Perceived justice and popular support for public health laws: A case study around comprehensive smoke-free legislation in Mexico City

The World Health Organization's Framework Convention on Tobacco Control promotes comprehensive smoke-free laws. The effective implementation of these laws requires citizen participation and support. Risk communication research suggests that citizens' perceptions of the fairness of smoke-free laws would help explain their support for the law. This study aimed to assess the factors that correlate with citizens' perceptions of the distributive, procedural and interpersonal justice of smoke-free laws, as well as how these perceptions are related to support for and intention to help enforce these laws. Study data came from a cross-sectional, population-based survey of 800 Mexico City inhabitants before a comprehensive smoke-free policy was implemented there in 2008. Structural equation modeling was used to estimate the bivariate and multivariate adjusted paths relating study variables. In the final multivariate model, the three justice concepts mediated the influence of smoking status, perceived dangers of secondhand smoke exposure, strength of home smoking ban, and perceived rights of smokers on the two distal constructs of support for smoke-free policy and intention to help enforce it. Statistically significant paths were estimated from distributive and procedural justice to support for the law and intention help enforce it. The path from interpersonal justice to support for the law was not significant, but the path to intention to help enforce the law was. Finally, the path from support for the law to the intention to enforce it was statistically significant. These results suggest that three distinct dimensions of perceived justice help explain citizen support for smoke-free policies. These dimensions of perceived justice may explain the conditions under which smoke-free policies are effectively implemented and could help shape the focus for communication strategies that aim to ensure effective implementation of this and other public health policies.