MENDOCINO COUNTY SMOKE FREE CASINOS. Final Evaluation Report CTCP Contract Number: Contract Period: 7/1/07 6/30/10

Transcription

1 MENDOCINO COUNTY SMOKE FREE CASINOS Final Evaluation Report CTCP Contract Number: Contract Period: 7/1/07 6/30/10 Project Director: Agency: Mary Williamson Mendocino County Health & Human Services Agency Community Health Services Branch Tobacco Control Program 1120 S. Dora St., Ukiah, CA Contact Information: (P) (F) (E) Report Author: M. Susan Haun, M.A., Evaluation Consultant, Haun & Associates Report Submitted: June 2010

2 Made possible by funds received from the Tobacco Tax Health Protection Act of 1988 Proposition 99, through the California Department of Public Health, California Tobacco Control Program (CTCP) Contract #07-23, Contract Term: 07/01/07 06/30/10. Recommended citation: Haun, S Mendocino County Smoke Free Casinos Final Evaluation Report. California: Mendocino County Tobacco Control Program.

3 MENDOCINO COUNTY SMOKE FREE CASINOS Abstract The cost of smoking in Mendocino County is very high in terms of morbidity, mortality, and economics. It has been estimated that $61 million in direct and indirect costs are caused by cigarette smoking each year. Since January 1, 1998, all employees in Mendocino County, like California as a whole, have been protected from SHS exposure by AB13, which prohibits smoking in places of employment under California Labor Code However, this law does not apply to American Indian gaming facilities, i.e., casinos and gaming clubs on tribal land, as they are controlled by sovereign entities the tribes. Statewide, 60 tribal casinos operate in 27 California counties. Of these, five are located within Mendocino County s borders and employee an estimated part- and full-time workers; all of whom are unprotected by the California Smoke Free Workplace Law. During the Communities of Excellence (CX) needs assessment, Mendocino County Tobacco Control Program (MCTCP) staff and community advisory members rated SHS exposure in local casinos a high priority in order to protect employees health. The most effective method for reducing SHS exposure to employees is smoke-free workplace policies. Based on these considerations, MCTCP developed the following objective for this intervention: By June 30, 2010, MCTCP will collaborate with at least one Native American tribe to provide tobacco education, resources and support to youth and other tribal community members for adopting a smoke-free policy in a tribal casino. This is California Tobacco Control Program (CTCP) priority area Reduce Exposure to Secondhand Smoke; it is a primary objective and addresses CX indicator # MCTCP and the Coyote Valley Tribal Education Director, a subcontractor hired in years 2 and 3 of the funding cycle, conducted major intervention activities under the following 6 TCS/OTIS intervention categories: 1) coordination and collaboration, 2) community education, 3) educational materials, 4) policy, 5) advocacy campaign materials, and 6) training. The activities targeted the Coyote Valley Tribal Council members as the decision-makers who can adopt a smoke-free casino policy, and the Coyote Valley Tribal Reservation middle school youth who would develop knowledge and leadership skills necessary to provide community education and policy advocacy activities. Although many of the intervention activities were completed, most were not done until year 3 of the funding cycle as intervention activities did not happen as quickly as planned. As a result, the following community education, and policy advocacy activities were not implemented: Presentations by the tribal youth group to 5-15 organizations such as the county medical society, senior citizen groups, voluntary health organizations, etc., including information on tribal gaming, in order to gather support and written endorsements from organizations for smoke-free gaming in tribal casinos in Mendocino County. Training community representatives and youth advocates how to discuss/present smokefree policies to tribal councils and other tribal leadership.

