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RESOURCE MANUAL-ECONOMIC IMPACT OF SMOKE-FREE POLICIES i ECONOMIC IMPACT OF SMOKE- FREE POLICIES e Compiled by Raymond Porfiri, Tobacco Control Resource Center,Inc. i Critical Findings A.Do smoke-free laws have a nega tive economic impact on bars and restaurants? A growing body of research from Massachusetts and other states suggests that the answer to the question above is"no." This research is summarized below. Copies of the summarized research studiesl are also included in this section of the resource manual in the order in which they have been quoted. Massachusetts • etts adults and published in 1997 concluded A study based on a survey of Massachus that,(1)"smoke-free policies are likely to increase overall patronage of restaurants and bars"; and that (2)"smokers are no more likely than nonsmokers to be frequent restaurant or bar users." -Lois Biener and Michael Siegel,Behavior Intentions of the Public after Bans on Smoking in Restaurants and Bars,87 AM.J.PUBLIC HEALTH 2O42(1997). • A comprehensive study of taxable meal receipts from numerous Massachusetts communities revealed that the adoption of a local smoke-free restaurant policy does not cause a statistically significant change in town taxable meals revenue. -William J.Bartosch and Gregory C.Pope,Effect of Smoking Restrictions on Restaurant Business in Massachusetts. Other States • restaurants published in 1994 concluded that A study of California and Colorado "[s]moke-free restaurant ordinances do not adversely affect restaurant sales." -Stanton A. Glantz and Lisa R A. Smith,The Effect of Ordinances Requiring Smoke Free Restaurants on Restaurant Sales, 84 AM.J.PUBUC HEALTH 1081(1994). • A study of restaurants in Texas published in 1995 concluded that total sales in the restaurants included m the study did not decrease after the implementation of a 100% smoke free ordinance. -P.Hwang et al.,Assessment of the Impact of a 100•/Smoke free Ordinance on Restaurant Sales—West Lake Hills, Texas, 1992_1994,44 MORBIDrrY&MORTALrrY WKLY.REP.370(1995). • A study published in 1996 concerning the impact of New York City's Smoke-Free-Air Act indicated that nonsmokers were more than making up the revenues lost from inconvenienced diners who smoke. -David L.Corsun et al.,Should NYC's Restaurateurs Lighten Up?COIL HOT.&REST•ADMna.QUnR 25, 26(1996). • A study published in the American Journal of Public Health in 1997 concluded that smoke-free ordinances do not adversely affect either restaurant or bar sales. -Stanton A.Glantz and Lisa R.A.Smith,The Effect of Ordinances Requiring Smoke-Free Restaurants and Bars on Revenues:AFollow-Up,87 AM.JOUR.PUB.HEALTH 1687(1997). 1 The Pope and Bartosch article is a summary of a study that has been submitted for publication. A study of restaurants in Flagstaff, Arizona concluded, "prohibiting smoking in restaurants did not affect restaurant sales." -John P. Sciacca and Michael I.Ratliff,Prohibiting Smoking in Restaurants: Effects on Restaurant Sales, 12 AM.J. HEALTH PROMOTION 176(1998). B. Should boards of health consider economic factors? If smoke-free policies do not have a negative economic impact on restaurants and bars as the above studies seem to indicate, how and why does the economic issue come up? Notwithstanding the evidence discussed above, the tobacco and restaurant industries have long opposed smoke-free laws, arguing, in part, that smoke-free policies cause economic harm to restaurant and bar owners. Paradoxically, in some states, opponents of ETS laws have successfully sued local health boards, in part, because the board considered economic factors when enacting its ETS regulation! Specifically, health boards have encountered legal challenges when they have allowed non-health-related exceptions to ETS regulations based on economic or social factors. For example, in Cookie's Diner v. Columbus Bd. of Health, 65 Ohio Misc.2d 65, 640 N.E.2d 1231, 1241 (Mun. Ct. 1994), an Ohio court found that city and county boards of health had impr(,perly considered "concerns (such as...economics) other than those solely for the protection of public health." In essence, the court ruled that the power of the boards to regulate ETS was limited to considerations of"protecting the public health, preventing disease and abating nuisance." See id. at 1239. Similarly, in Nassau Bowling Proprietors Ass'n v. County of Nassau 965 F. Supp. 376, 380 (E.D.N.Y. 1997), a New York federal court judge ruled that "the [county] Board-in enacting an ordinance which includes significant provisions based on non-health related considerations--exceeded its authority as an administrative, as distinct from a legislative body." In light of this potential problem, what should a board do when opponents of an ETS regulation argue that economic factors justify non-health-related exceptions to a proposed ETS regulation? One possible approach for a board would be to limit its deliberations to health-related concerns only. For example, such an approach might result in a regulation that completely prohibits smoking in all public places and which does not )\µ5 exempt certain