Voluntary Smoke-Free Measures Among Oklahoma Nightlife Owners: Barriers and Facilitators

Abstract

Smoke-free policies prevent exposure to secondhand smoke and encourage tobacco cessation. Local smoke-free policies that are more comprehensive than statewide policies are not allowed in states with preemption, including Oklahoma, which has the sixth highest smoking prevalence in the United States. In states with preemption, voluntary smoke-free measures are encouraged, but little research exists on venue owners’ and managers’ views of such measures, particularly in nightlife businesses such as bars and nightclubs. This article draws from semistructured interviews with 23 Oklahoma bar owners and managers, examining perceived risks and benefits of adopting voluntary smoke-free measures in their venues. No respondents expressed awareness of preemption. Many reported that smoke-free bars and nightclubs were an inevitable societal trend, particularly as younger customers increasingly expected smoke-free venues. Business benefits such as decreased operating and cleaning costs, improved atmosphere, and employee efficiency were more convincing than improved employee health. Concerns that voluntary measures created an uneven playing field among venues competing for customers formed a substantial barrier to voluntary measures. Other barriers included concerns about lost revenue and fear of disloyalty to customers, particularly older smokers. Addressing business benefits and a level playing field may increase support for voluntary smoke-free nightlife measures.

INTRODUCTION

Smoke-free policies are important interventions that protect nonsmokers from exposure to secondhand smoke (SHS; U.S. Department of Health and Human Services, 2006). Smoke-free policies also encourage tobacco cessation and reduce tobacco prevalence, consumption, and youth initiation (Callinan, Clarke, Doherty, & Kelleher, 2010; Hopkins et al., 2010; International Agency for Research on Cancer, 2009). Smoke-free policies result in improved cardiovascular health outcomes, reduced smoking-related mortality, and positive pulmonary and perinatal health outcomes (Frazer et al., 2016). Extending these policies to bars, restaurants, and nightclubs may also counteract tobacco industry marketing strategies that aggressively promote tobacco use with alcohol (Jiang & Ling, 2011). Public acknowledgment of the hazards of SHS in the United States is high, including in Oklahoma. As of 2010, more than 90% of smokers and 95% of nonsmokers in Oklahoma viewed SHS as dangerous (Rhoades & Beebe, 2015).

To block local smoke-free policies, tobacco companies have promoted preemption (Nixon, Mahmoud, & Glantz, 2004), wherein local jurisdictions are legally prevented from passing stricter laws than those passed by the state (Siegel et al., 1997). In 2011, the Institute of Medicine recommended avoidance of preemption, and Healthy People 2020 objective TU 16.1 calls for the reversal of all preemptive tobacco laws (U.S. Department of Health and Human Services, 2016). According to the Centers for Disease Control and Prevention, Oklahoma is one of only six states to have local control preempted in smoke-free policies, tobacco advertising, and youth access to tobacco products (Centers for Disease Control and Prevention, 2011). Preemption has existed in Oklahoma since 1987 (Americans for Nonsmokers’ Rights, 2016; Givel, 2005) and was reconfirmed in the state’s 2003 Smoking in Public Places and Indoor Workplaces Act, which exempted all bars from smoking restrictions and allowed ventilated smoking rooms in restaurants. Oklahoma’s smoking prevalence is 22%, sixth highest in the United States and above the national average of 17.8% (Centers for Disease Control and Prevention, 2016).

Social ecological theory holds that behavior change should be influenced from multiple levels (Bronfenbrenner, 1989). One conceptualization intended for use in health promotion delineates intrapersonal, interpersonal, institutional, community, and policy levels in order of proximity to the individual (McLeroy, Bibeau, Steckler, & Glanz, 1988). Since preemption limits policy-level actions that promote smoke-free environments, interventions in Oklahoma have had to concentrate on community- and institutional-oriented efforts, such as voluntary smoke-free policies (Douglas et al., 2015) enacted by businesses themselves. Social ecological theory also emphasizes that health promotion influences are reciprocal and that a change at levels close to the individual can precipitate changes at the levels farther out. With this in mind, there is promise that voluntary measures may not just alleviate SHS exposure but also increase support for nonsmoking policies at the state level by denormalizing smoking, encouraging public dialogue, and generating firsthand experience with smoke-free workplaces (Mowery, Babb, Hobart, Tworek, & MacNeil, 2012). Benefits to business might increase support for voluntary measures. For example, tobacco retailers in Oklahoma expressed receptivity to voluntarily removing tobacco advertisements in their stores in exchange for positive publicity (Chan, Douglas, & Ling, 2015).

