U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

Evaluation Toolkit 

for Smoke-Free Policies 
We would like to thank the New York State Tobacco Control Program, which pioneered several of the evaluation 

approaches reviewed in this publication, for its generosity in sharing its evaluation strategy and its study 

protocols. We would also like to acknowledge ClearWay Minnesota’s A Toolkit for Implementing and Defending 

Smoke-Free Ordinances, which helped us in organizing and presenting the information in this publication. 

Ordering Information 

To download or order copies of this book, go to http://www.cdc.gov/tobacco to order single copies, or call toll-free
 

1 (800) CDC-INFO 


1 (800) 232-4636
 

Centers for Disease Control and Prevention. Evaluation Toolkit for Smoke-Free Policies. Atlanta: U.S. Department 


of Health and Human Services; 2008. Available at http://www.cdc.gov/tobacco. 

Evaluation Toolkit
 

for 

Smoke-Free Policies
 

Brett Loomis, MS
 

Matthew Farrelly, PhD
 

Joanne Pais, MS
 

RTI International
 

Andrew Hyland, PhD
 

Roswell Park Cancer Institute
 

Paul Mowery, MA
 

Biostatistics, Inc.
 

Stephen Babb, MPH
 

Natasha Jamison, MPH
 

Jerelyn Jordan, BA
 

CDC Office on Smoking and Health
 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Centers for Disease Control and Prevention
 

Coordinating Center for Health Promotion
 

National Center for Chronic Disease Prevention and Health Promotion
 

Office on Smoking and Health
 

Contents 

Introduction.................................................................................................................................5
 

Choosing Among Evaluation Studies for Smoke-Free Policies.............................................7
 

Key Questions to Consider in Choosing Among Study Types ...........................................9
 

Evaluating the Impact of Smoke-Free Policies: 

Overview of Available Approaches .........................................................................................12
 

Public Support..................................................................................................................12
 

Compliance.......................................................................................................................13
 

Air Quality Monitoring .......................................................................................................14
 

Employee Health...............................................................................................................15
 

Economic Impact..............................................................................................................17
 

Step-by-Step Guide to Selecting Appropriate
 

Evaluation Studies for Smoke-Free Policies..........................................................................21
 

Key Questions ..................................................................................................................21
 

Study Recommendations .................................................................................................22
 

Before the Policy is Passed or Implemented..........................................................22
 

Within One Year of Implementation ........................................................................25
 

One Year or Longer After Implementation ..............................................................28
 

Selected Bibliography..............................................................................................................31
 


 

INTRODUCTION 

This publication is intended for use by Centers for Disease Control and Prevention (CDC) staff in 

providing technical assistance to state tobacco control programs on approaches to evaluating the 

effects of state policies and laws that restrict smoking in workplaces and public places. (These policies 

and laws are often referred to as “smoke-free” policies and laws.) Additionally, it is intended for use 

by state tobacco control program evaluation staff in conducting such evaluations, and for use by 

national tobacco control partner organizations and other public health professionals in responding 

to requests for technical assistance on this topic. 

This publication can also be used by state tobacco control program staff to help community tobacco 

control programs and coalitions assess the impact of local smoke-free laws. The evaluation approaches 

described in this publication and the findings of studies conducted using these approaches may also 

be useful to other stakeholders who are interested in the effects of smoke-free laws, including business 

organizations (e.g., chambers of commerce, restaurant associations) and labor unions. This publication 

is based on the science reviewed in the 2006 U.S. Surgeon General’s Report, on more recent published 

studies, and on the experiences of U.S. states and other countries that have implemented and evaluated 

smoke-free laws. 

Increasingly, states and communities are passing laws to make indoor workplaces and public places, 

including restaurants and bars, smoke-free. Once a smoke-free law is passed, state and local tobacco 

control programs and their stakeholders often want to evaluate the law’s effects to assess if the law 

is achieving its intended benefits and to be certain that it is not having negative side effects. An 

evaluation can also help answer questions that policy makers and other key stakeholders may have 

about a law’s impact. 

In most cases, evaluation results are likely to indicate that a smoke-free law is having effects that 

are broadly similar to those observed in other sites. Nevertheless, confirming that this is the case is 

important for local evaluation and surveillance purposes and for responding to the questions and 

interests of stakeholders, who typically want to review local data. In other cases, evaluations may bring 

to light different or unexpected findings that may be helpful in identifying gaps or deficiencies in the 

law (e.g., exemptions for certain venues), in the implementation and enforcement of the law, or in the 

process leading to the enactment and implementation of the law (e.g., inadequate education of the 

public and the business community). 

Evaluation results may also be useful in comparing the effects of smoke-free laws in different sites 

(e.g., sites with more comprehensive laws compared with sites with less comprehensive laws, urban 

compared with rural sites, sites with different population compositions, state laws compared with local 

laws, state laws in states with previous experience with local smoke-free laws compared with state laws 

in states without such experience). 


 
Evaluation Toolkit for Smoke-Free Policies 

Evaluating a smoke-free law involves considerable planning before the law takes effect. One major 

reason is that several of the evaluation studies commonly used require the collection of baseline, 

pre-implementation data. Additionally, gathering data before a law is passed may be necessary 

to demonstrate the need for a law. 

Several factors should be considered to determine what studies to undertake:

 • The stage the site has reached in the policy process.

 • The types of information that policy makers, the news media, the business community, and the public 

are requesting.

 • The provisions of the law, including any exemptions, and the venues that the law does and does not
 

cover.


 • The resources available to evaluate the law. 

Most sites will not need to conduct all the studies described in this document. Sites should make 

strategic decisions about which studies to undertake on the basis of their local situations, needs, and 

resources. The Evaluation Toolkit for Smoke-Free Policies is designed to help state and local tobacco 

control programs select the specific studies that are best suited to their needs and resources. It also 

provides general information on how to design and conduct each study. 

Studies of smoke-free laws typically examine one of five outcomes: public support, compliance, 

air quality, employee health, and economic impact. Section 1 of this publication outlines four major 

issues to consider when selecting among these studies. Section 2 provides an overview of the studies, 

including what information the studies generate, how this information can be used, what potential pitfalls 

to guard against, when to collect data, and what specific approaches are available. Section 3, which 

is primarily intended for staff in CDC’s Office on Smoking and Health and others who provide technical 

assistance to state and local tobacco control programs, draws on the criteria in Section 1 to present 

a step-by-step process to help programs decide which studies are most appropriate for their site. Finally, 

Section 4 provides a selected bibliography of key peer-reviewed studies for each of the five types of 

studies examined. 


 
CHOOSING AMONG EVALUATION STUDIES FOR SMOkE-FREE POLICIES 

There are five broad studies that state or local tobacco control programs can conduct to prepare for 

a smoke-free law or to evaluate the law’s effects after its implementation. Most sites will not need 

to conduct all five studies. Each site should decide which studies best meet its needs and can be 

implemented feasibly with its resources. The purpose of this section is to discuss several factors that 

sites should consider when developing an evaluation plan for a smoke-free law. After reading this 

section, a decision maker should understand how the local context—including the stage the site has 

reached in the policy process; the kinds of information that are being requested by policy makers, the 

news media, the business community, and the public; the specific provisions of the law in question; and 

the resources available to a site—helps determine what outcomes to assess. Section 2 provides greater 

detail on the five types of studies. 

The five types of studies are as follows:

 • Public Support. These studies use surveys to assess public awareness of the health effects of 

secondhand smoke and of the proposed policy and public support for smoke-free environments 

and for a smoke-free law. They are useful before a law has been passed to determine if support is 

sufficiently high to warrant moving forward and to document the levels of support. After a law has 

been passed and implemented, these studies track levels of support and changes in these levels over 

time.

 • Compliance. These studies are useful for assessing compliance with a smoke-free law in hospitality 

venues and other workplaces and public places. They can be used to document compliance rates, to 

assess how implementation is proceeding, to identify types of venues and geographic regions where 

increased educational and enforcement efforts are needed, and to monitor trends in compliance over 

time.

