Smoke-Free Outdoor Seating Policy: 1-Year Changes in Compliance of Bars and Restaurants in Philadelphia

Abstract

Purpose: To evaluate changes in compliance with a smoke-free outdoor seating policy before and after passage of a local regulation in 2015, which reinterpreted Philadelphia’s Clean Indoor Air Worker Protection Law to include outdoor seating areas of food or beverage establishments. Design: Natural experiment. Setting: Philadelphia, Pennsylvania. Sample: Food or beverage establishments (N = 108). Establishments were comprised of sit-down restaurants, cafes, quick-service restaurants, and bars. Measures: Presence of outdoor smoking and smoking-related litter on a given day were measured as binary variables. A geographic information system–based survey developed for this study was used to collect observational data. Analysis: Logistic regressions were used to determine the change in odds of observing outdoor smoking and smoking-related litter on a given day from baseline (preregulation) to follow-up (postregulation). Results: Compliance with smoke-free outdoor seating increased from 84.5% to 95.4% after passage and implementation of the regulation. Results showed a significant 75% decrease (odds ratio [OR]: = 0.25, 95% confidence interval [CI]: 0.08-0.67) in odds of outdoor smoking and a slight decrease in smoking-related litter (OR: 0.81, 95% CI: 0.39-1.65) at follow-up in establishments overall. However, at baseline, bars had higher odds of outdoor smoking (OR: 2.68, 95% CI: 0.57-12.72) and smoking-related litter (OR: 4.09, 95% CI:, 1.87-9.49) compared to sit-down restaurants. Conclusion: Results suggest there is high compliance with low-cost, low-burden, smoke-free outdoor seating policy and that enforcement is best targeted toward bars.