Luis RodriguezHST 3700

Las Vegas, Nevada - Second Hand Smoke - Community Analysis

Community Diagnosis

Demographics

To many tourists, the strip is the first thing that comes to mind when Las Vegas is

mentioned (McCollister, 1992)Las Vegas is the city where high rollers can lose a fortune with a

simple toss of a dice, or a spin of the wheel (McCollister, 1992).Las Vegas’s is renowned for its

gambling, shopping, and fine dining (Forbes, 2014). Las Vegas is known by the many people

around the world as “The Entertainment Capital of the World” (Forbes, 2014).

In the city of Las Vegas, there are 425 smoke shops (Yellowpages, 2014d). There are 908

gas stations (Yellowpages, 2014c). Ninety-eight Walmarts would also be found in Las Vegas

(Yellowpages, 2014f). Eighty-four different Walgreens would be located in Clark County

(Yellowpages, 2014e) 198 different 7-Elevens can be located at your convenience in Las Vegas

(Yellowpages, 2014g). Seven Cigarette Expresses will help a smoker find their favorite

cigarettes in a swift manner (Yellowpages, 2014b). Eighty-seven wholesale and manufacture

smoke shops are also located in Las Vegas (Yellowpages, 2014a). These are all companies that

sell tobacco products at the convenience of the customers. Now that there a better understanding

of Las Vegas’ background, now it is appropriate to see how second hand smoke affects Las

Vegas.

Las Vegas is one city where people are fearless in making high risks decisions

(McCollister, 1992). Every year, tens of thousands of recent immigrants strive to live in Las

Vegas (Rusell, 2005). Las Vegas has an increasingly divided society (McKenzie, 2005). Las

Vegas, Nevada is the fastest growing city in the nation and is creating a global trend of reshaping

the spatial, social, and political order accordingly (McKenzie, 2005). One risk that is a health

hazard, and very important to be aware of, is smoking cigarettes that leads to second hand

smoke. Before the effects of second-hand smoke are analyzed, the demographics of Las Vegas,

Nevada will be discussed first; there is more to Las Vegas than just the strip.

The population of Las Vegas Nevada is 2,043,000 people (Forbes, 2014). The major

industries that are the backbone of Las Vegas’ income are gambling and tourism (Forbes, 2014).

The median household income is $50, 356 (Forbes, 2014). The median home price is $173,500

(Forbes, 2014). The unemployment rate is 8.2% (Forbes, 2014). As of 2013, the job growth is

2.9% (Forbes, 2014). The percentage of college students completing college is 22.1% (Forbes,

2014). For best places, business, and careers, Las Vegas is ranked 111 (Forbes, 2014). Las Vegas

is one of the most unionized cities in America, allowing low taxes to ease the stress and worry to

start a new business (Rusell, 2005). The job growth of Las Vegas is ranked 195 (Forbes, 2014).

The education in Las Vegas is ranked 163 (Forbes, 2014). The poverty rate in Las Vegas is 8

percent (Nevada, 2004). In some way, Nevada is still experiencing the effects of the Great

Recession because there are 100,000 people fewer with jobs than before the recession (Vogel,

2014).

Unemployment can greatly impact a person’s health for the worse (Pharr, Moonie,

Bungum, 2012). The unemployed have a higher risk of impaired mental health including

depression, anxiety, and stress (Pharr, Moonie, Bungum, 2012). People who have experienced

unemployment for more than thirty-seven months are two time more likely to be depressed, or

anxious (Pharr, Moonie, Bungum, 2012). Unemployment is linked to unhealthy behaviors, such

as an increase in alcohol and tobacco consumption (Pharr, Moonie, Bungum, 2012). Being

employed satisfies a psychological need, which is healthy for the mind (Pharr, Moonie, Bungum,

2012). There is a relationship betweens one’s work status and mental health that means that

when one is employed, that person values their self-worth of employment (Pharr, Moonie,

Bungum, 2012).

There are seven common industries that the men of Las Vegas work in: Accommodation

and food and services (20%), construction (11%) administrative and support and waste

management services (9%), arts and entertainment (8%), professionals, scientific, and technical

services (6%), public administration (4%), and other transportation, support activities (4%) (Las

Vegas, 2014). There are seven common industries that the women in Las Vegas work in:

Accommodation and food services (21%), health care (13%), educational services (8%), arts,

entertainment, and recreation (7%), professional, scientific, and technical services (7%),

administrative and support and waste management services (5%), and public administration (5%)

(Las Vegas, 2014a).