4 Mendocino County Smoke Free Casinos Final Evaluation Report Page 4 Presentations by the tribal youth group on SHS smoke to 2-5 groups including tribal leaders, casino employees and/or the Native American community. Anecdotal information indicated that the targeted casino had previously attempted to go smoke free in January 2001 but abandoned the process after approximately two months because it was losing revenue. Although planning sessions were conducted with a task force of tribal members/staff from the tribal Education Center, the tribal Education Center Director and other task force members were not willing to champion a smoke-free casino policy. This may have been due to the fact that they were employees and taking such a position was deemed personally risky or because of other cultural influences. MCTCP staff attempted repeatedly to contact the tribal administrator and the casino administrator directly, with no success. As a result, a meeting with the tribal council members was not obtained and a smoke-free casino policy was not adopted. Consequently, the following media and policy activities were not implemented: Providing radio and print media with press releases regarding the policy adopted. Providing technical assistance to the casino in drafting and implementing a smoke-free casino policy. The evaluation used for this intervention was a non-experimental design with no pre- and post-test measures and no comparison group. The primary outcome was the adoption of a voluntary, written smoke-free workplace policy by at least one American tribal casino in Mendocino County that affords workers protection that is comparable to the protection under California Labor Code Process evaluation activities were conducted to determine if there were any observable smoke-free zones within each casino or formal/informal smoke-free policies in any administrative or employee-only areas, to determine casino patron support (if any) for a smoke-free policy, and to provide information about needed intervention modifications. As with intervention activities, evaluation activities experienced repeated delays. With the exception of the casino observation/contact survey, evaluation activities were not completed until late in year 3 of the funding cycle. The objective of getting at least one Native American tribal casino to adopt a smoke-free policy was not met. Based on the process data results, the biggest barrier was a concern about a loss of casino patrons/revenue. Process data also suggested that a barrier to influencing the tribal council was the fact that most of the tribal council members and many casino employees smoked. Other intervention activities such as presentations to the tribal council by the tribal middle school youth regarding SHS or smoke-free casino policies, or providing information about other casinos that had successfully gone smoke-free were not completed by the end of the funding cycle. This was despite having hired the Coyote Valley Educational Director as a subcontractor to implement intervention activities with the tribal middle school youth. A stronger evaluation design would be needed to understand the strengths and weaknesses of the intervention plan and its implementation, as well as the cultural implications. The evaluation design could be strengthened by collecting preintervention key informant interview data early in the funding cycle so that intervention activities can be adjusted based on the barriers encountered. Future work should focus on identifying and addressing the barriers to policy adoption.

5 MENDOCINO COUNTY SMOKE FREE CASINOS Final Evaluation Report PROJECT DESCRIPTION Background. Mendocino County is a rural county located in the northwestern portion of California. The county covers 3,509 square miles of mountains, redwood forest, and coastline, and has a population of 86,265 1 people (U.S. Census 2000). The county has four incorporated cities and an unincorporated area with 32 communities. The majority of the population is Caucasian (80.8%) with the second and third largest ethnic populations being Hispanic (16.5%) and Native American (4.8%) (U.S. Census 2000). The cost of smoking in Mendocino County is very high in terms of morbidity, mortality, and economics. It has been estimated that $61 million in direct and indirect costs are caused by cigarette smoking each year (Max et al. 1999). Tobacco smoke harms both smokers and non-smokers. According to the National Toxicology Program, secondhand smoke (SHS) contains at least 2500 chemical constituents. The U.S. Environmental Protection Agency classified SHS as a Group A Carcinogen and, according to the Surgeon General (2006), there is no risk-free level of exposure to SHS. Since January 1, 1998, all employees in Mendocino County, like California as a whole, have been protected from SHS exposure by AB13, which prohibits smoking in places of employment under California Labor Code However, this law does not apply to American Indian gaming facilities, i.e., casinos and gaming clubs on tribal land, as they are controlled by sovereign entities the tribes. Statewide, 60 tribal casinos operate in 27 California counties. Of these, five 2 are located within Mendocino County s borders and employee an estimated part- and full-time workers; all of whom are unprotected by the California Smoke Free Workplace Law. Despite substantial progress in tobacco control, SHS exposure remains a major public health concern that is entirely preventable (U.S. Department of Health and Human Services 2000), and smoke-free workplace policies are the most effective method for reducing SHS exposure to employees (Hopkins et al. 2001). Given these considerations, it was clear that this was an issue that needed to be addressed by the Mendocino County Tobacco Control Program (MCTCP) during the funding cycle. Objective and Rationale. By June 30, 2010, MCTCP will collaborate with at least one Native American tribe to provide tobacco education, resources and support to youth and other tribal community members for adopting a smoke-free policy in a tribal casino. This is California Tobacco 1 Mendocino County has a population density of 25 people per square mile in comparison to 235 people per square mile for California as a whole. 2 The five casinos and associated tribes are: 1) Red Fox Casino in Laytonville, Cahto Tribe of Laytonville Rancheria; 2) Coyote Valley Casino in Redwood Valley, Coyote Valley Band of Pomo Indians; 3) Sherwood Valley Casino in Willits, Sherwood Valley Rancheria; 4) Hidden Oaks Casino in Covelo, Round Valley Indian Tribes, and 5) Shodakai Casino in Hopland, Hopland Band of Pomo Indians.

