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A formative study of the perceived impacts of the Pueblo smoke free air act

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Title:
A formative study of the perceived impacts of the Pueblo smoke free air act
Creator:
Diedrich, R. Theodore
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English
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x, 131 leaves : ; 28 cm

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Subjects / Keywords:
Antismoking movement -- Colorado -- Pueblo ( lcsh )
Smoking -- Law and legislation -- Colorado -- Pueblo ( lcsh )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Bibliography:
Includes bibliographical references (leaves 125-131).
General Note:
Department of Humanities and Social Sciences
Statement of Responsibility:
by R. Theodore Diedrich.

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|University of Colorado Denver
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Auraria Library
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Resource Identifier:
166881971 ( OCLC )
ocn166881971
Classification:
LD1193.L65 2007m D53 ( lcc )

Full Text
A FORMATIVE STUDY OF THE PERCEIVED IMPACTS
OF THE PUEBLO SMOKE FREE AIR ACT
by
R. Theodore Diedrich
B.A., University of Colorado at Denver and Health Sciences Center, 2004
A thesis submitted to the
University of Colorado at Denver and Health Sciences Center
in partial fulfillment
of the requirements for the degree of
Master of Social Sciences
2007


This thesis for the Master of Social Sciences
degree by
R. Theodore Diedrich
has been approved
by
Walter Yoi
Lori Crane
i

pj
Date


Diedrich, R. Theodore (M.S.S., College of Liberal Arts and Sciences)
A Formative Study of the Perceived Impacts of the Pueblo Smoke Free Air Act
Thesis directed by Professor Loma G. Moore
ABSTRACT
The Pueblo Smoke-Free Air Act (PSFAA) is an ordinance that bans
smoking in public places in Pueblo, Colorado. The PSFAA was enacted in May,
2003 by the City Council and withstood a voter-based challenge and subsequent
referendum. The law has proven to be a polarizing issue in that city, dividing
proponents and opponents into generally distinct camps. The former readily
acknowledge the positive outcomes of the PSFAA; the latter discount the
ordinances merits, and feel that it has negatively impacted the community.
This qualitative study characterizes the perspectives of both supporters
and opponents by using data from 22 semi-structured interviews with Puebloans.
The data are analyzed using a grounded theory approach and interpreted with a
constructivist perspective. This thesis addresses the following research questions:
Primary Research Question: What impacts of the PSFAA are perceived by
members of community of Pueblo?
Secondary Research Question: How do the Pueblo food and beverage
industry and their patrons perceive the economic impacts of the PSFAA?
Tertiary Research Question: What unanticipated or unintended outcomes and
impacts has the PSFAA had on the Pueblo community?


The studys data suggest that some, if not all, participants perceive that the
PSFAA:
Is widely effective in reducing secondhand smoke in Pueblos public places.
Has had positive health impacts for the public in Pueblo.
Has infringed on smokers individual rights and the rights of businesses to
determine their own smoking policies.
Has had an array of economic impacts on bars, restaurants, and the city of
Pueblo as a whole.
Has caused a great deal of controversy in Pueblo.
These findings are used, in aggregate, to formulate a substantive grounded
theory that attempts to explain part of the controversy surrounding the PSFAA
and why the participants support or oppose the ordinance.
The results derived from the data and the substantive theory form the basis
for suggestions for future research regarding attitudes and perceptions about
legislated public smoking bans.
This abstract accurately represents the content of the candidates thesis.
I recommend its publication.
Signed
,orna Moore


ACKNOWLEDGMENTS
Many thanks to my committee members for their contributions and efforts,
especially Susan L. Dreisbach for all of the energy she put into guiding me in this
thesis. I would also like to especially thank Snip Young for getting this project
started.
I am also thankful for the financial contributions I received from the American
Lung Association of Colorado and the Health and Behavioral Sciences
Department at UCDHSC.


TABLE OF CONTENTS
List of Tables............................................ix
List of Figures...........................................x
CHAPTER
1. INTRODUCTION.............................................1
The Pueblo Smoke-Free Air Act.........................1
Problems and Interventions: Smoking, Disease, and
Tobacco Control.......................................6
Purpose of this Thesis................................6
What this Thesis Adds to the Study of Tobacco Control.7
Structure of this Thesis..............................8
2. BACKGROUND..............................................10
Smoking as a Health Problem..........................10
Tobacco Control......................................14
3. FOUR FUNCTIONS OF THEORY................................19
The Process Theory: Grounded Theory..................19
Interpretation and Constructivism....................21
Substantive Theory: A Step Beyond Description........22
Building upon Formal Theories: Libertarianism and
Social Justice.......................................23
4. METHODS.................................................27
Setting for this Study...............................27
The Three Participant Categories.....................29
Sampling and Recruitment.............................32
Participant Consent and Confidentiality..............35
Data Collection......................................36
vi


Disposition of the Data and Identifying Materials......37
Data Analysis..........................................38
5. FINDINGS...................................................43
The PSFAA is Perceived to be Widely Effective in
Reducing Environmental Tobacco Smoke in Pueblos
Public Places..........................................44
The PSFAA is Perceived by Some People to Have Had
Positive Health Impacts for the Public in Pueblo.......46
The PSFAA is Perceived by Some People to Infringe on
Smokers Individual Rights and the Rights of Businesses
To Determine their Own Smoking Policies................50
The PSFAA is Perceived to Have Had an Array of
Economic Impacts on Bars, Restaurants, and the City of
Pueblo as a Whole......................................54
The PSFAA is Perceived by Many People to Have
Caused a Great Deal of Controversy in Pueblo...........64
6. DISCUSSION.................................................70
Theoretical Sensitivity of the Researcher..............71
Discussion of this Studys Findings about PSFAA
Outcomes...............................................72
One of Two Principal Characteristics that Distinguishes
Proponents and Opponents of the Pueblo Smoke-Free
Air Act is Their Ideological Stance on Civil Rights:
Proponents Advocate Social Justice, and Opponents
Advocate Libertarian Ideals....................85
Comments on this Studys Validity, Reliability, and
Overall Credibility............................89
Implications for Future Research...............98
APPENDIX
A. KEY STAKEHOLDER CONSENT FORM.....................101
B. CONSENT FORM FOR RESTAURANT AND BAR
OWNERS...........................................104
Vll


C. RESTAURANT AND BAR PATRON CONSENT FORM..107
D. INTERVIEW GUIDE FOR KEY STAKEHOLDERS....110
E. INTERVIEW GUIDE FOR BAR AND RESTAURANT
OWNERS OR STAFF..........................112
F. INTERVIEW GUIDE FOR BAR AND RESTAURANT
PATRONS..................................114
G. CODES FOR QUALITATIVE ANALYSIS..........116
H. CODE FAMILIES...........................120
REFERENCES......................................125
viii


LIST OF TABLES
Table
1. Sample Population, by Participant Category, Gender,
Approximate Age, and Smoking Status......................
IX


LIST OF FIGURES
Figure
1. Predictive Model for Overall Perceptions of the PSFAA
x


CHAPTER 1
INTRODUCTION
People chose to smoke tobacco, and it was legal all over the world.
Smoking was a victimless holocaust, because the dead people had
chosen to die that way. (Gately, 2001:323)
[In the U.S. from 1997 to 2001] .. .an estimated 38,112 lung cancer and
heart disease deaths annually were attributable to exposure to
secondhand smoke. (Armour et al, 2005:288)
The Pueblo Smoke-Free Air Act
The Pueblo Smoke-Free Air Act (PSFAA) is an ordinance that prohibits
smoking within the city limits of Pueblo, Colorado in public places of
accommodation, enclosed places of employment, and within 20 feet of the outside
entrances to the aforementioned places (City of Pueblo, 2006). According to this
studys participants, the impetus for the law was to protect the employees of
private businesses as well as the general public in Pueblo from the dangers of
environmental tobacco smoke (ETS). The PSFAA was approved by the Pueblo
city council in December of 2002, but passage of the law proved to be quite
contentious. Smokers and some business owners immediately voiced opposition
to the law on the grounds that it violated smokers rights and that business owners
should have the prerogative to run their businesses with minimal government
interference (McCrimmon, 2006). Within weeks those groups circulated a
petition that suspended the PSFAA and called for a citywide special election to
recall the council members who voted for it. On 10 May 2003 Pueblo voters
1


approved the PSFAA by referendum.1 The ordinance went into effect on 22 May
2003, and sustained a ballot referendum to exempt bars that was held in
November of that year.
Smokers rights advocates and business owners in Pueblo, along with the
tobacco industry and tobacco control opponents throughout Colorado, maintain
that public smoking laws violate individual and business rights, and that these
laws adversely affect businesses where they are enacted (Scollo et al, 2003;
Thalheimer, 2005; McCrimmon, 2006). Moreover, despite volumes of evidence
to the contrary (see USDHHS, 2006), some of these groups assert that public
smoking prohibitions are unwarranted because the dangers of ETS are minimal or
nonexistent (Cordador, Hazan, & Glantz 1995; Frieden & Blakeman, 2005;
Gately, 2001).
The PSFAA preceded a statewide public smoking law by more than three
years, and was the primary jurisdictional ordinance in Pueblo at the time of
implementation. It was a controversial issue for both opponents and proponents
of a statewide public smoking ban. Tobacco control advocates called the PSFAA
a victory for public health; adversaries said that it was bad for business and
violated smokers civil liberties (Cotton, 2003). Even though the entire state of
Colorado now prohibits smoking in most public places, the PSFAA remains a
contentious topic for members of the Pueblo community.
Problems and Interventions: Smoking,
Disease, and Tobacco Control
The health effects of tobacco use are well known (see the U.S. Surgeon
Generals Advisory Committee Reports: USDHHS, 1964-2006), and the harmful
effects of ETS exposure are increasingly established (see Pachacek & Babb,
1 One of the recalled councilmen who had initially voted for the PSFAA also lost his seat in that
election.
2


2004). The scientific literature linking improved health outcomes and tobacco
control is extensive and spans decades (see Brownson et al, 1997). Tobacco
smoke remains the leading preventable cause of cardiovascular disease and
pharyngeal, tracheal, lung, and other cancers in the U.S. All told, tobacco causes
hundreds of thousands of annual deaths in this country (Frieden & Blakeman,
2005; USDHHS, 2005).
Smoking and environmental tobacco smoke (ETS) are behaviorally-
influenced causes of numerous cancers, cardiovascular diseases (CVD), and other
illnesses. Yet tobacco smoke is not a deterministic cause of health problems
because a nonsmoker can develop CYD or contract lung cancer, and a lifelong
heavy smoker may not develop either. Chronic diseases such as these result from
a web of antecedents, including genetic conditions, environmental insults, and so-
called lifestyle factors. Nonetheless, smoking and ETS do greatly increase the
probability of contracting cancer and CVD, making smoking a sufficient but not
necessary cause of those diseases (Mellor, 1995). The risks of contracting those
diseases can be reduced (as can smoking prevalence and tobacco consumption),
and their incidence and prevalence can be mitigated by a wide variety of health
promotion programs intended to prevent smoking. Government policies intended
to curtail tobacco sales, policy-based interventions such as public smoking
prohibitions, and programs that facilitate smoking cessation all address those
health problems. The PSFAA is an example of a public policy as a legislated
public health intervention intended to improve health outcomes.
Not only are health effects potentially serious for smokers and people
exposed to ETS, but tobacco-related diseases can result in broad and pervasive
social and economic impacts because the internal and external costs2 of tobacco
2 Internal costs refer to those which directly affect the tobacco user: the expense of the products
themselves; suffering resulting from tobacco-caused illnesses; the financial expenses incurred by
medial treatment for those illnesses, workdays lost, etc. External costs affect people other than the
3


use are pervasive and devastating. Hence, the impact of smoking extends beyond
adverse health consequences for individuals. Every pack of cigarettes sold in the
U.S. will eventually cost the nation an additional seven dollars. Half of that
money will go to medical bills incurred for treating chronic diseases; the rest will
be attributed to lost worker productivity (MDPHS 2006).
The smoking epidemic in Colorado mirrors that of the rest of the nation,
both in terms of smoking prevalence and the burden of morbidity imposed by
smoking, however the Colorado Department of Public Health and the
Environment (CDPHE, 2006) reports that until recently, the smoking prevalence
in Pueblo was nearly 30 percent higher than in the rest of the state). In Colorado,
130,000 smoking-related illnesses occur each year, and smoking causes 4,200
annual deaths (CDPHE, 2006). Annual costs in Colorado directly related to
tobacco use exceed $1 billionthat is $259 per capita. This ultimately means
that on average, every Colorado household incurs more than $511 per year in state
and federal taxes to pay for smoking-related costs (CDPHE, 2006). Although the
costs of the morbidity and mortality related to ETS in Colorado are not currently
available for this study, it is assumed that those costs would add to the total per
capita costs of smoking for the state.
In order to reduce both the incidence and prevalence of smoking-related
diseases, many smokers will have to quit, and the number of new smokers will
have to decline. Decades of intervention studies have demonstrated that
comprehensive tobacco control strategies are effective at reducing tobacco
consumption and smoking prevalence, and consequently the morbidity and
mortality caused by smoking (Institute for Tobacco Control, 2002; Stillman et al,
tobacco user: the nuisance and health risks of ETS; inadequate distribution of household incomes
due to tobacco purchases; divergence of public and private healthcare monies and other resources
to the treatment of tobacco-caused illness; psychosocial difficulties for people close to the people
sick and dying from tobacco-caused illnesses; and many others (Dixon 2005; Jha 1999).
4


1999). Those strategies include measures that have proximate, intermediate, and
distal targets. Proximate interventions are aimed at changing individual behaviors
through health promotions such as public service announcements (PSAs) and
support services such as nicotine replacement therapy (Stillman et al, 1999).
Intermediate targets are addressed with policy-based interventions that limit how
tobacco can be sold and smoked via laws that establish age limits for smoking,
public smoking bans, and various supply and demand-side economic measures
(Jha, de Bayer, & Heller, 1999). Long-term interventions attempt to reshape
cultural knowledge systems, social norms, and other distal targets through public
policy and health promotion programs such as tobacco advertising restrictions and
social marketing (Cummings, 1999).
Public smoking prohibitions, such as the PSFAA, have some of the most
efficacious results. Smoking bans produce the trifurcated benefit of eliminating
ETS in public places, reducing the incidence and prevalence of smoking, and
reducing the overall quantity of tobacco consumed by smokers (Frieden et al,
2005; USDHHS, 2005; Siegel & Biener, 1997). When smoking bans are
implemented, health outcomes improve for smokers and non-smokers alike, and
the overall disease burden decreases (Sargent, Shepard, & Glantz, 2004; Pechacek
& Babb 2004). In short, everyone benefitsexcept, of course, the tobacco
industry. Cigarette producers argue that smoke-free policies infringe on smokers
rights (Gori, 1995), harm the bottom line for their industry, and also the reduce
profits for businesses like restaurants and bars that have traditionally been
smoking venues (Cardador, Hazan, & Glantz, 1995).
5


