C H A P T E R 3�

Goal Area 2: Eliminating Nonsmokers’ 

Exposure to Secondhand Smoke 

Goal Area 2

�

Eliminating Nonsmokers’ Exposure to Secondhand Smoke

Inputs Activities Outputs Outcomes

▲

State health

department

and partners marketing

Community

mobilization

Policy and

action

Counterregulatory

C H A P T E R 3 Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

123�

to disseminate

information about

secondhand smoke

policies

Short-term Intermediate Long-term

knowledge of,

support for the

policies

policies

public policies

Compliance

policies

Reduced

secondhand

smoke

Reduced

tobacco

consumption

Reduced

morbidity and

mortality

disparities

1

2

3

4

5

6

7

8

9

10

Completed activities

and tobacco-free

Completed activities

to create and enforce 

tobacco-free policies

Increased

improved 

attitudes toward,

and increased

creation and active 

enforcement of

tobacco-free

Creation of

tobacco-free

Enforcement of

tobacco-free

with tobacco-free

exposure to

tobacco-related

Decreased

tobacco-related

▲

Targeted to 

populations

with tobaccorelated 

disparities

GOAL AREA 2�
Goal Area 2�

Eliminating Nonsmokers’ Exposure to Secondhand Smoke �

Short-term Outcomes

■�Outcome 3: Increased knowledge of, improved attitudes toward, and increased 

support for the creation and active enforcement of tobacco-free policies

▲

▲

▲

▲

▲

▲

▲

▲

▲

▲

2.3.1 Level of confirmed awareness of media messages on the dangers 

of secondhand smoke

2.3.2 Level of receptivity to media messages about secondhand smoke

2.3.3 Attitudes of smokers and nonsmokers about the acceptability of 

exposing others to secondhand smoke

2.3.4 Proportion of the population willing to ask someone not to smoke 

in their presence

2.3.5 Proportion of the population that thinks secondhand smoke is harmful

2.3.6 Proportion of the population that thinks secondhand smoke is harmful 

to children and pregnant women

2.3.7 Level of support for creating tobacco-free policies in public places 

and workplaces

2.3.8 Level of support for adopting tobacco-free policies in homes and 

vehicles

2.3.9 Level of support for active enforcement of tobacco-free public policies

2.3.10NR Level of support for creating tobacco-free policies in schools

■ Outcome 4: Creation of tobacco-free policies

▲

▲

▲

▲

▲

▲

2.4.1� Proportion of jurisdictions with public policies for tobacco-free 

workplaces and other indoor and outdoor public places

2.4.2� Proportion of workplaces with voluntary tobacco-free policies

2.4.3� Proportion of the population that works in environments with 

tobacco-free policies

2.4.4� Proportion of the population reporting voluntary tobacco-free home 

or vehicle policies

2.4.5� Proportion of schools or school districts reporting the implementation 

of 100% tobacco-free policies

2.4.6� Changes in state tobacco control laws that preempt stronger local 

tobacco control laws

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

■ Outcome 5: Enforcement of tobacco-free public policies

▲

▲

▲

2.5.1� Number of compliance checks conducted by enforcement agencies

2.5.2� Number of enforcement agency responses to complaints regarding 

noncompliance with tobacco-free public policies

2.5.3� Number of warnings, citations, and fines issued for infractions of 

tobacco-free public policies

Intermediate Outcomes

■ Outcome 6: Compliance with tobacco-free policies

▲

▲

▲

▲

▲

2.6.1� Perceived compliance with tobacco-free policies in workplaces

2.6.2� Perceived compliance with tobacco-free policies in indoor and 

outdoor public places

2.6.3� Proportion of public places observed to be in compliance with 

tobacco-free policies

2.6.4� Perceived compliance with voluntary tobacco-free home or 

vehicle policies

2.6.5� Perceived compliance with tobacco-free policies in schools

Long-term Outcomes

■ Outcome 7: Reduced exposure to secondhand smoke 

▲

▲

▲

▲

▲

2.7.1� Proportion of the population reporting exposure to secondhand 

smoke in the workplace

2.7.2� Proportion of the population reporting exposure to secondhand 

smoke in public places

2.7.3� Proportion of the population reporting exposure to secondhand 

smoke at home or in vehicles

2.7.4� Proportion of students reporting exposure to secondhand smoke 

in schools

2.7.5� Proportion of nonsmokers reporting overall exposure to secondhand smoke

■ Outcome 8: Reduced tobacco consumption �

▲

▲� ▲

2.8.1� Per capita consumption of tobacco products

2.8.2� Average number of cigarettes smoked per day by smokers

2.8.3� Smoking prevalence

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

125
K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

126
GOAL AREA 2 

Outcome 3

Outcome 3

▲

Increased Knowledge of, Improved Attitudes Toward,

and Increased Support for the Creation and Active Enforcement 

of Tobacco-free Policies 

The theory of change associated with eliminating nonsmokers’ exposure to secondhand smoke starts with increasing people’s knowledge of the dangers of exposure 

to secondhand smoke, changing their attitudes toward the acceptability of exposing 

nonsmokers to secondhand smoke, and increasing their support for passing and 

enforcing tobacco-free policies. Ideally, such changes should lead to increases in the 

number of environments with tobacco-free policies and increased compliance with 

those policies as people become more conscious of the importance of smoke-free air. 

In reality, passing tobacco-free policies is subject to many inhibiting and facilitating 

influences and factors. Moreover, adopting a policy does not ensure that the policy 

will be actively enforced or become self-enforcing. 

Experience suggests that interventions intended to increase knowledge of and 

support for passing or enforcing tobacco-free policies can be effective.1,2 In addition, 

experience and logic dictate that sufficient support for tobacco-free policies by 

either the public or decision makers will lead to the adoption of tobacco-free 

policies (including voluntary tobacco-free policies).3

Experience also shows that policy makers review data on public support for tobaccofree policies carefully before they decide whether to support such policies.4–7 One 

study, for example, showed that support for a New York City law requiring that 

restaurants be tobacco free was associated with compliance with the law.3 In addition, 

a study from California showed that exposure to a state media campaign promoting 

tobacco-free policies and laws was significantly associated with increases over time 

in reported smoking bans in homes.8

 Other studies show that increased knowledge 

of the adverse health effects of secondhand smoke is associated with increased efforts 

by individuals to minimize their exposure to secondhand smoke and with reductions 

in actual exposure to secondhand smoke.9,10

Listed below are the indicators associated with this outcome:

▲

▲

▲

▲

▲

2.3.1� Level of confirmed awareness of media messages on the dangers of 

secondhand smoke

2.3.2� Level of receptivity to media messages about secondhand smoke

2.3.3� Attitudes of smokers and nonsmokers about the acceptability of exposing 

others to secondhand smoke

2.3.4� Proportion of the population willing to ask someone not to smoke in 

their presence

2.3.5� Proportion of the population that thinks secondhand smoke is harmful

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

127
▲

▲

▲

▲

▲

2.3.6� Proportion of the population that thinks secondhand smoke is harmful 

to children and pregnant women

2.3.7� Level of support for creating tobacco-free policies in public places and 

workplaces

2.3.8� Level of support for adopting tobacco-free policies in homes and vehicles

2.3.9 Level of support for active enforcement of tobacco-free public policies

2.3.10NR Level of support for creating tobacco-free policies in schools

References

1. �Clarke H, Wilson MP, Cummings KM, Hyland A. The campaign to enact 

New York City’s Smoke-Free Air Act. Journal of Public Health Management 

and Practice. 1999;5(1):1–13.

2. �Magzamen S, Glantz SA. The new battleground: California’s experience 

with smoke-free bars. American Journal of Public Health. 2001;91(2):245–52.

3. �Hyland A, Cummings KM, Wilson MP. Compliance with the New York City 

Smoke-Free Air Act. Journal of Public Health Management and Practice. 1999;

5(1):43–52.

4. �U.S. Department of Health and Human Services. Reducing tobacco use: a report 

of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention; 

2000.

5. �U.S. Department of Health and Human Services. Women and smoking: a report 

of the Surgeon General. Rockville, MD: Office of the Surgeon General; Washington, 

DC: Government Printing Office; 2001.

6. �Thomson GW, Wilson N. Public attitudes about tobacco smoke in workplaces: 

the importance of workers’ rights in survey questions. Tobacco Control.

2004;13(2):206–7.

7. �Howard KA, Rogers T, Howard-Pitney B, Flora JA, Norman GJ, Ribisl KM. 

Opinion leaders’ support for tobacco control policies and participation in tobacco 

control activities. American Journal of Public Health. 2000;90(8):1283–7.

8. �Rohrbach LA, Howard-Pitney B, Unger JB, Dent CW, Howard KA, Cruz TB, 

Ribisl KM, Norman GJ, Fishbein H, Johnson CA. Independent evaluation of the 

California Tobacco Control Program: relationships between program exposure 

and outcomes, 1996–1998. American Journal of Public Health. 2002;92(6):975–83.

9. �Li C, Unger JB, Schuster D, Rohrbach LA, Howard-Pitney B, Norman G. Youths’ 

exposure to environmental tobacco smoke (ETS): associations with health beliefs 

and social pressure. Addictive Behaviors. 2003;28(1):39–53.

10. Kurtz M, Kurtz JC, Johnson SM, Beverly EE. Exposure to environmental tobacco 

smoke: perceptions of African American children and adolescents. Preventive 

Medicine. 1996;25(3):286–92.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

128
GOAL AREA 2 

Outcome 3 ▲

For Further Reading

Ashley M, Cohen J, Ferrence R, Bull S, Bondy S, Poland B, Pederson L. Smoking in 

the home: changing attitudes and current practices. American Journal of Public Health 

1998;88(5):797–800.

Brenner H. Smoking behavior and attitude toward smoking regulations and 

passive smoking in the workplace. A study among 974 employees in the German 

metal industry. Preventive Medicine. 1997;26(1):138–43.

Crone MR, Reijneveld SA, Burgmeijer RJ, Hirasing RA. Factors that influence passive 

smoking in infancy: a study among mothers of newborn babies in The Netherlands. 

Preventive Medicine. 2001;32(3):209–17. 

Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behaviour: 

systematic review. British Medical Journal. 2002;325(7357):188. 

Gilpin EA, Emery SL, Farkas AJ, Distefan JM, White MM, Pierce JP. The California 

Tobacco Control Program: a decade of progress. Results from the California Tobacco Surveys, 

1990–1998. La Jolla, CA: University of California, San Diego; 2001. Available from: 

http://repositories.cdlib.org/tc/surveys/.Accessed February 2005.

Gilpin EA, Pierce JP. The California Tobacco Control Program and potential harm 

reduction through reduced cigarette consumption in continuing smokers. Nicotine 

and Tobacco Research. 2002;4(Suppl 2):S157–66.

Glantz SA, Jamieson P. Attitudes toward secondhand smoke, smoking, and quitting 

among young people. Pediatrics. 2000;106(6):E82.

Hopper JA, Craig KA. Environmental tobacco smoke exposure among urban 

children. Pediatrics. 2000;106(4):E47.

Kegler M, Malcoe LH. Smoking restrictions in the home and car among rural 

Native American and white families with young children. Preventive Medicine.

2002;35(4):334–42.

Kurtz ME, Kurtz JC, Johnson SM, Beverly EE. Exposure to environmental tobacco 

smoke: perceptions of African American children and adolescents. Preventive 

Medicine. 1996;25(3):286–92. 

Li C, Unger JB, Schuster D, Rohrbach LA, Howard-Pitney B, Norman G. Youths’ 

exposure to environmental tobacco smoke (ETS): associations with health beliefs 

and social pressure. Addictive Behaviors. 2003;28(1):39–53. 

Philpot SJ, Ryan SA, Torre LE, Wilcox HM, Jalleh G, Jamrozik Y. Effect of smoke-free 

policies on the behaviour of social smokers. Tobacco Control. 1999;8(3):278–81.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

129
Pikora T, Phang J, Karro J, Corti B, Clarkson J, Donovan R, Frizzell S, Wilkinson A. 

Are smoke-free policies implemented and adhered to at sporting venues? Australian 

and New Zealand Journal of Public Health. 1999;23(4):407–9.