While initiatives have long promoted voluntary smoke-free schools and workplaces (Douglas et al., 2015), support is also growing for smoke-free nightlife. Support for smoke-free bars and similar venues increased nationally from 24.1% in 1992–1993 to 56.8% in 2014–2015 (U.S. Department of Commerce, Census Bureau, 2016). In 2010, 51% of nonsmoking Oklahomans favored smoking bans in bars and nightclubs (Rhoades & Beebe, 2015). Previous studies have examined restaurant proprietors’ views of voluntary smoke-free measures, both nationally (McDaniel, Offen, Yerger, Forsyth, & Malone, 2015) and in North Carolina (Johnson, Becker, Inman, Webb, & Brady, 2010). Respondents in these studies felt that they had the public’s support for smoke-free restaurant measures following implementation. In addition to health benefits, smoke-free measures conferred greater customer satisfaction, less cleaning costs, and more customer turnaround. However, these studies did not include operators of bars or nightclubs. The current study is the first to examine attitudes about voluntarily adopted smoke-free measures among owners and managers of a range of nightlife venues in a state with preemption. It has the potential to inform stronger smoke-free policies in preemptive states and to provide avenues for advocacy groups to promote smoke-free environments despite legislative barriers.

METHOD

Study Context

In 2015, semistructured interviews were conducted with 23 nightlife venue owner/managers in urban and suburban venues near Tulsa and Oklahoma City, Oklahoma. Oklahoma has a conservative sociopolitical environment with self-identified political conservatives outnumbering liberals 2-to-1 (Pew Research Center, 2015), suggesting less support for government regulation of business than in more liberal states.

Two media campaigns promoted voluntary smoke-free measures to nightlife venue owner/managers in Oklahoma in the years prior to and concurrent with data collection. These were (1) Breathe the Music/Musicians for a Smoke-Free Oklahoma run by the American Cancer Society from 2010 to 2012, which sought to protect performers and attendees in Oklahoma from SHS, and (2) Free The Night (FTN), a statewide campaign run by the social marketing agency RESCUE and funded by the Oklahoma Tobacco Settlement Endowment Trust, which promoted voluntary smoke-free measures by highlighting demand for nonsmoking bars. FTN launched in 2014, prior to data collection, and is ongoing. The campaign focuses on the Oklahoma City and Tulsa areas, encouraging nightlife venue owners and managers to adopt smoke-free “pledges,” and promotes the venues that do so via print and digital channels.

This article draws from data collected as part of formative research to inform implementation of the FTN media campaign. The purpose of the study was to describe bar owners’ and managers’ views of voluntary smoke-free policies and to provide a baseline for future campaign evaluation. The semistructured interview guide included two sections: (1) to elicit nightlife venue owners’/managers’ general views of and experience with smoke-free measures and (2) to elicit owners’/managers’ responses to existing campaign materials (print and video messages). The opportunities and barriers to adopt voluntary smoke-free policies emerged as analytic categories during analysis of the transcripts.

Data Collection

A comprehensive list of 496 bars and nightclubs and their smoke-free measure status was maintained by FTN. Bars both with and without smoke-free measures were purposively sampled with the goal of recruiting equal numbers of each. Participation with FTN was not used as a recruitment criterion.

Nightlife venue owners/managers were difficult to recruit. Pilot efforts by academic research partners in Oklahoma to conduct interviews in 2014 were unsuccessful. In 2015, a market research firm in Oklahoma was contracted to assist with recruitment and interviewing. Between May and June 2015, respondents were recruited by phone, social media, and in-person visits. A target of 20 to 25 participants was set based on prior experience reaching theme saturation in interviews with tobacco retailers (Chan et al., 2015). Participants received $100 incentives. Interviews were conducted at the bar/nightclub, the market research firm’s offices, or any other location convenient for participants.

