CCAP SATISFACTION SURVEY July 2012 Summary of Results

Introduction CCAP SATISFACTION SURVEY July 2012 Summary of Results California Clean Air Project ended their second year (July 2011 through June 2012) of work focusing solely on providing technical assistance to funded CTCP projects working on promoting smoke-free tribal casinos. An annual online survey was sent to 27 local lead agencies in counties with tribal casinos to assess satisfaction and obtain feedback on future types of support. Survey invitations were also sent to five competitive grantees and one non-funded agency (Win-River Casino) with whom CCAP had worked in the past year. A total of 21 completed surveys were received, representing an overall response rate of 64%. Please see Appendix A for a detailed breakdown of the projects participation status. Key Findings Satisfaction with CCAP s Technical Assistance 1. Eleven of 21 (52%) indicated they were actively involved with activities related to promoting smoke-free tribal casinos. Of these 11 projects, ten reported that they had received technical assistance or support from CCAP in the past year. 2. More than half of the projects who received technical assistance from CCAP indicated that CCAP had facilitated group teleconferences (70%), provided technical assistance in person (70%) or by telephone (60%), as well as provided educational materials (60%). 3. When asked to describe outcomes that projects achieved with CCAP s assistance, projects highlighted the unique niche CCAP had as a member of CNIGA, which allowed them to obtain and share information about issues facing tribal casino management that is not available elsewhere. CCAP s trainings and technical assistance via SidePak air monitoring as well as casino patron surveys were also viewed positively. 4. All nine projects who had received assistance from CCAP expressed high satisfaction with the quality, usefulness, responsiveness and timeliness of the assistance (one project did not respond). Overall, eight of nine projects indicated they were very satisfied, and one respondent indicated they were satisfied. Satisfaction with CCAP s Trainings 5. Nine of 20 (45%) also indicated that they had attended a training or conference presentation facilitated by CCAP in the past year. 6. Eight of 9 strongly agreed or agreed that they gained new skills or knowledge, and that they plan to use what they learned from the session in their future work. Feedback on CCAP s Website 7. Twelve of 20 (60%) indicated that they had visited CCAP s website in the past year. All who had visited the website found it easy to navigate. The vast majority (10 of 12 ) visited the website between two and five times in the past year. CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 1 of 11

8. Half of the 12 indicated that they downloaded materials from CCAP s website and 5 of the 6 found the materials to be very useful or useful to their work. Future Support 9. When asked to prioritize the types of support projects would need in the next year, the need for educational materials, casino patron surveys and Side Pak air monitoring tied for the highest, followed by local coalition trainings and continual technical assistance support throughout the year. Recommendations and Comments 10. Overall, projects commented favorably on CCAP s quality and availability of support. Respondents praised the level of knowledge, leadership and respect that CCAP brings to the field of working with American Indians, as well as their accessibility to all projects. 11. Future recommendations for CCAP s work include an integration of casino work into tribal health care systems, cultural trainings on working with tribal groups, and more publicity of the advantages for going smoke-free within Indian gaming magazines. Data Tables Table 1. Summary of participation rates Project Type n All Local Lead Agencies 27 17 63% Local Lead Agencies Participating in Casino 14 8 57% Committee and/or have casinos in their SOW Competitive Grantees 5 3 60% Non-funded agency 1 1 100% Total 33 21 64% 1. In the past year (since July 1, 2011) has your project/ county been actively involved with activities related to promoting smoke-free tribal casinos? Please include activities that you conducted even if they were outside of your official scope of work. Response Yes 11 52.4% No 10 47.6% 2. Please describe these activities. General activities Our primary objective is to get one of two casinos in Fresno County to adopt a smoke free policy. Provided education at casino health fair event and presented to tribal council. The SHARE Project is working in Amador County with the Jackson Rancheria Tribal Casino to expand their non-smoking area which is very small. CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 2 of 11

