CALIFORNIA S CLEAN AIR PROJECT (CCAP) FINAL EVALUATION REPORT

CALIFORNIA S CLEAN AIR PROJECT (CCAP) FINAL EVALUATION REPORT Objective 3: Technical Assistance Related to Tribal Casinos (July 2005 June 2008) Project Director: Narinder Dhaliwal, M.A. 2210 21st Street Sacramento, CA 95818 Phone: (916) 452 8065 Fax: (916) 452 7374 E mail: narinderd@etr.org Website: www.ccap.etr.org Report submitted by: Pamela Drake, Ph.D., Senior Research Associate Seow Ling Ong, M.S.W., Research Associate ETR Associates Date of Submission: June 30, 2008 Made possible by funds under Grant Number 05 45720 with the California Department of Public Health, Tobacco Control Program, contract term: 7/01/05 6/30/08. Recommended citation: Ong, S.L. & Drake, P.M. 2008. California s Clean Air Project Objective 1 Final Evaluation Report. California: California Department of Public Health/ Tobacco Control Program

Table of Contents I. ABSTRACT... 1 II. PROJECT DESCRIPTION... 3 A. BACKGROUND... 3 B. OBJECTIVE AND RATIONALE... 3 i. Objective... 3 ii. Rationale... 3 iii. Intervention Activities... 3 III. EVALUATION METHODS... 5 A. DESIGN... 5 B. SAMPLE... 5 C. DATA COLLECTION INSTRUMENTS AND PROCEDURES... 5 D. DATA ANALYSIS... 6 IV. PROCESS EVALUATION RESULTS... 7 i. Casino policy survey... 7 ii. Technical Assistance... 8 iii. Satisfaction with technical assistance... 9 iv. Casino information packet... 10 v. Casino Advisory Committee... 11 vi. Training Evaluations... 12 vii. Impact of billboards... 13 viii. TSI Side Pak Monitor... 14 V. CONCLUSIONS AND RECOMMENDATIONS... 15 LIST OF CITATIONS... 17 APPENDIX A... 18 APPENDIX B... 20

I. Abstract American Indian gaming facilities i.e. casinos and gaming clubs on tribal land, are controlled by sovereign entities the tribes. Therefore, these sites are not subject to California state law unless the law is included in an agreement known as a Compact between state or local government and the tribe. These sites can also be protected if casino management voluntarily adopts a smoke free policy. The rising demand by patrons for smoke free gaming areas has caused several American Indian casinos to take a leadership role in protecting workers and patrons from secondhand smoke (a Class A Carcinogen ) by designating smoke free gaming areas/rooms. CCAP recognized the need for worker protection in these smoke filled tribal casino workplaces. Currently, tribal casinos are virtually the only unprotected workplaces in California. To this end, an objective was developed to work with TCP funded agencies in making tribal casinos smoke free. The objective was: By June 30, 2008, a minimum of 8 tribal casino/resorts will adopt 100% smoke free gaming area policies. (CX Indicators: 2.2.3) Intervention activities within this objective included 1) Communication via telephone, e mail, phone and in person with 3 5 TCP funded projects to promote activities addressing smoke free tribal casinos, 2) Recruit a 5 8 member Advisory Committee of representatives of TCP funded projects and other interested parties, 3) In collaboration with TCP, place 100+ billboards throughout California in both rural and urban regions, 4) Conduct trainings on smoke free tribal casino issues for all tobacco control funded organizations, TCP and other interested parties, and 5) Provide technical assistance on all secondhand smoke multi unit housing issues to tobacco control funded organizations, TCP, other interested parties and the general public. The evaluation design was a non experimental design to collect rich information on the process of providing technical assistance to stakeholders. The primary data collection methods for the process evaluation included online surveys, a database tracking system, website monitoring, a billboard survey, a focus group, training evaluations, and data from a TSI side pak particle monitor. While CCAP s technical assistance did not result in any of the tribal casinos going entirely smoke free, several notable activities occurred in the course of the grant: CCAP became a member of California Nations Indian Gaming Association (CNIGA) CCAP successfully formed the Tribal Casino Advisory Committee and conducted seven meetings CCAP is currently working extensively with WinRiver Casino in Shasta County and preparing information for the casino management to consider going smoke free Page 1