There are seven common occupations for men and women in Las Vegas, Nevada, but

first the men will occupations will be mentioned (Las Vegas, 2014a). Five percent of men obtain

building cleaning and pest control occupations (Las Vegas, 2014a). Five percent have

management positions except in farms, ranch, and other agricultural managers (Las Vegas,

2014a). Five percent are responsible for food preparation, or work as cooks (Las Vegas, 2014a).

Four percent work as protective service workers (Las Vegas, 2014). Four percent have

maintenance, repairers, and installers (Las Vegas, 2014a). Three percent are material movers, or

laborers (Las Vegas, 2014a). The other 3% are driver/sales and truck drivers (Las Vegas, 2014a).

The women’s seven common occupations are similar to those of men, but not quite the

same. 8% of women have building cleaning and pest control occupations (Las Vegas, 2014a).

Three percent have management positions, except in the agriculture profession (Las Vegas,

2014a). Three percent are elementary and middle school teachers, personal care (except personal

appearance, but service workers), cooks, and registered nurses (Las Vegas, 2014a).

The population that makes up Las Vegas, 50% are males and 49.6% are females (Las

Vegas, 2014a). The median resident age is thirty-six years old and the Nevada median age is

thirty-six point five years old (Las Vegas, 2014a). In 2012, the median gross rent was $936 (Las

Vegas, 2014a From 2000 to 2012, there has been a $8,100 increase value of a home, or a condo

(Las Vegas, 2014a). Aside from the economic perspective, lets look more closely at the different

races that make up Las Vegas, Nevada.

Forty-seven point eight percent of the population in Las Vegas are white (Las Vegas,

2014a). Thirty-two point eight percent of the population make up the Hispanic community (Las

Vegas, 2014a). Ten percent of the population make up the Black community (Las Vegas, 2014a).

Five point nine percent of the population make up the Asian community (Las Vegas, 2014a).

Two point eight percent of the population make up the population that consists of two, or more

races in Las Vegas (Las Vegas, 2014a). Point three percent of the population in Las Vegas are

responsible for the Native Hawaiian and other Pacific Islander community (Las Vegas, 2014a).

Point two percent of the population is accountable for the American Indian community (Las

Vegas, 2014a). For every square mile, there are 5,264 people (Las Vegas, 2014a). Now lets

concentrate on the population of twenty five years and over in Las Vegas.

Eighty-three point three percent of the population in Las Vegas have earned a High

School diploma, or higher (Las Vegas, 2014a). Twenty one point eight percent have earned a

Bachelor’s degree (Las Vegas, 2014a). Seven point seven percent have earned a graduate, or

professional degree (Las Vegas, 2014a). Fourteen percent are unemployed (Las Vegas, 2014a).

The mean commuting time to work is twenty-four point six minutes (Las Vegas, 2014a). The

high school dropout rate is fourteen percent (Nevada, 2014). Twelve-point-nine percent have

some high school, but no diploma (Nevada, 2014). Now, the marriage related status of the

population for fifteen years and older in Las Vegas will be discussed.

Thirty-two point three percent of the population have never been married (Las Vegas,

2014a). Forty-four point three percent are now married (Las Vegas, 2014a). Two-point-eight

percent are separated (Las Vegas, 2014a). Five-point-six percent are widowed (Las Vegas,

2014a). Fifteen-point-one percent are divorced (Las Vegas, 2014a). Per 100,000 people, in 2012,

the crime rates in Las Vegas will be explored.

Risk Assessment

Per 100,000 people, there have been five-point-one murders (Las Vegas, 2014a). The rate

of rapes are forty-point-three rapes (Las Vegas, 2014a). The rate of robberies are 258.5 robberies

per 100,000 (Las Vegas, 2014a). The rate of assaults is 480.1 (Las Vegas, 2014a). The burglary

rate is 961.2 (Las Vegas, 2014a). The thefts rate is 1725.2 (Las Vegas, 2014a). The auto thefts

rate is 451.9 (Las Vegas, 2014a). Lastly, the arson rate is fourteen-point-six (Las Vegas, 2014a).

Lets take a step backwards and concentrate on what Las Vegas academically offers to its

students.

