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Establishing Smokefree Policy in California Indian Casinos

Institution: HBSA, Inc.
Investigator(s): Roland Moore, BA, MA, Ph.D.
Award Cycle: 2011 (Cycle 20) Grant #: 20CA-0103 Award: $734,712
Subject Area: Public Health, Public Policy, and Economics
Award Type: California Research Award

Initial Award Abstract
Through lowered exposure to secondhand smoke, smokefree indoor space policies aim to reduce worker health risks, as shown by research on the global expansion of smokefree workplace laws. However, worker and customer protection from secondhand smoke is still limited in the gaming industry in California and elsewhere, because the sovereignty of California Indian tribes means that they are not subject to state tobacco control policy, and fears of business loss have kept most tribes from eliminating smoke from their casinos. The pioneering fieldwork of Pritsos and others has shown that as smoking prevalence has dropped in the general population, old assumptions promoted by the tobacco industry about loss of business following smokefree casino policies may be entirely unwarranted.

A promising intervention has been developed by ETR Associates, with funding from the California Tobacco Control Program, to work collaboratively with a Northern California gaming tribe's council, through its casino management team, to implement smokefree workplace policies. The overall goal of this proposed study, therefore, is to conduct research that will enhance, refine, and establish the feasibility of a standardized version of this intervention for working collaboratively with gaming tribes\' councils through their associated casino management to establish smoke-free workplace policies in their casinos. The objectives by which we will meet this goal are as follows:

Specific Aim 1: To conduct formative research by interviewing Northern California tribal leaders and their casinos\' management teams on specific barriers to implementing casino smokefree policies, and to elicit their feedback on the most culturally acceptable and business sensitive methods to formulate, implement and uphold policies to eliminate secondhand smoke from their premises.

Specific Aim 2: To build casino management teams’ capacity for influencing smokefree policy changes at the level of the tribal council. These interventions will incorporate feedback from tribal leaders and casino managers, results from surveys with casino patrons regarding their attitude towards smokefree policies in these casinos, and measurements of airborne particulates in different areas of their casinos.

Specific Aim 3: To assess the effectiveness of these policy change interventions through pre- and post- observations of smoking behavior and measurements of tobacco-related air quality in two distinctly different Northern California casinos. Qualitative interviews with casino managers will provide process evaluation as the interventions proceed.

To meet our study goals, we will analyze qualitative interviews with 2 casino managers per 8 reservations randomly selected from the 37 tribally-owned casinos in Northern California. Incorporating their suggestions, we shall implement a structured intervention with two Northern California casinos, which will be included in the research team's pre- and post-observations and air quality, ambient nicotine, and cotinine monitoring.

This collaborative feasibility research addresses a gap in California’s comprehensive smokefree workplace law by seeking to restrict smoking in sovereign Native-owned casinos which are not subject to this state law. Findings from this study can be used to establish a standardized protocol for implementing tobacco control policy change in tribally-owned casinos through capacity building in the casino management team. These findings represent the necessary groundwork for larger-scale research efforts to test such feasible smokefree casino policies. In this systematic, step-by-step manner, it will be possible to enable tribes elsewhere to create smokefree workplace policies in new and existing casinos, thereby strengthening worker health protection.