6 Mendocino County Smoke Free Casinos Final Evaluation Report Page 6 Control Program (CTCP) priority area Reduce Exposure to Secondhand Smoke; it is a primary objective and addresses Communities of Excellence (CX) indicator # This objective was chosen by MCTCP staff and the community advisory group during the Communities of Excellence (CX) Needs Assessment process in February Community members participating in the CX process included representatives from the County Department of Public Health, the County Office of Education, Law Enforcement, adult- and youth-serving organizations, community-based organizations, concerned citizens, and representatives of the Native American communities in Mendocino County a total of approximately 50 participants. As a result of the data gathered during the needs assessment process, MCTCP staff and the community advisory group rated SHS exposure in local casinos a high priority. As such, focusing on at least one of the American Indian casinos in Mendocino County without a voluntary smoke-free workplace policy became the basis for a primary objective in order to protect employees health. Other counties throughout the state are working to reduce SHS in tribal casinos by adopting voluntary smoke-free policies. Smokers, on average, miss 6.16 days of work per year due to sickness (including smoking related acute and chronic conditions), compared to nonsmokers, who miss 3.86 days of work per year (Americans for Nonsmokers Rights 2006). The Centers for Disease Control and Prevention (CDC) puts a $3,391 price tag on each employee who smokes: $1,760 in lost productivity and $1,623 in excess medical expenditures. In addition, estimated costs associated with SHS s effects on nonsmokers can add up to $490 per smoker per year (Americans for Nonsmokers Rights 2006). Smoke-free workplace policies lead to less smoking among workers and elimination of SHS exposure, thus creating a healthier workforce (U.S. Surgeon General s Report 2006). Opponents claim going smoke free puts a casino at a competitive disadvantage. However, research has shown that casinos do not lose revenue as a result of implementation of smoke-free policies. After implementation of Delaware s smoke-free law, Dover Downs Gaming and Entertainment reported an initial loss in revenue, but soon thereafter saw an increase in gaming revenue of 13.8% (Americans for Nonsmokers Rights 2004). Intervention, Targets and Setting. MCTCP and the Coyote Valley Tribal Educational Director, a subcontractor hired in years 2 and 3 of the funding cycle, conducted major intervention activities under the following 6 TCS/OTIS intervention categories: 1) coordination and collaboration, 2) community education, 3) educational materials, 4) policy, 5) advocacy campaign materials, and 6) training (see below for more details). The activities targeted the Coyote Valley Casino in Redwood Valley with an estimated part- and full-time employees. Specially, the activities targeted the Coyote Valley Tribal Council members as the decision-makers who can adopt a smoke-free casino policy and the Coyote Valley Reservation middle school youth who would develop knowledge and leadership skills necessary to provide community education and policy advocacy activities. The settings for the interventions were the Coyote Valley Reservation facilities, as well as the offices of MCTCP. 3 Communities of Excellence Indicator #2.2.25: Proportion of businesses with a voluntary policy that designates American Indian casino/leisure complexes as smoke-free to a level that is consistent with protection provided to other California workers under California Labor Code or Proportion of American Indian tribes with a policy that designates casino/leisure complexes as smoke-free to a level that is consistent with protection provided to other California workers under California Labor Code