Popham WJ, Potter LD, Bal DG, Johnson MD, Duerr JM, Quinn V. Do anti-smoking 

media campaigns help smokers quit? Public Health Reports. 1993;108(4):510–3.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

130
GOAL AREA 2 

▲Outcome 3

Outcome 3

Increased Knowledge of, Improved Attitudes Toward,�

and Increased Support for the Creation and Active Indicator Rating�

Enforcement of Tobacco-free Policies� better

Number Indicator Overall quality Resources

needed

low high Strength of

evaluation evidence

Utility

Face validity

practice

Accepted

2.3.1 Level of confirmed awareness of media messages on 

the dangers of secondhand smoke | | | | | | $$

2.3.2 Level of receptivity to media messages about 

secondhand smoke | | | | | |† $$† *

2.3.3 Attitudes of smokers and nonsmokers about the acceptability of exposing others to secondhand smoke | | | | | |† $$$† *

2.3.4 Proportion of the population willing to ask someone 

not to smoke in their presence | | | | | | $$† † *

2.3.5 Proportion of the population that thinks secondhand 

smoke is harmful | | | | | |† $$†

2.3.6 Proportion of the population that thinks secondhand 

smoke is harmful to children and pregnant women | | | | | | $$†

2.3.7 Level of support for creating tobacco-free policies in 

public places and workplaces | | | | | | $$†

2.3.8 Level of support for adopting tobacco-free policies in 

homes and vehicles | | | | | |† $$$

2.3.9 Level of support for active enforcement of tobacco-free 

public policies | | | | | | $$$†

2.3.10NR Level of support for creating tobacco-free policies 

in schools | | | | | |

* �Denotes low reviewer response: that is, greater than 75% of the experts either did not rate the indicator, or gave the 

criterion an invalid rating (see Appendix B for an explanation).

†�Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this indicator were within one 

point of each other (see Appendix B for an explanation).

Denotes no data.� NR Denotes an indicator that is not rated (see Appendix B for an explanation).�

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

131
________________________________________________________________________

________________________________________________________________________

Indicator 2.3.1�

Level of Confirmed Awareness of Media Messages 

on the Dangers of Secondhand Smoke

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure Proportion of the target population that can accurately recall a media message about 

the dangers of exposure to secondhand smoke

Why this indicator� Evaluators should measure exposure to media messages to confirm awareness of

is useful� these messages by asking respondents to provide specific information about the 

message.1 As people increase their knowledge about the health effects of secondhand 

smoke, the number of their actions to reduce exposure to secondhand smoke should 

also increase.2

Example data Legacy Media Tracking Survey (LMTS), 2003

source(s) Information available at: http://tobacco.rti.org/data/lmts.cfm

Population group(s) Young people aged less than 18 years

Example survey 

question(s)

From LMTS 

Have you recently seen an anti-smoking or anti-tobacco ad on TV that shows

__________________________?

Yes Maybe, not sure No Refused to answer

What happens in this advertisement? (DO NOT READ RESPONSE CATEGORIES)

What do you think the main message of this ad was? 

(DO NOT READ RESPONSE CATEGORIES)

Comments� The example survey questions could be asked of adults.

Evaluators may want to categorize awareness of the medium (e.g., billboard, television, 

print) through which respondents learned of the anti-tobacco media message.

Programs may want to evaluate confirmed awareness of an advertisement by 

respondents’ smoking status (current, former, or never) and addiction level 

(e.g., light, moderate, or heavy) because awareness levels may differ significantly 

among groups with different levels of addiction.

Evaluators should work closely with countermarketing campaign managers to 

(1) develop a separate series of questions for each main media message and 

(2) coordinate data collection with the timing of the media campaign.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

132
GOAL AREA 2 

▲Outcome 3

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $$

better

References

1. �Sly DF, Heald GR, Ray S. The Florida “truth” antitobacco media evaluation: design, first year results, and implications 

for planning future state media evaluations. Tobacco Control. 2001;10(1):9–15.

2. �Task Force on Community Preventive Services. The guide to community preventive services: tobacco use prevention and 

control. American Journal of Preventive Medicine. 2001;20(Suppl 2):1–88.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

133
Indicator 2.3.2�

Level of Receptivity to Media Messages About Secondhand Smoke �

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure� The level of receptivity to media messages by the intended audience. Receptivity is 

generally defined as the extent to which people are willing to listen to a persuasive 

message. In tobacco control evaluation, however, the definition is narrower; 

receptivity is the extent to which people believe that the message was convincing, 

made them think about their behavior, and stimulated discussion with others.1

Why this indicator� Message awareness is necessary but not sufficient to change the knowledge of and

is useful� attitudes toward tobacco-free policies, as well as for increasing support for creating 

and enforcing such policies. Media campaigns are effective only if their messages 

reach and resonate with the intended audience. A well-received message helps to 

ensure campaign effectiveness.2–5

Example data Legacy Media Tracking Survey (LMTS), 2003

source(s) Information available at: http://tobacco.rti.org/data/lmts.cfm

Population group(s) Young people aged less than 18 years �

Example survey 

question(s)

From LMTS 

Tell me how much you agree or disagree with the following statement: 

This ad is convincing. Would you say you: 

Strongly agree Agree Disagree 

Strongly disagree Have no opinion Don’t know

Would you say the ad gave you good reasons not to smoke? 

Yes No Don’t know

Did you talk to your friends about this ad? 

Yes No Don’t know

Comments� The example questions could be asked of adults.

Evaluators may want to assess receptivity by the medium through which respondents 

learned of the media message (e.g., television, print, or radio).

Evaluators should work closely with countermarketing campaign managers to 

(1) develop a separate series of questions for each main media message and 

(2) coordinate data collection with the timing of the media campaign. 

Rating Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation practice

evidence

low 

| | | | | |† †� * $$

better

* �Denotes low reviewer response: that is, greater than 75% of the experts either did not rate 

the indicator, or gave the criterion an invalid rating (see Appendix B for an explanation).

† �Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

134
GOAL AREA 2 

▲Outcome 3

References

1. �Sly DF, Heald GR, Ray S. The Florida “truth” anti-tobacco media evaluation: design, first year results, and implications 

for planning future state media evaluations. Tobacco Control. 2001;10(1):9–15.

2. �McGuire WJ. Public communication as a strategy for inducing health-promoting behavioral change. Preventive Medicine.

1984;13(3):299–319.

3. �Kotler P, Armstrong G. Principles of marketing, 9th ed. Upper Saddle River, NJ: Prentice-Hall; 2001.

4. �Carter WB. Health behavior as a rational process: theory of reasoned action and multiattribute utility theory. In: Glanz K, 

Lewis FM, Rimer BK, editors. Health behavior and health education: theory, research, and practice. San Francisco, CA: JosseyBass; 1990. pp. 63–91.

5. �Maibach E, Parrott RL, editors. Designing health messages: approaches from communication theory and public health practice. 

Thousand Oaks, CA: Sage; 1995.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

135
Indicator 2.3.3�

Attitudes of Smokers and Nonsmokers About the 

Acceptability of Exposing Others to Secondhand Smoke

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure The attitudes of smokers and nonsmokers concerning exposing others to secondhand 

smoke

Why this indicator

is useful

Attitudes about the acceptability of exposing others to secondhand smoke are leading 

indicators of social norms with regard to smoking. Even in places without formal secondhand smoke regulations, changes in attitudes can increase (1) self-regulating behavior by 

smokers (i.e., they refrain from smoking in places where nonsmokers would be exposed 

to secondhand smoke) and (2) personal advocacy behavior by nonsmokers (i.e., they ask 

smokers not to smoke around them).1,2

Example data National Social Climate Survey of Tobacco Control, 2001

source(s) Information available at: http://www.ssrc.msstate.edu/socialclimate

Population group(s) Adults aged 18 years or older

Example survey Smoking should not be allowed in any public place. Do you:

question(s) Strongly agree Agree Disagree Strongly disagree

From National Social Climate Survey of Tobacco Control 

It is acceptable for parents to smoke in front of children. Do you: 

Strongly agree Agree Disagree Strongly disagree

Comments The authors created the first example question. It is not in any commonly used 

data source.

The example survey questions could be asked of young people.

Rating Overall quality

low high

Resources 

needed

Strength of 

evaluation 

evidence

Utility Face validity Accepted 

practice

† $$$† *

better

* Denotes low reviewer response: that is, greater than 75% of the experts either did not rate 

the indicator, or gave the criterion an invalid rating (see Appendix B for an explanation).

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

| | | | | |

References

1. �U.S. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, GA: Centers 

for Disease Control and Prevention; 2000.

2. �McMillen RC, Winickoff JP, Klein JD, Weitzman M. U.S. adult attitudes and practices regarding smoking restrictions and 

child exposure to environmental tobacco smoke: changes in the social climate from 2000–2001. Pediatrics. 2003;112(1 Pt 1):

E55–60. 

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

136
GOAL AREA 2 

▲Outcome 3

Indicator 2.3.4

Proportion of the Population Willing to Ask �

Someone Not to Smoke in Their Presence �

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure Proportion of the population who report that they have asked or would ask someone 

not to smoke in their presence (including in homes, vehicles, and public places)

Why this indicator� Compliance with tobacco-free policies and changes in smokers’ behavior in places

is useful� without policies require that nonsmokers be willing to ask smokers to refrain from 

smoking in their presence.1,2 Experience in California suggests that nonsmokers’ 

willingness to ask someone not to smoke increases over time and that smokers’ 

responses are usually positive.3

Example data � ▲

▲

Adult Tobacco Survey (ATS): CDC Recommended Questions: Supplemental

source(s)� Section D: Environmental Tobacco Smoke, 2003

California Adult Tobacco Survey (CATS), 1999�

Information available at: http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/�

Evaluation_Resources.htm�

Population group(s) Adults aged 18 years or older �

Example survey 

question(s)

From ATS 

If someone were smoking near you in the nonsmoking area of a restaurant, 

would you ask them to stop?

Yes No Maybe Don’t know/Not sure Refused 

In the past 12 months, have you ever asked a stranger not to smoke around you so you 

wouldn’t have to avoid their tobacco smoke? 

Yes No Don’t know/Not sure Refused

From CATS 

In the past 12 months, have you ever asked someone not to smoke?

Yes No Don’t know/Not sure Refused

If the answer is “yes,” ask the following:

On that same occasion, what was the primary reason you asked that person 

not to smoke?

Smoke was annoying to you

Concerned about long-term health effects of secondhand smoke 

Smoking was illegal

Concerned about the smoker’s health

Concerned about your own health (respondent’s health)

Other (specify)______________________________________________

Don’t know/Not sure

Refused to answer

Comments The example survey questions could be asked of young people.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

137
Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | |� † † * $$

better

* �Denotes low reviewer response: that is, greater than 75% of the experts either did not rate 

the indicator, or gave the criterion an invalid rating (see Appendix B for an explanation).

† �Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

References

1. �Cains T, Cannata S, Poulos R, Ferson MJ, Stewart BW. Designated “no smoking” areas provide from partial to no 

protection from environmental tobacco smoke. Tobacco Control. 2004;13(1):17–22.

2. �Repace J. An air quality survey of respirable particles and particulate carcinogens in Delaware hospitality venues before and 

after a smoking ban. Bowie, MD: Repace Associates; 2003. Available from: http://www.tobaccoscam.ucsf.edu/pdf/

RepaceDelaware.pdf. Accessed December 2004.

3. �Independent Evaluation Consortium. Final report. Independent evaluation of the California Tobacco Control Prevention and 

Education Program: waves 1, 2, and 3 (1996–2000). Rockville, MD: The Gallup Organization; 2002. Available from: 

http://www.dhs.ca.gov/tobacco/documents/WavesComplete.pdf. Accessed December 2004.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 3

Indicator 2.3.5

Proportion of the Population That Thinks Secondhand Smoke Is Harmful

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure Proportion of the population that believes exposure to secondhand smoke is harmful 

to one’s health

Why this indicator� Several studies found that increased knowledge of the adverse health effects of secondis useful� hand smoke was associated with (1) an increased number of actions to reduce exposure 

to secondhand smoke, (2) reduced exposure to secondhand smoke, and (3) increased 

intention to quit and higher quit rates among smokers.1–3 Changes in attitudes and 

behaviors concerning secondhand smoke are often preceded by an understanding of 

its ill effects.

Example data 

source(s)

Population group(s)�

▲�▲

▲�▲

Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003 �

Youth Tobacco Survey (YTS): CDC Recommended Questions: Core, 2004 �

Adults aged 18 years or older

Young people aged less than 18 years

Example survey From ATS

question(s) Do you think that breathing smoke from other people’s cigarettes is:

Very harmful to one’s health Not very harmful to one’s health

Somewhat harmful to one’s health Not harmful at all to one’s health

Would you say that breathing smoke from other people’s cigarettes causes:

Lung cancer in adults Respiratory problems in children

Heart disease in adults Sudden infant death syndrome

Colon cancer in adults

From YTS 

Do you think the smoke from other people’s cigarettes is harmful to you?

Definitely yes Probably yes Probably not Definitely not

Comments The example questions could be asked of decision makers or opinion leaders.

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

† | | | | | | † $$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

References

1. �Kurtz ME, Kurtz JE, Johnson SM, Beverly EE. Exposure to environmental tobacco smoke: perceptions of African 

American children and adolescents. Preventive Medicine. 1996;25(3):286–92. 

2. �Li C, Unger JB, Schuster D, Rohrbach LA, Howard-Pitney B, Norman G. Youths’ exposure to environmental tobacco 

smoke (ETS): associations with health beliefs and social pressure. Addictive Behaviors. 2003;28(1):39–53.

3. �Glantz SA, Jamieson P. Attitudes toward secondhand smoke, smoking, and quitting among young people. Pediatrics. 

