State preemption of smoke-free air laws are inhibiting adolescent and adult quitting behaviors

Background: State smoke-free air (SFA) law preemption inhibits tobacco control (TC) policymaking by restricting local governments’ ability to enact stronger SFA policies. When state law is weak, preemption ensures weak laws exist statewide. While the impact of SFA bans on smoking behaviors is known, little is known about SFA preemption laws’ impact on smoking-related outcomes, particularly quitting.

Methods: State laws (identified through CDC’s STATE System and NCI’s SCLD) were reviewed to determine full SFA preemption. Quitting-related data were obtained from the Youth Risk Behavior Survey (adolescents/young adults, 1991-2011); the Behavioral Risk Factor Surveillance System (adults, 1991-2010); and the Current Population Survey-Tobacco Use Supplement (adults, 1992-2010). Dichotomous outcomes included quit attempts/ever quit and currently quit. Multivariate logistic regressions were conducted, controlling for state environment (other TC policies, TC spending, demographic/SES characteristics, tobacco growing); individual characteristics; state fixed effects (FEs); and year FEs/year trends.

Results: Full SFA preemption was associated with a 1.7% reduction (p<.05) in the probability of youths’ quitting but not associated with quit attempts (YRBS). Full SFA preemption was associated with a 1% reduction (p<.01) in adult quit attempts probability but not associated with ever quitting (BRFSS). Full SFA preemption was associated with a 2.5% decrease (p<.05) in adult quitting probability and 0.4% reduction in the probability of adult quit attempts (CPS-TUS).

Conclusions: Individuals in full SFA preemption states are less likely to attempt to/quit. Given that >480,000 deaths/year are attributable to cigarette smoking, repealing SFA preemption laws could increase quitting behaviors and reduce tobacco-related deaths by thousands.