摘要：Executive orders are important presidential tools for health policymaking that are subject to less public scrutiny than are legislation and regulatory rulemaking. President Bill Clinton banned smoking in federal government buildings by executive order in 1997, after the administration of George H. W. Bush had twice considered and abandoned a similar policy. The 1991 and 1993 Bush proposals drew objections from agency heads and labor unions, many coordinated by the tobacco industry. We analyzed internal tobacco industry documents and found that the industry engaged in extensive executive branch lobbying and other political activity surrounding the Clinton smoking ban. Whereas some level of stakeholder politics might have been expected, this policy also featured jockeying among various agencies and the participation of organized labor. THE US GOVERNMENT HAS acted to restrict indoor smoking in only 2 venues: aircraft and federal buildings. 1 , 2 The health risks of direct and indirect smoking are now well documented, 3 – 5 and a recent US surgeon general's report declared that there is no safe exposure to secondhand smoke. 6 In 1997, President Bill Clinton issued an executive order banning smoking in federal buildings, protecting nearly 2 million workers and their patrons from exposure to secondhand smoke. Tobacco control policy gained considerable national attention during the Clinton administration, with the convergence of grassroots movements, critiques from major health organizations, lawsuits, congressional hearings, and journalistic accounts that described how the tobacco companies knowingly marketed a deadly product while the government was slow to respond. 7 , 8 In 1994, the Food and Drug Administration (FDA) began to regulate cigarettes as a drug delivery device. The authority of the FDA was challenged by the tobacco industry at every step, until finally the Supreme Court ruled that the agency lacked the proper legal footing. 9 After his administration had presided over several health policy decisions favoring the tobacco industry, 10 , 11 President Clinton, as chief of the executive branch bureaucracy, finally banned smoking in federal buildings with Executive Order 13058, signed in August 1997. 2
