Asian Coalition for Tobacco Use Prevention (ACT-UP) Final Evaluation Report

Transcription

1 Asian Coalition for Tobacco Use Prevention (ACT-UP) Final Evaluation Report Sacramento County Menalin Ganal, Project Director Sacramento Chinese Community Service Center, Inc. 420 I Street, Suite 5 Sacramento, CA Phone: (916) Fax: (916) Report Author: Allison Burke, Evaluation Project Manager LPC Consulting Associates, Inc J Street, Suite 205 Sacramento, CA (916) Report Submitted: June 30, 2008 TCP Contract Number /01/05 06/30/08

2 Made possible by funds received from the California Department of Public Health, Tobacco Control Program under contract number , contract term: 10/01/05 06/30/08 Suggested citation: LPC Consulting Associates, Inc Asian Coalition for Tobacco Use Prevention Final Evaluation Report. California: Asian Coalition for Tobacco Use Prevention (ACT-UP) Project, Sacramento Chinese Community Service Center.

3 Table of Contents Abstract... i Section 1 Project Description Background Objective Intervention Activities... 2 Section 2 Evaluation Methods Evaluation Design Sampling and Data Collection Procedures Data Analysis... 6 Section 3 Evaluation Results Outcome Data Results Process Data Results Public Intercept Survey Findings Youth Focus Group Findings Staff Focus Group Findings Key Informant Interview Findings Section 4 Conclusions and Recommendations ATTACHMENTS... 33

4 Table of Figures Table 1 Smoke-Free Policy Adoption by Event... 7 Table 2 Observation Details by Event... 8 Table 3 People Smoking... 9 Table 4 Cigarette Litter Figure 1 Average Number of Litter Observed Table 5 Public Intercept Survey Details by Event Figure 2 Likelihood of Attending an API Event with a Smoke-Free Policy Figure 3 Is Smoking an Issue in the API Community? Figure 4 Would the API Community Benefit from Non-Smoking Policy?... 16

5 Abstract In 2006, the Sacramento Chinese Community Service Center, Inc. (SCCSC) identified the Asian and Pacific Islander (API) community as a population requiring attention and education in reducing exposure to second-hand smoke. It was determined that within this community, smoking norms have generally remained unaltered because no effective approaches to the issue have been undertaken in Sacramento County. Specifically, public awareness regarding smoke-free policy at outdoor events is very low in the API community due to a lack of culturally and linguistically appropriate education. In order to address this issue, the SCCSC obtained funding from the Tobacco Control Program (TCP) of the California Department of Health Services to conduct the Asian Coalition for Tobacco Use Prevention (ACT-UP) Project. Objective The primary objective of the ACT-UP Project is: By June 30, 2008, a minimum of five (5) Asian Pacific Islander outdoor health, cultural and faith-based events such as the Pacific Rim Festival, Mana Health and Cultural Fair, Philippine National Day, Mien New Year, Hmong New Year, and Chinese New Year in Sacramento County will adopt and implement a smoke-free policy that designates a portion or all of the outdoor event as smoke-free. This objective addresses CX indicators # the extent to which outdoor recreational facilities, areas and events have policies designating a portion or all the area or event as smoke-free, and # the extent that faith community organizations designate their events and grounds as smoke-free. The ACT-UP Project worked with organizers of Asian Pacific Islander (API) outdoor community events in Sacramento County to encourage the adoption and implementation of smoke-free policy in order to meet the objective. Intervention Activities The intervention activities of the ACT-UP Project centered around four groups: (1) outdoor event organizers and planning groups; (2) API general public; (3) communitybased organizations; and (4) youth. The major intervention activities included: Scheduling and conducting educational presentations to community event organizers and planning groups to encourage smoke-free policy adoption and implementation; Scheduling and conducting presentations to community-based organizations to increase the awareness of second-hand smoke issues and raise awareness and support for smoke-free policy at outdoor events; Recruiting a coalition of youth volunteers to: (1) develop and perform an antitobacco skit; (2) assist in implementing smoke-free policy; (3) conduct public LPC Consulting Associates, Inc. i