2000;106(6):E82.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

139
Indicator 2.3.6�

Proportion of the Population That Thinks Secondhand 

Smoke Is Harmful to Children and Pregnant Women

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure Proportion of the population that believes exposure to secondhand smoke is harmful 

to children and pregnant women

Why this indicator Exposure to secondhand smoke is especially harmful to children and pregnant women.1

is useful Increased public awareness of this danger reduces exposure of children and pregnant 

women to secondhand smoke.2

Example data Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003

source(s)

Population group(s) Adults aged 18 years or older�

Example survey 

question(s)

From ATS 

Would you say that breathing smoke from other people’s cigarettes causes:

Lung cancer in adults Respiratory problems in children

Heart disease in adults Sudden infant death syndrome�

Colon cancer in adults�

Do you agree or disagree with the following statement: Smoke from other people’s 

cigarettes is harmful to children?

Strongly agree Somewhat agree Neither agree nor disagree 

Somewhat disagree Strongly disagree Don’t know/Not sure

Refused to answer

Comments The example survey questions could be asked of pregnant women and young people. �

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

References

1. �U.S. Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Rockville, MD: U.S. 

Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

2. �McMillen RC, Winickoff JP, Klein JD, Weitzman M. U.S. adult attitudes and practices regarding smoking restrictions and 

child exposure to environmental tobacco smoke: changes in the social climate from 2000–2001. Pediatrics. 2003;11(1 Pt 1):

E55–60.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 3

Indicator 2.3.7

Level of Support for Creating Tobacco-free Policies in Public Places and Workplaces

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure Proportion of adults who support the creation of policies that restrict smoking in public 

places and workplaces

Why this indicator Tobacco-free policies are unlikely to be adopted without support among business

is useful owners, policy makers, and the general public.1–4

Example data �

source(s)�

▲

▲

▲

Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003 �

Adult Tobacco Survey (ATS): CDC Recommended Questions: Supplemental 

Section D: Environmental Tobacco Smoke, 2003

Behavioral Risk Factor Surveillance System (BRFSS): Tobacco Use Prevention 

Module, 2000

Population group(s) Adults aged 18 years or older �

Example survey 

question(s)

From ATS: Core 

In indoor work areas, do you think that smoking should be allowed in all areas, some 

areas, or not at all?

Allowed in all areas Allowed in some areas Not allowed at all

Don’t know/Not sure Refused

From ATS: Supplemental Section D 

In ______________, (Fill blank with each of the following: public buildings, bars 

and cocktail lounges, day care centers, indoor sporting events) do you think smoking 

should be allowed in all areas, some areas, or not allowed at all? 

Allowed in all areas Allowed in some areas Not allowed at all

Don’t know/Not sure Refused

Would you prefer a stronger workplace smoking policy, a weaker workplace 

smoking policy, or no change? 

Prefer stronger policy Prefer weaker policy Prefer no change

Don’t know/Not sure Refused

From BRFSS 

In the following locations do you think that smoking should be allowed in all areas, some 

areas, or not allowed at all? 

Allowed Some areas Not allowed Don’t know Refused

in all areas at all Not sure to answer

• Restaurants

• Schools

• Day Care Centers

• Indoor Work Areas

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

141
Comments� Evaluators may want to analyze the level of support for creating tobacco-free policies 

according to (1) the smoking status of the responder and (2) the place where the smoking 

restrictions would or do apply.

These example questions could be asked of decision makers, employers, opinion leaders, 

or young people. 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

References

1. �U.S. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, GA: Centers 

for Disease Control and Prevention; 2000.

2. �U.S. Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Rockville, MD: U.S. 

Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

3. �Thomson GW, Wilson N. Public attitudes about tobacco smoke in workplaces: the importance of workers’ rights in survey 

questions [letter]. Tobacco Control. 2004;13(2):206–7.

4. �Howard KA, Rogers T, Howard-Pitney B, Flora JA, Norman GJ, Ribisl KM. Opinion leaders’ support for tobacco control 

policies and participation in tobacco control activities. American Journal of Public Health. 2000;90(8):1283–7.

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GOAL AREA 2 

▲Outcome 3

Indicator 2.3.8

Level of Support for Adopting Tobacco-free Policies in Homes and Vehicles

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure Proportion of adults who support tobacco-free policies that restrict the use of tobacco 

products in homes and vehicles

Why this indicator Tobacco-free policies in private homes and vehicles are voluntary. To increase the number

is useful of homes and vehicles with these policies, it is necessary to increase the number of adults 

who support such policies.

Example data University of California at San Diego, California Tobacco Survey (CTS): Adult Attitudes

source(s) and Practices, 1996

Information available at:

• http://ssdc.ucsd.edu/tobacco

• http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/Evaluation_Resources.htm

Population group(s) Adults aged 18 years or older

Example survey 

question(s)

From CTS 

I am going to read you some reasons why people have smoke-free homes. For each, 

please indicate whether it is very important, somewhat important, or not important 

to you for your household. The reasons are:

To protect a household member who is sensitive to smoke

To protect family from harmful health effects of environmental tobacco smoke

To discourage young people from starting to smoke

To encourage smokers to quit

To avoid unpleasant odor of smoking

Because it annoys others

Comments� Evaluators may want to modify the example question to address tobacco-free policies 

inside vehicles.

Evaluators may want to analyze the level of support for creating tobacco-free policies in 

homes and vehicles based on the smoking status of the respondent.

The example question could be asked of young people. 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

† | | | | | | $$$

better

† �Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

Denotes no data.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

143
Indicator 2.3.9�

Level of Support for Active Enforcement of Tobacco-free Public Policies �

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure� Proportion of adults who support active enforcement of tobacco-free policies. An 

example of active enforcement is issuing citations for establishments found not to 

be in compliance with tobacco-free laws. 

Why this indicator Tobacco-free laws have a limited effect if they are not actively enforced. Policies are more

is useful likely to be actively enforced when business owners, decision makers, and the general 

public support them.1–4

Example data � California Independent Evaluation: Adult Survey, 1997

source(s)� Information available at: http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/

Evaluation_Resources.htm

Population group(s) Adults aged 18 years or older�

Example survey From California Independent Evaluation

question(s) Smoking bans in restaurants, cafeterias, and indoor work places should be strictly 

enforced. Do you:

Strongly agree Agree Disagree Strongly disagree

Comments This example question could be asked of decision makers or opinion leaders. �

More information about how to collect data on this indicator is in reference 5 below. �

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$$

better

† �Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

Denotes no data.

References

1. �Howard KA, Rogers T, Howard-Pitney B, Flora JA, Norman GJ, Ribisl KM. Opinion leaders’ support for tobacco control 

policies and participation in tobacco control activities. American Journal of Public Health. 2000;90(8):1283–7.

2. �U.S. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, GA: Centers 

for Disease Control and Prevention; 2000.

3. �U.S. Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Rockville, MD: U.S. 

Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

4. �Thomson GW, Wilson N. Public attitudes about tobacco smoke in workplaces: the importance of workers’ rights in survey 

questions [letter]. Tobacco Control. 2004;13(2):206–7.

5. �California Independent Evaluation, Opinion Leader Survey [online]. 1997. Available from: http://www.dhs.ca.gov/ps/

cdic/ccb/TCS/html/Evaluation_Resources.htm#os. Accessed December 2004.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 3

Indicator 2.3.10NR

Level of Support for Creating Tobacco-free Policies in Schools

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 3 Increased knowledge of, improved attitudes toward, and increased support for 

the creation and active enforcement of tobacco-free policies

What to measure Proportion of adults who support creating tobacco-free policies in schools �

Why this indicator

is useful

Young people’s attitudes concerning the acceptability of smoking in general, and 

smoking around nonsmokers in particular, are influenced by what they see their peers 

and educators doing at school. Strong anti-tobacco school policies require the support 

of parents, teachers, principals, policy makers, and the general public.1

 High levels of 

compliance with tobacco-free school policies reduce students’ exposure to secondhand 

smoke and reinforce anti-tobacco social norms.2

Example data � ▲

▲

▲

Adult Tobacco Survey (ATS): CDC Recommended Questions: Supplemental

source(s) Section F: Policy Issues, 2003

University of California at San Diego, California Tobacco Survey (CTS): Adult 

Attitudes and Practices Instrument, 1996

Information available at: http://ssdc.ucsd.edu/tobacco

Behavioral Risk Factor Surveillance System (BRFSS): Tobacco Use Prevention 

Module, 2000

Population group(s) Adults aged 18 years or older�

Example survey 

question(s)

From ATS 

How strongly do you agree or disagree with the following statement: Tobacco use by 

adults should not be allowed on school grounds or at any school events.

Strongly agree Agree Disagree 

Strongly disagree Don’t know/Not sure Refused

From CTS

Do you think schools should prohibit students from wearing clothing or bringing 

gear with tobacco brand logos to school?

Yes No

From BRFSS 

Do you think that smoking should be allowed in all areas of schools, restaurants, 

day care, and indoor work areas, some areas, or not allowed at all?

All areas Some areas Not allowed Refused to answer

Comments The example questions could also be asked of decision makers.

Evaluators may want to analyze the level of support for creating tobacco-free policies in 

schools based on the smoking status of the respondent.

This indicator was not rated by the panel of experts, and therefore no rating information 

is provided. See Appendix B for an explanation.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

145
Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | |

better

Denotes no data.

NR Denotes an indicator that is not rated (see Appendix B for an explanation).

References

1. �Task Force on Community Preventive Services Meeting, February 25, 2004. Meeting minutes available at: 

 http://www.thecommunityguide.org.

2. �Gilpin EA, White MM, White VM, Distefan JM, Trinidad DR, Lee L, Major J, Kealey S, Pierce JP. Tobacco control successes 

in California: a focus on young people, results from the California Tobacco Surveys 1990–2002. La Jolla, CA: University of 

California, San Diego; 2003. pp. 348–9. Available from: http://repositories.cdlib.org/tc/surveys/CTC1990–2002/.

Accessed December 2004. 

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

146
GOAL AREA 2 

Outcome 4

Outcome 4

▲

Creation of Tobacco-free Policies 

Creating tobacco-free policies in workplaces, other public places, and homes and 

vehicles not only protects nonsmokers from involuntary exposure to the toxins in 

tobacco smoke, but also may have the added benefit of reducing tobacco consumption by smokers and increasing the number of smokers who quit.1–3 Smoking bans 

and restrictions are effective in reducing secondhand smoke exposure.1,2 

Smoking bans may be implemented by governments (through legislation or 

regulation), oversight groups (e.g., the Joint Commission on Accreditation of 

Healthcare Organizations), individual employers or businesses, or private citizens 

(e.g., smoking bans in homes and vehicles). By approaching these groups or 

individuals and encouraging them to develop their own tobacco-free policies, 

tobacco control programs can protect the public from secondhand smoke. Where 

state law preempts stronger local laws, tobacco control programs retain the option 

of mobilizing the private sector to introduce voluntary smoking bans in workplaces 

and public places. In considering which channel to pursue, programs should take 

into account (1) the legal authority vested in various entities (e.g., counties, cities, 

local boards of health), (2) the level of support among relevant decision makers and 

their constituents, and (3) the feasibility of persuading these entities to implement 

tobacco-free policies. It is also worth remembering that despite the recent passage of 

a number of comprehensive state clean-indoor-air laws, comprehensive and strong 

laws can also be enacted at the local level, where such laws are easier to adopt and 

enforce.4

Experience shows that the education that occurs when a community debates whether 

it wants a local tobacco-free law—a debate that typically generates extensive media 

coverage—can greatly facilitate enforcement of the law, sometimes making it largely 

self-enforcing. Continued education of business proprietors, employers, and the public

during the implementation process is also important in this regard. Preemptive laws 

prevent communities from engaging in the process of public education, mobilization, 

and debate that occurs when a local ordinance is under consideration, a process that 

can increase awareness and change social norms.5

 Such laws also pose a barrier to 

local enforcement because communities and local enforcement agencies may be less 

likely to enforce state laws that they were not directly involved in adopting than to 

enforce local ordinances.5

Regardless of which route is used to implement them, smoking bans are effective, 

cost-effective, feasible, and broadly supported by the public.1,2,6 The dangers of 

secondhand smoke are well researched and well known, and the growth and 

spread of this knowledge has been accompanied by a radical reduction in the 

level of acceptability of smoking in public places and workplaces.7,8

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

147
▲

▲

▲

▲

▲

▲

Listed below are the indicators associated with this outcome:

2.4.1� Proportion of jurisdictions with public policies for tobacco-free �

workplaces and other indoor and outdoor public places�

2.4.2 � Proportion of workplaces with voluntary tobacco-free policies

2.4.3� Proportion of the population that works in environments with �

tobacco-free policies�

2.4.4� Proportion of the population reporting voluntary tobacco-free home �

or vehicle policies�

2.4.5� Proportion of schools or school districts reporting the implementation 

of 100% tobacco-free school policies

2.4.6� Changes in state tobacco control laws that preempt stronger �

local tobacco control laws�

References

1. �Task Force on Community Preventive Services. The guide to community preventive services: tobacco use prevention and control. American Journal of Preventive 

Medicine. 2001;20(Suppl 2):1–88.