locations based on concerns over the economic impact of the regulation. Beyond this "zero tolTerance'J approach,ft,Vxt—to which a board in Massachusetts is authorized to consider economic factors in relation to an ETS regulahoti"is uncle" -------------- b�� because no appellate court in thus stateEas considered the type of argument pressed in e New York and­0%ii6 ases discussed above,In the absence of controlling legal authority .. R ...:� in this state, thC� affest course for a health board in Massachusetts is to consult with its local counsel and the Tobacco Control Program Director for the MAHB if confronted with economic arguments. �Q_`G�17 t'' C Key Articles Lois Biener and Michael Siegel, Behavior Intentions of the Public after Bans on Smoking in Restaurants and Bars,87 AM.J.PUBLIC HEALTH 2O42 (1997).* William J.Bartosch and Gregory C.Pope,Effect of Smoking Restrictions on Restaurant Business in Massachusetts.** 1 Stanton A. Glantz and Lisa R. A. Smith, The Effect of Ordinances Requiring Smoke-Free Restaurants on Restaurant Sales, 84 AM.J.PUBLIC HEALTH 1081 (1994).*** P. Hwang et al.,Assessment of the Impact of a 100%Smoke free Ordinance on Restaurant Sales—West Lake Hills, Texas, 1992-1994,44 MORBIDITY&MORTALITY WKLY.REP.370(1995). 1 David L. Corsun et al_,Should NYC's Restaurateurs Lighten Up? COR. HOT. & REST. ADMIN. QUAR. 25 1I (1996).**** Stanton A.Glantz and Lisa R.A.Smith, The Effect of Ordinances Requiring Smoke-Free Restaurants and Bars on Revenues:A Follow-Up, 87 AM.JoUR.PUB.HEALTH 1687(1997).***** John P. Sciacca and Michael I.Ratliff,Prohibiting Smoking in Restaurants:Effects on Restaurant Sales, 12 ( AM.J.HEALTH PROMOTION 176(1998).****** { Acknowledgements: *Reprinted by permission. Copyright 1997 by the American Public Health Association. **Reprinted by permission of the authors. *"Reprinted by permission. Copyright 1994 by the American Public Health Association. ****Reprinted by permission of Elsevier Science from Should NYC's Restaurateurs Lighten Up?,by David L.Corsun et al.,COR.HOT.&REST.ADMIN.QUAR 25 (April 1996). Copyright 1996 by Cornell University. *****Reprinted by permission. Copyright 1997 by the American Public Health Association. ******Reprinted by permission of the authors. About the Tobacco Control Resource Center Page 1 of 6 TV'b0VVV car)-vol R"Ourcs? Comm Ina, The Tobacco Control Resource Center, Inc. is a 501(6)(3) non-profit organization Senior Staff: V Professor Richard A. Daynard, President Edward L. Sweda, Jr., Senior Attorney Mark A. Gottlieb, Staff Attorney . Not pictured: . Graham E. K_elder, Jr., Managing Attorney . Patricia Davidson, Staff Attorney . Bob Kline, Staff Attorney . Jacqueline Salcedo, Staff Attorney . Laura Hermer, Staff Attorney http://www.tobacco.neu.edu/About/tplpdes.htm 12/9/99 About the Tobacco Control Resource Center Page 2 of 6 . Michael Hankard, Special Projects Coordinator . Lissy Friedman, Administrative Assistant . Catherine Brady, Financial Administrator . Erin Abraham, TCB Publications Manager About TCRC and TPLP: The Tobacco Products Liability Project (TPLP) -- founded in 1984 by doctors, academics and attorneys -- studies, encourages and coordinates 1) products liability suits against the tobacco industry and 2) legislative and regulatory initiatives to control the sale and use of tobacco as a public health strategy. Products liability suits are a proven means of increasing public awareness about the dangers of cigarette smoking and of offsetting the billions of dollars spent annually by the tobacco industry in promoting its deadly products. These suits also help to increase the cost of each pack of cigarettes, thereby discouraging consumption and new addiction, particularly among the children and young adults who are principal targets of tobacco advertising. The legal assistance that TPLP provides to states and municipalities attempting to pass tobacco control measures ensures that such measures are 1) enacted in a legally valid manner, and 2) drafted so as to withstand probable tobacco industry legal challenges to the measures.. TPLP ultimately hopes to see 1) the true social cost of cigarette smoking reflected in the cost of each pack of cigarettes; and 2) municipalities undertake tobacco control measures armed with the legal information necessary to resist tobacco industry intimidation. TPLP's primary mission involves it in a wide variety of tasks around which a law reform clinic could be built. Some of these tasks are tied to specific contracts and grants which will be described in brief below. General Activities: As part of its general activities, the Tobacco Products Liability Project . publishes Tobacco On Trial, (a national newsletter published eight times per year) . sponsors an annual conference . refers potential plaintiffs to attorneys . provides an information clearinghouse . files amicus curiae briefs . performs legal research and analysis in support of http://www.tobacco.neu.edu/About/tplpdes.htm 12/9/99 About the Tobacco Control Resource Center Page 3 of 6 municipalities undertaking tobacco control . testifies at Congressional hearings . gives workshops & lectures. For attorneys