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An Analysis of State and City Actions to Limit Smoking in Public Places and Workplaces

Nancy A. Rigotti, MD; Chris L. Pashos, PhD

JAMA. 1991;266(22):3162-3167.

Abstract
Objective.
—To assess the prevalence, content, and growth of state and city laws restricting smoking in public places and workplaces in the United States and to identify factors associated with their passage.

Design.
—A mailed survey of city clerks in US cities with a population of 25000 or greater (N =980) and review of existing data sources confirmed the status of smoking restrictions in 902 (92%) of the cities in the sample. State laws were identified by contacting each state's Legislative Reference Bureau (100% response). Content of laws was coded using previously developed categories.

Main Outcome Measures.
—Prevalence, comprehensiveness, and cumulative incidence of no-smoking laws in states and in cities with a population of 25000 or greater.

Results.
—By July 1989, 44 states and 500 (51%) of the cities in our sample had adopted some smoking restriction, but content varied widely. While 42% of cities limited smoking in government buildings, 27% in public places, 24% in restaurants, and 18% in private workplaces, only 17% of cities and 20% of states had comprehensive laws restricting smoking in all four of these sites. The number of city no-smoking laws increased tenfold from 1980 to 1989. City no-smoking laws were independently associated with population size, geography, state tobacco production, and adult smoking prevalence. Laws were more common in larger cities, Western cities, and states with fewer adult smokers. Laws were less common in tobacco-producing states and in the South.

Conclusions.
—No-smoking laws are more widespread than previously appreciated, especially at the local level, reflecting a rapid pace of city government action in the 1980s. Nonetheless, comprehensive laws, which are most likely to provide meaningful protection from environmental tobacco smoke exposure, remain uncommon and represent a major gap in smoking control policy. Laws are most needed in smaller and non-Western cities and in states that produce tobacco and have a higher proportion of smokers.

(JAMA. 1991;266:3162-3167)

Author Affiliations
From the Institute for the Study of Smoking Behavior and Policy, John F. Kennedy School of Government, Harvard University (Drs Rigotti and Pashos), and the General Internal Medicine Unit, Massachusetts General Hospital, Harvard Medical School (Dr Rigotti), Boston, Mass. Dr Pashos is now with the Department of Health Care Policy, Harvard Medical School.

Footnotes
An earlier version of this report was presented at the Seventh World Conference on Tobacco and Health, Perth, Australia, April 4, 1990.

Reprint requests to the General Internal Medicine Unit, Massachusetts General Hospital, Fruit Street, Boston, MA 02114 (Dr Rigotti).

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