CCAP has revised and updated several of its fact sheets on working with tribal casinos, based on feedback from the Casino Advisory Committee CCAP has placed more than one hundred billboards with the slogan Smoke free Casinos are your best bet, garnering positive feedback from local agencies and the public, including casino staff workers In total, CCAP responded to 111 technical assistance requests from 36 separate agencies. Evaluation findings also showed that respondents who had worked on activities related to casinos and received technical assistance from CCAP reported that the assistance received was excellent in terms of usefulness and quality. Recommendations for future work include Continue to further explore innovative ways and alternate strategies to facilitate smokefree casinos Continue to facilitate the Casino Advisory Committee, maintaining at least 50% attendance for each meeting As membership increases for the Casino Advisory Committee, consider forming subcommittees to increase member participation, contribution and productivity Complete and undertake periodic updates on the casino information packet, continuously incorporating feedback from the field Page 2

II. Project Description A. Background American Indian gaming facilities i.e. casinos and gaming clubs on tribal land, are controlled by sovereign entities the tribes. Therefore, these sites are not subject to California state law unless the law is included in an agreement known as a Compact between state or local government and the tribe. These sites can also be protected if casino management voluntarily adopts a smoke free policy. The rising demand by patrons for smoke free gaming areas has caused several American Indian casinos to take a leadership role in protecting workers and patrons from secondhand smoke (a Class A Carcinogen ) by designating smoke free gaming areas/rooms. B. Objective and Rationale i. Objective By June 30, 2008, a minimum of 8 tribal casino/resorts will adopt 100% smoke free gaming area policies. (CX Indicators: 2.2.3) ii. Rationale CCAP recognizes the need for worker protection in these smoke filled tribal casino workplaces. Currently, tribal casinos are virtually the only unprotected workplaces in California. Smoky casinos contain up to 50 times more cancer causing airborne particles than highways and city streets clogged with diesel trucks at rush hour. This cancer causing particulate is virtually eliminated when indoor smoking bans are instituted (Repace, 2004). A survey of tribal casino guests and staff in California revealed that 80%, including 98% of non smokers, prefer to play or work in a smoke free environment (American Indian Tobacco Education Partnership, 2005). 88.7% of all Californians agree that all indoor workplaces should be smoke free (California Department of Health Services, 1997). iii. Intervention Activities a) Communicate via telephone, e mail, phone and in person with 3 5 TCP funded projects to promote activities addressing smoke free tribal casinos. b) Recruit a 5 8 member Advisory Committee of representatives of TCP funded projects and other interested parties. c) In collaboration with TCP, place 100+ billboards throughout California in both rural and urban regions. Page 3

d) Conduct trainings on smoke free tribal casino issues for all tobacco control funded organizations, TCP and other interested parties e) Provide technical assistance on all secondhand smoke multi unit housing issues to tobacco control funded organizations, TCP, other interested parties and the general public. Page 4

III. Evaluation Methods A. Design The evaluation design was a non experimental design to collect rich information on the process of providing technical assistance to stakeholders. The primary data collection methods for the process evaluation included online surveys, a database tracking system, website monitoring, a billboard survey, a focus group, training evaluations, and data from a TSI side pak particle monitor. One limitation was low response rates for some of the surveys. Another challenge was the difficulty in bringing together a group of casino staff members for a focused discussion. B. Sample The population for this objective included all TCS funded projects as well as anyone else who received training or technical assistance from CCAP related to smoke free casino worksites. All participants received the online surveys and training evaluations. In addition, all communities in which Casino billboards were placed were invited to take part in the billboard survey. C. Data Collection Instruments and Procedures All instruments were developed by the evaluation team for the project. Table 1: List of instruments Instrument Method Sample Variables Data Collection Casino Policy survey Online survey Funded project directors Status of smoke free gaming Types of barriers and successes encountered in the course of their work with tribal casinos around second hand smoke issues May 2006 May 2007 May 2008 Types of CCAP trainings that would be helpful to projects Page 5

