Variation in Enforcement of the Ohio Smoke Free Work Place Act by Local Health Departments – A Robert Wood Johnson Foundation Quick Strike Project

Background: In 2007, Ohio public health (PH) jurisdictions were charged with enforcement of the Smoke Free Work Place Act, limiting public exposure to tobacco smoke. Little is known about PH practice of Act enforcement across 88 counties, and whether variation is associated with agency characteristics. Objectives: Determine barriers, incentives, practice patterns, and opinions among the PH workforce involved in enforcement. Identify differences in these factors across rural/sub/urban jurisdictions, PH agency factors, levels of employment and their associations. Data: Focus groups and phone interviews at executive and direct enforcement (E/DE) levels were used to collect comments on enforcement practice. Critical issues were identified to develop an online survey (currently in field) that targets the statewide PH workforce. Survey analysis plan: Response demographics will reflect area demographics, E/DE respondents, and associations. Agreement and approval scales were used. Results-Focus groups: Agencies use registered sanitarians, health educators and contracted inspectors for enforcement. Worker safety spurred practice change. State reimbursement for timely and appropriately documented enforcement can often determine whether agencies enforce or opt out, leaving enforcement to the State PH agency. E/DE workers generally believe most businesses adapted easily. State Attorney General collection of large fines is perceived as spotty. Few agencies recover enforcement costs. Food and business inspections are seen as priorities. Conclusions: Smoke free work place laws require state support of enforcement costs to be effective. Loss of state financial support and an effective fine collection process may cause many public health agencies to opt out, increasing state burden to enforce.