In the article “Clean Indoor Air Ordinance Coverage in the Appalachian Region of the United States,” Ferketich et al. recommend that clean indoor air laws in certain Appalachian states “should be statewide, because, clearly, leaving the effort to local communities does not result in a large number of strong local CIA ordinances.”1(p1317) The authors make a monumental leap in their conclusion that efforts to pass strong statewide smoke-free laws should take priority over local laws in Appalachian states. Their study does not analyze the effectiveness of statewide laws; rather, it only reviews the existence and strength of municipal smoke-free ordinances in six selected Appalachian states.
In drawing this conclusion, Ferketich et al. do not consider the many political, societal, and contextual factors affecting tobacco control policy in Appalachia and the tobacco-growing states.2–5 Nor do the authors consider the risks associated with enacting smoke-free legislation before there is capacity at the local level for adequate implementation and enforcement.6,7 Only three of the 13 Appalachian states have enacted comprehensive smoke-free workplace legislation, and they are all located in northern, nontobacco growing states.8 Further, Georgia, which has a weak state law without explicit preemption, had very few municipal laws, indicating that local officials in Georgia may have lacked the political will to enact stronger local laws, resulting in implicit preemption.9 The fact that Appalachia is plagued by low socioeconomic status and high unemployment puts these states at risk for enacting weak, preemptive statewide smoke-free legislation, which their study findings support.
Mothers participate in a regular physical exercise and social support program titled Caminando Con Fe (Walking With Faith) in a child-friendly place at The Most Precious Blood Church in Chula Vista. The group partnered with the Healthy Eating, Active Communities program to refurbish a nearby park for community use. Photo by Tim Wagner for Partnership for Public's Health. Available at http://www.twagnerimages.com. Printed with permission.
The observation that so few Appalachian communities have comprehensive state or municipal smoke-free laws and regulations is not surprising given that these communities are disproportionately affected by high smoking rates, weak tobacco control laws, and lack of funding for comprehensive tobacco control. 2,10 Their study design focused solely on the most affected Appalachian communities, further underscoring the disparities that exist. The authors should have concluded that a crucial first step in smoke-free policy development is to foster capacity and demand at the local level for strong smoke-free laws by creating a mass of local elected officials who will together advocate for the ultimate goal: a comprehensive anti-preemptive statewide smoke-free law that covers all workers.11
Acknowledgments
The authors are supported by a research grant from the National Heart, Lung, and Blood Institute (grant R01HL086450).
Note. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health.
References
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