A growing number of states and cities in the United States have enacted smoke-free policies in public areas and, to improve the health outcomes of employees and patrons, have extended the policies to indoor tourism and hospitality venues including casinos, bars, and restaurants. However, the introduction of smoke-free policies in casinos has lowered gaming revenues by up to 20% in some jurisdictions (Eadington, 2011; Pakko, 2005; Thalheimer & Ali, 2008). Smoke-free policies have the potential to reduce the participation rate of gamblers either because smoking gamblers choose not to gamble if they cannot smoke, or because they choose to migrate to an alternative gambling opportunity which allows smoking. Since the goal of implementing smoke-free policies is to improve the health outcomes of employees and customers, some states' or locales' exemption from the bans may be temporary (Goodman, Agnew, McCaffrey, Paul, & Clancy, 2007). As a result of these changing external influences, it may be necessary to develop effective marketing strategies for continued growth in the casino industry. This study aimed to enhance insight into this phenomenon that results from external market influences by focusing on gamblers' behavioral changes with respect to their decisions to visit casinos when smoking bans are implemented. This dissertation proposed and tested a gambling-specific behavior model to examine the antecedents of individual changes in gambling patronage. The model was tested by using Path Analysis on data that were collected through an online survey of gamblers who visited gaming facilities in Deadwood, South Dakota. The results indicated that both the psychological reactance trait and the attitude importance of the freedom to smoke influence gambling behavioral changes after a smoking ban went into effect. Individual attitudes towards secondhand smoking also explained changes in casino patronage. No moderator effect was found in the path analysis. Supplementary analyses for other hospitality sectors were also conducted and the results also showed psychological reactance trait, the attitude importance of the freedom to smoke, and the attitude towards secondhand smoking explain changes in restaurant and bar patronage, and video lottery terminal participation. Discussion on the results of hypotheses testing and implications are presented followed by future research directions. / Tourism and Sport

Because tobacco smoking causes 430,000 U.S. deaths annually, wide-reaching smoking bans are needed. Bans reduce cigarette consumption, encourage cessation, protect nonsmokers from second-hand smoke, and promote an attitude that smoking is undesirable. Therefore, bans may prevent future generations from suffering many smoking-related health problems. The federal government has not implemented widereaching smoking bans so it falls on individual states, counties, or communities to devise appropriate smoking policy. To date, smoking policy has been determined by legislators, who may have conflicts that prevent them from acting in the publics best interest. However, this method of implementing smoking policy may be changing. In 2005, Washington residents voted by ballot initiative to strengthen existing state smoking regulations. In 2006, Arizona, Nevada, and Ohio residents voted by ballot initiatives to implement strict statewide smoking bans. This research presents a way to predict how residents of other states might vote if given the opportunity. Two research hypotheses are tested and accepted: a positive relationship between favorable votes and urbanness, and a preference favoring smoking bans where smoking regulations already exist. Finally, a projection is made that a smoking ban vote in Kentucky would yield favorable results, and a map showing projected county votes is provided.

Politicians and social marketers considering whether, and how, to implement a national smoking ban in their countries require sound evidence regarding what the causes of support are amongst key stakeholders, how this support will develop over the short to medium term in which they seek to be re-elected, and how support relates to critical outcomes like enforcement. In response to this need, I use structural equation models to develop a model of the antecedents of support, based on theories of self interest and common sense justice, amongst hospitality industry managers. I show that support is determined more by fairness related constructs than self interest constructs, that support for national smoking bans increases consistently over time, and that the initial level of support, and the rate at which support increases, is positively related to subsequent enforcement behaviour by bar managers, in the year after implementation of such a ban, in New Zealand. I use growth mixture modeling to identify two subgroups of bar managers whose support changes at different rates. First, a class of bar managers with a high proportion of smokers who reported fewer instances of respiratory related health problems, showed low initial support, and whose support for the legislation slowly decreased. And second, a class of bar managers comprised of fewer smokers, but reporting more instances of respiratory related health problems. This class began with a high degree support, and steadily increased in support for the national smoking ban. I discuss the implications of these findings for social marketers, health educationalists, and politicians interested in introducing a similar ban in other countries.

The purpose of this study was to determine if there is a difference in opinion between chain and franchise restaurant managers and independent owner/operators toward the effects of a smoking ordinance. Results of this study showed a significant statistical difference between restaurateur groups toward the perception of economic effects.

