    Centers for Disease Control and Prevention. Evaluation Toolkit for Smoke-Free Policies. Atlanta: U.S. Department

    of Health and Human Services; 2008. Available at http://www.cdc.gov/tobacco.

  • Evaluation Toolkit for

    Smoke-Free Policies

    Brett Loomis, MS Matthew Farrelly, PhD

    Joanne Pais, MS RTI International

    Andrew Hyland, PhD Roswell Park Cancer Institute

    Paul Mowery, MA Biostatistics, Inc.

    Stephen Babb, MPH Natasha Jamison, MPH

    Jerelyn Jordan, BA CDC Office on Smoking and Health

    U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Coordinating Center for Health Promotion

    National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health

  • Contents

    Introduction.................................................................................................................................5

    Choosing Among Evaluation Studies for Smoke-Free Policies .............................................7

    Key Questions to Consider in Choosing Among Study Types ...........................................9

    Evaluating the Impact of Smoke-Free Policies: Overview of Available Approaches .........................................................................................12

    Public Support..................................................................................................................12

    Compliance.......................................................................................................................13

    Air Quality Monitoring .......................................................................................................14

    Employee Health...............................................................................................................15

    Economic Impact..............................................................................................................17

    Step-by-Step Guide to Selecting Appropriate Evaluation Studies for Smoke-Free Policies..........................................................................21

    Key Questions ..................................................................................................................21

    Study Recommendations .................................................................................................22

    Before the Policy is Passed or Implemented..........................................................22

    Within One Year of Implementation ........................................................................25

    One Year or Longer After Implementation ..............................................................28

    Selected Bibliography ..............................................................................................................31

  • INTRODUCTION

    This publication is intended for use by Centers for Disease Control and Prevention (CDC) staff in

    providing technical assistance to state tobacco control programs on approaches to evaluating the

    effects of state policies and laws that restrict smoking in workplaces and public places. (These policies

    and laws are often referred to as “smoke-free” policies and laws.) Additionally, it is intended for use

    by state tobacco control program evaluation staff in conducting such evaluations, and for use by

    national tobacco control partner organizations and other public health professionals in responding

    to requests for technical assistance on this topic.

    This publication can also be used by state tobacco control program staff to help community tobacco

    control programs and coalitions assess the impact of local smoke-free laws. The evaluation approaches

    described in this publication and the findings of studies conducted using these approaches may also

    be useful to other stakeholders who are interested in the effects of smoke-free laws, including business

    organizations (e.g., chambers of commerce, restaurant associations) and labor unions. This publication

    is based on the science reviewed in the 2006 U.S. Surgeon General’s Report, on more recent published

    studies, and on the experiences of U.S. states and other countries that have implemented and evaluated

    smoke-free laws.

    Increasingly, states and communities are passing laws to make indoor workplaces and public places,

    including restaurants and bars, smoke-free. Once a smoke-free law is passed, state and local tobacco

    control programs and their stakeholders often want to evaluate the law’s effects to assess if the law

    is achieving its intended benefits and to be certain that it is not having negative side effects. An

    evaluation can also help answer questions that policy makers and other key stakeholders may have

    about a law’s impact.

    In most cases, evaluation results are likely to indicate that a smoke-free law is having effects that

    are broadly similar to those observed in other sites. Nevertheless, confirming that this is the case is

    important for local evaluation and surveillance purposes and for responding to the questions and

    interests of stakeholders, who typically want to review local data. In other cases, evaluations may bring

    to light different or unexpected findings that may be helpful in identifying gaps or deficiencies in the

    law (e.g., exemptions for certain venues), in the implementation and enforcement of the law, or in the

    process leading to the enactment and implementation of the law (e.g., inadequate education of the

    public and the business community).

    Evaluation results may also be useful in comparing the effects of smoke-free laws in different sites

    (e.g., sites with more comprehensive laws compared with sites with less comprehensive laws, urban

    compared with rural sites, sites with different population compositions, state laws compared with local

    laws, state laws in states with previous experience with local smoke-free laws compared with state laws

    in states without such experience).

  • Evaluation Toolkit for Smoke-Free Policies

    Evaluating a smoke-free law involves considerable planning before the law takes effect. One major

    reason is that several of the evaluation studies commonly used require the collection of baseline,

    pre-implementation data. Additionally, gathering data before a law is passed may be necessary

    to demonstrate the need for a law.

    Several factors should be considered to determine what studies to undertake:

    • The stage the site has reached in the policy process.

    • The types of information that policy makers, the news media, the business community, and the public are requesting.

    • The provisions of the law, including any exemptions, and the venues that the law does and does not cover.

    • The resources available to evaluate the law.

    Most sites will not need to conduct all the studies described in this document. Sites should make

    strategic decisions about which studies to undertake on the basis of their local situations, needs, and

    resources. The Evaluation Toolkit for Smoke-Free Policies is designed to help state and local tobacco

    control programs select the specific studies that are best suited to their needs and resources. It also

    provides general information on how to design and conduct each study.

    Studies of smoke-free laws typically examine one of five outcomes: public support, compliance,

    air quality, employee health, and economic impact. Section 1 of this publication outlines four major

    issues to consider when selecting among these studies. Section 2 provides an overview of the studies,

    including what information the studies generate, how this information can be used, what potential pitfalls

    to guard against, when to collect data, and what specific approaches are available. Section 3, which

    is primarily intended for staff in CDC’s Office on Smoking and Health and others who provide technical

    assistance to state and local tobacco control programs, draws on the criteria in Section 1 to present

    a step-by-step process to help programs decide which studies are most appropriate for their site. Finally,

    Section 4 provides a selected bibliography of key peer-reviewed studies for each of the five types of

    studies examined.

  • CHOOSING AMONG EVALUATION STUDIES FOR SMOkE-FREE POLICIES

    There are five broad studies that s