7 Mendocino County Smoke Free Casinos Final Evaluation Report Page 7 1. Coordination and Collaboration. Major intervention activities in this area included collaborating with the California Clean Air Project (CCAP) Statewide Casino Workgroup and other statewide agencies to share ideas on casino campaign strategies, monitoring SHS and gaming issues through national and state media, convening a local task force of tribal Education Center employees, and speaking with the tribal leaders/administrators from each of the five tribal casinos in Mendocino County to assess the interest in participating in a tobacco education campaign on the reservation and adopting a smoke-free casino policy. From these conversations, MCTCP developed further intervention activities. 2. Community Education. Educating community members, including local key decision makers, is important to creating forward momentum in changing social norms regarding the adoption of tobacco control policies. Major intervention activities in this area included training tribal middle school youth to do outreach and education at tribal community events such as health fairs regarding SHS and related health risks, and to strive to increase support for smoke-free casinos. 3. Educational Materials. Developing effective education materials is important to ensure that community members and local key decision makers have the necessary information to make informed decisions. Major intervention activities in this area included developing approximately 50 kits that provided information regarding the dangers of SHS exposure, smoke-free gaming, compacts, tribal sovereignty, and the direct and indirect costs of smoking. Information included a model smoke-free casino policy, a local public opinion survey, fact sheets, and assorted documents from the California Tobacco Control Program (CTCP) and statewide partners such as the California Clean Air Project (CCAP), California Nations Indian Gaming Association (CNIGA), the Technical Assistance Legal Center (TALC), and the Tobacco Education Clearinghouse of California (TECC). 4. Policy. Developing a road map to organize the policy campaign and build the power necessary to influence local policy makers is critical to the successful adoption of a local tobacco control policy. Major activities in this area included completing the Midwest Academy Strategy Chart with a task force of tribal Education Center staff to identify goals, organizational considerations, constituents, allies and opponents, as well as targets and tactics. 5. Advocacy Campaign Materials. Increasing awareness about tobacco control issues is important to building support for local tobacco control policies. Major intervention activities in this area included purchasing and distributing through the tribal youth group at least 200 promotional materials such as t-shirts, water bottles, and fanny packets. 6. Training. Providing ongoing training and technical assistance is necessary to build the capacity of tobacco control advocates and ensure the success of a local campaign. Major activities in this area included educating the tribal youth group in monthly sessions on tobacco industry tactics, effects of tobacco on the environment and tobacco, sacred use of tobacco, social influences on tobacco use, peer norms regarding tobacco use, policy development and implementation, and advocacy campaigns. Although many of the intervention activities were completed, most were not done until year 3 of the funding cycle. For example, the Midwest Academy Strategy Chart was not completed until March 2010, rather than early in year 1 of the funding cycle as originally intended. As a strategic planning tool for policy advocacy campaigns, it provides information to help shape the messages and

8 Mendocino County Smoke Free Casinos Final Evaluation Report Page 8 intervention activities. This tool could not be effectively utilized under the current conditions as there were only three months left to the funding cycle. The timeline on the other intervention activities was similarly delayed as intervention activities did not happen as quickly as planned. As a result, the following community education and policy advocacy activities were not implemented: Presentations by the tribal youth group to 5-15 organizations such as the county medical society, senior citizen groups, voluntary health organizations, etc., including information on tribal gaming, in order to gather support and written endorsements from organizations for smoke-free gaming in tribal casinos in Mendocino County. Training community representatives and youth advocates how to discuss/present smokefree policies to tribal councils and other tribal leadership. Presentations by the tribal youth group on SHS smoke to 2-5 groups including tribal leaders, casino employees and/or the Native American community. Anecdotal information indicated that the targeted casino had previously attempted to go smoke free in January 2001 but abandoned the process after approximately two months because it was losing revenue. Although planning sessions were conducted with a task force of tribal members/staff from the tribal Education Center, the tribal Education Center Director and other task force members were not willing to champion a smoke-free casino policy. This may have been due to the fact that they were employees and taking such a position was deemed personally risky or because of other cultural influences. MCTCP staff attempted repeatedly to contact the tribal administrator and the casino administrator directly, with no success. As a result, a meeting with the tribal council members was not obtained and a smoke-free casino policy was not adopted. Consequently, the following media and policy activities were not implemented: Providing radio and print media with press releases regarding the policy adopted. Providing technical assistance to the casino in drafting and implementing a smoke-free casino policy. EVALUATION METHODS Evaluation Design. The evaluation of this objective used a non-experimental design. Specifically, it was designed as a Single Policy Policy Adoption Only plan; only process measures were collected. The outcome is the adoption of a voluntary, written, smoke-free workplace policy by at least one American tribal casino in Mendocino County that affords workers protection that is comparable to the protection under California Labor Code The design does not have a pretest or post-test because it is a policy adoption only objective; as such, there is no quantifiable outcome. Limitations to the design include the absence of a comparison group. Process data were gathered through a pre-intervention casino observation/contact survey and a preintervention public intercept survey. The purpose of the casino observation/contact survey was to determine if there were any observable smoke-free zones within each casino, and whether there were any formal/informal smoke-free policies in any administrative or employee-only areas. This survey was conducted at the beginning of the project between March 2008 and May 2008, and served as baseline data. The purpose of the public opinion poll was to determine support (if any) for a smoke-free casino policy. Although this was intended to be conducted in year 1 of the funding cycle to help shape the intervention activities with the tribal council, permission to conduct the

