Voter Preferences and State Regulation of Smoking

I. INTRODUCTION Tobacco taxation and smoking restrictions are two areas of regulation for which states have maintained a high level of control relative to the federal government. (1) Given this flexibility, states have established a wide range of restrictions on smoking in areas such as government workplaces, restaurants, bars. shopping malls, indoor arenas, and hospitals. (2) Although most states restrict smoking in hospitals, there is considerable variation among states in restrictions in other areas. In the 1998-99 period of this study, about two-thirds of states restricted smoking in restaurants, whereas only four states restricted smoking in bars. What has led to variation in smoking restrictions across states? In a democratic society one would expect voter preferences to play an instrumental role in determining which policies are enacted and which are not. This article provides the first empirical exploration of whether state-level smoking restrictions are consistent with preferences of the citizenry, taking into account both voting behavior and the role of smoking status in influencing whether an individual votes. Specifically, we examine whether voters' preferences for smoking restrictions in restaurants, bars, malls, indoor sporting events, and hospitals are consistent with state-level restrictions on smoking in each of these public areas. (3) Our research draws on public choice models of policy making by state and local governments. Voters' preferences typically play a central role, because voting affects legislators incentives to support regulations. (4) Public choice research also finds that nonvoter factors may influence state and local policy making. (5) In the case of smoking regulations, public health advocates or tobacco industry lobbyists might influence regulatory policies. The specific building block of our analysis of state restrictions on smoking is information on individuals' voting behavior, which we link to their smoking status and preferences over smoking restrictions. Our analysis uses measures of political pressure that account for individual preferences as well as their voting behavior. To examine the possible role of interest group pressures, we also control for nonvoter influences on smoking regulation, including the proportion of the state population who smoke, measures of state ideology, and size of the tobacco industry. With the exception of smoking in bars, there is majority support for smoking restrictions. Unsurprisingly, smokers are less supportive of restrictions than are nonsmokers. Nonetheless, even smokers demonstrate a high level of support for many restrictions. Smokers are also less likely to vote than are nonsmokers, even after controlling for other demographic factors. The lower voting rate diminishes voter opposition to antismoking regulation but is usually not critical in view of the substantial support that most smoking restrictions have among smokers. The political pressure indices for restrictions on smoking in each public area are generally significantly related to the probability that a state restricts smoking in that public area. The nonvoter factors, such as the smoking rate in the state and tobacco's role in the state economy, are rarely influential. Policy debates over the desirability of smoking restrictions emphasize possible health risks due to exposure to environmental tobacco smoke (ETS) and effects on business profitability. The primary argument for expanding smoking restrictions is to protect workers and customers from exposure to ETS. (6) As our results show, voters are generally supportive of smoking restrictions in public areas, which would thereby protect workers as well as themselves and other customers. However, there is a substantial controversy over the extent of health risks associated with exposure to ETS. The basis for the push by the U.S. Occupational and Safety Health Administration (OSHA) for increased smoking restrictions to protect workers is the highly controversial U. …