Associations of Local Comprehensive Smoke-Free Ordinances With Cancer Incidence Trends in Louisiana.

Introduction: Louisiana has a high prevalence of smoking-related cancers. Although the 2007 Louisiana Smoke-Free Air Act restricted smoking in many public places, exemptions for bars, casinos, and other venues left many workers unprotected. Comprehensive local ordinances were later adopted in Orleans Parish (2015) and Ouachita Parish (2017). Methods: We conducted an ecological analysis of Louisiana Tumor Registry data from 2007 through 2022 to examine age-adjusted incidence of lung cancer and tobacco-related cancers. Orleans and Ouachita Parishes were compared with parishes covered only by the partial statewide law. Trends were assessed with Joinpoint regression using annual percent change (APC), average annual percent change (AAPC), and tests of parallelism. Results: In the primary parish-level analysis, lung cancer trends differed between ordinance and nonordinance parishes (P = .04). Orleans Parish declined steadily (APC, -3.02%; P < .001). Ouachita Parish showed a 2016 joinpoint, preceding implementation of the 2017 smoke-free ordinance, followed by a post-2016 decline of -7.33% annually (P = .01). In sensitivity analyses combining Orleans and Ouachita Parishes, lung cancer declined more rapidly than in the remainder of Louisiana (AAPC, -3.08% vs -1.70%; P = .004); tobacco-related cancers also declined more rapidly (-1.26% vs -0.64%; P = .02). Conclusion: Comprehensive local smoke-free ordinances were associated with more favorable long-term cancer incidence trends than Louisiana's partial statewide law. Broader statewide coverage may help reduce tobacco-related cancer burden and inequities over time.