Interview guide questions were organized into two sections: (1) description of the venue attributes and customer base, status and opinions of the smoking measures in the venue, and views of smoke-free measures in Oklahoma more broadly and (2) feedback on a series of print and video materials from smoke-free campaigns. Questions were developed by the researchers, who coordinated with campaign managers to elicit useful feedback. All interviews were recorded and professionally transcribed, and all protocols were approved by the Public Health Institute’s institutional review board.

Analysis

Transcripts were coded using thematic analysis (Braun & Clarke, 2006). Two authors read five transcripts to identify broad themes and to generate an initial list of codes that was developed and refined iteratively by several authors. The first author then coded transcripts in Dedoose, a cloud-based collaborative qualitative research platform (SocioCultural Research Consultants, 2015). A subset of transcripts was double coded, and discrepancies were resolved by discussion. After iterative team discussions, codes were modified and subcodes were created. The subsequent coding scheme was applied to all transcripts. Codes were grouped to develop overarching themes, which were reviewed and refined by the team for coherency and consistency. Responses selected as examples of each theme were stripped of identifying information. Pseudonyms were applied for participant confidentiality.

RESULTS

Of the 23 participants, only three recognized the names of at least one of the smoke-free campaigns and were able to describe the purpose of the campaign(s). One venue signed a pledge with FTN to go smoke-free. Another nine had some recognition of one or more campaign names but were unable to state the purpose of the campaign(s). The remaining 11 reported no campaign recognition at the time of the interviews. As the study focused on respondents’ views of smoke-free policies for campaign formative research rather than evaluation, more extensive measures of awareness of campaign themes and messages beyond name recognition were not used.

Just under half of the venues (n = 11) never allowed indoor smoking (noted as “N” following pseudonym). The remaining establishments sometimes or always allowed indoor smoking (noted as “S” following pseudonym). Nightlife venue owners’/managers’ perceptions and attitudes are organized below into (1) opportunities for promoting voluntary smoke-free measures in Oklahoma nightlife venues and (2) barriers to promoting such measures. Table 1 presents a full list of themes and representative quotes.

TABLE 1.

Attitudes Toward Voluntary Smoke-Free Measures: Emergent Themes

Theme	Quote	Smoking in bar?a
Themes suggesting opportunities to promote smoke-free measures
Trends favoring smoke-free norms	“It works there because the younger people, I mean, there’s been so much awareness about cigarette smoke and the harmful effects that it has on your body. I think that younger people are more educated about that so they’re more apt to not smoke.”	Yes
Customer gratitude for smoke-free measures	“‘I’m so glad this is a non-smoking place.’ Most people don’t realize that it has to be non-smoking anyway on the inside. They still say it, and they say, ‘That’s a good idea. That way, I can come here and have a good time. I usually can’t go to the other bars that you can smoke at, or don’t want to.’”	No
Customer loyalty to venue	“People come here for many reasons, and smoking is just a small part. People, they have a home here, they have family here, good friends, so they’re going to keep coming here no matter what. It’ll just be a little bit of a transition for them to get used to having to step outside and take a couple drags.”	Yes
Mixed groups prefer nonsmoking bars	“I think people will find that, yes, there are many more nonsmokers than there are smokers. They will not go into a smoking environment, period. I do from time to time, but they won’t. They will absolutely not do it. You’re going to find out, yeah, you’re right, those people they’re staying home, they’re not spending their money, and once the smoke goes you’re going to be fine. The smokers, you’re going to find that they’re still going to walk out, have a smoke on the street, or walk out and have a smoke wherever they can, and come back and still keep spending their money with you.”	No
Cost and labor savings	“Just say hey, it’s against the law. I can’t do anything about it. It might improve business because I know that every year there’s less and less people smoking. I’ve been wanting to come in and redo the place. Every year, I think they’re going to push something through but I don’t want to come in and put brand new carpet in and all that if they’re not going to …”	Yes
Improved customer service	“We made it a point to hire non-smokers and the reason we did that is because all of this being in the bar industry, you’re busy from the time you get there usually until the time you leave and we’ve been there with people who’ve taken 5 smoke breaks and we don’t want to have to deal with that, deal with finding a place where they could go smoke or wasn’t in front of customers …”	Yes
Improved musician/performer satisfaction	“For the most part, musicians don’t [like smoking]. Singers don’t. Just general. I know plenty that do. It damages … they don’t have a choice and they’re right up at the front and center, so everyone is looking at them and blowing smoke at them too. Even if they do smoke, I don’t think that is something they enjoy.”	No
Themes suggesting barriers to promoting smoke-free measures
“Uneven playing field”—smoke-free venues lose to competitors	“It would have to be you made it a law not do it on your own, because if you do it and they have the option to go somewhere else … then they’ll probably go somewhere else. It would hurt your business as opposed to if they went state-wide, ‘Okay, nobody can smoke.’ Then they don’t have an option to go somewhere else where they can smoke, they’ll go wherever they want to go.”	Yes
Business slump after going smoke-free	“Just so I’m being fair to this bar, is I would think the first thing that happens is negative, because even if you believe that to be true, you’re going to lose a clientele before you gain a clientele. It’s not an instantaneous thing, and if you don’t have a deep pocket, you can be out of business.”	Yes
Venue loyalty to customer	“We have this girl that works for Home Depot. She’s here five days a week for three hours a day, but she drinks Grey Goose and cigarette. I do not have the ability or the dumbness to tell this girl that I don’t want you in here because you smoke. That would be like walking out in the street and getting hit by a car.”	Yes
Mixed groups prefer smoking bars	“People said, ‘If you’d make this non-smoking, we’ll be here all the time.’ And so I did that, and it was empty. I had a line to get in this club here, and the people that said, ‘If you’d make this non-smoking, we’ll be here all the time,’ I would go up to them and say, ‘What’s the deal?’ ‘Well, we’ve got to be where the crowd is.’ So, smoking wasn’t the factor, the crowd was the factor in their decision.”	No
Need for outdoor smoking spaces	“For here, it would be trying to find a place where you could smoke because we’ve only got the main entrance. You’d either have to go out to your car to smoke or we’ve got the backdoor but once you step out the backdoor you’re right in the parking lot, too. We don’t have anywhere to setup a patio or anything like that.”	Yes
Employees responsible for own health	“I hate to say this because I’m a non-smoking bar but they made their decision. I don’t know, if they didn’t want to work in a smoking bar, you’ve got a lot of smokers out there still that wouldn’t mind working in a smoking bar.”	No