2. �U.S. Department of Health and Human Services. Reducing tobacco use: a report of 

the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention; 

2000.

3. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 12. 

Population-based smoking cessation: proceedings of a conference on What Works to 

Influence Cessation in the General Population. Bethesda, MD: National Cancer 

Institute; 2000. NIH Publication No. 00-4892.

4. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 11. 

State and local legislative action to reduce tobacco use. Bethesda, MD: National 

Cancer Institute; 2000. NIH Publication No. 00-4804.

5. �Centers for Disease Control and Prevention. Preemptive state tobacco-control 

laws—United States, 1982–1998. Morbidity and Mortality Weekly Report. 1999;47

(51 & 52):1112–4.

6. �Gilpin EA, Lee L, and Pierce JP. Changes in population attitudes about where 

smoking should not be allowed: California versus the rest of the USA. Tobacco 

Control. 2004:13(1):38–44.

7. �Brownson RC, Eriksen MP, Davis RM, Warner KE. Environmental tobacco smoke: 

health effects and policies to reduce exposure. Annual Review of Public Health.

1997;18:163–85.

8. �Brownson RC, Hopkins DP, Wakefield MA. Effects of smoking restrictions in the 

workplace. Annual Review of Public Health. 2002;23:333–48.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

148
GOAL AREA 2 

Outcome 4 ▲

For Further Reading

Gilpin EA, Pierce JP. The California Tobacco Control Program and potential harm 

reduction through reduced cigarette consumption in continuing smokers. Nicotine 

and Tobacco Research. 2002;4(Suppl 2):S157–66.

Hyland A, Cummings KM, Wilson MP. Compliance with the New York City SmokeFree Air Act. Journal of Public Health Management and Practice. 1999;5(1):43–52.

Lakind J, Graves C, Ginevan M. Exposure to environmental tobacco smoke 

in the workplace and the impact of away-from-work exposure. Risk Analysis. 

1999;19(3):349–58.

Moskowitz JM, Lin Z, Hudes ES. The impact of California’s smoking ordinances 

on worksite smoking policy and exposure to environmental tobacco smoke. American 

Journal of Health Promotion. 1999;13(5):278–81, iii.

National Cancer Institute. Smoking and Tobacco Control Monograph No. 12. 

Population-based smoking cessation: proceedings of a conference on What Works to 

Influence Cessation in the General Population. Bethesda, MD: National Cancer 

Institute; 2000. NIH Publication No. 00-4892.

National Cancer Institute. Smoking and Tobacco Control Monograph No. 11. �

State and local legislative action to reduce tobacco use. Bethesda, MD: National Cancer �

Institute; 2000. NIH Publication No. 00-4804.�

Rigotti NA, Stoto MA, Schelling TC. Do businesses comply with a no-smoking law? �

Assessing the self-enforcement approach. Preventive Medicine. 1994;23(2):223–9.�

Sorensen G, Glasgow RE, Corbett K, Topor M. Compliance with worksite nonsmok-�

ing policies: baseline results from the COMMIT study of worksites. American Journal �

of Health Promotion. 1992;7(2):103–9. �

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

149
Outcome 4�

Creation of Tobacco-free Policies Indicator Rating

better

Number Indicator Overall quality Resources

needed

low high Strength of

evaluation evidence

Utility

Face validity

practice

Accepted

2.4.1 Proportion of jurisdictions with public policies for 

tobacco-free workplaces and other indoor and outdoor 

public places

| | | | | | $$$

2.4.2 Proportion of workplaces with voluntary tobacco-free 

policies | | | | | | $$

2.4.3 Proportion of the population that works in 

environments with tobacco-free policies | | | | | | $$†

2.4.4 Proportion of the population reporting voluntary 

tobacco-free home or vehicle policies | | | | | | $$†

2.4.5 Proportion of schools or school districts reporting the 

implementation of 100% tobacco-free school policies | | | | | | $$

2.4.6 Changes in state tobacco control laws that preempt 

stronger local tobacco control laws | | | | | | $

†�Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this indicator were within one 

point of each other (see Appendix B for an explanation).

Denotes no data.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 4

Indicator 2.4.1

Proportion of Jurisdictions with Public Policies for Tobacco-free

Workplaces and Other Indoor and Outdoor Public Places

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 4 Creation of tobacco-free policies

What to measure Proportion of local jurisdictions that have public policies requiring tobacco-free workplaces, including restaurants, bars, and other indoor and outdoor public places

Why this indicator Evidence shows that workplace smoking restrictions reduce nonsmokers’ exposure

is useful to secondhand smoke.1,2 Policies that restrict smoking in workplaces are also linked 

to reduced tobacco use by smokers and possibly lower smoking prevalence.2,3

Example data �

source(s)�

▲

▲

Policy tracking system�

Americans for Nonsmokers’ Rights (ANR)

Information available at: http://www.no-smoke.org

Population group(s) Not applicable. This indicator is best measured by tracking and monitoring pertinent 

local tobacco laws, ordinances, and regulations.

Example survey Not applicable

question(s)

Comments Evaluators may also choose to gather data on the size and demographics of the �

population affected by the relevant laws or ordinances. �

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $$$

better

References

1. �Task Force on Community Preventive Services. The guide to community preventive services: tobacco use prevention and 

control. American Journal of Preventive Medicine. 2001;20(Suppl 2):1–88.

2. �U.S. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, GA: Centers 

for Disease Control and Prevention; 2000.

3. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 12. Population-based smoking cessation: proceedings 

of a conference on What Works to Influence Cessation in the General Population. Bethesda, MD: National Cancer Institute; 2000. 

NIH Publication No. 00-4892.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

151
Indicator 2.4.2�

Proportion of Workplaces with Voluntary Tobacco-free Policies�

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 4 Creation of tobacco-free policies

What to measure Proportion of workplaces (including restaurants and bars) with voluntary 

tobacco-free policies

Why this indicator Individual employers may opt to institute tobacco-free policies on their premises. These

is useful policies reduce nonsmokers’ exposure to secondhand smoke.1,2

Example data �

source(s)�

▲ ▲ ▲ ▲

Worksite Survey�

Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003 

Current Population Survey: Tobacco Use Supplement (CPS TUS), 2003 

Arizona Workplace Survey

Information available at: http://www.tepp.org/evaluation 

Population group(s) Employers

Example survey From ATS

question(s) Which of the following best describes your place of work’s official smoking policy for 

work areas?

Not allowed in any work areas Allowed in some work areas

Allowed in all work areas No official policy

Don’t know/Not sure Refused 

Which of these best describes your place of work’s smoking policy for indoor public or 

common areas such as lobbies, restrooms, and lunch rooms?

Not allowed in any public areas Allowed in some public areas

Allowed in all public areas No official policy 

Don’t know/Not sure Refused

From CPS TUS 

Does your place of work have an official policy that restricts smoking in any way?

Yes No

From Arizona Workplace Survey 

According to the policy, are employees allowed to smoke in the following areas?

Private offices

Open work and production areas

Reception areas

Break areas and lounges

Cafeterias

Hallways and stairwells

Restrooms

Other areas inside the building

Company vehicles

Immediately outside entrances

The rest of the grounds outside

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152
GOAL AREA 2 

▲Outcome 4

Comments� Few surveys have been conducted to assess the percentage of workplaces with tobaccofree policies.

More information about how to collect data on this indicator is in reference 3 below.

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $$

better

References

1. �Task Force on Community Preventive Services. The guide to community preventive services: tobacco use prevention and 

control. American Journal of Preventive Medicine. 2001;20(Suppl 2):1–88.

2. �U.S. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, GA: Centers 

for Disease Control and Prevention; 2000.

3. �Eisenberg M, Ranger-Moore J, Taylor KA, Hall RA, Brown J, Lee H. Workplace tobacco policy: progress on a winding 

road. Journal of Community Health. 2001;26(1):23–37.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

153
Indicator 2.4.3�

Proportion of the Population That Works in Environments with Tobacco-free Policies

Goal area 2� Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 4 Creation of tobacco-free policies

What to measure Proportion of adults employed outside the home whose place of work has a 

tobacco-free policy

Why this indicator� Measuring this indicator shows the degree of protection provided to nonsmoking

is useful� workers by policies that restrict smoking in the workplace.1–4 Examples of such 

polices include a ban on using tobacco on the grounds, a ban on smoking indoors, 

or permitting smoking only in designated areas.

Example data �

source(s)�

▲ ▲

Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003 

Current Population Survey: Tobacco Use Supplement (CPS TUS), 2003 

Population group(s) Adults aged 18 years or older

Example survey From ATS

question(s) Which of the following best describes your place of work’s official smoking policy for 

work areas?

Not allowed in any work areas Allowed in some work areas

Allowed in all work areas No official policy

Don’t know/Not sure Refused

Which of these best describes your place of work’s smoking policy for indoor public or 

common areas such as lobbies, restrooms, and lunch rooms?

Not allowed in any public areas Allowed in some public areas

Allowed in all public areas No official policy 

Don’t know/Not sure Refused

From CPS TUS

Does your place of work have an official policy that restricts smoking in any way?

Yes No

Comments Evaluators may also want to categorize the data collected by occupation of the respondents.�

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

References

1. �Shopland DR, Gerlach KK, Burns DM, Hartman AM, Gibson JT. State-specific trends in smoke-free workplace policy 

coverage: the current population survey tobacco use supplement, 1993 to 1999. Journal of Occupational and Environmental 

Medicine. 2001;43(8):680–6.

2. �Gerlach KK, Shopland DR, Hartman AM, Gibson JT, Pechacek TF. Workplace smoking policies in the United States: 

results from a national survey of more than 100,000 workers. Tobacco Control. 1997;6(3):199–206.

3. �Wortley PM, Caraballo RS, Pederson LL, Pechacek T. Exposure to secondhand smoke in the workplace: serum cotinine 

by occupation. Journal of Occupational and Environmental Medicine. 2002;44(6):503–9.

4. �Shopland DR, Anderson CM, Burns DM, Gerlach KK. Disparities in smoke-free workplace policies among food service 

workers. Journal of Occupational and Environmental Medicine. 2004;46(4):347–56.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

154
GOAL AREA 2 

▲Outcome 4

Indicator 2.4.4

Proportion of the Population Reporting Voluntary 

Tobacco-free Home or Vehicle Policies

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 4 Creation of tobacco-free policies

What to measure Proportion of adults who report some form of voluntary tobacco-free policy in their 

homes or vehicles

Why this indicator� Evidence shows that children living in households with smoking bans are exposed to

is useful� substantially less secondhand smoke than children not protected by such policies.1,2 This 

is especially true in households with at least one smoker.1,2 Examples of such policies are 

(1) smoking not allowed anywhere in the home, (2) smoking restricted to some places in 

the home, or (3) smoking restricted to certain times in the home or vehicle.

Example data Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003

source(s)

Population group(s) Adults aged 18 years or older�

Example survey From ATS

question(s) Which statement best describes the rules about smoking inside your home? 

Do not include decks, garages, or porches.

Smoking is not allowed anywhere inside the home

Smoking is allowed in some places or at some times 

Smoking is allowed anywhere inside the home

Don’t know/Not sure 

Refused

Comments� Evaluators could modify the example question to address tobacco-free policies 

inside vehicles.

The example question could be asked of young people. 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

References

1. �Biener L, Cullen D, Di ZX, Hammond SK. Household smoking restrictions and adolescents’ exposure to environmental 

tobacco smoke. Preventive Medicine. 1997;26(3):358–63. 

2. �Wakefield M, Banham D, Martin J, Ruffin R, McCaul K, Badcock N. Restrictions on smoking at home and urinary cotinine 

levels among children with asthma. American Journal of Preventive Medicine. 2000;19(3):188–92.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

155
Indicator 2.4.5�

Proportion of Schools or School Districts Reporting 

the Implementation of 100% Tobacco-free School Policies

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 4 Creation of tobacco-free policies

What to measure� Proportion of schools or school districts that report having a policy that prohibits 

anyone from using tobacco at all times on school grounds, at all school-sponsored 

functions, and in school vehicles

Why this indicator Young people spend much of their time in school. Their attitudes about the acceptability

is useful of smoking in general and smoking around nonsmokers in particular are influenced by 

the actions of their peers and educators at school.1,2

Example data CDC School Health Profiles: School Principal Questionnaire (Profiles), 2002

source(s)

Population group(s) School principals�

Example survey From Profiles

question(s) Has this school adopted a policy prohibiting tobacco use?

Yes No

Does the tobacco-free policy specifically prohibit use of each of these types of tobacco 

products for each for the following groups? 

Type of tobacco product � Students Faculty/Staff Visitors

Yes No Yes No Yes No

• �Cigarettes

• �Smokeless tobacco

• �Cigars

• �Pipes

Does the school’s tobacco-free policy specifically prohibit tobacco use during each of the 

following times for each for the following groups?

