Eat, Breathe & Dine Smoke Free! Ohio’s Smoke Free Restaurant Campaign 1998 to 2001 Tracy Clopton, M. S. W. Ohio Department of Health Tobacco Risk Reduction Program Special Thanks to the Ohio Department of Health and Tobacco Free Ohio Staff Who Contributed to This Project • Thallia Blight, TFO Project Assistant, media kit development. • Theresa Campbell B.S., data entry. • Ellen Capwell, Ph.D. Professor, technical assistance. • Wen Fang Chan, M. S., Epidemiologist, data analysis. • Eric Green, M. A., Social Marketing Consultant, media development. • Winnie Miller, data entry. • Patrick Harsch, Ph.D. Tobacco Program Consultant, graphics and charts. Learning Objectives • Define Diffusion of Innovations Theory. • Describe how theory components were incorporated into the statewide campaign. • Identify outcomes and lessons learned from multi-component assessment. • How can others apply this statewide model to assist local communities, with little experience, to promote a public health issue. 1986 Surgeon General Report Health Consequences of Involuntary Smoking • Involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers. • The children of parents who smoke… have increased frequency of respiratory infections, increased respiratory symptoms… • Simple separation of smokers and nonsmokers within the same air space may reduce but does not eliminate exposure…to environmental tobacco smoke. Secondhand Smoke Causes… • • • • • • • Heart Disease Low Birth Weight Sudden Infant Death Syndrome (SIDS) Asthma Bronchitis Pneumonia Nasal Sinus Cancer Source: Health Effects of Exposure to Environmental Health, Monograph 10, National Institutes of Health-NCI Where Adults Will Tolerate Smoking in Indoor Work Areas: Ohio, 1998 Not Allowed 64.9 Some Areas 28.9 All Areas 0.9 0 20 40 Percent 60 80 Where Adults Will Tolerate Smoking in Indoor Work Areas: Ohio, 2000 Not Allowed 67.4 Some Areas 30.1 All Areas 2.5 0 20 40 Percent 60 80 Where Adults Will Tolerate Smoking in Indoor Work Areas: Ohio, 2004 Not Allowed 67.6 Some Areas 26.3 All Areas 4.2 0 10 20 30 40 50 Percent Source: Ohio Adult Tobacco Survey, 2004 60 70 80 Where Adults Will Tolerate Smoking in Restaurants: Ohio, 1998 50 45 40 45.5 46.6 Some Areas Not Allowed Percent 35 30 25 20 15 10 5 2.3 0 All Areas Where Adults Will Tolerate Smoking in Restaurants: Ohio, 2000 50 45 40 48.4 45.5 48.1 46.6 Some Areas Not Allowed Percent 35 30 25 20 15 10 5 3.5 0 All Areas Where Adults Will Tolerate Smoking in Restaurants: Ohio, 2004 55 54.1 50 45 40 43.0 Percent 35 30 25 20 15 10 5 2.2 0 All Areas Some Areas Not Allowed Source: Ohio Adult Tobacco Survey, 2004 Where Adults Will Tolerate Smoking in Indoor Work Areas by Smoking Status: Ohio, 1999 Percent 100 90 Some Areas 80 Not Allowed at All 70 74.5 65.4 60 50 40 63.8 54.6 43.2 33.7 30 35.3 25.4 20 10 0 Current Smokers Former Smokers Never Smoked All Persons Adults Tolerating Smoking in Some Indoor Areas by Smoking Status: Ohio, 2004 100 90 80 80.3 Percent 70 60 50 40 69.3 68.2 57.7 42.3 30 31.8 20 30.7 19.7 10 0 Current Smokers Former Smokers Never Smoked All Persons Where Adults Will Tolerate Smoking in Restaurants by Smoking Status: Ohio, 1999 100 90 Some Areas 80 Not Allowed at All Percent 70 77.8 60 61.1 50 50.3 40 52.1 47.3 45.1 38.6 30 20 10 15.0 0 Current Smokers Former Smokers Never Smoked All Persons Adults Tolerating Smoking in Some Areas of Restaurants by Smoking Status: Ohio, 2004 100 90 80 Percent 70 80.3 78.9 68.2 60 50 40 42.3 47.6 30 45 30.7 20 10 0 Current Smokers Former Smokers Never Smoked All Persons “No Smoking” Section ? Theoretical Model Diffusion Innovations Theory: 1. How the development of new ideas, products, and social practices can improve health promotion interventions and strategies within society. 