 • Air Quality Monitoring. These studies use a small, portable device to measure particulate matter 

suspended in air. The study results can be used before a law takes effect to document air quality 

in hospitality venues that allow smoking. After a law has taken effect, these studies can be used to 

assess changes in air quality in these venues.

 • Employee Health. These studies can be used before a law takes effect to assess secondhand smoke 

exposure and related health problems among nonsmoking employees in hospitality venues that 

allow smoking. After a law has been implemented, these studies can measure changes that occur in 

employees’ secondhand smoke exposure and related health outcomes. For employee health studies, 

it is critical to collect data before and after the law goes into effect.

 • Economic Impact. These studies use objective data on employment levels and taxable sales 


revenues to assess the economic impact of a smoke-free law on hospitality venues such as 


restaurants, bars, and casinos.
 

The last three types of studies typically focus on hospitality venues, while the first two study types are 

also applicable to other workplaces and public places. 


 
Evaluation Toolkit for Smoke-Free Policies 

In addition to these five types of studies, several studies have examined the impact of smoke-free 

laws at the local, state, and regional levels on hospital admissions for heart attacks. To date, all seven 

published studies of this type have found that smoke-free laws are associated with substantial, rapid 

reductions in heart attack admissions. Studies of this type are clearly very important, and have major 

implications for public health practice. However, because these studies involve complex analytical 

approaches and assess health outcomes in the general population, and not simply among employees 

of hospitality venues, they are beyond the scope of this publication. Finally, some studies examine the 

impact of smoke-free laws on smoking behavior. These studies examine several outcomes, including 

smoking prevalence, quit attempts, successful cessation, and cigarette consumption among continuing 

smokers. Most of these studies focus on adults, and many focus on the impact of workplace smoking 

restrictions on employee smoking behavior. While these studies assess an important effect of a smokefree law, changes in smoking behavior represent a secondary benefit of a smoke-free law and are driven 

by a number of factors. As a result, these studies are not considered here. 

It is never too early or too late to assess the impact of a smoke-free law. Useful studies can be conducted 

at every stage of the policy process. However, whenever possible, data should be collected before 

a law takes effect to provide the baseline needed to measure change. If baseline data are unavailable, 

alternative study designs are necessary (e.g., comparing sites or venues that are and are not covered 

by the law). These designs generate useful findings, though the findings can be weaker and more open 

to criticism. Table 1 presents the activities that can be carried out under the five major study domains 

at each stage in the policy process. 

Table 1. Timing of an Evaluation Plan for Smoke-Free Policies 

Study Before the Law Is 

Passed or Takes Effect 

Within One Year of 

Implementation 

One Year or Longer 

after Implementation 

Public support Assess support. Assess support. Assess support. 

Compliance Conduct baseline 

observations of smoking 

in hospitality venues. 

Assess short-term 

compliance. 

Assess long-term 

compliance. 

Air quality monitoring Measure baseline air 

quality in hospitality 

venues. 

Measure short-term 

changes in air quality. 

Measure long-term 

changes in air quality. 

Employee health Assess baseline worker 

secondhand smoke 

exposure and related 

health effects. 

Assess short-term 

changes in worker 

secondhand smoke 

exposure and related 

health effects. 

Assess long-term 

changes in worker 

secondhand smoke 

exposure and related 

health effects. 

Economic impact Identify available data 

sources and plan 

analyses. 

As employment data 

become available, 

assess the law’s impact 

on hospitality venues. 

As taxable sales revenue 

data become available, 

assess the law’s impact 

on hospitality venues. 


 
Choosing Among Studies 

key Questions to Consider in Choosing Among Study Types 

When deciding on an evaluation plan, consider the following questions:

 • What stage has the site reached in the policy process? Is the law still under consideration, or has
 

it been enacted? If it has been enacted, has it taken effect? How long has the law been in effect?


 • What kinds of information are decision makers, the news media, the business community, and the 


public requesting? What aspects of the law and its impact are generating the most discussion?


 • Does the law contain exemptions or other provisions that have the potential to significantly reduce
 

its reach and impact?


 • What resources are available to design and conduct an evaluation? 

What stage has the site reached in the policy process? Is the law still under consideration, or has 

it been enacted? If it has been enacted, has it taken effect? How long has the law been in effect? 

If the smoke-free law is under consideration, three types of studies are particularly helpful. Studies 

to assess public support for the law help determine whether support is strong enough to move ahead 

with an effort to put a law in place or whether additional public education is necessary. Air quality and 

employee health studies document air quality in venues that allow smoking and assess secondhand 

smoke exposure and any related health problems among nonsmoking workers. In addition to these three 

types of studies, a summary of economic impact studies from sites that have implemented smoke-free 

laws can provide policy makers with information to address concerns that the law could have a negative 

economic impact on the local hospitality industry. 

Whenever possible, data should be collected before a smoke-free law takes effect in order to establish 

a baseline. Ideally, data should be collected within 3 months before the law’s effective date, within 

3 months after this date, and again about 12 months after this date. Collecting data at these intervals 

may require modifying or supplementing an existing survey, such as the Adult Tobacco Survey (ATS). 

During the first year or so after a smoke-free law is implemented, policy makers, the news media, the 

business community, and the general public are especially interested in the law’s effects. Consequently, 

it is important to be able to report findings on how implementation is proceeding, on whether air quality 

and employee secondhand smoke exposure in hospitality venues have changed, and on whether the 

law is having an economic impact on these venues. For example, follow-up assessments of public 

support conducted shortly after the law takes effect and periodically thereafter can document changes in 

public support for the law. Similarly, conducting an observational compliance study along with a smaller 

air quality study in a subset of the same hospitality venues can assess compliance with the law and 

changes in air quality in these venues. A compliance study can also identify types of venues and regions 

where intensified educational and enforcement efforts are needed. Finally, although objective local data 

on the economic impact of the law take longer to become available, it is important to provide policy 

makers with these data as soon as possible. 


 
Evaluation Toolkit for Smoke-Free Policies 

In most cases, collecting additional data in all five study domains becomes less critical after a smokefree law has been in effect for a year. However, in situations where a law has long phase-in provisions for 

certain venues (e.g., bars or casinos), or where certain venues have been permanently exempted from 

the law, repeated measurements over longer periods may be needed to document smoking levels, air 

quality, and employee health in these venues. 

What kinds of information are decision makers, the news media, the business community, and the 

public requesting? What aspects of the law and its impact are generating the most discussion? 

Sites should choose studies that address the issues that are generating the most discussion. The 

following concerns are frequently raised:

 • Is there public support for a comprehensive smoke-free law that covers all workplaces and public 


places, including restaurants and bars?


 • Will hospitality venues and smokers comply with the law? Will enforcement be expensive and
 

time-consuming, and will it divert resources from more urgent law enforcement needs?


 • Is the air quality in hospitality venues that allow smoking unhealthy? Does the air quality improve 

following the implementation of a smoke-free law? How effective is installing an advanced ventilation 

system or creating a separately ventilated smoking room as an alternative to going smoke-free?

 • To what extent are nonsmoking restaurant and bar employees exposed to secondhand smoke at 

work? Is this exposure harmful to employees’ health? How do employee exposure on the job and 

related health outcomes change following the implementation of a smoke-free law?

 • Will a smoke-free law have a negative economic impact on restaurants and bars? 

Occasionally, it will be necessary to provide local data quickly to policy makers or the media. Public 

opinion surveys, air quality studies, and observational studies of smoking levels and compliance 

in hospitality venues can be performed quickly and with fewer resources. Because employee health 

studies are complex, they cannot be fielded quickly or inexpensively. Economic impact studies cannot 

be conducted in the immediate post-implementation period because economic data are usually not 

available for several months after the period in question. If the main questions raised concern employee 

health or economic impact, the best short-term approach is to summarize the evidence from peerreviewed studies conducted in other sites that have implemented smoke-free laws and then to make the 

case that the site in question can expect similar results. 