This master thesis was tasked to find out how the parameter of interior atmosphere changes at student's club "Mrtvá Ryba", that means atmospheric aerosols sized from 0,524 to 20 micrometers. This work tries to show indoor aerosols before and after the smoking ban and its comparison. This work describes concentrations PM1 and PM10, and their behavior per day. Concentrations was measured by APS (Aerodynamic particle sizer). The measurement was the first step in the non-smoking club, then processing with retrieved informations in CoPlot, CoStat and Excel, where the statistical method has done, and comparison with previous values. T-tests was used for statistics and linear regresion. The result confirms, what was it supposed to, so concentracion values are significantly different. The average concentration of all measured days (six) of smoking campaign was at PM1 13,28 µg.m-3 and at PM10 23,38 µg.m-3. The average concentration of all measured days (thirty six) of non-smoking campaign was at PM1 4,88 µg.m-3 and at PM10 24,61 µg.m-3. Resulting concentration of aerosol particles was explicity lower at non-smoking period than at smoking period. Contamination of interior enviroment is influenced by many factors. The most important factor is presence of persons and their number, concentration of outdoor...

The aim of this study is to draw attention to the fact that daily practices which tend to be overlooked due to their taken for grantedness actually signify power coming into existence here and now as well as that everyday problems bring along accordingly ordinary coping ways. In this respect, resistance in everyday life means a refusal that does not identify itself as political and organized, and who intends to make do with the rule by finding immediate and effective solutions to negative effects power generates rather than overtly challenging it. In order to render visible this type of resistance, to understand how it is experienced and perceived, the implementation of smoking ban in enclosed areas was covered in entertainment venues. Participant observations and semi-structured in-depth interviews were conducted in Nevizade Street that is located in Beyoglu district of Istanbul and consists of meyhanes as well as beerhouses. Although customers resist based on pleasure principle, managers in order not to go bankrupt and employees not to fall out of work, it is concluded that what is thwarted here is not public health that the related law aims to protect but rather the troubles that the implementation of the law brings about.

Politicians and social marketers considering whether, and how, to implement a national smoking ban in their countries require sound evidence regarding what the causes of support are amongst key stakeholders, how this support will develop over the short to medium term in which they seek to be re-elected, and how support relates to critical outcomes like enforcement. In response to this need, I use structural equation models to develop a model of the antecedents of support, based on theories of self interest and common sense justice, amongst hospitality industry managers. I show that support is determined more by fairness related constructs than self interest constructs, that support for national smoking bans increases consistently over time, and that the initial level of support, and the rate at which support increases, is positively related to subsequent enforcement behaviour by bar managers, in the year after implementation of such a ban, in New Zealand. I use growth mixture modeling to identify two subgroups of bar managers whose support changes at different rates. First, a class of bar managers with a high proportion of smokers who reported fewer instances of respiratory related health problems, showed low initial support, and whose support for the legislation slowly decreased. And second, a class of bar managers comprised of fewer smokers, but reporting more instances of respiratory related health problems. This class began with a high degree support, and steadily increased in support for the national smoking ban. I discuss the implications of these findings for social marketers, health educationalists, and politicians interested in introducing a similar ban in other countries.

abstract: This dissertation focuses on consequences of public policy on consumption responses. Chapter 1 evaluates the effect of Thailand's car tax rebate scheme in 2012 on household consumption by examining aggregate and administrative data. Car sales doubled during the policy and dramatically declined afterwards while domestic household spending was sluggish following the policy, suggesting a substantial dampening effect of the policy on future household consumption. Chapter 2 develops a formal model to evaluate Thai household consumption responses. A life-cycle model of consumption and saving is developed with features including uninsured income risks, liquidity constraints, durable goods with embedded adjustment costs and non-homothetic preference in durable goods. Adjustment costs and liquidity constraints are important frictions in the evaluation of the shorter-term responses to changes in relative prices, while non-homotheticity captures the income effect given that cars are luxury goods in the Thai economy context. Key parameters and the partial equilibrium responses, which are key inputs to inform the aggregate outcome of the policy, are estimated. The results show that the car-tax rebates had a sizable impact on slowing Thai household consumption following the policy due to high level of elasticity of intertemporal substitution among Thai households. Chapter 3 examines the effect of public smoking bans in the EU countries. Using individual-level data, this chapter investigates whether nationwide smoke-free laws in Europe lead to higher smoking reduction and cessation rates among mature smokers. Exploiting the different timing in imposing smoking ban laws and using a difference-in-differences approach, I find that light smokers and heavy smokers were more likely to quit smoking after comprehensive bans were in place while there was no significant effect on average smokers. The results confirm that smoking bans, particularly when enforced more strictly and comprehensively, lead to higher smoking cessation rates even among mature smokers with well-established addiction. / Dissertation/Thesis / Doctoral Dissertation Economics 2018

