Community Support For Policy-Based Solutions To Reduce Secondhand Smoke Exposure

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Community Support For Policy-Based Solutions To
Reduce Secondhand Smoke Exposure

• Liz Dobie, MPH, University of Minnesota, Division
  of Epidemiology
• Angela Watkins, MA, Caroline Dunn, PhD, Phyllis
  Pirie, PhD
• 1300 South Second Street, Suite 300, Minneapolis,
  MN 55454
• Http//www.epi.umn.edu/research/SHSstudy

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BACKGROUND
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• Problem Recently, tobacco control strategies
  have emphasized local advocacy and policy to
  reduce exposure to secondhand smoke (SHS). Little
  is known about the association between
  community-based policy efforts and community
  support for such efforts.
• Methods To explore this issue, a cross-sectional
  study was carried out in 16 rural communities
  each with varying degrees of involvement in SHS
  advocacy and policy. The study utilized two
  instruments. A SHS campaign survey assessed
  perceptions of the local level of effort and
  extent of strategies being used. Most respondents
  were active coalition members who were familiar
  with efforts to reduce SHS in their community.
  The second instrument, a community opinion
  survey, measured individual preferences and
  behaviors related to SHS, and awareness of
  community-wide advocacy and policy efforts. This
  survey was mailed to a random sample of 600
  adults (ages 22-80 years) in each community. Both
  surveys explored SHS issues in a variety of
  venues (homes and cars, restaurants, workplaces,
  and outdoor recreation areas).
• Results Summary scores were developed from the
  SHS campaign survey to indicate the extent of
  campaign activity in various venues. Related
  summary scores from the community attitude survey
  indicate the level of public support for smoking
  restrictions in these same venues. This
  presentation will provide preliminary results
  that describe the relationship between advocacy
  work, policy activity and public opinion.
• Conclusions This study suggests that the
  intensity of campaign effort may influence
  supportive attitudes towards smoke-free policy,
  and that the degree of effort needed may be
  specific to that venue.

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Background

• Recently, tobacco control strategies have
  emphasized local advocacy and policy to reduce
  exposure to secondhand smoke (SHS).
• Little is known about the association between
  community-based policy efforts and community
  support for such efforts.
• Community-based grantees of the Minnesota Youth
  Tobacco Prevention Initiative were required to
  include secondhand smoke education and advocacy
  as a component of their program in 2002-2003.

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METHODOLOGY
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Overall Study Design

• 16 community study.
• Communities differed in their history of SHS
  campaigns.
• Two surveys in each community
• Community attitudes survey(population based)
• SHS campaign survey

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Community Attitudes Survey

• Purpose
• The survey measured individual preferences and
  behaviors related to SHS and policy efforts.
• Sample
• The survey was mailed to a random sample of 600
  adults (ages 22-80 years) in each community.
• Response rate was 63, N5496.

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SHS Campaign Survey

• Purpose
• The survey assessed key informants perceptions
  of the amount of effort and extent of strategies
  being used in local SHS campaigns.
• Sample
• Key informants identified by the community-based
  grantees.
• Most respondents were active coalition members.
• Response rate was 84, N115.

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Measures

• Community Attitudes Survey
• Four scales were constructed to assess attitudes
  in four venues
• Outdoor Recreation Areas
• Workplaces
• Restaurants
• Homes and Cars
• 6-items were included in each scale
• Most opinion questions were 4-point
  agree/disagree likert items.
• Intention/behavior questions used a 5-point
  likert scale where 1 not very likely and 5 very
  likely.
• Scales ranged from 1 to 19 higher scores
  indicated a stronger level of support

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• SHS Campaign Survey
• Overall Effort
• Level of activity One continuous item defined on
  a 6 point scale where 0 no activity and 5
  considerable amount.
• Duration of activity One categorical item, began
  within the last 6 months, began more than 6
  months ago to 2 years ago, began more than 2
  years ago.
• Consistency of efforts One continuous was
  defined on a 5 point scale, where 1 very
  sporadic and 5 constant.

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• Strategies used
• The strategies assessed were
• Educational materials (brochures, flyers)
• Presentations to community groups
• Mass media (radio, TV, newspapers)
• Policy advocacy
• The extent to which a strategy used was
  determined on a 5-point scale from, where 1 very
  little and 5 a considerable amount.

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Analysis

• An aggregate data set was created bridging both
  surveys.
• Correlation and regression analyses were
  completed to examine the relationship between the
  SHS campaigns and community attitudes.