Purpose of this Thesis
While the initial intention of this investigation was to explore Puebloans
perceptions of the economic impacts that the PSFAA has had on their community,
early in the research process it became apparent that the story of the PSFAA is
about much more than economics. The PSFAA has proven to be a polarizing
issue in that city, dividing proponents and opponents into generally distinct camps
(Cotton, 2003). The former readily acknowledge the positive outcomes of the
PSFAA; the latter discount the laws merits, and feel that it has negatively
impacted them personally. Hence, the purpose of this thesis is an attempt to
characterize both perspectives, and to study the full range and nature of perceived
impacts that the PSFAA has had on the Pueblo community. Consequently, this
study was designed to address these research questions:
Primary Research Question: What impacts of the PSFAA are perceived by
members of the Pueblo community?
Secondary Research Question: How do the Pueblo food and beverage
industry and their patrons perceive that the PSFAA has impacted their
community?
Tertiary Research Question: How do members of the Pueblo community
perceive the overall impacts of the PSFAA?
The study findings are used, in aggregate, to formulate a substantive grounded
theory that attempts to explain the results. The findings and the resultant
substantive theory form the basis for suggestions for future research about
attitudes and perceptions about legislated public smoking bans.
My interest in the PSFAA began when the principal investigator of a
parallel, quantitative study proposed that I contribute qualitative components to
his assessment of the economic impacts of the PSFAA. At that time, Colorado
had not yet passed a comprehensive law prohibiting smoking in most public
6


places. Since a key argument against such policies is that they hurt bars and
restaurants where they are implemented (Glantz & Smith, 1997), the mixed-
method study was intended to determine if the PSFAA had indeed impacted the
Pueblo economy. Previously, well designed, peer reviewed research has shown
that public smoking ordinances do not adversely affect the food and beverage
industry where they are implemented (Scollo, Hyland, & Glantz, 2003). Thus the
principal investigator hypothesized that the findings of the quantitative economic
impact assessment, coupled with my qualitative findings, would demonstrate that
the PSFAA had little or no negative economic impact on restaurants and bars.
The mixed-methods study could then be used to support arguments in favor of a
statewide public smoking law in Colorado
It is important to note that the impetus for this thesis helped to shape its
overall character. The research question, How do the Pueblo food and beverage
industry and their patrons perceive the economic impacts of the PSFAA? was
conceived to satisfy the needs of the mixed-method study. However, that
question turned out to be a mere jumping-off point for this study as a standalone
project. In order to answer that question, I needed to include questions in my
design that were essential to the formative inquiry: What is the Pueblo Smoke
Free Air Act? What is its primary intent? Who does it affect? How well does it
satisfy its objectives? Besides its primary intentions, what other effects does the
ordinance have? And, what general or overall opinions do people have about the
PSFAA? Interpreting the answers to all of the aforementioned questions became
the overarching purpose for this inquiry.
What this Thesis Adds to the Study of Tobacco Control
Much of the research published to date about public smoking prohibitions
has employed conventional econometric methodology; the social science
7


literature is also largely quantitative in nature (Siegel & Biener, 1997).
Longitudinal quantitative evaluations are still called for to reinforce the efficacy
of public smoking prohibition as a tobacco control measure and to refute claims
that smoke-free ordinances are economically detrimental to the hospitality
industry (Stillman et al 1999; Institute for Tobacco Control, 2002). Yet a relative
paucity of published qualitative research on public smoking policies exists. This
is not to say that such literature is non-existent (see Tang et al 2004), nor that
unpublished pilot or formative studies like this one have not employed a
qualitative methodology like the one outlined in Chapter 4 of this thesis.
More qualitative research is needed to catalog the range of stakeholder
attitudes and perceptions regarding the impacts of public smoking prohibitions
(Institute for Tobacco Control, 2002). Additionally, social justice and libertarian
ideologies concerning tobacco control need to be better understood (Katz, 2005).
This study uses qualitative methods to explore the nature and range of those
perceptions and perspectives in Pueblo. As a result, this thesis provides a better
understanding of the impacts of tobacco control policies on a diverse public for
public health experts, policy-makers, and non-professionals alike.
Structure of this Thesis
This thesis follows from a logical examination of smoking as a public
health problem, to the PSFAA as an intervention for that problem, to an
investigation of Puebloans perceptions of that intervention, to the ideology
underlying tobacco control and its opposition. Chapter 1 introduces the research
problem and its context, the research questions, and this studys purpose. To put
the PSFAA in context, Chapter 2 briefly describes smoking as a health risk, and
cites some of the key researchers and policy makers who have addressed it as
such. Chapter 2 also includes a brief history of tobacco control efforts in the U.S.
8


Chapter 3 explains the four types of theory implemented in this thesis, and briefly
defines the theory that corresponds with each application. The first type,
grounded theory, is the process theory for this study. It is the framework for how
this study was designed and conducted, and includes expectations and overall
assumptions about the work itself (Rossi, Freeman, & Lipsey, 1999). The second,
constructivism, is the theoretical paradigm that informed the interpretation of this
studys findings. The third and fourth types are substantive and formal theories.
The former is the theory formulated specifically to explain the empirical
phenomena examined in this thesis; the latter are the more conceptual, abstract
constructssocial justice and libertarianismthat refer to the ideologies
underpinning this studys conclusions. Chapter 4 explains this studys design and
qualitative methods. It summarizes how this study was conducted, its sampling
strategies, and its methods for data analyses. Chapter 5 outlines the findings of
the inquiry that pertain to the research questions. Chapter 6 is a discussion of the
studys findings. It compares the conclusions detailed in Chapter 5 to
libertarianism and social justice, interprets their theoretical significance, and uses
them to help formulate a grounded substantive theory about the phenomena
examined by this investigation. This final chapter also considers what
implications this thesis may have for future tobacco control studies, and outlines
this studys limitations and its overall strengths and weaknesses.
9


CHAPTER 2
BACKGROUND
Like.. .bullets, cigarettes are only used once. (Gately, 2001:262)
In order to better understand the context, precedent, and impetus for the
PSFAA and this study, a review of the epidemiology of smoking-related diseases
and tobacco control efforts is in order.
Smoking as a Health Problem
Not long after tobacco was introduced to Europe in the 16th century,
people began to debate the health merits of tobacco use (Bayne-Jones et al, 1964).
As tobacco became more popular, so did claims that smoking may be hazardous
to health. Health problems, such as cardiovascular disease (CVD) and various
cancers, were increasingly associated with smoking after cigarettes became the
most widely used vehicle for nicotine (Doll, 1999). Around the turn of the 20th
century, mechanization spurred cigarette manufacturing; advertising and low
prices helped to increase demand. Consequently, by 1920 Americans were
consuming over 100 billion cigarettes per year (Gately, 2001).
The growth of cigarette sales in the 20th century was exponential, and so
was a concomitant increase in cancer. In 1933, there were 2,357 reported cancer
deaths; by 1940 reported mortality had increased to 7,121 (Gately, 2001).3 Along
with the increased cigarette consumption and cancer prevalence, doctors began to
3 It should be noted that these are raw numbers, not rates, and that the population in the U.S. was
also rapidly increasing at that time. It should also be noted that standards for disease reporting
were not as sophisticated as it is today, and cancer may have been under-reported.
10


make clinical observations that smoking might be causing cancers and CVD.
Scientists did not make any organized attempts to show causality, though, until
the first case-control study was conducted in Germany in 1939. Although its
methods and design were flawed, that study was the first of many such studies in
the 20th century (Doll, 1999). Cancer and CVD studies also began in the U.S. in
the 1930s; but despite the accumulating evidence, smoking received little
attention in medical texts before the 1950s. The tobacco industry must have been
somewhat in tune, though, with the notion that smoking could be unhealthy
because as early as the 1930s they introduced menthol cigarettes as healthy
alternatives to the then unadulterated varieties (Gately, 2001).
Nineteen-fifty was a watershed for worldwide tobacco research because
five case-control studies were published that year. Three are especially worth
citing: Levin (1950) reported a ten-fold increase in risk for lung cancer among
smokers in an article in the Journal of the American Medical Association {JAMA).
In that same JAMA issue Wynder and Graham (1950) reported that 96 percent of
the lung cancer patients in their study were smokers4; and in the British Medical
Journal Doll and Hill (1950) reported that, in their study population, heavy
smokers were 50 times more likely to contract lung cancer than subjects without
that dose-exposure. Later in the 1950s, reports from cohort studies began to
emerge, as did criticisms of the epidemiological methods of those early studies.
Detractors claimed that the results of the studies indicated and association
between smoking and disease but not causation (Doll, 1999). The tobacco
industry responded to the early scientific reports on smoking by launching
elaborate campaigns denying that smoking was a health hazard. Ironically,
4 Ironically, Evarts Graham, a chain smoker, died of lung cancer seven years later.
11


though, manufacturer Lorillard introduced the Kent brand in the 1950s as the
first sanitary cigarette; it had an asbestos filter5 (Gately, 2001:274).
The first time a U.S. government official weighed-in on the health risks
involved with smoking was in 1957, when Surgeon General Leroy Burney issued
A Joint Report of a Study Group on Smoking and Health, which stated that
prolonged cigarette smoking was a causative factor in cancer. However, that
report went virtually unnoticed by the American public. It was not until Surgeon
General Luther Terrys Advisory Committee released Smoking and Health:
Report of the Advisory Committee to the Surgeon General of the Public Health
Service that the mounting scientific evidence had an overwhelming impact on
public opinion (Harkness, 2006). That report was published amid unprecedented
media attention, and it convinced many smokers that cigarette smoking shortens
human life, causes cancer, and exacerbates heart disease, emphysema, bronchitis,
and a number of other illnesses (Gately, 2001).
The 1964 Surgeon Generals report was the first in a series of 28 Reports
on Smoking and Health. Each successive statement contained more conclusive
findings about the dangers of tobacco use (including smokeless/chewing tobacco)
than the one that preceded it (USDHHS, 1964-2006). Meanwhile, physicians and
other researchers published countless journal articles about tobacco, such that the
evidence that smoking was dangerous could in no way be considered anecdotal.
Throughout the following years, the science involved in those studies became
more and more sophisticated, as did researchers understandings of the pathology
of smoking-related diseases, nicotine addiction, and patterns of tobacco use
(USDHHS, 1964-2006).
5 Adding to this irony is the fact that the first major lawsuit against a tobacco company that yielded
any noteworthy settlement was filed over Kent cigarettes. But it was not the cigarette itself that
caused the lawsuitthe asbestos in the Kent filters was killing the factory workers (Gately, 2001).
12


Evidence also mounted regarding the dangers of secondhand smoke. The
1972 Surgeon Generals Report was the first in the series to address the dangers
of passive smoking, based on the developing literature (USDHHS, 2006). In
1986, Surgeon General C. Everett Koops advisory committee published The
Health Consequences of Involuntary Smoking, which reported that a substantial
portion of cancers that occur in nonsmokers are caused by passive smoking
(USDHHS, 1986). In 1990 the Environmental Protection Agency (EPA) released
a draft report on 24 epidemiological studies on ETS; that report asserted that
secondhand smoke caused 3,800 deaths per year, thus corroborating the 1986
Surgeon Generals Report (Jacobson & Wasserman, 1997). The tobacco industry
persistently made efforts to refute such assertions, and continues to do so up to the
present day (Gori, 1995).
The general public has become better informed about the hazards of ETS
since that 1986 report. This process culminated with Surgeon General Richard
Carmonas 2006 Advisory Committee Report, The Health Consequences of
Involuntary Exposure to Tobacco Smoke, which unequivocally stated that ETS
causes cancer and CVD. Moreover, that 2006 report concluded that secondhand
smoke is especially hazardous for children, and that it increases risks for chronic
ear infections, sudden infant death syndrome, acute respiratory infections, and
may exacerbate asthmatic conditions (USDHHS, 2006). Additionally, that report
expands on what is known about the pathology of the adult diseases, and that even
short-term ETS exposure causes immediate adverse affects. The report concludes
by asserting that there are no safe levels of ETS exposure, and that eliminating
secondhand smoke (as opposed to providing separate smoking rooms or special
ventilation) in indoor places is the only effective way to protect people from it
(USDHHS, 2006). Finally, recent studies have suggested that eliminating ETS
can have an immediate positive impact on public health (Pechacek & Babb,
2004).
13


Tobacco Control
Contemporary tobacco control measures come in several forms. Among
the most effective are: raising prices via taxation (which drives down demand);
regulating how tobacco can be sold and marketed (i.e. restricting youth sales or
youth tobacco use, limiting advertising, and requiring health warnings);
implementing health promotion and health education programs (e.g. quit-lines,
providing counseling and nicotine replacement therapy; and providing public
service announcements); and prohibiting smoking in public places and places of
employment (Jacobson & Wasserman, 1997; Stillman et al, 2001; Siegel &
Biener, 1997). Furthermore, decades of research and recent meta-analyses have
shown that the most successful tobacco interventions are comprehensive, in that
they combine all of the above strategies to prevent smoking onset, reduce tobacco
consumption, and reduce ETS exposure (Brownson et al, 1997; Cummings,
1999).
Tobacco control dates to the early 17th century, when several European
countries, Japan, and Russia attempted partial or total tobacco bans (Doll, 1999).
Those early efforts were motivated by morality; in Europe and in the U.S.,
tobacco control was associated with the temperance movement rather than public
health (Gately, 2001). Indeed, in the U.S., anti-smoking laws intended to protect
public health did not emerge until the middle 19th centuryand those were meant
to mitigate fire hazards (Jacobson & Wasserman, 1997).
By the beginning of the 20th century, 14 states had passed laws that
banned the production, sale, ads for, or use of cigarettes (Doll, 2001). The 1897
prohibition against cigarette sales in Tennessee is especially noteworthy because
challenges to that law went all the way to the U.S. Supreme Court. In 1900 the
Court majority in Austin v. Tennessee ruled in favor of the ban, stating that the
law was a constitutional exercise of a states police power to protect public health
14


(Jacobson & Wasserman, 1997). Despite the emerging clinical observations of
the early 20th century, smoking received little more regulatory attention as a
health issue.6 Tobacco control had an added setback in 1938, when the U.S.
Congress declined to define tobacco as a drug that should be regulated (Jacobson
& Wasserman, 1997).
It was not until after the watershed publications of the 1950s and early
1960s that the government began to regulate tobacco in an effort to decrease
smoking to improve public health. The history of federal tobacco control
legislation is extensive; only a brief summary is provided here. In 1965 the
Cigarette Labeling and Advertising Act stipulated that all cigarette packages carry
the warning, Cigarette smoking may be hazardous to your health. (Gately,
2001). A 1969 law banned cigarette advertising on television. Subsequent
decades saw a succession of federal laws dictating how cigarettes should be
packaged, sold, and smokedincluding rules set by the Federal Trade
Commission dictating that all tobacco advertising should include health warnings
(Jacobson & Wasserman, 1997). Later, the Comprehensive Smoking Education
Act of 1984 required that four rotating health warnings be prominently placed on
all cigarette packs and ads (Gately, 2001). Throughout that time, individual state
efforts for tobacco control were also varied and numerous, but they will not be
detailed here.
Over the course of many years, precedents for the PSFAA have been set
across the U.S. Thus passage of the PSFAA was not anomalous, and was
consistent with national trends. Since the 1970s, various entities have made
inroads toward removing ETS from public places. For instance, the U.S.
government started restricting smoking on airline flights in 1989, however federal
ETS legislation has since been generally limited (Jacobson and Wasserman,
6 Tobacco was consistently regulated via taxation, however that was done to take advantage of
tobaccos revenue-generating abilities, rather than to curtail sales (Gately, 2001).
15


n
1997). In 1975 Minnesota was the first state to pass a comprehensive law against
public smoking to .protect public health, comfort and environment by
prohibiting smoking... (Gately, 2001; MDPH, 2006). Several states followed
with smoking bans of varying degrees of strictness, however the California
Smoke-free Workplace Law led the way by banning smoking in private
workplaces and restaurants on 1 January 1995; and in bars, taverns, and casinos
on 1 January 1998, becoming the first statewide smoke-free law in the U.S. that
included such venues (Magzamen, Charlesworth, & Glantz, 2001). By 2007, 16
states, Puerto Rico, and Washington, DC, had passed public smoking laws that
included restaurants and bars (American Lung Association, 2007). Also, over the
course of many years, local governments have been active in passing such
legislation. By 2007, 2,507 municipalities had passed laws that restricted
smoking in public venues (American Lung Association, 2007).
Privately established prohibitions that limit smoking in workplaces (often
before or in place of legislative efforts) have consistently been shown to be
effective at providing health benefits and controlling tobacco use (Fichtenburg et
al, 2002; Bauer et al, 2005). Public policy-based prohibitions, like the PSFAA,
have been shown to be effective on several levels. Each of these policy types
reduce ETS exposure for nonsmokers and smokers alike, and are especially
beneficial for people who had previously worked in environments where the
smoke was ever-present (USDHHS, 2005). Public smoking laws also reduce the
prevalence of smoking and the consumption of tobacco (Levy & Friend, 2003).
For example, smoking reportedly decreased 11 percent after the 2003 public
smoking ban in New York City (Frieden et al, 2005). Furthermore, to produce
results comparable to a comprehensive public smoking prohibition, tobacco taxes
would have to be increased from $.76 to $3.05 per pack (Fictenburg et al, 2002). 7
7 The MN ban was not complete, however, and still does not include some bars and other
workplaces (MDPH, 2006).
16


These cumulative environmental policies are especially effective at promoting
cessation because they not only produce results comparable to other interventions,
they reach smokers whether they want them or not (Kadowaki et al, 2006).
A growing body of research examines the impacts that smoking
ordinances have on the business sector. This line of research addresses two major
arguments against such laws: that enforcement of the laws puts an unfair burden
on private businesses; and that mandatory smoking bans have negative economic
outcomes for bars and restaurants. Contrarily, the literature shows that these
ordinances are self-enforcing, in that after they are implemented the public
generally complies on their own. Hence, the laws do not put undue enforcement
burdens on businesses that had previously allowed smoking (Sciacca, 1996;
Weber et al, 2003). Moreover, the absence of ETS has been shown to increase
enjoyment and patronage in restaurants (Wakefield, Roberts, & Miller, 1999;
Torabi & Seo, 2004). Lastly, longitudinal econometric studies have shown that
smoke-free ordinances do not adversely affect either restaurant or bar sales after
they are implemented (Glantz & Smith; Scollo et al, 2003).
The most poignant affirmations of the effectiveness of public smoking
ordinances are reports of short-term improvements in health outcomes. In 2004
Sargent, Shepard, & Glantz reported that in the six months following a public
smoking ban in Helena, MT hospital admissions for myocardial infarctions (MI)
fell significantly. They concluded that the public smoking ordinance may be
associated with the decline in morbidity (Sargent, Shepard, & Glantz, 2004).
Even more germane to this thesis, a Pueblo physician, Dr. Carl Bartecchi, and
colleagues (2006) reported that after it was enacted, the PSFAA was positively
associated with a decrease in Mis in Pueblo.
In conclusion, although the etiologies of the chronic diseases associated
with tobacco use and ETS are complex, smoking prevention and cessation
interventions have been shown to be effective at reducing the incidence and
17


prevalence of CYD, cancer, and other diseases. Among the most effective of
those interventions are laws that prohibit public smoking. Such laws are
beneficial on several levels because they reduce ETS exposure for smokers and
nonsmokers alike, and they may help to reduce smoking prevalence and the
overall amount of tobacco consumed by active smokers. Finally, recent studies
have suggested that public smoking ordinances such as the PSFAA may provide
both short and long-term health benefits.
18