Las Vegas has sixty-eight elementary school in its city (Schools in Las Vegas, Nevada,

2014b). Also, Las Vegas has fourteen middle schools and eleven high schools in its city

(Schools in Las Vegas, Nevada, 2014b). Moreover, there are sixteen other alternative schools in

the city of Las Vegas (Schools in Las Vegas, Nevada, 2014b). Nevada high school students are

judged in reading, writing, and math (USNews, 2014). Multiple Nevada high school participate

in the GEAR UP programs, which offers grants for students to attend Nevada System of Higher

Education colleges and universities (USNews, 2014). To receive a grant, students must

participate in tutoring, attend a participating school, and have a GPA of at least 2.0 (USNews,

2014). One of the highly ranked Nevada school is in Las Vegas - Advanced Technologies

Academy (USNews, 2014). There are 134,449 students enrolled in a school and 5,734 full-time

teachers (USNews, 2014).

Nevada children are not impressive in the overall well-being category (Millard, 2014).

Looking at the quality of children’s health, education, economic security, and state families, the

only two states behind Nevada are New Mexico and Mississippi (Millard, 2014). In 2012, close

to forty percent of the Nevada’s high school seniors did not graduate in time (Millard, 2014).

Nevada still ranks in 47th place in children’s health considering Nevada has the highest rate of

uninsured children in the U.S - 17% compared to the national average of 7% (Millard, 2014). In

the state of Nevada, one in four children live in poverty (Millard, 2014) This rate has increased

to eighty-five percent since 1990 (Millard, 2014).

The health and fitness is not so impressive compared to other cities (MensFitness, 2014).

Las Vegas residents are three percent more likely than average to use their health-club

membership (MensFitness, 2014). Thirty-eight-point-seven percent of adults are heavy enough to

most likely experience weight-related health problems; compared to the national average of 36 %

(MensFitness, 2014). Las Vegas residents scored poorly in the fruits and vegetables consumption

(MensFitness, 2014). Only twenty-one percent of the Las Vegas residents eat the recommended

of five, or more servings per day. Las Vegas has sixty-nine municipal parks, which is a small

amount compared to other cities (MensFitness, 2014). There has been a connection of obesity

rates and the lack of access to parks and green space (MensFitness, 2014). Las Vegas residents

participate in sports fifteen percent less than average while there is sixty-eight percent more fast-

food joints than the average (MensFitness, 2014). Moreover, Las Vegas has 106 percent more

pizza places per capita than the average (MensFitness, 2014). For every 10,748 residents, there is

one basketball court (MensFitness, 2014). Ice Cream shops are 151 percent more popular in Las

Vegas than average (MensFitness, 2014). Other students participate in a CDC-sponsored

program to reduce obesity and other chronic diseases, but Nevada does not (MensFitness, 2014).

On the contrary, there has been an increase in adolescents walking and using their bicycle to

transport them to school (Bungum, Lounsbery, Moonie, & Gast, 2009). Smokers will discourage

people to ride their bicycles, or walk.

At Risk Group

It is important to begin by understanding of who smokes. Although there are no specific

statistics for Las Vegas, there are statistical highlights of Nevada. Nevada ranks 43rd among the

rest of the states that smoke (CDC, 2014). Twenty-two percent of the adult population (18+

years) are current cigarette smokers (CDC, 2014). The national median is 18.4% (CDC, 2014).

Males tend to smoke more than females (CDC, 2014). Students with only a high school diploma

smoke more cigarettes than students with an education less and more than a high school diploma

(CDC, 2014). Las Vegas is ranked 10th place that have smoking problems (TheDailyBeast,

2011). Las Vegas smokers smoke an average of 14.2 cigarettes and sixty-six percent have tried

to quit with the help of a patch, gum, or support program (TheDailyBeast, 2011). Let’s focus on

what exactly second hand smoke is.

Secondhand smoke, also known as environmental smoke, involuntary smoke, and passive

smoke, is the combination of smoke given off by a burning tobacco product and smoke exhaled

by a smoker (National Cancer Institute [NCI], 2004). Exposure to secondhand smoke (SHS)

from cigarettes is estimated to cause 41,000 deaths among non-smoking U.S adults each year and

a staggering $5.6 billion annually in lost in productivity (King, Patel, & Babb, 2014).

There are sixty-nine chemicals in secondhand smoke that are known to cause cancer

(NCI, 2004). Secondhand smoke is also known to cause heart disease in adults, sudden infant

death syndrome, ear infections, and asthma attacks in children (NCI, 2004). To be clear, there is

no safe level of exposure to secondhand smoke (NCI, 2004).

