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In 2007, although Tennessee was (and still is) the third largest tobacco¬producing state, it enacted the Non¬Smoker Protection Act (NSPA), making most enclosed public and workplaces, and restaurants 100% smoke-free. This study triangulates archival documents with interviews, legislative debates and quantitative data for a stakeholder analysis of why and how the diverse interests in the state collaborated to develop the policy and identifies areas and opportunities for improvement. The study utilizes the policy cycle and stages of policy development approach and three public policy models – garbage can or multiple streams, policy networks, and socio¬economic influences – to give us understanding of the phases of the development of the NSPA – agenda-setting, legislative development, and implementation. While the dominant thesis for the origin of this smoke¬free policy (SFP) was government¬centered, the activities of non¬governmental actors, such as efforts by students of University of Tennessee in Knoxville to have smoke¬free domitories and that of Campaign for Healthy and Responsible Tennessee (CHART) to repeal preemption (nongovernmental¬centered thesis), and societal changes (bubble¬up thesis) contributed to its emergence. The SFP entered the state’s policy agenda when the problem of tobacco use in the state (health consequences and costs) and policy solutions (including SFP) became coupled with favorable political circumstances involving Governor Phil Bredesen’s unexpected announcement of support for a statewide SFP during smoke¬free state buildings bill signing ceremony in June 2006. This announcement created a window of opportunity for SFP change, which was seized by a change agent in the state, CHART. In February 2007, the Governor included SFP in the administration's legislative package for the 105th Legislative Session. Additionally, SFP bills were sponsored in both houses of the Legislature to make SFP a priority item on the state’s policy agenda. The development of the NSPA was facilitated by factors, such as the administration’s continuous support for the SFP, activities of CHART, public support for the SFP, U¬turn in the position of Tennessee Restaurant Association (now Tennessee Hospitality Association) to support 100% SFP and limited opposition from tobacco interests in the state. Although implementation of the NSPA has generally proceeded smoothly, about half of the stakeholders prefer that the exemptions are repealed, particularly those for age¬restricted venues, non¬enclosed areas of public places and private businesses with three or fewer employees. This study suggests that there is high level of knowledge on tobacco use (the problem) and control (policy solutions) in policy circles and the key remaining factors for policy change are favorable political environment and a change agent. The development of the NSPA suggests that proponents for policy change should know and understand their policy and political environment and be alert for any change that will facilitate the development of an SFP.

References which constitute the “data” for the paper “Civil Society and the Negotiation of the Framework Convention on Tobacco Control” by H.M. Mamudu and S.A. Glantz, published in Global Public Health, that are cited with numbers in the paper.

This paper examines the historical experience of tobacco control in the last five decades and shares important lessons of public health interventions to inform current and future tobacco control programs in other countries. The paper is divided into four parts. The first part gives an overview of the political economy, principal influences and interventions in tobacco control in the United States. It stresses the importance of information shocks and the role played by grassroots organizations. The current situation of tobacco control in the United States is further discussed in the second part, with emphasis on the economic case that led to litigation, as well as the response of the industry and the States. The third part focuses on the present efforts of multilaterals like the World Bank, technical UN agencies such as the World Health Organization, in the context of the new global governance structure: the Framework Convention on Tobacco Control (FCTC). The last section discusses lessons learned and provides recommendations for comprehensive tobacco control programs.The paper suggests five major policy drivers that constitute components of a comprehensive tobacco control program: – science to inform policy, information strategies to educate consumers, advocacy to stimulate interventions, legal actions to develop regulations, and international collaboration through the FCTC. The paper concludes that while government has the responsibility for funding and implementing these activities; these can be most effective when supported by civil society.

OBJECTIVES: COVID-19 vaccination in the United States has stalled, with some of the lowest rates in the South. Vaccine hesitancy is a primary contributor and may be influenced by health literacy (HL). This study assessed the association between HL and COVID-19 vaccine hesitancy in a population residing in 14 Southern states. STUDY DESIGN: Cross-sectional study using a web-based survey conducted between February and June 2021. METHODS: The outcome was vaccine hesitancy, and the main independent variable was HL, assessed as an index score. Descriptive statistical tests were performed, and multivariable logistic regression analysis was conducted, controlling for sociodemographic and other variables. RESULTS: Of the total analytic sample (n = 221), the overall rate of vaccine hesitancy was 23.5%. Vaccine hesitancy was more prevalent in those with low/moderate HL (33.3%) vs those with high HL (22.7%). The association between HL and vaccine hesitancy, however, was not significant. Personal perception of COVID-19 threat was significantly associated with lower odds of vaccine hesitancy compared with those without perception of threat (adjusted odds ratio, 0.15; 95% CI, 0.03-0.73; P = .0189). The association between race/ethnicity and vaccine hesitancy was not statistically significant (P = .1571). CONCLUSIONS: HL was not a significant indicator of vaccine hesitancy in the study population, suggesting that general low rates of vaccination in the Southern region may not be due to knowledge about COVID-19. This indicates a critical need for place-based or contextual research on why vaccine hesitancy in the region transcends most sociodemographic differences. [ABSTRACT FROM AUTHOR]