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Observational Survey of Smoking Provisions in Food Service Establishments --- Southeast Health District, Georgia, 2001

In the United States, approximately 38,000 deaths are attributable to second hand smoke (SHS) exposure each year (1). One of the national health objectives for 2010 is to reduce public exposure to environmental tobacco smoke (ETS) (objective 27.10) (2). To reduce public exposure to ETS, CDC recommends smoking bans and restrictions in public places (3). Some of the highest reported exposures to concentrations of SHS are found in food service establishments; however, Georgia does not have a state law prohibiting smoking in these places (4,5). In March 2001, the director of Georgia's Southeast Health District* requested assistance from the state health department in developing a surveillance system of smoking provisions in food service establishments. This report summarizes an observational survey of smoking provisions in food service establishments of Georgia's Southeast Health District in 2001, which found that although 69.4% (506) of all surveyed establishments were completely smoke free, the remaining establishments failed to provide several physical modifications designed to minimize ETS exposure. Public health officials in the Southeast Health District will use survey results to target interventions toward establishments lacking ETS-minimizing provisions.

A survey was developed to ascertain the status of smoking allowed on the premises and provisions to minimize exposure to ETS. Provisions included clear display of signs designating smoking and nonsmoking areas, nonadjacent smoking and nonsmoking sections, barriers between smoking and nonsmoking sections, separate ventilation systems for smoking and nonsmoking sections, and the exclusion of common-use areas from the smoking section. The survey was completed by sanitarians at the time of their routine food safety inspections during June--December 2001. Descriptive analysis of data was conducted by using SAS.

The Southeast Health District has a population of 319,128 (6). During the study period, district sanitarians conducted routine inspections of 880 (94.8%) of the 928 eating establishments. Of these, 151 (17.1%) did not have indoor seating and were not eligible for the survey. Of the 729 inspected and surveyed establishments with indoor seating, 506 (69.4%) had a nonsmoking policy, 163 (22.3%) accommodated both smoking and nonsmoking patrons with separate sections, and 61 (8.4%) accommodated both smoking and nonsmoking patrons but did not have separate smoking and nonsmoking sections (Table 1).

Among the 163 establishments accommodating both smoking and nonsmoking patrons in separate seating sections, observance of provisions varied (Table 2). A total of 95 (58.3%) establishments clearly displayed nonsmoking section signs, and 63 (38.7 %) clearly displayed signs for the smoking section. In addition, 43 (26.4%) had nonadjacent smoking and nonsmoking sections, 40 (24.5%) had physical barriers, 21 (12.9%) had separate ventilation systems to reduce ETS exposure, and 83 (50.9 %) excluded common-use areas from the smoking section.

Reported by: JT Holloway, MD, LB Sweat, Southeast Health District; KE Powell, MD, D Kanny, PhD, Georgia Div of Public Health. RL Tan, DVM, EIS Officer, CDC.

Editorial Note:

Because the majority of food service establishments in the Southeast Health District are completely smoke free, public health efforts in this district should focus on the remaining establishments (30.6%) still accommodating both smokers and nonsmokers. The Georgia Division of Public Health (GDPH) is conducting a survey to determine the presence and content of county tobacco ordinances. GDPH can then use eating establishment observational survey data to determine restaurant compliance with local ordinances, characterize ordinance noncompliance, and target areas for improvement.

The findings in this report are subject to at least three limitations. First, because 48 (5.2%) of the 928 eating establishments were not visited for routine inspections, they were not included in the data set. However, 83.7% of 777 eligible establishments were surveyed. Second, the survey was designed to observe physical provisions to minimize ETS and does not provide information about employee or patron compliance with clean indoor air practices. Finally, because approximately 20 sanitarians were working throughout the district, different interpretations of implementation of provisions included in the survey were possible. In addition, although the survey was intended to be observational, some data might have been collected through interviews with establishment management rather than through observation. These differences could reduce the comparability of data collected by different sanitarians. However, the survey was integrated with food safety inspections, was easy to administer, and provided a high rate of establishment coverage.

This survey was a practical instrument for ongoing surveillance of smoking provisions in food service establishments. Other than simple data entry, survey administration required no extra personnel and was completed quickly. The Southeast Health District will continue conducting surveys of establishments during routine food safety inspections. The district plans to publish future survey results on a public access website and provide public recognition for establishments that become smoke free or install protective barriers to reduce public exposure to ETS. In addition, this surveillance system is being considered for use by other districts. The survey instrument is available at

This survey serves as the basis for a comprehensive program to assess and correct establishment noncompliance with county clean indoor air ordinances. Future actions include increasing public awareness of ETS exposure in food service establishments, encouraging establishments to voluntarily reduce exposure to their patrons, enforcing local clean indoor air ordinances, and tracking the district's success in ETS exposure reduction.


Data for this report were contributed by environmental health staff of the Southeast Health District of Georgia.


  1. National Cancer Institute. Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency. Bethesda, Maryland: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1999 (Monograph 10).
  2. U.S. Department of Health and Human Services. Healthy People 2010, 2nd ed. With Understanding and Improving Health and Objectives for Improving Health (2 vols). Washington, DC: U.S. Department of Health and Human Services, 2000.
  3. CDC. Strategies for reducing exposure to environmental tobacco smoke, increasing tobacco-use cessation, and reducing initiation in communities and health-care systems. MMWR 2000;49(RR-12).
  4. U.S. Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders. Cincinnati, Ohio: National Service Center for Environmental Publications, 1992 (EPA-600-6-90-006F).
  5. CDC. Smokefree indoor air for restaurants. Available at
  6. U.S. Census Bureau. Census 2000 data for the state of Georgia. Available at

* The Southeast Health District of Georgia comprises 16 counties that share public health resources under district leadership. The health district oversees and manages the operational plans for the entire health district. Counties within the health district include Appling, Atkinson, Bacon, Brantley, Bulloch, Candler, Charlton, Clinch, Coffee, Evans, Jeff Davis, Pierce, Tattnall, Toombs, Ware, and Wayne Counties.

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