9 Mendocino County Smoke Free Casinos Final Evaluation Report Page 9 survey in front of the casino or on tribal reservation land was not granted. As a result, a shot gun approach to conducting the public opinion poll was utilized to complete the survey between March 2010 and June 2010 (see below for more details). Post-intervention key informant interviews were originally planned, but were modified to be pre-intervention key informant interviews as intervention activities were not gaining any forward momentum. The purpose of the key informant interviews was to determine barriers and facilitators to policy adoption. The key informant interviews were completed between March 2010 and June A post-intervention public opinion poll was also originally planned but not conducted as a voluntary smoke-free policy was not adopted. Evaluation activities, like intervention activities, experienced repeated delays as activities did not happen as quickly as planned. With the exception of the casino observation/contact survey, evaluation activities intended to help shape the intervention activities were not completed until late in year 3 of the funding cycle. The limitations to the evaluation design include the absence of a comparison group Sample, Data Collection Instruments, Procedures and Analysis. Process data were gathered through a casino observation/contact survey, a public intercept survey, and key informant interviews. The sample, data collection instruments, procedures and analysis for each process measure are summarized below. Casino Observation / Contact Survey A casino observation/contact survey was conducted between March 2008 and May 2008 in year 1 of this project, prior to the intervention. The survey targeted all five of Mendocino County s tribal casinos and was conducted on-site with a follow-up call to the tribal/casino administrators for formal smoke-free policy information. After eliminating one site visit because the tribal casino was deemed unlikely to adopt a smoke-free policy, a total of 4 out of 5 surveys were completed. The survey instrument was developed by the local evaluator with sample surveys provided by the Tobacco Control (TC) Evaluation Center. A number of items were documented or assessed during each survey: 1) any areas in which smoking, or other indicators of smoking such as ashtrays or odor, was observed; 2) whether or not there were any apparent smoke-free zones; 3) whether or not a casino representative reported that there was a policy regarding cigarette smoking; and, if so 4) the policy. (See Appendix A for the data collection instrument.) Due to the small sample size, fieldtesting the survey was deemed unnecessary and verbal instructions were provided by the local evaluator to MCTCP staff who conducted the survey. Survey responses were manually tabulated (again, due to the small sample size) and analyzed by conducting frequencies and percentages of yes/no questions. Public Opinion Poll (Public Intercept Survey) As indicated above, a pre-intervention public opinion poll of casino patrons was originally intended to occur in year 1 of the funding cycle, prior to any presentations to the tribal council or casino leadership. Also indicated above, a shot-gun approach to distributing the survey was utilized in an attempt to find casino patrons in the general community. Specifically, several methods of distributing the survey were attempted through the Coalition members, through Health & Human Services Agency staff, and by trying to intercept casino patrons at various venues including a grocery store. A total of 202 surveys were completed.

