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Table 2. Beliefs About Harwfulness Caused by Envirm.untal Tobacco Smoke (% of Respondents) by Smoking Status ETS Harnful to Non-snokers Smoking Status rv rr n Former Nonsmokers Never Ta Smokers k r m ke3 Roper 1974 30 57 46 Roper 1976 38 61 52 Roper 1978 40 69 58 Gallup 1983 64 80 84 Research and Forecasts 1985 AVTS 1986 69 82 85 87 77 (Physicians-87) 81 NHIS-CEC 1987 67 84 89 82 Gallup 1988 64 86 89 81 Gallup 1989 86X (To Adults) 88% (To Pregnant Woawn) 89% (To Children) $7808189 Source: Roper Organiaation 1978; Gallup Surveys 1983, 1988; Adult Use of Tobacco Survey 1986, Research and Forecasts 1985

Table 3.a Annoyance Caused by Environmental Tobacco Smoke (% of Respondents) by Smoking Status Annoyed by ETS Survey Current Smokinx Former Status Nonsmokers Never Total Smokers Smokers Smokers Roper 1978 5 60 AUTS 1964 20 49 64 69 46 AUTS 1966 26 52 70 48 AUTS 1970 34 63 73 78 59 AUTS 1975 35 72 79 79 63 ROPER 1978 5 60 AUTS 1986 42 73 80 83 69 NHIS-CEC 1987 34 75 88 69 Source: Adult Use of Tobacco Surveys 1964, 1966, 1970, 1975, 1986; Roper Organization 1978, NBIS-CEC 1987.

Fewer current smokers reported annoyance than on the 1986 AUTS (34% vs 42%), but this difference may be in part due to the different methodologies and sampling frames used in these two surveys. A greater percentage of never smokers reported annoyance in 1987 than in 1986 (88% vs 83%), but the overall response was exactly the same (69% annoyed) on the two surveys. The N$IS-CEC also collected information about what non-smokers did in response to exposure to ETS. About half of respondents moved away from the exposure source, 40% did nothing, 3% did something else, and only 4% asked the person not to smoke. Despite high positive responses to perceived harm caused by and annoyance to ETS, most non-smokers remain rather passive in their behavior toward exposure sources (Davis, in press). Limiting or Banning Smoking in Public Places Roper Surveys The Roper Surveys began questioning the public about laws to prohibit smoking or to segregate smokers in 1974. The percentage of respondents favoring segregation in a variety of public places is shown in Table 4. The majority of respondents felt that smokers should at least be segregated in all the public places cited. After asking about segregation of smokers and nonsmokers, respondents were asked if amoking should be banned outright in selected public places. The percentage of respondents favoring bans is shown in Table 5. The majority of respondents favored smoking bans in retail stores, physicians' or dentists' waiting rooms, and elevators. The Roper Survey was careful to ask about segregating smokers before asking about entirely banning smoking in public places. The narrative pointed out that after recognizing the option to segregate smokers, respondents were probably less likely to be in favor of a total ban (Roper 1978). The two most important reasons given by Roper Survey respondents prior to 1978 as to why smoking should be restricted always had to do with dangers to others, specifically, cigarette smoking as a fire hazard and ETS as a health hazard to nonsmokers. In 1978, the "health of non-smokers is harmed by other people smoking iti their presence" became the chief reason given by respondents (33%) in favor of public laws against smoking. Gallup Surveys and Polls In 1983, 1985, 1987, and 1989, the Gallup Poll telephone surveys conducted on behalf of the American Lung Association (ALA) asked if smokers should refrain from smoking in the presence of nonsmokers. Table 6 shows the results of these surveys. Overall, 11 00 ~ ~ O OD N

adopted by the Public Health Service, recommend that all 50 states have laws by 1990 that both prohibit smoking in enclosed public places and require separate smoking areas in the workplace and in dining establishments (Public Health Service 1980). As of the publication date of the 1989 Report of the Surgeon General (January, 1989), 31 State had laws restricting smoking in public worksites, 13 had laws restricting smoking in private worksites, and 26 had laws restricting smoking in restaurants (US DHHS 1989). It is important to continue to assess public knowledge and beliefs regarding tobacco use as new information becomes available. These survey results assist public health providers in measuring the success of policies to control health hazards such as ETS. In addition, these data.emphasize the change in the social milieu surrounding tobacco use. As public attitudes shift away from the social acceptability of smoking, it may be more and more important both for smokers to quit and for potential smokers to avoid smoking. It may also be easier for policy-makers to address tobacco issues more directly if they understand the nature of and the changes in public opinions expressed through these surveys. I 17