Does the law contain exemptions or other provisions that have the potential to significantly 

reduce its reach and impact? 

Although states and communities are increasingly enacting comprehensive smoke-free laws that contain 

few exemptions, some smoke-free laws have limitations that need to be taken into account when 

planning an evaluation. For example, laws may exempt certain types of venues, such as stand-alone 

bars, private clubs, or casinos, or they may allow smoking in separately ventilated rooms or in adultsonly establishments. Laws can include hardship exemptions and waiver provisions that temporarily 

10 
Choosing Among Studies 

exempt hospitality venues that can show that the law has hurt their business. Finally, there may be long 

lag times between the date a law is passed and the date it takes effect in all or certain venues. In these 

cases, an effective strategy is to design an evaluation to examine the impact these limitations have 

on a law’s effectiveness (e.g., by assessing air quality and employee health in exempted or phased-in 

hospitality venues, or by examining the impact of exemptions or other provisions on compliance). 

What resources are available to design and conduct an evaluation? 

Before deciding which studies to pursue, it is important to assess the available resources. Although 

all studies benefit from careful planning and as much lead time as possible, some studies can be 

conducted relatively quickly with fewer resources. For example, an observational compliance study that 

uses volunteer observers can be conducted on a tight time line with limited resources. Other studies are 

complex and should not be attempted without in-depth planning, substantial lead time, and statistical 

expertise. These include employee health and economic impact studies. Employee health studies also 

typically require significant funding. 

Additionally, because both public support and employee health studies involve surveying human 

subjects, and because some employee health studies also involve taking biological specimens or 

conducting physical exams, these studies may require approval by an Institutional Review Board (IRB). 

Requirements for IRB review and approval vary by organization. It is important to know and follow the 

applicable requirements for the organization in question. If IRB approval is required, it is necessary 

to allow substantial lead time, and it is advisable to consult with a researcher or other resource 

person who has IRB experience. Lastly, sites should check whether Health Insurance Portability and 

Accountability Act (HIPAA) regulations apply, especially for employee health studies. 

When selecting studies to pursue, consider the following questions about available resources and 

organizational capacity:

 • How much funding is available?

 • Is statistical expertise available for survey design and data analysis?

 • Are paid staff or volunteers available?

 • What data are available or can be obtained? 

An additional question to consider is at what level the study will be conducted. If a state smoke-free 

law is being evaluated, use statewide data. For local laws, use the appropriate level of local data (e.g., 

city level data for municipal laws, county level data for county laws). The availability of data dictates the 

type of study that can be conducted. A number of local data sources may be available. For example, 

for tobacco use behaviors and attitudes, it may be possible to develop sub-state estimates using data 

collected by the state ATS or the state Behavioral Risk Factor Surveillance System (BRFSS) (see http:// 

apps.nccd.cdc.gov/brfss-smart/index.asp for information on available local BRFSS data by state). As 

another example, state bureaus of labor statistics can often provide county-level employment data. 

11 
EVALUATING THE IMPACT OF SMOkE-FREE POLICIES: 

OVERVIEW OF AVAILABLE APPROACHES 

Section 1 outlines factors to consider when developing an evaluation plan. This section provides 

in-depth information on the five main types of studies commonly used to evaluate smoke-free laws. 

It describes the information each study yields, the way this information can be used, the potential pitfalls 

associated with each study, the optimal times to collect data, and some recommended approaches 

to use. Table 2 summarizes this information for all five studies. 

Public Support 

Why Do I Need This Information? 

Before the Law Is Passed 

The study findings document levels of public awareness of the health effects of secondhand smoke 

and of the proposed policy and public support for smoke-free environments and for a smoke-free 

law. Findings can help determine whether support is strong enough to move forward, or if more public 

education is needed. In addition, the findings establish a baseline to measure change. 

After the Law Is Implemented 

The study findings document levels of public support and changes in these levels over time. These 

findings help document shifts in social norms by tracking trends in support for the law and for smokefree environments in specific types of venues. 

What Information Will I Get? 

The study findings document the proportion of the public that supports the law and how this support 

changes over time. Findings can also be used to determine the support for extending the law to cover 

venues exempted permanently or for phase-in periods. In addition, it may be possible to assess public 

awareness and concern regarding the health effects of secondhand smoke and changes in these beliefs 

and attitudes that may occur because of the discussion regarding and the implementation of the smokefree law and related media coverage or paid media campaigns. 

What Pitfalls Should I Guard Against? 

Because the study involves human subjects, check the relevant institution’s IRB requirements. When 

developing survey questions, choose unbiased wording to safeguard the validity and credibility 

of the study and its findings. Using standard questions from existing surveys or publicly available 

questionnaires is useful to allow the study results to be compared to other studies with the same 

questions. A helpful source of standard survey questions is the CDC Office on Smoking and Health’s 

Question Inventory on Tobacco (http://apps.nccd.cdc.gov/QIT/QuickSearch.aspx). 

When Do I Need This Information? 

Collecting pre-implementation data is important to assess public readiness, to document levels of public 

support, and to establish a baseline to measure change. Collecting post-implementation data helps track 

changes in public support and shifts in social norms over time. If possible, data should be collected 

within 3 months before the law takes effect, within 3 months after this date, and at regular intervals 

thereafter (e.g., annually). This may require innovative approaches such as conducting rolling quarterly 

surveys or special surveys. 12 
Evaluating Impact 

Possible Approaches 

One approach to assess public attitudes is to analyze data from existing population health surveys, 

such as the Adult Tobacco Survey (ATS) (in states that conduct this survey) or the Behavioral Risk Factor 

Surveillance System (BRFSS), that already include relevant questions. If such a survey lacks relevant 

questions, a second approach is to add those questions to the survey. A third approach is to conduct 

a public opinion survey using a probability sample. Keep in mind that this approach is substantially more 

expensive than the other options. Each of these approaches requires expertise in survey administration 

and analysis and may involve obtaining IRB approval. 

Compliance 

Why Do I Need This Information? 

The enactment of a smoke-free law does not automatically result in smoke-free workplaces and 

public places. For a law to reduce secondhand smoke exposure, compliance levels must be high. 

Observational compliance studies assess whether this is the case. In addition to documenting 

compliance levels and monitoring trends in compliance over time, these studies can identify specific 

types of venues or regions where increased educational and enforcement efforts are needed. In sites 

where adequate planning and extensive communication with business owners and the public have 

occurred, observational compliance studies typically find that most workplaces and businesses, 

including most hospitality venues, come into compliance with a law shortly after it takes effect. 

What Information Will I Get? 

This study provides data on the proportion of hospitality venues that are complying with the law. 

Compliance is assessed by observing the smoking levels in these venues and the measures that these 

venues take to comply, such as posting “No Smoking” signs and removing ashtrays. Compliance can 

also be assessed by determining the proportion of patrons who report that they observed smoking the 

last time they visited a restaurant or bar. 

By collecting pre- and post-implementation data, it is possible to document whether the proportion of 

hospitality venues where smoking occurs changes after the law takes effect. Conducting assessments 

at two or more intervals following implementation allows sites to monitor trends in compliance over 

time. (Because the law is not yet in effect, baseline data measure the presence of smoking in hospitality 

venues, not compliance.) 

What Pitfalls Should I Guard Against? 

Be prepared to encounter less than full compliance. Certain types of venues and geographic areas 

(e.g., bars, rural areas, communities that lack previous experience with local smoke-free laws) often take 

longer than others to achieve high compliance rates. A compliance study can indicate types of venues 

and areas that could benefit from intensified educational and enforcement efforts. Plan to conduct 

observations during peak business hours to ensure that the results reflect real-world conditions. 

1
 
Evaluation Toolkit for Smoke-Free Policies 

When Do I Need This Information? 

Ideally, compliance data should be collected within 3 months before the law takes effect, within 3 

months afterward, and thereafter at regular intervals, such as annually, if possible. This may require 

innovative approaches such as rolling quarterly surveys or special surveys. Pre-implementation data are 

not essential, but are highly recommended as a baseline to assess change. Data collected soon after 

the law takes effect help document short-term compliance levels and inform education and enforcement 

activities. Longer-term data help document ongoing compliance levels, track trends in compliance, and 

inform education and enforcement activities. 