^aRefers to smoking policy in respondent’s bar. Themes were not segregated by bar smoking policy.

Opportunities for Promoting Voluntary Smoke-Free Measures

Nightlife venue owners/managers discussed trends favoring smoke-free norms, customer gratitude for going smoke-free, and customer adaptation to smoke-free measures, as well as several benefits of going smoke-free, including cost and labor savings, improved customer service, and increased musician/performer satisfaction. The majority (n = 15) of respondents expected all nightlife venues in Oklahoma to eventually become smoke-free. Many expected smoking bans in bars and restaurants to be enacted by legislation, though opinions differed as to whether this would be welcome or intrusive. None seemed aware of Oklahoma’s preemption blocking local smoke-free policies. Respondents described younger patrons as having a lower tolerance for smoking than older patrons and as increasing demand for more nonsmoking policies and measures over time. Participant explanations for why younger bar patrons were more likely to embrace nonsmoking policies included health, the unpleasant aesthetics of tobacco smoke, and the greater ease with which younger smokers refrain from or quit smoking.

Several proprietors of smoking bars noted a generational split in smoking norms. Norman (S) said that he “noticed a couple of the bars here downtown that are smoke-free, and they’re all full with yuppies. You very seldom see a guy my age in that bar.” By contrast, he said, “Old people like me, I’m going to go somewhere where I can sit down and have a cigarette.” David (N) objected to legislated smoke-free policies but viewed such legislation as inevitable given the preferences of younger patrons. Finally, Walter (N) expressed, perhaps, the strongest opinion in this regard:

The Millennials, the younger generation, I think that’s actually going to be the generation that stops smoking almost altogether in a lot of places. . . . Eventually it’s going to stop in all public places when they do that.

Respondents from nonsmoking venues noted receiving praise from nonsmokers for their smoke-free measures, especially regarding the venues’ lack of smell or residue, cleaner appearance, and the customers’ decreased respiratory discomfort. Some respondents felt that nonsmokers proactively seek smoke-free environments. Reggie (N) noted,

Smokers don’t call and ask if you’re a smoking bar because they’re going to smoke a cigarette regardless, inside or outside, somewhere. It’s always the nonsmokers …

Notably, none of the respondents recalled smokers thanking them for allowing smoking in their venue. Though many were anxious about being disloyal to their smoking customers, some believed loyalty could be an asset to bars going smoke-free. Bryan (S) explained,

People come here for many reasons and smoking is just a small part. People, they have a home here, they have family here, good friends, so they’re going to keep coming here no matter what.

