Rookverbod Californië allesbehalve totaal

INTRODUCTION

This paper describes an ongoing project utilizing participant observation to investigate noncompliance with workplace tobacco control regulations within standalone bars in one California city. Five years after a statewide workplace smoking ban was extended to include bars, lingering pockets of noncompliance in bars were found throughout the city. The researchers sought to identify characteristics of bars and the social dynamics within bars that either supported or presented barriers to the implementation of the smoke-free ordinance. These characteristics might be utilized to leverage increased compliance. Early findings from the observations are highlighted as the type of useful conclusions that systematic unobtrusive bar observations can yield.

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METHODS

UNOBSTRUSIVE PARTICIPANT OBSERVATION

The present study utilizes participant observation, in combination with data collected in interviews, to identify practices, norms, and beliefs related to tobacco smoking in bars. Pairs of trained researchers conducted hour-long observations in a random sample of bars that serve patrons of a wide variety of ages, ethnicities, and socio-economic backgrounds. The observers entered the bar as patrons and casually interacted with staff and other patrons. They collected data using a structured observation protocol and recorded their findings in a database programmed on handheld computers, as well as provided qualitative records of their observations in the form of brief narratives.

Unlike many fieldworkers conducting participant observation, however, the bar study researchers did not disclose to other patrons and staff members that they were conducting observations (Fernald, 1997). Various other forms of unobtrusive data collection that do not involve covert observations have been used to good effect in public health research. Methods such as archival data analysis and measures of physical traces (Webb, Campbell, Schwarts, & sechrest, 1966) could also be useful in a study of smoking in bars, and some such measures are in fact incorporated in the present study; for example, field workers record physical evidence of smoking such as the presence of ashtrays and cigarette butts inside bars. However, the purpose of the present study is to identify patterns of behavior, norms, and beliefs that may impact the reasons why some bars comply with the nonsmoking ordinance and others do not. Many of these other forms of data analysis rely solely on quantitative data.

Participant observation has the advantage of allowing for the collection of both quantitative and qualitative data. As we will show, this combination can effectively identify patterns of behavior that indicate the norms and beliefs supporting either compliance or noncompliance with the smokefree ordinance. Fieldworkers conducting unobtrusive observations have been able to witness and record not only behaviors related to smoking by staff and patrons, but, moreover, some of the social dynamics that encourage or discourage smoking in bars. The themes raised in the observations have allowed for a sharper focus on salient issues in the currently ongoing interviews with bar staff and patrons.

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The observations were largely conducted in the fifth year after the implementation of the 1998 extension of the smokefree workplace ordinance to bars, i.e., the period of 2002 and early 2003. The four sets of observations were intended not to capture time-dependent trends but rather to cover a range of times of day and days of the week, which time periods might contribute to compliance patterns. The research staff hypothesized that, five years after the law became effective, compliance patterns would have stabilized to a large extent, and this assumption seems to have been supported by our observations. Of the 121 bars in which we conducted observations, we have identified 11 possible cases of “conversion,” wherein noncompliant bars may have become compliant; these cases may, however, reflect other factors, such as a change of management or ownership, rather than direct responses to the smokefree ordinance. In-depth interviews currently underway with bar staff and patrons indicate that the compliance patterns observed during the study period indeed reflect a stable situation; further interviews are expected to clarify this.

Field staff used three separate instruments to collect both qualitative and quantitative data: a Visor form, a narrative form, and maps. The first instrument was a closed-ended survey programmed onto a handheld computer, a Handspring Visor, which allowed the observers to rapidly log information for each bar on the type and general characteristics, interior and exterior condition, size, seating, ambiance, basic demographic information on staff and patrons, tobacco products sold or visible, and incidences of smoking inside the bar, as well as circumstantial evidence of smoking inside the bar. This instrument was adapted from checklists employed by previous bar studies (Hennessy & Saltz, 1993; Graham, 2001). The data were entered into the Visor and downloaded directly onto a Microsoft Access database remotely. The observers were trained in procedures related to use of the handheld Visor (see Moore, Martin, & Lee, n.d., for further discussion of the use of the Visor).

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On the first two observations, each of the team of bar observers produced a diagram mapping the physical space of the bar and functional use of these spaces. These maps served to sharpen observers’ awareness of spatial relations as well as provide the research staff with diagrammatic information with which to read and interpret the narrative deions. Additionally, spatial relations such as the size and layout of the bar relative to the bartender’s sightlines are hypothesized as one possible characteristic supporting either compliance or noncompliance, particularly in regards to the bartender’s ability to control the social space. Analyses of the spatial relations data will be presented in future publications.

