Competing initiatives: a new tobacco industry strategy to oppose statewide clean indoor air ballot measures.

To describe how the tobacco and gaming industries opposed clean indoor air voter initiatives in 2006, we analyzed media records and government and other publicly available documents and conducted interviews with knowledgeable individuals. In an attempt to avoid strict "smoke free" regulations pursued by health groups via voter initiatives in Arizona, Ohio, and Nevada, in 2006, the tobacco and gaming industries sponsored competing voter initiatives for alternative laws. Health groups succeeded in defeating the pro-tobacco competing initiatives because they were able to dispel confusion and create a head-to-head competition by associating each campaign with its respective backer and instructing voters to vote "no" on the pro-tobacco initiative in addition to voting "yes" on the health group initiative.