Tobacco Prevention in a Southern Tobacco State: A Perspective on North Carolina’s Approach

Saying that tobacco has an important place in North Carolina’s history is something of an understatement. Tobacco leaves are carved into state government buildings and helped build some of our best universities. Despite our history, we have achieved some important milestones in tobacco control in North Carolina and thought others may be interested in the approach taken in our state.

North Carolina now has smoke-free bars, restaurants, primary and secondary schools, and hospitals. For years, North Carolina led the nation in the number of tobacco-free college and university campuses. While there is still much work to be done, how did these policies come to pass?

One important strategy in North Carolina, and the one we want to focus on, is how tobacco control policies began with something that everyone could agree on. Advocates, policymakers, and organizational leaders helped push for smoke- and, later, tobacco-free policies in places where they make perfect sense: hospitals and schools. Following recommended strategies of media advocacy and coalition building, local communities pushed to protect hospital patients from secondhand smoke and to prevent children from being exposed to secondhand smoke in their elementary, middle, and high schools. Pressure was also applied from state government with a letter from the governor to school districts. As tobacco-free schools spread across the state, colleges and universities also began to go tobacco-free.

Tobacco-free schools and hospitals across North Carolina exposed large portions of the state’s population to tobacco-free policies when children were dropped off at school and when friends and family were visited in the hospital. To date, the Tobacco-Free Colleges Initiative has had particular success among community colleges, where large numbers of people are exposed to cleaner air on tobacco-free campuses. While these policies were not easy to pass, they were largely successful; people generally complied and the policies ultimately proved popular. Legislators could see these tobacco-free spaces in their local communities. This, combined with a statewide media campaign, and separate national campaigns, likely helped the passage of the state-wide smoke-free bars and restaurants policy in 2009.

In North Carolina, a state “preemption” law prevented advocates from working on city and county smoke-free policies, so advocates turned instead to schools, hospitals, college campuses, and, more recently, parks and beaches. When schools in places such as Tobaccoville, NC, and hospitals in Winston-Salem, NC, went tobacco-free, it showed legislators and North Carolinians that smoke- and tobacco-free policies were working in their own communities. Sharing the successes of these policies widely likely helped promote the statewide clean air law.

The approach taken in North Carolina was one that first focused on areas that the general public agreed should be smoke-free: schools and hospitals. Once those policies were in place, and the public became familiar with smoke-free areas, support grew for more places with clean air. When the time came to pass a state-wide restaurant and bar smoke-free policy, the state was ready. Even in a state with a strong history of tobacco, smoke-free policies are possible.

By Joseph G. L. Lee, University of North Carolina at Chapel Hill & Erin L. Sutfin, Wake Forest School of Medicine