10 Mendocino County Smoke Free Casinos Final Evaluation Report Page 10 The limitations of this approach include the use of a convenience sample and conducting the survey at venues other than the targeted casino. The results may not reflect the opinions of casino patrons or of the general public. The survey instrument was developed by the local evaluator with sample surveys provided by the TC Evaluation Center. Respondents to the survey were asked which casino(s) they visited in Mendocino County, how frequently they visited a casino(s), the main reason they go to a casino, and support (if any) for a smoke-free section, a smoke-free night, or a smoke-free casino policy. Respondents were also asked if they or their spouse/partner smoked. The survey was field-tested, and one question was later added because of the shotgun approach to identify which casinos were patronized by respondents. (See Appendix B for the data collection instrument.) The evaluator provided verbal training to MCTCP staff that collected the data through the various venues mentioned above. The pre-intervention survey originally planned for the start of the project in fall 2007, was not conducted until between March 2010 and May Survey responses were entered into Surveymonkey and analyzed by conducting frequencies and percentages of yes/no questions. The results were included in the educational kits developed in June Key Informant Interviews Key informant interviews were conducted pre-intervention by MCTCP staff between March 2010 and June The intent was to include tribal leaders, tribal administration and other individuals with expertise and experience with tribal casinos. However, past and current casino employees, tribal Education Center employees, as well as adult members of another local tribe were interviewed. Ten interviews were planned and seven key informants were interviewed. The key informant interview questionnaire was developed by the evaluation consultant after consultation with the TC Evaluation Center. The survey was conducted face-to-face by MCTCP staff. The questions asked about likely supporters or champions of efforts to pass a smoke-free casino policy, as well as opposition. (See Appendix C for the data collection instrument.) A content analysis of the open-ended responses was conducted to identify barriers and facilitators to policy adoption. EVALUATION RESULTS Process Data Collection Results Casino Observation/Contact Survey The casino observation/contact surveys were completed for four of the five Mendocino County casinos between March 2008 and May 2008 in year 1 of the project. (See Appendix A for a sample survey.) Highlights of the results are presented below. All (100%) of the four American Indian tribal casinos surveyed permit smoking in all or part of their facility. Three of the four (75%) casinos have smoke-free zones for patrons (one group of slot machines, bingo, entertainment and dining/buffet areas). However, it was observed that cigarette smoke/odor permeated these areas within the facility.

11 Mendocino County Smoke Free Casinos Final Evaluation Report Page 11 Two of the four (50%) casinos each have a policy that prohibits employees from smoking in employee-only areas (e.g., employee break rooms). Public Opinion Poll (Public Intercept Survey) Results The public opinion poll survey was completed by 202 respondents between March 2010 and June (See Appendix B for a sample survey.) Highlights of the results are presented below. The majority (76.6%) of respondents visited a casino once a month or less frequently, 9.9% visited a casino 1-2 times per month, and 13.3% visited a casino once a week. Of those that visited casinos, most (69.8%) visited Coyote Valley Casino in Redwood Valley and/or Shodakai Casino in Hopland (57.9%). Most (76.3%) of the respondents indicated they would be willing to go to the casino during smoke-free nights. Most respondents (84.2%) and their partners/spouse (80.5%) were nonsmokers. Respondents indicated that they would support the following statements: The whole casino should be smoke free (51.8%). There should be a smoke-free section at the casino (43.5%). Key Informant Interviews The responses to the seven key informant surveys regarding barriers and facilitators to adoption of a smoke-free casino policy were analyzed. (See Appendix C for a sample data collection instrument.) The key findings are summarized below. Respondents identified the following barriers to the casino adopting a smoke-free policy: Concern about loss of patrons/commerce (all seven respondents). Tribal council members must approve the policy change (all seven respondents). Many tribal council members are smokers (all seven respondents). A large percentage of the casino employees are also smokers (all seven respondents). The casino targeted in this intervention had previously tried to go smoke free and lost money (six respondents). SHS is a low priority for casino administration (six respondents). Respondents identified the following facilitators to adopting a smoke-free casino policy: Awareness of the negative effects of SHS (all seven respondents). Concern about the SHS exposure of tribal youth who frequently eat in the casino restaurants which have SHS drift from the casino gaming areas (four respondents). Awareness of the poor example for youth that is set by adult smokers in the native community (three respondents). Engaging the Casino Human Resources Manager, as this person has knowledge of employee turnover and illness as a result of SHS exposure (two respondents). In response to the challenges, the respondents identified the following: Find a champion among tribal council members. Educate the tribal council regarding the exposure of tribal youth to SHS in the casino restaurants.