The social norms concept provides a fresh basis for thinking about how public health policies and campaigns impact health behaviour. Social norms offer much promise to the field of public health, nonetheless, the potential role of norms in changing health behaviour have not been fully embraced. This thesis demonstrates that one of the mechanisms by which national level policies (e.g. tobacco control) can promote health behaviour change, such as an increase in quit intentions, is by making smoking less normative and an undesirable behaviour. This study is vital as it provides a broad conceptualization of tobacco denormalisation and shows how its reasoning is able to influence normative beliefs and smoking behaviour. A review of literature was carried out to establish the generic origins of denormalisation as well as demonstrate that this approach (i.e. social norms) has been widely adopted in schools and college settings to influence health behaviour. As a broader perspective of this thinking was imperative to address public health issues at a societal level, tobacco control was employed to investigate how individual polices influence behaviour and normative beliefs. The research methodology used was pluralistic in nature, given that the majority of past tobacco control policy studies employed either quantitative or qualitative methods. Thus adopting both methods a richer amount of data would be obtained in order to generate an improved understanding of how public policy affects norms and smoking behaviour. To empirically examine the relationship between public policy, social norms and smoking behaviour a broad conceptualization was developed to investigate the normative pathways between national level tobacco policy effects on youth and adults’ smoking behaviour. Quantitative results from the longitudinal study, the International Tobacco Control (ITC) Scotland/UK survey, indicate that a comprehensive smoke-free law that covers, without exception, an entire nation (i.e. Scotland) has increased adult smokers’ perceived social unacceptability of smoking, to some extent higher in Scotland than rest of the UK which, in turn, is associated with quit intentions at follow-up, in both countries. The examination of data from the UK Youth Tobacco Policy Study (YTPS) also demonstrated that the influence of tobacco marketing awareness on adolescents’ smoking intentions is mediated by perceived norms. Prior to the enactment of the UK Tobacco Advertising and Promotion Act (TAPA), higher levels of awareness of tobacco advertising and promotion were independently associated with higher levels of perceived sibling approval which, in turn, were positively related to smoking intentions. Independent paths from perceived smoking prevalence and benefits fully mediated the effects of advertising and promotion awareness on intentions, during and after the enactment of the TAPA. Results from the qualitative study generally supported the quantitative findings and provided new insights into how adolescents’ normative beliefs and smoking behaviour are influenced by tobacco control policies. The qualitative group discussion suggests that smoke-free legislation and anti-smoking ads influence perceptions of prevalence, acceptability and smoking behaviour. A number of theoretical implications were presented, including the belief that social norms campaigns and interventions must be focal and salient in individuals’ consciousness so as to effect the desired behaviour change. A theoretical framework of the various normative mechanisms should consequently be integrated into tobacco control policies and norm-based interventions to work in a synergistic manner to influence health-related behaviour. Practical implications of this conceptualization include the view that, instead of public health interventions focusing on conventional approaches (for example, scare tactics), an appropriate strategy would be to incorporate specific information that corrects normative misperceptions and ambiguities among referent populations at individual and societal levels, with consequential normative and health behaviour change. It is recommended that future research employing tobacco industry perceptions and possibly a descriptive norm as additional normative mediators, aside from unacceptability, would be of value to examine whether smoke-free legislation influences quitting partly via changing favourable tobacco industry perceptions, social acceptability of smoking and perceived prevalence of smoking. To sum up, the findings demonstrate that societal level policy measures such as smoke-free legislation and the TAPA are critical elements of a comprehensive tobacco control program that can significantly influence adult smokers’ quit intentions and reduce adolescents’ smoking intentions respectively, by signifying smoking to be less normative and to be socially unacceptable.