Instrument Method Sample Variables Data Collection Satisfaction survey Database tracking system Advisory Committee survey Participant training evaluations Billboard survey Focus groups TSI side pak particle monitor Online survey Funded project directors Self reported change in their capacity to implement SHS policies Satisfaction with quality, timeliness, responsiveness and usefulness of technical assistance. NA NA Type of assistance, topic area, outcome, and time spent. Online survey Paper survey Online survey In person focus group Side pak monitor Casino Advisory Committee members Training participants Billboard company, LLA staff in communities where billboards were placed Casino Advisory Committee members Satisfaction with discussion of agenda items Overall satisfaction with meeting Quality and usefulness of training Number and type of public feedback to billboards Suggestions to improve impact of billboards Needs of projects currently working or planning to work on casino related issues Presentation and layout of information Tribal casinos Air particle monitoring in tribal casinos over time May 2006 May 2007 May 2008 Ongoing After each Advisory Committee After each training November 2006 February 2008 May 2008 D. Data analysis For quantitative data, means and percentages were calculated and reported. Qualitative data were reviewed for key themes and patterns and summarized. Page 6

IV. Process evaluation results i. Casino policy survey The first casino policy survey conducted in May 2006 asked respondents to provide feedback on factors that had contributed to successes or barriers in working with tribal casinos around secondhand smoke. Overall, the survey revealed that there were few projects working with tribal casinos, and for those who have attempted to work with tribal casinos, they described it as a complex and often challenging process. The most common barrier faced by counties working with tribal casinos around second hand smoke issues was Native American sovereignty (6 counties or 32%), followed by that of tribal businesses not seeing smoke free casinos as a priority (4 counties or 21%). Only a handful of counties indicated they have experienced any type of successes. Three counties (16%) expressed that interest or support of tribal casino staff had helped them when it came to addressing secondhand smoke in tribal casinos. When asked to indicate the kinds of barriers or successes tribal casinos face when trying to adopt or implement smoke free policies in their counties, more than 70% of the respondents expressed that they had no knowledge. Those who did felt that economic concerns due to competition was the biggest barrier faced by tribal casinos, and patron support was identified as the factor that led to success. The annual casino policy survey also collected information on the different types of activities project staff have implemented in connection to their work with tribal casinos. For all three years, about half of the counties with tribal casinos in their jurisdictions usually commented that they had not implemented any activities. The other responses centered around participation in AITEP teleconferences, and later the CCAP casino advisory committee. Some other strategies respondents reported using included: Engaging tribal leaders by inviting them to local coalition meetings Periodic communication with casino management; attendance at tribal law training; attendance at various other casino events targeting the community at large (e.g. casino employee health fairs, Pow wows). Participating in site visits to Rancheria medical facilities and keeping an informal dialogue going with management. Been in contact with casino staff to discuss the possibility of providing cessation services to their staff. CCAP made a networking attempt with members of the Casino. Page 7

Observation survey of smoking in Casinos by staff with follow up calls to Casino staff. In process of recruiting and organizing task force with tribal members to work on SHS issues in tribal casinos. Contacted tribal health professionals and began work on youth education Discussed the issue with State legislator. The need for CCAP trainings in the area of smoke free casinos was also assessed within the survey (please see Table 2). Educational materials remained a significant need for respondents throughout all three years. In the most recent survey (May 2008), respondents indicated a higher need for educational materials and collaborative trainings with Native American Tobacco control groups. Table 2: Percent of respondents indicating need for CCAP trainings related to work with tribal casinos Type of TA or training 2006 a (n=16) 2007 b (n=20) 2008 b (n=13) a. SHS and Priority Partnership trainings 81% 65% 54% b. Local coalition or regional trainings 75% 40% 54% c. Collaborative trainings with Native American Tobacco Control groups 94% 45% 85% d. TA support for the Local Lead Agencies 94% 60% 69% e. Trainings such as ʺPromoting Smoke Free Casinosʺ or ʺA Sure Bet with Smoke Free Casinosʺ or ʺSmoke free Casinos Good for Health and 100% 55% 69% Good for Businessʺ f. Media (e.g., billboards and/or and gaming magazine ads) 80% 55% NA g. Educational materials 93% 75% 85% a Response options for that year were Very helpful, Somewhat helpful, and Not helpful at all. Percentage included respondents who selected Very helpful and Somewhat helpful. b Response options for that year were No need, Low need, Medium need and High need. Percentage included respondents who selected Medium need and High need. ii. Technical Assistance Table 3 presents the number of agencies CCAP has provided technical assistance to, number of technical assistance logs recorded and time spent for each year of the grant. Page 8

