Smoking control in restaurants: the effectiveness of self-regulation in Australia

Effect of Self-regulation Training on Management of Type 2 Diabetes

Background:

Diabetes is the most common metabolic disorder which is required to be taken under control. According to some studies, the impact of self-regulation on health has been considered as a monitoring strategy to achieve individual’s goals.

Objectives:

This study, which was performed in 2012, aimed at determining the consequences of self-regulation on controlling type 2 diabetes.

Patients and Methods:

In this double-blind clinical trial, 60 patients with type 2 diabetes - who were referred to Diabetes Clinic of Bisto-Dou Bahman Hospital in Gonabad, Iran - were divided randomly into case and control groups. Self-regulation questionnaire, nutritional information and physical activity checklists were completed by both groups once at the beginning and once at end of the training. Fasting blood sugar (FBS) of both groups were measured as well. Case group was trained for a month, whereas the control group received no special training. Data were analyzed by SPSS version 19 software, K-square and paired t-tests.

Results:

Comparing the case with the control group before and after the training showed that teaching patients self-regulatory strategies had significant impact on lowering blood sugar (-16.50 vs. -2.47, P < 0.001), observing dietary behaviors (5.97 vs. -0.87, P < 0.001) and increasing physical activities (6.2 vs. -0.73, P < 0.001) of the former group.

Conclusions:

Learning self-regulations has a role to play in controlling type 2 diabetes. Therefore, it is suggested to professionals in healthcare centers to educate patients about self-regulatory techniques and use them as auxiliary methods for keeping type 2 diabetes under control.

Conveying misinformation: Top-ranked Japanese books on tobacco

Background

Tobacco control efforts in Japan have lagged other high income countries, possibly because the Japanese government partially owns Japan Tobacco, Inc. In Japan, tobacco use is still often regarded as an issue of manners rather than an issue of health. Information about tobacco is available, but may not always be accurate. We explored what information Japanese consumers might access by reading popular Japanese books about tobacco.

Methods

We searched Amazon.com Japan using the term "Tobacco", identifying the top 12 books by "relevance" and "bestselling." We eliminated duplicates and books not concerned with tobacco use and classified the remaining books as pro-smoking, anti-smoking, or neutral. We reviewed the pro-smoking books, published 2004-2009, and analyzed examples of misinformation by theme.

Results

Pro-smoking popular books conveyed five types of misinformation: doubt about science; suggestions that smoking increased health, longevity, virility, etc.; trivializing tobacco's effects; attacking public health advocates/authorities; and linking tobacco use with authenticity, history, or civil rights. At least one book was authored by a former Japan Tobacco employee; another used a popular Japan Tobacco advertising phrase.

Conclusions

Creating doubt and confusion about tobacco serves tobacco industry interests and re-creates a strategy developed by US tobacco interests more than 40 years ago. Japanese readers may be misled by texts such as those reviewed. Tobacco control and public health advocates in Japan and globally should expose and counter such misinformation. "Naming and shaming" may be effective.

Is government action out-of-step with public opinion on tobacco control? Results of a New South Wales population survey

OBJECTIVE

To assess community attitudes towards smoking bans, tobacco availability, promotion and product regulation, tobacco industry donations to political parties, and government spending on tobacco control activities. To compare public preferences on these issues with policies of the NSW and Commonwealth governments.

METHOD

Anonymous, computer assisted telephone interviews of adults from randomly selected households in the NSW Electronic White Pages conducted in 2004. All subjects completed a core question set and subsequently, one of three sub-sets.

RESULTS

Overall 49.1% of eligible subjects consented. Data from two sub-samples containing 1,191 and 1,158 subjects are reported. Majority support existed for smoking bans in all six settings assessed: children's playgrounds (89%), sports stadia (77%), licensed premises (72%), outdoor dining (69%), beaches (55%) and motor vehicles carrying children (55%). Respondents nominated vastly higher tobacco control budgets than current levels of government expenditure. On a scale assessing support for tobacco control (maximum score = 13), the mean scores of both non-smokers (10.4) and smokers (8.0) were high. Of seven variables tested, only two: living with a smoker and personal smoking status were independent predictors of having a high pro-tobacco control score.

CONCLUSION

There is strong community support for additional government regulation mandating smoke-free provision and other counter tobacco measures.

