Key Informant Interviews – Content analysis was used to look for themes and variations among responses of the seven key informant interviews that were conducted to understand barriers and facilitating factors toward adoption of a smoke-free casino policy. (See Appendix C for the interview protocol.) The key findings are summarized below.

Respondents identified the following barriers to the casino adopting a smoke-free policy:

• Concern about losingcore patrons (all seven respondents).

• The casino targeted in this intervention had previously tried to go smoke free and lost money (all seven respondents).

• Many tribal council members are smokers (all seven respondents).

• A large percentage of the casino employees are also smokers (five respondents).

• Tribal council members must approve the policy change (all seven respondents).

• SHS is a low priority for casino administration (five respondents).

• The tribal affiliation with a tobacco company may be jeopardized (three respondents).

Clearly, the biggest concern was potential harmful economic impact a smoke-free policy would have on casino (and tribal) revenue. Given their negative past experience with attempting to go smoke-free, it was an uphill battle to convince administrators and the tribal council that this time would be different. More work is needed to identify causal factors for the past revenue decline (perhaps there were outside causes that had an impact), and ways to mitigate them in the future. Examples (and contacts) from other casinos with a smoke-free policy, would help greatly.

Respondents identified the following incentives or facilitating factors toward adopting a smoke-free casino policy:

• Awareness of the negative effects of SHS (all seven respondents).

• Concern about the SHS exposure of tribal youth who frequently eat in the casino restaurants which have SHS drift from the casino gaming areas (four respondents).

• Awareness of the poor example for youth that is set by adult smokers in the native community (three respondents).

• The Casino Human Resources Manager is concerned about employee turnover and illness as a result of SHS exposure (two respondents).

• Insurance and maintenance costs for the facility will be lower if it is smoke free (one respondent).

• The example of other casinos that have successfully gone smoke free would demonstrate that it can be done (six respondents).

• Given that the majority of Californians are non-smokers, going smoke free would give this casino a competitive marketing advantage over other casinos in the area (five respondents).

Concern for the impact of smoking and secondhand smoke on youth is one area that seemed to provide some traction toward a policy. Community values are very strong in the tribe, so this may be an area which can be leveraged into policy champions. The other idea that seemed novel, yet appealing was the cost savings that going smoke-free could lead to. If provided some ballpark expense estimates from the casino, fairly accurate savings projections could be made and pitched to administrators. Similarly, cost projections for absenteeism due to smoke could be done.

In response to the challenges, the respondents suggested the following strategies:

•Provide an example of a casino that has gone smoke free to reassure the tribal council that they can go smoke free and still make a profit.

•Pitch the economic savings of a smoke free facility to human resources manager and CFO.

•Find a champion among tribal council members.

•Educate the tribal council regarding the exposure of tribal youth to SHS in the casino restaurants.

Because these interviews happened somewhat late in the funding cycle, insufficient progress was made on these recommendations. Work was done to educate the tribal council about the dangers of secondhand smoke, but more data needs to be collected about the number of youth going to casino restaurants. Case studies are being drawn up about the experiences of other casinos that went smoke-free to share with the tribe. Cost figures were obtained and pitched to the HR manager and CFO and received favorably. This needs to be leveraged into advocacy within the full council.

Mendocino County Health & Human Services Agency Community Health Branch

American Indian Casinos and Secondhand Smoke Exposure

KEY INFORMANT INTERVIEW

Date of Interview:Interview Conducted:  In Person  By Phone

Key Informant Name:Position/Title:

Key Informant Organization:Months/Years with Org.:

Phone:Email:

Interview Start Time:Duration of Interview:

1.Can you tell me a little about your roles and responsibilities within the casino?

2.What is the process for getting the casino administration to consider an issue or create a policy? [Possible probe: Who controls it? Is there one person that is the key, or a number of people that have to be involved?]

3.Recent studies have documented the harmful effects that exposure to secondhand smoke has on health. In casinos, secondhand smoke can drift from one section to the next through doors, windows, and even air vents. How informed do you think the casino administration is about the problem of drifting secondhand smoke in casinos? [Possible probe: What leads you to that perception?]

4.Have casino workers ever complained about being exposed to secondhand smoke? [Possible probe: How are complaints like those handled?]

5.Regarding the casino administration priorities, where does the issue of secondhand smoke exposure for casino patrons and staff fall?

6. Who among the casino administration might be likely supporters or champions of efforts to pass a smoke-free casino policy? Who in the administration would most likely oppose such efforts?

7.What type of policy that regulates smoking in casinos would have the best chance of getting adopted – completely smoke free, smoke-free sections, smoke-free nights/events, etc.?

8.[If not already apparent, ask:] How supportive would you be of any such policies? If not initially supportive, ask: Are there any conditions under which you would support a policy to regulate smoking in this casino?

9. Can you suggest other Casino administration or staff members that are likely to be influential on this issue that we should talk to? [Possible probe: Who might have a different viewpoint?]

10.Is there anything else that you would like to add?

• • • • • • • •Example adapted from Mendocino County 2010 FER