CHAPTER 3
FOUR FUNCTIONS OF THEORY
This thesis has required the implementation of four different types of
theories. These theories guided how the study was conceived, how it was
undertaken, how the data were analyzed, and how the results were collated and
compiled to make a comprehensive statement about those data. The process
theory for this study, grounded theory, dictated how this inquiry was designed and
conducted. A theoretical paradigm, constructivism, informed how this
investigations results were interpreted. The third type of theory, substantive
theory, is an end product of the grounded theory process implemented by this
investigationit is the systematic explanation of why the study participants either
support or oppose the PSFAA. Libertarianism and social justice are the formal
theories that provided the ideological underpinnings for the interpretation of this
studys results.
The Process Theory: Grounded Theory
Process theory refers to how this study was designed and conducted; it is
the model by which data were collected, organized, and analyzed in order to
address the research questions and study goals (Rossi, Freeman, & Lipsey, 1999).
Those questions and goals drove the qualitative design and made grounded theory
a suitable process for generating data and developing the unrefined ideas
discovered there. Some confusion might arise regarding the semantics of stating
that the process theory of this study is grounded theory. For this thesis,
grounded theory does not refer to a theory of another theory, but rather a theory
19


for both the nature of the qualitative research and for the qualities the end result of
that process should have (Strauss & Corbin, 1990). On one level, grounded
theory is simply the theory of how to generate data, collate it, and then set out to
discover the meaning that is embedded in the data corpus via interpretive
analyses. For this study, the grounded theory process began with data collection,
then proceeded with a methodical, constant, iterative comparison of the raw data
for interrelated thematic traits (Strauss & Corbin, 1990). When properly
conducted, the end result of the grounded theory process is the formulation of a
theory about the phenomena under investigation that is grounded in the data
(Strauss and Corbin, 1990).
Strauss and Corbin define grounded theory this way: A grounded theory
is one that is inductively derived from the study of the phenomenon it
represents... it is discovered, developed, and provisionally verified through
systematic data collection and analysis of [the] data... (1990:23). Theirs is both
a definition of a qualitative methodology and of its theoretical product. They
explicitly state that the grounded theory method, if properly conducted, should
result in a bona fide theory that is comprised of .. .a set of interrelated
constructs, definitions, and propositions that represent a systematic view of the
phenomena by specifying relations among variables, with the purpose of
explaining and predicting the phenomena, (Strauss & Corbin, 1998:15). Hence,
for Strauss and Corbin, the formulation of that theory is the ultimate goal of the
process.
Henceforth, grounded theory refers to the idealized processes of data
collection, organization, and comparison conducted during this study and the
ideal qualities of the cohesive substantive theory that is the end product of this
investigation.
!
20


Interpretation and Constructivism
I call making sense of what has been learned the art of interpretation.
(Denzin, 1998)
While this study was being designed, it was tacitly assumed that the
participants would each perceive the PSFAA and its various impacts in different
ways. Therefore, this studys qualitative methodology was intended to yield and
utilize data that was both enriched by that diversity of information and capable of
telling stories that revolved around the research questions. Yet the telling of
those stories has not been an exercise in cut-and-dried analysis because the study
participants did not provide right or wrong answers to the interview questions. In
fact, the very purpose for developing three separate instruments for semi-
structured interviews of three distinct categories of subjects (see Chapter 4 below)
was to elicit unique answers to each and every question. Consequently,
constructivism was the theoretical paradigm chosen to help inform this studys
interpretive processes because it is particularly well suited for ascribing meaning
to qualitative data.
Constructivism is an interpretive approach for learning and understanding
new knowledge which presumes that empirical realities are socially constructed
and uniquely perceived by each person (i.e. the study participants), and that those
multiple realities can be discovered through systematic research processes (S.
Dreisbach, personal communication, 22 March 2007). Three of constructivisms
main tenets are:
1) People do not merely discover new knowledge; rather, they make it from an
empirical context. Therefore, the researcher should learn as much about that
particular context as possible (Denzin, 1998).
2) People may not perceive a shared sociocultural context the same way.
Therefore, the researcher must give each participant a voice, that is, a way
21


to express their unique perception of that empirical context (Miller &
Crabtree, 1999).
3) There is no purely objective knowledgeeverything that is known is known
relative to something else, be it one reference point or a multitude of them
(Schutt, 2004).
These tenets acknowledge that the participants individual perceptions of the
empirical phenomena under investigation (e.g. the impacts of the PSFAA) are
highly subjective, and that a researcher introduces bias when she or he interprets
those subjective perceptions. While that bias can shape a studys outcomes,
constructivism openly acknowledges that it exists, and adjusts analytic methods to
account for that bias and to optimize the validity of the study (S. Dreisbach,
personal communication, 22 March 2007).
Whereas positivism strives to uncover and isolate provable facts
(Schwandt, 2001), constructivism explicitly acknowledges the ongoing dialogue
between the emic perspective of the participant and the etic perspective of the
researcher. That dialogue does not produce verifiable absolute truths, but it does
result in the assemblage of findings that are uniquely valid interpretations derived
from the data by the researcher (Denzin, 1998).
Substantive Theory: a Step Beyond Description
For this investigation, a goal for the grounded theory process was to build
a substantive theory from the study results. A substantive theory is a set of
interrelated concepts and propositions that provide a cohesive and comprehensive
explanation of the results of specific empirical inquiries such as this one
(Kerlinger, 1986; Glaser, 1978). The explanatory power of the substantive theory
depends on its ability to speak specifically to the populations from which it is
derived (Strauss and Corbin, 1998). This means that a substantive theory is good
22


for explaining phenomena .situated in one particular situational context,
(Strauss & Corbin, 1990:174) but it is less likely that such conclusions could be
generalized to phenomena outside that context. Strauss and Corbin are here
referring to the acuity of a substantive theory that is grounded in the data. In
other words, a substantive theory is only as good as the data from which it is
derived and the processes by which those data are acquired.
The substantive grounded theory developed for this thesis articulates
meaning that underlies the findings and strives to plausibly explain the
participants overall perceptions of the PSFAAthat is, why they are opponents
or proponents of the ordinance. For qualitative research, substantive theories do
not, however, simply emerge from the data as self-evident explanations. There
must be an analytic linkage between the research process and its conclusions that
provides an interpretive vantage point that indicates how the data are
conceptualized and how meaning is to be assessed and applied. Thus, when
qualitative research is properly designed and carried out, the color and candor of
the data are apparent and clear, but it is up to the researcher to interpret that data
and give it a voice (Denzin, 1998). This does not imply abandonment of
objectivity, however, since the researcher must at the very least represent the
participants perceptions fairly and give an accurate interpretation of the data that
is as impartial as possible (Strauss & Corbin, 1998). As mentioned above, the
analytic-paradigmatic vantage point taken for this thesis is constructivism.
Building upon Formal Theories: Libertarianism and Social Justice
In order to build a substantive theory for this thesis, it was necessary to
compare this studys findings about the participants perceptions of the PSFAA to
the broader tobacco control milieu. While the data were being collected and
interpreted, it became apparent that the study participants generally described
23


themselves as adherents to one of two ideologies regarding their civil rights: they
were either advocates of social justice or libertarian ideals. It is no coincidence
that those are ideologies, or formal theories, that also underpin the ongoing
tobacco control debate in the U.S. Unlike their substantive analogs, formal
theories are applicable to more abstract, conceptual areas of inquiry. Moreover
formal theories emerge from the study of phenomena examined in multiple
situational contexts (Glaser, 1978). Thus, for the purposes of this study,
libertarianism and social justice were formal theories about civil rights referenced
while examining smoke-free ordinances as tobacco control interventions and also
while building a substantive theory about perceptions of the PSFAA as one
specific tobacco control measure.
At this point in this thesis, it may be helpful to define libertarianism and
social justice as alternate philosophies on the nature of civil rightsespecially as
they relate to legislated smoking bans. Civil rights are simply defined here as the
individual freedoms, privileges, and protections accorded to members of a
democratic society. Social justice and libertarianism are different theoretical
interpretations of the ideal provisions of those civil rights.
Libertarianism
The libertarian philosophy rests on a so-called moral entitlement to freely
pursue life, liberty, and the pursuit of property (Katz, 2005). For libertarians
these unfettered individual freedoms are the most import constituent elements of
civil rights (see Friedman, 1962 and Nozick, 1974). Among the core individual
freedoms valued by libertarians are self-determination, free enterprise, individual
autonomy, personal accountability, private property rights, and minimal
government intervention into peoples private lives and capital endeavors
(Barnett, 1977; Cohen et al, 2000).
24


The tobacco industry, smokers rights organizations, and some food and
beverage industry lobbyists argue that legislated public smoking bans contravene
the above libertarian ideals. Their rationale is principally based on three
arguments:
1) That the health risks associated with secondhand smoke are insignificant and
therefore do not merit government intervention (Gori, 1995);
2) That (in part) because tobacco is a legal substance, smoking is a right that
individuals should be allowed to exercise as they see fit (Cohen, et al 2000);
3) And that business owners have a right to decide for themselves, without
government intervention, whether or not to permit smoking within the
confines of their private property (Cardador, Hazan, & Glantz, 1995).
As will be explained in Chapters 5 and 6, the PSFAA is perceived by its
opponents as an example of how government infringes on individual and business
rights that are tantamount to civil rights for libertarians.
Social Justice
Social justice is often couched as so-called distributive justice, akin to
philosopher John Rawlss (2005) justice as fairness, which is served by assuring
that individuals and groups of citizens are allocated an equitable share of the
benefits and burdens that a democratic society has to offer (Tumock, 2004). In
that sense, social justice for health strives for socioeconomic fairness via equal
access to affordable healthcare, and so on (Daniels, 2001; Ruger, 2005). For this
thesis, however, the definition of social justice is expanded beyond the fair
distribution of capital and physical resources. Here social justice means that all of
the determinants and social conditions necessary for health promotionespecially
healthy social environmentsare fairly and equally distributed (Powers &
Faden, 2000). Social justice thus sees to the goal of protecting communities of
25


individuals rights to their own health, and as such, social justice is the very
foundation of public health (Krieger & Bim, 1998). Indeed, some would argue
that a democratic government has the moral obligation to take protective and
preventive actions on behalf of the health and welfare of its citizens (Kreuter,
2005). For adherents of social justice, those actions fulfill such moral obligations.
Social justice is not entirely unlike libertarianism because it is also
concerned with individual rights that are tantamount to civil rights. However,
social justice departs from libertarianism in that it idealizes the right to health and
freedoms from environmental insult and unnecessary harm. Additionally, it
considers these rights to be held collectively by all members of society (Krieger &
Bim, 1998). Social justice is therefore served by a well-regulated society that
protects and provides for its members while reducing the health risks that they
may share (Gostin, 2001).
As will be explained in Chapters 5 and 6, the PSFAA is perceived by its
proponents as a way that public health, as an extension of government, protects
individual rights that are tantamount to civil rights for adherents of social justice.
26


CHAPTER 4
METHODS
The PSFAA is a contentious issue for Puebloans; their perspectives on the
ordinance touch on issues ranging from public health, to economics, to its
implications about civil rights, social justice, and libertarian ideals. The research
questions about those complex issues called for qualitative methods and inductive
processes to explore heretofore unknown perceptions of the PSFAA. Semi-
structured interviews were conducted with 22 participants in Pueblo, Colorado
who were recruited for this study. The resultant transcripts were the raw data for
this study. The research process was informed by a grounded theory approach for
gathering and analyzing the interview data. The investigator adopted a
contructivist perspective when interpreting the data, and for formulating a
substantive grounded theory about its underlying meaning. In accordance with
the grounded theory approach, the entire research methodology entailed reflexive
procedures of data collection, refinement, and analysis of interrelated emergent
themes (Strauss & Corbin, 1990; Creswell, 2003).
Setting for this Study
Pueblo is about as thin an economic market as there is in the state...
We don't have the same kinds of income structures that other
communities have... So, we treat our customers with velvet gloves
because we love 'em and we haven't got a lot. (Bill, key stakeholder and
restaurant owner)
This investigation has been greatly influenced by the character of Pueblo,
itself. Economics and the recent history of tobacco control in Colorado have also
27


!
affected how this study has been conducted. Ergo, some contextual information
will enable a better understanding of the logic behind this studys methods and
design. Accordingly, this section is included to provide some details about
Pueblo and the timing of the PSFAA.
The city of Pueblo is the county seat of surrounding Pueblo County. It is
located in south-central Colorado, about 100 miles south of Denver, and straddles
Interstate 25, the major north-south highway in the state. Pueblos population has
maintained modest growth in recent years, but is not expanding rapidly like other
communities along Colorados Front Range. Its historically largest industry, steel
production, has been in decline for several years. Pueblo does not host the
economic staples, such as tourism, major higher-ed institutions, or military bases,
as do other cities in Colorado of comparable size. Pueblo West, a town to the west
of the city of Pueblo, is its nearest and largest suburb, and has a growing
population in Pueblo County. According to key stakeholders and business owners
interviewed for this study (see Chapter 5), Pueblo Wests market share of the
service industry, retail stores, and the hospitality industry is also increasing
relative to the city of Pueblo.
The PSFAA was enacted amid an accelerating national trend toward the
regulation of public smoking in states and their municipalities (see Chapter 2).
The trend culminated in Colorado with the passage of the Colorado Clean Indoor
Air Act in March 2006. That statewide smoking ban was slated to take effect
(and did) on 1 July of that year, so by the time this study was designed and
conducted, it was apparent that the provisions of the PSFAA would be superseded
by the statewide law. Moreover, because of the inevitability of the statewide law,
the study participants characterized the PSFAA as a still-controversial but
somewhat moot issue.
1
t
t
28


The Three Participant Categories
Triangulation is a research method intended to increase study validity. It
involves checking the integrity of the studys interpretations and conclusions by
collecting similar data from different sources (Schwandt, 2001). To that end,
triangulation was sought for this investigation by interviewing three types, or
categories, of people: 1) key stakeholders', 2) restaurant and bar owners', and
3) restaurant and bar patrons. This division also lent itself well to open, axial, and
selective coding processes (see below) when the data were analyzed because
selecting participants that fit into three categories essentially pre-sorted the data
by source. These were not necessarily discrete categories, though, because one
key stakeholder was also a patron, and one business owner was also a key
stakeholder. When participants seemed to fit into more than one grouping, the
investigator used the interview guide for the category that best suited that persons
primary description. Participants were not selected solely because of their stance
on the PSFAA, smoking status, or demographic characteristics. An individual
could have been a smoker or nonsmoker, and either a proponent or opponent of
the PSFAA. Participants were recruited because the investigator assessed the sum
of each individual persons traits, and then decided that they would improve the
study sample because they had unique characteristics. For more information
about selection criteria, see the Sampling and Recruitment section below.
Key stakeholders were people who were involved with PSFAA legislation
either before or after its passage such as health experts, public officials, or
petitioners against the ordinance. These were thought to be people who could
provide crucial information about events and attitudes surrounding the PSFAA,
and would have a feel for how the general public in Pueblo perceived the law.
Bar and restaurant owners were people who owned food and beverage
establishments in Pueblo. Those had to be businesses that were open throughout
29


PSFAA legislation. Owners were selected to address questions about food and
beverage business trends relevant to the PSFAA, and were specifically asked if
the ordinance had affected their businesses.
Restaurant and bar patrons were adults who lived In Pueblo from the time
of PSFAA legislation up to the time of this study. They were asked questions
about their patronage of bars and restaurants in Pueblo both before and after the
PSFAA became law.
See Table 1 below for a complete list of participants (identified by
pseudonym) which includes their interview category, demographic information,
and smoking status.
!
!
30