Possible Approaches 

The most cost-effective approach to assess compliance is to draw on an existing population health 

survey, such as a state ATS or BRFSS, that already includes relevant questions. Another fairly 

inexpensive approach is to add relevant questions to such a survey. A third approach is to conduct 

an observational study, which can be relatively inexpensive if it makes use of volunteers from partner 

organizations. 

A fourth approach is to analyze enforcement agency records on complaints, violations, and citations. 

This approach should be used to complement other approaches, not as the sole source of data, 

because these data do not reflect all the violations of the law and can be difficult to interpret. For 

example, a small number of citations can reflect either high compliance or lack of enforcement. Similarly, 

an increase in citations can reflect either a decrease in compliance or an increase in enforcement, and 

an increase in complaints can reflect either decreased compliance or increased publicity about the law. 

However, because the level of enforcement influences the interpretation of enforcement agency records 

and is an important determinant of compliance with a smoke-free law, evaluations of compliance should 

assess and take account of enforcement activities. 

Air Quality Monitoring 

Why Do I Need This Information? 

Before the Law Is Passed 

These studies document air quality in restaurants, bars, and other hospitality venues that allow smoking. 

Pre-implementation data are essential for establishing a baseline to measure change. 

After the Law Is Implemented 

Measurements taken before and after a smoke-free law takes effect document changes in air quality. 

Air quality studies can be conducted relatively quickly and can provide real-time data. 

What Information Will I Get? 

It will be possible to collect information on the concentrations of respirable suspended particles or 

particulate matter present in hospitality venues, which are measures of air quality. The data collected will 

14 
Evaluating Impact 

also include the cigarette density (average number of burning cigarettes) in a venue, the average number 

of persons present, the volume of the venue, and the presence of signs about the venue’s smoking policy. 

What Pitfalls Should I Guard Against? 

This study requires sites to purchase, rent, or borrow air quality monitoring equipment and related 

computer software and to train data collectors to use the equipment. In addition, measurements 

should be taken during peak business hours to reflect real-world conditions. Lastly, to ensure that data 

processing and analysis are performed correctly, it is best to have researchers supervise these steps. 

When Do I Need This Information? 

Ideally, air quality data should be collected within 3 months before and within 3 months after the law 

takes effect. Baseline data are very important for this type of study. Pre-implementation data are needed 

to assess post-implementation changes in air quality in venues. An additional wave of data collection 

(e.g., 1 year after the law’s effective date) may be useful, but is not necessary. 

Possible Approaches 

The necessary equipment and software are not prohibitively expensive. Monitoring can be carried out 

either by volunteers or by professional data collectors, though all data collectors must be trained prior 

to conducting measurements. An air quality study can be conducted in conjunction with a compliance 

study by taking air quality measurements in a subset of the venues visited during the compliance study. 

Employee Health 

Why Do I Need This Information? 

Before the Law Is Passed 

This information documents secondhand smoke exposure and related health effects among nonsmoking 

employees in hospitality venues that allow smoking. Collecting pre-implementation data is essential 

to assess changes in employee exposure and health outcomes following implementation of the law. 

After the Law Is Implemented 

Reduced secondhand smoke exposure and improved health outcomes among nonsmoking hospitality 

workers after a law is implemented can help demonstrate that the law is achieving its purpose. 

Conversely, persistent or increasing secondhand smoke exposure and health problems among workers 

in hospitality venues exempt from the law can demonstrate the benefit of extending protections to these 

workers. 

What Information Will I Get? 

These studies provide both objective and self-reported data on changes in secondhand smoke exposure 

and health outcomes among nonsmoking employees in hospitality venues. A common objective 

measure is the level of cotinine, a metabolite of nicotine which is used as a biomarker of secondhand 

smoke exposure. Cotinine can be measured in saliva, urine, or blood. Saliva measurements are least 

1
 
Evaluation Toolkit for Smoke-Free Policies 

expensive and least intrusive. Detectable cotinine levels indicate that nonsmoking workers are exposed 

to secondhand smoke, and higher cotinine levels indicate higher levels of exposure. Another objective 

measure is the level of NNAL, a marker for exposure to the tobacco-specific lung carcinogen NNK. 

NNAL is typically measured in urine, generally in conjunction with measurements of cotinine. Detectable 

levels of NNAL demonstrate the presence of a potent carcinogen in the bodies of employees who 

have been exposed to secondhand smoke in the workplace. This is an intermediate step toward 

demonstrating that secondhand smoke exposure is causing health effects in workers. A third objective 

measure is to use spirometry to assess lung function. In addition to assessing objective measures, 

employee health studies also typically collect self-reported data on secondhand smoke exposure and 

respiratory and sensory symptoms. 

What Pitfalls Should I Guard Against? 

Employee health studies are complex and time-intensive and can be expensive. They require 

considerable planning and adequate lead time to design the study, to recruit participants, and to 

obtain baseline data before a law takes effect. Depending on an organization’s funding source and 

requirements, IRB approval may be required to conduct interviews, take saliva or urine samples, and 

perform measurements of lung function. 

Additionally, it is best to collaborate with researchers experienced in collecting and analyzing biological 

samples and, if necessary, in IRB procedures. Lastly, these studies require access to laboratory services 

to analyze saliva and urine samples for the presence of biomarkers. 

When Do I Need This Information? 

Baseline data are essential for this study and should be collected within 3 months before the law takes 

effect. Post-implementation data should be collected within 3 months after the law takes effect 

to document short-term changes. Another round of data collection one year after the law takes effect 

is useful to document long-term changes. 

Possible Approaches 

Employee health studies are typically the most expensive study to conduct because of the need for 

laboratory and clinical resources and for multiple waves of data collection. Common study designs 

include (1) self-collected, mailed-in saliva cotinine samples, combined with telephone surveys assessing 

self-reported secondhand smoke exposure and respiratory and sensory symptoms; (2) clinic-based urine 

studies measuring cotinine and/or NNAL levels; and (3) spirometry to measure lung function, combined 

with personal interviews. 

The first approach is relatively inexpensive, while the second and third approaches require significant 

funding. It is important to secure funding, identify research partners, and arrange for access to clinical 

resources well in advance. If possible, combine measurements of cotinine with measurements of NNAL 

and combine monitoring of self-reported respiratory symptoms with clinical measurements of lung 

function. 

1
 
Evaluating Impact 

Economic Impact 

Why Do I Need This Information? 

Before the Law Is Passed 

Objective data from economic impact studies conducted in other sites that have implemented smokefree laws can be used to address concerns among policy makers and proprietors of hospitality venues 

about the law’s potential economic impact on restaurants and bars. 

After the Law Is Implemented 

Objective local economic data are useful to gauge the law’s aggregate economic impact on all hospitality 

venues in a jurisdiction. Concerns about a law’s impact often peak immediately after the law takes effect 

and largely subside after a year. 

What Information Will I Get? 

Economic impact studies focus primarily on hospitality venues, most commonly restaurants and bars, 

because these are generally the focus of debate. Employment levels and taxable sales revenue are the 

two types of objective data most often used to gauge economic impact, and are currently the indicators 

of choice in this area. Other indicators include the number of venues that have opened or closed, hotel 

revenues and occupancy levels, the number of licenses issued to restaurants and bars, and self-reported 

consumer patronage intentions and patterns. 

What Pitfalls Should I Guard Against? 

Policy makers and other groups frequently ask for reports on the economic impact of a law before 

objective local data are available. It is important to be prepared to respond to policy makers’ concerns 

and to claims that the law is having a negative economic impact on hospitality venues. Reporting 

on economic impact data can be problematic because of the time it takes for these data to become 

available. Employment data have the quickest turnaround, but still take 6–9 months after the month 

in question. Taxable sales revenue data take about 18 months after the quarter in question. In addition, 

for a study to be considered reliable in determining trends, it will need to include enough data points 

before and after the law (at least one year of data after the law’s effective date), and it will need to control 

for underlying economic trends and seasonal factors. For example, any analysis of bar employment or 

sales needs to take into account the fact that the stand-alone bar industry has declined in recent years. 