Some respondents, primarily those with smoke-free measures, noted that mixed groups of smoking and nonsmoking customers seem to favor nonsmoking venues. Walter (N) observed that nonsmokers “will not go into a smoking environment, period,” whereas smokers could smoke outside and later rejoin their group.

Respondents with smoking establishments, on the other hand, tended to have the opposite perception, reporting that smokers were more likely than nonsmokers to choose a venue based on its smoking rules. Most ascribed this to the convenience of not having to get up in smoking-allowed venues to smoke. Jerry (S), a dance club owner, recounted an effort to enact smoke-free measures on customer request, only to suffer an attendance drop and find those same customers in line at another club. Jerry promptly reinstated smoking in his venue.

The cost and labor needed to mitigate physical damage to venues may present another opportunity to promote voluntary smoke-free measures. Cigarette burns are costly, as dance club proprietor Leonard (S) recalled:

I could put down new carpet and the first night I’ll have 40 burns. I’ve done that three times.

He also complained about the labor needed to clean what he referred to as “nicotine fuzz” from the electronics in the venue. One smoking establishment owner was convinced that smoke-free legislation was imminent and said that he would wait for the implementation of such legislation to make upgrades to his bar. Similarly, Adam (N) decided to implement a smoke-free measure when he made improvements to his establishment to protect his investment.

Economic concerns also underlay several respondents’ preferences that employees not smoke on the job. Respondents from smoking-allowed bars perceived employee smoking as reducing customer service quality and employee productivity. Norman (S) saw it as compromising the atmosphere of his venue:

Don’t even wait on one of my customers with a cigarette in your hand. Don’t go fix a drink with that cigarette in your hand. Don’t go wipe the bar down with that cigarette in your hand.

Roger (S) refused to hire smokers due to loss of productivity during smoke breaks:

You’re busy from the time you get there usually until the time you leave and we’ve been there with people who’ve taken five smoke breaks and we don’t want to have to deal with that …

Adam (N) did hire smokers but restricted smoking until the end of service saying, “I can’t afford to allow you to go on smoke breaks.”

Finally, some participants mentioned the desire to provide a smoke-free environment for performers. Reggie (N), for example, found that musicians “don’t want to perform in a smoky room. . . . Even if you are a smoking room, you will turn non-smoking for that night for certain artists. It’s easier to go non-smoking all the time.”

Barriers to Promoting Voluntary Smoke-Free Measures

Nightlife venue owners/managers discussed perceived barriers to voluntary smoke-free measures. These included different smoke-free statuses among venues disrupting what Roger (S) termed the even playing field, a business slump after going smoke-free, damage to loyal customer relationships, the need for outdoor smoking spaces, and the belief that employees should choose their working environment to avoid SHS.

Many respondents worried that voluntary measures create a disadvantage when competing for customers. Opinions varied as to whether this could be offset legislatively. Some respondents were opposed to any form of government regulation. For example, Derek (S) said, “It’s America. You should be able to do what you want to do.” However, other respondents viewed legislation as necessary to protect the “even playing field” in competing for customers. As Michael (S) explained, a law would be necessary for his bar to adopt nonsmoking measures since “if you do it and [customers] have the option to go somewhere else, then they’ll probably go somewhere else.”

Some of the campaign materials shown to respondents included the message that business rebounds after implementation of smoke-free measures. This provoked concerns among respondents that a period of reduced business following smoke-free measure adoption would close the venue before a rebound. Roger (S) explained,

It’s kind of like building an expressway and saying, “Oh, when this expressway’s finished, your business will be booming.” Well, if you go out of business while the construction is going because it destroyed your business, you’re out of business.