contemplating or already involved in active tobacco litigation, TPLP offers Attorney Membership which includes conference discounts, prioritized access to our legal staff. and a subscription to the print edition of Tobacco on Trial. National Cancer Institute Grant TPLP's parent organization, the Tobacco Control Resource Center ("TCRC") is a subcontractor on the National Cancer Institute grant recently awarded to the Northeastern University, and Professor Richard A. Daynard is the Principal Investigator on that grant. Under the NCI grant, Northeastern University School of Law and TCRC have agreed to do the legal research and analysis needed to support states, municipalities, health insurers and public interest groups as they pursue innovative legal interventions to reduce tobacco use. Specifically, Northeastern and TCRC have agreed to produce a series of legal policy papers on the most effective legal strategies that states, municipalities and private parties can pursue in order to reduce tobacco use, especially by minors. Northeastern and TCRC propose to do research in the three broad areas outlined below. (1) Local Legal Policy Research: To support local governments in their efforts to reduce tobacco use and curtail youth access to tobacco products, Northeastern and TCRC have agreed to produce carefully researched and authoritative legal policy papers on the scope of authority granted to local governmental bodies -- primarily city, county and town legislative bodies and local boards of health -- under their respective state laws to enact local tobacco control measures. Northeastern and TCRC will identify seven states which reflect the current range of approaches to local legislation and regulation and will examine seven key issues for each of the seven states. The first issue that we will examine will be the sources from which local governmental bodies in each of the seven states derive the power to restrict and control tobacco sale and use, and the limits inherent in their powers to do so. Northeastern and TCRC will then investigate all relevant law in each of the seven states for each of the following specific types of tobacco control measures: h4://www.tobacco.neu.edu/About/tplpdes.htm 12/9/99 About the Tobacco Control Resource Center Page 4 of 6 . bans of tobacco billboards and taxi roof ads; . bans on smoking in public areas such as restaurants; . bans of free-standing tobacco product displays; . bans of free distribution of cigarettes (sampling); . vending machine bans; and . the use of compliance checks to prevent tobacco sales to kids. For each of the tobacco control measures listed above, we will explain and justify our conclusions as to: (a) the legal authority for the measure, (b) the probable tobacco industry legal challenges to the measure, (c) the legal validity (if any) of these challenges, and (d) the best strategy for formulating each measure (e.g., drafting statutory preambles or building legislative history) to maximize the chance of surviving a legal challenge. (2) Statewide Reimbursement Legal Policy Research States and health insurers are beginning to sue for reimbursement from the tobacco industry for smoking cessation costs and for health care costs due to tobacco- caused illnesses. These interventions are designed to transfer the costs associated with smoking cessation therapies and tobacco-induced illnesses from the states and health plan subscribers to the tobacco industry. Such a transfer of costs will increase the price of tobacco products, thereby reducing consumption, especially consumption by minors. The tobacco industry has, however, launched constitutional and procedural attacks designed to derail this strategy. To assist state authorities in controlling tobacco use by transferring the exorbitant smoking cessation and health care costs associated with it from states and private insurers to the tobacco industry, Northeastern and TCRC have agreed to produce policy papers on the viability of three possible strategies. Specifically, Northeastern and TCRC will . assess the states' ability to use consumer protection laws and common law theories to recoup tobacco- caused medical costs -- such as those associated with smoking cessation devices or therapies like the nicotine patch -- from the makers of tobacco products; . study and report on o the states' ability to sue tobacco companies for the medical expenditures caused by tobacco- http://www.tobacco.neu.edu/About/tplpdes.htm 12/9/99 About the Tobacco Control Resource Center Page 5 of 6 induced diseases paid from the Medicaid and group health insurance accounts, and o the right of private health insurers to obtain such recovery, as Blue Cross and Blue Shield are doing in conjunction with the Attorney General's office in Minnesota; . investigate the optimal design and constitutional validity of state legislation, such as that passed in Florida and Massachusetts, that would simplify and strengthen the legal procedures for obtaining such reimbursement of health care costs from the tobacco industry. (3) Statewide Consumer Protection Legal Policy Research: States --and citizens acting as private