The observers’ training included extensive attention to demeanor. This was particularly important in those cases where observers were assigned to conduct observations in “locals'” bars, establishments with a regular and often intimate set of patrons and staff, where observers’ presences might more possibly be noticed, or in situations where the observers did not match the bar’s demographic (although field staff were selected to match, as much as possible, the ethnically diverse populations that might be expected in the city’s bars).

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RESULTS

COMPLIANCE

Smoking (including all types) was observed in 33.4% of observations and at least one time in 49.6% of bars. Review and coding of the narrative data allowed for the development of a scale to differentiate degrees of smoking. First, two general types of “smokiness,” which the researchers characterized as “incidental” smoking and “endemic” smoking, were identified. Endemic smoking described situations where either the majority of persons smoked, or many individuals smoked continuously and openly:

All interactions were smoking-related. Cigarette packs, ashtrays and lighters graced the entire length of the bar, except for the area in front of my partner and me. I look left, and I look right, and see at least four smokers at any one point. They alternate between smoking, ashing, and drinking. The bartender didn’t do anything to facilitate this behavior except allow it. Numerous ashtrays were already present. One of them, by the way, next to us, was filled to the brim. The male using it, sitting alone, was smoking nonstop. Before he left, he finished his pack and bought another from the bartender. Butts were all over the ground, below our feet, and outside the entrance in the planters. Out of 12 patrons, eight were regularly smoking. Not at any point during the evening did anything disrupt this flow of smoking behavior.1

I spotted at least 10 patrons smoking inside. But I suspect many more patrons who were out of my field of vision were also smoking. At least two male patrons were smoking at the bar in front of all the staff members. The other eight smokers were split up between the two young groups. Patrons would take turns lighting up and would smoke casually together. This group was smoking cigarettes continuously in the open. None of the patrons seemed concerned about being reprimanded or fined.

Incidental smoking, on the other hand, refers to more situational or occasional smoking. This designation included bars where people were observed smoking in or near doorways; seated inside the bar holding a lit cigarette out a window and attempting to blow smoke outside; and lighting a cigarette inside the bar and then taking it outside to complete smoking it. Other situations considered incidental were when only one person smoked inside the bar; when the only smokers smoked surreptitiously (e.g., holding the lit cigarette under the table, or smoking in distant corners of the bar space); and when people smoked at or near closing time. These situations often seemed to be underlain by either misunderstandings about the nonsmoking ordinance or recognition of the law if not full willingness to comply:

The bartender left the area behind the bar and sat down on the chair that props the alternative entrance/exit door. She’s smoking in the chair. She then sees a patron approach the bar, stands up, and hands her cigarette to a white male patron, who then finishes the cigarette. After she deals with the patron, she pulls a cigarette out of a pack resting behind the bar, and returns to her seat at the alternative exit/entrance. She lights this cigarette by herself with a lighter. There were six patron smokers. At least four smoked near the entrance.

In the back by the pool table, a man lights up a cigarette on the inside steps that lead to the pseudo patio. He smokes inside, inhales and exhales inside, but ashes his cigarette outside.

I spotted at least one patron who lit his cigarette a foot away from the main door before exiting to smoke his cigarette. Another patron was holding a cigarette in his hand as he walked toward the door to smoke outside.

Towards the end of the observation, the bartender informs us that they will be closing a little before 10:00. He leaves and goes back to his conversation with the three remaining patrons and one of them opens up the front window and smokes inside the bar, but ashes and blows his smoke outside. The bar is closing, and my partner and I are transient patrons who have one drink and are about to be kicked out, so the bartender feels comfortable letting his friend talk and smoke inside. He uses the ashtray on the sill, and keeps it on the sill.

Bars in which smoking was characterized as endemic often also were found to supply smoking paraphernalia. Many endemic smoking bars supplied ashtrays:

Along the northwest and southwest corners of the bar, there were plastic red or white ashtrays that the bartender would clean every so often with a dishrag. At the northwest corner, three to four people smoked at irregular intervals. One of them, the woman with the poodle, dumped her ashes into a large, bowl-shaped ashtray. The others used their regular, plastic ashtrays.

In some bars, ashtrays were visible on or behind the bar upon the observers’ entry, while in other bars ashtrays were offered when patrons lit up. In other bars ashtrays were offered to all patrons as a matter of course:

The bartender immediately put an ashtray in front of my partner when she entered, without any kind of notice that she wanted to smoke. At least five people were smoking inside the bar.

