Background: Clean indoor air regulations reduce both exposure to secondhand smoke and use of tobacco, two significant causes of death in the United States. In 2003, the Board of Health in Pierce County, Washington State, adopted a resolution prohibiting indoor smoking in all public places. Assessment activities were used in three key steps during the secondhand smoke policy development process: (1) setting prevention priorities, (2) monitoring and evaluating interventions, and (3) adopting local policy change.
Methods: Step 1 included calculating attributable risks for morbidity and mortality caused by preventable health behaviors. Step 2 involved designing logic models and outcomes-based evaluations to collect and analyze data from prevention efforts. Surveillance of restaurants documented voluntary adoption of smoke-free policies. Step 3 included conducting telephone surveys to track public support for tobacco policy approaches.
Findings: Results demonstrated tobacco's high impact on morbidity and mortality, illustrated a plateau of restaurants' voluntary smoke-free policies, and identified growing public support for secondhand smoke policy. Assessment results were included in multiple policy and support documents and cited by Board of Health members during policy adoption.
Conclusions: Assessment data contributed critical support to local public health decision makers during key steps of a lengthy secondhand smoke policy development process.
This article describes the pivotal role played by assessment in establishing clean indoor air regulations in an urban setting.
Cindan Gizzi, MPH, is Community Assessment Manager, Office of Community Assessment, Tacoma-Pierce County Health Department, Tacoma, Washington.
Alexandre Klementiev, PhD, is Epidemiologist II, Office of Community Assessment, Tacoma-Pierce County Health Department, Tacoma, Washington.
John Britt, RN, MPH, is Prevention Coordinator, Prevention Priorities Program, Tacoma-Pierce County Health Department, Tacoma, Washington.
Federico Cruz-Uribe, MD, MPH, was Director, Tacoma-Pierce County Health Department, Tacoma, Washington.
The authors acknowledge the work of additional colleagues at the Tacoma-Pierce County Health Department who collaborated on the work described in this article, especially Jim Crabbe, Susan Ferguson, David Freiheit, Beth Glynn, Victor Harris, Jim LaRue, Rick McCornack, Rick Porso, Dan Pritchard, Jill Smith, Rebecca Sullivan, and Lori Tanner.
Corresponding Author: Cindan Gizzi, MPH, Office of Community Assessment, Tacoma-Pierce County Health Department, 3629 South D St, Tacoma WA 98418.