Finding: Counteradvertising programs are effective in preventing tobacco initiation and in increasing tobacco cessation in target audiences.
Tobacco-free policies have been shown to increase tobacco cessation (CDC, 2009a; US Surgeon General, 2004). Policies and regulations restricting tobacco use adopted outside the DoD and VA systems are described below. They point to similar opportunities for DoD and VA to restrict tobacco use by their target audiences. Such policies and regulations have the potential to affect tobacco use by military personnel and their dependents, civilian employees on military installations, and veterans.
Tobacco-use restrictions are most effective when they apply to a variety of public and private settings. Smoking prevalence and annual per-capita consumption are 4% and 14 packs higher, respectively, and quitting rates are 6% lower in states without comprehensive clean-indoor-air laws (Bonta, 2007; Emont et al., 1992). The effects on secondhand smoke, quitting rates, and consumption are maximized when smoking is banned as opposed to restricted to designated areas (Heironimus, 1992; Pizacani et al., 2003). It has been estimated that clean-air laws can reduce smoking prevalence by 10% (Levy and Friend, 2003). Smoking bans in public places and workplaces are generally supported by the public, including smokers (Fong et al., 2006; RTI International, 2005; WHO, 2008).
Enforcement of tobacco-free laws and policies is critical for their effectiveness. Comprehensive legislation establishing clear penalties for violations needs to be paired with effective enforcement policies for smoking restrictions to advance tobacco control. Fining the owners of establishments where violations occur is the most effective way to enforce the law (WHO, 2008). Those measures can be combined with penalties for tobacco users who break the rules.
Community settings for tobacco restrictions include private and public workplaces, restaurants and bars, and hospitals. By January 4, 2009, 23 states had laws calling for 100% smoke-free public and private workplaces, 23 states had laws calling for 100% smoke-free bars, and 28 states had laws calling for 100% smoke-free restaurants (ANRF, 2009a). As a result, over 70% of the US population is protected by some type of 100% smoke-free law, and nearly 40% by a law calling for 100% smoke-free workplaces, restaurants, or bars (ANRF, 2009b). Many states and