The majority of respondents from smoking venues believed that smoking customers would desert them if they went smoke-free, and many expressed concern about causing distress to loyal customers. As Derek (S) put it, “I have a lot of old-time customers that smoke and don’t really want to offend them by going smoke free.” Peter (N) experienced this type of customer distress after restricting smoking to his venue’s patio:

I had a lot of angry, angry people. . . . People would come in here and they’d light cigarettes, “Sorry, we’re non-smoking, sorry we’re non-smoking.” They’d say, “You’ll never make it. You’ll never make it.” Throw the cigarette on the floor.

Respondents recognized that smoke-free measures may be easier to implement in venues with outdoor drinking spaces, such as patios. However, not all bars have such spaces, and Michael (S) regarded this as a hindrance to smoke-free measures: “We’ve only got the main entrance. You’d either have to go out to your car to smoke or we’ve got the backdoor.” Although Adam (N) was aware of some bars and restaurants that have separate nonsmoking and smoking rooms, he saw those as problematic:

The problem when you do a smoking room is it’s a closed environment, it’s too close of a space and it becomes a cloud of smoke. There’s no enjoyment in smoking when it’s that small of a room.

Few respondents felt compelled by employee health to go smoke-free. Natasha (N) attributed this to high staff turnover rates: “They’re here and they’re gone.” In response to viewing campaign materials that emphasized the dangers of SHS for staff, nine respondents stated that employee SHS exposure is a consequence of employee choice to work in a smoking bar. Peter (N) said,

They made their decision. I don’t know, if they didn’t want to work in a smoking bar, you’ve got a lot of smokers out there still that wouldn’t mind working in a smoking bar.

DISCUSSION

These findings suggest that even in states with preemption, nightlife venues can be persuaded to adopt smoke-free measures. Health promotion practitioners in preemptive states (or policy environments where the political will for clean-air laws is otherwise lacking) may be able to use these results to persuade venues to adopt voluntary smoke-free policies. In addition, some of these findings suggest that some current messaging lacks salience and may help guide efforts for evaluation and improvement.

Previous qualitative research on attitudes toward smoke-free venues has focused on restaurants and/or legislatively mandated smoke-free policies (Johnson et al., 2010; Linnan, Weiner, Bowling, & Bunger, 2010). The current study, in an environment that only allows for voluntary policies, nonetheless echoed some of the attitudes and perceptions described in the existing literature. These attitudes include the following: customer gratitude for going smoke-free (Johnson et al., 2010; McDaniel et al., 2015), customer adaptation to smoke-free policies (Borland et al., 2006), the facilitative role of outdoor spaces (Heim et al., 2009; Satterlund, Lee, & Moore, 2012), cost and labor savings (Johnson et al., 2010; Parrott, Godfrey, & Raw, 2000), improved employee performance (Sarna, Bialous, Wewers, Froelicher, & Danao, 2005), business slumps after going smoke-free (Glantz & Smith, 1997; Lund & Lund, 2011), and damage to loyal customer relationships (Heim et al., 2009; Johnson et al., 2010). In addition, we found some novel attitudes that were not congruent with the existing literature. These findings include the following: first, the belief that employees—not employers or customers—bear responsibility for their own health, and second, the perception that an “uneven playing field” can result from different smoke-free statuses between venues. Moreover, although nightlife trends favoring smoke-free environments had been observed in large cross-sectional surveys (U.S. Department of Commerce, Census Bureau, 2016), the current study provides elaboration on how venue owners view these changes.

Respondent disinterest in appeals to employee health runs contrary to the assumption informing many voluntary smoke-free workplace campaigns (e.g., Americans for Nonsmokers’ Rights, 2017; FTN, 2017; Smoke-Free Fort Worth, 2017). Participants expressed more concern about negative customer perceptions of employee smoking and labor inefficiency due to smoking breaks. Several participants expressed the conviction that employees were responsible for managing their own health by choosing where to work. This emphasis on personal choice might reflect the civil libertarian sociopolitical context of Oklahoma. Respondents were more accommodating of performers’ preferences for smoke-free environments than employees, perhaps because performers help draw customers. Campaigns promoting voluntary smoke-free nightlife environments might highlight the immediate financial benefits of securing entertainment and improved customer experience rather than employee health.