6 intercept surveys and observation; and (4) paint anti-tobacco murals, postcards, and posters to display at outdoor community events; Developing media materials such as public service announcements, print ads, and postcards and distributing the materials to API media outlets and the general public; and Attending outdoor events to distribute promotional items and educated the API community about second-hand smoke and the benefits of smoke-free policy. Evaluation Methods The evaluation of ACT-UP was based on the collection and analysis of qualitative and quantitative data to determine the API public s opinion of smoking and smoke-free policy, the effectiveness of smoke-free policies at outdoor events, and the challenges and barriers of smoke-free policy adoption and implementation. The evaluation design of the ACT-UP Project was quasi-experimental, as a comparison was made between events implementing a smoke-free policy and a control group of events not implementing a smoke free-policy. Data collected with an observation checklist completed at outdoor events by youth volunteers served as a measure of policy implementation outcomes. Process data was collected through a public intercept survey of event attendees which was also conducted by youth volunteers. The youth received data collection tool training semi-annually to ensure uniform and accurate data collection. In addition, the evaluator conducted staff and youth focus groups and key informant interviews with event planners to determine the successes and challenges of the intervention activities. The findings presented in the final evaluation report are the result of the cumulative content analysis and qualitative data analysis conducted by the evaluator. Conclusions By implementing the intervention activities, the ACT-UP Project did not achieve its objective by June 30, The evaluation results indicate that four instead of five API outdoor events adopted and implemented a full or partial smoke-free policy. However, public intercept survey responses show that the API community is generally in support of smoke-free policy at outdoor events. Over 90 percent believe the API community would benefit from smoke-free policies of this nature, and 73 percent would be more likely to attend an event with a smoke-free policy. In addition, the ACT-UP intervention activities were valuable learning experiences for staff and youth volunteers. Attending the outdoor events provided opportunities for youth to develop and expand teamwork and communication skills. The project empowered youth to become involved in community education and change and also provided an opportunity to build leadership and teamwork skills in the process. Through community presentations and event interactions, project staff and youth volunteers effectively engaged API decision-makers and the public to inform and educate about second-hand smoke and non-smoking policy. It was clear that staff and youth volunteer participation were critical factors in the successes accomplished by the ACT-UP Project. LPC Consulting Associates, Inc. ii

7 Section 1 Project Description 1.1 Background Sacramento County, located in the central valley of California State, has a culturally and ethnically diverse population. The Asian/Pacific Islander community represents a large portion (13%) of the population residing in the County. As identified by a Community Planning Group convened by the Sacramento Chinese Community Service Center, there are very few smoke-free public outdoor events within the Asian/Pacific Islander (API) community. Furthermore, public awareness regarding second-hand smoke and smoke-free policy at outdoor events is very low in the API community due to a lack of culturally and linguistically appropriate education. Using API outdoor community events to address this gap in education and policy within the API community can lead to great strides in tobacco prevention. In order to reduce exposure to second-hand smoke at API outdoor events, in mid-2006 the Sacramento Chinese Community Service Center (SCCSC) obtained funding from the Tobacco Control Program (TCP) of the California Department of Heath Services to undertake the Asian Coalition for Tobacco Use Prevention (ACT-UP) Project. 1.2 Objective The primary objective of this project is: By June 30, 2008, a minimum of five (5) Asian Pacific Islander outdoor health, cultural and faith-based events such as the Pacific Rim Festival, Mana Health and Cultural Fair, Philippine National Day, Mien New Year, Hmong New Year, and Chinese New Year in Sacramento County will adopt and implement a smoke-free policy that designates a portion or all of the outdoor event as smoke-free. This objective was chosen by the Sacramento Chinese Community Service Center based on data gathered by their Community Planning Group. According to the Community Planning Group for the Asian Coalition for Tobacco Use Prevention (ACT- UP), smoking norms within Sacramento s API population have remained largely unaltered because no effective approaches to the issue have been undertaken. Because outdoor events such as health fairs, faith-based events, and festivals are venues that individuals of all ages gather, these events provide a significant opportunity to educate event planners and the public about the detrimental health effects of tobacco use and second-hand smoke, as well as the benefits of smoke-free policy. In addition to encouraging smoke-free policy in Sacramento County, the ACT-UP Project aims to raise API public awareness about smoking issues and involve youth to empower community members to take an active role in the anti-tobacco movement and further promote smoke-free policy in order to reduce second-hand smoke. SCCSC partnered with Asian Pacific Community Counseling (APCC) to recruit youth volunteers LPC Consulting Associates, Inc. 1

8 who then had the opportunity to attend outdoor events with project staff, interact with and educate the public, and collect data for the evaluation study. 1.3 Intervention Activities In order to achieve the policy objective, the ACT-UP Project implemented a number of intervention activities in Sacramento County. The intervention activities were aimed at several distinct groups within the API community: (1) outdoor event organizers and planning groups; (2) API general public; (3) community-based organizations; and (4) youth. At the onset of the project, staff compiled a database of Asian and/or Pacific Islander events in order to track smoking policy information. From that list, project staff identified outdoor events to target for the intervention activities. Below is a brief description of the main intervention activities focused on the target groups: Activities focused on event organizers and planning groups included: Scheduling and conducting educational presentations to event planning groups regarding the harmful effects of second-hand smoke and the benefits of adopting a smoke-free policy at outdoor events; and Providing technical assistance to support the four events that chose to adopt a smoke-free policy, including providing and posting no-smoking signage and media advertisements. Activities focused on the general public included: Performing an anti-tobacco skit at the outdoor events; Surveying event-goers and taking opportunities to educate them about secondhand smoke; Creating print, radio, and television public service announcements in API languages to be used by events who adopted a smoke-free policy; and Distributing educational materials and promotional items at outdoor events in order to increase public awareness of the ACT-UP Project and its objective. Activities focused on community-based organizations included: Scheduling and conducting educational presentations to faith-based and community-based organizations regarding the harmful effects of second-hand smoke in order to garner support for smoke-free policy adoption. Activities focused on youth included: Recruiting a coalition of youth volunteers to participate in the ACT-UP Project activities; Developing, rehearsing, and performing an anti-tobacco skit at outdoor events; Painting anti-tobacco murals displayed at outdoor events; LPC Consulting Associates, Inc. 2