Table 1: Sample Population, by Participant Category,
Gender, Approximate Age, and Smoking Status
This table includes demographic and descriptive information about
_____________________this studys 22 participants_____________________
Participant Participant Category Sex Estimated Age Smoking Status*
Bill Owner/ Key Stakeholder M 60s Former Smoker
Phil Key Stakeholder M 70s Nonsmoker
Anne Key Stakeholder F 60s Former Smoker
Wade Patron/Key Stakeholder M 50s Smoker
Dan Key Stakeholder M 50s Former Smoker
Kyle Owner M 50s Former Smoker**
Martin Owner M 40s Former smoker
Jimmy Owner M 40s Smoker
Kevin Owner M 40s Nonsmoker
Michelle Key Stakeholder F 40s Nonsmoker
Carol Owner F 60s Nonsmoker
Pam Key Stakeholder F 50s Former Smoker
Laura Owner F 40s Nonsmoker
Mel Key Stakeholder M 50s Nonsmoker
Buzz Owner M 40s Former Smoker**
Patron A Patron F 20s Nonsmoker
Patron B Patron M 30s Smoker
Patron C Patron F 50s Smoker
Patron D Patron F 40s Smoker
Patron E Patron M 50s Smoker
Patron F Patron F 60s Nonsmoker
Patron G Patron M 30s Former Smoker
n = 22; Key Stakeholders = 8; Owners = 8; Patrons = 8***
Males = 13; Smokers = 6; Nonsmokers = 8; Former Smokers = 8
Twenties = 1; Thirties = 2; Forties = 7; Fifties = 7; Sixties = 4 ; Seventies = 1
*A11 data are self reported. Smokers are currently habitual users. Nonsmokers
may have experimented with tobacco, but had never use it habitually. Former
smokers are not currently habitual users, but were at some time in the past. **Oral tobacco users
***The sum of elements of the three categories is greater than 22 because some
key stakeholders may also have been owners or patrons. Those people were
interviewed with the instrument that best accorded with their primary role.
31


Sampling and Recruitment
Consistent with standard qualitative methodology, this study employed
non-probability, purposive sampling that used the city of Pueblo as its sampling
frame (Schutt, 2004). Non-probability, purposive samples rely on the judgment
of the researcher to select members that best suit the study purposes, rather than
strive for an ideal representation of the study population (Backstrom & Hursh-
Cesar, 1981). The objective of convenience sampling patrons was to quickly
recruit that group of participants in one location. The objective of the snowball
method for key stakeholders and owners was to deliberately build (rather than
randomly identify) a sample that could provide a range of perspectives. The
investigator did not leave the characteristics of the sample to chance. As such,
purposive sampling techniques were well suited for including opinion leaders and
representatives of specific groups, such as males and females, PSFAA opponents
and proponents, etc. (Schutt, 2004). Although Pueblo has a substantial Hispanic
population, the scope of the study limited participant recruitment to English
speakers only.
Key stakeholders and owners were identified and recruited by snowball
sampling. Since the Pueblo community is relatively small and thus ostensibly
interconnected, it was effective to recruit people who would be rich sources of
information by having one participant nominate another who might have had
unique perspectives and perceptions about the PSFAA (Schutt, 2004). The
sampling process began with four key stakeholders. Two were named in Pueblo
Chieftain (the local newspaper) articles as members of the healthcare community
who were thought to be strong proponents of the PSFAA. Another was identified
via the Pueblo County website, http://www.co.pueblo.co.us/ as a government
employee who knew about overall economic impacts of the PSFAA. A fourth key
stakeholder/restaurant owner was identified through the Pueblo Chamber of
32


Commerce as a long-standing member of the bar and restaurant community. As
part of their interviews, each of these first four participants were asked if they
knew of any Pubeloans who were particularly vocal opponents or proponents of
the PSFAA who would be valuable additions to the study. The investigator noted
those nominations and the traits and characteristics of the people suggested. After
those interviews, the sample snowballed via the referrals to other key stakeholders
and owners.
Not all referrals, however, were considered suitable candidates for
participation. The selection criteria called for the recruitment not necessarily of
equal numbers of males and females, or known PSFAA proponents or opponents,
but the investigator did strive, for example, to make sure that some female owners
were represented. It was left to the discretion of the investigator to purposively
select and recruit people who would comprise a diverse sample. For example,
one bar owner was recruited because his business was known (by other
participants) to cater to a working class Spanish-speaking clientele; hence it was
believed that he might have a perspective that differed from other bar owners.
Participants named a few bar owners who were known to be violators of the
PSFAA, but the scope of the study allowed for the selection of only one such
participant. Likewise, several Puebloans were known to be vocal opponents of
the ordinance, but the investigator considered only a few interviews of such
people to be necessary for the study. Similarly, the investigator deliberately chose
to recruit some bar or restaurant owners because they were either known to be
supporters of the PSFAA, or female, or ran a business that was unique compared
to others mentioned, etc. More participants were selected in this way until the
sample was considered to be sufficiently large enough to provide data saturation
(but not unmanageably large for the scope of the study), meaning that new
interviews seemed to yield little new information (Schutt, 2004).
i
33


Patrons were selected by convenience, or chunk sampling, a method
whereby participants were identified quickly and in one location (Backstrom &
Hursh-Cesar, 1981). The sample was not meant to represent the overall
population of patrons in Pueblo, nor even the population in the place where they
were encountered. That chunk of people included the first few people
encountered who met the selection criteriathey had to be Pueblo residents who
had lived there since before the PSFAA took effect. While there were no
established quotas, the investigator sought to recruit people of varying ages and
roughly equivalent numbers of patrons who were both male and female, smokers
and nonsmokers. This was not difficult, since some people could be observed
smoking outside the cafe, and those who stayed inside the cafe for while without
exiting to smoke could be assumed to be nonsmokers. Ages were estimated based
on appearances, as was the persons sex. Prior to the interviews, the investigator
had no way of knowing if the patrons would be opponents or proponents of the
PSFAA
All key stakeholders and owners were recruited via email or telephone by
the researcher. The investigator introduced himself and the study, and then
invited the people to participate. All eight stakeholders who were recruited
agreed to participate. The interviews were conducted at the stakeholders places
of business, and lasted between 20 and 45 minutes. Eight owners were also
interviewed at their places of business, and those interviews lasted between five
and 20 minutes. Not all owners who were contacted agreed to participate; one
owner of a franchise restaurant declined, stating that he was unwilling to act or
speak as the representative of a corporate entity. When the investigator asked
questions intended to add to the snowball sample, it was emphasized that all that
was said during the interview would be kept confidential, as would participation
in the study.
34


Eight patrons were recruited at the location where they were
interviewedan independently owned coffee shop in Pueblo that agreed to host
the research. That location was chosen because it was deemed suitable for
convenience sampling: it was centrally located, had a high volume of patrons, and
had an outdoor patio where smoking was permitted (making easy the
identification of smokers). While there was no quota system for recruiting, the
investigator applied an ocular test to assure that patrons were both male and
female, younger (<40) and older (>40), and smokers and nonsmokers. Again, the
investigator introduced himself and the study, and then invited the people to
participate. Not all of the patrons who were approached by the investigator
became interviewees. None declined to participate, but some people did not meet
the selection criteria because they were not residents or did not live in Pueblo
prior to PSFAA legislation. Since there was no private space at the coffee shop,
interviews were conducted as far away from other customers as possible to
maximize confidentiality. Those interviews lasted from five to 15 minutes.
Patrons were compensated for their time with a $5 gift certificate redeemable at
the coffee shop where they were interviewed.
Participant Consent and Confidentiality
Each participant gave informed consent at the beginning of each
interview, and was made to understand that participation and anything said during
the interview would be kept confidential (See Appendices A, B, and C for copies
of the consent forms approved by the University of Colorado at Denver Human
Subjects Committee). Participants were assured that no identifying information
would be included in this thesis or any other product of the research. All
participants retained a copy of their signed consent forms, as did the investigator.
!
|
35


Because Pueblo is a relatively small community, and this study dealt with
small sample sizes, discretion was used in the recording and reporting of data.
References to any identifying characteristics of organizations, businesses, or
persons were be minimized and avoided wherever possible. The names of
participants and their places of business were changed to pseudonyms during
transcription.
Data Collection
Data were collected by the principal investigator via semi-structured, in-
person interviews with 22 Puebloans in May, June, and July of 2006. Three
interview guides were designed and utilized, one for each of the participant
categories: key stakeholders, bar and restaurant owners, and patrons (see
Appendices D, E, and F). Interview questions focused on the nature of the
PSFAA, its economic impacts, and peoples perceptions of the ordinance in
general.
Each interview followed a prescribed instrument that exclusively utilized
open-ended questions to elicit more breadth of response (Fontana & Frey, 1998).
For example, a grand-tour question (Werner & Schoepfle, 1987) began each
interview, Tell me about the Pueblo Smoke-Free Air Act. Participants were
then allowed to direct the course and pace of the interview with their initial
answers, starting out with definitions of the law, its perceived impacts, or their
opinions about it. To enhance data triangulation, and to reinforce the validity and
reliability of the data, people were asked some before and after questions.
For example: bar and restaurant owners and patrons were asked, What was your
opinion of the PSFAA before it became law? and What is your opinion of the
PSFAA now that it is a law? and key stakeholders were asked, What was your
(or the name of your organizations) official position on the PSFAA before it
became law? and What is your (or your organizations) official position on the
36


PSFAA now that it has passed and been law for nearly three years? It was
believed that this technique provided more complete answers than one question
that probed for opinions could.
The interview guides were followed, in that all of the questions were
asked, but at times the order of the questions was rearranged so that the
interviewees could complete ideas or follow particular themes. That technique
enabled the participants to use as much thick description as possible, which
according to Geertz (1973), includes elaborate interpretations of circumstances,
meanings, and other contextual details in which the cultural phenomena are
embedded. Thick description was a goal of this qualitative process because it
gave more complete answers to the interview questions, and therefore better
answered the research questions.
Disposition of the Data and Identifying Materials
The investigator took handwritten field notes during each interview, and
annotated them following each session. The notes were later washed of any
information that could personally identify the participants. All field notes were
stored in a locked cabinet at the investigators home. Signed consent forms were
also kept there locked in a cabinet, but they were separated from the field notes.
All but one interview were recorded on audiotape. An owner was not
willing to have his interview recorded on audiotape, and the field notes from that
session were the only data available for analysis. The audiotapes were transcribed
verbatim directly into Microsoft Word files by a research assistant employed by
the investigator. The sensitive nature of the material was discussed with the
assistant, who signed a confidentiality agreement not to discuss the interview
contents with anyone besides the investigator, and all transcribed data were stored
on a USB memory stick devoted exclusively to this task. Once all interviews had
37


been transcribed, the audiotapes were returned to the investigator and locked in a
cabinet separate from other study materials. Data were then uploaded to the
investigators personal computer, and deleted from the USB memory stick.
The researcher reviewed and edited all transcribed Word files while
listening to each recorded interview. Personal names and proper place names were
replaced by pseudonyms when necessary. The investigator converted the Word
files into basic text files, and then uploaded each transcript as a dataset to
ATLAS/ti, a software application designed specifically for managing and
analyzing qualitative data (ATLAS/ti, 2006). All of those data were kept on the
personal computer of the researcher, and all files were password protected.
Data Analysis
Grounded theory stipulates that analysis begins with the first interview,
which shapes and leads to the next interview, and then more analysis, and so on
(Strauss & Corbin, 1998). For this study, data were mentally coded and analyzed
contemporaneously with their collection, such that emergent themes were teased
out of ongoing interviews (Strauss & Corbin, 1998). That process did not lead to
new questions being formulated for the interviews, nor change how they were
conducted, but it did cause the researcher to constantly ask himself questions
about the data and make comparisons within and between interviews. These are
fundamental processes for grounded theory because they drive the formulation of
conclusions and theories (Strauss & Corbin, 1990). As such, grounded theory
process permitted the story of the PSFAA to unfold as the inquiry went along,
and thus prepared the investigator for the open, axial, and selective coding of the
data (Strauss & Corbin, 1990).
A fundamental principal of a grounded theory approach to analyzing
interviews is to read and re-read the dataset to categorize its content with
38


conceptual labels drawn from the data itself. This first-level analysis of
phenomena in the data is referred to as open coding, whereby meaningful
quotations are categorically labeled and organized with specific, descriptive
codes. New emergent ideas call for creating and applying new codes, and
analogous quotes can be selected and given existing codes (Strauss & Corbin,
1990). Additionally, because some quotes convey multiple meanings, they can
also be labeled with more than one code.
For this study, ATLAS/ti greatly facilitated the coding process because
this software enabled the investigator to select and highlight sections of text (data)
and create a code that described those sections. If a quote fit an already existing
code, ATLAS/ti also enabled the investigator to tag those quotations with codes
from a running list. Furthermore, the software allowed the investigator to
annotate and organize all of the codes and quotes (ATLAS/ti, 2006; Strauss &
Corbin, 1998). For example, while reading the transcripts, a segment of text like
this one was selected because is was indicative of common emergent themes:
We have our families and kids in mind. We want to prepare and provide our
kids with safer and friendlier environments, and the ordinance can help with that.
(Michelle, key stakeholder). This quote was labeled with the code attitudes re
smoking: ETS health hazard, which was a theme common to other interviews.
When other quotes within that or other datasets mentioned ETS as a health
hazard, they were also labeled with that code. As each code emerged, it may have
been annotated with a memo that defined or expanded on the theme or alluded to
an association with another code/theme. Many quotes were labeled with more
than one code. For example, the above statement was also coded as social justice
and perceptions re health impacts: child/family.
As each code was used, it was added to a master memo that served as a
running code list. Codes were grouped in that list according to common thematic
or factual characteristics. For example, the demographic traits of each participant
39


were coded, along with their interview categories and personal experiences with
smoking. Pre and post-legislative perceptions of health, economic, and overall
impacts of the PSFAA were also grouped together. It was thought that such
temporal codes might indicate if peoples perceptions or attitudes about the
PSFAA had changed over time. For a complete list of the codes employed for
this studys analyses, see Appendix G.
Open coding proceeded in that manner for all transcripts. Since the
coding was an iterative process, and new codes were developed with each dataset,
all transcripts were reread and coded at least twice so that all codes in the running
code list could be thoroughly applied. The datasets were thus converted from a
collection of transcriptions to a collection of quotes, codes, and memos. The
former consisted of empirical data; the latter two were more conceptual in nature.
Culling through the datasets in that manner allowed for the noise of extraneous
information to be removed for ease of further analysis.
When open coding was completed, those conceptual datasets were
reassembled and axially coded to organize the results. Axial coding refers to a
second level of data analysis, so-called because .. .coding occurs around the axis
of a category, linking categories at the level of properties and dimensions.
(Strauss & Corbin, 1998:123). Axial coding used language taken from
respondents, and ideas formed by the researcher during analysis, to label
ideational phenomena and compare overlapping concepts with each other. That
gave the analysis some explanatory power because the linkages helped to answer
questions about the phenomena (Strauss & Corbin, 1998). For example, the quote
and its code mentioned above were linked to and compared with quotes and codes
pertaining to attitudes re smoking: dirty and attitudes re smoking: legal activity in
an attempt to explore attitudes about smoking. ATLAS/ti facilitated the
construction of those axial linkages, and their grouping into families, i.e. related
codes (ATLAS/ti, 2007). At that level of organization, the codes were no longer
40


just descriptive interpretations of quotes, but were also the links between those
quotes and purely conceptual, interconnected abstractions (Strauss & Corbin,
1998). For a complete listing of how this studys codes were grouped into
families, see Appendix H.
The third level of data analysis was selective coding. That was the process
of integrating and refining code families, and then organizing them around core
categories (Strauss & Corbin, 1998). The core categories were primary
conceptual hubs for thematically related codes; core categories were also the
kingpins for developing the substantive theory of this thesis. All relevant
families, codes, and respective quotes were selectively related to the core
categories: People Oppose the PSFAA Because it Contravenes Libertarian Ideals
and People Support the PSFAA Because it Serves Social Justice (See Chapter 6
for a thorough discussion of how these core categories relate this studys findings
to its substantive grounded theory). For example many quotes, open codes, and
code families were selectively coded as members of the core category, People
Oppose the PSFAA Because it Contravenes Libertarian Ideals. Code families
such as libertarian, and its constituent codes, government intrusion: business
rights, government intrusion: right to engage in legal activities, market forces
should dictate business practices, etc, were grouped and compared with all other
quotes, codes, and code families that related to People Oppose the PSFAA
Because it Contravenes Libertarian Ideals.
Strauss and Corbin (1998) point out that such an integrating process can
be facilitated by ATLAS/ti, drawing diagrams, or sorting and combining memos
to write a storyline. While ATLAS/ti proved to be a powerful tool for sorting and
coding this studys raw data, it was not considered expedient for creating core
categories and orienting them in a graphic manner. Rather, the investigator
combined memos, sketched a predictive model, and wrote a storyline to complete
selective coding and formulate a substantive theory (see Chapter 6 and Figure 1).
41