Many respondents expressed concern about an uneven playing field, meaning their business might suffer if they went smoke-free while other venues still allowed smoking. Many participants were ideologically opposed to government regulation, but many also preferred a legislated smoke-free policy over voluntary measures because this would require all establishments to go smoke-free at the same time. Businesses may be more open to smoke-free measures when enacted simultaneously by a group of venues and promoted as a voluntary action. Respondents in this study also had little awareness of statewide preemption of local policies. Efforts to repeal preemption may be more popular if bar owners and managers received more education about the legislative context and if such efforts were framed as efforts to fight government overreach and return power to the local community.

Social ecological theory posits that changes across levels can be reciprocal; therefore, encouraging voluntary bans may have a “trickle-up” effect and change community-level attitudes toward smoking. For example, local experience with voluntary smoke-free policies and their effect on business may increase support for these policies more widely. The desire for a “level playing field” may hinder implementation of some policies, as observed in prior research (Satterlund, Antin, Lee, & Moore, 2009), but this study adds that it may also be used to support efforts to overturn state level preemption to allow uniform local policies rather than voluntary measures alone. These views of smoke-free bar policies may also inform implementation of other smoke-free policies, such as smoke-free multiunit housing. For example, the U.S. Department of Housing and Urban Development adopted a rule effective February 3, 2017, that all public housing agencies must implement a “smoke-free” policy in living units, common areas, and administrative buildings (U.S. Department of Housing and Urban Development, 2016). Our study suggests that implementation of this policy would be enhanced by communication of benefits of smoke-free policies to owners and property managers, such as increased consumer demand for smoke-free housing, decreased cleaning and turnover costs, and lower fire risk and insurance costs. The findings may also apply to those encouraging adoption of voluntary smoke-free policies in private multiunit housing, which lacks state mandates for smoke-free policies.

Business concerns remain of primary importance to venue owners and managers. Many respondents expressed skepticism about messages that smoke-free policies would not harm their business. However, many perceived younger clientele as more likely to select a venue based on smoking status and mixed smoking–nonsmoking groups of customers as preferring a nonsmoking bar. At least one respondent suggested that knowing these changing preferences might have attenuated his opposition to smoke-free legislation. Several venues with smoke-free measures in place cited property damage as both a reason for and benefit of smoke-free measures; a well-funded campaign could assist in facility improvements in exchange for smoke-free pledges. Respondents identified loyalty to older customers as a reason not to adopt smoke-free measures, a concern described previously (Heim et al., 2009). Highlighting potential benefits of smoke-free policies for older customers or testimonials from older bar patrons supportive of smoke-free environments might address these concerns.

There is an ongoing campaign in Oklahoma (FTN) designed to increase support for voluntary smoke-free policies, and the themes found in this study may inform campaign development. Future research will include a second wave of data collection to solicit venue owner or manager feedback on new campaign messages and an evaluation of the campaign’s implementation and effectiveness. Potential strategies to support adoption of voluntary smoke-free measures include intrapersonal-level interventions (e.g., clientele self-advocacy), institutional interventions (e.g., neighborhood business alliances collectively adopting nonsmoking policies, partnerships with nonnightlife businesses to promote smoke-free venues), and community interventions (e.g., communication campaigns, direct subsidies). Chan et al.’s (2015) study with tobacco vendors, assessing receptiveness to multiple hypothetical interventions, provided insight into methods that may encourage businesses to reduce tobacco advertising voluntarily. The current study suggests that a similar type of “exchange” that links business benefits to measures that promote health may support voluntary smoke-free policies in nightlife venues. Bar and nightclub owners and managers are a difficult population to recruit for research and to reach with educational campaigns. Findings from this study reflect only views of those participants willing to participate. While a representative quantitative survey of bar owners has not been feasible in the past, these qualitative findings could be complemented by larger scale quantitative studies to determine which findings may be transferable to other settings. Future qualitative studies should attempt to provide a better understanding of patron/venue loyalty and potential differences by age (e.g., the motivations of younger bar patrons seeking out smoke-free environments or of older bar patrons resisting the same).

CONCLUSION

Although preemption remains a barrier to tobacco control in Oklahoma, nightlife proprietors expressed attitudes and perceptions that may be leveraged in promoting voluntary smoke-free measures. Messaging related to employees might emphasize benefits to efficiency and customer service rather than employee health. Organizing smoke-free coalitions of venues to enact voluntary policies as a group, leveraging material improvements as incentives for smoke-free policies, and demonstrating loyalty to older customers might enhance current and future campaigns.