IMPLICATIONS

Continued advocacy campaigns are required to align government tobacco control agenda more closely with public preferences.

Insufficient smoking restrictions in restaurants around junior high schools in Japan

Controls for second hand smoke (SHS) and adolescent smoking have been still sociomedical concerns in Japan. Restaurant smoking restrictions are associated with community social norms affecting adolescent smoking behavior, and the status in areas around Junior high schools (JHSs) in the community could be a sign of community practices on regulating SHS for adolescents. To examine whether restaurant smoking restrictions are seen especially in areas around JHSs in Japan, a survey using the direct inspection of a total of 163 restaurants (64 restaurants within and 99 outside a 1-km radius from the nearest JHSs) was conducted in May 2003 in Yonago city, Japan. We assessed smoking restriction status in each restaurant and classified them into 2 groups according to the distance from the nearest JHSs. There were only 2 (3.1%) restaurants with 100% non-smoking and 11 (17.2%) with some partial restrictions among the restaurants within a 1-km radius of JHSs. There were 1 (1.0%) restaurant with 100% non-smoking, 3 (3.0%) with complete non-smoking sections and 17 (17.2%) with some partial restrictions among the restaurants outside a 1-km radius of JHSs. Among restaurants with some partial restrictions, restriction methods were considered insufficient. The smoking restriction status was not significantly different between the restaurant groups within and outside a 1-km radius of JHSs. These results suggest that the public awareness of and attitude toward adolescent smoking problems remains low in Japan. Further SHS control actions for adolescents are needed in Japan.

A survey of restaurant smoking restrictions in a Japanese city

Japan has been behind the times in terms of promoting smoking control. The health-promotion law, which included the aim of preventing environmental tobacco smoke (ETS) in public places, was newly introduced in Japan in 2003. The community-based survey on the present state of restaurant smoking restrictions and restaurant owners' concern of smoking is important as it is a reflection of the community's desire to prevent ETS. Data on the smoking restrictions in 163 restaurants in Yonago, one Japanese community, and the owners' smoking-related awareness were collected just one month after the law was enacted. This study revealed that only 6 (3.6%) restaurants were under sufficient conditions: 3 with totally smoke-free and 3 with complete non-smoking sections. The styles (e.g., Western-, Japanese- and Chinese-styles) and kinds of restaurants (e.g., family restaurants and tearooms) were not related to the state of smoking restrictions. Rates of smokers were relatively high among owners, and smoking owners significantly provided insufficient smoking restrictions. 26.4% of owners knew about the new law. However, there were no restaurants that started their smoking restrictions due to the law. Owners' knowledge of the law did not correlate with smoking restrictions. The owners especially feared the negative effects on business due to smoking restrictions. These survey findings suggested little protection from ETS in a sample of restaurants and a large gap in restaurant smoking restrictions compared to other countries. More widespread adoption of the health-promotion law in restaurants is an issue.

Support for smoking restrictions in bars and gaming areas: review of Australian studies

OBJECTIVE

To document levels of public support in Australia for smoking restrictions in licensed premises, including trends over time, and to examine the potential effects of a ban on patronage.

METHOD

Systematic review of published and unpublished studies of community and staff attitudes towards smoking in bars, gaming areas and related venues were identified using Medline, Current Contents, PsycINFO and AUSTHealth prior to September 2002. State and Territory health departments, cancer organisations and branches of the National Heart Foundation were approached. Cross-sectional surveys reporting data on attitudes towards smoking restrictions and/or perceptions of effects on patronage were sought. Two reviewers assessed studies for inclusion. One extracted data using pre-coded categories with checking by the second.

RESULTS

Thirty-four community and seven staff surveys were synthesised qualitatively, with greater emphasis given to surveys using random selection. All surveys conducted since 1993, which included the separate smoking area response option, have demonstrated majority support for some form of smoking restriction on licensed premises. From 2000, surveys with the ban option alone report majority support for prohibiting smoking completely in bars (52-68%) and gaming areas (64-76%). Support increased significantly after the Sharp damages award. Customer preference data indicate banning smoking is most likely to have a neutral or positive effect on patronage.