Table 9. Reported Worksite Smoking Policies and Worksite Exposure to Environmental Tobacco Smoke (% of Respondents), 1986 Worksite Policv %&evorting Policv %&eoortina Exnoaure to ETS Not Restricted 55.4 64.8 Restrictive 42.1 53.2 Total Ban 2.5 21.1 Source: Adult Use of Tobacco Survey 1986

racial, and age distribution of the U.S. population based on the 1986 Current Population Survey of the U.S. Bureau of the Census. More detailed information on attitudes, beliefs, and exposure regarding ETS was collected in this survey. National Health Interview Survey The National Health Interview Survey of Cancer Epidemiology and Control (NHIS-CEC) collected data in-person from 22,000 adults >_18 years of age in households throughout the United States. The data are weighted to reflect the entire U.S. population, and the overall response rate for NHIS-CEC was 82%. Respondents were asked about the harmfulness of ETS and about attitudes toward passive smoking. These included perceived annoyance and whether smoking should occur inside public places. Nonsmokers were asked about their actions in response to smokers' lighting up in their presence. Other Surveys Worksite Surveys Several surveys of worksites and businesses have been carried out in the last several years. These are described in detail in The 1986 and 1989 Surgeon General's Reports (U.S. DHHS 1987, 1989). The Bureau of National Affairs and the American Society for Personnel Administration (ASPA) conducted a mail-in questionnaire survey of ASPA members. Six hundred twenty-three respondents reported on activities related to smoking in the workplace. The response rate was 54%. A similar survey had been carried out in 1986 on 662 businesses, and results on the presence or absence of restrictions were comparable. In 1988, the Office of Health Promotion and Disease Prevention (OHPDP) of the United States Public Health Service reported on worksite health promotion activities, including smoking control. The survey was carried out in 1985 on a sample drawn from the Dun and Bradstreet list of businesses. Using a telephone interview, 320 worksites with 50-90 employees and 1,038 worksites with 100 or more employees, drawn from a probability sample based on geographic region, size of firm, and industry type, were surveyed. Questions about smoking restrictions were included. In December 1984, the American Board of Family Practice (ABFP) sponsored a National telephone survey of 1007 adults >_18 years of age and of 303 Family Physicians conducted by Research and Forecasts, Incorporated. The results were published in a report entitled, Riohts and ResDonsibilities: Healthcare Octions. Questions were asked regarding beliefs about the harmfulness of ETS, the rights of smokers and non-smokers, and whether smoking restrictions are effective in stopping or discouraging smoking. The final sample response rates were 41% for the general public 9

telephone survey of 1500 persons which was conducted by Hamilton, Frederick, and Schneiders (Hamilton, Frederick and Schneiders, 1989). This survey asked about various public policy issues and was to measure levels of support on governmental policy on smoking. The respondents were asked what they thought about restrictions on smoking in restaurants and worksites. The results were not reported by smoking status of the respondents, but 401 (27%) of the respondents were smokers. The response rates were not reported. Other Public Ooinion Surveys Gallup Surveys Gallup Poll results have been- published monthly by the Gallup organization since 1965. Surveys are either personal interviews or by telephone, with a population-based sample of at least 1000 adults, >_ 18 years of age. The sampling error for overall responses is reported to be no more than ±ZA (Gallup Report 1987). In addition, Gallup surveys may be commissioned by a variety of organizations. The surveys reported here were commissioned by the American Lung Association (1983, 1985, 1987, and 1989) and The American Cancer Society (1988) to study both the prevalence of smoking and public opinions regarding smoking issues. An additional Gallup Survey was commissioned by the National Restaurant Association (1987) to obtain public opinion on smoking in restaurants. The 1989 Gallup Survey sponsored by the American Lung Association did not ask respondents about their smoking status. Harris Poll Louis Harris and Associates have performed eight national surveys between 1974 and 1987 using probability samples of adults aged 18 and older. These surveys were conducted on behalf of various organizations, including Prevention magazine and Pacific Mutual Life Insurance Co., to ascertain health practices in Americans. In 1987, 1250 persons were also asked about regulating smoking in public places. Government Soonsored Surveys Adult Use of Tobacco Surveys (AUTS) The Office on Smoking and Health (formerly, National Clearing House on Smoking and Health) commissioned surveys of adult smoking behavior, attitudes, and beliefs beginning in 1964. These surveys oversampled smokers, but final results were weighted to represent the United States resident population aged 21 years and older (1964, 1966, 1970, 1975). The 1986 AUS oversampled smokers and also collected data from persons aged 17 and older. The final data in this survey were weighted to reflect the educational, regional, 8