9 Developing anti-tobacco posters and postcards and distributing them at outdoor events; Conducting tobacco education presentations to local elementary and high schools regarding the risks of second-hand smoke and highlighting the ACT-UP policy objective; and Interacting with the public at outdoor events to develop advocacy skills and elicit support for smoke-free policy. LPC Consulting Associates, Inc. 3

10 Section 2 Evaluation Methods The Sacramento Chinese Community Service Center contracted with LPC Consulting Associates, Inc. to conduct an evaluation study of the ACT-UP Project. The purpose of the evaluation is to track the process of and success rate of non-smoking policy adoption and implementation at API outdoor events. The evaluation study identifies process and outcome measures and provides both quantitative and qualitative documentation to indicate data for assessing the effectiveness of smoke-free policies at API outdoor events. The evaluation seeks to gather information about API public opinion on smoking-related issues, as well as feedback from the youth volunteers and staff to inform the project of the successes and challenges of implementing smoke-free policies at community outdoor events. This report presents the results of the evaluation study and offers recommendations based on the findings and lessons learned. 2.1 Evaluation Design The evaluation of the ACT-UP Project incorporated several components, including the collection of process and outcome data. The evaluation design was quasiexperimental, as a group of events not implementing a smoke-free policy was used to compare results with events implementing a smoke-free policy. This evaluation design was selected in order to measure the incidence and prevalence of cigarette litter, people smoking, no-smoking signage, and anti-tobacco paraphernalia at events with a smokefree policy as opposed to events with no smoke-free policy. Outcome data for the evaluation was collected via an observation checklist form completed by youth volunteers at eight API outdoor events. Youth conducted an average of four observations per event and data was collected uniformly across events. Of these eight events, three were in the policy group (implemented a policy) and five were in the comparison group (did not implement a policy). A limitation to the outcome evaluation design to assess the policy objective was that observation checklists were not completed at all of the events implementing a smoke-free policy. Therefore, the analysis of outcome data includes only a partial sample of events that implemented a smoke-free policy. 2.2 Sampling and Data Collection Procedures Public Intercept Survey In order to gather qualitative and quantitative data about the API community s awareness of and attitude towards smoking and smoke-free policy at outdoor events, the ACT-UP Project administered a public intercept survey. The survey was developed by evaluation staff in collaboration with project staff. ACT-UP youth volunteers administered a total of 730 surveys during the outdoor events using a convenience sample of event participants who were members of the API community. The survey topics included: opinion about smoking as an issue in the API community, attitude LPC Consulting Associates, Inc. 4

11 toward smoke-free policy at outdoor events, and support for smoke-free policy in the API community. Before youth attended events, and semiannually thereafter, the evaluator trained the volunteers on how to correctly and accurately administer the public intercept survey. The training included verbal instruction on data collection terminology and uniform interviewing skills, as well interactive instruction via survey role-plays and feedback from the trainer. Observation Checklist As mentioned above in the Evaluation Design section of this report, an observation checklist was developed by the evaluator to gather outcome data on the implementation of smoke-free policy. Youth volunteers completed at least one observation checklist at eight of the ten events attended by ACT-UP. Youth completed the data collection individually and in pairs. The purpose of the observation checklist was to document the incidence and prevalence of smoking-related information such as cigarette liter, nonsmoking signage, and the number of people smoking at the event in order to determine policy implementation or non-implementation. The youth completed a total of 32 observation checklists. Semiannually, youth were trained by the evaluator on how to correctly and accurately complete the observation checklist tool. The trainings included verbal instruction on data collection terminology and uniform data collection procedures, as well as visual instruction on how to identify the elements of the observation checklist from. Staff Focus Group The evaluator conducted an annual focus group with three project staff from Sacramento Chinese Community Service Center and Asian Pacific Community Counseling. In addition, evaluation staff interviewed the Project Director on an annual basis using the staff focus group questions. The focus group questionnaire developed by the evaluator included the following topics of discussion: the intervention activity process, project successes, project challenges, and what was learned about adopting and implementing smoke-free policy at outdoor events. The qualitative data from staff responses provided insight to document the intervention activities undertaken, identify and describe lessons learned, and to establish recommendations for project improvement and replication. Youth Volunteer Focus Group The evaluator conducted an annual focus group with ACT-UP youth volunteers from Asian Pacific Community Counseling. Ten youth participated in the first year s focus group, while fourteen participated in the final focus group. All of the youth participating in the focus group were high school age, ranging from 9 th to 11 th grade. The discussion topics included: involvement in the project, attitude toward smoking and smoke-free policy, and feedback about the volunteer experience. The qualitative data from youth LPC Consulting Associates, Inc. 5