CONCLUSIONS AND IMPLICATIONS

Support for a ban on smoking in licensed premises has increased by almost 20% in the past decade. State and Territory governments should introduce legislation banning smoking in all indoor drinking and gaming areas immediately.

Changes of attitudes and patronage behaviors in response to a smoke-free bar law

OBJECTIVES

We examined patron responses to a California smoke-free bar law.

METHODS

Three telephone surveys measured attitudes and behavior changes after implementation of the law.

RESULTS

Approval of the law rose from 59.8% to 73.2% (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.58, 2.40). Self-reported noncompliance decreased from 24.6% to 14.0% (OR = 0.50; 95% CI = 0.30, 0.85). Likelihood of visiting a bar or of not changing bar patronage after the law was implemented increased from 86% to 91% (OR = 1.76; 95% CI = 1.29, 2.40).

CONCLUSIONS

California bar patrons increasingly support and comply with the smoke-free bar law.

Public opinion on smoke-free policies in restaurants and predicted effect on patronage in Hong Kong

BACKGROUND

The Hong Kong government has proposed legislation for smoke-free policies in all restaurants and bars. This is opposed by certain sections of the catering industry.

OBJECTIVE

To assess public opinion on smoke-free restaurants and to estimate changes in patronage.

DESIGN

A population based, cross sectional random digit dialling telephone survey conducted from November 1999 to January 2000.

SETTING AND PARTICIPANTS

1077 randomly selected subjects age 15 years or over (response fraction of 81.6%).

RESULTS

68.9% (95% confidence interval (CI) 66.2% to 71.7%) supported a totally smoke-free policy in restaurants. Experiences of discomfort or symptoms from second hand smoke in restaurants were common. The majority (77.2%, 95% CI 74.7% to 79.7%) anticipated no change in their frequency of use of restaurants after a smoke-free policy. Increased use was predicted by 19.7% (95% CI 17.3% to 22.1%) of respondents, whereas 3.2% (95% CI 2.2% to 4.4%) stated that they would dine out less often. In multivariate analyses, non-smokers (adjusted odds ratio (OR) 4.9), people who ate three times or less per week in restaurants as compared to those who ate >10 times per week (OR 2.1), those who had previous experience of discomfort from exposure to passive smoking in restaurants (OR 2.8), or who had avoided restaurants in the past because of smoking (OR 1.9), were more likely to support a totally smoke-free policy in restaurants. Smoke-free policies do not appear to have an adverse effect on restaurants, and may increase business by a considerable margin.

CONCLUSION

This comprehensive survey-the first in Asia-shows strong community support for smoke-free dining and predicts an overall increase in the patronage of restaurants after the introduction of legislation for totally smoke-free restaurants.

Evaluation of smoke-free dining in South Australia: support and compliance among the community and restaurateurs

OBJECTIVES

To evaluate the impact of smoke-free dining legislation introduced in South Australia on 4 January 1999. Specifically, to determine changes in public support and support among the restaurant and cafe industry; to determine changes to self-reported experiences of dining out; and to assess compliance with the legislation.

METHODS

A series of independent, representative, cross-sectional surveys were undertaken over time. Study 1: 3000+ South Australians, aged 15 and over, were interviewed about opinions of the legislation and about dining out, in an annual household survey in October-November in 1997, 1998 and 1999. Study 2: 500+ owners and managers of public dining venues were interviewed about their opinions about and experiences of the legislation in face-to-face surveys in May-June 1999 and July 2000.

RESULTS

Study 1: Public support for smoke-free dining increased from 73.4% in 1997 to 84.2% in 1999. In 1999, 60.2% reported the ban had made dining out more enjoyable and 35.1% indicated no difference. Study 2: 88.2-92.3% of restaurants were complying with the legislation at five months and 95.7-99.6% at 18 months. In 2000, 82% of restaurateurs reported that they had spent no money in order to implement the law.

CONCLUSIONS AND IMPLICATIONS

Smoke-free dining in South Australia is popular and has resulted in increased perceived enjoyment for patrons. The legislative change has apparently been adhered to by both the majority of restaurateurs and customers, and was inexpensive for restaurateurs to implement. Smoke-free dining legislation can be implemented with confidence.

