Smoking restrictions gain support across all 50 states over 30 years

by Lizelda Lopez, University of California - San Diego

edited by Gaby Clark, reviewed by Robert Egan

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A recent study from researchers at the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California San Diego developed and validated a new way to measure changing social norms around cigarette smoking and secondhand smoke exposure in the United States over the past three decades. The findings are published in the journal BMJ Public Health.

Using data from 1.5 million respondents in the Tobacco Use Supplement to the Current Population Survey, researchers created a "Willingness to Restrict Smoking" (WTRS) scale that captures how strongly people believe smoking should be restricted in public settings. The results offer tobacco control programs a new way to evaluate their success and solve a decadeslong challenge for researchers: how to effectively measure social norms around tobacco.

In the early 1990s, the National Cancer Institute (NCI) helped transform the public health approach to tobacco control by shifting the focus from individual behavior change to changing social norms around smoking, particularly around where smoking should and should not be permitted. The California Tobacco Control Program (CTCP) became a leading example of this strategy, paving the way for California to successfully implement the world's first smoke-free bar law in the late 1990s. This achievement was made possible by prior CTCP efforts to reshape attitudes toward smoking in bars through mass media campaigns featuring bar workers' testimonials and targeted outreach to bar owners and employees. Since then, researchers and public health officials alike have sought a clear and reliable way to measure social norms around tobacco use.

The new study analyzed survey responses collected between 1992 and 2022 across all 50 states. Participants were asked whether smoking should be allowed in locations such as hospitals, workplaces, restaurants, shopping malls, bars, playgrounds and casinos. Researchers found that support for smoke-free environments increased steadily over time, particularly in indoor public spaces. Hospitals and playgrounds consistently received the strongest support for smoking restrictions.

The researchers say the findings support the longstanding public health strategy of reducing smoking by shifting social norms around secondhand smoke exposure. They also found that the scale remained stable and reliable across survey years despite changes in survey questions and settings over time. According to the study, the WTRS scale may offer tobacco control programs a new way to quantitatively evaluate whether campaigns and policies are successfully changing public attitudes toward smoking restrictions.

Publication details

David R Strong et al, Social norms and the decline in US cigarette smoking: evidence from 30 years of US representative surveys, BMJ Public Health (2026). DOI: 10.1136/bmjph-2024-002389

Journal information: BMJ Public Health

Key medical concepts

Tobacco Smoking

Clinical categories

Preventive medicineCommon illnesses & PreventionHealthy living Provided by University of California - San Diego Who's behind this story?

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