There are more than 7,000 chemicals that have been identified in secondhand smoke, and

of those 7,000 chemicals, 250 of them are known to be harmful (NCI, 2004). At least sixty-nine

toxic chemicals in secondhand smoke causes cancer (NCI, 2004). Smoke is also linked to the

increased risk for Alzheimer’s disease and other forms of dementia (Fisher Center For

Alzheimer’s Research Foundation, 2012). There are international studies that have found that

you only need to inhale smoke-filled air to increase the chances of suffering deleterious effects

of cigarette smoke (Fisher Center For Alzheimer’s Research Foundation, 2012). More

specifically, secondhand smoke is linked to thinking and memory problems (Fisher Center For

Alzheimer’s Research Foundation, 2012). A current study found that people who are exposed to

secondhand smoke have a 29 percent greater chance of developing severe dementia in old age

(Fisher Center For Alzheimer’s Research Foundation, 2012). Secondhand smoke also causes

other severe health hazards and diseases.

Secondhand smoke exposure is linked to cardiovascular disease (World Health

Federation [WHF], 2014). Smoking causes about ten percent of cardiovascular disease (CVD)

and is the second leading cause of CVD, after high blood pressure (WHF, 2014). Globally,

tobacco causes 6 million deaths a year (WHF, 2014). Constant exposure to secondhand smoke,

either at home or at work, has been found to double the risk of having a heart attack (WHF,

2014). Children area at a higher risk as well.

Nicotine is a ganglion stimulator and a depressor (Al-Sayed & Ibrahim, 2014). Cotinine

is a major metabolite of nicotine and is helps measure passive exposure to tobacco smoke (Al-

Sayed & Ibrahim, 2014). It is estimated from cotinine measurements that the total nicotine dose

received by children whose parents are smokers is equivalent to children who actively smoke 60

to 150 cigarettes per year and children with nonsmoking parents have the lowest exhaled CO

concentrations (Al-Sayed & Ibrahim, 2014). Children’s immune system are not fully developed,

so it is important to have a smoke-free home because children spend more time at home,

therefore, are likely to experience more intense and prolonged smoke exposure from parental

smoking (Al-Sayed & Ibrahim, 2014).

Passive smoking affects the immune system and makes children more vulnerable of

getting sick (Al-Sayed & Ibrahim, 2014). Smoking both affects the cell-mediated and humoral

immune responses (Al-Sayed & Ibrahim, 2014). Nicotine blocks lymphocyte proliferation and

differentiation including suppression of antibody-forming cells (Al-Sayed & Ibrahim, 2014).

Being exposed to smoke leads to alterations in the epithelial function, such as a decrease in

mucociliary activity, which causes a reduces clearance of inhaled substances (Al-Sayed &

Ibrahim, 2014). The risk is doubled if both parents smoke (Al-Sayed & Ibrahim, 2014). In the

state of Nevada, from 2010-2011, 55 percent of all the homes have at least one smoker in each

home (King, Patel, & Babb, 2014).

Home is most likely the best place to keep children away from a smoking environment

(Webmd, 2014). Exposure to secondhand smoke can cause asthma in children who have not

previously showed symptoms and make asthma symptoms more clear (Environmental Protection

Agency [EPA], 2011). For infants who are exposed to secondhand smoke on a regular basis, they

are at a very high risk of low respiratory track infections, such as pneumonia and bronchitis

(EPA, 2011). Environmental tobacco smoke (ETS) is a human carcinogen, which is responsible

for about 3,000 lung cancer deaths per year in the U.S (EPA, 2011). The people of Las Vegas

smoke for many reasons: social, stress, a way to relax, etc. We will take a look at the associations

between psychological demands, decisions, and job strain with smoking in female (majority of

the employees) hotel room cleaners in Las Vegas to have a better understanding of what keeps

the habit of cigarette smoking alive (Rugulies, Sherzer, Krause, 2008).

Over the last two decades, in Las Vegas, there has been strong evidence that has evolved

explaining the link between exposure to adverse psychological characteristics that leads to

increased job strain that causes smoking (Bongers, de Winter, Kompier, & Hildebrandt, 1993;

Davis & Heany, 2000; Grenier & Krause, 2000). The disadvantage psychological work

characteristics increase the likelihood to poor health behaviors, especially smoking, perhaps as a

way to tolerate stressful condition and negative emotions (Rugulies, Sherzer, Krause, 2008).

Although there isn’t a concrete evidence proving this hypothesis, in some studies, participants

exposed to adverse psychological work characteristics showed a higher prevalence of intense

smoking (Rugulies, Sherzer, Krause, 2008).

