To our knowledge, this is only the second study to attempt to quantify the effect of state laws that preempt stronger local smoking restrictions and the first study to document the effect of state preemptive laws on a national level and to assess multiple outcomes of these laws.
The most striking finding of the study is that state preemptive laws are associated with reduced support for smoke-free environments in indoor settings among current smokers. (A similar effect was found among former and never smokers, but it was not significant.) In other words, current smokers in states with preemption were less likely to express support for smoke-free environments than their counterparts in states without preemption. State preemption could have this effect by preventing or delaying shifts in social norms that may be generated in part by the discussion, adoption, and implementation of local smoke-free laws.
The discussion and debate that typically occur when communities are considering adopting smoke-free ordinances may raise public awareness regarding the health effects of secondhand smoke and the need for smoke-free policies and contribute to changes in public attitudes regarding the social acceptability of smoking [8
]. This discussion also generates news media coverage [32
]. Studies have suggested that increased news media coverage of tobacco issues, in turn, is associated with decreases in annual per capita cigarette consumption, decreases in weekly cigarette sales, and increases in adult tobacco use cessation [32
]. Increased news coverage of secondhand smoke issues may also be associated with increased adoption of local smoke-free laws [37
In addition to losing opportunities for discussion, residents in preemption states also lose the opportunity to live under smoke-free ordinances. This is a significant loss, as a number of studies have reported that public support for smoke-free environments increases after smoke-free laws go into effect [18
]. Studies have found that this effect is especially pronounced among smokers, in part because their baseline levels of support are typically lower than those of nonsmokers [18
]. It may be that having the experience of actually living under a smoke-free law dispels concerns about potential adverse effects of such laws and provides firsthand evidence of their benefits. It may also be that people, and smokers in particular, simply adjust to and become accustomed to these laws.
Evidence from a number of states' experiences suggests that the shifts in social norms that occur when smoke-free laws are being considered, adopted, and implemented foster a climate that supports smoking cessation, reduced adult tobacco use, and reduced youth tobacco use initiation [13
]. Evidence also indicates that these shifts lead to increased efforts to reduce secondhand smoke exposure even in settings which are not covered by smoke-free laws, for example, increased adoption of voluntary smoke-free home rules [18
]. In fact, the evidence indicates that such changes in public attitudes, which are largely generated by smoke-free laws and other tobacco control policies, are one of the single most important mechanisms through which state and local tobacco control programs reduce tobacco use [44
]. One of the most significant, although indirect, effects of state preemptive laws may be their denial to state residents of the opportunity to have these experiences during the discussion, adoption, and implementation of smoke-free ordinances, and to undergo the resulting shifts in social norms. This may perpetuate disparities among states in tobacco control policies and tobacco use by freezing local policies and norms in place, thus impeding the efforts of these states to “catch up” with states that have achieved greater progress in reducing tobacco use.
The study also demonstrates that state preemptive provisions are associated with a reduced level of worker protection from secondhand smoke. Indoor workers in states with preemption provisions are less likely to be covered by smoke-free workplace policies than their counterparts in states without preemption.
The implementation of smoke-free laws and smoke-free workplace policies is associated with increased cessation among adult smokers and reduced adult smoking prevalence [13
]. Several studies have suggested that smoke-free laws and policies are also associated with reduced youth smoking initiation [41
]. These effects could operate through several mechanisms, including reduced opportunities to smoke, reduced cues prompting smoking, and shifts in public attitudes regarding the social acceptability of smoking.
This analysis also suggests that state preemptive provisions are associated with fewer local ordinances restricting smoking. This is in keeping with the findings of previous reviews [7
It should be noted that there are some exceptions to this finding. Some states with preemption have local ordinances in place. This can be due to a number of factors. For example, North Carolina provided a window of opportunity for local jurisdictions to adopt ordinances restricting smoking before the state preemption provision took effect. Other states, such as Illinois, preserved local control in some communities which had already adopted local smoking restrictions before the preemptive state law took effect (i.e., these communities could revisit and strengthen their ordinances). Some states, such as Michigan, preempt local smoking restrictions only in certain venues, while allowing such restrictions in other venues. In other states, such as Florida, local smoking restrictions adopted before the preemptive state law remain in the books, but are not enforced. And in some states local jurisdictions may have passed smoking restrictions, unaware of potential impediments to such action posed by state statutes and legal precedents. However, the data bear out the common sense proposition that the absence of preemption is in most cases a necessary, though not sufficient, condition for the adoption of local smoking restrictions.
This study has some noteworthy strengths, including nationally representative data and control for a variety of state policy and individual-level variables. The study is also subject to several limitations. In particular, because the study is cross-sectional and examines the relationship between state preemption laws and the three outcomes of interest at a single point in time, it cannot establish the causality of the observed associations.
Opponents of smoke-free legislation have not abandoned the use of preemption to impede the adoption of comprehensive local smoking restrictions. In recent years, tobacco control advocates have noted instances in several states of legislation that carves out exemptions for specific venues (e.g., cigar bars and outdoor seating in restaurants) while preempting local governments from restricting smoking in these venues.
In conclusion, this study suggests that state provisions preempting local smoking restrictions affect several outcomes in ways that could impede progress in advancing secondhand smoke protections and broader tobacco control efforts. The issue of the implications of preemption is not unique to tobacco control. Preemption of stronger restrictions at lower jurisdictional levels has surfaced with regard to a number of other public health issues, including alcohol control, and, most recently, menu labeling requirements for restaurants. Because it is somewhat a technical issue and can initially appear to be innocuous, preemption can easily be overlooked, but it can have profound implications. It took tobacco control practitioners and advocates several years to reach consensus on the dangers of preemption—years during which several additional states enacted preemptive laws. It is important that practitioners and advocates working on other public health issues fully understand the benefits of local policymaking and the potential impact of preemption.
There is a need for additional studies replicating the findings of this analysis, especially longitudinal studies. In addition, there is a need for studies exploring the effects of the repeal of state provisions preempting local smoking restrictions on the outcomes we have considered—a type of study that to our knowledge has yet to be attempted.