摘要：Objectives. We examined the pattern of the passage of smoking laws across venues (government and private workplaces, restaurants, bars) and by strength (no law to 100% smoke-free). Methods. We conducted transition analyses of local and state smoking restrictions passed between 1970 and 2009, with data from the Americans for Nonsmokers’ Rights Ordinance Database. Results. Each decade, more laws were enacted, from 18 passed in the 1970s to 3172 in the first decade of this century, when 91% of existing state laws were passed. Most laws passed took states and localities from no law to some level of smoking restriction, and most new local (77%; 5148/6648) and state (73%; 115/158) laws passed in the study period did not change strength. Conclusions. Because these laws are “sticky”—once a law has passed, strength of the law and venues covered do not change often—policymakers and advocates should focus on passing strong laws the first time, rather than settling for less comprehensive laws with the hope of improving them in the future. Enactment of strong laws that end smoking in restaurants, workplaces, and bars is followed by reduced cardiovascular and pulmonary morbidity and mortality, 1–4 reduced tobacco consumption, 5,6 and voluntary smoke-free home rules. 7 The 2006 surgeon general’s report The Health Effects of Involuntary Exposure to Tobacco Smoke summarized a large body of evidence about the qualitative aspects of cultural norm change, political, and advocacy processes behind enacting smoking laws, including state preemption of local authority and key historical events related to tobacco control and public understanding of the dangers of secondhand smoke. 8 Despite the extensive literature on the social and political processes that have led to enactment of smoking restriction laws, 8–22 no study has quantitatively examined the pattern of the passage of smoking laws by venue (e.g., whether private workplace laws are passed before or simultaneously with restaurant laws) or by strength within venue (e.g., whether a bar law goes from having partial coverage to 100% coverage). Such a quantitative examination is important because the pattern of the passage of smoking restriction laws in general (at any level of strength) provides a measure of how communities address a known health issue (secondhand smoke) with population-level interventions. The pattern of passage of smoking laws describes the evolution of laws (often culminating in 100% smoke-free laws) that provide population-level protection from secondhand smoke and smoking-related diseases. Moreover, understanding which venues are covered by smoking laws is important because advocates need to know what has been successful in other localities in order to most effectively influence policy. Specifically, if communities successfully enact workplace, then restaurant, and then bar laws, advocates can engage in an incremental policymaking process, extending coverage by venue, beginning with the least controversial (government workplaces) and building toward the most difficult (bars). 23–25 However, if communities enact smoking laws only once or rarely, then it is important to create as strong a policy package as possible. In the latter case, advocates might consider opposing a weak proposed law, because the likelihood of strengthening weak laws or passing additional laws would be low. Finally, it is important to understand how patterns of lawmaking vary at the state and local levels, so that advocates can adjust their strategies accordingly. To understand in what order states and localities regulate indoor smoking by venue and whether they adopt stronger laws over time, we used transition analyses to examine the venue pattern and strength of smoking laws passed between 1970 and 2009.