Time � Students Faculty/Staff Visitors

Yes No Yes No Yes No

• �During school hours

• �During non-school hours

Does the school’s tobacco prevention policy specifically prohibit tobacco use in each 

of the following locations for each of the following groups?

Location � Students Faculty/Staff Visitors

Yes No Yes No Yes No

• �In school buildings

• �On school grounds

• �In school buses or other vehicles �

used to transport students �

• �At off-campus, school- �

sponsored events�

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 4

Comments� To measure this indicator fully, evaluators should use all four example questions, not just 

one or two.

Evaluators may also want to collect information on school districts in order to measure 

the proportion of students in the district who are covered by anti-tobacco policies.

This indicator can be used to measure progress toward achieving Recommendation 1 of 

CDC’s “Guidelines for School Health Programs to Prevent Tobacco Use and Addiction.”1

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $$

better

References

1. �Centers for Disease Control and Prevention. Guidelines for school health programs to prevent tobacco use and addiction. 

Morbidity and Mortality Weekly Report Recommendations and Reports. 1994;43(RR-2):1–18.

2. �U.S. Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General.

Atlanta, GA: Centers for Disease Control and Prevention; 1994.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

157
Indicator 2.4.6�

Changes in State Tobacco Control Laws That �

Preempt Stronger Local Tobacco Control Laws �

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 4 Creation of tobacco-free policies

What to measure Any change in legislation that prevents local jurisdictions from enacting restrictions 

that are more stringent than the state’s restrictions on smoke-free indoor air laws

Why this indicator

is useful

Preemptive legislation is the tobacco industry’s chief strategy for eradicating local 

tobacco control ordinances.1

 Because of the striking increase in the number of local 

tobacco control ordinances from the mid-1980s to the mid-1990s, the tobacco industry 

aggressively pushed for states to pass legislation that preempted local regulation of 

tobacco in various areas, including smoke-free indoor air, minors’ access, and marketing.2

As of December 31, 2004, a total of 19 states had at least one type of preemptive provision 

for smoke-free indoor air legislation.2 As of December 31, 2004, only two states, Maine 

and Delaware, had successfully repealed preemption laws in their entirety in any area 

of tobacco control policy. Preemptive laws prevent communities from engaging in the 

process of public education, mobilization, and debate that occurs when a local ordinance 

is under consideration, a process that can increase awareness and change social norms. 

These laws also pose a barrier to local enforcement because communities may be less 

likely to enforce state laws that they were not directly involved in adopting.2 

Example data CDC State Tobacco Activities Tracking and Evaluation (STATE) system

source(s) Data available at: http://www.cdc.gov/tobacco/STATEsystem

Population group(s) Not applicable. This indicator is best measured by tracking and monitoring state tobacco 

control laws.

Example survey Not applicable

question(s)

Comments None 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $

better

Denotes no data.

References

1. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 11. State and local legislative action to reduce tobacco 

use. Bethesda, MD: National Cancer Institute; 2000. NIH Publication No. 00-4804.

2. �Centers for Disease Control and Prevention. Preemptive state smoke-free indoor air laws—United States, 1999–2004. 

Morbidity and Mortality Weekly Report. 2005;54(10):250–3.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

158
GOAL AREA 2 

Outcome 5

Outcome 5

▲

Enforcement of Tobacco-free Public Policies

Experience shows that tobacco-free policies make a difference only when voluntary 

compliance is adequate or the policies are actively enforced. If the entities that are 

regulated (e.g., businesses, public agencies) do not experience any pressure to follow 

newly legislated policies, the policies will contribute little to reducing exposure to 

secondhand smoke. Although little research has been done on the effects of enforcing 

tobacco-free policies, research concerning other policies shows that policy enforcement is effective in improving compliance.1

 With the recent trend toward passing 

comprehensive smoke-free laws that cover bars, the need for active enforcement of 

those laws is likely to become greater.2

Listed below are the indicators associated with this outcome: ▲ ▲ ▲

2.5.1� Number of compliance checks conducted by enforcement agencies

2.5.2� Number of enforcement agency responses to complaints regarding 

noncompliance with tobacco-free public policies

2.5.3� Number of warnings, citations, and fines issued for infractions of 

tobacco-free public policies

References

1. �U.S. Department of Health and Human Services. Preventing tobacco use among 

young people: a report of the Surgeon General. Atlanta, GA: Centers for Disease 

Control and Prevention; 1994.

2. �Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long-term compliance with 

California’s Smoke-Free Workplace Law among bars and restaurants in Los 

Angeles County. Tobacco Control. 2003;12(3):269–73.

For Further Reading

Biener L, Cullen D, Di ZX, Hammond SK. Household smoking restrictions and 

adolescents’ exposure to environmental tobacco smoke. Preventive Medicine.

1997;26(3):358–63. 

Farkas A, Gilpin EA, Distefan JM, Pierce JP. The effects of household and workplace 

smoking restrictions on quitting behaviours. Tobacco Control. 1999;8(3):261–5.

Farkas AJ, Gilpin EA, White MM, Pierce JP. Association between household and 

workplace smoking restrictions and adolescent smoking. Journal of the American 

Medical Association. 2000;284(6):717–22.

Gilpin EA, Pierce JP. The California Tobacco Control Program and potential harm 

reduction through reduced cigarette consumption in continuing smokers. Nicotine 

and Tobacco Research. 2002;4(Suppl 2):S157–66.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

159
Gilpin EA, White MM, Farkas AJ, Pierce JP. Home smoking restrictions: which 

smokers have them and how they are associated with smoking behavior. Nicotine 

and Tobacco Research. 1999;1(2):153–62. 

Hopper JA, Craig KA. Environmental tobacco smoke exposure among urban 

children. Pediatrics. 2000;106(4):E47.

Hyland A, Cummings KM, Wilson MP. Compliance with the New York City SmokeFree Air Act. Journal of Public Health Management and Practice. 1999;5(1):43–52.

Jacobson PD, Wasserman J. The implementation and enforcement of tobacco control 

laws: policy implications for activists and the industry. Journal of Health Politics, Policy 

and Law. 1999;24(3):567–98.

Kegler M, Malcoe LH. Smoking restrictions in the home and car among rural 

Native American and white families with young children. Preventive Medicine.

2002;35(4):334–42.

Lynch BS, Bonnie RJ. Growing up tobacco free: preventing nicotine addiction in children 

and youths. Washington, DC: National Academy Press; 1994. 

Pentz MA, Brannon BR, Charlin VL, Barrett EJ, MacKinnon DP, Flay BR. The power 

of policy: the relationship of smoking policy to adolescent smoking. American Journal 

of Public Health. 1989;79:857–62.

Task Force on Community Preventive Services. The guide to community preventive 

services: tobacco use prevention and control. American Journal of Preventive Medicine.

2001;20(Suppl 2):1–88.

Wakefield M, Banham D, Martin J, Ruffin R, McCaul K, Badcock N. Restrictions of 

smoking at home and urinary cotinine levels among children with asthma. American 

Journal of Preventive Medicine. 2000;19(3):188–92.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 5

Outcome 5

Enforcement of Tobacco-free Public Policies Indicator Rating

better

Number Indicator Overall quality Resources

needed

low high Strength of

evaluation evidence

Utility

Face validity

practice

Accepted

2.5.1 Number of compliance checks conducted by enforcement 

agencies | | | | | | $$$

2.5.2 Number of enforcement agency responses to complaints 

regarding noncompliance with tobacco-free public 

policies 

| | | | | |† $$$

2.5.3 Number of warnings, citations, and fines issued for 

infractions of tobacco-free public policies | | | | | | $$$

†�Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this indicator were within one 

point of each other (see Appendix B for an explanation).

Denotes no data.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

161
Indicator 2.5.1�

Number of Compliance Checks Conducted by Enforcement Agencies �

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 5 Enforcement of tobacco-free public policies

What to measure� The number of checks conducted by enforcement agencies (e.g., police, health 

department inspectors, and building inspectors) to assess the level of compliance 

with laws, regulations, and ordinances related to tobacco-free policies

Why this indicator� An effective means of enforcing tobacco-free public policies is to conduct regular

is useful� compliance checks. Such checks convey the message that policy makers and the public 

care about tobacco-free policies and are serious about enforcing them.1,2

Example data �

source(s)�

▲ ▲

Enforcement Agency Survey�

California Independent Evaluation: Policy Enforcement Survey: Exposure to 

Environmental Tobacco Smoke, 2000

Information available at: http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/

Evaluation_Resources.htm 

Population group(s) Agency representatives responsible for enforcement�

Example survey From California Independent Evaluation

question(s) In the last year, how often has your agency conducted any of the following types 

of enforcement activities related to clean indoor air laws? Don’t know

1–7, where 1 = never and 7 = very often Not applicable

•�Responded to inquiries 1 2 3 4 5 6 7 

•�Responded to complaints 1 2 3 4 5 6 7 

•�Issued warnings 1 2 3 4 5 6 7 

•�Issued citations 1 2 3 4 5 6 7 

•�Issued fines 1 2 3 4 5 6 7 

•�Conducted compliance checks 1 2 3 4 5 6 7 

•�Educated business owners about the law 1 2 3 4 5 6 7 

•�Educated others about the law 1 2 3 4 5 6 7 

Comments Survey respondents may not have access to all requested information. 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $$$

better

Denotes no data.

References

1. �Kiser D, Boschert T. Eliminating smoking in bars, restaurants, and gaming clubs in California: BREATH, the California 

Smoke-Free Bar Program. Journal of Public Health Policy. 2001;22(1):81–7.

2. �Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long-term compliance with California’s Smoke-Free Workplace Law 

among bars and restaurants in Los Angeles County. Tobacco Control. 2003;12(3):269–73.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 5

Indicator 2.5.2

Number of Enforcement Agency Responses to Complaints 

Regarding Noncompliance with Tobacco-free Public Policies

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 5 Enforcement of tobacco-free public policies

What to measure� The number of checks (prompted by outside complaints) by enforcement agencies 

(e.g., police, health department inspectors, and building inspectors) to assess the 

level of compliance with tobacco-free public policies

Why this indicator

is useful

Recording complaints of noncompliance with tobacco-free public policies is one way 

of identifying noncompliance with such policies. Such checks convey the message that 

policy makers and the public care about tobacco-free policies and are serious about 

enforcing them.1,2 Following up on these complaints is an easy way of targeting noncompliance. The number of complaints received by enforcement agencies also provides a 

sense of the public’s attitude toward tobacco-free policies. 

Example data �

source(s)�

▲ ▲

Enforcement Agency Survey�

California Independent Evaluation: Policy Enforcement Survey: Exposure to 

Environmental Tobacco Smoke, 2000

Information available at: http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/

Evaluation_Resources.htm

Population group(s) Agency representatives responsible for enforcement�

Example survey � From California Independent Evaluation

question(s) In the last year, how often has your agency conducted any of the following types of 

enforcement activities related to clean indoor air laws?

Don’t know

1–7, where 1 = never and 7 = very often Not applicable

•�Responded to inquiries 1 2 3 4 5 6 7 •�Responded to complaints 1 2 3 4 5 6 7 •�Issued warnings 1 2 3 4 5 6 7 •�Issued citations 1 2 3 4 5 6 7 •�Issued fines 1 2 3 4 5 6 7 •�Conducted compliance checks 1 2 3 4 5 6 7 •�Educated business owners about the law 1 2 3 4 5 6 7 •�Educated others about the law 1 2 3 4 5 6 7 

Comments Survey respondents may not have access to all the requested information. 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

† | | | | | | $$$

better

† �Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

Denotes no data.

References

1. �Kiser D, Boschert T. Eliminating smoking in bars, restaurants, and gaming clubs in California: BREATH, the California 

Smoke-Free Bar Program. Journal of Public Health Policy. 2001;22(1):81–7.

2. �Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long-term compliance with California’s Smoke-Free Workplace Law 

among bars and restaurants in Los Angeles County. Tobacco Control. 2003;12(3):269–73.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

163
Indicator 2.5.3�

Number of Warnings, Citations, and Fines Issued 

for Infractions of Tobacco-free Public Policies

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 5 Enforcement of tobacco-free public policies

What to measure The number of the warnings, citations, and fines issued to retailers for infractions 

of tobacco-free public policies

Why this indicator Compliance with tobacco-free public policies improves when noncompliance has

is useful repercussions.1,2 Issuing warnings or citations sets an example and shows that 

noncompliance with tobacco-free policies has adverse consequences.

Example data �

source(s)�

▲ ▲

Enforcement Agency Survey�

California Independent Evaluation: Policy Enforcement Survey: Exposure to 

Environmental Tobacco Smoke, 2000 

Information available at: http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/

Evaluation_Resources.htm

Population group(s) Agency representatives responsible for enforcement�

Example survey � From California Independent Evaluation

question(s)� In the last six months, please estimate how many citations for violation of clean indoor 

air laws were

• Issued in your jurisdiction? _____(# of citations issued) 

• Prosecuted in your jurisdiction? _____(# of citations prosecuted) 

Comments� The example survey question does not measure warnings given for noncompliance. 