12 responses provided insight to determine the impact of the ACT-UP Project on the youth and document their role in the project activities. Key Informant Interviews To collect qualitative data regarding the smoke-free adoption and implementation process, the evaluator conducted key informant interviews with a sample of event planners approached by ACT-UP staff about policy adoption. A key informant interview questionnaire developed by the evaluator was used to conduct the interviews. In total, five key informants agreed to be interviewed during the last year of the project. Four of the key informants were representatives from organizations which adopted and implemented a smoke-free policy at their event. One interview was with a key informant whose event declined to adopt a policy. The purpose of the key informant interviews was to determine the successes and challenges of smoke-free policy adoption and implementation from an event planner perspective. The interviews also collected data regarding planners recommendations and suggestions to improve or enhance the ACT- UP Project in achieving the policy objective. 2.3 Data Analysis Different methods of analysis were performed according to the type of data that was analyzed. The evaluator performed content analysis to determine the findings of the qualitative data collected during the evaluation of ACT-UP. Data from the staff focus group and data from the Project Director interview was analyzed together to surface common themes and identify overarching lessons learned. Youth focus group data and key informant interview data was also analyzed in this manner. From the analysis of the focus groups and interviews, the evaluator generated recommendations for intervention activity improvement. Analysis of the quantitative data collected during the ACT-UP Project consisted of using average and percentage calculations to determine the results of the public intercept survey and observation checklist. Survey responses were calculated in percentages to show the public s relative support and attitude towards smoking in the API community and smoke-free policy. The qualitative question responses in the survey were analyzed for content in the same manner described in the above paragraph. Similarly, the results of the observation checklist were analyzed by calculating the average number of each observed activity at each event. Then, the relevant findings from the events implementing smoke-free policy were compared to the findings of the events not implementing a smoke-free policy. All data was averaged to ensure an equal comparison across the treatment and control groups. LPC Consulting Associates, Inc. 6

13 Section 3 Evaluation Results 3.1 Outcome Data Results Between October 2006 and June 2008, ACT-UP staff and volunteers attended ten API outdoor events in Sacramento County. Of these ten events, project staff met with six event organizations to elicit support for smoke-free policy adoption, and out of these six events, four elected to adopt and implement a smoke-free policy, as shown in Table 1 below. Although four events adopted a smoke-free policy, the policies differed by event. Two of the events, the Fortune Festival and Hmong Family Fun Day, chose to adopt a full smoke-free policy that designated their entire event as smoke-free on a continuous basis. The two other events, Filipino Fiesta and Vietnamese New Year, opted for a one-year smoke-free policy with designated smoking areas on the event premises. In return, the events that opted to elect a partial smoke-free policy received a partial stipend of $500.00, while those adopting a full policy received the full stipend amount of $1, Table 1 Smoke-Free Policy Adoption by Event Adopted Duration of Event Name Smoke-Free Policy Type of Policy Policy Chinatown Mall Street Fair Festival 2007 No None None Filipino Fiesta 2007 No None None Filipino Fiesta 2008 Yes Designated areas One year Fortune Festival 2007 No None None Fortune Festival 2008 Yes Full Continuous Hmong Family Fun Day 2007 Yes Full Continuous Pacific Rim Festival 2007 No None None Pacific Rim Festival 2008 No None None Vietnamese New Year 2007 No None None Vietnamese New Year 2008 Yes Designated areas One year Total 4 2 partial policies, 2 full policies 2 one year, 2 continuous In order to document the implementation of smoke-free policy at the API outdoor events and to determine the different outcomes of the smoke-free events compared to the non smoke-free events, youth volunteers completed observation checklists at eight of the ten events attended by ACT-UP. The observation checklist was used to record the presence or absence of smoking-related activities and information, such as signage, cigarette litter, and people smoking. Altogether, 47 youth completed 32 observation checklists, representing over six hours (372 minutes) of observation time, as shown in LPC Consulting Associates, Inc. 7

14 Table 2. For several observations, youth worked in teams of two or more to complete the observation checklist. On average, each youth (or group of youth) spent 12 minutes per observation. The following table describes the number of observers and number of observation minutes spent at each event. Table 2 Observation Details by Event Number of Number of Total minutes of Event Name observers observations observation Chinatown Mall Street Fair Festival Filipino Fiesta Fortune Festival Fortune Festival 2008* Hmong Family Fun Day 2007* Pacific Rim Festival Vietnamese New Year Vietnamese New Year 2008* Total minutes * implemented smoke-free policy According to the observation data, smoking at the eight API outdoor events was somewhat prevalent. At all but one event, at least one observer saw a minimum of one event participant smoking. In total, 52 people were observed smoking during the 372 minutes of observation time. On average, 47 percent of the observations indicated that there was smoking on event premises. However, at the events that adopted and implemented a smoke-free policy the percent of observers who witnessed people smoking was below the average. At Hmong Family Fun Day, zero percent of the observations reported smoking, at the 2008 Fortune Festival only 33 percent reported smoking, and at the 2008 Vietnamese New Year 40 percent reported smoking. Table 3 below details the number of people who were observed smoking during the events. LPC Consulting Associates, Inc. 8

