Assessing the Impact of State Preemption Laws

点击翻译按钮获取中文摘要

Project Summary/Abstract Tobacco use remains the leading cause of preventable death, contributing to 480,000 deaths in the U.S. annually. Smoking alone causes 90% of all lung cancer-related deaths and 80% of all chronic obstructive pulmonary disease-related deaths. Another 16 million people in the U.S. live with a disease caused by smoking. Despite unknown long-term health effects, the increasing popularity of e-cigarettes (10.8 million adults are current users) is a growing concern, especially given that this is the most popular form of tobacco among youth. In recent years, there has been an increase in the number and variety of laws that preempt local public policies. Preemption occurs when a higher level of government restricts or withdraws the authority of a lower level of government to act on a particular issue, thereby prohibiting lower levels of government from enacting more stringent laws. Preemptive laws are common on a variety of health issues, including tobacco. For example, about 32 states had at least one form of preemption of local tobacco control ordinances as of September 30, 2018. The laws vary by states in many aspects, including whether e-cigarettes are included. Numerous stakeholders have concerns about the potential negative impacts of these laws. For instance, the American Medical Association, the Institute of Medicine, and Healthy People 2020 have recognized preemption law(s) as a barrier to public health. However, to date, there is no existing rigorous empirical evidence on how, or if, these preemption laws affect local policy innovation and key health outcomes. The proposed study will address these critical knowledge gaps by using a rigorous quasi-experimental design to assess the impact of state preemption laws on tobacco and e-cigarette use. Specifically, we propose an original systematic legal analysis to characterize and code state tobacco preemption laws as well as their dimensions (Aim 1), assess the impact of state preemption laws on county smoke-free indoor policy (Aim 2), cigarette smoking (Aim 3) and e-cigarette use (Aim 4). Aims 3 and 4 will also assess the heterogeneous impact of state preemption laws among (a) subgroups (defined based on gender and race/ethnicity) and whether the effects of these laws vary between (b) rural and urban communities. Our interdisciplinary team has extensive experience in substance abuse epidemiology, quantitative analysis, policy and legal research. The proposed research will address a severely understudied area with high public health significance: state preemption laws functioning as a significant barrier to public health. This is an area of critical importance, as the number and variety of preemption laws are increasing in the U.S. The results of this highly innovative study will provide timely empirical evidence and have a sustained impact in informing future decision making on preemptive policies and laws.