When the server brought us to our seats, he had two ashtrays in his hand. But when he saw that ashtrays were already on the table, he took them back to the bar. All the tables had ashtrays with additional trays at the bar.

The server had nonbranded clear glass ashtrays on her drink tray. I presume she handed the ashtrays out to patrons who wanted to smoke.

Ashtrays included those obviously designed as such, as well as makeshift ash containers. These included tin breath mint boxes (which patrons also may carry with them); drink coasters folded by either bar staff or patrons to contain ash; coffee cups; and pieces of foil torn from rolls kept behind the bar and folded into ashtrays for smoking patrons. These makeshift ashtrays are apparently utilized in response to local understandings that ashtrays are “illegal” (health inspectors may cite the presence of ashtrays in their reports as evidence of lack of a good faith effort on the part of the bar to comply with AB 13).

The differentiation between endemic and incidental smoking has been found to be stable over observations overall, so that bars may generally be typified as either endemic or incidental smoking bars. A scale was developed to determine the percent of bars in the sample characterized by either endemic or incidental smoking. Research staff assessed the smoking described in each narrative file and assigned a code of N, E or I (nonsmoking, endemic smoking, or incidental smoking) for each narrative record. These codes were assigned a value of 0.0 for nonsmoking, 0.5 for incidental smoking, and 1.0 for endemic smoking; these scores were then averaged per bar. The results showed that 14.9% of bars were characterized by endemic smoking (i.e., smoking was reported in 100% of observations). Over fifty percent (50.4%) of the sample bars are characterized as nonsmoking (i.e., zero reports of smoking). The remainder includes bars characterized by incidental smoking as well as the possible conversion cases (11 bars or 9% of the sample). In these bars, observations conducted early in the year showed both observers reporting endemic smoking, followed by one or more visits with both observers recording no smoking (with one case of a bar flip-flopping between endemic smoking to nonsmoking and back to endemic smoking).

THE IMPACT OF THE SMOKEFREEACT IN BARS

The observers’ acceptance and inclusion in the everyday life of bars has allowed them to gather vital data not only on naturalistic smoking behaviors but also on the bar patrons’ and staff’s awareness of and attitudes towards the nonsmoking law as well. Patrons and staff expressed their attitudes about the law in unsolicited or overheard conversations: one mid-20’s male patron standing outside the front entrance by a short ashcan full of butts remarked that he felt like a criminal for being sent outside to smoke and the least they could have done was to give the “criminals a bench to sit on.”

At another bar, in a conversation with two women, he [bartender] said loudly “I used to be able to smoke back here… in the old days.” He had gone outside for smokes twice during the observation.

In many bars where endemic smoking was observed, bar staff and management exhibited an ironic attitude of formal recognition but effective undermining toward the no-smoking law, either through direct action:

A male patron needs an ashtray and approaches the bartender; the bartender says: “There’s no smoking in the state of California…” and then pushes a little black ashtray towards him. There are ten [smokers out] of 12 patrons in the bar, and all the smokers had ashtrays in which to ash and extinguish their cigarettes.

Or through indirect means:

Behind the bar there are two signs that at first glance appear to be “no smoking” signs, but on second glance they actually encourage smoking. They read, “No smoking unless it’s in an ashtray.” The establishment does not want the cigarettes put out on the floor.

In many of the bars characterized by incidental smoking, on the other hand, bar staff appeared to allow smoking by regulars as long as people who were neither clearly nonsmokers nor strangers were present. Senior research staff attempted as far as possible to reduce observer bias by matching the ethnicity, age, and style of dress of the observers to what was known about the bars to which they were assigned, based on the initial field survey and previous bar observations. Given the limited number of staff and the wide range of patrons’ types, this was not always possible. On some occasions it appeared that the bartender’s efforts to enforce the law might have been for the benefit of the observers, particularly when the observers stood out as unknowns to the bartender:

One of the older male patrons lights a cigarette at the end of the bar. We do not observe a lighter or a pack, just one cigarette. As soon as he lights it, the bartender leaves her conversation with the other two by the jukebox and asks him, in Spanish, to put out the cigarette. He does and resumes his seat at the bar over by the jukebox. There he relights the cigarettes and turns over to us to ask, in English, if we mind if he smokes. We say no, the bartender smiles again and he resumes smoking.

