Protecting West Virginians from secondhand smoke through regulation at the local level.

West Virginia's communities have made substantial progress in protecting citizens from secondhand smoke exposure (SHS) through adoption of local regulations through county boards of health. The EPA and the U.S. Surgeon General have confirmed exposure to SHS causes serious disease and death in nonsmoking adults and children. The Centers for Disease Control and Prevention recommends enactment of federal, state and local policies to reduce exposure among nonsmokers and to reduce smoking prevalence. West Virginia's local boards of health have regulated smoking in workplaces and public spaces since 1992 and their authority to do so has been affirmed in state courts. Early smoke free regulations covered primarily non-hospitality workplaces. Mounting evidence of the public health risk of SHS exposure accelerated local efforts to prohibit smoking in all workplaces and public establishments. Every West Virginia county has adopted a smoke free regulation, though levels of protection vary. Forty-seven counties comprising 90.2% of the population, prohibit smoking in non-hospitality workplaces and restaurants. Twenty-six counties, (52% of the population), prohibit smoking in all workplaces, including restaurants, bars and gaming establishments. In the presence of strong smoking bans, the state has observed a decline in hospital admissions for acute coronary syndrome, a reduction in smoking prevalence among youth, and changes in beliefs and behaviors regarding secondhand smoke among adults. To build on West Virginia's success in this area of public health, increased state and community efforts are needed to strengthen and maintain existing smoke free policies.