Clean Indoor Air Ordinances in Appalachia

Background: The decline in smoking prevalence can be attributed to a number of factors, including clean indoor air (CIA) ordinances. Not all communities have CIA ordinances and there has been limited examination of factors that are associated with their adoption. The objective of this study was to examine their reach and characteristics of communities with CIA ordinances in the Appalachia region of the U.S.

Methods: We used data from communities in the Appalachian region of six states. All CIA ordinances were collected and rated for strength and whether it was a 100% comprehensive workplace, restaurant or bar ordinance. In the analysis we determined whether the strength of the ordinance was related to community measures of socioeconomic status. Qualitative interviews were then conducted with tobacco control leaders in 30 communities to determine the role coalitions played in the passage of the ordinances and the barriers they faced during the process.

Results: A total of 332 communities were included in the analysis. Only 69 had either a workplace or restaurant smoking ban. Communities with a higher average unemployment rate were less likely and those with a higher average education level were more likely to have a strong ordinance. The preliminary qualitative data suggest that presence of a strong coalition and leader, as well as public support facilitate passage of CIA ordinances.

Conclusions: Few Appalachian communities have adopted strong CIA ordinances. Given that many resources are needed to pass such ordinances it might be more efficient to work towards passage of statewide laws.