CHAPTER 1 PASSIVE SMOEING--BELIEFB, ATTITUDEB, AND EXPOSURES IN TBB UNITED STATES Thomas E. Novotny, MD Chief, Program Services Activity office on smoking and Health Centers for Disease Control Introduction The relationship between public attitudes, policies, and exposure to certain health hazards is complex. with the release of the *18th Surgeon General's report on smoking and health, "The Health consequences of Involuntary Smoking," (US DHHS 1987) public attention on the issue of Environmental Tobacco Smoke (ETS) was more strongly focused than ever before. For many years, however, pollsters, the tobacco industry, and the health promotion community have surveyed the public concerning attitudes toward ETS and toward restrictions against exposure to ETS. The Surgeon General's Report described data from several of these surveys as well as results from evaluations of worksite and local policy changes. Additional detailed data on public beliefs and attitudes toward smoking in general are found in the 1989 Surgeon General's Report: Reducina the Health Conseauences of Smokina -- 25 vears of Proaress. Recently, surveys have also included both questions on beliefs about the harmfulness of ETS to the nonsmoker and on respondents' reported exposure to ETS. In addition to such individual exposure data, surveys of worksites and of personnel managers have provided information about restrictions on ETS exposure to workers. Because changes in public attitudes toward ETS usually precede laws or policies regarding ETS exposure (US DHHS 1987), an examination of trends in these data over time is useful. This section will consider several different nationally-based data sets andsummarize the most important findings from them. e5 The surveys reported in this section are summarized in Table 1. 6

Table 7.a Opinions Regarding Smoking In Selected Public Places and Worksites, (% of respondents) by Smoking Status, 1983, 1985, 1987, 1989 Hotels and Motels Set Aside Totally Ban Certain Areas Snokina No Restrictions Don't Know. !3 JI In jU flZ M M AZ .'94 -M M '94 8'780819'7 Current Smokers 49 61 7 6 42 30 2 3 Former Ssokers 54 72 13 9 27 16 6 3 Nonswokers 60 68 15 14 20 15 5 3 All Respondents 54 67 63 12 10 12 30 20 18 4 3 6 Restaurants Set Aside Totally Ban Swokina Certain Areas No Restrictions Don't Know _ M 3? _82 !N ~ $1 Current Smokers 74 79 12 7 13 13 1 1 Forwr Smokers 71 74 19 19 9 6 1 1 Nonsmokers 65 71 26 23 7 5 2 1 A11 Respondents 69 74 66 19 17 23 10 8 B 2 1 3 Worksites Set Aside Certain Areas Totally Ba Smoking n No Restrictions Don 't K now !3 M '9Z M _g3 M ~07 94 M In _5i 18 .Z M Current Snokers 64 76 72 11 4 8 21 19 1B 4 1 2 For.er Sewkers 68 80 73 14 12 16 14 6 8 4 2 3 Nonsmokers 63 80 67 24 9 23 9 10 8 4 1 2 All Respondents 64 79 70 65 17 8 17 21 15 12 11 10 4 1 2 4 Source: Gallup Surveys 1983, 1985, 1987. 1989

Hamilton, Frederick, and Schneiders Survey Interestingly, the Tobacco Institute-sponsored survey (Table 5b) showed even stronger responses for restaurant and worksite restrictions in 1988. For each of these sites, the question referred to the "current policy" as a choice; for restaurants, the choice was up to customers to select smoking vs. nonsmoking sections, and for worksites, the choice was up to employers and employees to decide on worksite policies. Fewer respondents in this survey favored no restrictions on smoking than in the American Lung Association survey (restaurants 2% vs 8%, worksites 3% vs 104). Adult Use of Tobacco Surveys Between 1964 and 1975, the percentage of respondents favoring restrictions on smoking in public places increased from 52% to 70% (Strongly agree and mildly agree) (Table 8). The question asked in 1986 was quite different from the questions asked in the earlier surveys, but the 1986 responses are also shown in Table e. Between 1964 and 1975, AUTS respondents favoring increased restrictions increased 18 percentage points, from 52% to 70% overall. About half of respondents in 1986 felt that restrictions against smoking were adequate, perhaps because many more restrictions were in place by 1986. In 1966 and 1975, respondents were also asked if employers have a right to regulate smoking in their places of business. In 1966, 92% felt that the "employer has a right to tell a person when or where he can smoke while on the job," whereas in 1975, 78% felt that "management should have the right to prohibit smoking in their places of business." These are somewhat different questions; the first has to do with management's right to regulate employees, and the second has to do with management's right to regulate customers, visitors, and employees. Harris Poll In 1987, respondents to the Harris Poll, performed on behalf of Prevention magazine, were asked if they think that laws should prohibit smoking in public places, should these laws require. separate smoking and nonsmoking sections, or should smoking in public places not be regulated by law. Among all respondents, 23% felt that laws should prohibit smoking in public places, 61% felt that laws should require separate smoking and nonsmoking sections, and only 13% felt that laws should not regulate smoking in public places at all (3% were unsure). Again, more than 801 of respondents, smoking and nonsmoking, favored restrictions against smoking in public places. 13