LLA has continued to support Win-River Casino efforts to designate its casino as smoke-free. LLA representatives assisted CCAP in conducting air quality assessments in December. Member of Valley View Casino task force Member - Smoke-free Casinos Workgroup (state) Participant Smoke-free Casinos Call (national) Brainstorming Meeting, Casino survey Participation on CCAP Casino Advisory Committee Regular Casino Committee Teleconferences; use of smoke-free casino materials; technical assistance from CCAP staff via telephone and in-person; reports of key information from CNIGA meetings which CCAP Director attends; help with observational surveys from CCAP; and general feedback on my project's tribal casino-related objective and activities. Activities have been limited to participation in the Casino Advisory Committee. Our project has participated in quarterly CCAP Calls, webinars, and hosted a local coalition presentation sponsored by CCAP on working with tribal casinos. Also local TEP and coalition staff have provided efforts to educate and promote tobacco free casinos in Imperial County through media sources, tribal presentations and community health fairs. Data collection at casino Completed community survey in regards to non-smoking casino Collecting preliminary data SECTION I: TECHNICAL ASSISTANCE/ SUPPORT 3. Has your project received any technical assistance or support from CCAP on activities related to promoting smoke-free tribal casinos since July 1, 2011? Response Yes* 10 47.6% No 11 52.4% *Ten of the 11 projects that were actively involved with casinos in the past year (as per Q2) indicated that they received technical assistance from CCAP. DID NOT RECEIVE TA 4. For which of the following reasons did you or your project not receive technical assistance/ support from CCAP? (mark all that apply) Response (n=11) Our project/agency didn t need TA/S during this time 1 9% Our project/agency did not not work on smoke-free tribal 10 91% casino issues this past year It didn t occur to us to seek TA/S from CCAP 2 18% Our project/agency was unsure of what assistance was 1 9% available from CCAP Unable to get hold of CCAP staff -- -- Did contact CCAP but did not receive a response -- -- Other: Did not know CCAP was still in operation CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 3 of 11

RECEIVED TA 5. Please mark the type(s) of assistance CCAP provided to you/your project (mark all that apply): Response (n=10) Draft sample casino policy language 2 20% TA through in person meetings 7 70% TA by telephone 6 60% Facilitated group teleconferences 7 70% Facilitated regional/local trainings and workshops 3 30% Provided educational materials 6 60% Provided observational data on estimating percentage of 4 40% smokers in the casino Side Pak air monitoring 3 30% Other: Provided contacts at several casinos such as employees or managers who have assisted us. 6. Please describe or comment on any outcomes you feel your project has achieved in the past year related to smoke-free tribal casinos that you would attribute (even in part) to CCAP s involvement. Educational materials and technical assistance Development of informational packet. Due to CCAP's TA support in providing educational materials and regional training, local TEP staff and coalition members were educated and were able to provide statistics and culturally competent materials during tribal events and meetings with key decision makers. Kept abreast of casino issues Getting to know the 'casino scene' has been another area that CCAP has assisted our project. Trying to get additional information about some of the very rural casinos and contact information about casino management from CNIGA has also been something that CCAP is doing well. CCAP has been a very helpful bridge to tribal members via CNIGA. This has served as a point of entry for my project. CCAP has maintained contact and momentum with Win-River Casino despite fears and complications due to the depressed economy. Without CCAP, conversations regarding the casino would likely have stopped. Collected data at casinos Percentage of smokers and side pak data collection Air monitoring data from local casino. Education Kit development. Other CCAP adjusts to the needs of the community readily CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 4 of 11

7. On a scale from 1 to 5, please rate the following regarding the TA/Support related to smoke-free tribal casinos you received from CCAP. (Please check one of the numbers below, with 1 being Very Poor and 5 being Excellent ) N=9 Excellent Good Neutral Poor Very poor Quality of TA (n=9) 8 (89%) 1 (11%) -- -- -- Usefulness of TA (n=9) 8 (89%) 1 (11%) -- -- -- Responsiveness to request(s) (n=9) 7 (78%) 2 (22%) -- -- -- Timeliness in meeting request (n=8) 6 (75%) 2 (25%) -- -- -- 8. On a scale from 1 to 5, please rate your overall satisfaction with the TA you have received from CCAP related to promoting smoke-free tribal casinos. (Please mark one of the numbers below, with 1 being Very dissatisfied and 5 being Very Satisfied ) Response (n=9) Very satisfied 8 89% Satisfied 1 11% Neutral -- -- Dissatisfied -- -- Dissatisfied -- -- 9. What other support would you like to see CCAP provide in the future related to promoting smokefree casinos? Continue being a conduit for mutual information exchange Just continued support. The conference calls are very helpful. CCAP currently does and I hope will continue to provide vital leadership in building communication and positive working relationships with California gaming Tribes. Our work could not succeed without CCAP's leadership. They do a marvelous job. Future work expansion At this point, I am very satisfied with CCAP support, but possibly in the future with greater financial resources smoke-free ads could be placed in Native American Gaming magazines. Integration of casino work into tribal health care system to demonstrate continuity between business practices and health concerns of tribal members. Collaboration to develop the TCP objective. Assistance with staff training and development. SECTION II: CCAP TRAININGS OR CONFERENCE PRESENTATIONS 10. In the past year, have you attended any trainings or conference presentations facilitated by a CCAP staff member? Response Yes 9 45.0% No 11 55.0% CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 5 of 11

