1. Restaurant Smoking Policies and Reported Exposure to ETS The case of Massachusetts Tandiwe Njobe National Conference on Tobacco or Health November 2002 Research supported by MA DPH

2. Introduction  Question: Do local restaurant smoking ordinances reduce the likelihood of exposure to ETS (for Massachusetts residents) when dining out?

3. Background to Analysis  Exposure to ETS is known to have adverse health impacts  Studies show patrons and restaurant workers to be disproportionately affected by exposure to ETS  Support for smoke free restaurants is growing in Massachusetts  Few studies address the extent to which ordinances reduce exposure to ETS

4. The Massachusetts Context  Policies restricting exposure are enacted at the town level  Local Boards of Health funded by MTCP identify and support the enactment of tobacco control policies  By June 2001, 182 towns (out of 351) representing 78% of MA population had a restaurant ordinance in effect

5. Data Sources  Massachusetts Adult Tobacco Survey (MATS) Random digit dial survey (Center for Survey Research, UMASS Boston) Includes fiscal years 1995 – 2000 n = 13,000+  MTCP Ordinance Tracking System Data on 26 types of ordinance provisions for 351 towns (July 1993 – June 2000)

6. Methods  Individual level analysis Demographics and household characteristics Individual’s home town ordinance situation  Survey respondents mapped to ordinance data by town of residence and time period of interview 14 six month time periods Ordinances coded as being in effect for a time period if in existence for at least 3 out of 6 months

7. Methods continued….  Dependent variable derived from the following survey question: “When you eat out in restaurants how often are you exposed to other people’s tobacco smoke?” Always Often Sometimes Rarely Never

8. Methods continued ……  Covariates: Demographics (age, race, gender, education) Smoker or not Frequency of dining out Children under 12 in the household Number of restaurants in respondent’s town (2001) Time

9. Ordinances – Predictor Variable of Interest  Status of restaurant ordinance in home town Ordinance in effect at time of interview = 1 No ordinance in effect at time of interview = 0  Status of restaurant ordinances in other towns in the state Percentage of towns in the state covered by an ordinance at the time of the interview.

10. Model  Estimated 2 models in SUDAAN to account for complex sample design Model 1: Ordered logit specification 5 categories for dependent variable More sensitive measure of exposure Harder to interpret coefficients

11. Model Model 2: Dichotomous logit model specification 2 categories for dependent variable (yes/no) 5 categories collapsed as follows  Always/ Often/ Sometimes coded “Yes = 1”  Rarely/ Never coded “No = 0” Less sensitive measure of exposure Easier to interpret coefficients

12. Results/ Findings  The presence of a restaurant ordinance in a town reduces the likelihood of exposure to ETS in restaurants of that town.  The presence of restaurant ordinances elsewhere in the state may reduce the likelihood of exposure to ETS in restaurants (marginally significant).

13. Results/ Findings continued.. VARIABLE OF INTEREST COEFFICIENT (ordered logit specification) ODDS RATIO (dichotomous specification) Home Ordinance -0.2283 (p < 0.001) 0.8332 (0.7106 – 0.9769) State Ordinance -1.1634 (p < 0.10) 0.3432 (0.0791 – 1.4888)

14. Results/ Findings continued..  Demographics: Age – Older people less likely to report exposure than people under 25 years Race – Racial/ ethnic minorities reported less exposure than non Hispanic Whites Education & Gender – Differences not statistically significant  Time Reduced exposure over time

15. Results/ Findings continued..  Other respondent level variables: High frequency of dining out – greater likelihood of reported exposure compared to residents who eat out less than one a month Smokers – More likely to report exposure than non-smokers Children & Number of restaurants – Not significantly related to exposure

16. Discussion  Local restaurant smoking restrictions lead to lower reported levels of exposure to ETS in restaurants Prior research shows MTCP funding to be strongly correlated with ordinance enactment MTCP funding stimulates ETS ordinance adoption which leads to reduced exposure to ETS

17. Discussion continued…  Ordered logit versus dichotomous logit Consistent message is that ordinances have the effect of reducing risk of exposure  State ordinance term is marginally significant Improve specification by including distance  Ordinance duration -- effect of ordinance not significantly increased by length of time it has been in existence Limited testing -- specification may be weak.

18. For more information contact: Tandiwe Njobe Abt Associates Inc. 55 Wheeler Street Cambridge, MA 02138-1168 Email: Tandiwe_Njobe@abtassoc.comTandiwe_Njobe@abtassoc.com Analysis will be published in 2002 Annual Report on Independent Evaluation of the Massachusetts Tobacco Control Program