Whenever possible, it is best to collaborate with researchers with econometric or statistical expertise, 

especially when conducting more sophisticated analyses. 

When Do I Need This Information? 

For this study, collecting baseline data is not necessary because government agencies routinely collect 

these data. During the policy adoption phase, objective economic data from other sites that have 

implemented smoke-free laws should be used to respond to policy makers’ questions. Once the law 

is implemented, objective local economic data are needed as soon as possible to address any concerns 

or claims that the law is adversely impacting hospitality venues. 

1
 
Evaluation Toolkit for Smoke-Free Policies 

Possible Approaches 

Most economic impact studies involve obtaining and analyzing publicly available data on employment 

(e.g., Current Employment Statistics [CES] data), taxable sales revenues, business openings and 

closings, or some combination of these measures. These data are often available either free of charge 

or for a small processing fee from government agencies. Relevant agencies include state bureaus 

of labor statistics and state departments of labor, revenue, and taxation and finance. 

Another approach is to add a question on consumer patronage intentions or patterns to an existing 

survey, such as the ATS. However, this information should be used to complement objective data, not 

as the sole data source. Ideally, an economic impact study should compare economic trends in the site 

in question to trends in a control site that has not implemented a smoke-free law. 

Table 2. Evaluating the Impact of Smoke-Free Policies: Overview of Available Approaches 

Type of Study Why Do I Need This 

Information? 

What Information Will 

I Get? 

What Pitfalls Should 

I Guard Against? 

When Do I Need This 

Information? 

Possible 

Approaches 

(Relative Cost: 

$ to $$$$) 

Public Support Before the law is passed:

 • To assess public awareness of the health effects 

of secondhand smoke and 

of the proposed law.

 • To assess public readiness.

 • To document the level 

of public support for 

smoke-free environments 

and for the proposed law.

 • To establish a baseline for 

measuring change. 

After the law is implemented:

 • To assess levels of public 

support for the law and 

changes in these levels 

over time.

 • To document shifts 

in social norms.

 • To monitor public support 

for extending the law 

to cover additional venues.

 • The proportion of the 

population that supports 

the law and how this 

changes over time.

 • The proportion of the 

population that supports 

extending the law to 

additional venues.

 • The proportion of the 

population that is aware 

of and concerned about 

the health effects of 

secondhand smoke.

 • Institutional Review Board 

(IRB) approval may be 

required to conduct 

surveys. Check on IRB 

requirements.

 • Take care to use unbiased 

wording on survey 

questions.

 • If possible, use standard 

questions from existing, 

publicly available surveys.

 • If possible, data should be 

collected within  months 

before the law takes 

effect, within  months 

after this date, and at 

regular intervals thereafter 

(e.g., annually).

 • Use existing population 

health surveys, such 

as the Adult Tobacco 

Survey (ATS) or the 

Behavioral Risk Factor 

Surveillance System 

(BRFSS), that include 

relevant questions.

 • Add questions to an 

existing population 

health survey such as 

the ATS or BRFSS ($).

 • Conduct your own 

public opinion survey 

using a probability 

sample ($$$–$$$$). 

Compliance After the law is implemented:

 • To assess compliance with 

the law.

 • The proportion of hospitality venues that comply with 

the law (i.e., no observed 

smoking), and how this 

changes over time.

 • Do not expect full compliance in all venues.

 • Certain types of venues 

and certain geographic 

regions often take longer 

than others to achieve high 

compliance rates.

 • Although not essential, 

collecting baseline data 

before the law goes into 

effect makes it possible 

to assess changes 

in smoking levels in 

hospitality venues.

 • Use existing population 

health surveys, such 

as the ATS or BRFSS, 

that include relevant 

questions.

 • Add questions to an 

existing population 

health survey, such as 

the ATS or BRFSS ($). 

1
 
Evaluating Impact 

Type of Study Why Do I Need This 

Information? 

What Information Will 

I Get? 

What Pitfalls Should 

I Guard Against? 

When Do I Need This 

Information? 

Possible 

Approaches 

(Relative Cost: 

$ to $$$$) 

Compliance 

(continued)

 • To identify types of venues 

and geographic regions 

where increased educational and enforcement 

efforts are needed.

 • To monitor compliance 

over time in order to 

assess trends and address 

any new problem areas.

 • Information on measures 

hospitality venues take 

to comply with the law 

(e.g., posting “No Smoking” 

signs, removing ashtrays).

 • The proportion of patrons 

who report having 

observed smoking 

in venues.

 • Conduct observations 

during peak business 

hours to reflect real-world 

conditions.

 • If possible, data should be 

collected within  months 

before the law takes 

effect, within  months 

afterward, and thereafter 

at regular intervals (e.g., 

annually).

• Conduct an observational 

study using volunteers 

from partner organizations ($).

 • Analyze enforcement 

agency records. (Use 

to complement other 

approaches, not as the 

sole information source.) 

Air Quality 

Monitoring 

Before the law is passed:

 • To document air quality 

in hospitality venues that 

allow smoking.

 • To establish a baseline for 

measuring change. 

After the law is implemented:

 • To document changes 

in air quality.

 • Concentrations of respirable suspended particles 

or particulate matter.

 • Cigarette density (average 

number of burning 

cigarettes).

 • Average number of persons

present. 

• The volume of the venue.

 • Signs about the venue’s 

smoking policy. 

• Air quality monitoring 

equipment and computer 

software are required.

 • Data collectors must 

be trained to use the 

equipment.

 • Obtain air quality 

measurements during peak 

business hours to reflect 

real-world conditions.

 • Data processing and analysis should be supervised 

by researchers.

 • If possible, data should be 

collected within  months 

before the law takes effect 

and within  months after 

this date. An additional 

wave of data collection 

(e.g., 1 year after the law’s 

effective date) may be 

useful, but is not essential.

 • Equipment and software 

expenses should be

moderate ($–$$).

 • Volunteers or staff are 

needed to conduct the 

measurements.

 • This study can be 

carried out in a subset 

of the hospitality venues 

included in a larger 

observational compliance study ($–$$). 

Employee Health Before the law is passed:

 • To document secondhand 

smoke exposure and related 

health problems among 

nonsmoking workers in 

hospitality venues that 

allow smoking. 

After the law is implemented:

 • To document changes 

in secondhand smoke 

exposure and related 

health problems among 

nonsmoking workers 

in venues covered by the 

law.

 • To document exposure 

and related health 

problems among workers 

in hospitality venues not 

covered by the law, and 

to compare these 

outcomes to outcomes 

for workers in covered 

venues.

 • Levels of cotinine 

(a biomarker for secondhand smoke exposure) 

in saliva or urine, and the 

proportion of workers with 

cotinine levels above the 

limit of detection.

 • Prevalence and duration 

of self-reported secondhand smoke exposure.

 • Prevalence of self-reported 

sensory and respiratory 

symptoms.

 • Levels of NNAL (a biomarker for exposure to the 

tobacco-specific lung car

cinogen NNK) in urine, and 

the proportion of workers 

with NNAL levels above the 

limit of detection.

 • Clinical measures of lung 

function (spirometry).

 • How these indicators 

change over time after the 

law takes effect.

 • Employee health studies 

are complicated and timeintensive, and require careful planning and substantial 

lead time.

 • IRB approval may be 

needed to conduct surveys 

or interviews, to take saliva 

or urine samples, and 

to measure lung function. 

Check on IRB requirements.

 • If possible, collaborate with 

researchers experienced 

in collecting and analyzing 

biological samples and, 

if necessary, experienced 

in IRB procedures.

 • Laboratory services are 

needed to analyze saliva 

or urine samples.

 • Recruiting participants can 

be time-consuming and 

costly.

 • Baseline data should be 

collected within  months 

before the law takes 

effect.