The second we walked in, the bartender put out a cigarette. She was the only one smoking in the bar. A patron bummed a cigarette off of her, and she told the patron to be careful because “we aren’t supposed to be smoking.”

Bars that actively flaunted the law were relatively few; early results from interviews with bar staff point to the critical role of enforcement in this regard. While the research staff had expected to address this issue through interviews, the field observers were also able to gather some data on the bar staff’s knowledge of and impact of enforcement of the law. One bar in the sample had been well known for tolerating and even encouraging smoking. Following enforcement efforts, however, the management began to uphold the nonsmoking law. In unsolicited conversation, a talkative bartender described this process in detail to the field observers:

The bartender was telling us how this bar used to be known as a smoking bar. He said if you asked flight attendants where the smoking bars in San Francisco were, they would recommend this bar. He said that this bar had been getting a lot of notices saying that they were known for their smoking violations. He said they just ignored the notices until one day when someone came in and wrote them a ticket. He said the ticket was $2,000 and that the fine would double on each subsequent citation; so the next ticket would be $4,000, then $8,000, and so on. He said that the citation officers can cite the same bar multiple times in the same day so the bar could end up paying $20,000 of fines in one day.2 So they decided to make it a no-smoking bar.

Observers were also able to capture some snapshots of a bar- going public in a period of transition, conflicted or confused about whether or not smoking was allowed in bars:

There were three people smoking inside tonight. The first was one of the Korean patrons sitting at the bar; she enjoyed at least two cigarettes and used an ashtray on top of the bar. The other two smokers were in the party of five; one of the females was smoking a clove [-flavored cigarette] when she walked inside. She was going to sit down at one of the tables, but when she noticed that two of her male friends were still outside smoking, she walked over to the door and inquired, “What are you guys doing out here?” I had the impression she knew that smoking was acceptable inside and her friends did not have to finish their cigarettes outside. The two men finally entered with one of them still holding his lit cigarette.

Such details convey a situation of flux and lingering ambiguity concerning bar smoking policies. These quotes from the observers’ narratives illustrate the complex interaction of bar traditions and a substance use – tobacco smoking – that has only recently been defined as illicit in those spaces.

CONCLUSIONS

The results presented here should be read as preliminary; further analysis may yield more information about characteristics of compliant and noncompliant bars. The foregoing does serve to elucidate the impact of the smoke-free policy on the bar world of this California city. While many bars were found to be noncompliant with the smoking prohibition, the field observers were able to capture nuances of this situation, in particular the distinction between bars that are chronically noncompliant and may be typified as recalcitrant, and those that are incidentally noncompliant, where patrons and staff are making some efforts to comply. Interventions and outreach efforts can be tailored to each type of noncompliant bar in order to better enhance compliance. For example, brief bartender training on the rationale behind the ban and how to uphold it, bolstered by stepped-up enforcement, could improve compliance with the law for many of the bars characterized by incidental smoking, while more intensive measures may be needed for endemic smoking bars.

However, because the observers were instructed to limit their interactions to the minimum acceptable level of sociability and to not elicit information from patrons or staff, the observational data is limited in scope to what observers could see, hear, and infer. Due to this limitation, the researchers are also conducting in- depth interviews with bar managers, bartenders, and patrons to elicit attitudes, opinions, and feelings; to document the history of the transition from smoking to nonsmoking for individual bars; and to elicit suggestions and recommendations for enhancing compliance from these frontline participants. These interviews are conducted with the explicit informed consent of the respondents and are intended to complement the observational data as well as relieve the observers of any need to interact with other bar goers and staff beyond normal patron behavior.

Another limitation of the present study is that it is being conducted in only one California city, and the observed patterns may reflect socio-political dynamics unique to that community. Further community-level studies of compliance with smoke-free workplace ordinances in bars are needed to assess the generalizability of the findings presented here.

Perhaps the most interesting finding from a policy perspective is the degree to which bar culture has changed in response to the smoke- free bar ordinance. The limited range of things one can do at a bar has expanded to include going out for a smoke-break in most San Francisco bars. Interviews with bartenders, substantiated by the observation data, indicate that San Francisco bar patrons and staff in compliant bars have begun to change the ways in which they think and act in regard to smoking in bars. Bartenders have frequently described this norm change as something that the patrons and staff “just got used to.” Although this paper has described both endemic and incidental patterns of smoking in the study’s randomly selected establishments, the sheer amount of smoking inside the city’s stand- alone bars has diminished dramatically.