attorneys general -- are beginning to use consumer protection laws in the battle to reduce tobacco consumption by seeking to enjoin tobacco company advertising that wrongfully targets minors, women and minorities and to require the tobacco industry to set up corrective public education campaigns. States, parents and public interest groups can also pursue legal action under state consumer protection laws against retailers who sell cigarettes to minors, a strategy which has proved enormously successful in Massachusetts. The tobacco industry, however, vigorously disputes both the legal and factual bases of these actions. To assist state authorities and individuals in their efforts to reduce tobacco use, Northeastern and TCRC have agreed to provide them with the legal means necessary to combat illegal tobacco advertising and sales by producing policy papers on the viability of two possible strategies. Specifically, Northeastern and TCRC will . examine consumer protection laws that may provide authority for legal action by citizens acting as private attorneys general, a statewide class action and/or action by attorneys general to o enjoin tobacco companies whose advertising unlawfully or unfairly targets minors, women and minorities, and o require that all tobacco companies which have engaged in unfair or unlawful advertising be required to set up corrective public education campaigns controlled by independent third parties; and . research the ability of states, parents and public interest groups to pursue legal action under consumer http://www.tobacco.neu.edu/About/tplpdes.htm 12/9/99 About the Tobacco Control Resource Center Page 6 of 6 protection laws against retailers that sell cigarettes to children. MTCP Brookline, Newton & Waltham Tobacco Control Programs: Under these contracts, TCRC manages the tobacco control programs in Brookline, Newton and Waltham. This involves a wide variety of work, including the conducting of compliance checks so that retailers who make illegal sales of tobacco products to minors can be ticketed. Conferences: TPLP has hosted more than 15 conferences at Northeastern on legal issues in tobacco control, which have attracted the leading figures in tobacco control, including prominent attorneys and leading medical experts. Attorneys from across the United States, as well as Canada, Finland, Italy, Israel, Great Britain, and Australia, have also attended. Northeastern University School of Law 400 Huntington Avenue Boston, MA 02115 . (617) 373-2026 (tel) . (617) 373-3672 (fax) . Or feel free to send us e-mail. Back to main page http://www.tobacco.neu.edu/About/tplpdes.htm 12/9/99 1 Behav ior Intentions of the Public after I Bans on Smoking in Restaurants and Bars . . ' Lois Biener.PhD and Michael Siegel,MD, MPH O I c1i . Introduction Methods o Bars and restaurants have been shown Sampling e to have high levels of employee exposure to environmental tobacco smoke,12 and this Data for this study were derived from exposure has been linked to an increased the Massachusetts Adult Tobacco Survey, a risk of lung cancer among food service 20-minute telephone survey of a probability I workers. In response, communities sample of Massachusetts housing units throughout the United States have passed drawn via random-digit dialing tech- ordinances to restrict or eliminate smoking niques."o On the basis of a household in bars and restaurants.' As of August enumeration, a representative sample of I 1996, 191 cities, towns, and counties had adults 18 years of age or older was selected ` enacted ordinances requiring smoke-free for interview. The survey was conducted r restaurants; 30 of these ordinances required monthly starting in March 1995. Approxi- I that bars be smoke free as wetl.4 Despite mately 225 interviews were conducted the strong public health justification, the each month. This report includes data for di a tobacco and restaurant industries have vig- the 10 months during 1995 (March through c orously opposed such laws, arguing that December) in which the survey was con- i a smoke-free policies will result in economic ducted. Interviews were completed with BS' hardship for bar and restaurant owners.s 76% of sampled households and with 81% e This argument assumes that if bars and of eligible respondents, resulting in a restaurants in one community eliminate sample size of 2356. I ' smoking, smokers will choose to dine in neighboring communities or will not dine Measures i out as often_ It neglects the possibility that an increase in patronage by nonsmokers The survey assessed personal tobacco could more than make up for the decrease use, as well as attitudes and beliefs related in patronage by smokers. to smoking, environmental tobacco smoke, To date, no published US study has and tobacco control policies. Smokers were explored potential changes in restaurant and defined as those who reported having bar patronage as a consequence of smoke- smoked at least 100 cigarettes in their life free policies.One Australian study has done and who now smoked "every day" or 6 as have "some days." The survey also assessed so with regard to restaurant use, two unpublished studies conducted in the respondents' frequency of bar and restau- _ United States.''