12 Mendocino County Smoke Free Casinos Final Evaluation Report Page 12 Provide an example of a casino that has gone smoke free to reassure the tribal council that they can go smoke free and still make a profit. CONCLUSIONS AND RECOMMENDATIONS The objective of getting at least one Native American tribal casino to adopt a smoke-free policy was not met. Based on the process data results, the biggest barrier was a concern about a loss of casino patrons/revenue. Process data also suggested that a barrier to influencing the tribal council was the fact that most of the tribal council members and many casino employees smoked. However, this data was collected late in the funding cycle so it could not be used to modify the messages and intervention activities. Other intervention activities such as presentations to the tribal council by the tribal middle school youth regarding SHS or smoke-free casino policies, or providing information about other casinos that had successfully gone smoke-free were not completed by the end of the funding cycle. This was despite having hired the Coyote Valley Educational Director as a subcontractor to implement intervention activities with the tribal middle school youth. A stronger evaluation design would be needed to understand the strengths and weaknesses of the intervention plan and its implementation, as well as the cultural implications. Lessons learned from this project and recommendations for future projects include the following: Casino observation/contact surveys were able to establish a baseline of casino smoking policy. Future interventions may want to target a casino that has not had a previously unsuccessful attempt implementing a smoke-free policy or strengthen the process data (see below for more details). The shot gun approach to conducting a public opinion poll of casino patrons was somewhat effective in finding the targeted casino s patrons. However, they were mostly infrequent patrons, visiting the casino once a month or less. Future interventions should focus on providing research results of gaming facilities that have successfully gone smoke-free and statewide studies regarding attitudes about SHS in casinos. The key informant interviews were able to identify barriers and facilitators to policy adoption. For example, the tribal casinos are a business and, like any other business, they have to make money. Future interventions should focus on influencing the tribal council through the casino administration, and influencing the casino administration by providing the business-related costs associated with smoking and SHS. Future interventions should also include culturally appropriate cessation services to help tribal leaders and casino employees quit smoking. A stronger evaluation design would help strengthen the process data and shape the intervention activities to support policy adoption. For example, the design could be strengthened by including key informant interviews of the casino administrator, the casino Human Resources Manager and other key personnel pre-intervention. Future work should focus on identifying and addressing the barriers to policy adoption. The lessons learned from this project will be useful in accomplishing this goal.

13 Mendocino County Smoke Free Casinos Final Evaluation Report Page 13 WORKS CITED Americans for Nonsmokers Rights. Gambling with your health. ANR Update 23(4), Winter Retrieved June 1, 2010, from Americans for Nonsmokers Rights. Business costs in smoke-filled environments, August Retrieved June 1, 2010, from Hopkins D.P., Briss P.A., Ricard C.J., Husten C.G., Carande-Kulis V.G., Fielding J.E., et al. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine, 2001;20(2 Suppl): Max W., Rice D.P., Zhang X., Sung H-Y., Miller L. The cost of smoking in California, Sacramento, CA: California Department of Health Services, National Toxicology Program, Tobacco related exposures. Retrieved June 1, 2010, from U.S. Census Bureau (2000), CenStats Databases. Retrieved May 12, 2010, from U.S. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Washington, D.C.: US Government Printing Office, U.S. Department of Health and Human Services: Centers for Disease Control and Prevention. Clean indoor air regulations fact sheet. Retrieved June 1, 2010, from U.S. Surgeon General s Report. The health consequences of involuntary exposure to tobacco smoke. Smoking & Tobacco Use, Retrieved June 1, 2010, from

