In 1992, fewer than half of Americans thought smoking should be banned in restaurants; by 2022, that number had soared to over 85%, reflecting a quiet but profound transformation in public attitudes that has unfolded in every corner of the United States. Researchers at the Herbert Wertheim School of Public Health at UC San Diego have now captured this shift with unprecedented precision, analyzing 1.5 million survey responses to create the "Willingness to Restrict Smoking" (WTRS) scale—a reliable, long-sought tool that quantifies how social norms around smoking have evolved over three decades. This isn’t just about policy—it’s about people. The shift began in the early 1990s when the National Cancer Institute redefined tobacco control, moving beyond individual willpower to reshape the social acceptability of smoking. California led the charge, launching the California Tobacco Control Program (CTCP), which used powerful media campaigns featuring real stories from bar workers to shift public perception. That groundwork made it possible to pass the world’s first smoke-free bar law in the late 1990s—a once-unthinkable victory that now seems inevitable.
The new study, published in BMJ Public Health, reveals that support for smoke-free environments grew steadily across all 50 states between 1992 and 2022. Restrictions in hospitals and playgrounds consistently drew the strongest backing, with over 90% of respondents supporting bans in these spaces by the end of the study period. Even in traditionally resistant venues like bars and casinos, support rose significantly. The WTRS scale proved remarkably stable over time, despite changes in survey design, offering public health officials a validated metric to measure the success of anti-smoking campaigns and policies. This kind of data is crucial—not only to understand the past, but to guide future efforts in reducing tobacco use, which still causes more than 480,000 deaths annually in the U.S.
The implications extend beyond cigarettes. As new products like e-cigarettes and vaping enter the scene, the WTRS scale could help track how public opinion evolves and inform where and how to implement regulations. The study confirms what public health advocates have long believed: that changing social norms is one of the most powerful tools in reducing harm. When people collectively decide that secondhand smoke is no longer acceptable, policy follows. And when policy reinforces those norms, the cycle strengthens. Today, smoke-free air is no longer a luxury—it’s an expectation. With tools like the WTRS scale, communities can continue building on this progress, ensuring that the air people breathe in public spaces remains clean, safe, and smoke-free for generations to come.