$ The present study evaluat- rant use (never, less than once a month, ed the potential impact of smoke-free once or twice a month, once a week, more I policies on bar and restaurant patronage than once a week), their past history of using data from the 1995 Massachusetts having avoided places because of tobacco Adult Tobacco Survey. Our objectives were smoke or because of smoke-free policies, (1)to compare attitudes, beliefs,and behav- and their predictions of how elimination of iors related to environmental tobacco smoking in bars and restaurants would smoke among smokers and nonsmokers in affect the frequency of their use of these Massachusetts; (2) to compare the frequen- establishments in the future. cv of use of bars and restaurants among smokers and nonsmokers in Massachusetts; 9 and(3) to measure self-reported predictions - T of change in the frequency of bar and Lois Biener is with the Center for Survey restaurant use among Massachusetts adults Research. University of Massachusetts, Boston. in response to a policy eliminating smoking Michael Siegel is with the Boston University P g P in these establishments School of Public Health. . _ Requests for reprints should be sent to Lois Biener, PhD.Center for Survey Research,Univer sity of Massachusetts, 100 Morrissey Blvd. Boston, 02125. This paper was accepted February 12, 199 1 bar and restaurant use was assessed with increased use was almost twice as large as relationship between frequency of bar the following question: "Some cities and the proportion predicting decreased use patronage and predicted increase in usage, towns are considering laws that would (20% vs 10.8%). Few smokers reported that but the relationship was not statistically make restaurants smoke free, that is, elimi- they would use bars and restaurants more significant nating all tobacco smoke from restaurants-, frequently if such establishments were if restaurants allowed no smoking at all, smoke free. However, since smokers consti- Concern about Environmental do you believe you would use them more tute less than one quarter of the adult Tobacco Smoke often, less often, or would it make no dif- population, the number of adults who pre- ference?" A comparable question assessed dicted a decrease in bar and restaurant The predicted impact of smoke-free the impact on patronage of"clubs, bars, or patronage was smaller than the number who policies on restaurant and bar patronage is lounges where alcohol is served." predicted an increase, consistent with the attitudes, beliefs, and Three percent of the respondents past behaviors of respondents. The vast Analysis reported that currently they do not eat out at majority of both nonsmokers and smokers all. Twenty-two percent of this group indi- reported that they believed environmental Data were weighted to adjust for the cated that if restaurants were smoke free, tobacco smoke could cause cancer in non- sampling design so that estimates would they would dine out more. Thirty-two per- smokers and was harmful to the health of accurately reflect the adult population of cent of respondents indicated that they children (Table 1). Sixty-four percent Massachusetts. Chi-square analyses were ❑ever go to bars or clubs. Ten percent of reported being bothered "a great deal" or conducted with SUDAAN.tt this group indicated that if bars, clubs, and "some" by environmental tobacco smoke. lounges were smoke free, they would Although nonsmokers' reactions were patronize them more often. significantly more negative than smokers', Results it is noteworthy that a substantial propor- Frequency of Patronage tion of smokers expressed concern about Predicted Impact of Smoke-Free environmental tobacco smoke. Nearly 40% Policies on Frequency of Bar Massachusetts smokers and nonsmok- of the respondents reported having avoided and Restaurant Patronage ers are equally likely to be frequent going to a place because of tobacco smoke; restaurant and bar patrons (Table 1). Since of these individuals, 34% indicated that Approximately two thirds of respon- there are more than four times as many they had avoided going to restaurants, and dents reported that their patronage of nonsmokers in the population, nonsmokers nearly 40% indicated that they had avoided restaurants and bars would not change if constitute a larger proportion of both fre- going to bars or clubs (an estimated 13% these facilities were to become smoke free quent restaurant users (82%) and frequent and 1 5%of the population,respectively). In (see Table 1). Of those predicting a change bar users (78%). Furthermore, frequent contrast,only 8.5%of respondents reported in their restaurant patronage, the proportion patrons were significantly more likely than having ever avoided going somewhere predicting increased use was almost four infrequent patrons to predict an increase in because smoking was not permitted. times greater than the proportion predicting their use of restaurants in response to - - I Table 1-Beliefs,Attitudes, and Behaviors in Relation to Restaurant and Bar Smoking Policies.1995 Massachusetts Adult Tobacco Survey Total Nonsmokers Smokers (n=2356) In=1895) (n=461) %(95%Cl) %(95%Cl) %(95%Cl) Predicted impact of smoke-free policies on restaurant patronage I Increase use 31.0(27.1,34.9) 37.7(33.2.42.2) 2.7(.4,5.0) Decrease use 7.9(5.5, 10.3) 2.2(.9,3.5) 31.9(22.4,41.4) No change 61.1 (57.0, 65.2) 60.1 (55.5,64.7) 65.4(55.9,7a.9) Predicted impact of smoke-free policies on bar/club patronage Increase use 20.0(16.7, 23.3) 24.5 (20.5,28.5) 0.6(0. 