Has the ban on smoking in New South Wales restaurants worked? A comparison of restaurants in Sydney and Melbourne

OBJECTIVE

To evaluate compliance with a legislative ban on smoking inside restaurants by comparing smoking in Sydney restaurants (where it is legally banned) with smoking in Melbourne restaurants (not subject to a legal ban).

DESIGN AND PARTICIPANTS

Unobtrusive observational study of restaurant patrons, and interviews with restaurant staff, carried out by 159 volunteers.

SETTING

78 Sydney restaurants with smoke-free indoor environments (as required by legislation) and 81 Melbourne restaurants not subject to legislation preventing smoking. The study took place from 20-31 October 2000.

INTERVENTION

Legislation to ban smoking in indoor areas of restaurants was introduced in New South Wales in September 2000 (about six weeks before our study).

OUTCOMES

Observed incidents of smoking inside restaurants; staff attitudes to the ban; customer satisfaction as indicated by comments to staff; staff perceptions of restaurant patronage.

RESULTS

No restaurant patrons were seen smoking in 78 Sydney restaurants during 156 hours of observation of 2,646 diners, compared with 176 smokers among 3,014 Melbourne diners over 154 hours of observation. Thirty-one per cent (24/78) of Sydney restaurants had experienced smokers attempting to smoke indoors after the legislation was introduced; 6% (5/78) reported instances of smokers refusing to stop smoking when asked; 79% (62/78) of restaurants had received favourable comments from patrons about the smoke-free law; 81% (63/78) of restaurant staff interviewed either supported or strongly supported the law. Since introduction of the legislation, 76% of restaurants reported normal trade, 14% increased trade, and 9% reduced trade.

CONCLUSIONS

Smoke-free restaurants do not require "smoking police" to enforce bans, present few ongoing difficulties for staff, attract many more favourable than unfavourable comments from patrons, and do not adversely affect trade.

Actual and perceived impacts of tobacco regulation on restaurants and firms

OBJECTIVE

To examine the actual and anticipated costs of a law regulating workplace smoking and smoking in restaurants, taking into consideration observed and anticipated infrastructure costs, lost productivity, increased absenteeism, and loss of clientele.

SETTING AND DESIGN

A survey of 401 Québec restaurants and 600 Québec firms conducted by the Québec Ministry of Health before the enactment of the law was used to derive costs incurred by those who had already complied and anticipated by those that did not.

RESULTS

Direct and indirect costs associated with tobacco regulation at work and in restaurants were minimal. Annualised infrastructure costs amounted to less than 0.0002% of firm revenues and 0.15% of restaurant revenues. Anticipated costs were larger and amounted to 0.0004% of firm revenues and 0.41% of restaurant revenues. Impacts on productivity, absenteeism, and restaurant patronage were widely anticipated but not observed in currently compliant establishments.

CONCLUSION

Firms and restaurants expected high costs to result from strict tobacco regulation because of infrastructure costs, decreased productivity, and decreased patronage. That none of these were actually observed suggests that policy makers should discount industry claims that smoking regulations impose undue economic hardship.

The inertia of self-regulation: a game-theoretic approach to reducing passive smoking in restaurants

Two alternate regulatory approaches can be used to reduce exposure to environmental tobacco smoke in workplaces. The first is voluntary, self-regulation introduced by management, which is supported by common law and occupational health legislation that emphasises the employers' 'duty of care'. The second is public health legislation that bans smoking outright in enclosed places. In Australia, self-regulation has succeeded in restricting tobacco smoking in most indoor workplaces but has been a relative failure in the hospitality industry. Claims that this reflects consumer preference by diners, club and hotel patrons are not backed by survey evidence, typically showing large majority support for non-smoking establishments. Insights from game theory show why reliance on the duty of care is unlikely to succeed even when establishment operators collectively support a non-smoking policy. Using plausible assumptions about the net costs of unilaterally introducing smoking restrictions, what makes good sense for society as a whole is likely to be the least profitable option for an individual operator acting alone. Operators find themselves in the classic prisoner's dilemma. If the aim of policy is to restrict smoking in public places in order to protect the health of employees then game-theory predicts that public health legislation banning smoking in enclosed places will be more effective than self-regulation and reliance on the duty of care.