 • Follow-up data from the 

same workers sampled 

at baseline should be 

collected within  months 

after the law takes effect 

to document its short-term

effects.

 • It is helpful to collect data 

again 1 year after the law 

takes effect to document 

long-term changes in 

employee exposure and 

health effects.

 • A study using self-collected, mailed-in saliva 

cotinine specimens combined with a telephone 

survey assessing selfreported secondhand 

smoke exposure and 

sensory and respiratory 

symptoms in nonsmoking hospitality workers 

($$$).

 • A study of cotinine levels 

and, if possible, NNAL 

levels in urine, combined 

with personal interviews 

($$$).

 • Measurement of lung 

function using spirometry, 

combined with personal 

interviews ($$$). 

­

1
 
Evaluation Toolkit for Smoke-Free Policies 

Type of Study Why Do I Need This 

Information? 

What Information Will 

I Get? 

What Pitfalls Should 

I Guard Against? 

When Do I Need This 

Information? 

Possible 

Approaches 

(Relative Cost: 

$ to $$$$) 

Economic Impact Before the law is passed:

 • Findings from objective 

economic impact studies 

conducted in other sites 

with smoke-free laws 

can address stakeholder 

concerns about the law’s 

potential impact on 

hospitality venues. 

After the law is implemented:

 • Objective local economic 

data provide information 

about the law’s economic 

impact on hospitality 

venues. 

Information on the economic 

impact of the law on hospitality venues, including:

 • Employment levels, which 

are typically available in 

monthly increments, often 

from Current Employment 

Statistics (CES) data.

 • Taxable sales revenue, 

which is typically available 

in quarterly increments.

 • The number of venues that 

have opened or closed.

 • The number of licenses 

issued to restaurants and 

bars.

 • Self-reported consumer 

patronage intentions 

or patterns.

 • Anticipate high interest 

among policy makers, who 

may request reports on a 

law’s economic impact 

before objective information 

is available.

 • It takes time for objective 

economic data to become 

available: about – 

months for employment 

data and about 1 months 

for taxable sales revenue 

data.

 • Have enough data points 

before and after the law 

to determine trends reliably 

(at least one year of data 

after the law’s effective 

date).

 • Control for underlying economic trends and seasonal 

variations.

 • Econometric or statistical 

expertise is necessary 

to conduct more 

sophisticated analyses.

 • Before the law is passed, 

use findings of objective 

studies conducted in 

other smoke-free sites to 

address decision makers’ 

concerns.

 • After the law takes effect, 

analyze objective economic data as this information 

becomes available and 

report findings.

 • Baseline data do not need 

to be collected before 

the law takes effect; 

these data are routinely 

collected by government 

agencies and should be 

available later.

 • Obtain and analyze 

publicly available data 

on employment levels, 

taxable sales revenue, 

business openings and 

closings, and licenses 

issued. These data 

should be available free 

or for a nominal fee from 

appropriate government 

agencies (e.g., state 

departments of revenue, 

state departments 

of taxation and finance, 

state departments of 

labor, state bureaus 

of labor statistics).

 • Add a question on 

consumer patronage 

intentions or patterns 

to an existing survey, 

such as the ATS. (Use 

to complement other 

approaches, not as the 

sole information source.) 

($)

 • If possible, in addition 

to comparing economic 

indicators in your site 

before and after the law 

takes effect, compare 

data from your site 

to data from a similar 

control site that has not 

implemented a smokefree law. 

20 
STEP-BY-STEP GUIDE TO SELECTING APPROPRIATE EVALUATION
 

STUDIES FOR SMOkE-FREE POLICIES
 

This section is primarily intended for use by public health professionals who are providing technical 

assistance to state or local tobacco control programs to help these programs plan how to evaluate 

a proposed or existing state or local smoke-free law. The steps presented in this section help to identify 

appropriate studies to conduct on the basis of four factors: 

1.	 The stage the site has reached in the policy process. 

2.	 The key issues that have emerged in the policy debate and that are of greatest interest to policy 

makers, other community leaders, the news media, the business community, and the public. 

3.	 Any major exemptions in the smoke-free law. 

4.	 The level of resources available. 

These factors help programs select studies that are feasible and that provide the information necessary 

for an evaluation. 

key Questions 

The person providing technical assistance can quickly assess the situation by asking the following four 

questions: 

1.	 What stage has the site reached in the policy process? 

• The law has not yet been passed. 

• The law has been passed but not implemented. 

• The law has been in effect for less than 1 year. 

• The law has been in effect for 1 year or longer. 

2.	 What are the key issues? 

• Public support for the law. 

• Compliance with the law. 

• Air quality and secondhand smoke levels in hospitality venues. 

• Secondhand smoke exposure and related health effects among nonsmoking employees 

of hospitality venues. 

• The economic impact of the law on hospitality venues. 

21 
Evaluation Toolkit for Smoke-Free Policies 

3. Does the proposed or existing law contain major exemptions? These can include the following: 

• Exemptions for bars, restaurant bar areas, casinos, bingo venues, other gaming venues, 

bowling alleys, billiard parlors, private clubs, or other specific venues. 

• Ventilation provisions. 

• Provisions allowing smoking in adults-only settings. 

• Economic hardship exemptions. 

• Long phase-in periods (longer than 3 months) for certain settings, such as bars and 

casinos. 

• Other provisions that create gaps in coverage or weaken protections. 

4. What resources are available? 

• Funding: minimal, moderate (<$25,000), or significant (≥$25,000). 

• Labor (including paid staff and volunteers). 

• Access to an Institutional Review Board (IRB). 

• Access to statistical expertise for survey design, implementation, and data analysis. 

Study Recommendations 

Before the Policy is Passed or Implemented 

Useful studies to conduct during this phase include assessing public support for a smoke-free law, 

observing the level of smoking in hospitality venues, measuring air quality in these venues, and 

assessing secondhand smoke exposure and related health effects among nonsmoking workers in these 

venues. It is also helpful to begin identifying data sources to use for economic impact studies. 

Whenever possible, sites should collect baseline data before the law takes effect. The combination 

of baseline data and data collected after the law has taken effect is essential for showing that changes 

occurred in key outcomes after the law was implemented. To be comparable, all data must be collected 

using the same methods. Collecting baseline data is especially critical for employee health studies and 

is important for air quality and compliance studies as well. Although public support studies benefit from 

baseline data, in this case these data are not crucial. If sites are unable to collect data before the law 

is passed, they can still do so in the interim between when the law is passed and when it takes effect. 

Sites need to consider the level of resources available (i.e., minimal, moderate, or significant) both when 

selecting among the five broad study types and when selecting the specific approach to use 

in conducting each type of study. 

22 
Step-by-Step Guide 

In this section, we use the terms “probability sample” and “convenience sample” to describe two 

different ways to generate a sample of people or venues for a study. A probability sample is a true 

probabilistic, or random, sample designed by a specialist in statistical survey methodology. This method 

is preferred whenever an organization has the resources to take this approach. A convenience sample is 

not a true probability sample. This approach is used primarily when sampling venues for compliance or 

for air quality. 

A convenience sample of venues is typically small, with fewer than 20 venues, and it deliberately 

includes all of the main types of venues present in the study site. The goal of a convenience sample is to 

choose a sample of venues that is “representative” of the venues in the study site without the burden of 

designing a probability sample. This approach should be adopted only by sites that lack the resources to 

select a true probability sample. 

Sites should select the specific approach they take in conducting each type of study on the basis 

of their level of resources. 

Minimal Resources: small community partner (no funding, no paid staff, volunteers only). 

• Public Support 

Use an existing population health survey, such as the Adult Tobacco Survey (ATS), that includes 

relevant questions. 

• Compliance 

n Use an existing population health survey that includes relevant questions. 

n Have volunteers conduct observations in a convenience sample of hospitality venues. 

• Air Quality Monitoring 

Rent or borrow an air quality monitoring device and have volunteers collect data in a 

convenience sample of hospitality venues. 

