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Institution: Stanford University
Investigator(s): Judith Prochaska, Ph.D., M.P.H.
Award Cycle: 2016 (Cycle 25) Grant #: 25IR-0032 Award: $461,799
Subject Area: State and Local Tobacco Control Policy Research
Award Type: High Impact Research Project Award

Initial Award Abstract

The 1994 Smokefree Workplace Act made California the first state to amend its Labor Code to require employers to prohibit smoking in enclosed places of employment. Although widely perceived as a comprehensive smokefree air law, gaping holes in the Labor Code remained. As a result, 1 in 7 Californians continued to face secondhand smoke (SHS) exposure at work. These exemptions were believed to contribute to tobacco-related health inequities in California by making it easier for workers in the affected job settings to start smoking, more difficult to quit smoking, and more likely that such populations would die from diseases associated with tobacco use and SHS exposure. The affected populations were primarily the working poor and communities of color.

Analyzing state policy and health data from 2012-2016, this TRDRP Research Award aims to quantify at the state and local level the impact of the loopholes that remained in California’s Smokefree Workplace Act and to identify opportunities for addressing tobacco-related disparities. With broad relevance and impact, we hypothesize that communities with local ordinances that closed the Labor Code loopholes would have significantly: (H1) lower smoking prevalence and SHS exposure and (H2) fewer tobacco-related medical concerns (e.g., asthma, heart disease) among the categories of workers not protected by the state smokefree workplace law. Further, we hypothesize that communities with local ordinances closing the Labor Code loopholes would have significantly (H3) less saturation of tobacco retailers and (H4) lower representation of residents of color and of residents of lower socioeconomic status. In parallel, in an exploratory analysis, we are examining expansion of local smokefree workplace ordinances to include e-cigarettes, exposure to secondhand aerosol, and smoked marijuana. Our ultimate aim is to disseminate this evidence-base to tobacco control advocates so that communities have actionable information to convince decision makers about the need to strengthen laws protecting workers from harmful SHS.

The proposed Research Award is a collaboration of tobacco control researchers at the Stanford Prevention Research Center with legal and health policy experts at ChangeLab Solutions. Our systematic legal analysis will yield new policy data on the city and county laws of California communities. We will combine these new policy data with statewide data on adult smoking status, extent and location of workplace SHS exposure, and tobacco-related medical visits (e.g., asthma, heart disease) from the Behavior Risk Factor Surveillance Survey (BRFSS) waves 2012 through 2016. We anticipate data on 17,000 California adults with representation in over 500 California jurisdictions. A third aim incorporates tobacco retailer license data and US census data on the communities in which the respondents reside (e.g., tobacco retailer density, census demographics).

This research is highly timely and will serve as essential baseline data following enactment of two new legislative bills, effective June 2106 in California. The first eliminated some of the exemptions in the Smokefree Workplace Act by prohibiting smoking in: owner-operated businesses with no employees; hotel lobbies, meeting and banquet rooms; warehouse facilities; employee break rooms; and workplaces with 5 or fewer employees. Exemptions, however, still remain for smoking in outdoor workplaces, tobacco shops, private homes where employees enter, and hotel guest rooms. Because of these remaining exemptions, a significant number of employees in California, particularly low-income workers, may still be exposed to SHS at their worksite. In the future, the methods developed can be applied in a longitudinal analysis as part of a natural experiment examining the effect of closure of California’s Labor Code loopholes yielding valuable data as a model nationally. The second key bill expanded the definition of “smoking” to include electronic nicotine delivery systems (ENDS), thereby prohibiting the use of e-cigarettes in any location in which smoking is prohibited under the Labor Code.

This Research Award directly aligns with the goals of the State and Local Tobacco Control Policy Research priority area, with a focus on California Gaps in Tobacco-free Policies. The project will yield evidence of exposure to and the harm from SHS and aerosol exposure to workers in industries that remained unprotected by current policy. The research will shed light on the impact of local ordinances on smoking and SHS exposure rates amongst affected workers. Further, the recent legislative development offers a significant opportunity to advance critical, real-time research essential in demonstrating the role of comprehensive smokefree laws in protecting workers from harmful SHS and emerging ENDS use. The study findings will be of national significance.