Policy and politics of smoking control in Japan

The tobacco industry took root well before the hazards of its products were proven scientifically. As elsewhere, smoking control policy has not proceeded automatically nor smoothly in Japan. Examination of the past political process discloses that the failure to enact effective smoking control is attributable to several factors, including the political environment, administrative inadequacy and an inactive medical community. Especially remarkable in this failure have been: the political leverage of the tobacco industry; a lack of clear leadership by the health ministry; the successive rejection of law suits in the courts; and the relatively weak health advocacy groups in Japan. The Diet had been effectively immobilized by pro-tobacco interests and without support from the government, administrative agencies have remained inactive. Since the late 1970s, a series of smoking control measures has been introduced by government agencies, propelled by the social movement. However limited, the introduction of smoking control measures was accomplished with, or at least facilitated by the following: the advocacy of local and international groups and organizations; the continuous visibility of the issue in the media; and changing public attitudes. Involvement of the Diet and the Ministry of Health and Welfare (MHW) was essential in translating commitments into government action. Nevertheless, the resulting measures were not comprehensively legislated. Moreover, they were not subject to continuous evaluation. Consequently, they have been mostly ineffective in decreasing the prevalence of smoking among the populace. Clearly, leadership by the health ministry coupled with political support are the key to advancing effective smoking control.

Perceptions of the effect of an impending restaurant smoking ban on dining-out experience

BACKGROUND

The introduction of bans on smoking in restaurants is frequently marred by claims that they will lead to a loss of business.

METHODS

A representative sample of 3,019 South Australians age 15+ years were asked questions about dining-out frequency and perceived effects of the ban on their dining-out enjoyment and restaurant patronage.

RESULTS

Sixty-one percent thought the ban would make dining out more enjoyable, 5% thought it would be less enjoyable, and 34% thought it would make no difference. Overall, 82% thought the ban would make no difference to their likelihood of dining out, 14% would be more likely to dine out, and 4% would be less likely.

CONCLUSIONS

These data suggest that the public expects bans on smoking in restaurants to result in both increased enjoyment and increased patronage of restaurants.

Attitudes and experiences of restaurateurs regarding smoking bans in Adelaide, South Australia

OBJECTIVES

To determine compliance with a voluntary code of practice (VCP) for restricting smoking in restaurants and to canvass the attitudes of restaurateurs towards tougher smoking restrictions.

DESIGN

Cross-sectional survey conducted in 1996 using a telephone questionnaire.

SETTING

Metropolitan restaurants and cafes in Adelaide, South Australia.

PARTICIPANTS

276 (86.8%) of a sample of randomly selected owners and managers.

MAIN OUTCOME MEASURES

Restaurant non-smoking policies, reported and anticipated change in business, and restaurateurs' attitudes towards smoking restrictions.

RESULTS

26.8% of restaurants had a total smoking ban; 40.6% restricted smoking some other way; and 32.6% permitted unrestricted smoking. Only 15.1% of restaurants with a ban or restrictions had used the VCP to guide the development of their policy, and only half of these were complying with it. Although 78.4% of those with bans and 84.4% of those with restrictions reported that their non-smoking policy had been associated with either no change or a gain in business, only 33.3% of those allowing unrestricted smoking expected that this would be the case, if they were to limit smoking. A total of 50.4% of restaurateurs, including 45.3% of those with no restrictions, agreed that the government should ban smoking in all restaurants.

CONCLUSIONS

The VCP made an insignificant contribution to adoption of non-smoking policies, and compliance with the code was poor. Despite concerns about loss of business, there was considerable support for legislation which would ban smoking in all dining establishments.

Behavior intentions of the public after bans on smoking in restaurants and bars

OBJECTIVES

This study assessed the potential effect of smoke-free policies on bar and restaurant patronage.

METHODS

Random-digit dialing techniques were used in surveying a representative sample of Massachusetts adults (n = 2356) by telephone.

RESULTS

Approximately 61% of the respondents predicted no change in their use of restaurants in response to smoke-free policies, 30% predicted increased use, and 8% predicted decreased use. In turn, 69% of the respondents predicted no change in their patronage of bars, while 20% predicted increased use and 11% predicted decreased use.

CONCLUSIONS

These results suggest that smoke-free policies are likely to increase overall patronage of bars and restaurants.