It is well documented that women with low income are more likely to smoke than women

with high income (Rugulies, Sherzer, Krause, 2008). Smokers with job strain smoke, on average,

twelve cigarettes per day, whereas smokers without job strain smoke seven cigarettes (Rugulies,

Sherzer, Krause, 2008). The educated, the highly skilled upper end of the economy do well -

everyone from attorneys, doctors, consultants, to health professionals - find opportunities that

reward their choice of career (Rothman, 2000). These professionals sell their knowledge

(Rothman, 2000). On the other hand, wage workers, the semi-skilled and unskilled people in the

economic, simply have lost value (Rothman, 2000). Wage workers do not have job security,

wages, or exceptional benefits (Rothman, 2000). Inevitably, smoking decreases in men and

women of high socioeconomic position and becomes predominantly a habit in people of low

socioeconomic positions (Rugulies, Sherzer, Krause, 2008). The amount of cigarettes smoked

varies depending what ethnicity is being evaluated.

Participants of African American and Caucasian ethnicity were more likely to be smokers

compared to participants of Hispanic ethnicity (Rugulies, Sherzer, Krause, 2008). Also,

participants who were born in the United States were more likely to smoke (Rugulies, Sherzer,

Krause, 2008). In a specific occupation - hotel room cleaner - participants of Hispanic ethnicity

born in the USA were 2.4 times more likely to be smokers than Hispanic room cleaners born

outside of the USA (Rugulies, Sherzer, Krause, 2008). Smokers of African American and

Caucasian ethnicity and smokers born in the USA also smoked more cigarettes (Rugulies,

Sherzer, Krause, 2008). Moreover, people who are sensitive to stressors are more likely to be

smokers as well (Rugulies, Sherzer, Krause, 2008). The social scene is Las Vegas has plenty of

smokers as well.

In the absence of a smoke free law that covers bars and nightclubs, the people in these

venues are exposed to a high level of secondhand smoke (Fallin, Neilands, Jordan, & Ling

2014). Bars and nightclubs have been an important social scenes that have welcomed lesbian,

gay, bisexual, and transgender (LGBT) rights movement (Fallin, Neilands, Jordan, & Ling

2014). However, compared with non-LGBT venues, LGBT bars and nightclubs have higher

smoking rates due to a friendly, welcoming environment, compared to heterosexual venues

(Fallin, Neilands, Jordan, & Ling 2014). Overall, exposure to SHS in bars and nightclubs was

frequent: eighty-five-point-six percent of patrons (people who give financial support, or other

type of support to another person) of LGBT bars and nightclubs and 78.5% of patrons of non-

LGBT venues reported that they have been exposed to SHS in a bar, or nightclub in the past

seven days (Fallin, Neilands, Jordan, & Ling 2014). Nevada has historically lagged behind the

nation in progressing in taking action towards smoke-free policies (Fallin, Neilands, Jordan, &

Ling 2014). Adolescents are also being exposed to secondhand smoke in Las Vegas casinos.

Smoke-free laws, which restrict smoking in certain areas, are vital in reducing, or

eliminating secondhand smoke exposure (Fallin, Neilands, Jordan, & Ling 2014). The Nevada

Clean Indoor Air Act (NCIAA), a non-comprehensive smoke-free law, permits smoking in

designated areas of casinos, bars, and taverns (Cochran, Henriques, York, & Kiyoung, 2012).

The law banned smoking in childcare facilities, movie theaters, arcades, public places, retail

establishments, indoor areas of restaurants, and school property (Nevada Revised Statutes,

2006). The set rules of many casinos consist of a combination of gaming, dining, and

entertainment venues, that the NCIAA has made a mixture of smoking and nonsmoking zones

within Nevada casinos (Cochran, Henriques, York, & Kiyoung, 2012).

This study turned its focus towards a specific demographic: children (Cochran,

Henriques, York, & Kiyoung, 2012). Despite the adult nature of casinos, multiple on and off

strip casinos in Las Vegas have made attempts to cater to younger audiences (Cochran,

Henriques, York, & Kiyoung, 2012). Given well-documented research of the effects of smoke

drift on nearby non smoking zones and the ineffectiveness of partial smoke-free laws, the scope

of this study is to focus its attention on the potential, excessive SHS exposure to children (York

& Lee, 2010). Blood and urine cotinine concentrations, a metabolic byproduct of nicotine

produced by the body, produces twice as high in children as those found in nonsmoking adults

(Cochran, Henriques, York, & Kiyoung, 2012). Each year, SHS exposure is responsible for

7,500 to 15,000 hospitalizations of children aged 18 months, or younger (U.S Department of

Health and Human Services, 2006).

