How Comprehensive Smoke-Free Laws Promote Public Health

Hannah Bergmann

MMC4300

July 28th, 2017

For most the of the twentieth century, it was common to see people smoking cigarettes

inside of restaurants, work, shopping malls, airports, and generally anywhere they pleased. The

majority of people during this time did not know or understand the critical dangers behind

smoking, and even the dangers of direct exposure to secondhand smoke. As time went on,

health advocates continued their research to determine the direct effects of secondhand

smoke and educate people of the toll it can take on you or your loved ones health. In the

1970s, US Surgeon General Jesse Steinfeld declared that nonsmokers had the right to breathe

clean air at meetings in their office building. Shortly after this in 1972, the US Surgeon Generals

report mentioned that exposures from tobacco smoke (secondhand smoke) could likely be

harmful to the health of nonsmokers. This was just the very beginning of society beginning to

notice the harmful effects of secondhand smoke. Since then, the U.S. Environmental Protection

Agency concluded that exposure to secondhand smoke presents a substantial public health

problem. Finally, in 2006, the U.S. Surgeon Generals report stated that the debate is over and

science is clear secondhand smoke has the ability to cause lung cancer and heart disease, as

well as many other conditions in nonsmokers. (Truth Initiative) I am going to be analyzing

comprehensive smoke-free laws and the what elements of the innovation affects its diffusion.

An innovation that works decrease nonsmokers risk of contracting a condition relating

to secondhand smoke are comprehensive smoke-free laws for worksites, restaurants, and bars.
Clean Indoor Air Laws have been disseminated at each level of government local, state, and

federal. The number of states that have implemented these comprehensive smoke-free laws

increased from zero in 2000 to 27 in 2015. This then increased the number of the U.S.

population that is protected from the harmful effects of secondhand smoke. This number went

from 2.72% protected to 49.6% protected in 2015.(Truth Initiative) Even if there are no

statewide smoke free laws implemented in some of these states, local laws still protect

nonsmoking citizens by still prohibiting smoking in worksites, restaurants, and bars. Today, it is

very rare to see anyone smoking in a public indoor place and this is due to these comprehensive

local and state smoke-free laws that have been implemented around the United States during

the 21st century. However, the southeast states still have no comprehensive smoke-free bans so

the jobs of opinion leaders and change agents are far from over.

The role of change agents and opinion leaders

Opinion leaders and change agents played a vital role for numerous years to educate

people on the harmful effects of secondhand smoke and push for legislation to protect the

lungs and hearts of nonsmokers. A change agent is someone who introduces innovations into a

society that they expect will have desirable, direct, and anticipated consequences. Change

agents are often seen as the invisible hands that make the change happen. They have the

knowledge and skills to implement change into any type of society. An opinion leader is often

an active and influential member of their community. They are knowledgeable, trustworthy,

reliable, and held in high esteem by people who accept their opinions. People often look to

them for approval or disapproval, which is why they play a huge part in the diffusion process.
 Change agents involved in the diffusion of comprehensive smoke-free laws include

members of government that are working to pass legislation at each level or lobbyists focused

on shutting down the efforts of the tobacco industry. When laws are passed, citizens are more

likely to respond and consent to the smoking restrictions now placed upon them due to the

complex and educational process involved in passing a law. Another important change agent to

highlight is the U.S. Food and Drug Administration (FDA) who historically pushed to change

Americas terrible smoking habit. In 2009 under President Barack Obama, The Family Smoking

Prevention and Tobacco Control Act was implemented as a federal statute that gives the FDA

power to regulate the tobacco industry. This act is what imposed new labels and warning on

tobacco packages in attempt to highlight adverse health effects of tobacco and discourage

minors from trying tobacco. Passing of this law was supported by the American Cancer Society

who praised the legislative efforts to break the dangerous chain of addiction for generations to

come. The Centers for Disease Control and Prevention (CDC) is also a critical change agent in

advocating for comprehensive smoke-free laws in public places across the United States. Their

priority remains reducing disease and death caused by smoking and exposure to secondhand

smoke. Overall, organizations that work to pass smoke-free comprehensive laws are change

agents against the tobacco industry. They spread the message through communication

channels to diffuse the idea that secondhand smoke is harmful and even deadly to nonsmokers.

The diffusion of comprehensive smoke-free laws has been occurring for some time and will

continue to until federal laws protect all nonsmokers.

