Learning Objectives: Describe how to develop and validate a coding system to assess the strength of local clean indoor air policies.
PROBLEM/OBJECTIVE: Studies of the effect of clean indoor air policies rely on scales that measure the strength of different policies. Our objective was to develop a coding system for local restaurant smoking regulations in Massachusetts that is tied to a conceptual hypothesis and validated based on intermediate measures of effect.
METHODS: We developed a conceptual hypothesis to explain the potential effect of clean indoor air policies on secondhand smoke exposure and smoking behavior, developed a system to code the provisions of all restaurant smoking regulations in Massachusetts, coded the regulations for the 351 towns, and validated our coding system by examining the relationship between the measured strength of restaurant smoking policies and self-reported secondhand smoke exposure and attitudes toward restaurant smoking among youths and adults living in towns with varying local restaurant smoking policies.
RESULTS: A 15-level coding system was developed and successfully described the restaurant smoking restrictions in all 351 towns. While 64% of towns in Massachusetts had enacted restaurant smoking regulations, only 20% of the towns actually ensured a smoke-free environment for restaurant patrons or employees. Failure to code the specific provisions of these regulations in previous reports has led to substantial overestimates of the prevalence of meaningful restaurant smoking restrictions.
DISCUSSION: Measuring the strength of clean indoor air policies should be guided by a clear conceptual hypothesis. Specific provisions of these policies must be measured to accurately assess their strength. Major discrepancies in understanding may result without a conceptually-based and validated coding system.
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