Smoke-free workplace ballot campaigns: case studies from Missouri and lessons for policy and media advocacy.

Purpose: To assess the key components of smoke-free campaigns that may have influenced voting outcomes in three communities.

Design: Community case studies with content analysis of tobacco-related newspaper articles.

Setting: Three semiurban Missouri communities.

Subjects: One hundred eighty-one articles referencing tobacco published during the campaigns and five key informant interviews.

Measures: Articles were coded for type, community referenced, tobacco control position, source of quotations, use of evidence, and frame. Semistructured interviews with key informants collected additional information.

Analysis: Descriptive statistics were utilized to examine media coverage in each community. Key themes and events for each campaign were identified from qualitative interviews.

Results: The only community that failed to pass its initiative had the highest proportion of letters to the editor (81.1%), anti-tobacco control articles (34.2%), use of a rights frame (28.8%), no evidence used (36.9%), no neighboring communities with policies, strong Tea Party presence, and no support from the chamber of commerce. Across all communities, more articles incorporating health frames were pro-tobacco control (70.7%) and more articles with a rights frame were anti-tobacco control (62.0%), compared to other positions.

Conclusion: Several factors can influence the policy process. Tobacco control policy advocates facing strong opposition should consider the many factors (demographics, proximity to other adopting localities, politics) driving the debate and use media as an avenue to influence the discussion, connect with the public and policymakers, and mobilize proponents.