Topics of trainings or conference presentations included: Smoke-Free Casinos (4) Working with Tribal Casinos CCAP Casino Calls Smoke-free Tribal Casinos Achieving Health Equity with Tobacco Control Smoke Free Casinos: a Real Possibility 11. On a scale from 1 to 5, please rate the following regarding the trainings/ conference presentations you attended. N=9 Strongly agree Agree Neutral Disagree Strongly disagree The session was useful to my work 5 (56%) 2 (22%) 2 (22%) -- -- I gained new skills or knowledge as 4 (44%) 4 (44%) 1 (11%) -- -- a result of the session I know how I can apply what I 4 (44%) 4 (44%) 1 (11%) -- -- learned in the session to my work I plan to use what I learned from the session in my work 4 (44%) 4 (44%) 1 (11%) -- -- 12. Please provide any comments you might have regarding CCAP trainings in general, or suggestions for future topics. Cultural trainings on tribal groups. History and impact of Compacts with tribes. Overview of successful campaigns for smoke-free casinos. Convener of all casino projects in CA. CCAP's trainings are accessible and practical. They stay ahead of new developments and provide great perspective and guidance in a complex area of tobacco control. It is a pleasure to work with dedicated tobacco control advocates, such as CCAP staff. CCAP staff have been a tremendous help in keeping us at the local level informed and educated with the latest surrounding Smoke Free Tribal Casinos. Narinder always shares the most recent information she collects and this is very helpful. I appreciate her updates on what progress is happening nationally on tribal casinos and the risk factors or breathing secondhand smoke how tribal casino's employees are affected. Excellent work being done by CCAP. However, my project doesn't include smoke-free casinos. SECTION III: CCAP WEBSITE 13. Have you visited the NEW CCAP website (http://ccap.etr.org) this past year (since July 1, 2011)? Response Yes 12 60.0% No 8 40.0% CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 6 of 11

DID NOT VISIT CCAP S WEBSITE 14. If you have not visited the CCAP website, please check all that reasons that apply: Response (n=8) Had no need as our agency is not actively working 7 87.5% on smoke-free tribal casino issues Did not know there was a CCAP website 1 12.5% Prefer to talk to CCAP staff directly 1 12.5% VISITED CCAP S WEBSITE 15. Did you find the CCAP website easy to navigate? Response (n=12) Yes 12 100% No -- -- 16. How many times do you recall visiting the CCAP website this past year (since July 1, 2011)? Response (n=12) Just once -- -- 2-5 times 10 83.3% 6-9 times 1 8.3% 10 or more times 1 8.3% 17. When you visited the CCAP website, did you download any educational materials (fact sheets, etc.) from the website? Response (n=12) Yes 6 50% No 6 50% 18. If you downloaded materials from the CCAP website, what was your overall satisfaction with the usefulness of information contained in the materials? Response (n=6) Very satisfied 2 33.3% Satisfied 4 66.7% Dissatisfied -- -- Very dissatisfied -- -- 19. How useful were these materials in advancing your project s work in developing or implementing policies related to promoting smoke-free tribal casinos? Response (n=6) Very useful 3 50.0% Useful 2 33.3% A little useful 1 16.7% Not at all useful -- -- CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 7 of 11

20. Please provide any comments you may have about CCAP s website. General positive comments It seems to work well. It's great CCAP's materials reflect a real knowledge and respect for tribal gaming operations. This is key to our efforts. Provides great insight. Other I miss the list of policies. That was an extremely helpful piece of information I went on the site for info on SidePacks and monitoring indoor SHS, not re tribal casinos so there is not an appropriate answer to Q12. SECTION IV: CCAP FUTURE SUPPORT 21. CCAP would like to know how best to support your agency in activities to promote smoke-free tribal casinos. Please indicate the kind of support your agency would like to have in the short-term (within the next six months) or in the longer term (within the next year)? Type of support or training n No need Within the next 6 months Within the next year Throughout the year a) Local coalition or regional trainings 19 8 (42%) 1 (5%) 8 (42%) 2 11%) b) Collaborative trainings with Native American tobacco control 19 8 (42%) 2 (11%) 7 (37%) 2 (11%) groups c) TA support for the Local Lead Agencies and Competitive 20 8 (40%) -- 7 (35%) 5 (25%) Grantees d) Trainings related to smoke-free tribal casinos and how to work with tribal entities: Smoke-free Tribal Casinos your Best Bet, 18 9 (50%) -- 5 (28%) 4 (22%) Smoke-free Tribal Casinos A Possibiity e) Educational materials 19 6 (32%) -- 8 (42%) 5 (26%) f) Casino observational surveys to determine percentage of smokers 18 9 (50%) -- 8 (44%) 1 (6%) g) Side Pak air monitoring 17 6 (35%) 2 (12%) 8 (47%) 1 (6%) CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 8 of 11