• Employee Health 

n An original study is not feasible. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

• Economic Impact 

n An original study is not feasible. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

2
 
Evaluation Toolkit for Smoke-Free Policies 

Moderate Resources: organized community coalition, small health department (limited 

or significant funding, paid staff, access to many volunteers). 

• Public Support 

n Use an existing population health survey that includes relevant questions.
 

n Pay to add one or more questions to an existing population health survey.
 

• Compliance 

n Use an existing population health survey that includes relevant questions.
 

n Pay to add one or more questions to an existing population health survey.
 

n Have volunteers conduct observations in a convenience sample of hospitality venues.
 

• Air Quality Monitoring 

Purchase, rent, or borrow an air quality monitoring device and have volunteers collect data 

in a convenience sample of hospitality venues. 

• Employee Health 

n An original study is not feasible. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

• Economic Impact 

n Pay an economic or statistical consultant to collect and analyze economic data. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

n Lack of baseline data is not an issue with economic data, because historical data are typically 

available from government agencies. 

Significant Resources: large community partners, state health department, involvement of 

other partners, such as voluntary organizations, national organizations, funders, or researchers 

(significant funding, large paid staff, large network of volunteers, access to IRB, statistical 

expertise, and laboratory services). 

• Public Support 

Conduct a population survey using a probability sample. 

• Compliance 

n Have volunteers conduct observations in a convenience or probability sample of hospitality 

venues. 

n Use an existing population health survey that includes relevant questions, or add one or more 

questions to such a survey. 

• Air Quality Monitoring 

Purchase one or more air quality monitoring devices and have volunteers, contractors, or 

environmental health staff collect data in a convenience or probability sample of hospitality 

venues. 

24 
Step-by-Step Guide 

• Employee Health 

n Conduct a study using self-collected and mailed-in saliva cotinine specimens from 

nonsmoking workers in hospitality venues, combined with a telephone survey assessing 

self-reported secondhand smoke exposure and respiratory and sensory symptoms among 

these workers. 

n If more funding is available, conduct a study measuring NNAL in urine and/or measuring lung 

function using spirometry, combined with personal interviews, among nonsmoking hospitality 

workers. 

n Baseline data are essential. 

• Economic Impact 

n Collect and analyze relevant economic data. 

n Lack of baseline data is not an issue with economic data, because historical data are typically 

available from government agencies. 

Within One Year of Implementation 

Useful studies to conduct during this phase include assessing public support for the smoke-free law, 

assessing compliance, measuring air quality in hospitality venues, and assessing secondhand smoke 

exposure and related health effects among nonsmoking hospitality employees. Because of the long lag 

times in the availability of economic data, the first economic impact studies (which rely on employment 

data) must typically wait until 6–9 months after the law takes effect. Some studies can be conducted in a 

way that partially compensates for a lack of baseline data. 

Sites should select the specific approach they take in conducting each type of study on the basis of their 

level of resources. 

Minimal Resources: small community partner (no funding, no paid staff, volunteers only). 

• Public Support 

n Use an existing population health survey that includes relevant questions. 

n Although baseline data are optimal, they are not essential. Check whether existing state 

population health surveys have relevant historical data. 

• Compliance 

n Use an existing population health survey that includes relevant questions. 

n Have volunteers conduct observations in a convenience sample of hospitality venues. 

n If baseline data are unavailable, consider collecting and comparing data on smoking levels 

in hospitality venues from jurisdictions or venues not subject to the proposed law. 

• Air Quality Monitoring 

n Rent or borrow an air quality monitoring device and have volunteers collect data in a 

convenience sample of hospitality venues. 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions 

or venues not subject to the proposed law. 

2
 
Evaluation Toolkit for Smoke-Free Policies 

• Employee Health 

n An original study is not feasible. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

• Economic Impact 

n An original study is not feasible. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

Moderate Resources: organized community coalition, small health department (limited 

or significant funding, paid staff, access to many volunteers). 

• Public Support 

n Use an existing population health survey that includes relevant questions. 

n Pay to add one or more questions to an existing population health survey. 

n Although baseline data are optimal, they are not essential. Check whether existing state 

population health surveys have relevant historical data. 

• Compliance 

n Use an existing population health survey that includes relevant questions.
 

n Pay to add one or more questions to an existing population health survey.
 

n Have volunteers conduct observations in a convenience sample of hospitality venues.
 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions
 

or venues not subject to the proposed law. 

• Air Quality Monitoring 

n Purchase, rent, or borrow an air quality monitoring device and have volunteers collect data 

in a convenience sample of hospitality venues. 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions 

or venues not subject to the proposed law. 

• Employee Health 

n An original study is not feasible. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

• Economic Impact 

n Pay an economic or statistical consultant to collect and analyze economic data. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

n Lack of baseline data is not an issue with economic data, because historical data are typically 

available from government agencies. 

2
 
Step-by-Step Guide 

Significant Resources: large community partners, state health department, involvement of 

other partners, such as voluntary organizations, national organizations, funders, or researchers 

(significant funding, large paid staff, large network of volunteers, access to IRB, statistical 

expertise, and laboratory services). 

• Public Support 

n Conduct a population survey using a probability sample. 

n Although baseline data are optimal, they are not essential. Check whether existing state 

population health surveys have relevant historical data. 

• Compliance 

n Have volunteers conduct observations in a convenience or probability sample of hospitality 

venues. 

n Use an existing population health survey that includes relevant questions, or add one or more 

questions to such a survey. 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions 

or venues not subject to the proposed law. 

• Air Quality Monitoring 

n Purchase one or more air quality monitoring devices and have volunteers, contractors, 

or environmental health staff collect data in a convenience or probability sample of hospitality 

venues. 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions 

or venues not subject to the proposed law. 

• Employee Health 

n Conduct a study using self-collected and mailed-in saliva cotinine specimens from 

nonsmoking workers in hospitality venues, combined with a telephone survey assessing selfreported secondhand smoke exposure and respiratory and sensory symptoms among these 

workers. 

n If more funding is available, conduct a study measuring NNAL in urine and/or measuring lung 

function using spirometry, combined with personal interviews, among nonsmoking hospitality 

workers. 

n Baseline data are essential. 

• Economic Impact 

n Collect and analyze relevant economic data. 

n Lack of baseline data is not an issue with economic data, because historical data are typically 

available from government agencies. 

2
 
Evaluation Toolkit for Smoke-Free Policies 

One Year or Longer After Implementation 

Useful studies to conduct during this phase include assessing long-term public support for the smokefree law, assessing compliance, measuring air quality in hospitality venues, assessing secondhand 

smoke exposure and related health effects among nonsmoking hospitality workers, and assessing 

economic impact on hospitality venues by measuring employment levels and taxable sales revenue. 

Some studies can be conducted in a way that partially compensates for a lack of baseline data. 

Sites should select the specific approach they take in conducting each type of study on the basis 

of their level of resources. 

Minimal Resources: small community partner (no funding, no paid staff, volunteers only). 

• Public Support 

n Use an existing population health survey that includes relevant questions. 

n Although baseline data are optimal, they are not essential. Check whether existing state 

population health surveys have relevant historical data. 

• Compliance 

n Use an existing population health survey that includes relevant questions. 

n Have volunteers conduct observations in a convenience sample of hospitality venues. 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions 

or venues not subject to the proposed law. 

• Air Quality Monitoring 

n Rent or borrow an air quality monitoring device and have volunteers collect data in a 

convenience sample of hospitality venues. 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions 

or venues not subject to the proposed law. 

• Employee Health 

n An original study is not feasible. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

• Economic Impact 

n An original study is not feasible. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

2
 
Step-by-Step Guide 

Moderate Resources: organized community coalition, small health department (limited 

or significant funding, paid staff, access to many volunteers). 

• Public Support 

n Use an existing population health survey that includes relevant questions.
 

n Pay to add a question to an existing population health survey.
 

n Although baseline data are optimal, they are not essential. Check whether existing state 


population health surveys have relevant historical data. 