1.6) Decrease use 10.8(8.1, 13.5) 2.9 (1.4,4.4) 44.0(34.3, 53.7) No change 69.2(65.2,73.2) 72.5(68.4.76.6) 55.4(45.7,65.1) Usual patronage patterns Use restaurant at least once a week 58.3(54.0,62.5) 58.8(54.1,63.5) 55.9(46.5.65.3) j 40-8 36.8,44.8 39.5(35.0,4-4.0) 46.3(36.7, 55.9) oil Use bars/clubs at least once a month ( ) Reaction to ETS Believes ETS can cause cancer in nonsmokers 87.3(84.4. 90.2) 91.2(88.5.93.9) 85.8 (60.2,79.0) Believes ETS is harmful to children 94.5(92.6, 96.4) 96.4(94.7.98.1) 85.8(78.8, 45.6) Bothered more than"a little"by ETS 64.3(60.0,68.6) 71.1 (66.5, 75.7) 36.4(27.6,45.2) Ever avoided a smoky place 39.6(35.7, 43.5) 47.4(42.9,51.9) 6.6(2.0, 11.2) Ever avoided a smoke-free place 8.5(6.3, 10.7) 4.7(2.6.6.8) 24.7(17.3,32.1) i Note.Cl=confidence interval; ETS=environmental tobacco smoke. December 1997,Vol.87,No. 12 American Journal of Public Health 2043 Public Health Briefs Discussion implementation of a smoke-free olic P P Y Washington, DC: Environmental Protection To our knowledge, this study is the first to Agency, 1997- EP.AJ600i6-90/006F ' Although exposure to environmental report the baseline frequency of bar ur_se and 2. Siegel M. Involuntary smoking in the restau_ tobacco smoke is an important occupational predicted changes after elimination of rant workplace: a review of employee health hazard for bar and restaurant work- smoking among a representative sample of exposure and health effects. JAMA ers, many local governments have been adults. We found a potential new market for t99312 70:490-493. reluctant to protect these workers. This is bars among nonsmokers. Of the 32% of 3. Shopland DR, Pertschuk M. Major Local largely due to claims by the tobacco and adults who do not presently frequent bars, Tobacco CORf7Ol Ordinances in the United Stares. Bethesda, Md: US Dept of Health and restaurant industries that smoke-free poli- 10% stated that they would start going if Human Services; 1993. NIH publication 93- cies would have adverse economic smoking were eliminated. In the relatively 3532. consequences by causing smokers to eat in small state of Massachusetts, this amounts 4. 100% Smokefee Ordinances: August 28. neighboring communities or to eat out less to approximately 120 000 people who 1996. Berkeley, Calif: Americans for Non- often.The potential changes in location and would start going to smoke-free bars and smokers'Rights; 1996. ; frequency of dining behavior among non- clubs. We estimated that approximately 5. Samuels B, Glantz SA. The politics of local smokers have been largely ignored. Our 40 000 people who do not presently eat out tobacco control.JAMA. 1991;266:2110-21 l7. analysis of a representative sample of at restaurants would start doing so if restau- 6. Schofield MJ,Considine R Boyle CA Sanson- Fisher R. Smoking control in restaurants: the �tassachtuetts adults suggests that smoke- rants were smoke free. effectiveness of self-regulation in Australia-Am free policies are likely to increase overall Our findings must be interpreted with J Public Health. 1993;83:1284-1288. patronage of restaurants and bars. It also caution since respondents were reporting 7. A Gallup Organization Public Opinion Survev indicates that, contrary to tobacco industry behavioral intentions in response to a hypo- on New Yorkers'Attitudes about Smokejree assertions, smokers are no more likely than Dining. New York, NY: Coalition for a thetical event. Despite this limitation, the nonsmokers to be frequent restaurant or bar Smokejrec City; 1994. j users. Furthermore,although patronage pat- results are consistent with econometric 8. Public Opinion Surveys on Tobacco Control terns are unrelated to smoking status, 78% studies indicating no significant effects of Policies for the Robert Wood Johnson Smoke- of and/or restaurant smoke-free bar d/ taurant ordinances less States Program,June 3, 1995. Princeton, Of frequent bar users and 82/0 of frequent t,t- NJ:Mathematica Policy Research Inc; 1995. restaurant users are nonsmokers. on total bar and restaurant sales. This 9. Biener L, Roman AM. 1995 Massachusetts These results are consistent with the study provides further evidence that work- Adult Tobacco Survey. Boston, Mass: Center attitudes of Massachusetts adults, which ers can be protected from hazards of for Survey Research; 1996. demonstrate a widespread belief in the environmental tobacco smoke without 10. Waksberg J. Sampling method for random health risks associated with environmental adverse consequences for bar and restaurant digit dialing.JAm Stat Assoc. 1978;73:40-46. :obacco smoke and high levels of personal business. ❑ 11. Shah VS, Barnwell BG, Hunt PN, et al. 