Evaluators may also want to assess the effects that different penalties (e.g., graduated 

fines) have on compliance with tobacco-free public policies.

Data must be interpreted in context. For example, a low number of citations may 

indicate either high compliance or low enforcement. 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $$$

better

Denotes no data.

References

1. �Centers for Disease Control and Prevention. Best practices for comprehensive tobacco control programs. Atlanta, GA: Centers 

for Disease Control and Prevention; 1999.

2. �Task Force on Community Preventive Services. The guide to community preventive services: tobacco use prevention and 

control. American Journal of Preventive Medicine. 2001;20(Suppl 2):1–88.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

164
GOAL AREA 2 

Outcome 6

Outcome 6

▲

Compliance with Tobacco-free Policies

The evidence is clear that exposure to secondhand smoke is harmful and that 

increasing the number of tobacco-free environments can save lives.1 Compliance 

with voluntary tobacco-free policies in homes and vehicles is an important marker 

of social normative changes that have an effect on the health of children and 

on tobacco use among young people.2 Although the need for compliance with 

tobacco-free policies is apparent, little research has been done specifically on 

whether increased compliance leads to decreased exposure to secondhand smoke 

(perhaps because the connection has face validity). Perceived compliance can be 

measured as that reported by members of a community responding to questionnaires 

and interviews. Actual compliance can be measured by observation. Observational 

measures capture a point in time, while population-based surveys capture the 

perceptions of individuals regarding compliance over a prior period. 

Listed below are the indicators associated with this outcome: ▲ ▲ ▲ ▲ ▲

2.6.1� Perceived compliance with tobacco-free policies in workplaces

2.6.2� Perceived compliance with tobacco-free policies in indoor and 

outdoor public places

2.6.3� Proportion of public places observed to be in compliance with tobaccofree policies

2.6.4� Perceived compliance with voluntary tobacco-free home or vehicle 

policies

2.6.5� Perceived compliance with tobacco-free policies in schools

References

1. �U.S. Department of Health and Human Services. The health consequences of smoking: 

a report of the Surgeon General. Atlanta, GA: Centers for Disease Control and 

Prevention; 2004.

2. �Wakefield M, Chaloupka F, Kaufman N, Orleans C, Barker D, Ruel E. Effect of 

restrictions at home, at school, and in public places on teenage smoking: cross 

sectional study. British Medical Journal. 2000;321(7257):333–7. Erratum in: British 

Medical Journal. 2000;321(7261):623.

For Further Reading

Lynch BS, Bonnie RJ. Growing up tobacco free: preventing nicotine addiction in children 

and youths. Washington, DC: National Academy Press; 1994. 

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

165
Pentz MA, Brannon BR, Charlin VL, Barrett EJ, MacKinnon DP, Flay BR. The power 

of policy: the relationship of smoking policy to adolescent smoking. American Journal 

of Public Health. 1989;79(7):857–862.

U.S. Department of Health and Human Services. Preventing tobacco use among young 

people: a report of the Surgeon General. Atlanta, GA: Centers for Disease Control and 

Prevention; 1994.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

166
GOAL AREA 2 

▲Outcome 6

Outcome 6

Compliance with Tobacco-free Policies� Indicator Rating

better

Number Indicator Overall quality needed

low high Resources

Strength of

evaluation evidence

Utility

Face validity

practice

Accepted

2.6.1 Perceived compliance with tobacco-free policies in 

workplaces | | | | | | $$†

2.6.2 Perceived compliance with tobacco-free policies in 

indoor and outdoor public places | | | | | | $$$†

2.6.3 Proportion of public places observed to be in compliance 

with tobacco-free policies | | | | | | $$$$†

2.6.4 Perceived compliance with voluntary tobacco-free home 

or vehicle policies | | | | | | $$†

2.6.5 Perceived compliance with tobacco-free policies 

in schools | | | | | | $$

†�Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this indicator were within one 

point of each other (see Appendix B for an explanation).

Denotes no data.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

167
Indicator 2.6.1�

Perceived Compliance with Tobacco-free Policies in Workplaces �

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 6 Compliance with tobacco-free policies

What to measure Proportion of adults employed outside the home reporting employee compliance with 

their workplace’s tobacco-free policies

Why this indicator� Perceived compliance with tobacco-free policies is one measure of actual compliance

is useful� with these policies.1,2 If tobacco-free policies are not followed, they are unlikely to protect 

nonsmokers from the harmful effects of secondhand smoke or change social norms.1

Example data Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003

source(s)

Population group(s) Adults aged 18 years or older�

Example survey From ATS

question(s) As far as you know, in the past 7 days, that is since [fill in date], has anyone 

smoked in your work area?

Yes No Don’t know/Not sure Refused

Comments� Evaluators may also want to gather each company’s demographic data (e.g., on the 

company’s size or type of business).

Evaluators should determine the scope of the tobacco-free policies before evaluating 

perceived compliance with them.

The example questions could also be asked of employers.

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$

better

† �Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

Denotes no data.

References

1. �Shopland DR, Anderson CM, Burns DM, Gerlach KK. Disparities in smoke-free workplace policies among food service 

workers. Journal of Occupational and Environmental Medicine. 2004;46(4):347–56.

2. �Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long-term compliance with California’s smoke-free workplace law 

among bars and restaurants in Los Angeles County. Tobacco Control. 2003;12(3):269–73.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

168
GOAL AREA 2 

▲Outcome 6

Indicator 2.6.2

Perceived Compliance with Tobacco-free Policies 

in Indoor and Outdoor Public Places

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 6 Compliance with tobacco-free policies

What to measure Proportion of adults and young people who report compliance with tobacco-free policies 

in public places (e.g., bars, restaurants, and sporting arenas)

Why this indicator� Perceived compliance with tobacco-free policies is one measure of actual compliance

is useful� with these policies.1,2 If tobacco-free policies are not followed, they are not likely to protect nonsmokers from the harmful effects of secondhand smoke or change social norms.1

Example data No commonly used data sources were found

source(s)

Population group(s)�

▲ ▲

Adults aged 18 years or older

Young people aged less than 18 years

Example survey � In your community, how many people break the policy that bans smoking in:

question(s) None A few Some Most All Don’t Not Refused

of know applicable to

them Not sure answer

•�Bars

•�Restaurants 

•�Indoor public places 

•�Outdoor public places 

Comments� The authors created this example question. It is not in any commonly used data source.

Evaluators should determine the scope of tobacco-free policies before evaluating 

perceived compliance with them.

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$$

better

† �Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

Denotes no data.

References

1. �Shopland DR, Anderson CM, Burns DM, Gerlach KK. Disparities in smoke-free workplace policies among food service 

workers. Journal of Occupational and Environmental Medicine. 2004;46(4):347–56.

2. �Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long-term compliance with California’s smoke-free workplace law 

among bars and restaurants in Los Angeles County. Tobacco Control. 2003;12(3):269–73.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

169
Indicator 2.6.3�

Proportion of Public Places Observed to Be in Compliance with Tobacco-free Policies

Goal area 2� Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 6 Compliance with tobacco-free policies

What to measure Proportion of indoor or outdoor places (e.g., bars, restaurants, and sporting arenas) 

in a community in which employees and patrons comply with tobacco-free policies

Why this indicator� Observing whether people (employees and patrons) comply with tobacco-free policies

is useful� is a systematic way to measure compliance at a given place and time.1

 If tobacco-free 

policies are not followed, they are not likely to protect nonsmokers from the harmful 

effects of secondhand smoke or change social norms.2

Example data �

source(s)�

▲ ▲

Direct observation of employees’ and patrons’ behavior�

California’s BREATH (Smoke-Free Bars, Workplaces, and Communities Program)

Information available at: http://www.breath-ala.org 

Population group(s) Not applicable. This indicator is best measured by observation.�

Example survey Not applicable. This indicator is best measured by observation.

question(s)

Comments� In addition to observing smoking-related behavior in public places, evaluators 

can measure the environmental tobacco smoke in these places by monitoring indoor 

air quality.3–5

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$$$

better

† �Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

Denotes no data.

References

1. �Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long-term compliance with California’s Smoke-Free Workplace Law 

among bars and restaurants in Los Angeles County. Tobacco Control. 2003;12(3):269–73.

2. �Shopland DR, Anderson CM, Burns DM, Gerlach KK. Disparities in smoke-free workplace policies among food service 

workers. Journal of Occupational and Environmental Medicine. 2004;46(4):347–56.

3. �Cains T, Cannata S, Poulos R, Ferson M, Stewart B. Designated “no smoking” areas provide from partial to no protection 

from environmental tobacco smoke. Tobacco Control. 2004;13(1):17–22.

4. �Repace J. An air quality survey of respirable particles and particulate carcinogens in Delaware hospitality venues before and after 

a smoking ban. Bowie, MD: Repace Associates; 2003. Available from: http://www.tobaccoscam.ucsf.edu/pdf/

RepaceDelaware.pdf. Accessed December 2004.

5. �Kiser D, Boschert T. Eliminating smoking in bars, restaurants, and gaming clubs in California: BREATH, the California 

Smoke-Free Bar Program. Journal of Public Health Policy. 2001;22(1):81–7.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 6

Indicator 2.6.4

Perceived Compliance with Voluntary Tobacco-free Home or Vehicle Policies

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 6 Compliance with tobacco-free policies

What to measure Proportion of adults and young people who report compliance with tobacco-free policies 

in their homes or vehicles

Why this indicator� Perceived compliance with tobacco-free policies is one measure of actual compliance with

is useful� these policies.1,2 Self-reported data on people’s exposure to secondhand smoke at home or 

in vehicles can be used to measure compliance with tobacco-free policies.3,4 Compliance 

with home and vehicle tobacco-free policies is especially important for protecting the 

health of children and for supporting anti-tobacco social norms.5,6

Example data Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003

source(s)

Population group(s) Adults aged 18 years or older�

Example survey From ATS

question(s) For respondents who report they have a smoke-free home policy

During the past 7 days (that is, since [fill in date]), how many days did anyone smoke 

cigarettes, cigars, or pipes anywhere inside your home?

___ days (0–7) Don’t know/Not sure Refused

Comments� Evaluators may want to modify the example question to address tobacco-free policies 

inside vehicles.

Evaluators should determine the scope of the tobacco-free policies before evaluating 

perceived compliance with them.

The example survey question could be asked of young people. 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

References

1. �Shopland DR, Anderson CM, Burns DM, Gerlach KK. Disparities in smoke-free workplace policies among food service 

workers. Journal of Occupational and Environmental Medicine. 2004;46(4):347–56.

2. �Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long-term compliance with California’s smoke-free workplace law 

among bars and restaurants in Los Angeles County. Tobacco Control. 2003;12(3):269–73.

3. �Biener L, Cullen D, Di ZX, Hammond SK. Household smoking restrictions and adolescents’ exposure to environmental 

tobacco smoke. Preventive Medicine. 1997;26(3):358–63. 

4. �Wakefield M, Banham D, Martin J, Ruffin R, McCaul K, Badcock N. Restrictions on smoking at home and urinary 

cotinine levels among children with asthma. American Journal of Preventive Medicine. 2000;19(3):188–92.

5. �U.S. Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders.

Washington, DC: EPA Office of Research and Development; 1992. Publication No. EPA/600/6-90/006F. 

6. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 10. Health effects of exposure to environmental 

tobacco smoke: the report of the California Environmental Protection Agency. Bethesda, MD: National Cancer Institute; 1999. 

NIH Publication No. 99-4645.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

171
Indicator 2.6.5�

Perceived Compliance with Tobacco-free Policies in Schools �

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 6 Compliance with tobacco-free policies

What to measure Proportion of students who report that the school population is complying with the 

school’s tobacco-free policies

Why this indicator Perceived compliance with tobacco-free policies is one measure of actual compliance with

is useful these policies.1,2 Compliance with tobacco-free school policies reduces students’ exposure 

to secondhand smoke and reinforces anti-tobacco social norms.3

Example data �

source(s)�

▲ ▲ ▲

Youth Tobacco Survey (YTS): CDC Recommended Questions: Core, 2004�

CDC Youth Risk Behavior Surveillance System (YRBSS), 2003 �

California Independent Evaluation: Youth Survey, 2000�

Information available at: http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/�

Evaluation_Resources.htm�

Population group(s) Young people aged less than 18 years�

Example survey 

question(s)

From YTS and YRBSS 

During the past 30 days, on how many days did you smoke cigarettes 

on school property?

0 days 1 or 2 days 3 to 5 days 6 to 9 days 

10 to 19 days 20 to 29 days All 30 days 

During the past 30 days, on how many days did you use chewing tobacco, snuff, 

or dip on school property?

0 days 1 or 2 days 3 to 5 days 6 to 9 days 

10 to 19 days 20 to 29 days All 30 days

From California Independent Evaluation

Is there a rule at your school that no one is allowed to smoke cigarettes in the school 

building or on the school yard?

Yes No I don’t know/I’m not sure

Have you seen any students break that rule?