Many opinion leaders and change agents are responsible for the implementation of

comprehensive smoke-free laws but an opinion leader I want to highlight is the Truth Initiative.
Truths mission is to deliver facts about the devastating health effects and social consequences

of tobacco. The Truth Initiative seeks to expose the marketing tactics of the tobacco industry so

young adults can make smart and informed decisions for themselves and hopefully inspire

others to do the same. The Truth Initiative partnered with The Society for Research on Nicotine

& Tobacco in order to commend the U.S. Department of Housing and Urban Development for

making strides to create smoke-free policies in public housing. (Truth Initiatve) Truth partners

with community colleges and universities across the country to work to make them tobacco-

free. The education this program provides to youth helps them understand the downsides to

tobacco and why comprehensive laws for smoke-free establishments are necessary for the

public health of our society. Opinion leaders in this aspect can be anyone that wants to educate

you on the adverse effects of tobacco. Your teachers, parents, mentors, and idols are people

you look up to and their opinion of the subject could influence you.

Anticipated and Unanticipated Consequences of Smoke-Free Laws

Consequences that are anticipated are recognized and intended. On the other hand,

unanticipated consequences are neither recognized, nor intended. Both types of consequences

have the ability to be positive or negative. A positive anticipated consequence of smoke-free

laws is protecting workers and patrons from unwanted exposure to smoke. Also, customers

who are against any facility that allows smoking would not give the company business and

therefore profits are not as high as they potentially could be. A negative anticipated

consequence of these laws could also include a reduction in profit for a business. If a regular

customer who is a smoker is now not legally allowed to smoke inside, the likelihood of return

for them is slim. A positive unanticipated consequence of this law was increased socializing
amongst workers or customers when they gathered outside to smoke. This could lead to

networking and meeting a new friend, potential business partner, or customer. A negative

unanticipated consequence include threat to bystanders safety when they stand on the street

outside of a bar to smoke. This is especially harmful for women who are alone at night and

might be placed in a dangerous situation. (Moore)

The Future of Comprehensive Smoke-Free Laws

Smoke-free laws have made incredible advances over the past few decades and will

continue to throughout history. Smoke-free laws will hopefully one day be able to be

implemented in more social settings like outdoor venues, outdoor sporting events, parks, etc.

Although this may be more problematic because of a persons individual freedom. (Cerak &

Eriksen) Changes in the types of tobacco products that are consumed will also hopefully change

in the near future. The FDA just recently proposed cutting down the nicotine levels in cigarettes

to make them less addictive and proposing smokers to make the switch to e-cigarettes or

vapes. (Clarke) Public health advocates will continue working hard to figure out the best way to

stop a dangerous addiction in its tracks and have alternatives that smokers can choose from. As

always, anti-smoking campaigns will continue to do their work across the country, educating

citizens on the adverse effects and encouraging minors to stray away from tobacco. (Hyland)

Conclusion

Overall, the innovation of comprehensive smoke-free laws have been in place for many

decades and the the majority of the public has garnered respect and advocated for the

legislation. The diffusion of these laws are largely due to change agents like the United States
government, CDC, FDA and opinion leaders like non-profit organizations against the big tobacco

industry.

References

CDC Foundation. (2017) The Impact of Smoke-free Policies on Restaurants and Bars.

http://www.cdcfoundation.org/smokefree

Cerak, R. & Eriksen, M. (2008) The Diffusion and Impact of Clean Indoor Air Laws.

http://www.annualreviews.org/doi/pdf/10.1146/annurev.publhealth.29.020907.090920

Clarke, T. (2017) U.S. proposes cigarette nicotine cut, shift toward e-cigarettes.

https://www.reuters.com/article/us-fda-tobacco-regulation-idUSKBN1AD1VW

Edney, A. & Kaplan, J. (2017) FDA Targets Cigarettes in Broadening of Fight Against Addiction.

https://www.bloomberg.com/news/articles/2017-07-28/fda-looks-to-cut-nicotine-in-

cigarettes-to-non-addictive-level

Hyland, A. (March 21, 2012) Smoke-free air policies: past, present and future.

https://www.ncbi.nlm.nih.gov/pubmed/22345239
Moore, R. Annechino, R, & Lee, J. Unintended Consequences of Smoke-Free Bar policies for

Low-SES Women in Three California Counties.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730500/

Truth Initiative. (June 23rd, 2016), CDC highlights need for comprehensive smoke-free policies.

https://truthinitiative.org/news/cdc-highlights-need-comprehensive-smoke-free-policies