Antecedentes: Varios estudios han demostrado como las políticas de control del tabaquismo favorecen el abandono del consumo del tabaco entre los fumadores, incrementan la aceptabilidad y el cumplimiento de los espacios sin humo. Sin embargo, se desconoce el impacto que las diferentes medidas de control del tabaquismo tienen en los hospitales catalanes. Hipótesis: 1) La política de espacios sin humo en los hospitales reduce la prevalencia de consumo de tabaco entre los trabajadores, favoreciendo cambios en la actitud y el comportamiento en el cumplimiento de las normativas. 2) La Ley 28/2005 ha contribuido a la progresión y el avance de las políticas de control de tabaquismo en los hospitales y 3) ha fomentado cambios en la disminución del humo ambiental del tabaco (HAT) en los hospitales de Cataluña. 4) Los hospitales de 7 países europeos que han desarrollado el modelo de hospital sin humo de la Red Europea sin Humo (ENSH) presentan niveles bajos de HAT en distintas áreas de hospitalización. 5) El programa de cesación tabáquica dirigido a trabajadores fumadores de los hospitales miembros de la Red Catalana de Hospitales sin Humo (XCHsF) consigue una alta tasa de abstinencia. Objetivos: 1) Describir los efectos en el consumo de tabaco tras la implantación progresiva de las políticas de control de tabaquismo en un centro hospitalario: el Instituto Catalán de Oncología (ICO). 2) Valorar la progresión de las políticas de control de tabaquismo en los hospitales miembros de la XCHsF antes y después de la implantación de la Ley de medidas de control del tabaco 28/2005. 3) Evaluar el impacto de la Ley de control de tabaquismo 28/2005 en la exposición al HAT en los hospitales públicos catalanes, antes (2005) y después (2006) de su implantación. 4) Describir los niveles de HAT mediante la determinación de partículas PM2.5, en una muestra de hospitales europeos en el año 2007. 5) Evaluar la efectividad de un programa de cesación tabáquica dirigido a los trabajadores hospitalarios. Metodología: Para conseguir los objetivos marcados se han realizado cinco estudios que incluyen: una serie de encuestas transversales, un estudio pre-post de evaluación de las medidas de control del tabaco, dos estudios de determinación del HAT - uno realizado en Cataluña, y el otro en 7 países europeos- y un estudio de evaluación de la efectividad de un programa de cesación tabáquica coordinado por la XCHsF en 33 hospitales. Resultados: La prevalencia de consumo de tabaco en el ICO disminuyó del 34,5% en 2001 al 30,6% en el 2006. Entre los médicos la prevalencia descendió del 20,0% al 15,2%, entre las enfermeras del 34,0% al 32,6%, y entre los administrativos del 56,0% al 37,0%. Se produjeron cambios en el patrón de consumo como la reducción del número de cigarrillos y del número de fumadores diarios. La puntuación media de la implementación de las políticas de control del tabaco en los hospitales fue del 52,4 (IC 95%: 45,4-59,5) en 2005 y 71,6 (IC 95%: 67,0-76,2) en 2007 (aumento del 36,7%). Los hospitales con mayor incremento fueron los hospitales generales (48%), hospitales con >300 camas (41,1%), hospitales cuyos trabajadores fuman entre un 35-39% (72,2%), hospitales con un implantación reciente de políticas de control del tabaco (74,2%). En los hospitales de Cataluña la concentración media de nicotina disminuyó de 0,23 μg/m3 (rango intercuartil: 0,13-0,63) antes de la Ley 28/2005, a 0,10 μg/m3 (rango intercuartil: 0,02-0,19) después de la Ley (disminución del 56,5%). Tras la Ley se observaron reducciones significativas en la concentración mediana de nicotina en todas las localizaciones, aunque se continuaron detectando valores de HAT en las entradas de los hospitales, sala de urgencias, escaleras de incendios y cafeterías. La mediana de las concentraciones de PM2.5 en una muestra de 30 hospitales europeos fue de 3,0 μg/m3. La mitad de las medidas presentaron valores entre 2,0 a 7,0 μg/m3. Los niveles de PM2.5 fueron similares entre los diferentes países. Once medidas (5,5%) estaban por encima de 25,0 μg/m3, límite recomendado por la OMS para los espacios exteriores. Los trabajadores de una muestra de hospitales catalanes que entraron en el programa de cesación tabáquica coordinado por la XCHsF presentaron una probabilidad de abstinencia global a los 6 meses de 0,504 (IC 95%: 0,431- 0,570). Los hombres obtuvieron mejor abstinencia 0,526 (IC 95%: 0,398-0,651) que las mujeres (0,495 IC 95%: 0,410-0,581). Por grupos profesionales, los médicos obtuvieron una abstinencia más alta (0,659, IC 95%: 0,506-0,811) que las enfermeras (0,463, IC 95%: 0,349-0,576). Los trabajadores con mayor dependencia a la nicotina tuvieron una menor probabilidad de abstinencia (0,376, IC 95%: 0,256-0,495) que los trabajadores con baja dependencia (0,529, IC 