Tobacco Smoke Pollution and Compliance Before and After Passage of a Comprehensive Statewide Smoke-Free Law

Purpose: The purpose of this study was to determine to what extent the passage of North Dakota’s comprehensive statewide smoke-free law has influenced the quantity of tobacco smoke pollution in hospitality venues statewide.

Methods: This post-law study included selected pre-study venues that had been chosen by random sampling, a statistical best practice rarely used in studying indoor tobacco smoke pollution. The indoor air quality indicator of particulate matter 2.5 μm aerodynamic diameter or smaller (PM2.5) was assessed in 65 restaurants and bars using a modification of Roswell Cancer Park Institute’s protocols.

Results: A statistically significant 83% average reduction in tobacco smoke pollution levels occurred in hospitality venues studied after passage and jmplementation of North Dakota’s comprehensive statewide smoke-free law. Compliance with North Dakota’s new law varied. An analysis of tobacco smoke pollution levels from pre-law to post-law by rurality revealed statistically significant reductions in each of the rural categories. After passage of the comprehensive statewide smoke-free law, no statistical difference by rurality occurred. This was in contrast to the pre-law study. Additionally, compliance did not differ by rurality.

Conclusion: A policy implication is the objective support of the effectiveness of North Dakota’s comprehensive statewide smoke-free law to dramatically decrease the levels of tobacco smoke pollution both in bars and restaurants. These decreases remained true across the levels of rurality. Although overall compliance with the comprehensive statewide law was varied it did not differ by level of rurality. A strong recommendation, based upon the low compliance rates with some of the new law’s requirements, is to intensify education and enforcement efforts to increase compliance with the law. Ongoing assessment studies and enforcement similar to the Synar requirements to prevent tobacco sales to minors, are recommended to determine and increase compliance. A study of outdoor compliance should be repeated after sufficient time for education and enforcement has passed and with consideration of identifying seasonal differences. Future statewide studies within North Dakota should be conducted to determine continuing effectiveness of the law to protect the public against the dangers of exposure to tobacco smoke pollution.