BERMAN ET AL. RESPOND

Abstract

We certainly agree with Hahn et al. that the ultimate goal is for residents of the Appalachian region to be protected by comprehensive, anti-preemptive statewide smoke-free laws, but we evidently disagree about the best strategy to reach that goal.1 Although we do not intend to downplay the determined efforts and tremendous accomplishments of local advocates in parts of Appalachia, our study found that years of local advocacy for smoke-free laws have produced only modest results. Moreover, the communities that have successfully passed comprehensive smoke-free laws have tended to be those with relatively high socioeconomic profiles, likely further exacerbating the health disparities that already exist within the region. We believe that all residents of the Appalachian region deserve protection from breathing toxic environmental tobacco smoke, and a community-by-community approach simply will not move the process along quickly enough. Hahn et al.'s own research has found that there is strong public support for smoke-free laws in the Appalachian region, and the recent passage of a strong smoke-free law in North Carolina—combined with encouraging progress toward a smoke-free law in Virginia—suggests that statewide success is possible even in historically tobacco-growing regions. We urge a strategy that will enlist the support of local leaders as part of a larger effort to pass and implement comprehensive statewide smoke-free laws.