The use of assessment in promoting secondhand smoke policy in a local health jurisdiction.

Background: Clean indoor air regulations reduce both exposure to secondhand smoke and use of tobacco, two significant causes of death in the United States. In 2003, the Board of Health in Pierce County, Washington State, adopted a resolution prohibiting indoor smoking in all public places. Assessment activities were used in three key steps during the secondhand smoke policy development process: (1) setting prevention priorities, (2) monitoring and evaluating interventions, and (3) adopting local policy change.

Methods: Step 1 included calculating attributable risks for morbidity and mortality caused by preventable health behaviors. Step 2 involved designing logic models and outcomes-based evaluations to collect and analyze data from prevention efforts. Surveillance of restaurants documented voluntary adoption of smoke-free policies. Step 3 included conducting telephone surveys to track public support for tobacco policy approaches.

Findings: Results demonstrated tobacco's high impact on morbidity and mortality, illustrated a plateau of restaurants' voluntary smoke-free policies, and identified growing public support for secondhand smoke policy. Assessment results were included in multiple policy and support documents and cited by Board of Health members during policy adoption.

Conclusions: Assessment data contributed critical support to local public health decision makers during key steps of a lengthy secondhand smoke policy development process.