Clean indoor air acts have served as a national patchwork for regulating smoking

behavior (Cochran, Henriques, York, & Kiyoung, 2012). In the past twenty years, state, and

county have had smoke-free regulations and laws that have been enacted across the United States

(Cochran, Henriques, York, & Kiyoung, 2012). Of the twenty-four states with casino-type

gambling allowed, only eight of those states have laws requiring 100% smoke-free environment

(ANR, 2011). It is estimated about 70% of the US population is protected by smoke-free laws,

but the majority of casinos workers and patrons in the US are at risk of SHS exposure

(Americans for Nonsmokers’ Rights [ANR], 2011).

In the study, an observer found smoking in all gaming areas with no smoking noted in

any of the children-friendly areas (Lee, Hahn, Robertson, Lee, Vogel, & Travers, 2009). Despite

the alarming information, there are no federal regulations for indoor air quality (Cochran,

Henriques, York, & Kiyoung, 2012). The Environmental Protection Agency (EPA) is required

by the Clean Air Act to set National Ambient Air Quality Standards (Cochran, Henriques, York,

& Kiyoung, 2012). According to these standards, exposure to Particle Matter 2.5 microns

(PM2.5), which is primarily made up of SHS from cigarettes, pipes, and cigars, should not exceed

annual and 24 hour concentrations of 15 and 35 µg/m3 respectively (Fong, Sendzik, Kennedy,

Elton, Jahn, Travers, 2006). This study found that the mean PM2.5 levels in 16 Nevada casinos

exceeded the 24-hour exposure limit in both gaming and non-smoking restaurant areas

(Cochran, Henriques, York, & Kiyoung, 2012). With mean exceeding PM2.5 concentrations in

child-friendly zones exceeding the annual exposure levels set forth by the EPA, the ambient air

quality in attached nonsmoking areas is not adequately preserved (Cochran, Henriques, York, &

Kiyoung, 2012). In the absence of federal indoor air regulations, there is a clear lack of energy

and focus for business to ensure clean air in the microenvironment that casinos create (Cochran,

Henriques, York, & Kiyoung, 2012). The current policy in Nevada has failed to maintain safe

indoor air quality for children in casinos (Cochran, Henriques, York, & Kiyoung, 2012).

NCIAA does not adequately preserve air quality in protected nonsmoking areas according to

EPA pollution guidelines (Cochran, Henriques, York, & Kiyoung, 2012). There should be more

focus, effort, and energy to not overlook an aspect in casino smoking policies: children

(Cochran, Henriques, York, & Kiyoung, 2012). Consequently, the shortcomings of smoke-free

legislation to protect certain groups in society (i.e. casino workers, bartenders, restaurant

workers, etc) have been carefully observed (Pilkington, 2007; Pristos, 2006; Pearson, Angulo,

Bourcier, Freeman, & Valdez, 2007).

Even though the majority of officials recognized smoking as a health hazard and nicotine

as addictive, there was not enough support to strengthen the NCIAA, raising cigarette excise

taxes (York, Pristos, Gutierrez, 2012). No other state relies on gaming revenues as much as

Nevada (York, Pristos, Gutierrez, 2012). Elected officials who have never smoked are more

supportive of comprehensive smoke-free (SF) laws than those who currently smoke, have a

history of smoking, or have a family member who has smoked (Anderson, Buller, Voeks,

Borland, Helme, Bettinghaus, 2006; Cohen, deGuia, Ashley, Ferrence, Northrup, Studlar, 2002;

deGuia, Cohen, Ashley, Pederson, Ferrence, Bull, et al., 2003).