In total, CCAP responded to 111 technical assistance requests from 36 separate agencies. On average, CCAP used 6.6 hours for each request. Technical assistance for casino related requests doubled from year 1 to year 3. Table 3: Technical Assistance from July 2005 to June 2008 July 2005 June 2006 July 2006 June 2007 July 2007 June 2008 Type of # Assistance Agen # TA cies Logs i Time Spent (hours) ii # Time # Time # TA # TA Agen Spent Agen Spent Logs Logs cies (hours) cies (hours) Total over Grant Period # Time # TA Agen Spent Logs cies (hours) Technical Assistance (Casino) 10 22 134.3 24 48 290.7 12 41 303.9 36 111 728.9 i A TA log is entered by each CCAP staff every time they respond to a technical assistance request. ii Time spent included phone consultation, research, email exchange, presentation, in person meeting, teleconference, conference, training session, composing letters, and other. This excludes travel time. iii. Satisfaction with technical assistance Throughout the grant period, CCAP provided 728.5 hours of technical assistance to 36 agencies (funded and non funded) working on casino related activities. While one tribal casino (Lucky Bear Casino) did adopt a smoke free policy, of the agencies CCAP provided technical assistance to, none have adopted smoke free policies for the entire tribal casino. Portions of the tribal casino may be smoke free, e.g. restaurants, non smoking are for game slots, etc. However, CCAP has invested substantial amount of time and energy in making the public more aware of the issue, in conducting trainings for local coalitions and statewide conferences, as well as in producing an information packet rich in strategies for promoting smoke free tribal casinos. Respondents who did receive technical assistance related to tribal casinos were asked to rate their satisfaction with the assistance in terms of quality and usefulness. While the number of respondents who received technical assistance pertaining to smoke free tribal casinos is small (n=2 in 2006, n=6 in both 2007 and 2008), all of the respondents indicated that the assistance received was excellent in terms of usefulness and quality. The majority of the respondents also reported that CCAP assistance increased their capacity to address SHS issues in their communities. Page 9

Table 4: Percentage of respondents who rated the quality and usefulness of assistance related to smoke free casinos as good to excellent. Number of respondents who received technical assistance related to smoke free casinos in the year prior to survey and responded to question Number of respondents who reported the quality of CCAP assistance to be good or excellent June 2006 June 2007 June 2008 2 6 6 2 6 6 Number of respondents who reported the usefulness of CCAP assistance to be good or 2 6 6 excellent Mean satisfaction rating by respondents (on a scale of 1 not at all satisfied to 5 very satisfied) Source: Client Satisfaction Survey 5.0 5.0 5.0 Table 5: Percentage of respondents who reported increased capacity to address SHS issues in their communities as a result of CCAP s technical assistance June 2006 June 2007 June 2008 Number of respondents who received technical assistance related to smoke free casinos in the year prior to survey and responded to question 2 6 5 Number of respondents who reported increased capacity to address SHS issues in their communities as a result of CCAP s technical 2 a 5 b 5 b assistance Source: Client Satisfaction Survey a Response options were Improved our capacity, Neither improved or reduced our capacity, Reduced our capacity, Don t know. Percentage was based on respondents who reported Improved our capacity. b Response options were Greatly improved our capacity, Somewhat improved our capacity, Little or no effect, Don t know. Percentage was based on respondents who reported Greatly improved our capacity or Somewhat improved our capacity. iv. Casino information packet In February 2008, CCAP convened a focus group with the Casino Advisory Committee members to solicit feedback on the materials within their Casino information packet. Overall, feedback on the packet was positive. Committee members liked the fact sheet emphasizing the economic facts around going smoke free and recommended that separate fact sheets be developed for Page 10

