title: Enforcement of Ohio's Smoke Free Workplace Law through the lens of public health practice.
abstract: OBJECTIVE
  Little is known about whether public health (PH) enforcement of Ohio's 2007 Smoke Free Workplace Law (SFWPL) is associated with department (agency) characteristics, practice, or state reimbursement to local PH agencies for enforcement. We used mixed methods to determine practice patterns, perceptions, and opinions among the PH workforce involved in enforcement to identify agency and workforce associations.
  
  
  METHODS
  Focus groups and phone interviews (n=13) provided comments and identified issues in developing an online survey targeting PH workers through e-mail recruitment (433 addresses).
  
  
  RESULTS
  A total of 171 PH workers responded to the survey. Of Ohio's 88 counties, 81 (43% rural and 57% urban) were represented. More urban than rural agencies agreed that SFWPL enforcement was worth the effort and cost (80% vs. 61%, p=0.021). The State Attorney General's collection of large outstanding fines was perceived as unreliable. An estimated 77% of agencies lose money on enforcement annually; 18% broke even, 56% attributed a financial loss to uncollected fines, and 63% occasionally or never fully recovered fines. About half of agency leaders (49%) felt that state reimbursements were inadequate to cover inspection costs. Rural agencies (59%) indicated they would be more likely than urban agencies (40%) to drop enforcement if reimbursements ended (p=0.0070). Prioritization of SFWPL vs. routine code enforcement differed between rural and urban agencies.
  
  
  CONCLUSIONS
  These findings demonstrate the importance of increasing state health department financial support of local enforcement activities and improving collection of fines for noncompliance. Otherwise, many PH agencies, especially rural ones, will opt out, thereby increasing the state's burden to enforce SFWPL and challenging widespread public support for the law.
authors.affiliation: Cleveland Department of Public Health, Cleveland, OH 44106-7069, USA. david.bruckman@case.edu
authors.forename: David
authors.initials: D
authors.lastname: Bruckman
authors.forename: Terry
authors.initials: T
authors.lastname: Allan
authors.forename: Matthew
authors.initials: M
authors.lastname: Stefanak
authors.forename: Aiswarya
authors.initials: A
authors.lastname: Chandran Pillai
authors.forename: Aylin S
authors.initials: AS
authors.lastname: Drabousky
authors.forename: Elaine A
authors.initials: EA
authors.lastname: Borawski
authors.forename: Scott
authors.initials: S
authors.lastname: Frank
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D035846:Law Enforcement; D008297:Male; D009820:Ohio; D015980:Public Health Practice; D012424:Rural Population; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D014505:Urban Population; D017132:Workplace / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data