'discomfort with exposure to environmental SUDAAN Professional Software jor Multi- :obacco smoke. In particular,the results are Stage Sample Designs. Research Triangle Acknowledgments Park, NC: Research Triangle Institute; 1992. supported by the finding that while nearlyg Computer program. ,10%of adults reported avoidin tionThi g places that research was supported by the Health Protec- 12 Glantz SA, Smith LR. The effect of ordi- xere too smoky, fewer than 9% reported Ron Fund nances requiring smokefree restaurants on We are grateful for the skillful data-analytic avoiding places because they were smoke assistance provided by Zhu Xiao Di. restaurant sales. Am J Public Health. tree. 1994;84:1081-1085. The results of this study are consistent 13. Centers for Disease Control and Prevention. with those of previous studies assessing References Assessment of the impact of a 100% smoke- self-reported predicted chap es in fre- R free ordinance on restaurant sales—west g I. espirator)Health Effects of Passive Smok- Lake Hills, Texas, 1992-1994. ldM1i'R Morb quency of restaurant rise among adults after ing: Lung Cancer and Other Disorders. Mortal Wkly Rep. 1995;44:521-525. The Effect of Smoking Restrictions On Restaurant Business in Massachusetts William J. Bartosch and Gregory C. Pope Center for Health Economics Research Waltham, MA One of the most contentious issues concerning smoke-free restaurant policies is the perceived negative effect of such restrictions on restaurant business. In particular, restaurant and tobacco industry representatives have made broad claims that restaurant revenue decreases as much as 30 percent when dining establishments are forced to adopt complete smoking bans.',2,3,4 At the same time, an attitudinal survey of Massachusetts adults found that the three-quarters of the population who do not smoke would visit restaurants and bars more frequently if policies were in place to protect them from exposure to environmental tobacco smoke (ETS).S With support for the Massachusetts Tobacco Control Program and the Robert Wood Johnson Foundation,this study examined whether local policies in Massachusetts banning smoking in restaurants had an adverse effect on restaurant business or, conversely, if smoke-free policies improved restaurant sales. The researchers analyzed town-level meals tax data collected by the Massachusetts Department of Revenue for 235 cities and towns in Massachusetts. Thirty-two of these localities (Table 1) implemented a smoke-free restaurant policy during the January 1992 through December 1995 study period. They served as experimental communities while the remaining 203 towns served as comparison communities. The study compared meals receipts before and after the imposition of local smoke-free restaurant policies to revenue generated by comparison communities during comparable time periods. The revenue of smoke-free versus non-adopting towns is shown on Chart 1. This chart includes the 19 smoke-free towns that implemented their policies at different points in time between November 1993 and January 1995, so there is at least one complete year of post-ban data for each town. The trend lines for both the experimental (smoke-free) and comparison (non- adopting) communities demonstrate that restaurant revenue varies seasonally. If the implementation of smoke-free policies had a large adverse effect on restaurant receipts, one would expect the aggregate smoke-free trend line to fall relative to non-adopting communities Y® beginning in 1994 as smoke-free policies started to become effective. Any large effect should be clearly visible by 1995 when all experimental towns had a smoke-free policy in place. These descriptive data suggest that the smoke-free policies did not have any significant adverse impact on aggregate restaurant monthly receipts. Table 2 shows average monthly post-ban receipts versus average receipts of corresponding pre-ban periods for all 32 experimental communities and the comparison group. These data indicate that, on average, the restaurant revenue of smoke-free towns were 3.7 percent greater during their post ban periods compared to their pre- ban periods. Restaurant sales in non-adopting communities also increased from the same pre- to post-ban periods, but this increase was only 2.2 percent. A statistical technique called fixed effects regression was used to estimate the extent to which a variety of factors (e.g., smoking-policy adoption, seasonal trends in local restaurant sales, population, income) influenced changes in a community's total restaurant receipts over time. The authors failed to find a statistically significant community-wide effect of local smoke- free policies on restaurant business controlling for other factors. They demonstrated that it is highly unlikely that smoke-free policies had a large adverse effect on a community's restaurant business. While their best estimate of the effect of smoke-free policies was a slight increase in restaurant revenues, whether the actual effect was a small increase or decrease, or no effect, could not be determined. This study provides evidence that communities' restaurant industries are not substantially adversely affected by local smoke-free policies, confirming similar studies that have been conducted in other regions of the count 67 a 9 10 A manuscript providing a more comprehensive g country. . . . . P P g P description of this study's methods and findings is currently undergoing peer review. The expected date of publication is January 1999. 