Finally, conclusions about the study questions were reevaluated by
relating them to a single core category, Civil Rights Perspectives, in order to help
finalize the formulation of the substantive theory of this thesis (Strauss & Corbin,
1990). The objective of that process was to make a cohesive statement about this
studys findings relative to the overall tobacco campaign being waged outside of
Pueblo. In so doing, this studys conclusions were compared with pro-tobacco
and tobacco control literature, editorials, and other documents that pertain to civil
rights. In many respects those were anecdotal comparisons, but according to
Glaser (1978), such comparisons are not necessarily inappropriate because formal
theories such as civil rights, social justice, and libertarianism are highly
conceptual and abstract.
42


CHAPTER 5
FINDINGS
This studys finding s are derived from data collected during 22
interviews. There were eight key stakeholders, bar or restaurant owners, and
patrons, respectively Thirteen of the participants were males. Six participants
were smokers, eight nonsmokers, eight former smokers, and two were oral
tobacco users. Their ages span the early 20s to the early 70s (see Table 1 for a
complete listing of participant descriptions.
These results describe the range and nature of perceived impacts that the
PSFAA has had on members of the Pueblo community. Additionally, these
results have lead to five substantive conclusions about the research questions:
1) The PSFAA is perceived to be widely effective at reducing environmental
tobacco smoke in Pueblos public places.
2) The PSFAA is perceived by some people to have had positive health impacts
for the public in Pueblo.
3) The PSFAA is perceived by some people to infringe on smokers individual
rights and the rights of businesses to determine their own smoking policies.
4) The PSFAA is perceived to have had an array of economic impacts on bars,
restaurants, and the city of Pueblo as a whole.
5) The PSFAA is perceived by many people to have created a great deal of
controversy in Pueblo.
Note: All of the personal names used in this chapter have been changed to
pseudonyms in order to maintain confidentiality for the participants. 8
8 Note that the sum of the members of the three participant categories is greater than 22 because
some key stakeholders may also have been owners or patrons. Those people were interviewed
with the instrument that best accorded with their primary role.
43


The PSFAA is Perceived to be Widely Effective in Reducing
Environmental Tobacco Smoke in Pueblos Public Places
All of the findings about the PSFAA included in this chapter depend on
this condition: the PSFAA is widely perceived to be in an effective law. That is,
the PSFAA has eliminated ETS in most of the places where it was intended to do
so.
All of the people interviewed for this study, both smokers and non, are
aware of the nature and scope of the law, that is, where it is and is not legal to
smoke. Participants agree that except for the two caveats mentioned below, the
PSFAA is essentially self-enforcing, meaning that Puebloans are aware of the law
and comply as a matter of course. Smokers did not report that they disregarded
the law, themselves, and nonsmokers noted that they had not been in the presence
of noncompliant smokers. Therefore, private businesses, restaurants, and most
bars do not have to actively enforce the law, and the policing agencies (that is, the
health department and police, themselves) do not expend much energy ensuring
compliance. In short, nearly all indoor public places in Pueblo have been smoke-
free since the initiation of the PSFAA.
The interviews revealed, however, that there have been exceptions to the
foregoing depiction of compliance. Some key stakeholders, bar and restaurant
owners, and patrons commented on anomalous but well known violations in some
Pueblo bars, and the names of those establishments came up repeatedly during
interviews. Dan, a key stakeholder who is a law enforcement official, mentioned
that both the police and the general public are well aware of the few bars that do
not comply with the PSFAA:
Some businesses are known to not be in compliance with the law, and
may or may not have been cited in the past.
44


Anne, a key stakeholder who is a member of Pueblos healthcare
community, also stated that three or four bars are known to have been flagrantly
ignoring the PSFAA:
The same three or four [bars] consistently are breaking the law.
Theyre letting people smoke and that kind of thing...
Jimmy, an owner of one of those businesses, confirmed that he had been
cited more than once, and successfully prosecuted for violations at least once:
So, they found me guilty. I paid the fifty dollars and the contempt of
court charge, and I left it at that.
That same owner plus a patron/key stakeholder, both smokers who were
active in the legal challenges to the PSFAA, commented that enforcement at
establishments known to be in violation tends to be overzealous:
Im in there, theres a lawyer in theretwo prominent businessmen
and were smoking.. ..I thought that was a bit overkill. I mean, come in
with bullet-proof vests and guns and the whole nine yards just to catch a
couple guys having a smoke! (Wade, patron/key stakeholder)
In addition to bar violations, another caveat to the theory that the PSFAA
is perceived to be an effective law should be noted. Most participants perceived
there to be widespread noncompliance within the twenty-foot buffer zone outside
building entrances. Members of all three interview categories, smokers and
nonsmokers alike, noted that daily they see groups of people smoking just outside
the entrances to buildings. In fact, at the coffee shop where the investigator
conducted patron interviews, people were smoking at tables set up right outside
the cafe door.
Key stakeholder, Mel, who was involved with PSFAA legislation,
commented that to him buffer zone violations are:
...okay, as long as youre even making an attempt at compliance inside
because the primary intent of the law was to eliminate smoking indoors.
45


Hence the PSFAA, as a legislated health intervention, essentially does
what it set out to do. With only a few exceptions, people do not smoke in public
indoor places. People who were concerned that ETS was health hazard, and
people who were generally against smoking in public, are satisfied with the laws
outcomes. People who for a variety of reasons opposed the law, are dissatisfied
with its outcomes.
The PSFAA is Perceived by Some People to Have Had
Positive Health Impacts for the Public in Pueblo
Because the PSFAA is effective at eliminating ETS in most public places,
some Puebloans perceive that the law has had positive health impacts. Those
people, most of them PSFAA supporters, acknowledge that tobacco smoke is a
pollutant and that it is a health hazard. Those participants perceive that by
essentially removing ETS, the PSFAA positively impacts their health, the health
of their families, the health of the general public, and (if they own businesses) the
health of their customers and employees.
Patrons and key stakeholders, who are smokers and nonsmokers alike,
acknowledge that ETS is a pollutant, and that the PSFAA provides for a cleaner,
healthier environment in Pueblo. Some of those people also stated that they
prefer going out in public now that the PSFAA has improved their city:
It was just so gross [before the PSFAA passed] having people blow
smoke in your face. I dont smoke, and I dont want to smoke their
smoke, either... (Patron A)
It's so much better than Denverwhere we'd get back and just want to
take off all our dirty clothes and wash up. (Michelle, key stakeholder)
46


Bar and restaurant owners also said that their businesses have been cleaner
since the PSFAA has been in effect:
You could just tell the atmosphere is a lot cleaner inside. (Martin, bar
owner)
I hated to be around smoke. You'd walk into the place in the morning
and the place would stink from smoke. (Carol, restaurant owner)
Even Kyle, a restaurant owner who was a fervent and active opponent of
the PSFAA during legislation, acknowledges that the ordinance has improved his
business environment:
I prefer nonsmoking. The airs smells better... I just kind of prefer
nonsmoking, but not because the government told me that.
Members of all three interview categories also expressed concerns about
the health hazards posed by ETS, and noted that the PSFAA helps to mitigate
those hazards. Those concerns were voiced by both smokers and nonsmokers,
and lay people and members of the healthcare community. However, PSFAA
supporters were generally more inclined to acknowledge that ETS is a health
hazard than were its opponents. Phil, a member of Pueblos healthcare
community and a key stakeholder, commented that the health hazards of ETS
were the impetus for the PSFAA:
We know that smoking is a health hazard, and so is secondhand smoke.
There is just so much evidence now that it is obvious to the medical
community that public smoking should be prohibited.. .most of the
people I worked with thought that it [the PSFAA] would be very positive
because they didn't want to be exposed to secondhand smoke anymore,
and physicians wanted to decrease the number of people affected by
smoking-related diseases.
Patron E, a smoker in his fifties, noted the health benefits of the PSFAA and
also that he knew the intervention was intended to change the habits of people like
himself:
47


I understand the health issues for the public. I think its a good thing. I
support it... Im a heavy smoker but its healthier for everybody.
Other nonsmoker patrons expressed similar health concerns about ETS, as
well as perceptions that the PSFAA had helped to mollify those concerns:
I see too many bad effects happen to all these people. People with
emphysema and cancer. (Patron G)
I dont want to get cancer just because other people, selfish people,
want to smoke. {Patron A)
Especially telling are concerns voiced by Laura, a restaurant owner and
nonsmoker. Her familys business had always allowed smoking before the
PSFAA went into effect because they felt they would lose customers if they
changed their policy:
I went to apply for life insurance [before the PSFAA was passed], so
they did a physical on me and they... called me back and they said they
found nicotine in my system. So basically I knew it was from that:
secondhand smoke. I've been inhaling second hand smoke since I was
thirteen years old.
That insurance company charged Laura higher premiums because she had levels
of nicotine in her bloodstream that essentially identified her as a smoker. So, she
was pleased when the PSFAA mandated that all restaurants in Pueblo be smoke-
free. Thereafter she was not exposed daily to secondhand smoke, and her family
had a business that competed with other restaurants on a level playing field.
Many participants recalled that in 2003 the PSFAA was promoted by its
sponsors as an ordinance intended to protect employees who would otherwise
have been constantly exposed to ETS. Yet some bar and restaurant owners also
pointed out that they were just as concerned about the health of their customers as
they were their employees. Kevin said as much outright:
I worried as much about the customers sitting there in the smoke as I
did employees.
48


Of all the health issues raised during interviews, though, people mentioned
the health of their families more often than any other. At the time the PSFAA
was being legislated, family concerns were commonly voiced to Anne (key
stakeholder) by members of the general public:
. .the two main things were the effect on them personally and their
family. And right about that time there was quite a bit more technical
information coming out about the dangers of secondhand smoke, and
more people were getting worried about it, saying 'I do not want to have
my children exposed... I heard quite a bit, statements like, 'it's almost
to the point where I dont want to take my family out to eat because they
will be exposed to secondhand smoke.
The implementation of the PSFAA seemed to allay some of those fears for
parents. Patron G, for example, mentioned that he was pleased that the PSFAA
made it mandatory that restaurants be smoke free because:
I don't want to go sit at a restaurant and have someone blowing their
smoke in my face or my kids' face...
Michelle (key stakeholder) summed up that sentiment even better:
We have our families and kids in mind. We want to prepare and provide
our kids with safer and friendlier environments and the ordinance can
help with that.
Members of Pueblos healthcare community noted that the PSFAA may
have already begun to improve health outcomes for people in the city. Among
them was Anne (key stakeholder), who mentioned a recently published study that
was conducted by a local physician, Dr. Carl Bartecchi, and colleagues9. That
studys findings associated decreased heart disease in Pueblo with the passage of
the PSFAA (see Chapter 2 and Bartecchi et al, 2006). In other words, the PSFAA
may have already resulted in positive short-term health impacts for Puebloans:
9 That study was conducted by Dr. Bartecchi, other Pueblo physicians, representatives from the
Pueblo City-County Health Department, and researchers from the University of Colorado Health
Sciences Center.
49


.we have a lower heart attack rate now with the ordinance. We are
definitely a healthier community, [with].. .less exposure to second hand
smoke.
It should not go without saying that not all of the participants in this study
perceive positive health impacts of the PSFAA. Opponents of the ordinance said
little about the health risks of ETS. Others, still, overlooked or denied outright
that ETS was a hazard. Kyle (restaurant owner) expressed this point best:
The health issue was about as phony as they come.
As will be explored below, some opponents of the PSFAA do not view it
as health issue. They perceive that the ordinance infringes on their individual
rights and on their rights as business owners. Furthermore, those opponents are
against smoking regulations in general, even if they are intended to protect public
health.
The PSFAA is Perceived by Some People to Infringe on Smokers Individual
Rights and the Rights of Businesses to Determine their Own Smoking Policies
The opponents of the PSFAA who participated in this study principally
based their rationale on two arguments: 1) that smoking is a right that individuals
should be allowed to exercise as they see fit; and 2) that business owners have a
right to decide for themselves, without government intervention, whether or not it
makes sense to permit smoking within the confines of their private property.
Those opponents are all smokers or former smokers. When they talked about
their opposition to the ordinance, they tended to overlook that the PSFAA may
have positively impacted the public health in Pueblo. They perceive, instead, that
the ordinance has primarily had negative impacts, the greatest being that it
infringes on their individual and business rights. As will be explored in the
Discussion chapter of this thesis, these arguments were made in reference to the
50


PSFAA, but they were framed in generalized terms. These are arguments that
could apply to many public smoking ordinances, not just to the one that directly
affects Pueblo.
The legality of tobacco was brought up repeatedlyeven by people who
are not PSFAA opponents. When Anne (key stakeholder) talked about positions
taken on the PSFAA by Pueblos medical community circa legislation, she
explained that even some doctors did not support the ordinance because tobacco is
a legal substance:
There are a few cowboy types [doctors], you know, that said people
have the right to do something that's legal... like I said, there were a
few, medical professionals who thought that... the whole reason we live
in the West is that we have these certain freedomsone of which is to be
able to do things that are legal.
Similar sentiments were expressed by still other Puebloans. It simply did
not make sense to Wade that the scope of the PSFAA was is so broad and its
enforcement so narrow because (among other things) smoking tobacco is legal:
[regarding citations] .. .It was supposed to be $100 for the bartender and
$100 for each customer. Well I have heard several just conflicting
stories that this one gals got popped, she was a bartender, [it ] was 300
bucks for her and three hundred for each customer that she had that was
smoking, and she had to pay that plus she had to do between 25 and 45
hours of community service.10 Hell, its cheaper to smoke weed! You
get caught smoking weedyou can just.. .it just.. .its a $100 fine if you
get caught with a joint!
Another point that was made by opponents was that smokers can account
for a greater proportion of bar clientele than nonsmokers (see Istvan &
Matarazarro, 1984), so smoking bans could be perceived as an infringement on
the individual rights of a majority subpopulation:
10 Dan, a law enforcement official, later stated that fines can go up to $300, but that most had been
in the $35-$50 range. He was not asked about the specific incident that Wade referred to.
51


I thought it would hurt my bar business. You know, in the bar
businessI think the statistics are about 20 to 25 percent of the public
smokebut the bar business is a micro-society of people who frequent
bars, and that percentage drastically rises to probably 50 to 60 percent.
(Kyle, restaurant owner)
Furthermore, some PSFAA proponents observed that the opponents
perceive that the law is unwarranted government intrusion on their civil rights:
[people were] just feeling like government was not stopping, they were
infringing on their personal lives, and where would they stop.. .One man
came to a Council meeting feeling that the government was taking
charge, and when would the government stop telling him what to do.
(Pam, key stakeholder)
Smokers felt that is was intrusive for the government to tell them what
to do.. .Smokers feel like they are denied their rights, which I suppose I
can understand.11 (Michelle, key stakeholder)
Arguments against the PSFAA are not limited to individuals rights to
smoke. Several participants, smokers and nonsmokers alike, are against smoking
bans in bars and restaurants out of principle. Some of those people are business
owners who resent the government dictating how they should run their
establishments. Libertarians also advocate limiting government interventions
(such as the PSFAA) into the realm of private business. The opponents of the
PSFAA expressed essential libertarian ideas when they argued that the ordinance
and the government have no right to intrude on their right to run their businesses,
and that it is the business owners prerogative to decide the smoking policy on
their property.
11 However, some PSFAA proponents did not express any sympathy for such views:
They think they are more entitled to smoke than people who are not to smoke. (Kevin)
52


