Adoption, diffusion, and implementation of Tobacco 21 policies to address health disparities

摘要 将法律的获取烟草制品的最低年龄提高到21岁， 预防或延迟青少年和年轻人开始使用烟草。然而，现代烟草行为 年轻人吸烟的情况越来越复杂，其特点是吸烟减少， 使用非卷烟烟草产品和聚烟草。此外，烟草使用模式和烟草 对未成年人的销售因种族/民族而异。虽然最近烟草21迅速传播， 在烟草政策方面，几乎没有关于烟草21法律的过程、内容或结果的数据。现有证据表明， 将MLA增加到21有望进一步减少年轻人的烟草使用，但程度 这些政策对所有烟草产品以及所有种族/民族群体都有效， 未知使用多流框架和覆盖面、有效性、采用、实施和 维护（RE-AIM）框架作为我们的概念框架，我们操作和评估卫生政策 影响烟草21的采用、实施和维护的因素。该项目使用混合 方法方法，以了解将工作重点提高到21的政策的执行情况和影响， 寻求扩大证据基础，重点是种族/族裔群体， 烟草环境。具体而言，我们将：（1）对15个州进行比较案例研究， 烟草21法案的文件分析、新闻媒体内容分析和关键线人访谈，以确定 可能导致通过或拒绝烟草21立法的因素;（2）进行反复交叉 部分烟草产品购买研究，以检查全州烟草21法律在新 泽西岛;以及，（3）通过模拟13至25岁之间的烟草使用行为来描述烟草21法律的影响 使用全国药物使用调查的数据， 健康拟议的研究与公共卫生的相关性在于其改善现有和未来的能力。 烟草21政策和减少烟草使用的差距。

ABSTRACT Raising the minimum age of legal access (MLA) to tobacco products to 21 decreases access and would likely prevent or delay initiation of tobacco use by adolescents and young adults. However, modern tobacco behavior use among young people is increasingly complex and is characterized by decreased cigarette use, increased use of non-cigarette tobacco product use and, poly tobacco use. In addition, tobacco use patterns and tobacco sales to minors vary based on race/ethnicity. While there has been recent and rapid diffusion of Tobacco 21 policies, little data exist on the process, content, or outcomes of Tobacco 21 laws. The existing evidence for increasing the MLA to 21 holds promise to further reduce tobacco use among young people but the extent to which such policies will be effective for all tobacco products as well as all racial/ethnic groups is largely unknown. Using the Multiple Streams Framework and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework as our conceptual frames we operationalize and assess health policy factors that impact Tobacco 21 Adoption, Implementation and Maintenance. This project uses a mixed methods approach to understand the implementation and impact of policies that raise the MLA to 21, seeking to expand the evidence base with a focus on racial/ethnic groups in the context of a diverse tobacco environment. Specifically, we will: (1) carry out a comparative case study of 15 states using document analysis of Tobacco 21 bills, news media content analysis, and key informant interviews to identify factors that may contribute to the adoption or rejection of Tobacco 21 legislation; (2) conduct a repeated cross sectional tobacco product purchase study to examine implementation of a statewide Tobacco 21 law in New Jersey; and, (3) describe the impact of Tobacco 21 laws by modeling tobacco use behavior among 13 to 25 year olds in states with and without Tobacco 21 laws using data from the National Survey on Drug Use and Health. The relevance of the proposed research to public health is its ability to improve existing and future Tobacco 21 policies and reduce tobacco use disparities.