different audiences: Indian Tribal Council, casino administrators and management, casino employees, casino patrons and Indian Health Clinics. Committee members also suggested including the following pieces of information within the packet: 1) An explanation of the tribal structure, 2) a glossary of politically correct language to use, 3) a list of best practices, 4) a how to implementation for casino management: Steps to Success, 5) a survey or sheet listing basic information that local lead agencies (LLAs) need to know when working with casinos, and 6) a comprehensive list of traditional and non traditional resources LLAs can access. The tribal casino information packet has been revised based on the feedback and will be ready to be disseminated in July 2008. v. Casino Advisory Committee CCAP facilitated their first Casino Advisory Committee meeting in December 2006. The Committee membership has since expanded from five members to an open invitation for all counties with casinos in their jurisdictions (26 counties). To date, seven meetings have taken place, five by teleconference and two in person meetings. After each meeting, committee members were invited to take part in a short one page survey that asked for their feedback on the clarity of presentation for each agenda item, their satisfaction with facilitation, overall satisfaction with meeting and suggestions for future agenda topics. Overall, the majority of members (85% or higher) at each meeting have expressed that they were either satisfied or very satisfied with the meeting. Members appreciated the sharing of updates in different counties and obtaining the latest information from CCAP on what is new in the field Some suggestions from members: As the membership grows, respondents suggested that an orientation be provided to newer members to explain their role and purpose on the Advisory Committee. Logistical issues such as ensuring all members receive and are given sufficient time to review materials before each meeting, and anticipating other technical issues common to teleconferences (static, maximum numbers of line for teleconference) should be addressed as they are crucial to a productive meeting. Selected comments from Committee members: I hope CCAP continues to work on casinos. If anybody can make smoke free casinos a reality in California, it is you guys. Hope more committee members can attend. Page 11

This teleconference was synergistic. Active exploration of options is energizing. I liked it a lot. Theresa and Dian are masters. Narinder did a good job of keeping us on schedule. I am looking forward to our next meeting. The handouts for this teleconference were superb. I learned much about the casino regulation process from them. More handouts like these would be extremely helpful for designing interventions. vi. Training Evaluations Participants were also invited to complete evaluation surveys after each CCAP training. See Appendix A for a full list of trainings provided throughout the grant period. As training organizers often provided their own evaluation forms, we did not want to burden the participants with an extra evaluation form to fill out. As a result, only a small number of participant evaluations were collected. To supplement participant evaluations, presentation organizers were also asked to complete collaborator evaluations. Complete results and selected comments from the collaborator evaluations are presented in Table 5. Due to the small sample size, these results cannot be generalized. All the collaborators surveyed (n=3) found CCAP trainings and/or presentations to be excellent. Table 6: Summary of Collaborator Evaluations from Training Evaluations related to casinos Percent rating quality of presentation as good or excellent Percent rating usefulness of presentation as good or excellent Collaborator Evaluations (n=3) 100% 100% Mean rating a : 4.7 Mean rating a : 4.7 Selected comments Presenters are very knowledgeable about the information they provided. Mariposa County does not have a casino, but the other information presented in the presentation was very helpful. The bill board ads are excellent! All three of the people who presented did an excellent job at presenting and answering questions. Well prepared; able to answer questions and inspire us. a Mean rating was computed on a scale of 1 poor to 5 excellent. SHS Strategies and Solutions Training Two full day trainings on SHS Strategies and Solutions were held in Sacramento and Los Angeles in September 2007. CCAP staff presented a session on SHS in tribal casinos for each of the trainings. A total of 69 participants attended the training in Sacramento; 63 participants attended the Page 12