95%: 0,458-0,599). Se observa una alta probabilidad de abstinencia en trabajadores que siguieron un tratamiento farmacológico combinado (bupropion y sustitutivos de la nicotina) (0,761, IC 95%: 0,588-0,933). Conclusiones: La introducción progresiva de políticas de control del tabaquismo en los hospitales se asocia con una ligera disminución del consumo de tabaco y la modificación del patrón de consumo entre los trabajadores fumadores. La política de espacios sin humo en los hospitales disminuye la percepción de la exposición al HAT e incrementa el cumplimiento auto reportado de la normativa entre los trabajadores. Los niveles de HAT disminuyen en los hospitales tras la entrada en vigor de la Ley 28/2005. La valoración de las concentraciones de nicotina en fase vapor ofrece un sistema de monitorización objetivo y fiable que refuerza el cumplimiento de los espacios sin humo. La presencia de HAT en los hospitales europeos monitorizada mediante PM2.5 es baja, a excepción de la hallada en lugares en los que se permite fumar cuya concentración es elevada. Los hospitales miembros de la XCHsF presentan un mayor control de tabaquismo (medidas mediante el cuestionario europeo selfaudit) tras dos años de implantación de la Ley 28/2005 (2007) que los obtenidos antes de la Ley (2005). El programa de cesación tabáquica coordinado por la XCHsF dirigido a los trabajadores hospitalarios fumadores obtiene una alta probabilidad de abstinencia a los seis meses. Los trabajadores tratados con dependencia baja o media, los fumadores de 10-19 cigarrillos al día y los tratados con terapia combinada obtuvieron mejores tasas de abstinencia / "Implementation and Evaluation of Tobacco control Policies in Hospitals" Background: Several studies have shown that tobacco control policies favour the cessation of tobacco use, increase population support and improve compliance with smoke free policies. However, the impact of tobacco control measures in Catalan hospitals is unknown. Hypothesis: 1) The smoke free policy in hospitals reduces the prevalence of tobacco consumption among workers and increases compliance with smoke free regulations; 2) Law 28/2005 has increased tobacco control policies in hospitals; 3) has decreased second-hand smoke (SHS) levels among Catalan hospitals; 4) European hospitals which have developed the European smoke free model (ENSH) have low levels of SHS in different areas; 5) the smoking cessation program addressed to hospital employees achieves a high rate of abstinence. Aims: 1) To describe the effects on tobacco consumption after the gradual implementation of tobacco control policies in a hospital; 2) to evaluate the progression of tobacco control policies in hospitals members of the XCHsF before and after the implementation of Law 28/2005, 3) To assess the impact of tobacco control Law 28/2005 on exposure to SHS in public hospitals in Catalonia, before (2005) and after (2006) its implementation. 4) To describe the levels of SHS by the assessment of PM2.5 particles in a sample of European hospitals in 2007; 5) to evaluate the effectiveness of a smoking cessation program addressed to hospital workers. Methodology: Five studies have been conducted, which were: a series of cross-sectional surveys, a pre-post evaluation of tobacco control measures, two studies for the assessment of SHS- one in Catalonia, and another in 7 European countries- and a study evaluating the effectiveness of a smoking cessation program. Results: The tobacco consumption at one hospital dropped from 34.5% in 2001 to 30.6% in 2006. Smokers changed their consumption patterns with the reduction of the number of cigarettes smoked per day and the decrease of daily smokers. The average score of the implementation of tobacco control policies in hospitals was 52.4 (95% CI 45.4 to 59.5) in 2005 and 71.6 (95% CI 67.0 to 76.2) in 2007 (up 36.7%). The average median concentration of nicotine decreased 56.5% after the implementation of Law 28/2005. However, nicotine was found in hospitals halls, emergency rooms, fire escapes and cafeterias. The median concentrations of PM2.5 in a sample of 30 European hospitals were low (3.0 ug/m3). The abstinence probability of the XCHsF tobacco cessation program at 6 months was 0.504 (95% CI 0.431 to 0.570). Workers with higher nicotine dependence showed a lower likelihood of abstinence (0.376, 95% CI: .256 to .495) than the low-dependence (0.529, 95% CI 0.458 to 0.599). There is a high probability of abstinence among workers treated with combined drug therapy (bupropion and nicotine replacement) (0.761, 95% CI 0.588 to 0.933). Conclusions: Tobacco control policies in hospitals are associated with a slight decline in smoking consumption, reduction of levels of SHS, and high probability of abstinence at 6 months.