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Stepwise Regression

• Dependent Variable
• Attitude
• Independent Variables
• Extent of effort
• Level of Activity
• Duration of Activity
• Consistency of Activity
• Extent of strategies used
• Educational materials
• Community Presentations
• Mass media (TV, Radio, Print)
• Policy Advocacy
• Covariates
• Proportion of current smokers in the community
• Existence of community-wide policy (where
  applicable)

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RESULTS

• Community Attitudes Survey
• SHS Campaign Survey
• Relation between Community SHS Campaigns and
  Attitudes

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Community Attitudes
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Community Member Characteristics

• Age
• 10 are age 22-30
• 40 are between ages 31 and 50
• 50 are age 51 years or older
• Smoking status
• 14 are current smokers
• 32 are former smokers
• 54 non-smokers
• 20 live with a smoker

• 60 are Female
• 97 are White
• 33 live with children (18 and under)
• 32 have a high school education or less
• 65 are employed for pay
• 93 have lived in their community for more than 2
  years

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Attitudes towards Smoke-free Outdoor Recreation

• The mean attitude score amongst the 16
  communities was 11.61, SD 0.33.
• Sample scale item
• 86 agree that Kids are more likely to become
  smokers if they are used to seeing adults around
  them smoke.

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Attitudes towards Smoke-free Workplaces

• The mean attitude score amongst the 16
  communities was 14.04, SD 0.50.
• Sample scale items
• Of those who work in a building, 75 prefer their
  employer does not allow smoking indoors...
• and 84 prefer their employer limit smoking on
  company grounds.

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Attitudes towards Smoke-free Restaurants

• The mean attitude score amongst the 16
  communities was 14.38, SD 0.49.
• Sample scale items
• 59 disagree that Getting rid of smoking in
  restaurants will hurt business.
• 91 would go as often or more if restaurants were
  smoke-free.

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Attitudes towards Smoke-free Homes and Cars

• The mean attitude score amongst the 16
  communities was 15.27, SD 0.39.
• Sample scale item
• 85 agree that Adults should smoke only when
  there are no kids around.

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Attitudes towards Smoke-free Venues
General Linear Modeling, Repeated
Measures N3971, F1784.33 Significance 0.001
Less supportive
More supportive
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Community SHS Campaign Efforts
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Outdoor Recreation Policy Campaigns

• Overall campaign effort, Mean (SD)
• Level of activity, 1.50 (1.10) 0-5 scale
• Duration of activity, 2.07 (0.55) 1-3 scale
• Consistency of efforts, 3.27 (0.85) 1-5 scale
• Strategies used

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Workplace Policy Campaigns

• Overall campaign effort, Mean (SD)
• Level of activity, 1.94 (0.93) 0-5 scale
• Duration of activity, 2.41 (0.50) 1-3 scale
• Consistency of efforts, 3.38, (0.45) 1-5 scale
• Strategies used

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Restaurant Policy Campaigns

• Overall campaign effort, Mean (SD)
• Average level of activity, 2.71 (0.49) 0-5
  scale
• Duration of efforts, 2.53 (0.38) 1-3 scale
• Consistency of efforts, 3.20 (0.68) 1-5 scale
• Strategies used

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Smoke-free Homes and Cars Campaigns

• Overall campaign effort, Mean (SD)
• Level of activity, 2.88 (0.97) 0-5 scale
• Duration of efforts, 2.51 (0.32) 1-3 scale
• Consistency of efforts 3.31(0.69) 1-5 scale
• Strategies used

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Relationship between Proportion of Smokers and
Community Attitude

• The proportion of smokers ranged from 9.6 to
  17.6

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Community Attitudes and Campaign Efforts
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Predictors of Supportive Attitudes towards
Smoke-Free Homes and Cars
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Predictors of Supportive Attitudes towards
Smoke-Free Restaurants
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CONCLUSIONS
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Summary

• Long standing and consistent SHS restaurant
  policy campaigns may have an important effect on
  community support for such policies.
• Highly active yet intermittent SHS home and car
  policy campaigns may have an effect on community
  support for such policies and personal behaviors.

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• There was no significant relationship between
  community attitude and the extent of efforts or
  strategies used relative to outdoor recreation or
  workplace policy campaigns. Secular trends may
  have outweighed community-specific effects.

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Findings

• Community members were supportive towards
  smoke-free spaces, and smokers were less
  supportive.
• Community support for smoke-free spaces varied by
  venue.
• Across communities, there was little variability
  in attitudes towards smoke-free policies.
• A relationship was found between overall campaign
  effort and community support for policies in
  homes and cars as well as restaurants.
• For each venue, the campaign strategies used had
  no relation to community attitudes.

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Limitations of the Study

• Study design cannot demonstrate causality between
  level of effort and degree of community support.
• The SHS campaign survey relied on the perceptions
  of several key informants, and was not an
  objective measure of efforts.
• The community attitudes survey assessed support
  for smoke-free spaces, not ordinances.
• Community opinion results were biased, there was
  under-representation of smokers, 22-40 year olds,
  and males.
• Study results may not be generalizable to all MN
  communities.

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Future Directions

• Further research needs to look at the change in
  attitude while campaigns are happening.
• The longevity of a campaign compared to its
  consistency over time needs to be examined.
• This study suggests that the intensity of
  campaign effort may influence supportive
  attitudes towards smoke-free policy, and that the
  degree of effort needed may be specific to that
  venue.