Analysis of community determinants of smokefree policies in the United States

In January 2010, North Carolina became the 23rd state to implement a statewide smokefree policy, which is in addition to hundreds of counties and municipalities that have already enacted and implemented smokefree ordinances around the country. This proliferation of smokefree policies around the country suggests that it is rapidly becoming one of the commonest tobacco control measure for protecting nonsmokers and motivating smokers to quit. In this study, we conducted multivariate analysis of merged smokefree policy data from the Americans for Nonsmokers Rights and socioeconomic, political, and cultural data from the Census Bureau and other federal and state departments, to disentangle the key determinants of this policy. We expect to find geographic contiguity, urbanization, interest group activities, shift in the economic importance of tobacco, the growing health and economic burden of tobacco use, and political culture to be associated with the adoption and implementation of smokefree policies. Our study provides guidance for public health professionals and people interested in pushing for smokefree policies as to the key determinants for success. By that, scarce resources could be directed to where the possibility of policy development is high while working on creating conducive environment in places not yet prepared for such policies. Moreover, as smokefree policies continue to be popular worldwide, our studies will provide lessons for people in other countries about the indicators of policy development and implementation.