'Ellis,GA, Hobart, RI,and DF Reed. "Overcoming a Powerful Tobacco Lobby in Enacting Local Smoking Ordinances: The Contra Costa County Experience." Journal of Public Health Policy. 17, no. 1(1996):28-46. 'Samuels, B_ and S.A. Glantz. "The Politics of Local Tobacco Control." Journal of the American Medical Association. 266, no. 15 (1991): 2110-21 17. 3 Samuels, B, Begay, M, Hazan, A, and SA Glantz. Philip Morris' Failed Experiment in Pittsburgh. Journal of Health Politics, Policy, and Law, 17(1992): 329-351. Traynor, M.P., Begay, M.E., and S.A. Glantz. "New Tobacco Industry Strategy to Prevent Local Tobacco Control." Journal of the American Medical Association. 270(1993): 479-486. 5 Biener, L.and M. Seigel. Behavior Intentions of the Public After Bans on Smoking in Restaurants-and Bars. American Journal of Public Health, 87,no. 12(1998): 2042-2044. 6 Glantz, S.A. and L.R. Smith. The Effect of Ordinances Requiring Smoke-Free Restaurants on Restaurants Sales. American Journal of Public Health. 84, no. 7(1004), 1081-1085. ' Huang, P.,Tobias, S., Kohout, S, et al. Assessment of the Impact of a 100%Smoke-Free Ordinance on Restaurant Sales, West Lake Hills, Texas, 1992-1994. Morbidity and Mortality Weekly. 44,No. 19(1995):370-372. e Glantz, S.A.and L.R. Smith. The Effect of Ordinances Requiring Smoke-Free Restaurants and Bars on Revenues: A follow-up. American Journal of Public Health. 87,No. 10(1997), 1687-1692. 9 Sciacco,J.P.and R.I. Ratliff. Prohibiting Smoking in Restaurants: Effects on Restaurant Sales. American Journal of Health Promotion. 12,No. 3 (1998): 176-184. 10 Hyland,A.and K.M.Cummings. Analysis of Taxable Sales Receipts: Has the New York City Smoke-Free Air Act Harmed the City's Restaurant or Hotel Industries? Journal of Public Health Management and Practice. Forthcoming. 9 �1 TABLE 1 ;i MASSACHUSETTS CITIES AND TOWNS THAT ADOPTED SMOKE-FREE RESTAURANT r. I POLICIES THROUGH 1995 �o e CITY/TOWN DATE EFFECTIVE NUMBER OF ESTABUSHMENTS' a Amherst September 1 Andover , 1994 77 a1 Arlington July 13, 1994 95 Attleboro June 15, 1995 100 J Bedford April 30, 1995 147 February 1, 1995 32 x Belmont January 1, 1995 Brookline 50 July 1, 1994 Chico141 cj Dover June 1, 1994 a 162 n; June 3, 1994 ° <10 East Longmeadow January 1, 1995 Easthampton 44 Foxborough September 1, 1994 41 Greenfield May 18, 1994 38 ` Holden November 15, 1994 65 ` Holyoke February 15, 1994 39 Lee August 1, 1994 122 Lenox July 1, 1995 39 " Lexington July 1, 199554 Longmeadow February 15, 1995 51 Medfield January 1, 1995 21 Montague January 1, 1994 20 June 1, 1995 Norfolk June Northampton August 1, 1995 b <10 Norwell November 1, 1994 124 Plainville April 1, 1993 ` 19 Plymouth July 1, 1994 29 Reading November 18,1993 128 Sharon July 1, 1995 52 South Hadley August 7, 1994 34 Southampton July 1, 1994 47 Stockbridge September 1, 1994 15 Sunderland July 1, 1995 66 Tewksbury November 1, 1995 11 Wakefield February 1, 1995 61 1995 ° West Springfield July 1, 76 July 1, 1994 104 NOTES Repealed February 22, 1995. ° Data unavailable because fewer than 10 restaurants reported. Repealed May 24,1994. ° Excluded from analysis due to poor tax data reporting. Total number of meals tax filers reporting in 1995. A"smoke free"restaurant policy is a 100 peroent restaurant smoking ban(including bar sections of restaurants) or a requirement confining smoking to a separately enclosed and ventilated room. SOURCES: Massachusetts Department of Public Health,Tobacco Control Program,Ordinance Update Forms . National Cancer Institu::!,Major Local Tobacco Control Ordinances in the United States,May 1993. Local Boards of Health y s�, @ � - $ (s uo|� [,W u§ sidm�N uosuedmoo k C @ � $ \ e � ® @ k £ E C E ® f 8 C14 ƒ � i o § 2 7 U) i E 2 k CD0 CD E Ck. c a � k / E 0 0 _ . k k ® \ \ _ k k t \ i �E k ( E 00 Or f # e ' k 7 $ L � { $ Cl a- e k . cc © ' S © ƒ ■ 0 t cc 2 § 0) k � g 2 § CAo § I 7 2 ®cis ca U b CY $ 7 Cl) E | x % .. � CD E A k cis 2 @ i ` 2 ~ k CD 2 g E « d § �kOF � 0) 0C* E Ca ' k O - § 2 © e \ § k ■ § k C14 x 2 § t 5. a � � © k k 2 § ID k kG { # © £ - _ �-cam � � I ' 7 co $ § � ( & CO)cn . $ £ ae # 0 0 ? k © § ■ © e ; � f o c a o7E 0 , (uo||I w m) md@�H J�a o@S 2 k 2 U D < 2 ! � . TABLE 2 AVERAGE TAXABLE MONTHLY MEALS RECEIPTS, PRE-AND POST-SMOKING BAN Pre- Post- Percent Smoke-Free Smoke-Free Chance Smoke-Free towns $1.45 m $1.51m 3.7% ' (n=32) Non-adopting towns $1.78 m $1.82 m 2.2% (n=203) Notes: Post-ban monthly town averages are weighted by the number of months post-ban in each town. Pre-ban averages are for a corresponding seasonal period to the post-ban average and are also weighted by months. Date adjusted for inflation using Boston CPI. Base month=December 1995. Source: Massachusetts Department of Revenue,Meals Tax Database. outlawlcastro\prepost124\tab-31nd 183