标题：Town-Level Characteristics and Smoking Policy Adoption in Massachusetts: Are Local Restaurant Smoking Regulations Fostering Disparities in Health Protection?
摘要：Objectives. We identified and quantified differences in sociodemographic characteristics of communities relative to the strength of local restaurant smoking regulations in Massachusetts. Methods. We examined the relationship between the strength of the 351 local restaurant smoking regulations in Massachusetts and a number of town-level characteristics, using a multinomial logistic regression model. Results. Characteristics important to the adoption of stronger restaurant smoking regulations included higher education and per capita income, geographic region, voter support for a state cigarette tax initiative, board of health funding to promote clean indoor air policymaking, and the presence of a bordering town with a strong regulation. Conclusions. The current pattern of smoke-free restaurant policy enactment fosters socioeconomic and geographic disparities in health protection, undermining an important national health goal. Healthy People 2010 calls for the protection of every citizen in the United States from the hazards 1– 4 of environmental tobacco smoke exposure in restaurants. 5 Because of the tobacco industry’s strong political influence at the state level, 6– 9 only 4 states have enacted smoke-free restaurant legislation, 10 making it unlikely that this objective will be reached via state action. However, more than 950 cities and towns nationwide have adopted restaurant smoking ordinances on a local level, 10 and in Massachusetts alone, it has been reported that more than 100 of the 351 communities have adopted stringent local restaurant smoking restrictions. 11 It is therefore the extent of the adoption of restaurant smoking policies at the local level that will most likely determine how effective we will be in achieving the goal of protecting the public from environmental tobacco smoke in restaurants. Healthy People 2010 also calls for the elimination of health disparities among various segments of the population, including differences that occur by race/ethnicity, education, income, and geographic location. 12 There is already a well-documented disparity in environmental tobacco smoke exposure across racial/ethnic and socioeconomic groups; 5 if protection by smoke-free policies varies among these same groups, it might be the case that these policies are actually fostering disparities in health protection. It is therefore critical that we understand the characteristics of towns that do or do not adopt smoke-free restaurant policies to ensure that we are not aiming to achieve one health objective at the expense of another. Unfortunately, at present we have very little understanding of the town-level characteristics (e.g., socioeconomic, demographic, and political variables) of communities that adopt smoke-free restaurant regulations. To the best of our knowledge, only 2 studies have examined the relationship between town-level characteristics and the adoption of local tobacco control policies, 13, 14 and only 1 of these 13 specifically examined the adoption of restaurant smoking regulations. Bartosch and Pope 13 examined a number of town-level characteristics of Massachusetts towns in relation to the percentages of Massachusetts towns with highly restrictive, moderately restrictive, and no local restaurant smoking restrictions as of March 1998. They did not, however, model the likelihood of ordinance adoption by varying town characteristics, and they examined only the bivariate relationships between town characteristics and ordinance adoption. In addition, the moderately restrictive restaurant smoking ordinances included those that merely created designated smoking areas, which do not protect patrons from environmental tobacco smoke exposure. 15, 16 In this article, we examine the relationship between town-level characteristics and the adoption and strength of local restaurant smoking regulations in Massachusetts. We expand upon previous work by (1) developing a model to estimate the likelihood of a town’s having a smoke-free restaurant ordinance on the basis of a variety of sociodemographic town-level variables, (2) creating a multivariate model to examine the simultaneous effects of town-level variables on ordinance adoption, (3) including in our analysis ordinances in effect through June 2002, many of which have been strengthened since 1998, (4) using 2000 Census data to identify town-level socioeconomic status, and (5) modeling the likelihood of 2 specific levels of local ordinances—elimination of smoking in restaurants entirely and restriction of smoking to separately ventilated areas—both of which, in theory, protect patrons from environmental tobacco smoke exposure. Identifying town-level characteristics associated with the successful adoption of effective smoke-free restaurant policies will advance the field of public health by (1) assisting in the identification of potential disparities in health protection—which are created by the current pattern of smoke-free restaurant ordinance adoption—that may undermine the nation’s overall public health goals, (2) enabling public health practitioners to develop strategies for targeting particular communities in the effort to protect the public from environmental tobacco smoke exposure in restaurants, and (3) helping to identify potential confounding variables that may need to be considered in research that assesses the impact of smoke-free restaurant regulations.