training in Los Angeles. A total of 39 participants filled out evaluations in Sacramento (a response rate of 57%), and another 39 participants filled out evaluations in Los Angeles (a response rate of 62%). Key findings for the session related to tribal casinos are: Comments about the casino session revealed that a number of participants do not have casinos in their county or were not going to be working with casinos this year. Nevertheless, participants valued listening to the seasoned presenters and learning of the efforts others were putting into their work with casino workers. An average of 63% of respondents agreed or strongly agreed that the training session was useful to their work. An average of 86% of respondents agreed or strongly agreed that they gained new skills as a result of the training. An average of 62% of respondents agreed or strongly agreed that they know how to apply what they learned to their work. vii. Impact of billboards To stimulate awareness and concern for secondhand smoke exposure in American Indian casinos, beginning June 2006, billboards were placed in a total of 9 counties with casinos. The billboard read, ʺSmoke free Casinos are the Best Betʺ. The billboard locations were: Oroville, Chico, Marysville/ Yuba City, Stockton, Redding/ Red Bluff, San Bernardino/ Riverside, Mendocino, Fresno and San Diego. Based on an estimate by the billboard company, the total count of looks this campaign has generated was 34,644,955. Local Lead Agency (LLA) representatives and three outdoor signage companies were invited to share feedback on their county s public reception to the Best Bets billboards. A total of 10 surveys were completed, representing a 63% response rate (all three outdoor signage companies responded, and 7 of 13 LLAs responded). As the toll free number listed on the billboards was linked to the main CCAP phone line, CCAP staff also completed the survey. Public feedback was received by three of the ten respondents. All feedback was positive. Local lead agencies suggested that they be notified ahead of time for future billboard placements. Working more closely with local lead agencies will improve the reach and increase the effectiveness of the billboards. Overall, local lead agencies liked the message and picture used on the billboard. CCAP received 39 calls via the toll free number placed on the billboard. The majority of the calls were from members of the public and casino employees. All, except four calls, provided positive feedback on the billboard message. Page 13

viii. TSI Side Pak Monitor Beginning in January 2008, CCAP obtained the TSI Side Pak monitor and began making it available for funded agencies to borrow and collect data. Most commonly designed for use in multiunit housing apartments and casinos, the Side Pak is an aerosol monitor, measuring particles that have been suspended in the air. Staff in LLAs can use the Side Pak for: Work with members of the community to monitor secondhand smoke in local casinos Package data for feedback to owners, employees, policy makers, and the public Train others in techniques for monitoring in casinos Thus far, CCAP has trained the management staff, casino employees, and Shasta County LLA staff at Win River Casino in Shasta County in using the Side Pak monitor. Data for the levels of air particles from smoking was also measured at the casino. See Appendix B for more details on the levels of smoke in different locations of the casino in one day as measured with the Side Pak. Page 14

V. Conclusions and Recommendations The evaluation data showed that the number of counties in California receiving technical assistance and/or training from CCAP related to smoke free casino worksites increased from two counties (8%) in the first year to six counties (24%) in the third year. Many counties reported that it was a challenging issue to address and in the annual 2007 casino survey, 83% (19 of 23 respondents) indicated that they had not incorporated casinos into their 07 10 scope of work. While CCAP s technical assistance did not result in any of the tribal casinos going entirely smoke free, several notable activities occurred in the course of the grant: CCAP became a member of California Nations Indian Gaming Association (CNIGA) CCAP has successfully formed the Tribal Casino Advisory Committee and conducted seven meetings CCAP is currently working extensively with Win River Casino in Shasta County and preparing information for the casino management to consider going smoke free CCAP has revised and updated several of its fact sheets on working with tribal casinos, based on feedback from the Casino Advisory Committee CCAP has placed 188 billboards with the slogan Smoke free Casinos are your best bet, garnering positive feedback from local agencies and the public, including casino staff workers Additionally, of those respondents who had worked on activities related to casinos and received technical assistance from CCAP, all of them expressed that the support received was excellent in terms of usefulness and quality. Projects need for casino related trainings varied slightly from year to year. Overall, need for educational materials remained high throughout all three years, as well as TA support for local lead agencies and in person trainings. In this respect, CCAP will be directly addressing projects need for comprehensive information on working with tribal casinos when their casino information packet is completed. Recommendations for future work include: Continue to further explore innovative ways and alternate strategies to facilitate smokefree casinos Continue to facilitate the Casino Advisory Committee, maintaining at least 50% attendance for each meeting Page 15

