Tob Control 19:i16-i20 doi:10.1136/tc.2009.030718
  • Research paper

Policy-driven tobacco control

Open Access
  1. Hye-Youn Park
  1. California Department of Public Health, California Tobacco Control Program, Sacramento, California, USA
  1. Correspondence to John A Francis, California Department of Public Health, California Tobacco Control Program, PO Box 997377, MS 7206, Sacramento, California 95899-7377, USA; johnaveryfrancis{at}
  • Received 1 April 2009
  • Accepted 9 February 2010


Background Since the passage of Proposition 99, California's comprehensive tobacco control programme has benefited from a localised policy adoption process that allows for the innovation and diffusion of strong local tobacco control policies throughout the state.

Methods The policy adoption continuum is described in the context of California's smoke-free workplace movement, and the influence of policy-driven tobacco control initiatives on social norms, behaviour and the public's health was examined.

Results The Smoke-free California policy adoption continuum reflects a general approach for policy innovation and diffusion that builds social acceptance and influences social norms, while minimising unintended consequences and creating best practices in tobacco control. California's local smoke-free workplace policies have reduced secondhand smoke exposure and supported attitude and behaviour changes. The effects of local policy adoption led to the nation's first statewide smoke-free workplace law.

Conclusions Proposition 99 created an unprecedented tobacco control infrastructure that supported local policy innovation and diffusion to influence social norms and behaviours. Tobacco control policy efforts should address campaign challenges, oppose pre-emption and confront tobacco industry influence. Advocates must be cautious of pursuing a statewide policy prematurely, as it may result in a weak and/or pre-emptive policy that can stymie local policy efforts and prolong the adoption of a meaningful statewide policy.


  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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