Stakeholder analysis of adoption and implementation of a statewide smoke-free policy in a tobacco producing state: Tennessee Non-smokers Protection Act

Background: Tennessee, the third largest tobacco-producing state in the U.S., enacted Non-Smokers Protection Act in 2007, making most enclosed public places 100% smoke-free.We conducted a stakeholder analysis of why and how the diverse interests in the state collaborated to develop the policy and identified areas and opportunities for improvement. Methods: We utilized qualitative research approach by triangulating interviews with archival documents and news reports. We thematically coded archival documents and interviews using Nvivo software to identify strategic relationships, cross-cutting issues, and themes in policy development and implementation process. Additionally, the coded data was analyzed using descriptive characteristics. To date, we have conducted 21 interviews with legislators, government officials, representatives from NGO's, health organizations and businesses. Preliminary results: The interviews revealed that the smoke-free policy idea for Tennessee originated in 2004 by a cluster of students living in a college dormitory and exposed to excessive secondhand smoke from peers. Subsequently, Campaign for Healthy and Responsible Tennessee (CHART), a smoke-free coalition of health and community organizations was formed to initiate the movement towards policy development. Although CHART was influential in getting the issue onto the agenda, favorable political circumstance was the main reason for adoption of the policy. The trade-offs between either having a policy or not, resulted in “super-preemption” clause and exemptions. Conclusions: This study not only provides insight into development and implementation of smoke-free policy and identifies areas for improvements but also provides a framework for stakeholders in other tobacco-producing states and countries interested in developing a smoke-free policy.