State officials who report tobacco use and SHS exposure is a community problem also

show greater support for indoor SHS laws (Anderson, Buller, Voeks, Borland, Helme,

Bettinghaus, 2006). In 2006, Nevada citizens voted for the Nevada Clean Indoor Air Act, but the

NCIAA allow for indoor smoking in casino gaming areas, stand-alone bars, and taverns, strip

clubs and brothels, and retail tobacco stores (York, Pristos, Gutierrez, 2012). Twenty-three of 63

Nevada legislators responded to a survey about their opinion of second hand smoking (York,

Pristos, Gutierrez, 2012). Eighty-seven percent of respondents agreed that smoking is a serious

health hazard while 52% believed that being exposed to SHS was a serious health hazard (York,

Pristos, Gutierrez, 2012). Also, 79% of respondents believed that nicotine is not addicting while

13% were unsure as to whether people smoke cigarettes because they were addicted to nicotine

(York, Pristos, Gutierrez, 2012). Interestingly, only 50% of officials surveyed believed SHS

exposure was a serious health hazard (York, Pristos, Gutierrez, 2012). This makes health

professionals feel uneasy considering the high number of NV citizens working in, and visitors

going to bars, taverns, casinos, strip clubs, and brothels (York, Pristos, Gutierrez, 2012). Even

more concerning, the majority of the legislators believed that a $1 increase in the cigarette tax

would hurt gaming and tax revenues, while being aware that a high number of people are

exposed to SHS (York, Pristos, Gutierrez, 2012). A 2010 Nevada poll found that 86% of the

states citizens believe it is important to work in a smoke-free environment (York, Pristos,

Gutierrez, 2012).

Intervention Priorities and Goals

Desired Change

The desired change is to change the level of knowledge, causes, and effects about

secondhand smoke towards children and adults. Moreover, policy advocates should strengthen

the current NICCIA and tobacco control laws. If people are not aware of how secondhand smoke

and tobacco smoking, affects the human body, then the people are going to smoke with less

worry. Millions of people know that smoking is bad for you, but I strongly believe that people do

not understand why and how tobacco smoking is bad for you; there is a difference.

Understanding how and why tobacco smoking is a serious health hazard could change the

perspective of smoking that, I believe, could create an undesirable motive to smoke that results

in a positive, healthier change. I strongly believe the legislators should be educated and the

federal government.

Target Audience

The best, realistic, method to reduce the incidence, prevalence, and impact of secondhand

smoke exposure in the community is to educate the politicians and legislators to help them

understand the negative effects of secondhand smoke. If these powerful people really understand

the negative effects of secondhand smoke that affects, not only for someone’s health, but the

economy (health care costs and lost of productivity), I believe more healthy people would feel

physically better that would benefit the their own health, other’s health, and the economy. As

said before, a majority of smokers preferred a smoke-free environment. For people who

absolutely do not smoke, these customers are not going to the tavern, bars, clubs, etc. Their voice

should reach out to the legislators.

Legislators, lawmakers, politicians, could ask for a variety of ways to advertise a much

better understanding of the health hazards of secondhand smoke that can be widely

commercialised that reaches all age groups so the education, and understanding of secondhand

smoke could improve to and spread to the adult and children audience to create a positive,

healthy change.The amount of money that is lost due to lost of productivity, and the cost of

health care towards people with tobacco smoking related health problems, all that money could

be spent on many other things including all sorts of adult entertainment that the state of Nevada

is afraid of losing if they strengthen the smoke-free laws.

The money could be spent of innovative ideas for bars, clubs, taverns, more parks,

recreational fields, etc, to attract more tourists and the local citizens. The people who visit

casinos, taverns, clubs, strip clubs, etc in Las Vegas, these people are initially interested in

participating in all sorts of adult entertainment. Therefore, cigarette smoking will not turn away

curious people, who are already interested people, or people who are willing to take risks.

Perhaps it is reasonable to say that cigarette smoking is a myth in the eyes of legislators of Las

Vegas, or the state of Nevada, that believe that the absence of smoking could deplete the state’s

revenue due to negative beliefs about the absence of cigarettes.

Barriers to Desired Change

The barriers to the desired change is that many legislators who are older adults have fixed

beliefs of secondhand smoke and cigarette smoking that would be difficult to educate and

change. Many Nevada and Las Vegas legislators are afraid to lose state, city annual revenue.

Certain type of people deny facts because certain facts will not be convenient to believe, or deny

certain facts for other, personal reasons. Having Nevada legislators be open minded and be

willing to be educated about the serious health hazards of secondhand smoke may be very

difficult. One can hear people educate them, but few listen, understand, process certain topics

and information. These barriers have a high risk of smoke-free laws to remain weak in Las

Vegas and throughout the state of Nevada.

Theories that will work best in this scenario

The best theories that would work best in this scenario is the Transtheoretical Model and

the Health Belief Model. The transtheoretical model consists of stages of change. The history

context of this model took bits and pieces from other theories, or models and put them together.

