235613 Variation in Enforcement of the Ohio Smoke Free Work Place Act by Local Health Departments A Robert Wood Johnson Foundation Quick Strike Project

Monday, October 31, 2011

David Bruckman, MS, PhD Candidate , Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
Aylin Drabousky, MA , Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
Aiswarya L. P. Chandran Pillai , Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
Terry Allan, RS, MPH , Administration, Cuyahoga County Board of Health, Parma, OH
Robert Campbell, PhD , Ohio Department of Health, Columbus, OH
Elaine A. Borawski, PhD , Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
Matthew Stefanak, MPH , Board of Health Commissioner, Mahoning County District Board of Health, Youngstown, OH
Scott Frank, MD, MPH , Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
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.

Learning Areas:
Other professions or practice related to public health
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Discuss differences and describe associations in local public health enforcement of Ohio's Smoke Free Work Place Act and public health agency characteristics. Identify perception differences in Act enforcement between public health administrators and enforcement staff. Assess the potential impact of ending state-level support of enforcement fees on direct enforcement of the Act by local public health agencies.

Keywords: Public Health Legislation, Workforce

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: as Chief Systems Analyst of the Cleveland Department of Public Health, I assess work force and clinic health utilization for the Department and devised, planned, coordinated and analyzed this research on public health work force issues and legislation on reducing tobacco smoke exposure in public areas.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.