Regarding business rights, Bill, a restaurant owner/key stakeholder and
PSFAA opponent, said that his restaurant had instituted a no-smoking policy
years before, but that he did so because it was something his customers, not
authorities, wanted:
[we were] opposed to it because of the fact we thought that businesses
ought to be able to call their own shots, and it's the market for each
business that ought to determine how that business is run.
That argument was raised repeatedly by other owners and their associates:
Its Big Brothernannyismthe man telling people how to run their
business...infringing on their management of the business and we have
no business telling them how to do that. (Mel, key stakeholder)
And Jimmy (bar owner) registered nearly the same complaint:
I didn't think that the people that pushed for the ordinance, then the
people that jumped on the bandwagon, didn't have any right, you know,
to tell other people how to run their business or other people how to
live.
Some opponents, like Patron B, talked about how to them such business
rights dovetail with property rights:
If you own a business or rent a space that's yours, your patrons know
what they are getting into whatever. They can take it or leave it.
Related arguments that opponents made regard the intent and nature of the
PSFAA. Some participants do not feel that ETS is a health issue that merits
government intervention via public health. Case in point, Kyle (restaurant owner)
is dubious about the danger of ETS compared to other potential hazards:
The health issue was about as phony as they come. You know, the way
I look at that is I have my employees use some real dangerous chemicals
to clean the restrooms and stuff like that... Is that next, where Im not
allowed to [long pause]... You know its all about employees and
customers, and... my thing was if somebody doesnt want to work in a
bar where theres...dangerous things going on, then dont apply to work
53


there... But it was all about health and... not even, nobody even cared
about the business part of it. The owners rights, you know.
Some owners simply perceive that public health issues should not
supersede business rights, and people outside the food and beverage industry got
that impression as well:
They wanted to separate health concerns from government's role.
(Michelle, key stakeholder)
We shouldn't be involved in health issues, either, theyd say, it's not a
health issue, it's a business decision. (Mel, key stakeholder)
The PSFAA is Perceived to Have Had an Array of Economic Impacts on Bars,
Restaurants, and the City of Pueblo as a Whole
The impetus for this study, and its initial thread of inquiry, was the
research question, How do the Pueblo food and beverage industry and their
patrons perceive the economic impacts of the PSFAA? According to the
participants, the salient economic impact is perceived to have been that the law
has had some negative impact on bar businesses, or more specifically, liquor sales
in bars and restaurants that do a substantial bar trade. However, the narratives
from study participants reveal that the PSFAA is perceived to have had an array
of economic impacts that go beyond bottom line gains and losses. In addition,
none of these impacts can be interpreted as standalone impacts because the
PSFAA is just one of many factors that has affected Pueblo businesses in recent
years. While not an exhaustive list of participant responses, this section reports
the most commonly mentioned economic impacts. Some people believe that the
PSFAA has improved Pueblos overall economic climate; that the PSFAA may
have had minor economic impacts on restaurants, possibly by improving those
businesses; and that the PSFAA has economically impacted bars, both in negative
and positive ways.
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Overall Economic Climate
Some key stakeholders and restaurant owners stated that they felt that the
passage of the PSFAA improved the overall economic climate and business image
for Pueblo. They commented that Pueblo was the first city in the area to go
smoke-free, and that that fact set Pueblo apart as a progressive city in the region,
thus helping to attract new businesses. For example, Pam was one of three
participants who pointed out that the Professional Bull Riders Association had
relocated to Pueblo since the PSFAA had passed, and that Pueblos improved
image may have helped to secure the site:
.. .also since then weve got things like PBR moving down from
Colorado Springs, putting their national headquarters here.. .that [the
PSFAA] really has helped improve Pueblos image as being a trend
setter, as not being afraid to step out and take the lead, and I believe
there are businesses that are coming in because of that.
Moreover, several participants asserted that because of the PSFAA,
Pueblo is a better, healthier environment to spend time and money inespecially
compared to Colorado Springs or Denver, neither of which had comprehensive
public smoking laws at the time:
I would say in general, the citizens were glad it passed, and it helped
because now they go out a little bit more... I think there were people
who didnt go out to... do different things because there was a smoking
atmosphere, and I think now that theres less of a smoking atmosphere
out there in the public areas that they do more things than they had done
before. (Mel, key stakeholder)
The people who said that they felt that the PSFAA had helped Pueblo
overall were self-proclaimed supporters of the ordinance and also nonsmokers or
former smokers. It should be noted that no opponents of the law or current
smokers shared similar impressions.
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Restaurants
Participants from all three interview categories indicated that the PSFAA
had had minor economic impacts on restaurants in Pueblo. Some owners stated
that during the period shortly after the PSFAA had passed, disgruntled smokers
. .swore they would never come in again... (Laura, restaurant owner).
Most restaurant owners agreed, though, that declines in revenues were
short lived, and as Carol put it, losses were of little consequence:
We lost customers, but I really don't think it had a great impact on our
business when it was all said and done. (Carol, restaurant owner)
All of the patrons interviewed, smokers and nonsmokers alike, noted that
they did not spend less time in restaurants than they had before the PSFAA had
passed. Some key stakeholders and patrons, all supporters of the PSFAA and all
former smokers or nonsmokers, also reported that they went to restaurants more
after the PSFAA took effect, often taking their families. Michelle {key
stakeholder) said that her family made that change because their dining
experiences were better in entirely smoke-free rooms:
We enjoy going out more because.. .well, before, smoking and
nonsmoking sections didnt fix the problem.
Some restaurant owners, all supporters of the PSFAA and all former or
nonsmokers, claimed that the ordinance may even have increased profits for their
businesses. For instance, Carol asserted that:
We received new customers because they wouldnt come in before
because there was smoke here.
Laura, was roundly positive about how the ordinance had improved her
familys business:
I think people were crazy when they said it was going to affect their
businesses in a negative way because I think it actually affected a lot of
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businesses in a positive way.
As mentioned below, many restaurants in Pueblo earn a substantial
proportion of their revenues from alcohol sales. Some of those business owners
claimed that post-PSFAA their food sales increased relative to alcohol sales.
Kyle noted that, for him, the PSFAA has resulted in a diminished bar trade, so he
had to make efforts to increase his food sales.
.. .before the smoking ban took affect my alcohol and food percentages
were about 50/50, and now they are about 68/32, food over alcohol...
So, while the PSFAA may be a perceived benefit for food sales in
businesses with combined revenues, that boost may have been offset by declines
in alcohol sales. To adapt to new business conditions, some restaurants made
changes, often entailing some financial investments. Bill, whose restaurant had
gone smoke-free several years before the advent of the PSFAA, commented that,
after the ordinance passed, some of his fellow restaurant owners needed to make
such changes in order to retain their market share:
A lot of them are doing more with food... Some have put patios
in.. .Others are serving a bigger menu than they did before, so they are
trying to attract a broader market.
Kyle said that he had to make changes to cater to his clientele:
I built this patio after the smoking ban, and now the summer months for
me are the busiest months in the year. So, this patio made all the
difference for me.
Neither he nor any of his fellow owners who had added patios mentioned outright
the dual benefits of those business improvements: patios increase the total number
of people they can accommodate, and also provide a place where customers can
eat, drink, and smoke on-premises.
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Bars
The PSFAA is perceived to have had positive, neutral, and negative
economic impacts on bars in Pueblo, although the latter were mentioned most
often. For the sake of this discussion, all restaurants and bars that have liquor
licenses are included in this section because alcohol sales (for onsite consumption,
as opposed to packaged liquor sales) were perceived to have been most affected
by the PSFAA. Also, participants seldom made a distinction between bars that
did not serve food at all and bars that were part of a restaurant.
Martin commented that although he was initially concerned that the
ordinance would hurt his business, the PSFAA may have positively impacted his
bar (which, incidentally, did not serve any food):
It hasnt. It hasnt affected my business at all... I have a bigger crowd
now than I did three years ago.
As Mel (key stakeholder) pointed out, other establishments, like Kyles,
have made adjustments to help retain their customers:
I know several bars are doing as well as they were doing before, and
then some have added covered patios to.. .to accommodate their
customers. They changed their business practices to accommodate the
trend.
All but one of the eight patrons who were interviewed for this study stated
that they did not visit bars any less frequently than they did before the PSFAA
passed. It seemed not to matter if they were smokers or nonsmokers, or if they
were supporters or opponents of the ordinance. Contrarily, members of all three
interview categories were under the impression that bars had suffered financially
after becoming smoke-free environments:
Pueblo has got a lot of drinkers, so I am sure it affects our economy a
little bit here. (Patron G)
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Some of the bars may have been economically impacted.
(Anne, key stakeholder)
The establishments that I feel sorry for are the small neighborhood bars
that are basically a social club for the people who live around them.
(Carol, restaurant owner)
Patron C was the only person interviewed who stated, in no uncertain
terms, that after the PSFAA took effect, she stopped frequenting bars:
[I] still go to restaurants, I do not go to bars...
Regardless of the underlying reasons, smokers in Pueblo may not be
smoking or drinking any more or less, but they may be doing either or both more
often outside of bars than they did before the PSFAA was passed (see Chapter 6).
When the law took effect, Bill (key stakeholder) suspected that this would be the
case:
.. .this was one of the concerns when the smoking ordinance was passed
that people were going... to take their booze home so they could smoke
and drink.
Anne (key stakeholder) surmised that may have been the case after the
PSFAA had been in effect for some time because she began to see fewer and
fewer people smoking outside the entrances to Pueblo bars:
.. .maybe.. .they're not going to bars. Maybe they're buying their liquor
at local liquor stores and going home.
Some of the study participants noted other ways that they perceived that
bars had been negatively impacted. Jimmy pointed to the PSFAA as a significant
contributor to his recent business decline:
My sales are down 70 percent... I mean the smoking ban is a huge
contributor... I cut like 13 positions... I worked the place by myself for
almost two years.
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To Jimmy, declining revenues meant that there would be ripple effects for
other businesses in Pueblo. For example, he could no longer afford to sponsor
local amateur sports teams:
. .this kids baseball program...you know its like when somebody
needs a benefit or a handout its the bar and the restaurant people that do
it and now.. .we cant do it anymore, cause we dont have the money.
Several participants said that bars in Pueblo have closed since the PSFAA
passed, and that the PSFAA could have been a factor that contributed to those
closures. Key stakeholders and bar and restaurant owners were asked if other
economic factors could have affected those businesses. Whether they were
opponents of the ordinance or not, participants said that those businesses did not
go under just because they could no longer allow their customers to smoke. For
instance, Jimmy, the bar owner who reported substantial business declines, is the
most ardent, outspoken opponent of the PSFAA who participated in this study.
He admitted to no positive outcomes of the ordinance. Nonetheless, he does not
blame his self-reported 70 percent business decline exclusively to the PSFAA:
In all honesty, I couldnt attribute it all to the smoking ban.
Similarly, out of principle, Bill (restaurant owner and key stakeholder) is
against all legislated smoking bans for bars and restaurants, but he does not seem
to let his beliefs completely bias his perspectives on local closures:
I only know of one or two places [that closed post-PSFAA] .. .one of
them was an institution in this town, whether it was a smoking ordinance
or management practices, I don't know... this is a volatile business. I
dont know that you could blame any one thing to cause people to want
to close their doors.
Kyle (restaurant owner) is also against legislated smoking bans for bars
and restaurants, and he related the same kinds of sentiments regarding bar
closures in Pueblo and the PSFAA:
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I got two or three good friends that own bars and they are out of
business now. Part of the reason is because of the smoking bannot all
the reason, part of the reason. It was a factor in them losing their
businesses.. .There were a couple of mom and pop bars that were in
Pueblono food, just barsthat.. .didnt have a chance because
neighborhood people would walk or drive down to their bar and sit and
visit with their friends at night and drink beer and smoke cigarettes, and
theyre out of business now.
Michelle (key stakeholder) supports the PSFAA, but she too is under the
impression that the PFAA, in part, contributed to bar closures:
I'd heard that the [one bar that closed] blamed the PSFAA as their
decision to close... but you know, they were on their way out before the
ordinance came along.
These comments allude to a point that was made repeatedly by this studys
participants: the PSFAA is just one of many economic factors that affect food and
beverage purveyors in Pueblo. The ordinance may well add to a decline in liquor
sales profits for some bars and restaurants. But, according to some participants,
other forces are also in play, and Pueblo has a relatively poor overall economic
climate as it stands. Bill (restaurant owner)perceives the situation this way:
Pueblo is about as thin an economic market as there is in the state...
We don't have the same kinds of income structures that other
communities have...
People who are not entrepreneurs have views that are similar, albeit
briefer:
The city is still struggling economically. (Anne, key stakeholder)
You know, the economy is not real good in Pueblo. (Laura, restaurant
owner)
Other participants talked about Pueblos less-than-robust economic
climate. Mel (key stakeholder) reflected on Pueblos declining steel industry, and
how that may contribute to volatility in the economy:
i
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Bars here in Bessemer [north end of town] cater to the steel mill, but
when the steel mill went down, you know then they still have loyal
customers... but those customers got older and older, and as they got to
be senior citizens, they don't come out at night as often.
So, while there may not have been steel layoffs just before or right after
PSFAA legislation, that and other factors added together may make for a tight
labor market. Several participants said as much:
Unemployment is problem here too. (Michelle, key stakeholder)
Compared to the other Front Range cities, we have a high
unemployment rate. (Bill, restaurant owner and key stakeholder)
The unemployment rate went up and it's still up. Unemployment is
endemic, and it did rise a little higher than usual during that time
period. (Anne, key stakeholder)
Participants believe that in addition to a reportedly weak economy, Pueblo
bars have to contend with competitors for food and beverage dollars. Michelle
{key stakeholder) felt that some customers were being drawn from the city proper:
There's been development on the edges and outside the city limits, like
in Pueblo West.
Kyle also discussed economic forces that pull customers from Pueblos
bars and restaurants:
.. .the City is on the inside of Pueblo county, kind of like a doughnuts
hole, and the county completely surrounds the inner city and.. .for the
past two or three years, however long the smoking ban has been in
affect, there has been smoking allowed in the county. Pueblo West has
been really growing, and they allow smoking... they really get a lot of
our smokers now...
Kyle also pointed out that there are some internal factors in Pueblo that
may cut into bar profits by allowing liquor licenses for large scale events:
Pueblo is laced with summer festivals on Friday nights, and most of
those summer festivals get anywhere from three to five thousand people
62


on Friday nights. And that has affected a big portion of the bar and
restaurant business in Pueblo. A few of them started ten years ago, and
now the liquor board just seems to pass them out like candy. Those
people have taken a big chunk out of the bar business in Pueblo.
Aside from the smoking ban, the most frequently mentioned and most
detailed issue considered detrimental to bar profits was DUI enforcement.
Comments on that topic ranged from brief to detailed:
I'm sure DUIs are a problem for bars. (Michelle, key stakeholder)
Yeah, I think MADD. I think the crackdown on drinking and driving
had a great effect on some of these establishments. You know, the
alcohol enforcement and the nonsmoking... I think the combination of
the two was just devastating to some small neighborhood type bars.
(Carol, restaurant owner)
Overall, liquor sales are down across the country [in bars and
restaurants] and all those things [bar closures] relate to itdrunk driving
laws.. .The drunk driving laws have people I know who are social
drinkers, who are very careful, who you know, used to have two drinks
are now having one drink.. .and parties are at homes now rather than out
where people are consuming alcohol [in bars]. (Bill, restaurant owner
and key stakeholder)
All of the key stakeholders and bar and restaurant owners at least
mentioned DUI arrests, or that drunk driving was no longer socially acceptable.
They mentioned that DUI enforcement, coupled with the PSFAA, substantially
contributes to declines in bar sales.
Indeed, the participants who spoke of financial slumps or closures for bars
acknowledged that no single, isolated cause could be identifiednot Pueblos
economic climate, not DUI enforcement, nor the PSFAA. None of these was
pointed to as the cause for business losses, and some people said during their
interviews that to assert otherwise would be fallacious:
All the businesses that said that is what closed them down, thats what
they could pin it on. They were already in trouble before, but it is easy
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to assert, Its not my fault. It was the smoking ban. It was 9/11. It was
everything else that goes on. (Kevin, bar owner)
Around the time it was looking like the ordinance was going to pass, or
right after it did pass, when people's liquor licenses or leases perhaps
came time to re-up, they just said... My business is already in a slide,
maybe, and I'm not going to make it, so do you know.. .they said
[were] not going to do it. (Bill, restaurant owner and key stakeholder)
The PSFAA is Perceived by Many People to Have Caused a
Great Deal of Controversy in Pueblo
According to this studys participants, the legislation of the PSFAA was
contentious, and it remains a controversial issue in Pueblo to date. The legislation
process was lengthy because of the legal challenges, the referendum, and the
recall election of the City Council members who had originally passed the
ordinance (see Chapter 1). Moreover, because the passage of the ordinance was
so complicated, the whole process was costly for the city, and was especially
costly for the City Council member who lost his seat.
Part of the controversy arises from how polarizing the PSFAA has been
for Pueblo. People interviewed for this study describe themselves as either for or
against the law, and they said that most Puebloans are not ambivalent about the
issue. Supporters like the PSFAA for several reasons: As mentioned in the above
section regarding health impacts, they perceive that tobacco smoke is dirty and
annoyingespecially for nonsmokers who could previously only avoid ETS by
leaving the places where people smoked. Furthermore, supporters believe that
ETS is a health hazard (for themselves, their families, and the general public) and
that the PSFAA effectively removes that threat. Opponents, whose views will be
explored in more detail in the Discussion chapter, believe that the PSFAA is an
example of government intrusion on individual liberties, that it infringes on
peoples right to engage in a legal activity (smoking tobacco), and that the
64