Behavior change concerning this model is all, or nothing. There are no impulse actions, or

decisions and the desired behavior change will change over time. The transtheoretical model

mentions that the at risk populations are not prepared to take action, or not ready to make the

change. Specific processes and principles of change should be applied at specific stages of

progress. Within this model, there are multiple stages: precontemplation, contemplation,

preparation, action, maintenance, termination, and decisional balance. Furthermore, the theory

that would as well is the health belief model.

The health belief model talks about perceived susceptibility, perceived severity,

perceived benefits, and perceived barriers. Perceived susceptibility talks about how likely do you

think you have a health issue; in this case, secondhand smoke related illnesses. Some people are

aware that secondhand smoke exposure is a health hazard just like smoking. Perceived severity

mentions how serious does someone have, in this case it is secondhand smoke related health

issues. People are aware that smoking is harmful for the body, so inhaling the toxic chemicals

after someone just exhaled a cloud of tobacco smoke would make people move away from the

smoker in some settings (this excludes clubs, taverns, clubs, etc.). Most people know that if they

are not around someone who smokes, then they are not harming their health. The negative

aspects of staying away from smokers is that smokers could be friends and family. Mostly

everyone enjoys spending time with their family and people who do not smoke can not regulate

how often and when a smoker wants to smoke.

Application of Theory

Las Vegas fits the theory now because there are many people in in different stages within

the transtheoretical theory that are probably working on to quit smoking. It is hard to say what

specific stage Las Vegas is in, but I believe it is reasonable to say that different groups of people

are in different stages of this model due to their socioeconomic status, level of education, and

obstacles that cause distractions from focusing on eliminating the harmful effects of secondhand

smoke, or smoking.

I believe this is the ideal model to apply to this situation because the problem is

secondhand smoke and smoking. Having someone to quit, or quitting smoking require steps

because rarely anyone quits smoking taking the cold turkey method (quit smoking immediately).

Quitting smoking requires support, steps, encouragement, education, and rewards. This relates to

the decisional balance stage. People weigh the pros/cons and there must be an increase amount of

pros to the standard deviation to increase the chances of progress towards quitting smoking. I

focus in quitting smoking, and not so much secondhand smoke because people who smoke cause

secondhand smoke. Without the smoker, there would not be secondhand smoke. If smokers

understand and appreciate the reality that if they quit smoking, they can live longer, live

healthier, save money, see their children/grandchildren grow, feel better, decrease stress, and be

overall happier. These pros outweigh the only con - feed the addiction of nicotine to feel

temporarily at ease right after smoking.

Even though there are smoke-free laws that take place in Las Vegas, these smoke-free

laws are weakly enforced. The reason these smoke-free laws remain weak, is because it seems

the number one factor that Las Vegas, or Nevada legislators only worry about is revenue. There

is progress, but not as progressive as other states. Nevada is one of the last states to enforce

smoke-free laws because legislators are afraid to risk the declination of annual revenue.

The health belief model is what legislators and the citizens of Las Vegas believe they

have the issue to some extent. Many are experiencing the health consequences from secondhand

smoke, or smoking and are taking steps to change their quality of health. They know that the

habit is a hazardous, and finally, after experiencing the life threatening consequences, they are

aware that they have barriers in front of them to make that positive change of quitting smoking.

For perceived barriers, quitting smoking results in headaches, irritation, and withdrawals of the

absence of nicotine. Many people are committed in quitting smoking because after some amount

of time, they finally have come to an understanding that smoking cuts multiple years from their

life. The perceived benefits are great because quitting smoking helps one to feel better, save

money, and enjoy life with family and friends for a longer time, which makes people happy. One

of the most beautiful things in life is seeing your family grow, and many smokers would rather

have smoke-free laws greatly enforced because it will help them quit because they are doing it

together. More importantly, people would do it for the kids.

Rejected Theories

Social cognitive theory is a theory that will not apply in Las Vegas concerning

secondhand smoke, or smoking. The purpose of this theory is to understand and predict

individual and group behavior. The theory explains that if you do something, it will change the

environment. A lot of people smoke because they enjoy, are addicted, or need something in their

hand. People do not choose to smoke because they want legislators to change public

environmental laws (i.e smoke-free laws). Also, the theory mentions that response consequences

will influence behavior. Well, people who are aware that smoking is bad for them in some way

shape, or form, but it is not enough for them to give up smoking that causes secondhand smoke,

or choosing to stay from from secondhand smoke if they have a choice.