15 Table 3 People Smoking Event Name Number of people observed smoking Percent of observations recording at least one person smoking Chinatown Mall Street Fair Festival % Filipino Fiesta % Fortune Festival % Fortune Festival 2008* 1 33% Hmong Family Fun Day 2007* 0 0% Pacific Rim Festival % Vietnamese New Year % Vietnamese New Year 2008* 12 40% Total 52 47% average * implemented smoke-free policy Youth volunteers also recorded the number of cigarette litter, including butts, wrappers, and matches observed at each event. Out of 32 observations completed, only one event (Hmong Family Fun Day) reported no cigarette litter on the ground. The observations at the remaining events reported a combined total of 1045 pieces of cigarette-related litter. The Pacific Rim Festival had the majority (699 pieces) of debris, as shown in Table 4. The significant amount of cigarette litter observed at the events indicates that many more event participants were smoking than merely those seen by the observers. All three of the events that implemented a smoke-free policy had a well below average number of pieces of litter observed. As mentioned before, there was no litter observed at Hmong Family Fun Day, the 2008 Fortune Festival had an average of two pieces of litter, and the 2008 Vietnamese New Year averaged 12 pieces of litter per observation. This data indicates that, on average, there was less cigarette-related litter at events that adopted and implemented a smoke-free policy. These results can play an important role in advocating for smoke-free policy at outdoor events. The lower incidence and prevalence of cigarette litter as well as people smoking at events may be used in future discussions with event planners as an incentive, or selling point, for them to adopt non-smoking policies. LPC Consulting Associates, Inc. 9

16 Table 4 Cigarette Litter Event Name Total pieces of litter observed Average pieces of litter observed Percent of observations that reported cigarette litter Chinatown Mall Street Fair Festival % Filipino Fiesta % Fortune Festival % Fortune Festival 2008* % Hmong Family Fun Day 2007* 0 0 0% Pacific Rim Festival % Vietnamese New Year % Vietnamese New Year 2008* % Total % * implemented smoke-free policy Figure 2 further illustrates the difference in the pieces of cigarette litter observed at smoke-free events compared to non-smoke-free events. As shown, the average number of pieces of litter at events that did adopt a policy was less than half that of the events that did not adopt a policy, 13 pieces compared to 33 pieces. The reduction of cigarette litter reiterates the benefit of smoke-free policy at outdoor events. Figure 1 Average Number of Litter Observed Average Number of Litter Observed Did Not Adopt Policy 33 Did Adopt Policy Number of Pieces of Litter Based on the observation results, the incidence and prevalence of litter and people smoking was the most compelling smoking-related outcome data collected. However, LPC Consulting Associates, Inc. 10

17 policy-related activities were also documented during observation of the events. Youth volunteers used the Observation Checklist to record the number of non-smoking signs, non-smoking announcements, verbal policy enforcement interactions, and non-smoking promotional items at each event. At the events implementing smoke-free policy, every observation team (13) except one witnessed non-smoking signage. In total, volunteers saw 189 signs at five of the eight events observed. Observers reported that a variety of non-smoking signs were posted in various locations at the events. Signs were generally mounted on poles, outdoor walls, and on booths and included small posters and banners. The largest number (128) of signs reported was at the 2008 Vietnamese New Year, while interestingly, the event with the second largest number of signs was the Chinatown Mall Street Fair Festival which did not adopt a smoke-free policy. According to project staff, although this event chose not adopt a policy, the organizers allowed ACT-UP to post nonsmoking signs on the premises. In regards to non-smoking announcements and verbal enforcement interactions, there was little difference observed between events implementing a policy and those not implementing a policy. Of the 32 observations conducted at the eight events, only one observer documented a non-smoking announcement at Hmong Family Fun Day. Similarly, only five verbal interactions between event staff and/or event participants were witnessed during two events, Hmong Family Fun Day and the 2008 Vietnamese New Year. Although the number of verbal interactions and announcements was low according to the observation data, from key informant interviews it is apparent that a greater number of announcements and interactions did occur during the smoke-free events. This demonstrates a limitation of the observation checklist as a data collection tool used to measure policy implementation. Naturally, because observation did not take place at all times for the entire duration of each event, it is assumed that the observers could not have witnessed every instance of activity during the events. Observations of non-smoking promotional items occurred at four of the events attended. Observers documented a total of 117 pieces of paraphernalia and 113 pieced of nonsmoking literature possessed by event-goers. The greatest number of promotional items was witnessed at the 2007 Fortune Festival and no significant difference was observed between the number of items at smoke-free events compared to non smokefree events. By comparing the observational data gathered from events implementing smoke-free policy to the data gathered from the comparison group, the evaluation study sought to document and describe the number of events that effectively implemented the policy. This comparison illustrates the differences between events implementing smoke-free policy and events not implementing smoke-free policy on a number of factors. Results indicate that as a whole, the events that implemented smoke-free policy averaged less pieces of cigarette litter and less people smoking on the premises than the comparison group. LPC Consulting Associates, Inc. 11

