Policy-driven tobacco control

Abstract

BackgroundSince the passage of Proposition 99, California's comprehensive tobacco control programme has benefited from a localised policy adoption process that allows for the innovation and diffusion of strong local tobacco control policies throughout the state.MethodsThe policy adoption continuum is described in the context of California's smoke-free workplace movement, and the influence of policy-driven tobacco control initiatives on social norms, behaviour and the public's health was examined.ResultsThe Smoke-free California policy adoption continuum reflects a general approach for policy innovation and diffusion that builds social acceptance and influences social norms, while minimising unintended consequences and creating best practices in tobacco control. California's local smoke-free workplace policies have reduced secondhand smoke exposure and supported attitude and behaviour changes. The effects of local policy adoption led to the nation's first statewide smoke-free workplace law.ConclusionsProposition 99 created an unprecedented tobacco control infrastructure that supported local policy innovation and diffusion to influence social norms and behaviours. Tobacco control policy efforts should address campaign challenges, oppose pre-emption and confront tobacco industry influence. Advocates must be cautious of pursuing a statewide policy prematurely, as it may result in a weak and/or pre-emptive policy that can stymie local policy efforts and prolong the adoption of a meaningful statewide policy.

Navigating institutional complexity in the health sector: lessons from tobacco control in Kenya

“…Similarly, a lack of goal setting for tobacco control, or at least unclear goals, appears to be a component of the weak institutional leadership. The present institutional context appears to rely on a more diffuse, decentralized leadership, where each division is working in parallel with limited overarching coordination (Francis et al 2010). Furthermore, the limited measures to ensure the accountability of senior leaders'-for example through new regulations or through obligating some other clear and public articulation of the policy goals-appears to be perpetuating the slow pace of tobacco control policy reform.…”

“…Furthermore, the limited measures to ensure the accountability of senior leaders'-for example through new regulations or through obligating some other clear and public articulation of the policy goals-appears to be perpetuating the slow pace of tobacco control policy reform. In other tobacco control contexts, successful efforts to increase leaders' accountability have proven to be instrumental in pushing deeper policy reform (Francis et al 2010) Another related central institutional challenge concerns the role and authority of the KTCB. It is important to note that the TCA grants the KTCB advisory rather than decision-making capacity.…”

Case Studies from Community Coalitions

“…1 Social norm change strategies are credited with effectively and simultaneously assisting smokers to quit or to decrease their consumption, protecting non-smokers from secondhand smoke, and preventing tobacco use uptake among youth. [2][3][4] Unlike individual education or action, a population-based approach like social norm change reinforces the idea that tobacco use in the community is unacceptable. 5 Previous research has shown that policy adoption can lead to changes in social norms and that changes in social norms can lead to policy adoption.…”

“…5 Previous research has shown that policy adoption can lead to changes in social norms and that changes in social norms can lead to policy adoption. 3,4,[6][7][8][9][10] Local coalitions, reflective of diverse perspectives, experiences, cultures, and levels of authority, are respected and popular forces for improving community health, often by changing social norms through policy adoption. 2,[11][12][13] Local policy efforts are limited by preemptive language in some states' tobacco laws-a tactic of the tobacco industry.…”

The Outer Circle: The Importance of NonorganizedAdvocacy Coalitions to the Passage of Smoke-Free Policy

“…Their recommendations included tracking community sentiment through letters to the editor to best address it throughout the campaign. Francis, Abramsohn, and Park (2010) use Proposition 99, California's comprehensive tobacco control program, as a case study in the implementation of policy-driven tobacco control. Based on the experience in California, they argue that stronger local policies lead to stronger state policies.…”