• Compliance 

n Use an existing population health survey that includes relevant questions.
 

n Pay to add a question to an existing population health survey.
 

n Have volunteers conduct observations in a convenience sample of hospitality venues.
 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions
 

or venues not subject to the proposed law. 

• Air Quality Monitoring 

n Purchase, rent, or borrow an air quality monitoring device and have volunteers collect data 

in a convenience sample of hospitality venues. 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions 

or venues not subject to the proposed law. 

• Employee Health 

n An original study is not feasible. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

• Economic Impact 

n Pay an economic or statistical consultant to collect and analyze economic data. 

n Summarize findings of peer-reviewed studies from other smoke-free sites and make the case 

that similar results can be expected in your community. 

n Lack of baseline data is not an issue with economic data, because historical data are typically 

available from government agencies. 

Significant Resources: large community partners, state health department, involvement of 

other partners, such as voluntary organizations, national organizations, funders, or researchers 

(significant funding, large paid staff, large network of volunteers, access to IRB, statistical 

expertise, and laboratory services). 

• Public Support 

n Conduct a population survey using a probability sample. 

n Although baseline data are optimal, they are not essential. Check whether existing state 

population health surveys have relevant historical data. 

2
 
Evaluation Toolkit for Smoke-Free Policies 

• Compliance 

n Have volunteers conduct observations in a convenience or probability sample of hospitality 

venues. 

n Use an existing population health survey that includes relevant questions, or add one or more 

questions to such a survey. 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions 

or venues not subject to the proposed law. 

• Air Quality Monitoring 

n Purchase one or more air quality monitoring devices and have volunteers, contractors, 

or environmental health staff collect data in a convenience or probability sample of hospitality 

venues. 

n If baseline data are unavailable, consider collecting and comparing data from jurisdictions 

or venues not subject to the proposed law. 

• Employee Health 

n Conduct a study using self-collected and mailed-in saliva cotinine specimens from nonsmoking 

workers in hospitality venues, combined with a telephone survey assessing self-reported 

secondhand smoke exposure and respiratory and sensory symptoms among these workers. 

n If more funding is available, conduct a study measuring NNAL in urine and/or measuring lung 

function using spirometry, combined with personal interviews, among nonsmoking hospitality 

workers. 

n Baseline data are essential. 

• Economic Impact 

n Collect and analyze relevant economic data. 

n Lack of baseline data is not an issue with economic data, because historical data are typically 

available from government agencies. 

0
 
SELECTED BIBLIOGRAPHY
 

The following bibliography includes published studies under each of the five domains addressed in this 

publication. These citations are provided as examples of methodologically sound studies, rather than 

as a comprehensive listing of studies that have been conducted in these areas. 

Public Support 

Tang H, Cowling DW, Lloyd JC, Rogers T, Koumjian KL, Stevens CM, Bal DG. Changes of attitudes and 

patronage behaviors in response to a smoke-free bar law. Am J Public Health 2003;93(4):611– 

617.

Tang H, Cowling DW, Stevens CM, Lloyd JC. Changes of knowledge, attitudes, beliefs, and preference 

of bar owner and staff in response to a smoke-free bar law. Tob Control 2004;13(1):87–89. 

Compliance 

Hyland A, Cummings KM, Wilson MP. Compliance with the New York City Smoke-Free Air Act. J Public 

Health Manag Prac 1999;5(1):43–52. 

Tang H, Cowling DW, Lloyd JC, Rogers T, Koumjian KL, Stevens CM, Bal DG. Changes of attitudes and 

patronage behaviors in response to a smoke-free bar law. Am J Public Health 2003;93(4):611– 

617.

Tang H, Cowling DW, Stevens CM, Lloyd JC. Changes of knowledge, attitudes, beliefs, and preference 

of bar owner and staff in response to a smoke-free bar law. Tob Control 2004;13(1):87–89. 

Weber MD, Bagwell DAS, Fielding JE, Glantz SA. Long term compliance with California’s Smoke-Free 

Workplace Law among bars and restaurants in Los Angeles County. Tob Control 2003;12(3):269– 

273.

Air Quality Monitoring 

Centers for Disease Control and Prevention. Indoor air quality in hospitality venues before and after 

implementation of a clean indoor air law—Western New York, 2003. MMWR 2004;53(44):1038– 

1041. A

Repace J. Respirable particles and carcinogens in the air of Delaware hospitality venues before and after 

a smoking ban. J Occup Environ Med 2004;46(9):887–905. 

Employee Health 

Eisner MD, Smith AK, Blanc PD. Bartenders’ respiratory health after establishment of smoke-free 

bars and taverns. JAMA 1998;280(22):1909–1914. A

1
 
Evaluation Toolkit for Smoke-Free Policies 

Farrelly MC, Nonnemaker JM, Chou R, Hyland A, Peterson KK, Bauer UE. Changes in hospitality 

workers’ exposure to secondhand smoke following the implementation of New York’s smokefree law. Tob Control 2005;14(4):236–241. 

Menzies D, Nair A, Williamson PA, Schembri S, Al-Khairalla MZH, Barnes M, et al. Respiratory 

symptoms, pulmonary function, and markers of inflammation among bar workers before and 

after a legislative ban on smoking in public places. JAMA 2006;296(14):1742–1748. 

Skeer M, Cheng DM, Rigotti NA, Siegel M. Secondhand smoke exposure in the workplace. Am J Prev 

Med 2005;28(4):331–337. 

Trout D, Decker J, Mueller C, Bernert JT, Pirkle J. Exposure of casino employees to environmental 

tobacco smoke. J Occup Environ Med 1998;40(3):270–276. 

Wakefield M, Cameron M, Inglis G, Letcher T, Durkin S. Secondhand smoke exposure and respiratory 

symptoms among casino, club, and office workers in Victoria, Australia. J Occup Environ Med 

2005;47(7):698–703. 

Economic Impact 

Centers for Disease Control and Prevention. Impact of a smoking ban on restaurant and bar revenues— 

El Paso, Texas, 2002. MMWR 2004;53(7):150–152. A

Glantz SA. Effect of smokefree bar law on bar revenues in California. Tob Control 2000;9(1):111–112. 

Glantz SA, Charlesworth A. Tourism and hotel revenues before and after passage of smoke-free 

restaurant ordinances. JAMA 1999;281(20):1911–1918. 

Glantz SA, Smith LRA. The effect of ordinances requiring smoke-free restaurants and bars on revenues: 

a follow-up. Am J Public Health 1997;87(10):1687–1693. 

Glantz SA, Smith LRA. The effect of ordinances requiring smoke-free restaurants on restaurant sales. Am 

J Public Health 1994;84(7):1081–1085. 

Hyland A, Cummings KM. Restaurant employment before and after the New York City Smoke-Free Air 

Act. J Public Health Manag Pract 1999;5(1):22–27. 

Hyland A, Cummings KM, Nauenberg E. Analysis of taxable sales receipts: was New York City’s SmokeFree Air Act bad for restaurant business? J Public Health Manag Pract 1999;5(1):14–21. 

Mandel LL, Alamar BC, Glantz SA. Smoke-free law did not affect revenue from gaming in Delaware. Tob 

Control 2005;14(1):10–12. A

Pyles MK, Mullineaux DJ, Okoli CTC, Hahn EJ. Economic effect of a smoke-free law in a tobaccogrowing community. Tob Control 2007;16(1):66–68. A

2
 
Bibliography 

Scollo M, Lal A, Hyland A, Glantz S. Review of the quality of studies on the economic effects of smokefree policies on the hospitality industry. Tob Control 2003;12(1):13–20. A

In addition, the following publications contain examples of all five types of evaluation studies. 

ClearWay Minnesota. A toolkit for implementing and defending smoke-free ordinances. Minneapolis, 

MN: Minnesota Institute of Public Health; 2006. A

New York State Department of Health. The health and economic impact of New York’s Clean Indoor Air 

Act. Albany, NY: New York State Department of Health; 2006. 


 
Notes 

4
 
Notes 


 


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