2. Program developers pay attention to social norms, member networks and social structures, in addition to the new intervention. Two Applicable Concepts of Diffusion Innovations Theory • Relative Advantage • Observability • Seen as a better idea or unique. • Can produce tangible results. • Statewide restaurant campaign new to Ohio. • Written feedback from restaurant patrons and managers. Campaign Purpose • Encourage restaurants to permanently convert to smoke free. • Local community education & assessment. • Promote local coalition development. • Participants use experience to address greater challenges within tobacco prevention. Participant Recruitment Efforts • Invitational letters to local health departments & tobacco coalitions seven months prior to the campaign date. • Support materials free of charge. • “Ready To Use” Media Kit. • Participating restaurants recruited by health depts. and tobacco coalitions in various ways. • Patron Card data provided to restaurant managers. • Certificate of Appreciation and free advertisement of their restaurant business. Support Materials (with restaurant campaign logo) • • • • • • Buttons Ink Pens Testimonial Brochure Manager Brochure Tray-Liner/Placemat Certificate of Appreciation • Poster Notices • Patron Cards for opinions. • Media Tool Kit (Press Release, Letter to Editor, etc.) • 3 Types of Stickers for Restaurant Bills • CDC’s Guide: “Making Your Workplace Smoke Free” (no program logo) MEDIA Campaign “Eat, Breathe & Dine Smoke Free!” Getting The Message Out 1. Local News Papers: Participants made connections and used the TFO Media Tool Kit. 2. Created two complementary radio spots: Borrowed California Dept. of Health’s TV Spot “Waitress” 3. Tagged the spots with 800# for advocacy packet: 300+ calls for 30+ days in 2000 and 2001. 4. Contracted with the Ohio Association of Broadcasters for $50,000: 3 free for 1 buy, or approximately $150,000 worth of air time for 31+ days. 5. CDC’s Media Campaign Resource Center’s movie slides, transit, & billboards funded by TFO: Supportive secondhand smoke spot “Secondhand Sound” “Eat, Breathe & Dine Smoke Free!” Restaurant Campaign Data Summary 1998-2001 • Local Participant Information • Patron Responses • Managers’ Evaluations • Local Participants’ Evaluations Number of Participating Agencies* By Year in Ohio 25 24 20 21 18 15 10 12 5 0 1998 1999 2000 2001 *Most were city/county health departments followed by voluntary non-profits or coalitions. Strongest involvement came from counties in the Northwest, Southwest, Northeast, then Southeast. ASHTABULA LAKE LUCAS FULTON WILLIAMS OTTAWA GEAUGA WOOD HENRY CUYAHOGA DEFIANCE TRUMBULL LORAIN SANDUSK Y ERIE SUMMIT SENECA PAULDING MEDINA HANCOCK 1 PUTNAM VAN WERT HURON ALLEN ASHLAND WYANDOT WAYNE CRAWFORD RICHLAND MAHONING STARK COLUMBIANA HARDIN MERCER MARION AUGLAIZE LOGAN COSHOCTON DELAWARE DARKE CHAMPAIGN LICKING MAMI GUERNSEY BELMONT MADISON MONTGOMERY 2 FAIRFIELD GREENE WARREN JEFFERSON HARRISON MUSKINGUM FRANKLIN CLARK BUTLER TUSCARAWA S KNOX UNION SHELBY CARROLL HOLMES MORROW PREBLE 3 P0RTAGE FAYETTE PICKAWAY MORGAN 4 HOCKING CLINTON ROSS