18 3.2 Process Data Results The process data collected for the evaluation consisted of the public intercept survey, staff and youth focus groups, and key informant interviews. The results of each evaluation activity are detailed in the following section and indicate that although there is significant public support for smoke-free policy at outdoor events in the API community, there are still several challenges and barriers in eliciting the support of event planners to adopt and implement smoke-free policy Public Intercept Survey Findings At each of the ten events attended by ACT-UP, youth volunteers administered public intercept surveys to event participants in order to gather qualitative and quantitative data about the API community s awareness of and attitude towards smoking and smoke-free policy. In total, 52 individual youth volunteers interviewed 730 event participants about smoking and policy-related issues. Of the 730 respondents, 639 were members of the API community and 91 were not. Table 1 below shows the number of surveys conducted at each event Table 5 Public Intercept Survey Details by Event Number of Surveys Event Name Conducted Chinatown Mall Street Fair Festival Filipino Fiesta Filipino Fiesta Fortune Festival Fortune Festival Hmong Family Fun Day Pacific Rim Festival Pacific Rim Festival Vietnamese New Year Vietnamese New Year Total 730 Four out of the ten events at which the public was surveyed implemented a smoke-free policy. At these four events, 40 percent (288) of respondents reported that they were aware of a non-smoking policy. However, out of the 288 respondents, only 13 percent were able to describe the policy, 25 of whom reported that there was no smoking allowed anywhere, eight who indicated there was no smoking in designated areas, and four who believed there was no smoking allowed around children. LPC Consulting Associates, Inc. 12

19 Based on the public intercept survey results, an overwhelming majority of people support smoke-free policy at API events. Over 90 percent of survey respondents agreed with having smoke-free policy, using words, like excellent, wonderful, and fantastic to describe their opinion about smoke-free outdoor events. Others reported they loved the idea and one respondent even said it sounded like the best idea I ve ever heard. Many identified their own health and children s health as reasons why they felt positively about a smoke-free policy at a public event. However, some people felt that smoke-free policy was not realistic and would not be effective outdoors because of enforcement issues. A small number of respondents did not support smoke-free policy because they believed that banning smoking restricted people from exercising free will and infringed on personal rights. Despite doubts about the feasibility of implementing a smoke-free policy, 73 percent of respondents said they would be more likely to attend an API event if the event had a smoke-free policy. Only 7 percent reported they would be less likely to attend, while 19 percent said they were either unsure or that it did not matter, as shown in Figure 1 below. Figure 2 Likelihood of Attending an API Event with a Smoke-Free Policy Likelihood of Attending an Event with a Smoke-Free policy (n=723) Doesn't matter 16% Unsure 3% More likely 73% Less likely 7% Among those who reported they would be more likely to attend an API outdoor event if it had a smoke-free policy, most explained that it was because they wished to avoid exposure to second-hand smoke for a number of reasons. Some of the most common examples reasons why respondents were more likely to attend a smoke-free event were: I don t want to smell it. Cleaner air. It saves people s lives. LPC Consulting Associates, Inc. 13

20 More comfortable environment. Safe place for children. Friendlier and healthier. Good for the community. You can breathe easier and its family friendly. I don t smoke and it offends me. It s better health-wise. Smoke is harmful and bad for the environment. Those who said that they were unsure, it did not matter, or they would be less likely to attend, cited it was because smoke-free policy doesn t make a big difference and it would never stop the smoking even if implemented. Some respondents acknowledged that time and expenses associated with implementing and enforcing smoke-free policy would outweigh any of its benefits. Others believed that event attendance would suffer because smokers would be less likely to participate. When asked about the API community as a whole, 91 percent of event participants agreed that the API community would benefit from stronger non-smoking policies at API events, while somewhat fewer (83 percent) interviewees believed smoking was an issue in the API community, as shown in Figures 3 and 4 below. Figure 3 Is Smoking an Issue in the API Community? Is Smoking an Issue in the API Community? (n=692) No 17% Yes 83% Participants reported a host of reasons why they believed smoking was an issue in the API community, the most common of which were: the high prevalence of smoking, the lack of education about smoking, and the cultural norms surrounding smoking. Although some respondents acknowledged that smoking is an issue that affects all ethnic communities, many indicated that smoking is especially an issue in the API community because of the high smoking rate. Event-goers felt there were too many LPC Consulting Associates, Inc. 14