Yes No My school does not have a no-smoking rule 

I don’t know/I’m not sure 

How many students who are smokers break that rule?

None A few Some Most All of them 

My school does not have a no-smoking rule I don’t know/I’m not sure

Have you seen adults break that rule?

Yes No My school does not have a no-smoking rule 

I don’t know/I’m not sure

Is there a rule at your school that no one is allowed to use chewing tobacco or snuff in 

the school building or on the school yard?

Yes No I don’t know/I’m not sure

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 6

Comments� If students report on the YTS or YRBSS instruments (1) the existence of a tobacco-free 

school policy and (2) having personally used tobacco products more than 1 day on school 

property, they are considered noncompliant. 

Evaluators may also want to categorize data by grade level and type of school 

(e.g., elementary, middle, high school, private, parochial, public). 

Evaluators should determine the scope of the tobacco-free policies before evaluating 

perceived compliance with them.

The example survey questions could be asked of teachers and principals.

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $$

better

References

1. �Shopland DR, Anderson CM, Burns DM, Gerlach KK. Disparities in smoke-free workplace policies among food 

service workers. Journal of Occupational and Environmental Medicine. 2004;46(4):347–56.

2. �Weber MD, Bagwell DA, Fielding JE, Glantz SA. Long-term compliance with California’s smoke-free workplace law 

among bars and restaurants in Los Angeles County. Tobacco Control. 2003;12(3):269–73.

3. �Gilpin EA, White MM, White VM, Distefan JM, Trinidad DR, Lee L, Major J, Kealey S, Pierce JP. Tobacco control successes 

in California: a focus on young people, results from the California Tobacco Surveys 1990–2002. La Jolla, CA: University of 

California, San Diego; 2003. pp. 348–9. Available from: http://repositories.cdlib.org/tc/surveys/CTC1990-2002.

Accessed December 2004.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

173
Outcome 7� ▲ ▲ ▲ ▲ ▲

Reduced Exposure to Secondhand Smoke 

There is substantial evidence regarding the harm caused by exposure to secondhand 

smoke. Secondhand smoke can lead to lung cancer and heart disease in adults and to 

many serious health problems (e.g., lower respiratory infections, asthma, 

sudden infant death syndrome, ear infections) in children.1–3 Evidence also indicates 

that tobacco smoke is especially harmful to pregnant women and to fetal development.1,2 Reducing nonsmokers’ exposure to secondhand smoke can prevent disease 

and save lives.1–4 Median exposure levels and the percentage of nonsmokers in the 

United States who are exposed to secondhand smoke have decreased significantly.5

Listed below are the indicators associated with this outcome:

2.7.1� Proportion of the population reporting exposure to secondhand smoke 

in the workplace

2.7.2� Proportion of the population reporting exposure to secondhand smoke 

in public places

2.7.3� Proportion of the population reporting exposure to secondhand smoke 

at home or in vehicles

2.7.4� Proportion of students reporting exposure to secondhand smoke �

in schools�

2.7.5� Proportion of nonsmokers reporting overall exposure to secondhand 

smoke

References

1. �U.S. Department of Health and Human Services. The health consequences of 

smoking: a report of the Surgeon General. Atlanta, GA: Centers for Disease Control 

and Prevention; 2004.

2. �U.S. Department of Health and Human Services. Women and smoking: a report of 

the Surgeon General. Rockville, MD: Office of the Surgeon General; Washington, 

DC: Government Printing Office; 2001.

3. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 10. 

Health effects of exposure to environmental tobacco smoke: the report of the California 

Environmental Protection Agency. Bethesda, MD: National Cancer Institute; 1999. 

NIH Publication No. 99-4645.

4. �U.S. Environmental Protection Agency. Respiratory health effects of passive smoking: 

lung cancer and other disorders. Washington, DC: EPA Office of Research and 

Development; 1992. Publication No. EPA/600/6-90/006F. 

5. �Changes in secondhand smoke exposure among nonsmokers from different 

racial/ethnic groups: United States, 1988–1994 and 1999–2000. Data from 1988–

1994 NHANES III survey and 1999–2000 NHANES survey. Poster Presentation. 

132nd Annual American Public Health Association Meeting, Washington, DC, 

November 6–10, 2004. 

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

174
GOAL AREA 2 

Outcome 7 ▲

For Further Reading

Mannino DM, Caraballo R, Benowitz N, Repace J. Predictors of cotinine levels in 

U.S. children: data from the Third National Health and Nutrition Examination 

Survey. Chest. 2001;120(3):718–24.

Pizacani BA, Martin DP, Stark MJ, Koepsell TD, Thompson B, Diehr P. Household 

smoking bans: which households have them and do they work? Preventive Medicine. 

2003;36(1):99–107.

Poulsen L. Exposure to teachers smoking and adolescent smoking behaviour: 

analysis of cross sectional data from Denmark. Tobacco Control. 2002;11(3):246–51.

Wakefield M, Banham D, Martin J, Ruffin R, McCaul K, Badcock N. Restrictions 

of smoking at home and urinary cotinine levels among children with asthma. 

American Journal of Preventive Medicine. 2000;19(3):188–92.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

175
Outcome 7�

Reduced Exposure to Secondhand Smoke� Indicator Rating

better

Number Indicator Overall quality Resources

needed

low high Strength of

Face validity

evaluation evidence

Utility

practice

Accepted

2.7.1 Proportion of the population reporting exposure to 

secondhand smoke in the workplace | | | | | | $$†

2.7.2 Proportion of the population reporting exposure to 

secondhand smoke in public places | | | | | |† $$$

2.7.3 Proportion of the population reporting exposure to 

secondhand smoke at home or in vehicles | | | | | | $$†

2.7.4 Proportion of students reporting exposure to secondhand

smoke in schools | | | | | | $$$

2.7.5 Proportion of nonsmokers reporting overall exposure 

to secondhand smoke | | | | | | $$

†�Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this indicator were within one 

point of each other (see Appendix B for an explanation).

Denotes no data.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 7

Indicator 2.7.1

Proportion of the Population Reporting Exposure 

to Secondhand Smoke in the Workplace

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 7 Reduced exposure to secondhand smoke

What to measure Proportion of adults who are employed outside the home and who report exposure 

to secondhand smoke in the workplace

Why this indicator� Exposure to secondhand smoke is a major cause of death and disease.1–4 For nonsmokers

is useful� who are not exposed to secondhand smoke in their homes, the workplace is typically 

their greatest source of exposure. Studies show that after only 3 months of decreased 

workplace exposure to secondhand smoke, nonsmokers’ lung function improves and 

their respiratory symptoms are reduced.5

Example data � California Adult Tobacco Survey (CATS), 1999

source(s)� Information available at: http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/

Evaluation_Resources.htm

Population group(s) Adults aged 18 years or older�

Example survey From CATS

question(s) During the past two weeks has anyone smoked in the area in which you work?

Yes No Don’t know/Not sure Refused

Comments None

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

References

1. �U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General.

Atlanta, GA: Centers for Disease Control and Prevention; 2004.

2. �U.S. Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Rockville, MD: 

U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

3. �U.S. Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders.

Washington, DC: EPA Office of Research and Development; 1992. Publication No. EPA/600/6-90/006F. 

4. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 10. Health effects of exposure to environmental 

tobacco smoke: the report of the California Environmental Protection Agency. Bethesda, MD: National Cancer Institute; 1999. 

NIH Publication No. 99-4645.

5. �Eisner MD, Smith AK, Blanc PD. Bartenders’ respiratory health after establishment of smoke-free bars and taverns. 

Journal of the American Medical Association. 1998;280(22);1909–14.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

177
Indicator 2.7.2�

Proportion of the Population Reporting Exposure 

to Secondhand Smoke in Public Places

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 7 Reduced exposure to secondhand smoke

What to measure Proportion of the population reporting exposure to secondhand smoke in public 

places, including bars, restaurants, sporting arenas, and concert venues

Why this indicator

is useful

Exposure to secondhand smoke is a major cause of death and disease.1–4 Many 

studies show that exposure to secondhand smoke leads to lung cancer and heart 

disease in adults and to multiple health problems, such as severe asthma, lower 

respiratory tract infections, and ear infections in children.1–4 The public is exposed 

to secondhand smoke in many public places. Measuring exposure in public settings 

is necessary for assessing overall exposure levels.5

Example data California Adult Tobacco Survey (CATS), 1999

source(s) Information available at: http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/

Evaluation_Resources.htm

Population group(s) Adults aged 18 years or older

Example survey From CATS

question(s) During the past 7 days, when you were some place other than work or home, how 

many days were you exposed to other people’s tobacco smoke?

Comments The example survey question could be asked of young people.

Rating Overall quality

low high

Resources 

needed

Strength of 

evaluation 

evidence

Utility Face validity Accepted 

practice

† $$$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

| | | | | |

References

1. �U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. 

Atlanta, GA: Centers for Disease Control and Prevention; 2004.

2. U.S. Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Rockville, MD: 

U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

3. �U.S. Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders. 

Washington, DC: EPA Office of Research and Development; 1992. Publication No. EPA/600/6-90/006F. 

4. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 10. Health effects of exposure to environmental 

tobacco smoke: the report of the California Environmental Protection Agency. Bethesda, MD: National Cancer Institute; 1999. 

NIH Publication No. 99-4645.

5. �Centers for Disease Control and Prevention. Taking action against secondhand smoke. Atlanta, GA: Centers for Disease 

Control and Prevention; 2004. Available from: http://www.cdc.gov/tobacco/ETS_Toolkit. Accessed March 2005.

K E Y O U T C O M E I N D I C A T O R S for Evaluating Comprehensive Tobacco Control Programs

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GOAL AREA 2 

▲Outcome 7

Indicator 2.7.3

Proportion of the Population Reporting Exposure 

to Secondhand Smoke at Home or in Vehicles

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke�

Outcome 7 Reduced exposure to secondhand smoke

What to measure Proportion of the population reporting exposure to secondhand smoke at home 

or in vehicles

Why this indicator� Exposure to secondhand smoke at home or in vehicles is a serious health hazard.1–4

is useful� Many studies show that exposure to secondhand smoke leads to lung cancer and 

heart disease in adults and to multiple health problems, such as severe asthma, 

lower respiratory tract infections, and ear infections in children.1–4

Example data 

source(s)

Population group(s)�

▲

▲ ▲ ▲

Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003 �

Youth Tobacco Survey (YTS): CDC Recommended Questions: Core, 2004 �

Adults aged 18 years or older

Young people aged less than 18 years 

Example survey 

question(s)

From ATS 

During the past 7 days (that is, since [fill in date]), how many days did anyone smoke 

cigarettes, cigars, or pipes anywhere inside your home? 

Less than 1 day per week Rarely None ___days (1–7) 

Don’t know/Not sure Refused

In the past 7 days (that is, since [fill in date]), have you been in a car with someone 

who was smoking? 

Yes No

From YTS 

During the past 7 days, on how many days were you in the same room with someone 

who was smoking cigarettes?

0 days 1 or 2 days 3 or 4 days 5 or 6 days 7 days

During the past 7 days, on how many days did you ride in a car with someone who 

was smoking cigarettes?

0 days 1 or 2 days 3 or 4 days 5 or 6 days 7 days

Comments The ATS and YTS example survey questions can only be used to gather data on exposure 

to smoke during the previous 7 days and not to quantify exposure level.

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | † $$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

179
References

1. �U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General.

Atlanta, GA: Centers for Disease Control and Prevention; 2004.

2. �U.S. Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Rockville, MD: 

U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

3. �U.S. Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders.

Washington, DC: EPA Office of Research and Development; 1992. Publication No. EPA/600/6-90/006F. 

4. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 10. Health effects of exposure to environmental 

tobacco smoke: the report of the California Environmental Protection Agency. Bethesda, MD: National Cancer Institute; 1999. 

NIH Publication No. 99-4645.

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180
GOAL AREA 2 

▲Outcome 7

Indicator 2.7.4

Proportion of Students Reporting Exposure to Secondhand Smoke in Schools

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 7 Reduced exposure to secondhand smoke

What to measure� Proportion of students reporting exposure to tobacco smoke while on school grounds, 

at school-sponsored functions, and in school vehicles (exposure can occur during or 

after regular school hours)

Why this indicator� Exposure to secondhand smoke is a major cause of death and disease.1–4 Young people

is useful� spend many of their waking hours in school, where they might be exposed to secondhand smoke. Compliance with tobacco-free school policies reduces students’ exposure 

to secondhand smoke and reinforces anti-tobacco social norms.5

Example data No commonly used data sources were found

source(s)

Population group(s) Students�

Example survey When you are at school, are you exposed to smoke from other people’s cigarettes, pipes,

question(s) or cigars?

Yes No

Comments� The authors created this example question. It is not in any commonly used data source.

Evaluators might also want to measure secondhand smoke exposure on college 

campuses. 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $$$

better

Denotes no data.

References

1. �U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General.

Atlanta, GA: Centers for Disease Control and Prevention; 2004.

2. �U.S. Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders.