VINTON HAMILTON HIGHLAND CLERMONT WASHINGTON ATHENS MEIGS PIKE JACKSON BROWN NOBLE PERRY ADAMS GALLIA SCIOTO LAWRENCE MONROE Number of Restaurants Participating Each Year in Ohio 160 140 142 120 124 100 80 114 93 60 40 20 0 1998 1999 2000 2001 Thirty or 6 percent of the restaurants converted to smoke free between 1998 and 2001 based upon participating in the campaign. Patrons’ Response Number of Restaurant Patrons Responding Each Year in Ohio 4500 4000 4219 3500 3000 2500 2485 2000 2282 1830 1500 1000 500 0 1998 1999 2000 Ohio Restaurant Four-Year Campaign 2001 Smoking Status of Smoke-free Restaurant Campaign Patrons, Ohio: 1998 100 90 93 80 Percent 70 74 60 50 52.1 45.1 40 30 25 20 10 0 Non Smokers Smokers Smoking Status of Smoke-free Restaurant Campaign Patrons, Ohio: 1999 100 90 93 80 Percent 70 60 66 50 52.1 45.1 40 30 32 20 10 0 Non Smokers Smokers Smoking Status of Smoke-free Restaurant Campaign Patrons, Ohio: 2000 100 90 93 80 Percent 70 73 60 50 52.1 45.1 40 30 27 20 10 0 Non Smokers Smokers Smoking Status of Smoke-free Restaurant Campaign Patrons, Ohio: 2001 100 90 93 80 Percent 70 60 68 50 45.1 40 30 30 20 10 0 Non Smokers Smokers Smoking Patrons of Smoke-free Restaurant Campaign Tobacco Use, Ohio: 1999 68 50 45 40 Percent 35 30 25 20 15 15 10 5 10 8 0 10 or less cigarettes per day 11 to 20 cigarettes per day 21 or more cigarettes per day No response Smoking Patrons of Smoke-free Restaurant Campaign Tobacco Use, Ohio: 2000 50 45 45 40 Percent 35 30 25 28 27 20 15 10 5 0 10 or less cigarettes per day 11 to 20 cigarettes per day 21 or more cigarettes per day Smoking Patrons of Smoke-free Restaurant Campaign Tobacco Use, Ohio: 2001 50 45 45 40 Percent 35 30 32 25 20 23 15 10 5 0 10 or less cigarettes per day 11 to 20 cigarettes per day 21 or more cigarettes per day Patrons’ Response to: “I Try to Protect Myself, Children or Grandchildren from Tobacco Smoke,” Ohio: 1999 100 90 93 80 Percent 70 60 50 54 45.1 40 30 23 20 10 0 Always Sometimes Patrons’ Response to: “I Try to Protect Myself, Children or Grandchildren from Tobacco Smoke,” Ohio: 2000 100 90 93 80 Percent 70 60 66 50 45.1 40 30 22 20 10 0 Always Sometimes Patrons’ Response to: “I Try to Protect Myself, Children or Grandchildren from Tobacco Smoke,” Ohio: 2001 100 90 93 80 Percent 70 60 50 57 45.1 40 30 25 20 10 0 Always Sometimes Patrons’ Response to: “I Am Glad to See This Restaurant Participate in a Smoke Free Campaign,” Ohio: 1998 100 90 45 80 70 78 60 50 40 30 20 19 10 0 Yes No Patrons’ Response to: “I Am Glad to See This Restaurant Participate in a Smoke Free Campaign,” Ohio: 1999 100 90 80 70 60 66 50 40 30 25 20 10 8 0 Yes Unsure No Patrons’ Response to: “I Am Glad to See This Restaurant Participate in a Smoke Free Campaign,” Ohio: 2000 100 90 80 70 76 60 50 40 30 20 16 10 8 0 Yes Unsure No Patrons’ Response to: “I Am Glad to See This Restaurant Participate in a Smoke Free Campaign,” Ohio: 2001 100 90 80 70 72 60 50 40 30 20 17 10 10 0 Yes Unsure No Patrons’ Response to: “If This Restaurant Became Totally Smoke Free Everyday I:” Ohio, 1999 50 45 40 Percent 35 33 30 63.8 25 20 21 19 15 17 10 8 5 0 Return more often Glad to see this Not like it but would return Would not dine here again Would not care either way Patrons’ Response to: “If This Restaurant Became Totally Smoke Free Everyday I:” Ohio, 2000 50 45 40 40 Percent 35 63.8 30 25 20 23 19 15 10 11 5 0 7 Return more often Glad to see this Not like it but would