21 smokers in the API community and several interviewees went as far as too say that most Asians smoke. One participant reported: Over half of my friends smoke. Many survey respondents singled out subgroups within the API community that had particularly high smoking rates. Specifically, the public mentioned smoking issues among youth, elders, men, and recent immigrants. Some respondents indicated that the younger generation had the greatest issue with smoking because they perceive cigarette smoking as cool and youth tend to not worry about how smoking affects others around them. Several respondents said they witness younger kids in their midteens smoking and that youth account for a large portion of API smokers. According to others, smoking is an issue in the API community because a high number of elders, specifically men, smoke. Respondents indicated that a lot of old Asians smoke and it is mostly men. People attributed this to the smoking norms present among the older generation and that smoking habits have been engrained in this segment of the community for many years. In addition to the older and younger generation of API smokers, some interviewees reported that smoking was an issue among recent API immigrants to the United States. This population, according to respondents, may not be sufficiently educated on the health facts of smoking and therefore don t know better. Survey respondents expressed concern that the API community isn t educated about tobacco and not everyone knows the dangers. There are still myths surrounding the health effects of tobacco, especially in the Asian community and many Asians that smoke are not educated on the hazards. Tobacco use will persist and even increase in a community when education is lacking because it can breed misinformation about the effects of the substance. These results show there is a great need for more education in the API community. To better understand the motivation for smoking in the API community, some of the respondents reported that smoking is a cultural habit. One participant shared that many people from the culture are smoking because it is part of the culture. The stigma associated with smoking is lessened in the API community because so many members of the community do smoke and therefore smoking becomes more acceptable or possibly, in some instances, encouraged. This is one reason that people are still doing it even though it is harmful, according to one survey respondent. It was apparent from the public s responses that they were concerned about the high prevalence of smoking in the API community, whether it be among the older or younger generations, or among recent immigrants, because it affects the health of not only the smoker but also negatively affects everyone around. Event participants acknowledged that health concerns were very serious and that smoking was an issue that needed to be addressed because people are dying. Although 83 percent of survey respondents said smoking is an issue in the API community, a higher percentage (91%) indicated that the community would benefit from LPC Consulting Associates, Inc. 15

22 stronger non-smoking policies at API events, as shown in Figure 4. Respondents believed smoke-free policy would benefit the API community by heightening community awareness, encouraging people to be healthy, and setting a good example for API youth and future generations. By adopting and implementing smoke-free policies, API outdoor events could raise awareness about smoking in the community and send a clear message to show that smoking is harmful. Figure 4 Would the API Community Benefit from Non-Smoking Policy? Would the API Community Benefit from Stronger Non-Smoking Policy? (n=711) No 9% Yes 91% Many event participants responded that smoke-free policies would benefit the community by promoting a healthy atmosphere not only at the events, but in the entire API community. Respondents stated that there would be less sick people and therefore a healthier community. Smoke-free policy, according to many respondents, would promote healthier attitudes in the population, and also improve the health of the environment by preventing litter and pollution from second-hand smoke. Overall, participants felt non-smoking policy would benefit the API community because people will have less health problems and it would ultimately save lives. Interviewees also believed smoke-free policy would prevent smoking among the younger generations in the API community by sending a positive message to children in support of tobacco awareness. They believed that it would set a good example and prevent kids from smoking if there were tobacco-free policies in place. However, many agreed that in order to be effective, the policies must be strictly enforced. By serving as a role model and sending the message that smoking is harmful, nonsmoking policy would be good for the kids and would ultimately better generations to come. In addition to tobacco prevention, respondents indicated that smoke free policy would support tobacco intervention and even cessation. Many believed that banning smoking LPC Consulting Associates, Inc. 16

23 at outdoor events would force people to stop smoking. One event-goer felt that people would not quit until under pressure and smoke-free policy would provide that added pressure to encourage cessation. In effect, more and more people would be in favor of no-smoking policies because there would be less smokers. Lastly, some respondents believed that implementing smoke-free policy would increase outdoor event attendance because people would enjoy the event more if it had smokefree policy. Also, families with small children would be more inclined to attend a smokefree event, and therefore more kids will show up. Respondents felt that by enforcing smoke-free policy, outdoor events could increase attendance and reach a greater number, and a broader range, of people in the API community. A portion of survey respondents suggested specific policies and proposed solutions to the non-smoking policy issue. Several respondents felt that an absolutely smoke-free policy would be best, while others favored designated smoking areas, stating there should be a designated area for smokers or an area away from the kids. One respondent suggested having smoking areas so you do not discourage smokers from coming to the event. Additional respondents said everyone has a right to do what they want, they just need a spot, specifying that they should have one [designated smoking area] at least 20 feet away from people. Those that reported the API community would not benefit from stronger non-smoking policy at events said it would limit people s rights, be ineffective, and stop people from coming. According to 9 percent of respondents it is a free country and therefore, it s your own choice to smoke. Policy of this nature at outdoor events gives less opportunities for people to make their own decisions, said some respondents, It s an open space, so it shouldn t affect anyone. Others reported that event participants who smoke are going to smoke anyways and a smoke-free policy would merely stop people from coming. As detailed in the paragraph above, the notion that it is one s right and freedom to smoke was a common feeling in public opinion about smoke-free policy both by those who supported it and those against it. Individuals who agreed there should be smokefree policy also said, but it is outdoors and it should be a free country. Some said that smoke-free policy was good, but still people have some rights. Other respondents stated they were opposed to smoke-free policy altogether because it s the public s choice and it is like taking away people s freedom. While the survey results illuminated the understanding of smoking knowledge, attitudes, and behavior among a sampling of members of the API community, and support for smoke-free event policies, there was some skepticism about policy impact or effectiveness, and some outright opposition. These findings indicate that additional education about the health impacts of second-hand smoke in the API community would be useful in changing negative perceptions about smoke-free policy. LPC Consulting Associates, Inc. 17