Washington, DC: EPA Office of Research and Development; 1992. Publication No. EPA/600/6-90/006F. 

3. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 10. Health effects of exposure to environmental 

tobacco smoke: the report of the California Environmental Protection Agency. Bethesda, MD: National Cancer Institute; 1999. 

NIH Publication No. 99-4645.

4. �U.S. Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Rockville, MD: 

U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

5. �Gilpin EA, White MM, White VM, Distefan JM, Trinidad DR, Lee L, Major J, Kealey S, Pierce JP. Tobacco control successes 

in California: a focus on young people, results from the California Tobacco Surveys 1990–2002. La Jolla, CA: University of 

California, San Diego; 2003. pp. 348–349. Available from: http://repositories.cdlib.org/tc/surveys/CTC1990-2002/.

Accessed December 2004.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

181
Indicator 2.7.5�

Proportion of Nonsmokers Reporting Overall Exposure to Secondhand Smoke �

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 7 Reduced exposure to secondhand smoke

What to measure Nonsmokers’ level of exposure to secondhand smoke. Such exposure can be caused �

by family members, co-workers, or strangers in public places.�

Why this indicator� Exposure to secondhand smoke is a major cause of death and disease.1–4 Trends in

is useful� nonsmokers’ overall level of exposure to secondhand smoke are an important gauge 

of the success of efforts to reduce this exposure.5–7

Example data 

source(s)

Population group(s)�

▲ ▲ ▲ ▲

Youth Tobacco Survey (YTS): CDC Recommended Questions: Core, 2004 �

California Independent Evaluation: Adult Survey, 2000 �

Information available at: http://www.dhs.ca.gov/ps/cdic/ccb/TCS/html/�

Evaluation_Resources.htm �

Adults aged 18 years or older

Young people aged less than 18 years

Example survey 

question(s)

From YTS 

During the past 7 days, on how many days were you in the same room with someone 

who was smoking cigarettes?

0 day 1 or 2 days 3 or 4 days 5 or 6 days 7 days

During the past 7 days, on how many days did you ride in a car with someone who was 

smoking cigarettes?

0 day 1 or 2 days 3 or 4 days 5 or 6 days 7 days

From California Independent Evaluation 

During the past 7 days, when you were at home, how many days were you exposed 

to other family members’ or visitors’ tobacco smoke? 

None 1 day 2 days 3 days 4 days 5 days 6 days 7 days

Was not home in the past 7 days

Of those who were exposed on some days, ask the following:

On these days, about how many hours per day were you exposed to other �

people’s smoke? �

Write the actual number of hours per day ____________________________________�

During the past 7 days, when you were at work, how many days were you exposed 

to other people’s tobacco smoke? 

None 1 day 2 days 3 days 4 days 5 days 6 days 7 days

Was not at work in the past 7 days

Of those who were exposed on some days, ask the following:

On these days, about how many hours per day were you exposed to other �

people’s smoke? �

Write the actual number of hours per day____________________________________�

During the past 7 days, when you were some place other than work or home, 

how many days were you exposed to other people’s tobacco smoke? 

None 1 day 2 days 3 days 4 days 5 days 6 days 7 days

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GOAL AREA 2 

▲Outcome 7

Example survey � Of those who were exposed on some days, ask the following:

question(s) (cont.)� On these days, about how many hours per day were you exposed to other 

people’s smoke? 

Write the actual number of hours per day____________________________________

Comments None

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $$

better

References

1. �U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General.

Atlanta, GA: Centers for Disease Control and Prevention; 2004.

2. �U.S. Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders.

Washington, DC: EPA Office of Research and Development; 1992. Publication No. EPA/600/6-90/006F. 

3. �National Cancer Institute. Smoking and Tobacco Control Monograph No. 10. Health effects of exposure to environmental 

tobacco smoke: the report of the California Environmental Protection Agency. Bethesda, MD: National Cancer Institute; 1999. 

NIH Publication No. 99-4645.

4. �U.S. Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Rockville, MD: 

U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

5. �U.S. Department of Health and Human Services. Healthy people 2010. 2nd ed. With Understanding and improving health 

and objectives for improving health. 2 vols. Washington, DC: Government Printing Office; 2000.

6. �International Agency for Research on Cancer. Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 

83. Tobacco smoke and involuntary smoking: summary of data reported and evaluation. Lyon, France: World Health Organization; 2002. Available from: http://monographs.iarc.fr/htdocs/indexes/vol83index.html. Accessed December 2004.

7. �National Institutes of Health, National Toxicology Program. 10th report on carcinogens, 2000. Research Triangle Park, 

NC: National Institute of Environmental Health Sciences; 2002. Available from: http://ehp.niehs.nih.gov/roc/toc10.html. 

Accessed December 2004.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

183
Outcome 8� ▲ ▲ ▲

Reduced Tobacco Consumption 

Although the main goal of activities to eliminate exposure to secondhand smoke is

protecting nonsmokers, another possible outcome is the reduced cigarette use that

may result from cessation by smokers or the decreased number of cigarettes smoked

per day by continuing smokers. Research shows that smokers in workplaces with

tobacco-free policies may reduce the number of cigarettes they smoke or quit smoking

altogether.1,2 In addition, young people who live in households with tobacco-free

policies are less likely to smoke than those who live in households in which people

smoke.3

Listed below are the indicators associated with this outcome:

2.8.1 Per capita consumption of tobacco products

2.8.2 Average number of cigarettes smoked per day by smokers

2.8.3 Smoking prevalence

References

1. �Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking 

behaviour: systematic review. British Medical Journal. 2002;325(7357):188. 

2. �Farrelly MC, Pechacek TF, Chaloupka FJ. The impact of tobacco control 

expenditures on aggregate cigarette sales: 1981–2000. Journal of Health 

Economics. 2003;22(5):843–59. Erratum in: Journal of Health Economics.

2004;23(2):419.

3. �Farkas AJ, Gilpin EA, White MM, Pierce JP. Association between household 

and workplace smoking restrictions and adolescent smoking. Journal of the 

American Medical Association. 2000;284(6):717–22.

For Further Reading

Biener L, Cullen D, Di ZX, Hammond SK. Household smoking restrictions and 

adolescents’ exposure to environmental tobacco smoke. Preventive Medicine.

1997;26(3):358–63. 

National Cancer Institute. Smoking and Tobacco Control Monograph No. 11. State 

and local legislative action to reduce tobacco use. Bethesda, MD: National Cancer 

Institute; 2000. NIH Publication No. 00-4804.

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GOAL AREA 2 

▲Outcome 8

Outcome 8

Reduced Tobacco Consumption Indicator Rating

better

Number Indicator Overall quality Resources

needed

low high Strength of

evaluation evidence

Utility

Face validity

practice

Accepted

2.8.1 Per capita consumption of tobacco products | | | | | | $

2.8.2 Average number of cigarettes smoked per day by 

smokers | | | | | | $$†

2.8.3 Smoking prevalence | | | | | | $$†

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this indicator were within one 

point of each other (see Appendix B for an explanation).

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

185
Indicator 2.8.1�

Per Capita Consumption of Tobacco Products

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 8 Reduced tobacco consumption

What to measure The number of cigarette packs sold per adult aged 18 years or older in the state�

Why this indicator In addition to decreasing nonsmokers’ exposure to secondhand smoke, smoke-free

is useful policies decrease the number of cigarettes smoked.1

Example data � ▲

▲

CDC State Tobacco Activities Tracking and Evaluation (STATE) system

source(s)� Data available at: http://www.cdc.gov/tobacco/STATEsystem

State departments of revenue

Population group(s) Not applicable. This indicator is best measured by examining tax records to assess the 

state’s sales of cigarettes. 

Example survey Not applicable

question(s)

Comments Evaluators need to measure statewide consumption of cigarettes, smokeless tobacco, 

and other tobacco products separately. 

Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low 

| | | | | | $

better

Reference

1. �Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behaviour: systematic review. British Medical 

Journal. 2002;325(7357):188.

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GOAL AREA 2 

▲Outcome 8

Indicator 2.8.2

Average Number of Cigarettes Smoked per Day by Smokers

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 8 Reduced tobacco consumption

What to measure The average number of cigarettes smoked per day by adult and young smokers

Why this indicator� Daily cigarette use by employees who smoke decreases when smoke-free policies

is useful� are adopted in the workplace.1

 In addition, young people who live in households 

with tobacco-free policies are less likely to smoke than those who live in households 

in which people smoke.2

Example data � ▲

▲

▲

▲

▲

▲

CDC State Tobacco Activities Tracking and Evaluation (STATE) system

source(s)� Data available at: http://www.cdc.gov/tobacco/STATEsystem

Youth Tobacco Survey (YTS): CDC Recommended Questions: Core, 2004

CDC Youth Risk Behavior Surveillance System (YRBSS), 2003

Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003 

Smokers 18 years of age or older�

Smokers aged less than 18 years�

Population group(s)�

Example survey 

question(s)

From YTS and YRBSS 

During the past 30 days, on the days you smoked, how many cigarettes did you 

smoke per day?

I did not smoke cigarettes during the past 30 days

Less than 1 cigarette per day

1 cigarette per day

2 to 5 cigarettes per day

6 to 10 cigarettes per day

11 to 20 cigarettes per day

More than 20 cigarettes per day

From ATS 

For everyday smokers

On the average, about how many cigarettes a day do you now smoke? 

Number of cigarettes ______ 

For some-day smokers

On the average, on days when you smoked during the past 30 days, about how many �

cigarettes did you smoke a day? �

Number of cigarettes ______ �

Comments Calculating the average number of cigarettes smoked per day by adults requires 

combining data for everyday smokers and some-day smokers.

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

187
Rating� Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation � practice

evidence

low

| | | | | | † $$

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

References

1. �Farrelly MC, Evans WN, Sfekas AE. The impact of workplace smoking bans: results from a national survey. Tobacco 

Control. 1999;8(3):272–7.

2. �Farkas AJ, Gilpin EA, White MM, Pierce JP. Association between household and workplace smoking restrictions and 

adolescent smoking. Journal of the American Medical Association. 2000;284(6):717–22.

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GOAL AREA 2 

▲Outcome 8

Indicator 2.8.3

Smoking Prevalence

Goal area 2 Eliminating nonsmokers’ exposure to secondhand smoke

Outcome 8 Reduced tobacco consumption

What to measure� Proportion of adults employed outside the home who have ever smoked at least 

100 cigarettes in their lives and who smoke every day or some days1

Proportion of young people who have smoked on at least 1 day during the previous 

30 days2

Why this indicator� Studies show that tobacco-free work policies lead to an increase in the number of

is useful� employees who quit smoking.3

 In addition, smoke-free workplaces and homes are 

associated with significantly lower rates of adolescent smoking and an increased 

likelihood of adolescent smoking cessation.4

Example data 

source(s)

Population group(s)�

▲

▲

▲

▲

▲

▲

Adult Tobacco Survey (ATS): CDC Recommended Questions: Core, 2003 �

Behavioral Risk Factor Surveillance System (BRFSS), 2003

Youth Tobacco Survey (YTS): CDC Recommended Questions: Core, 2004

CDC Youth Risk Behavior Surveillance System (YRBSS), 2003 

Adults aged 18 years or older

Young people less than 18 years of age

Example survey 

question(s)

From ATS and BRFSS 

Have you smoked at least 100 cigarettes in your entire life?

Yes No Don’t know/Not sure Refused

Do you now smoke cigarettes every day, some days, or not at all?

Every day Some days Not at all Refused

From YTS and YRBSS 

During the past 30 days, on how many days did you smoke cigarettes? 

0 days

1 or 2 days

3 to 5 days

6 to 9 days

10 to 19 days

20 to 29 days

All 30 days

Comments� To gather more complete data on tobacco use, evaluators may also want to ask questions 

about the use of other tobacco products such as spit (smokeless) tobacco, bidis, small 

cigars, and loose (roll-your-own) tobacco.

Rating Overall quality Resources Strength of Utility Face validity Accepted 

high needed evaluation practice

evidence

low 

| | | | | |� $$†

better

† Denotes low agreement among reviewers: that is, fewer than 75% of the valid ratings for this 

indicator were within one point of each other (see Appendix B for an explanation).

C H A P T E R 3 ▲Goal Area 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke 

189
References

1. �Centers for Disease Control and Prevention. Prevalence of current cigarette smoking among adults and changes in 

prevalence of current and some day smoking—United States, 1996–2001. Morbidity and Mortality Weekly Report.

2003;52(14):303–7.

2. �Centers for Disease Control and Prevention. Cigarette use among high school students—United States, 1991–2003. 

Morbidity and Mortality Weekly Report. 2004;53(23):499–502.

3. �Farrelly MC, Evans WN, Sfekas AE. The impact of workplace smoking bans: results from a national survey. Tobacco 

Control. 1999;8(3):272–7. 

4. �Farkas AJ, Gilpin EA, White MM, Pierce JP. Association between household and workplace smoking restrictions and 

adolescent smoking. Journal of the American Medical Association. 2000;284(6):717–22.

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