Better tobacco control policy starts locally


Local communities have long been involved in the fight against tobacco. As early as 2005, 540 places raised the minimum age to buy commercial tobacco products to 21, well before the federal government did this for the entire country. It is no surprise that this innovative tobacco control policy originated at the municipal or provincial level before it was adopted by states or the nation. Laying the groundwork at the local level is often the way policy is tested and the first step towards building wider support.

The tobacco industry is well aware that local efforts to protect public health threaten its profits. Rather than challenge tobacco control policies city by city, the industry had more success convincing state legislators to pass policies that would address the problem but in fact have little or no health benefits. This state policy anticipated a stronger local tobacco control policy that the industry especially hated.

This is yet another example of preemption, which occurs when a higher level of government limits the ability of a lower level of government to respond to a particular point. When used in this way, preemption threatens not only public health, but health equity — and even democracy — by undermining community and grassroots engagement and hindering local efforts to advance justice-based policies.

Preventing local measures in the sale and marketing of tobacco products

Last year, Florida Governor Ron DeSantis signed a bill raising the age for buying tobacco in the state to 21, while stripping local governments of the power to regulate the sale and marketing of commercial tobacco. Since federal law already banned the sale of tobacco to young people under 21, the bill’s public health provisions were almost meaningless — but the clause disproving local tobacco control was really damaging.

The tobacco industry is adept at crafting such misleading legislation, which appears to promote public health, but in fact harms it by limiting or crushing local measures. This strategy aims to confuse lawmakers and the public and protect the industry’s profits.

Florida law is an example of how states abuse preemption. With this law, municipalities cannot continue to regulate tobacco, even if it is in the best interest of their community. Undoing the damage of decades of marketing menthol cigarettes to black people is both a social justice and health problem that many cities and counties across the country have sought to address. Smoking-related diseases are the number one cause of death among black people in the United States, claiming 45,000 black lives each year.

Local bans on menthol tobacco products are said to save lives, reduce health inequalities and reduce smoking among young people. But Florida law fooled them.

Preventing local measures in smoke-free workplaces

Thirteen states have passed laws that prevent local governments from enacting smoke-free air policies, preventing cities from going beyond the state to regulate smoking in the workplace. Eight of these states have tobacco control laws that are particularly weak and do not protect against secondhand smoke in workplaces, restaurants and bars outside the hospitality industry.

One example is the Tennessee workplace smoking ban known as the Tennessee Non-Smoker Protection Act. It includes an exemption for any music venue, restaurant or bar that bans entry to those under 21 – exposing workers to secondhand smoke and forcing them to choose between their health or their livelihood. These policies also negatively impact health equity, as many of these jobs pay minimum wage and are disproportionately held by women and people of color.

States with policies that anticipate local public health laws often have the highest rates of disease. The adult smoking rate in Tennessee is 20 percent, the fifth highest in the nation. Chronic disease rates in Tennessee are also high. The state ranks third in the prevalence of chronic diseases, including diabetes, cardiovascular disease, and asthma — conditions directly linked to tobacco use. High rates of smoking and related chronic diseases cost all Tennessee residents, with $2.67 billion in health care costs attributed to tobacco use each year.

In light of these dire circumstances, lawmakers in cities like Nashville and Memphis might want to pass a law that would protect musicians and bar staff, but their hands are tied.

Public health advocates in Tennessee have passed a bill to restore local power to take action on smoke-free air and effectively override municipal ordinances to address smoking in age-appropriate locations. Governor Bill Lee recently signed this legislation that allows individual cities and counties to enact policies for their communities, proving that advocates for local tobacco control can reverse harmful preventive policies.

Why Local Tobacco Policy Matters

In the event of abuse, pre-emption undermines equity. Local tobacco control measures are a critical tool for communities seeking to improve health outcomes by addressing the tobacco industry’s disproportionate attacks on people of color. Restrictions on public health authority threaten the power of local officials to protect the communities they serve from commercial tobacco and the harmful effects of secondhand smoke.

Using tools such as house rules reform, advocates can take a proactive approach to increase the authority of municipalities to address public health challenges such as commercial tobacco.

Tennessee isn’t the only state to roll back priority, as cities, towns and community members support local tobacco control policies that will protect children and save lives. After decades of restrictions on cities and counties’ efforts to combat commercial tobacco use, in 2019 advocates successfully lobbied the Colorado legislature to repeal the Tobacco Preemption Act, paving the way for places to limit the age for smoking. to increase tobacco purchases to age 21 and to tax and regulate tobacco products. Since the bill was repealed, at least nine local proposals to increase taxes on tobacco products have been passed through a Colorado ballot initiative.

By introducing tobacco control at the local level, public health advocates can build a strong evidence base to advocate for these policies in other communities, at the state level, and even federally by:

Making a blueprint of local laws. They demonstrate the possibilities and show that moving forward with state-level tobacco regulation — whether by regulating the sale or marketing of commercial tobacco or by creating more smoke-free public spaces — would be feasible and enforceable.

Collecting health data showing impact. After a policy is implemented, public health advocates and community members can conduct research to determine the effect of policies on health outcomes, helping to advocate for policies based on health equity.

Refuting false economic impact arguments. Implementing local policies provides an opportunity to collect real economic impact data to refute the industry’s narrative that tobacco control policies would cause communities to lose business or decimate the tourism or hospitality industry.

The tobacco industry will almost certainly continue to adapt, and pre-emption will remain one of the key strategies to weaken tobacco control. Public health advocates also need to be strategic and work in coalitions to combat and roll back policies that would limit the authority of local governments to protect their residents from the dangers of commercial tobacco.