24 3.2.2 Youth Focus Group Findings Involving youth was an integral part of the ACT-UP Project. By utilizing young members of the Sacramento community, the project aimed to empower youth to take an active role in the anti-tobacco movement and further promote smoke-free policy. Because of their unique perspective on the issue, youth were able to reach out to other youth in peer-to-peer communication, and also appeal to the older generations of API members. At the outdoor API events, the volunteers effectively engaged the public in a discourse about smoke-free policy to promote education and awareness of smoke-free policy in the API community. In order to recruit youth to participate in the ACT-UP Project, the Sacramento Chinese Community Service Center (SCCSC) partnered with Asian Pacific Community Counseling (APCC). Approximately 40 youth volunteered for ACT-UP during the course of the project, around half of whom were involved for the full two years of implementation. Initially, youth reported they decided to volunteer because it seemed fun and they were able to meet new people. The youth s role in the ACT-UP Project was to attend the API outdoor events, perform an anti-tobacco skit, post no-smoking signs, interact with event participants, and administer the observation checklist and public intercept survey to collect data at the events. Youth were responsible for creating murals, posters, and postcards as an antitobacco advocacy tool at outdoor events. Youth reported that during the events they also asked people about what they thought about smoking and gave out free stuff, which included anti-tobacco paraphernalia such as yo-yos, calendar posters, and logo items. To document youth involvement in the project, 24 youth participated in two annual focus groups. The focus group participants ranged from 9 th grade to 11 th grade and each had attended at least one outdoor event in association with the ACT-UP Project. During the focus group discussions, all of the youth expressed strong anti-smoking opinions. It was apparent that they had a clear understanding that smoking was detrimental to the health of people and animals, as illustrated by the following quotes: I hate the idea of smoking. Smoking stinks I don t want to be wrinkly. Don t smoke, it will kill you. Every time you smoke, it takes minutes off your life. It s bad for kids to inhale it and it s bad for my dog. In addition, youth agreed that more widespread smoke-free policies are necessary to combat the negative effects of tobacco and second-hand smoke: There should be more smoke-free policy. It should be all over the country. They should ban cigarettes. LPC Consulting Associates, Inc. 18

25 [Smokers] should be made to go somewhere else. It kills humans, the environment, babies, and trees. Several youth reported that their views on smoking and related issues changed due to their participation in the ACT-UP Project. Participants acknowledged that volunteering made their negative views of second-hand smoke more intense and made them more aware of the prevalence of smoking in general. It also educated them about the health consequences of smoking and caused several to begin taking themselves out of situations where smoking was involved. Volunteering for ACT-UP made my view of second-hand smoke worse. It educated me about how bad it actually was. Now, I notice more about smoking at outdoor events. It did change our views because it made us hate [smoking] even more. When asked what they liked best about volunteering for ACT-UP, youth participants agreed that it is fun and it is good for the community. Several youth mentioned they enjoyed meeting a lot of people at the events and making new friends via the project, especially with other youth volunteers. Access to free food was a plus for others. Youth valued what they learned through their experiences with volunteering, as described in the quotes below: I learned about the community and I learned its very fun to help people. The thing I like best is learning leadership skills and learning how to communicate with people. You learn bravery and communication by learning how to approach people. You also learn how to deal with people when they turn you down. I interviewed this one lady and she looked like the type that didn t smoke, but she thought smoking was a good thing. That was weird because she didn t look the type, but it was good that she actually said her opinion. At the event, someone was actually true to what they said. They smoked and they wish they didn t. He was positive and he said he protects his family because he doesn t want to smoke around them. Youth had a more difficult time naming what they liked least about volunteering for ACT- UP. Several reported that the hardest thing about volunteering was the feeling of rejection when individual event-goers declined to participate in the public intercept survey. Others mentioned that hearing people s pro-smoking opinions and being around people that were smoking was what they liked least about the volunteer work. However, in general everyone agreed that their experience with the ACT-UP Project was positive. One youth summed up the feelings of the group by stating: It s perfect how it is. We don t need any changes as long as we have friendly people to work with. LPC Consulting Associates, Inc. 19