Science, prudence, and politics: The case of smoke-free indoor spaces

Purpose: We examine the process of how epidemiologic evidence regarding the harms of secondhand smoke (SHS) exposure has been translated into policy and distill lessons that could be applied to other public health areas. Methods: We detail the history of the growth of evidence and the development of prudent policies in this area and the parallel, organized efforts led by the tobacco industry to oppose them. We also describe how opposition to these policies helped shape the emerging research agenda. Results: Seven lessons emerged from our study. (i) Even after a policy goal has been achieved, the need for epidemiological evidence and inquiry remains. (ii) Dissemination and implementation research is necessary. (iii) The best and most necessary research questions do not always come from epidemiologists. (iv) There is a need for epidemiologists to work with other researchers across disciplines. (v) Epidemiologists must anticipate the opposition. (vi) Focused, well-organized advocacy is needed to translate even the strongest epidemiological evidence into policy change. (vii) Epidemiologists should be trained to engage and interact with public health advocates, practitioners, and policy makers. Conclusions: Although this case study shows that policy can be driven by science, it also demonstrates that clear scientific evidence does not automatically lead to optimal policy.