As membership increases for the Casino Advisory Committee, consider forming subcommittees to increase member participation, contribution and productivity Complete and undertake periodic updates on the casino information packet, continuously incorporating feedback from the field Page 16

List of Citations American Indian Tobacco Education Partnership, Secondhand Smoke Casino Advocacy Guide, (2005), California:American Indian Tobacco Education Partnership. California Department of Health Services (CDHS). California Tobacco Survey, California Department of Health Services, Tobacco Control Services, 1997. Repace JL. Smoke Free Casino Advocacy Guide, (April, 2004), California:American Indian Tobacco Education Partnership. Repace JL. Respirable Particles and Carcinogens in the Air of Delaware Hospitality Venues Before and After a Smoking Ban. Journal of Occupational and Environmental Medicine, 46:887 905 (2004). Page 17

Appendix A Table 7: List of CCAP Presentations Related to Tribal Casinos (July 2005 to June 2008) Project Name Agency Name Request Outcome Date Closed CCAP Casino Advisory Committee Smoke Free Tribal Casinos Objective 3-11-10: 20-30 Minute Presentation to TCS Contractors (Casino) "Strategies & Training requested by several Solutions"- one day All LLA's and LLA's with new staff covering SHS trainings in two Competitive Grantees topics of MUH, Casinos, LC cities- Los Angeles and 6404.5; outdoor & hookah. Sacramento CCAP Americans for Non Smoker Rights CCAP's Casino a/c meets 4 times per year ANR contacted CCAP staff to conduct a presentation at the "Clearing the Air" conference and TA follow up. Provided training, updates, MWA strategies and TA Narinder presented and followed up with 3 participants needing more information. Objective 3-11-11: 20-30 Minute Presentation (e.g., ALA, ACS, League of CA Cities) (Casino) 9 /30/2007 6 /30/2008 6 /4 /2008 WORK American Cancer Society To provide information and review of closing the gaps ACS is using the information for their advocacy program. 6 /30/2007 Tobacco-Free Communities All LLA's and Competitive Grantees American Lung Association of San Diego & Imperial Counties From Laurie Comstock president of Tobacco Victims Memorial for Theresa Boschert to speak on SHS and where it still exists. Asked for Dian to present on Tribal Casinos & SHS Theresa Boschert sopke at victims memorial rally at the capitol. 9 /12/2007 Presentation made 10/9 /2007 Tobacco Control Program Sutter County Health Department Local LLA's wanted info on sidepaks Presentation by Theresa on sidepaks 12/6 /2007 Tobacco Control Project Tobacco Education Program Tobacco Education Program Objective 3-2-8: 30-60 Minute Community Forum/Presentation (Casino) Tulare County Health and Human Services Agency Shasta County Department of Public Health Shasta County Department of Public Health Asked to give T.A. regarding several bars out of compliance and presentation on smoke free strategies at regional coalition meeting. Staff were asked to present casino information and answer questions from participants needing TA Shasta County LLA and Win River Casino re: beginning to enforce going 100% smoke-free. Provided technical assistance to LLA regarding bars and other issues. Conducted training at coalition meeting. Presented and responded to questions regarding tribal casinos in north state region Met with both groups, presented information and prepared packets. 4 /30/2006 11/5 /2007 6 /30/2008 Page 18

Trainings on tribal casinos also occurred at the following meetings: American Cancer Society American Lung Association- Oakland American Lung Association- Sacramento CDOC Conference Call Fresno County region tobacco coalition meeting Gold Country Meeting NCLGS Hearing NSTEPP Coalition PPP Conference San Diego & Imperial LLA Victims memorial rally @ the Capitol Page 19

Appendix B Note: Data on this graph was made available by Dr. Neil Kleipis. Page 20