Prevalence of workplace smoking bans in Victoria

Restrictions on smoking in the Victorian workplace have been measured since 1988. This paper investigates whether the trend of increasing prevalence of total bans found between 1988 and 1992 has continued. Estimates are based on workers' reports of the restrictions on smoking that apply at their workplaces. For indoor workers a total ban on smoking restrictions in the workplace has increased from 58% in 1992 to 66% in 1995. White collar workers continue to enjoy a higher rate of protection than blue collar workers. Factories, warehouses, hotels and restaurants are the worksites least likely to have restrictions. Bans result in considerable exiled smoking: half the smokers reported going out to smoke during working hours on their last work day.

Knowledge of cancer risk reduction practices in rural towns of New South Wales

The Australian Cancer Society has published guidelines for recommended risk reduction strategies for breast, cervical, smoking-related and skin cancer. While knowledge may not be sufficient for change, it is argued to be necessary for change to occur. A measure of the level of health knowledge in the community can be useful for health promotion practitioners, identifying where health messages are not reaching their proposed targets. Our aims were to examine the level of knowledge about risk reduction practices for breast, cervical, smoking-related and skin cancers, for a rural New South Wales sample, and to examine sex and age effects on knowledge levels. A survey of 2846 women and 1732 men from rural New South Wales, which used an unprompted recall strategy, revealed some notable deficits in recall of cancer risk reduction practices: only 26 per cent of women identified mammograms as a risk reduction strategy for breast cancer; only 5 per cent of women knew at which ages mammograms should start and stop; only 6 per cent of women could identify when Pap tests should be discontinued; less than half of the sample could identify common solar protection strategies; and less than one-third of people identified passive smoking as a lung cancer risk.

Community attitudes to bans on smoking in licensed premises

Information about public attitudes to the restriction of smoking in licensed premises could provide an impetus for a campaign to address the failure of the industry to improve the health of its employees and the public. A probability sample of 816 people was surveyed to determine community attitudes to the introduction of bans on smoking in licensed premises. A total ban on smoking was supported by 20 per cent and provision of special smoking areas by 65 per cent, and 15 per cent wanted no bans. More-educated people, white-collar workers, nonsmokers and those who went to licensed premises less than weekly were more likely to support bans than were the less educated, blue-collar workers, smokers, and those who went to licensed premises at least weekly. The less educated, smokers and those who went to licensed premises at least weekly were most likely to perceive that the introduction of smoking bands would reduce their patronage of licensed premises. Nonsmokers and those with more than 12 years of education were more likely to report that their patronage would increase if bands were introduced than were smokers and the less educated. The introduction of bans on smoking in licensed premises would result in only a small loss of patronage after accounting for potential increases from supporters of bans. The effect of the bans is likely to be felt most strongly among the less educated, smokers and regular patrons.

Smoking in hotels: prevalence, and opinions about restrictions

Exposure to high levels of environmental tobacco smoke can occur in hotels. Controversy exists about smoking regulation on licensed premises. This survey of 138 people attending one of three Newcastle hotels during 1993 found that 57 per cent of respondents were nonsmokers. Fifty-eight per cent (95 per cent confidence interval (CI) 50 to 66 per cent) of respondents in these hotels believed their health was being adversely affected by other people's smoke in the hotel. Seventy per cent (CI 62 to 78 per cent), including half the smokers, were in favour of restriction of smoking in the hotels. Most preferred the establishment of smoke-free areas to the introduction of total smoking bans in hotels. The failure of hotels to regulate smoking suggests that a legislative approach is required. The case for legislation would be strengthened by a larger study elsewhere in Australia.

Preference and requests for smoke-free dining

This study looked at whether people prefer to sit in smoking or smoke-free areas when they go to cafés and restaurants. It also considered whether those who said they would prefer smoke-free dining made this known when booking or going to a restaurant. The sample was 2387 Victorians, randomly selected and interviewed in their own homes. Overall, 68 per cent of respondents said they would prefer a nonsmoking area, and only 11 per cent preferred a smoking area. Even among smokers, less than half (42 per cent) wanted to sit in a smoking area. Of those people who wanted smoke-free dining, only 45 per cent said they always made this known. The results demonstrate strong community desire for smoke-free dining, but also point to the need for restaurant managers or the dining public to take the initiative, or for legislative action to ensure the provision of smoke-free areas.