Clients who access safety-net health services present with substantial health challenges as compared to the general population. Safety-net clients are two times more likely to report fair/poor health than other low-resourced clients, and present with higher rates of chronic diseases such as diabetes, asthma, and obesity (Shin et al., 2013). Poverty and high psychosocial stress are reliable determinants of chronic conditions such as cardiovascular diseases (CVDs), prevalent in low-income communities (Havranek et al., 2015). Given the substantial health risks faced by low-resourced, safety-net clients, initiatives that support treatment adherence and facilitate lifestyle change can reduce health disparities and improve their health outcomes. Interventions involving mobile health technologies (mHealth) show promise in promoting health care engagement in communities lacking health infrastructure. mHealth applications are already being used in clinical practice (Byambasuren, 2019); however, little is known about how providers are currently using these tools and the ways they may promote effective, evidence-based health care. mHealth is defined by the Global Observatory for eHealth (GOe) as "medical and public health practice supported by mobile

Purpose: To evaluate changes in compliance with a smoke-free outdoor seating policy before and after passage of a local regulation in 2015, which reinterpreted Philadelphia’s Clean Indoor Air Worker Protection Law to include outdoor seating areas of food or beverage establishments. Design: Natural experiment. Setting: Philadelphia, Pennsylvania. Sample: Food or beverage establishments (N = 108). Establishments were comprised of sit-down restaurants, cafes, quick-service restaurants, and bars. Measures: Presence of outdoor smoking and smoking-related litter on a given day were measured as binary variables. A geographic information system–based survey developed for this study was used to collect observational data. Analysis: Logistic regressions were used to determine the change in odds of observing outdoor smoking and smoking-related litter on a given day from baseline (preregulation) to follow-up (postregulation). Results: Compliance with smoke-free outdoor seating increased from 84.5% to 95.4% after passage and implementation of the regulation. Results showed a significant 75% decrease (odds ratio [OR]: = 0.25, 95% confidence interval [CI]: 0.08-0.67) in odds of outdoor smoking and a slight decrease in smoking-related litter (OR: 0.81, 95% CI: 0.39-1.65) at follow-up in establishments overall. However, at baseline, bars had higher odds of outdoor smoking (OR: 2.68, 95% CI: 0.57-12.72) and smoking-related litter (OR: 4.09, 95% CI:, 1.87-9.49) compared to sit-down restaurants. Conclusion: Results suggest there is high compliance with low-cost, low-burden, smoke-free outdoor seating policy and that enforcement is best targeted toward bars.