14 Mendocino County Smoke Free Casinos Final Evaluation Report Page 14 APPENDICES

15 Mendocino County Smoke Free Casinos Final Evaluation Report Page 15 APPENDIX A PRE-INTERVENTION OBSERVATION / CONTACT SURVEY 1. Casino: Observation Call/Contact 2. Date: 3. Time 6. Date: 7. Time 4. Please identify areas in which smoking, or other indicators of smoking, is observed: Smoking Ashtrays Odor Slot machines Table games Bingo Entertainment Formal dining Informal buffet Entrance to casino Employee lounge Administrative offices Security area Other 5. Are there any apparent smoke-free zones (i.e., no smoking observed, no ashtrays and no odor)? Yes No If yes, please specify: Slot machines Table games Bingo Entertainment Dining and buffet Entrance to casino Employee lounge Administrative offices Security area Other 8. Person Contacted: 9. Phone Number: 10. Title: 11. Does the casino have a written policy regarding cigarette smoking? Yes No 12. What is the casino s policy about cigarette smoking? a. The whole casino is smoke free. b. There is a smoke-free section at the casino. c. There are multiple smoke-free sections at the casino. d. There is one night when the casino is smoke free. e. There are multiple nights when the casino is smoke free. f. There are no smoke-free zones in the casino; smoking is allowed in all areas. g. Other 13. Comments:

16 Mendocino County Smoke Free Casinos Final Evaluation Report Page 16 APPENDIX B PRE-INTERVENTION CASINO PATRON SURVEY 1. Which casino do you like to visit? Please pick all that apply. Red Fox Casino (Laytonville) Coyote Valley Casino (Redwood Valley) Sherwood Valley Casino (Willits) Hidden Oaks Casino (Covelo) Shodakai Casino (Hopland) 2. How often do you visit a casino in Mendocino County? Please pick one. 1 time a week 3-4 times a month 1-2 times a month Once a month Every other month 1-4 times a year 3. What is the one, main reason that you go to a casino? Slot machines Table games Bingo Entertainment Dancing Dining and buffet Other. 4. Do you know if the casino you visit allows smoking on the premises? Yes No 5. Which of the following statements would you support? Choose all that apply. a. The whole casino should be smoke free. b. There should be a smoke-free section at the casino. c. There should be one night when the casino is smoke free. d. Other. 6. Would you be willing to come to a casino during smoke-free nights? Yes No 7. Do you smoke cigarettes? Yes No 8. Does your spouse or partner smoke cigarettes? Yes No The following questions are optional. You do not have to answer them if you prefer not to. 9. Gender? Male Female 10. Age? Race? African American Asian/Pacific Islander Hispanic Native American White/Non-Hispanic Other Thank you for taking the time to share your opinions! For Office Use Only 12. Date: 13. Event/Location:

17 Mendocino County Smoke Free Casinos Final Evaluation Report Page 17 APPENDIX C PRE-INTERVENTION KEY INFORMANT INTERVIEW Date of Interview: Key Informant Name: Key Informant Organization: Phone: Interview Start Time: Interview Conducted: In Person By Phone Position/Title: Months/Years with Org.: Duration of Interview: 1. Can you tell me a little about your roles and responsibilities within the casino? 2. Regarding the casino administration priorities, where does the issue of secondhand smoke exposure for casino patrons and staff fall? 3. What is the process for getting the casino administration to consider an issue or create a policy? [Possible probe: Who controls it? Is there one person that is the key or a number of people that have to be involved?] 4. Recent studies have documented the harmful effects that exposure to secondhand smoke has on health. In casinos, secondhand smoke can drift from one section to the next through doors, windows, and even air vents. How informed do you think the casino administration is about the problem of drifting secondhand smoke in casinos? [Possible probe: What leads you to that perception?] 5. Who among the casino administration might be likely supporters or champions of efforts to pass a smoke-free casino policy? Who among the casino administration would most likely oppose such efforts? 6. If it is not apparent, ask: Would you support the adoption of any kind of a policy that regulates smoking in casinos? [Possible probe: if yes, what type of policy e.g., completely smoke free, smoke-free night, smoke-free events, etc.] 7. If the informant is not initially supportive of any such policies, ask: Are there any conditions under which you would support a policy to regulate smoking in casinos? 8. Can you suggest other Casino administration or staff members that are likely to be influential on this issue that we should talk to? [Possible probe: Who might have a different viewpoint?] 9. Is there anything else that you would like to add?