Tobacco Control in Tennessee: Stakeholder Analysis of the Development of the Non¬Smoker Protection Act, 2007
In 2007, although Tennessee was (and still is) the third largest tobacco¬producing state, it enacted the Non¬Smoker Protection Act (NSPA), making most enclosed public and workplaces, and restaurants 100% smoke-free. This study triangulates archival documents with interviews, legislative debates and quantitative data for a stakeholder analysis of why and how the diverse interests in the state collaborated to develop the policy and identifies areas and opportunities for improvement. The study utilizes the policy cycle and stages of policy development approach and three public policy models – garbage can or multiple streams, policy networks, and socio¬economic influences – to give us understanding of the phases of the development of the NSPA – agenda-setting, legislative development, and implementation. While the dominant thesis for the origin of this smoke¬free policy (SFP) was government¬centered, the activities of non¬governmental actors, such as efforts by students of University of Tennessee in Knoxville to have smoke¬free domitories and that of Campaign for Healthy and Responsible Tennessee (CHART) to repeal preemption (nongovernmental¬centered thesis), and societal changes (bubble¬up thesis) contributed to its emergence. The SFP entered the state’s policy agenda when the problem of tobacco use in the state (health consequences and costs) and policy solutions (including SFP) became coupled with favorable political circumstances involving Governor Phil Bredesen’s unexpected announcement of support for a statewide SFP during smoke¬free state buildings bill signing ceremony in June 2006. This announcement created a window of opportunity for SFP change, which was seized by a change agent in the state, CHART. In February 2007, the Governor included SFP in the administration's legislative package for the 105th Legislative Session. Additionally, SFP bills were sponsored in both houses of the Legislature to make SFP a priority item on the state’s policy agenda. The development of the NSPA was facilitated by factors, such as the administration’s continuous support for the SFP, activities of CHART, public support for the SFP, U¬turn in the position of Tennessee Restaurant Association (now Tennessee Hospitality Association) to support 100% SFP and limited opposition from tobacco interests in the state. Although implementation of the NSPA has generally proceeded smoothly, about half of the stakeholders prefer that the exemptions are repealed, particularly those for age¬restricted venues, non¬enclosed areas of public places and private businesses with three or fewer employees. This study suggests that there is high level of knowledge on tobacco use (the problem) and control (policy solutions) in policy circles and the key remaining factors for policy change are favorable political environment and a change agent. The development of the NSPA suggests that proponents for policy change should know and understand their policy and political environment and be alert for any change that will facilitate the development of an SFP.