Studies show tobacco control lags in Southeast, with perception gaps between lawmakers and the public

January 13, 2016

A series of three studies conducted by researchers at Emory University's Rollins School of Public Health highlight lagging progress on tobacco control with the southeastern U.S., through measures such as tobacco taxes and public smoke-free policies.

The first study included an analysis of 26 former state legislators representing southeastern U.S. states in an effort to gain insight on their views and perceptions of tobacco control issues.

In the paper titled "Tobacco Taxes in the Southeastern US States: Views from Former Legislators," published in Health Behavior and Policy Review, the research team identified influences on southeastern state legislators' actions related to tobacco tax increases.

In interviews with 26 former state legislators in southeastern states, the team found recurring themes regarding factors impeding the increase of tobacco taxes including:

  • Tobacco's legacy in the South
  • Protecting vulnerable populations from increased cigarette costs
  • Concerns about the economic impact
  • Opposing "sin" taxes
  • Concerns about impact on reelection
  • Perceptions that constituents oppose all taxes
  • Health concerns were a major theme among state legislators who supported increasing tobacco taxes.

Complete findings of this study are available online.

The last pair of studies compared tobacco taxes and smoke-free policy support and opposition in southern and non-southern states. Using a cross-sectional, online survey of 2,501 adults, the team assessed varying perceptions and opinions of specific tobacco control policies and messaging strategies.

The paper titled "Reactions to Cigarette Taxes and Related Messaging: Is the South Different?" published in American Journal of Health Behavior, examined differences in reactions to tobacco taxes and related messaging among southerners and non-southerners, given the lag in the South's tobacco control policies.

Results of the online survey showed that southerners are receptive to increased tobacco taxation, are aware that tobacco taxes are low in their region, and are not distinctly opposed to tobacco tax increases despite the misconception of policymakers.  Results also showed that messaging strategies focused on youth tobacco use prevention, individual rights and responsibilities, and hospitality are particularly effective in the South.

The complete study is available through the American Journal of Health Behavior online.  

The final paper, titled "Reactions to Smoke-free Policies and Messaging Strategies in Support and Opposition," published online in Health Behavior and Policy Review, also examined results of the survey and found that southerners are somewhat aware that their states of residence lag behind other states in the adoption of public smoke-free policies; however, they are similar to non-southerners in their views on implementing smoke-free policies in personal settings and the level of support for public smoke-free policies 

According to the researchers, the paper's key finding is that factors other than public opinion are causes of lagging adoption of comprehensive smoke-free policies in the South. They offer two explanations for the lack of adoption of comprehensive smoke-free policies:

  1. Constituents are less engaged with their lawmakers — a critical method foradvancing tobacco control legislation.
  2. Policymakers' have misconceptions about the negative health impacts of second hand smoke or the economic and public health benefits of smoke free policies. 

More information is available online at

"Essentially, these articles highlight that Southeastern state residents are mostly aware that we are behind in tobacco control policies and are as much or more in support of increasing taxation and implementing smoke-free public policies as are people in other parts of the country," says Carla Berg, PhD, associate professor of behavioral sciences and health education at Rollins School of Public Health and lead author.

"Unfortunately, interviews with former state legislators reflected opposite concerns, alongside other misconceptions and gaps in their knowledge regarding tobacco taxation and comprehensive smoke-free policies, says Berg who is also associate director of Population Sciences for Winship Cancer Institute of Emory University. Efforts are needed to address these gaps and support constituents in engaging with lawmakers and fostering accountability."