Type of support or training n No need Within the Within the Throughout next 6 months next year the year Other: Our TURP may or may not have the time to pursue this during this Progress Period. We do like to keep informed. Issues related to secondhand smoke, third hand smoke It would depend on the content and nature of the trainings. Given the limited resources that all agencies have, unless this is a mandated deliverable, we probably won't be doing this work. There is not impetus at this time for our casino to change and the effort needed far outweighs the gain as measured against other winnable policy initiatives. (Not easy, but possible) Sure would like to use the Side Pak in apartments! Assistance with CX to assess casino indicator. Continue partnership with Dr. Klepeis at Stanford and coordinate data analysis from SidePak monitoring of casinos. 22. Please also briefly describe activities you are planning to conduct in the next year related to promoting smoke-free tribal casinos. Data collection Hopefully another observational survey and/or Side Pak air monitoring. Key Informant Interviews, public (patron) opinion polls. At the local level the project plans to complete Key Informant Interviews with key stakeholders and casino management; patron surveys, and air sampling at local Q Casino. Working with Indian casinos or management Cessation promotion and other TURP educational support which will actually be done mainly through the Indian Health Center, not the casino. Award ceremony if Jackson Rancheria increases its smoke-free area and meetings with tribal council and casino management. Will possibly be holding a tobacco coalition meeting in a casino conference room, so it would be a good opportunity to educate coalition membership regarding working toward creating smokefree casinos Working with management and tribal council and local groups who use the casino facilities for gaming and non-gaming activities. More outreach with Tribal Health Clinic & Urban Indian Clinic re cessation and basic outreach. No telling what this will lead to. Partner with CCAP to implement town hall meetings regarding smoking policies at the casino. Other None anticipated at this time. But would be happy to assist CCAP in any endeavors that they may have in Riverside County. None that we are aware of. CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 9 of 11

FINAL COMMENT QUESTION: 23. Do you have any other comments for CCAP? CCAP has been helpful in the past and we won't neglect keeping informed. Our current status with our casino is in remission regarding any move toward going smoke free. They provide a dining room that is "smoke free" and have "smoke free" casino sections but no separation of the areas much. CCAP staff are incredibly knowledgeable to helpful in offering technical assistance to our project. The staff and Director at CCAP are top notch! I appreciate your hard work and passion. You are certainly laying a foundation for health in our community. No, keep up the good work! We could use smoke free casinos in Del Norte but according to what I heard, third hand, smokers are the ones that gamble (from casino manager) I appreciate the leadership role CCAP takes and their accessibility to other programs. I was quite surprised to hear/see that CCAP still operates. It doesn't show up on PARTNERS list of state-wide TA websites so it's sort of off the radar for us. With just a focus on casinos, it might not be as relevant to some of the counties as it was when CCAP covered more shs air quality issues. We miss the TA CCAP provided when it covered a broader range of SHS issues. There really isn't another program that compares. Thank you for all your help! Keep up the great work! CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 10 of 11

Appendix A Table 2: Participation Status of Funded Projects to Whom Surveys were Sent County/Organization Casino in County On Casino Committee Casino in SOW Completed survey? Local Lead Agencies 27 19 4 21 Amador X YES Butte X YES Colusa X Contra Costa X Del Norte X YES El Dorado X YES Fresno X X YES Humboldt X X Imperial X X X YES Inyo X X Kings X YES Lake X X Lassen X X YES Madera X X Mendocino X X Modoc X YES Placer X YES Riverside X X YES San Bernardino X San Diego X X X YES Santa Barbara X YES Shasta X X YES Sonoma X YES Tehama X Tulare X X YES Tuolumne X X Yolo X X YES Competitive Grantees CASA X Project IMPACT ALA YES Vista Community Clinic X Wellness Initiatives Now X X YES SHARE X X YES Non funded Win-River Casino X YES CCAP TA Casino Satisfaction Survey Summary, July 2012 Page 11 of 11