Compliance is not enough: Smoking policies in state mental retardation and developmental disabilities agencies

Mounting scientific evidence implicating environmental tobacco smoke (ETS) in the incidence of serious diseases in children and adult nonsmokers, and documentation of widespread exposure to ETS in the general population have changed the tenor of the public debate about smoking and placed new emphasis on the need to protect nonsmokers from involuntary ETS exposure. Against this backdrop, there is little empirical information about how state mental retardation and developmental disabilities (MR/DD) agencies deal with this issue.; Key informants from 49 of the nation's 51 state MR/DD agencies provided information about their agency's policies on smoking. Data describing the organizational characteristics of agencies and smoking policies and practices in states were also analyzed to assess the influence of these factors on agency policies.; Among the 32 state agencies with policies on smoking, every policy applied to state-operated programs, but there was variation in their levels of restrictiveness and in the percentage of consumers and employees that the policy covered. Nationwide, only one state agency had a smoking policy that offered every consumer and employee associated with the agency full protection from ETS. This policy prohibited smoking in both state and vendor-operated programs, including residences.; Policies in the remaining 48 agencies fell short of this level of protection in several ways: (1) the policy banned smoking but allowed widespread exemptions for residences; (2) the policy restricted smoking to designated smoking areas that were not enclosed and separately ventilated; or (3) the agency had no smoking policies. Currently 84% of state MR/DD service recipients live in vendor-operated programs, yet only six state agencies extended their smoking policies to private vendors.; The largest single influence on whether state agencies had smoking policies was a state clean indoor air statute or executive order banning or restricting smoking in state government buildings. Most agencies were doing nothing less but they were also doing nothing more than state law required. State agencies with policies tended to be larger, less privatized and to spend less on individualized services than agencies without policies. Smoking policies and practices in states were not found to influence smoking policies in state MR/DD agencies.