摘要：Objectives. We examined patron responses to a California smoke-free bar law. Methods. Three telephone surveys measured attitudes and behavior changes after implementation of the law. Results. Approval of the law rose from 59.8% to 73.2% (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.58, 2.40). Self-reported noncompliance decreased from 24.6% to 14.0% (OR = 0.50; 95% CI = 0.30, 0.85). Likelihood of visiting a bar or of not changing bar patronage after the law was implemented increased from 86% to 91% (OR = 1.76; 95% CI = 1.29, 2.40). Conclusions. California bar patrons increasingly support and comply with the smoke-free bar law. Environmental tobacco smoke (ETS) exposure is well recognized to have long-term adverse effects on health. 1, 2 Epidemiological and biological evidence suggests an association between ETS and both lung cancer and cardiovascular disease. 1– 6 The health risks of exposure to ETS in the workplace have become a focus of scientific and public attention. 7– 9 Bar and tavern workers have been shown to be exposed to high levels of ETS in their work environments. 10– 13 Occupational exposure to ETS has been estimated to be 3.9 to 6.1 times higher among bar workers than among office workers. 10 In particular, bar workers who work in single-room bars have exceedingly high levels of exposure to ETS, approaching 10 times the levels of those who work in multiroom bars. 12 Also, nonsmoking bar workers have hair nicotine concentrations similar to those of daily smokers, in all likelihood owing to their occupational exposure to ETS. 13 These levels of ETS exposure suggest an increased risk of lung cancer in bar workers. 14, 15 Also, a recent study has demonstrated the positive health effects of eliminating indoor ETS by showing improvements in bar workers’ respiratory function after smoking was prohibited in their workplaces. 16 To protect bar and tavern workers—as well as bar patrons—from exposure to ETS, policies to restrict or ban smoking in bars have been implemented throughout the United States. In 1994, California became the first state to ban smoking in virtually all indoor workplaces, when the California legislature passed Assembly Bill 13 (AB13), codified as Section 6404.5 in the California Labor Code. 17 A provision of the law banning smoking in practically all bars went into effect on January 1, 1998. Both before and after this date, concerns were voiced about the dire consequences of this provision. Tobacco manufacturers, the National Smokers Alliance, and some bar owners complained that the provision would result in a loss of bar customers; they argued that customers would not continue to patronize bars if they could not smoke inside. 18, 19 Studies following the implementation of the law have demonstrated that the smoke-free bar law has had no negative impact on retail sales. 20, 21 These results echoed the findings from previous studies regarding the revenues of smoke-free restaurants and bars. 22, 23 In 1998, the California Tobacco Control Program launched a campaign to introduce the new law that emphasized the adverse effect of ETS on bar employees’ and patrons’ health. This program of the state Department of Health Services has focused on changing social norms regarding tobacco use through media and other educational efforts. Only a few studies conducted either in the United States or in other countries, however, have explored the ETS-related attitudes and behaviors of the general population before the establishment of smoke-free bars and restaurants. 24– 26 To our knowledge, the current study is the first effort to evaluate the acceptance of and compliance with a statewide smoke-free bar law among bar patrons. The purpose of this study was to determine the degree to which public opinion regarding the law, attitudes toward ETS, likelihood of visiting bars, and perceptions of self-compliance with the law have changed since California’s smoke-free bar law went into effect. We attempted to answer this question by analyzing 3 cross-sectional surveys of bar patrons. These surveys will provide an indication of the effectiveness of efforts by the California Tobacco Control Program to facilitate the implementation of the smoke-free bar provision of AB13.
