Reactions to smoke-free policies in the Southeastern U.S. and to messaging strategies in support and opposition

Background: The Southeastern U.S. is lagging in public smoke-free policy implementation. This study explored differences in public support for smoke-free policies in the Southern region versus elsewhere in the U.S.

Methods: In 2013, a cross-sectional survey with US residents was conducted using a commercial online consumer panel. The survey assessed tobacco use, personal smoke-free policies, reactions to public smoke-free policies, and persuasiveness of messages about smoke-free policies, with messages framed as arguments regarding health, youth prevention, economic impact, individual rights/responsibility, morality/religion, and hospitality. Differences between Southerners and non-Southerners were analyzed.

Results: Of the sample of 2,501 adults, 36.7% were past 30-day smokers, 31.6% were racial/ethnic minorities, and 26.7% were Southerners, due to oversampling of key groups. Southerners were no different from non-Southerners in prevalence of personal smoke-free policies or support for most public smoke-free policies; in fact, Southerners were less oppositional to smoke-free bars (p=.003) and bowling alleys (p=.030). The most effective messages in support of smoke-free bars/restaurants were related to hospitality, health, and individual rights/responsibilities. Southerners vs. non-Southerners rated as more persuasive the pro-policy messages related to economic impact, religion/morality, and hospitality. The most persuasive messages against smoke-free policies involved individual rights/responsibilities.

Conclusions: Southerners are supportive of public smoke-free policies and receptive to various messaging strategies in support of them. Thus, public opinion may not be the cause of lagging adoption of comprehensive smoke-free policies in the South. As such, other factors warrant exploration. Moreover, public health professionals can use these messaging strategies to garner support for these policies.