ordinance contravenes business owners property rights and their right to run their
businesses as they see fit. Participants have strong opinions about the law itself,
but they also have strong opinions about the supporters and opponents of the law.
That is, some proponents are still wary of those who blame them personally for
the laws passage, and people who are staunch opponents of the PSFAA are firm
in their opposition to both the ordinance and its backers.
Wade {patron and key stakeholder) was among the first petitioners against
the PSFAA. He still opposes to the law, and has not shifted blame away from its
origins:
...it was not right because they came in and were telling us what you
could do and what you can't do... That was what was not right and it was
the city council who did it.
Kyle (restaurant owner), who was also an early petitioner, echoes that
sentiment:
When the city government changed the smoking ban we fought it
went back and put it up to a vote of people. We got thousands and
thousands of signatures. We also recalled one of the City Councilman,
and we were trying to recall four of them.
Animosity is clearly perceived by people who were instrumental in
passing the law. Michelle, a city employee and key stakeholder, has close ties to
people who were involved with the legislation:
I know that the people who were opposed were vocal and malicious... I
learned that all four people [the councilmen who initially voted for the
PSFAA] had personal threats... phone calls and emails... Their photos
were posted in bars with slashes through their faces. Those councilmen
and their families lost lifelong friends.
Pam, another city employee and key stakeholder, also has close ties to
people involved with the legislation:
They [opponents] had ads running in the paper... with the pictures of the
four councilmen, calling them Nazis. There is still some sadness that the
65


wounds have not healed... and as I said there will be places all of our life
that we cannot go into, and there are lifelong friendships lost...
People who were involved in the legislation are not the only Puebloans
with mixed opinions. The food and beverage industry was also split on the issue.
As restaurant owner and key stakeholder, Bill, explained:
Well, there were definitely two sides as far as business owners were
concerned.
Bill was talking about arguments raised early in legislation. Pueblo, like
many cities in the U.S., has three kinds of food and beverage establishments:
restaurants that only have licenses to sell food; bars that only have licenses to sell
alcohol; and restaurants that also draw a substantial proportion of their revenues
from alcohol sales. These are businesses with dual-licenses; they can sell both
food and liquor. When the PSFAA was being debated, the City Council
considered an exemption for bars, which were defined as businesses with food
sales that amounted to less than 25 percent of their gross revenues. Businesses
that made more than 25 percent of their money on food sales would not have
qualified for that exemption, and they would not have been able to allow
smoking. That exemption was good news for owners like Carol who focused on
food, and wanted to go smoke-free without a customer backlash:
We had to do it [allow smoking], because everybody was doing it, and I
felt that [the ordinance would] level the playing field when nobody could
do it; and I thought that was a great benefit for us. I think it is the
greatest thing since sliced bread because it leveled the field for all bars
and restaurants.
However, the exemption could have been a financial burden for owners
who depend on both liquor and food sales because smokers may have migrated to
establishments that qualified for the exemption. Mel, a key stakeholder who was
close to the legislation process, explained:
66


The phone calls I had gotten there were some bar owners that said well,
You need to make it a level playing field because if Im going to be
forced to comply with this ordinance, but my competitor across the street
or down the street isnt, my customer base is going to go in that
direction.
Kevin (bar owner), while not ambivalent to the health issues involved, was
also primarily concerned with the financial ramifications of the PSFAA:
You know what, I was in the middle so I saw how selfish it was on both
sides... They wanted to break it down to.. .liquor licenses, things like
that. If they were bars they wanted to be able to smoke. If you served
food, you were suppose to be penalized, and not be able to have
smoking... I didnt want an unfair operating practice. I think it should
be one way or the other .. .as long as I knew it was an equal ordinance I
had no problem...
Ultimately, the 25 percent exemption was removed from the version of the
PSFAA that was voted on by the City Council and also by the public via general
referendum. The broader scope of the law quelled business anxieties for the
owners who either felt they couldnt make their restaurants smoke-free until all
were smoke-free, or resisted making their mixed-revenue establishments smoke-
free if any other businesses (i.e. bars) could allow smoking. For them, the law
provided for a level playing field. However, this is not to say that all bar and
restaurant owners then supported the PSFAA, nor that they were necessarily
sanguine about its prospects for their businesses. A more detailed discussion of
the PSFAAs financial implications is included in Chapter 6.
Despite how divisive the PSFAA has been, many Puebloans are not
inflexibly or universally for or against the ordinance, nor are they unsympathetic
to opinions that are not their own. Some have even changed their positions
somewhat since the law has been in effect. Patron A, an articulate and
opinionated young woman, is a proponent of the PSFAA, however she
acknowledges that her criticism of the opponents has softened over time:
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I was totally for it, and Im still totally for it... but I feel bad for
smokers, like my friends, who have to go outside [to smoke]...Its like
theyre ostracized or being punished or whatever because they
smoke.. .and its cold in the winter.
More nonsmokers acknowledge positive aspects of the law than do
smokers. However, smokers seem more inclined to warm up to the idea of the
ordinance now that some time had passed. Relaying comments that his customers
had made, Kevin (bar owner)pointed this out:
I have smokers here that would swear to you that they like it so much
better now than they did before.
Indeed, two of the patrons interviewed for this study who are smokers
stated that they support the PSFAA, at least in-part. Patron C is an outspoken
opponent of the PSFAA for several reasons. However she acknowledges an
upside:
I think it was a good thing passing it for restaurants.
Patron D volunteered that she had voted against the PSFAA but sees some
logic in it:
Well for me, its an inconvenience you know because I smoke but... I
think its a legitimate legislation because of the way... it impacts
everybody else in the environment.
The interviews for this study were conducted mere weeks before the
Colorado Clean Indoor Air Act took effect, and all of the participants were aware
that the governor had signed the bill weeks before. Many people made passing
remarks that suggested they thought the statewide ban would make the PSFAA
somewhat moot. Nonetheless, the PSFAAs opponents still retain some venom
for the laws supporters, many of whom are still sensitive about the attacks that
they sustained. The statewide ban did not seem to provide any common ground
68


for the two sides in Pueblo, and neither faction seemed like they would change
their approach much if they had it to do all over again.
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CHAPTER 6
DISCUSSION
This thesis has described the range and nature and of perceived impacts
that the PSFAA has had on members of the Pueblo community. It has drawn
substantive conclusions about how the participants perceive the PSFAAs
effectiveness, its positive health impacts, how it impacts their individual and
business rights, how it has had an array of economic impacts, and how it has
created or led to a great deal of controversy in Pueblo (see Chapter 5). This final
chapter will attempt to tie all of this studys findings together. In doing so, it will
explore the basis of the participants perceptions; it will relate the data and the
studys conclusions to tobacco control campaigns; and it will consider what
implications this thesis may have for future tobacco control research.
This chapter will also discuss the nature of this studys qualitative
approach and its overall strengths and weaknesses. This discussion will include
the biases and unique personal advantages and disadvantages that the researcher
has brought into this thesis. Moreover, this discussion will focus on how to
evaluate this studys qualitative methodology according to traditional scientific
canons for research. It also looks at this studys reliability and validity, its
potential reproducibility, and its objectivity relative to relative to the
epistemology that underpins its constructivist approach. Finally, this chapter
looks at specific strengths and weaknesses of this studys methods, sampling and
recruitment strategies, instruments, and the researchers influence.
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Theoretical Sensitivity of the Researcher
The interplay between research and researcher means that the researcher
is an instrument of analysis in qualitative studies. (Strauss & Corbin,1998:53).
In the social sciences there is only interpretation. Nothing speaks for
itself. (Denzin, 1998:313).
I have taken advantage of my interpretive qualities throughout the course
of this study, as is the province of a qualitative researcher. These qualities are
derived from what Strauss and Corbin call the researchers theoretical
sensitivitythe ability to give meaning to the content of the data and give it a
voice (1990). Theoretical sensitivity refers to a qualitative researchers
.. .awareness of the subtleties of meaning of data... It is the attribute of having
insight, the ability to give meaning to data, the capacity to understand, and
capability to separate the pertinent from that which isnt. (Strauss & Corbin,
1990: 41-42). This sensitivity is the attribute that empowers the researcher to
base an emerging theory on a corpus of data. Theoretical sensitivity is derived
from an understanding of the literature and theories that underpins the research
questions. However, my sensitivity, my academic acumen, is as much a
derivative of empirical as theoretical knowledge. Indeed, my background and
personal experiences may have done more to shape my interpretive qualities than
anything else.
I come from a working-class upbringing; several of my relatives were and
still are manual laborers. Some of them were union members, and I was raised to
believe in the power of collective-determination. This belief extends to the social
contract that we all agree to when forming a democracy. Despite my cynicism
and occasional lack of faith in my government, I firmly believe that its primary
71


