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.

"Anti-smoking data are exaggerated" versus "the data are clear and indisputable": examining letters to the editor about tobacco.

Media advocacy plays a unique role in tobacco control policy development. Letters to the editor in particular are an interesting form of media advocacy because they reflect community sentiment regarding the policy agenda and provide insight into the public debate. The authors used ethnographic context analysis to examine the techniques used by writers of 262 tobacco-related letters to the editor published in 61 newspapers across Missouri over a 2-year period when tobacco tax and smoke-free indoor air initiatives were occurring across the state. The authors found that pro-tobacco control letter writers often used didactic strategies, citing numbers and reports, to convey information and presented their training or experience as a health professional (e.g., M.D., Ph.D.) to add legitimacy to their arguments. Anti-tobacco control letter writers, in contrast, used narrative strategies to support their stance, claimed authority as a smoker or small business owner to legitimize their claims by relating to the audience, and used collectivity to capture the attention of policymakers. These results present the importance of strategic media advocacy in tobacco control. Tobacco control advocates should increase their use of narrative strategies and collectivity in order to better connect with the public and policymakers.