return Would not dine here again Would not care either way Patrons’ Response to: “If This Restaurant Became Totally Smoke Free Everyday I:,” Ohio, 2001 50 45 40 Percent 35 35 63.8 30 25 20 23 16 15 14 10 9 5 0 Return more often Glad to see this Not like it but would return Would not dine here again Would not care either way Average of Patrons’ Response to: “If This Restaurant Became Totally Smoke Free Everyday I:” Ohio, 1999 - 2001 50 45 40 Percent 35 35 30 63.8 25 20 22 17 15 17 13 10 5 0 Return more often Glad to see this Not like it but would return Would not dine here again Would not care either way Patrons’ Response to: “I Am Aware That Exposure to Smoke From Cigarettes and Cigars May Cause Health Problems for Children/Employers:” Ohio, 1998 100 90 93 80 Percent 70 60 50 40 30 20 10 4 0 Yes No Patrons’ Response to: “I Am Aware That Exposure to Smoke From Cigarettes and Cigars May Cause Health Problems for Children/Employers:” Ohio, 1999 100 90 80 84 Percent 70 60 50 40 30 20 10 2 12 No Do not agree 0 Yes Patrons’ Response to: “I Am Aware That Exposure to Smoke From Cigarettes and Cigars May Cause Health Problems for Children/Employers:” Ohio, 2000 100 90 80 90 Percent 70 60 50 40 30 20 10 1 9 No Do not agree 0 Yes Patrons’ Response to: “I Am Aware That Exposure to Smoke From Cigarettes and Cigars May Cause Health Problems for Children/Employers:” Ohio, 2001 100 90 80 88 Percent 70 60 50 40 30 20 10 2 0 Yes No 8 Do not agree Gender of Patrons of a Smoke Free Restaurant Campaign: Ohio, 1998 100 90 45 80 Percent 70 60 50 55 40 42 30 20 10 0 Female Male Gender of Patrons of a Smoke Free Restaurant Campaign: Ohio, 1999 100 90 45 80 Percent 70 60 50 40 48 49 30 20 10 0 Female Male Gender of Patrons of a Smoke Free Restaurant Campaign: Ohio, 2000 100 90 45 80 Percent 70 60 50 40 48 52 30 20 10 0 Female Male Gender of Patrons of a Smoke Free Restaurant Campaign: Ohio, 2001 100 90 45 80 Percent 70 60 50 40 49 45 30 20 10 0 Female Male Managers’ Responses Number of Restaurant Managers Responding Each Year in Ohio 90 80 70 72 60 57 50 51 40 30 32 20 10 0 1998 1999 2000 Ohio Restaurant Four-Year Campaign 2001 Managers Who Believe The Smoke-free Restaurant Campaign Was A Success: Ohio, 1998 50 45 40 41 Percent 35 30 25 20 15 22 19 10 5 0 Strongly Agree Agree Somewhat Agree Managers Who Believe The Smoke-free Restaurant Campaign Was A Success: Ohio, 1999 50 45 40 Percent 35 30 25 30 30 Agree Somewhat Agree 26 20 15 10 5 0 Strongly Agree Managers Who Believe The Smoke-free Restaurant Campaign Was A Success: Ohio, 2000 50 45 40 Percent 35 35 30 29 25 20 15 10 12 5 0 Strongly Agree Agree Somewhat Agree Managers Who Believe The Smoke-free Restaurant Campaign Was A Success: Ohio, 2001 50 45 40 Percent 35 35 30 31 25 20 15 10 15 5 0 Strongly Agree Agree Somewhat Agree Managers Knowledge Of ETS Effects On Employee After Campaign: Ohio, 1998 100 90 80 Percent 70 63 60 50 52.1 45.1 40 30 31 20 10 0 Increased Remained the Same Managers Knowledge Of ETS Effects On Employee After Campaign: Ohio, 1999 100 90 80 77 Percent 70 60 50 52.1 45.1 40 30 20 10 0 18 Increased Remained the Same Managers Knowledge Of ETS Effects On Employee After Campaign: Ohio, 2000 100 90 80 Percent 70 60 55 50 45.1 40 30 20 52.1 29 10 0 Increased Remained the Same Managers Knowledge Of ETS Effects On Employee After Campaign: Ohio, 2001 100 90 80 Percent 70 60 50 53 52.1 45.1 40 30 35 20 10 0 Increased Remained the Same Managers’ Initial Attitude About A Smoke-Free Campaign: Ohio, 1998 50 47 45 40 44 74.5 Percent 35 63.8 30 25 20 15 10 5 0 9 0 0 Not Like the Idea OK, Only if not negative to business Open to trying something new Needed to get used to the idea No Response Managers’ Initial Attitude About A Smoke-Free Campaign: Ohio, 1999 55 50 51 45 40 42 Percent 35 63.8 30 25 20 15 10 5 0 2 Not Like the Idea OK, Only if not negative to business Open to trying something new 2 4 Needed to get used to the idea No Response Managers’ Initial Attitude About A Smoke-Free Campaign: Ohio, 2000 55 50 55 45 40 Percent 35 35 30 63.8 25 20 15 10 5 0 4 Not like the Idea 4 OK, only if not negative to business Open to trying something new Needed to get used to the idea 2 No Response Managers’ Initial Attitude About A Smoke-Free Campaign: Ohio, 2001 50 45 40 42 42 Percent 35 63.8 30 25 20 15 10 5 0 8 Not Like the Idea 1 OK, Only if not negative to business Open to trying something new Needed to get used to the idea 7 No Response Influence of Health Representatives on Mangers’ Decision to Participate: Ohio, 1998 50 45 40 Percent 35 34 30 25 20 15 19 22 16 10 5 0 None Very Little or Little Some Much or Very Much Influence of Health Representatives on Mangers’ Decision to Participate: Ohio, 1999 50 45 40 Percent 35 30 30 25 32 20 15 11 16 10 5 0 None Very Little or Little Some Much or Very Much Influence of Health Representatives on Mangers’ Decision to Participate: Ohio, 2000 50 45 40 Percent 35 30 31 25 26 26 20 15 16 10 5 0 None Very Little or Little Some Much or Very Much Influence of Health Representatives on Mangers’ Decision to Participate: Ohio, 2001 50 45 46 40 Percent 35 35 30 25 20 15 13 10 5 0 6 None Very Little or Little Some Much or Very Much Managers’ Likely Behavior After Participating in a Smoke-Free Campaign: Ohio, 1998 55 56 50 45 40 Percent 35 63.8 30 25 20 21 15 10 5 0 9 9 3 Will Never go smoke Free Will not participate in another campaign Will participate in another campaign Will go or strongly consider going smoke free No response Managers’ Likely Behavior After Participating in a Smoke-Free Campaign: Ohio, 1999 55 50 47 45 40 Percent 35 30 32 63.8 25 20 15 10 5 0 12 9 4 Will Never go smoke Free Will not participate in another campaign Will participate in another campaign Will go or strongly consider going smoke free No response Managers’ Likely Behavior After Participating in a Smoke-Free Campaign: Ohio, 2000 61 55 50 45 40 Percent 35 63.8 30 25 20 18 15 10 5 0 8 12 2 Will Never go smoke Free Will not participate in another campaign Will participate in another campaign Will go or strongly consider going smoke free No response Managers’ Likely Behavior After Participating in a Smoke-Free Campaign: Ohio, 2001 65 55 50 45 40 Percent 35 63.8 30 25 20 15 16 10 5 0 10 6 Will Never go smoke Free 4 Will not participate in another campaign Will participate in another campaign Will go or strongly consider going smoke free No response Managers’ Positions Who Participated in A Smoke-Free Campaign: Ohio, 1998 50 45 40 Percent 35 30 63.8 31 28 25 25 20 15 13 10 5 0 3 Sole owner Owner in partnership Manager Owner and manager No Response Managers’ Positions Who Participated in A Smoke-Free Campaign: Ohio, 1999 50 45 47 40 Percent 35 63.8 30 25 20 23 15 14 10 12 5 0 4 Sole owner Owner in partnership Manager Owner and manager No Response Managers’ Positions Who Participated in A Smoke-Free Campaign: Ohio, 2000 50 45 40 Percent 35 