role is to provide for the safety, health, and welfare of society. Before I embarked
on this study, I believed that if an agent (such as tobacco smoke) threatens the
health of the public, then our government has the obligation and the duty to
regulate or remove that agent. This study has concluded, and I still believe that
that obligation is a moral imperative.
I am also a great believer in self-determination, and that people should be
afforded the opportunity to make the most of their potentialbe it in the
classroom, the marketplace, or in the home. Governments therefore should
infringe on that opportunity as little as possible, so long as people do not harm
others in the process. Clearly, it is sometimes difficult to find the right balance
between acting on behalf of many while trying to actualize the rights of
individuals. I have tried to bear in mind this juxtaposition while conducting this
research. The PSFAA is an ordinance intended to protect the public health. In
doing so, it prevents people from smoking when and where they choose to, and
also prevents some entrepreneurs from running their businesses as they see fit.
Although I support public smoking bans, I have kept in mind the competing
interests regarding the PSFAA, and I have tried to give all perspectives a voice
that does not resonate with bias.
Discussion of this Studys Findings about PSFAA Outcomes
This studys interview guides were effective at generating data that
answered the research questions. During the analysis phase of this study, those
data were collated, reexamined, and reorganized to compile the findings of the
investigation. That process was effective for answering the research questions. It
did not, however, further ground this studys substantive conclusions by
interpreting or further explaining them relative to their sociocultural or empirical
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contexts, linking the results to their sociocultural or philosophical origins, or by
relating the results to current pro-tobacco and tobacco control literature. This
section will examine each conclusion, compare it to the literature (where
appropriate), and make a summary statement about what that conclusion means to
public health and tobacco control.
The PSFAA is Perceived To Be Widely Effective in Reducing Environmental
Tobacco Smoke in Pueblos Public Places
The participants seemed to be in agreement that the PSFAA is effective in
reducing ETS in public places. Everyone who was specifically asked about
enforcement mentioned that the ordinance is self-enforcing, meaning that smokers
in Pueblo generally comply with the law as a matter of course. However, this
study was not prepared to address why smokers comply. The only question in the
interview guides that addressed the issue was the introductory grand-tour
question, Tell me about the Pueblo Smoke-Free Air Act, (see Appendices D-F).
Answers invariably indicated that all participants are aware that the law prohibits
smoking in public places. Hence, the noncompliance that was mentioned
probably cannot be attributed to ignorance of the law. I overlooked the
opportunity to probe the issue with Wade when he mentioned he was caught not
complying (see Chapter 5) and with Jimmy when he talked about being cited for
allowing smoking in his bar (see Chapter 5).
So, while compliance is taken as a given for the participants, I have no
empirical data to explain why they all said so. When Gilpin, Lee, and Pierce
(2004) studied compliance in California after it had been a virtually smoke-free 12
12 As an additional point, given the controversy and media hype that surrounded the PSFAA
during legislation, it would have been hard for (English-speaking) people in Pueblo to not know
about the laws basic precepts.
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state for several years, they reported that sociocultural norms about where
smoking should be permitted in public changed after that states laws were
enactedespecially among smokers. Perhaps those norms also changed in
Pueblo after the PSFAA was enacted, and that change has influenced compliance.
I am not prepared to go beyond this anecdotal comparison and present a
speculative explanation that is not supported by more data.
The PSFAA Is Perceived by Some People to Have Had
Positive Health Impacts for the Public in Pueblo
Both proponents and opponents of the PSFAA made statements indicating
at least some acknowledgement that smoking is a health hazard, and even some
opponents acknowledged that ETS is hazardous. Some participants believe that
because the law effectively removes ETS from public places, it has had positive
impacts on the community. Many proponents of the PSFAA went further by
stating that they perceive that the law protects the publics right to health. When
viewed this way, the PSFAA, like other public health ordinances, is an execution
of social justice because it benefits all of society when laws are passed that can
reduce health risks (See Chapter 3 and Gostin, 2001).
The PSFAA is a policy-based public health intervention intended to
provide safer environments for the citizens of Pueblo. It is not an intervention
that targets individuals or singles-out specific public places; the PSFAA applies
nearly everywhere and it is intended to benefit everyone. According to the
interview data, to proponents, the PSFAA demonstrates that public health efforts
contribute to top-down public policies that protect normal social functioning.
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Such policies in-tum help to equalize the distribution and the range of life
opportunities open to individuals across the community (Daniels, 2001).
PSFAA sponsors did not dwell on any negative after-effects that the law
might cause. Anne {key stakeholder) commented that the early PSFAA
supporters in the medical community got behind the law because they thought
removing ETS from public places would be beneficial for everyones health, other
consequences aside:
Yes it's for the health and safety of the public... I dont think the group
I worked with was very concerned it would have a negative economic
impact on Pueblo.
During the PSFAA legislative process, Mel {key stakeholder) countered
arguments that the City should not be involved in setting policy to protect public
health:
My response was, We owe it, from a health standpoint, to our
citizenship.
Mel went on to say that the PSFAA, as a public health ordinance, was not much
different from any other regulatory duty for the City:
We regulate business licenses, and other things like that. It is within the
police power of the City Council and the Municipal Government [to
prohibit public smoking].
Other statements made by supporters of the PSFAA directly refute any
notion that the government of Pueblo should not have implemented regulations
that protect public health. Yet, as mentioned in Chapter 5, those supporters were
also well aware that some people associated the ordinance with some negative
economic impacts. Nonetheless, Key stakeholders, patrons, and owners believed
that by removing ETS from public places, the PSFAA protected peoples right to
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health and a cleaner environment. Restaurant owner Carols understanding was
that this was the primary intention of the law:
I think our city fathers... wanted to protect the employees who have to
work around smoke and don't like to do so, but in order to have a job
they must. And I think they thought this was not fair, so they.. .have a...
smoke-free environment for the workers of Pueblo.
Many PSFAA supporters felt that the law protected not just employees but
also individuals, families, and the general public in Pueblo because it put non-
smokers rights to health in front of others liberty to smoke (Katz, 2005).
Anne (key stakeholder) stated that, in fact, the driving force and primary
intention of the PSFAA was to protect the public:
When I first went to talk to them at City Council, I said, It would be
incompetent of me to not come forward and tell you how dangerous this
[ETS] is... if there was any other substance that was as dangerous as
this, and I didn't come forward and tell you about it and tell you we need
to control it, you would call me incompetent and fire me.
This is a key example of how public health advocacyspecifically tobacco
controlfits the social justice construct of promoting health and well-being (See
Chapter 3 and Healton & Nelson, 2004).
There are PSFAA supporters who mentioned that some bars in Pueblo had
closed since the PSFAA had taken effect, and that the ordinance may have
contributed to a downward trend in liquor sales at other bars. Yet they focused on
what the law does to protect their health and the public health, rather than its
overall price tag:
Its awesome to come out of a place that put the health of people in
front of economic concerns... nonsmokers feel somewhat liberated.
(Michelle, key stakeholder).
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Here Michelle speaks of the onus and social responsibility for public health to
take protective and preventive action for its constituents. Whereas businesses
have traditionally considered their only social responsibility to make as much
money (for their shareholders) as possible, the government, in passing health
legislation, places its moral obligation to protect the public health before serving
the business interests of other citizens (See Chapter 3 and Kreuter, 2005).
Some supporters also pointed out that what could be called the
community of nonsmokers in Pueblo is greater in number than community of
smokers. That larger community of nonsmokers helped to pass the PSFAA, and
in the end, the law was for the greater good:
Well, from a patron's perspective it opens up to a larger percentage of
the population... right now, what is it, 20 percent of the population
smokes and 80 percent doesnt... I think health-wise, the community as
a whole... I think its been a benefit to the individual patrons.
(Patron F)
Finally, this notion that the PSFAA sees to the greater good in Pueblo was
expressed in terms that did not relate directly to individual health outcomes.
Carol (restaurant owner) spoke of how diseases associated with smoking and ETS
can eventually affect not only the majority, but everyone in a community, and that
the PSFAA may provide the added benefit of mitigating those social costs:
I think a lot of people who smoke don't have health insurance. So,
when they get sick they go to the emergency room and I pay for it,
through increased premiums and... my insurance. And it is expensive,
the diseases smoking causes. It is. It is and I am tired of paying for it. I
think something ought to be done to... we have to do something to try to
corral healthcare costs some, and you have something you know is
absolutely detrimental to people's health and causes.. .expensive,
expensive care and treatment, long-term care and treatment, you know
and you know about it, you need to do something about it.
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Some of those eventual costs of smoking are paid for by individuals, and
some of those individuals are nonsmokers. Chapter 5 mentioned Lauras
experiences with her insurance company. Although she is a nonsmoker, she
breathed ETS constantly on a daily basis. That had caused enough nicotine to be
in her bloodstream that the insurance company charged her higher premiums
ostensibly because if she were a smoker, she herself could cost the company more
money eventually because she would be at greater risk for CVD and cancer.
Perhaps the PSFAA serves social justice by not only providing smoke-free
environments for individuals and groups of individuals, but it may also justly
equalize other social conditions that the laws sponsors had not considered (See
Chapter 3 and Powers & Faden, 2000).
The PSFAA is Perceived by Some People to Infringe on Smokers
Individual Rights and the Rights of Businesses to Determine their
Own Smoking Policies
Only one opponent of the PSFAA who participated in this study, bar
owner Jimmy, dwelled appreciably on how he perceived the ordinance had
negatively impacted his business. Yet even he, like the other opponents
interviewed, principally explained his opposition to the PSFAA based on these
libertarian arguments (see also Chapter 3):
1) That the health risks associated with secondhand smoke are insignificant and
therefore do not merit government intervention13 (Gori, 1995);
2) That (in part) because tobacco is a legal substance, smoking is a right that
individuals should be allowed to exercise as they see fit (Cohen, et al 2000);
13 It should be reiterated here that arguments such as these that minimize the health risks of ETS
are not supported by peer-reviewed scientific evidence.
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3) And that business owners have a right to decide for themselves, without
government intervention, whether or not to permit smoking within the
confines of their private property (Cardador, Hazan, & Glantz, 1995).
These arguments, and those expressed by this studys participants, are
manifestations of broader assertions made by tobacco control opponents across
the U.S., namely that smoke-free laws contravene core American libertarian
ideals: personal accountability, individual freedom, free markets, personal
autonomy, and limited government control over these values (See Chapter 3 and
Cohen et al, 2000; Nozick, 1974).
Neither Jimmy nor any other PSFAA opponents directly referenced the
tobacco industry or even the libertarian philosophers, such as Robert Nozick or
Milton Friedman, from whom this rhetoric may have originally been derived. Yet
their language resonates, nonetheless, with libertarian ideology. Restaurant owner
Kyle argued that even his own personal preference regarding smoking did not
dictate the smoking policy for his business:
.. .like I told you earlier, I prefer nonsmoking14 but I am really against
smoking bans anywhere... [the bans are an] infringement on the private
sector's decision on how they want to run their business. I don't like the
government telling me how to run my business.
That point could have paraphrased the work of many prominent libertarian
philosophers because it fits into their ideology of freedom. As Libertarian
philosopher Randy Barnett asserts, .. .since the concept of right carries with it the
freedom to use property, rights are created along with property ownership. I
would contend that this is what ownership means, (Barnett, 1977:16). Thus civil
liberties, such as smoking or setting smoking policies on private premises, are
14 Coincidentally, Kyle volunteered during his interview that the passage of the PSFAA was a
motivating factor in his decision to quit smoking, himself.
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resolvable into property rights (Richman, 1994). These are key libertarian
assertionsthat businesses are extensions of their owners, and that those owners
should decide how to conduct that business, even if some business practices seem
to contravene some public good (Friedman, 1962). In the case of the PSFAA,
owners believed they should have been able to establish their own smoking
policies to suit their businesses and their clientele. Such assertions seem to
overlook there being an onus of social responsibility on restaurant or bar owners.
Patron Cs statements regarding individual rights exemplify the libertarian
rhetoric, and she framed her opposition to the PSFAA in clear libertarian terms:
My opinion is that government is controlling too much of our personal
choices. It's not an illegal substance. Therefore I feel that I should have
the freedom to choose. I think government is having too much of a say-
so in dictating what we can and cannot do in our private lives.
Opponents of the PSFAA also discounted it as a health measure. They
emphasized that because they do not perceive ETS as a substantial health hazard,
the PSFAA is an example of the government abusing its authority. As bar owner
Jimmy put it
.. .they [legislators and public health officials who push for laws to
protect public health] are neo-prohibitionists, theyre underground neo-
prohibitionists trying alcohol, just with a different weapon, thats what
the DUIs are about. Its not about saving lives or making the world safe,
its about prohibition and the smoking ban is the same thing.
The above are textbook tobacco industry and libertarian arguments against
tobacco control (see Chapter 3). Once evidence that ETS is dangerous started to
emerge at the national level, smoking was transformed from a personal to a social
problem (Cardador, Hazan, & Glantz, 1995). The first tobacco industry responses
to reports about the potential risks of secondhand smoke were attempts to debunk
the evidence that it is hazardous. That strategy persists to date, especially for
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supposedly autonomous smokers rights groups (Gori, 1995). Case in point, if
ETS is not really dangerous, the City of Pueblo (or any other municipality) should
not legislate a ban against public smoking (see Arno et al, 1996). Or, as Barnett
once again asserts, A right is a freedom to do something, that is to use property
which includes ones body in a certain way unimpinged by external
constraints... (Barnett, 1977:16).
However, as evidence mounted about the dangers of secondhand smoke,
tobacco companies shifted the emphasis of their arguments against smoking bans
away from health issues and more toward smoking as an ideological battleground
for individual rights, personal liberty, and freedom of choice (Gori, 1995; Cohen
et al, 2000). Public opinion polls and meta-analyses of tobacco industry media
efforts indicate that those campaigns have been successful at rallying smokers
around their cause (Advocacy Institute, 1999). The tenor and tone of PSFAA
opponents comments may have been informed by that pro-tobacco ideological
strategy, whereby smokers and cigarette manufacturers depict themselves as the
champions of libertarian ideals, and tobacco control supporters as enemies of
those ideals (Cardador, Hazan, & Glantz, 1995). Regardless of their origins, the
opinions collected for this study came from PSFAA opponents who were not self-
proclaimed libertariansat least not in name.
The PSFAA is Perceived to Have Had an Array of Economic Impacts on Bars,
Restaurants, and the City of Pueblo as a Whole
That this studys data suggest that decreased bar business is the PSFAAs
salient economic impact calls for further interpretation and explanation. As
outlined in Chapter 5, most participants, when queried, mentioned that they were
under the impression that bars had suffered financially after becoming smoke-free
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environments. However, those participants also mentioned that the PSFAA is one
of many economic factors that may affect those businesses, and they frequently
mentioned DUI enforcement as a detrimental factor. Therefore, decreased bar
business may result from an array of causes, and that, as evidenced in the data, the
small, neighborhood bars maintained a tentative existence before the smoking ban
took effect is worth noting (see Chapter 5).
Recall that Patron C stated that she stopped going to bars in Pueblo after
the PSFAA took effect:
[I] still go to restaurants, I do not go to bars..
Her reasoning behind her own behavior change may help to provide some
explanation as to why Pueblos bar sales are widely perceived to have suffered:
.. .tobacco and alcoholthey go hand in hand; and the fact that people
cant smoke when they are drinking, I think it really hurts the
businesses.
All of the key stakeholders and bar and restaurant owners perceived that
DUI enforcement has caused a decrease in bar business. Some participants also
suggested that because of social marketing efforts like Mothers Against Drunk
Driving and DUI arrests, drunk driving is no longer socially acceptable (see
Chapter 5). Their statements allude to a long-term national trend toward changes
in sociocultural norms about drinking and driving that may also be indicative of a
trend in Pueblo (Grasmick, Bursik, and Ameklev, 1993). Perhaps bars are
bringing in fewer customers and making less money not just because they can no
longer allow smoking, but also because the general publics drinking behaviors
are changing.
Statements such as those made by Patron C, also allude to axioms about
necessary versus sufficient causality (see Mellor, 1995). Participants suggested
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that the PSFAA could be considered a sufficient cause of diminished profits
because the smoking clientele spent less time in bars after the ordinance passed.
But, based on the data gathered for this study about Pueblos economic
conditions, the smoking ban was not considered to be a necessary cause for
business closures. That is, the PSFAA was not the essential condition that caused
economic downturns. This point is supported by the quantitative study of pre and
post-PSFAA economic conditions conducted by Young and colleagues (Young,
Karp, and Diedrich, 2006). The ordinance may well have been detrimental to
some businesses, but a constellation of economic factors are perceived to have
impacted Pueblos economy. People simply did not say that the PSFAA was an
overwhelming, dominant cause. Indeed, save for some isolated incidences, the
smoking ban may not have even been a sufficient cause for bar closures.
Some people may be habituated to smoking and drinking in the same
sitting. That may result, in part, from alcohol and nicotine both having addictive
properties (Istvan & Matarazzo, 1984), and from the integrated rituals of smoking
and drinking. Or, people who smoke and drink may simply prefer to do them
together. Whatever the underlying reason, smokers in Pueblo may not be
smoking or drinking any more or less, but they may be doing either or both more
often outside of bars than they did before the PSFAA took effect.
Quantitative data may substantiate this assertion. The study conducted by
Young, Karp, and Diedrich (2006) suggests that the PSFAA did not have an
economic impact on bars beyond trends projected from pre-implementation
period data. That finding is derived from statistical analyses of economic data
that show a downward trend in bars sales for the period leading up to the
enactment of the PSFAA which continued throughout the period of the laws
enforcement. Moreover, for those same periods, liquor store sales were
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increasing (Young, Karp, and Diedrich, 2006). Those data support the assertion
that, for whatever reason, Puebloans have been spending more money on take-
home alcohol and less money in bars for a period of time that predates the
PSFAA.
The PSFAA is Perceived by Many People to Have Created a
Great Deal of Controversy in Pueblo
There is a difference between how each side perceived the controversy
caused by the PSFAA. Opponents remain embittered about having lost the battle,
and because they still believe that their rights to smoke and run their businesses
unfettered are being contravened. Moreover, based on their interviews, opponents
still blame the City Council and other proponents of the law for instigating the
smoke-free interventions, despite the fact that a citywide referendum approved the
PSFAA after its initial recall (see Chapter 5).
Conversely, PSFAA proponents are pleased that Pueblos public places
are now virtually smoke-free. However, some of those proponents perceive the
controversy quite differently than the opponents do. The attacks that the City
Council and their associates sustained are remembered vividly. During
legislation, those people were compared to Nazis; the Pueblo Chieftain repeatedly
ran unfavorable editorials; pictures of the four City Council members who
initially voted for the ordinance, including hostile slogans, were posted in bars all
over Pueblo; and those Council members received (anonymous) hostile and
threatening phone calls, emails, and letters. During interviews, some of the
PSFAA proponents that were involved in, or otherwise close to, the legislative
process also lamented that because of the controversy that ensued, they lost
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lifelong friendships and are still unable to patronize establishments owned by
outspoken PSFAA opponents.
Each respective side of the PSFAA controversy has lived that experience
differently, but for both sides, the strife and controversy caused by the PSFAA is
anchored in how polarizing it has been as an issue in the Pueblo community.
The next section of this thesis posits a substantive theory to explain why people
were split into these two camps.
One of Two Principal Characteristics that Distinguishes Proponents and
Opponents of the Pueblo Smoke-Free Air Act is their Ideological Stance on
Civil Rights: Proponents Advocate Social Justice, and
Opponents Advocate Libertarian Ideals
The people who participated in this study can be neatly divided into one of
two groups: they are either proponents or opponents of the PSFAA. Yet these
two groups otherwise have a lot in common. Both groups have similar age
characteristics; they include men and women, key stakeholders, bar and restaurant
owners, and patrons of those businesses; and they also include both smokers and
former smokers. As demonstrated by the study data, both supporters and
opponents perceive that the PSFAA is effective at reducing ETS in public places,
that it has had positive health impacts, that it has had a range of economic
impacts, and that it has created a great deal of controversy. This is not to say that
the perceptions that they seem to share are without nuance. For example, PSFAA
opponents commented on negative economic impacts in more detail and
expressed rarely and reluctantly that the law has had positive health impacts (see
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Chapter 5). It is worth noting, however, that no nonsmokers are PSFAA
opponents.15
Based on the above interpretations of this studys findings, the following
substantive theory proposition explains why the participants support or oppose the
PSFAA, and how that difference may shape their overall perceptions of the
ordinance. For PSFAA proponents/advocates of social justice, the provision and
fair distribution of the determinants and social conditions (including healthy
social and physical environments) necessary for health promotion are foremost
civil rights (Powers & Faden, 2000). Regarding the PSFAA, proponents believe
that libertarian ideals should not supersede the publics right to health. That is,
people do not have a right to smoke or allow people to smoke on their property if
it endangers others because people have a right to live and work in healthy
environments.
For the PSFAA opponents/advocates of libertarian ideals, core individual
freedoms such as self-determination and personal accountability, free enterprise,
private property rights, and minimal government intervention into peoples
private lives and capital endeavors are foremost civil rights (Barnett, 1977; Cohen
et al, 2000). Regarding the PSFAA, opponents believe that health concerns
should not supersede their libertarian ideals. That is, people have a right to
choose to smoke in public or to allow smoking in their places of business because
ETS is not perceived as a substantial hazard.
The PSFAA, as a legislated health intervention, prohibits smoking in most
public places, and is widely effective at reducing ETS in those places. For
PSFAA proponents/advocates of social justice, the favorable intended outcomes
15 This is the only readily identifiable characteristic that could predict whether participants would
be PSFAA supporters or opponents. No demographic characteristics were capable of doing so,
nor was identification with any one interview category.
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are realized because Pueblos public places are smoke-free by legal mandate. For
PSFAA opponents/advocates of libertarian ideals, the unfavorable intended
outcomes are realized because by law people cannot smoke in public places and
restaurant and bar owners cannot set their own smoking policies.
Ultimately, the PSFAA actualizes social justice, so its adherents regard the
law favorably. Conversely, the law contravenes libertarian aspirations, so
adherents to that political philosophy regard the law unfavorably. See Figure 1
below for a predictive model based on the substantive theory articulated in this
section.
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Figure 1: Predictive Model for Overall Perceptions of the PSFAA
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Comments on this Studys Validity, Reliability, and Overall Credibility
This study has exclusively employed qualitative methods, and was
informed by a constructivist paradigm. Some social scientists suggest that for
such work the traditional positivist canons of reliability, validity, generalizability,
repeatability, and objectivity (which are well suited for quantitative analyses) are
inappropriate and should be abandoned ( Strauss, 1987). Others have adopted
post-positivist criteria and that do not abandon those traditional standards in as
much as they modify them to suit their paradigms (see Strauss & Corbin, 1998).
Others, still, choose to extend their constructivist interpretation and redefine or
translate validity, reliability, and objectivity into entirely different terms
(Denzin & Lincoln, 1998). I consider parts of those evaluation approaches to be,
on some levels, semantic tricks for comparing apples and oranges. Still, I believe
nonetheless that the credibility of qualitative research should be evaluated. Since
qualitative theorists have not fully developed a universally accepted vocabulary of
their own, I will comment on the design and methods employed by this
investigation using both traditional language and some of the terminology adopted
more recently.
The Quest for Objectivity
The constructivist paradigm employed by this thesis assumes that there is
not verifiable objective truth that can be discovered in the data because this study
was an interpretive exercise intended to increase our understanding of the
multiple perspectives and responses to the PSFAA. Strauss and Corbin (1998)
refer to objectivity in qualitative research as the ability of the researcher to
achieve some distance from the data, to represent them fairly, and to give them a
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voice that is not exclusively that of the researchers. That is how the quest for
objectivity has been undertaken for this thesis.
Validity
In the most basic sense, internal validity conventionally refers to whether
an investigation is able to isolate the factors it sets out to study (Glasgow, 2002),
and the extent to which the findings of a study accurately represent reality in the
study situation (Creswell, 1998; Kirk & Miller, 1986). The former refers to
elements of the research design, the latter the quality of the data produced by a
chosen method. For social science research, especially qualitative works,
complete internal validity is not theoretically obtainable (Kirk & Miller, 1986).
Quantitative and positivist studies have the ability to evaluate their internal
validity according to whether Type I and Type II errors exist. These errors refer
to whether the researcher is making inaccurate claims about what the data mean,
and there are multitudes of tests and methods that identify Types I and II errors
(Gordis, 2004). However, for a qualitative study such as this thesis, these kinds of
errors cannot be revealed. As mentioned in Chapter 3, there was no right or
wrong answer for the participants. Therefore, no test can evaluate whether they
answered correctly or incorrectly. Here internal validity refers to interpretive
validity (Altheide & Johnson, 1998), which is how well this investigation
examined what it intended to (first definition above) and how well the data were
interpreted.
Kirk and Miller (1986) assert that most validity errors in qualitative
research result from Type III errorsasking the wrong questions. Such questions
might by accident produce data valuable to a study, but in most cases even a right
answer to the wrong question undermines the internal validity of a study. I agree
90