Identifying barriers associated with policy implementation of smoke free public place initiatives

Introduction:  Local health departments are working to build upon success of the Smoke-free Illinois Act (2008), which protects Illinois residents from secondhand smoke in indoor public places. Through the Illinois Department of Public Health’s CDC Community Transformation Grant (CTG) Smoke-free Public Places (SFPP) initiative, local health departments are developing smoke-free policies at outdoor locations including parks, fair grounds, and campuses. While over 92 policies have been created to date, many barriers remain in developing new and implementing existing policies.

Methods: A performance management (PM) framework was developed to monitor progress, identify barriers and technical assistance needs, and comply with federal grant requirements. Fifteen county health departments funded by the CDC CTG reported barriers to SFPP policy implementation quarterly through the PM system.  An exploratory qualitative analysis of data collected over the past 2 years was analyzed using open coding with ATLAS.ti. Barriers were identified and grouped into themes.

Results: Preliminary analysis revealed a connection between the rural status of IL CTG communities and barriers to SFPP policy development and implementation. The most frequently reported barriers, such as concerns over enforcement, fell into three thematic categories:  procedural barriers, political barriers and cultural barriers.

Discussion: The PM system satisfied grant requirements while capturing rich programmatic detail. Barriers to SFPP implementation were complex; the relationship between barriers and geographic location needs more exploration.  Through routine data collection and identification of barriers, technical assistance providers can target technical assistance needs, helping healthcare professionals advance health of the communities in which we live and work.