Smokefree policies (SFPs) have diffused throughout the US and worldwide. However, the development of SFPs in the difficult policy environment of tobacco-producing states and economies worldwide has not been well-explored. In 2007, Tennessee, the third largest tobacco producer in the US, enacted the Non-Smoker Protection Act (NSPA). This study utilizes the multiple streams model to provide understanding of why and how this policy was developed by triangulating interviews with key stakeholders and legislative debates with archival documents. In June 2006, the Governor unexpectedly announced support for SFP, which created a window of opportunity for policy change. The Campaign for Healthy and Responsible Tennessee, a health coalition, seized this opportunity and worked with the administration and the Tennessee Restaurant Association to negotiate a comprehensive SFP, however, a weaker bill was used by the legislative leadership to develop the NSPA. Although the Governor and the Tennessee Restaurant Association's support generated an environment for 100 % SFP, health groups did not fully capitalize on this environmental change and settled for a weak policy with several exemptions. This study suggests the importance for proponents of policy change to understand changes in their environment and be willing and able to capitalize on these changes.

Introduction: The purpose of this study is to examine the change in smoking policy status among bars and restaurants since the Georgia Smokefree Air Act of 2005 was implemented and identify restaurant and bar characteristics that are associated with allowing smoking. Methods: Data was obtained from similar Georgia indoor air surveys conducted in 2006 and 2012. Both surveys were designed to gather information about restaurant and bar smoking policies and examine owner and manager perceptions of the Georgia Smokefree Air Act. Descriptive analysis and paired sample t-tests were performed to identify changes in smoking policy status and other variables over time. Chi-square and logistic regression analysis were used to test for significant associations between establishment smoking policy status and other characteristics. Results: The percent of restaurants and bars in Georgia allowing smoking nearly doubled from 9.2% in 2006 to 18.2% in 2012. The analysis showed a statistically significant increase in the percentage of establishments allowing smoking when minors are present. After adjusting for the effects of other variables, three variables were significant predictors of allowing smoking: having seats for drinking outdoors, having a liquor license, and generating greater than or equal to 25% of gross sales from alcohol. Conclusions: The Smokefree Air Act was enacted to protect the health and welfare of Georgia citizens, but the percentage of establishments allowing smoking has risen since it was implemented. These results suggest that policy makers should reevaluate the law and consider strengthening it to make restaurants and bars 100% smokefree without exemptions.

Introduction: Despite the known consequences of cigarette smoking, almost 20% of adults in the United States smoke. Smoking has been shown to harm nearly every organ of the body. Its detrimental effects have been seen not only in smokers themselves but also in those exposed to secondhand smoke (SHS) at work and in other public places. Methodology: The purpose of this thesis was to examine compliance with the signage requirement of the Georgia Smokefree Air Act (GSAA) of 2005 among 99 hospitality venues located in Atlanta. Photographs of bars and restaurant entrances were taken and raters then classified each venue as compliant or non-compliant with smoking status signage requirements of the GSAA. Additionally, air samples were collected using Sidepak equipment from 59 venues in order to estimate the PM2.5 levels, which is a recognized measure of air quality. With Spearman’s rho correlation coefficient (r), analyses were run to determine correlations between signage compliance, number of cigarettes being smoked, and smoking permitted with air quality (PM2.5). Analyses were conducted using the Statistical Package for Social Sciences (SPSS) version 19. Results: Of the 99 venues assessed, only 21 (21.2 %) complied with the signage requirements of the GSAA. Venues that do adhere to signage requirements and indicate no smoking on their signs and at the same time via telephone stated that smoking is prohibited had the lowest PM2.5 levels =15.03. On the contrary, those venues that display signs permitting smoking and via telephone indicated smoking is allowed had the highest PM2.5 levels =230.31. It was determined that there is a strong positive correlation between PM2.5 and “number of cigarettes” (r=.611, n=59, p<.001) as well as moderate correlation between PM2.5 and “smoking permitted” as indicated from phone calls (r=.464, n=59, p<.001). However, analysis showed a weak correlation between PM2.5 and “signage compliance” in accordance with GSAA (r=.107, n=59, p>.001). Conclusions: Enforcement of GSAA must be enhanced in order to better protect workers and patrons of Atlanta’s bars and restaurants from harmful exposure to SHS. Findings from this study support that prohibiting smoking in bars and restaurants and having signs stating that smoking is prohibited would improve air quality and protect workers by eliminating their exposure to SHS while working.

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Smokefree environment created by smokefree policies is associated with smoking reduction; however, there is paucity of literature on the relationship between smokefree home rules and smoking intensity in low-and-middle income countries (LMICs), and how smokefree policy affects smoking behavior of smokers at different stages of smoking cessation. This study examined the relationship between smokefree home rules and average number of cigarettes smoked per day (CPD) among daily smokers at different stages of the transtheoretical model (TTM) of change. Data from 18,718 current daily cigarette smokers from the Global Adult Tobacco Survey (GATS) conducted from 2011 to 2017 in 20 LMICs were analyzed. Weighted multivariable linear regression analyses were conducted using the log of CPD as the outcome variable with smokefree home rules as the exposure variable, controlling for selected covariates. Approximately 15% of the participants were in precontemplation, 5% were in preparation, 15% lived in partial smokefree homes, and 30% lived in complete smokefree homes. The average number of CPD was 12.3, 12.0, and 10.6 among participants living in homes where smoking was allowed, partial smokefree homes, and complete smokefree homes, respectively. Compared to living in homes where smoking was allowed, living in complete smokefree homes were associated with 22.5% (95%CI = 18.4%–26.5%), 17.9% (95%CI = 8.4%–27.3%), and 29.3% (95% CI = 17.1%–41.5%) fewer CPD among participants in precontemplation, contemplation, and preparation stages, respectively. These findings suggest that complete smokefree home policy will benefit smokers in LMICs irrespective of their intention to quit smoking in addition to protecting non-smokers from secondhand smoke exposure.