63.8 30 25 27 27 20 25 18 15 10 5 0 2 Sole owner Owner in partnership Manager Owner and manager No Response Managers’ Positions Who Participated in A Smoke-Free Campaign: Ohio, 2001 50 45 40 Percent 35 30 25 29 20 19 18 15 63.8 32 10 5 0 1 Sole owner Owner in partnership Manager Owner and manager No Response Managers’ Smoking Status: Ohio, 1998 81 50 45 40 Percent 35 30 25 20 15 16 10 3 5 0 Smoker NonSmoker No response Managers Smoking Status, Ohio: 1999 74 50 45 40 Percent 35 30 25 20 21 15 10 5 5 0 Smoker NonSmoker No response Managers’ Smoking Status: Ohio, 2000 76 50 45 40 Percent 35 30 25 20 15 16 10 8 5 0 Smoker NonSmoker No response Managers’ Smoking Status: Ohio, 2001 67 50 45 40 Percent 35 30 32 25 20 15 10 5 1 0 Smoker NonSmoker No response Smoking Bans Mangers’ Are Most In Favor Of: Ohio, 2000 50 45 40 Percent 35 33 30 37 25 20 18 15 10 12 5 0 City or county State No ban No response Smoking Bans Mangers’ Are Most In Favor Of: Ohio, 2001 50 50 45 40 38 Percent 35 30 25 20 15 10 5 0 10 City or county 3 State No ban No response Local Participants’ Responses Local Participants’ Average Response of Good to Excellent to Campaign Support Materials, Ohio 100 100 90 87 80 72 20 10 Press Releases Tray liners/ Placemats Manager Brochures TFO Testimonial Brochure 0 44.5 Year 1999 30 Years 2000 - 2001 40 Years 2000 - 2001 50 Years 2000 - 2001 60 Years 1998 - 1999 Percent 70 92 BillboardsMovie Slides Local Participants’ Average Response of Good to Excellent to Campaign Support Materials, Ohio: 1998-2001 100 90 94 99.5 95 89 80 88 Percent 70 63.8 60 50 40 30 20 10 0 CDC’s Guide Patron Survey Buttons Ink Pens Certificates Local Participants’ Average Response of Good to Excellent to Campaign Support Materials, Ohio: 1999-2001 100 90 88 80 80 Percent 70 60 63 69 63.8 50 40 36.4 30 20 10 0 Poster Notices Written Support Material Radio Spots Local Participants Who Agreed to Participate in Another Campaign: Ohio, 1999-2001 100 100 90 90 80 Percent 70 77.7 71 60 50 40 52.1 47.3 45.1 38.6 30 20 10 0 1999 2000 2001 Lessons Learned • Program Evaluation will help campaign evolve and become more effective. • Written feedback is beneficial and improves communication between local participants and state program developers. • Giving a voice to residents and restaurant managers is important for local policy work. • Much support and encouragement is needed for locals to try new projects. • Stress the importance of partnerships and coalition development (incl. communities of color and “everyday people”). • Statewide media can work synergistically with local efforts. Lessons Learned • Time Frames are needed for overall project success. • Logistical planning is important. • Have a strong follow up plan. Don’t be afraid to take risks… We have more support than we believe Local Ohio Clean Indoor Air Ordinances As of 11/2005 • • • • • • • • • • • Bexley Bowling Green Centerville Columbus Dublin Fairfield Grandview Heights Granville Health Hilliard Marble Cliff • • • • • • • • New Albany Newark Powell Toledo Upper Arlington Wauseon Westerville Worthington Municipalities with Local 100 Percent Smoke-Free Laws Cumulative Number, U.S., 1990-2005 Cumulative Number Workplaces Restaurants Bars Year States with Comprehensive Smokefree Workplace Laws As of 11/2005 • Washington • Massachusetts • California • Montana • Connecticut • New York • Delaware • Rhode Island • Maine • Ohio in 2006 • Vermont SmokeFreeOhio.org 2006