BACKGROUND: The study investigates whether variation in Washington State Local Health Department (LHD) enforcement of smoke-free workplace laws is associated with lower prevalence of Work-Related Asthma (WRA). WRA is an outcome strongly associated with Environmental Tobacco Smoke (ETS) exposure, and is subject to surveillance by a CSTE Occupational Health Indicator (OHI #21). LHD enforcement of a 2006 state-level smoke-free workplace law may serve to reduce ETS exposure through improved compliance and lower smoking prevalence in communities. However, there is minimal guidance in the law regarding regulation and enforcement, leading to substantial observed variation in enforcement and citation across jurisdictions.
METHODS: The study uses data from 62,900 BRFSS and 5,370 Asthma Callback Survey (ACBS) respondents residing in Washington state (survey years 2006-2013). Industry and occupation data in BRFSS also identify those who reported working in sectors (food service, office/administrative (n=8,809)), who may be at higher risk of exposure to ETS. These data were then merged with county-level LHD activity data from the Multi-Network Public Health Practice and Outcome Variation Examination) (MPROVE) study. The survey includes indicators of the strength of tobacco-related programs and smoke-free workplace enforcement (i.e. number of inspections and citations given) as well as the effectiveness of ongoing enforcement efforts (i.e. number of violations reported). Mixed effect logistic regression models will be constructed, with LHD programmatic data at the jurisdictional level (n=25), and the individual BRFSS respondent as the unit of analysis. Both the effect of enforcement (inspections and citations) and the presence of other jurisdiction-level anti-tobacco programs on the prevalence of WRA will be examined.
RESULTS: There is substantial variation in LHD enforcement and business compliance practices. In 2012, 16 of 25 LHDs reported violations of the ban in their jurisdiction (mean =17.0, SD=52.0), and 14 LHDs reported conducting inspections of establishments (mean = 108.7, SD=265.3). Additional analysis will report on the effect of variations in smoke-free workplace compliance and enforcement on WRA prevalence across industries, occupations, and jurisdictions. Initial analysis shows asthma prevalence ranges of 4.9% - 11.2% among occupational groups in Washington State.
CONCLUSIONS: This study furthers understanding of the evolving role of LHD in protecting worker health. Examining the associations between county-level enforcement and worker-level health outcomes highlights the potential impact of LHD smoking ban enforcement efforts on worker health, and justifies public health funding of these endeavors.