Improving U.S. health policy regarding water-pipe tobacco smoking

虽然吸烟在美国正在减少，但一种新兴的烟草使用形式--水烟 吸烟(WTS)，正在增加。WTS现在几乎和大学生使用香烟一样普遍， 它在高中和非大学成年人群中也很普遍。因为多达50%的 WTS用户不吸烟，它影响到许多本来会是烟草天真的人。这是 尤其令人担忧的是，典型的WTS会话可能会提供超过100倍的烟量 一支香烟。 尽管清洁的室内空气政策和法规在美国各地迅速传播，但更多的 这些法律中有90%以上没有解决WTS，这可能会加剧WTS。此外，最近 FDA颁布的家庭吸烟预防和烟草控制法案(FSPTCA，HR 1256)没有 在其规定中具体包括WTS。因此，我们设计了这个项目来深入生成 迫切需要信息，以告知和澄清联邦和州在这一领域的政策。国家通常充当 联邦政策实验室，因为各州和市政当局直接监管那些 销售烟草，有效的WTS政策将需要州和联邦的联合权力。作为一个缩影， 美国-无论是就地缘政治还是烟草控制政策而言-宾夕法尼亚州都是学习的理想州 这些主题。因此，我们设计了一个分两个阶段的项目，使我们能够提供详细的证据- 基于对未来烟草控制立法的建议，将考虑到复杂的 了解WTS的动态，并使我们能够主动与WTS周围的政策领导人接触。 首先，我们将全面分析8名官员每人现有的所有相关烟草政策 PA批准的卫生区(HDs)。对于每家房屋署，我们会同时研究有关 市级和县级，包括它们如何与州和联邦政策互动。我们将系统地 评估这些文本中的语言如何适用于烟草的每一种主要方面的WTS 受监管，包括使用限制、青少年准入、价格(例如，税收)、调味品和标签。 其次，我们将与具有影响力的个人探讨WTS及其相关法律问题 过去和/或未来可能参与宾夕法尼亚州与烟草相关的立法， 包括(1)立法者和工作人员；(2)公共卫生官员；(3)倡导团体领导人。我们将使用 用于深入访谈的结构化模板，以探讨特定问题，例如(1)知识、态度、 和与WTS有关的信念；(2)澄清具体条款和/或 先前立法的豁免(3)任何通过的立法的预期后果；和(4)相互作用 在市政、州和FSPTCA条款之间。综合文件分析和信息 深入的访谈将直接为减少WTS的多个层面的最佳决策提供信息。

While cigarette smoking is declining in the U.S., an emerging form of tobacco use, waterpipe tobacco smoking (WTS), is increasing. WTS is now nearly as common as cigarette use for college students, and it is also prevalent among high school and non-college adult populations. Because as many as 50% of WTS users do not smoke cigarettes, it affects many who would otherwise have been tobacco na¿ve. This is of particular concern because a typical WTS session may deliver over 100 times the smoke volume of a single cigarette. Although clean indoor air policies and regulations have rapidly propagated throughout the U.S., more than 90% of these laws do not address WTS, possibly fueling increased WTS. Furthermore, the recently enacted FDA Family Smoking Prevention and Tobacco Control Act (FSPTCA, HR 1256) does not specifically include WTS in its stipulations. Therefore, we designed this project to generate in-depth information urgently needed to inform and clarify federal and state policy in this area. States often serve as laboratories for federal policy, and because states and municipalities directly regulate the businesses that sell tobacco, effective WTS policy will require combined state and federal authority. As a microcosm of the U.S.-both in terms of geopolitics and tobacco control policies-Pennsylvania is the ideal state to study these topics. Therefore, we designed a two-phase project which will enable us to provide detailed, evidence- based recommendations for future tobacco-control legislation that will take into account the complex dynamics of WTS and will allow us to proactively engage with policy leaders around WTS. First, we will comprehensively analyze all relevant extant tobacco policies of each of the 8 official Health Districts (HDs) sanctioned by PA. For each HD, we will simultaneously examine laws on the municipal and county level, including how they interact with state and federal policy. We will systematically assess how language within these texts applies to WTS regarding each of the primary ways tobacco is regulated, including use restrictions, youth access, price (e.g., taxation), flavorings, and labeling. Second, we will explore WTS and its associated legal issues with influential individuals who have been and/or may be in the future involved in tobacco-related legislation in Pennsylvania in the past, including (1) legislators and staff; (2) public health officials; and (3) advocacy group leaders. We will use structured templates for in-depth interviews to explore particular issues such as (1) knowledge, attitudes, and beliefs related to WTS; (2) clarification of intentions and realities of specific provisions and/or exemptions of prior legislation (3) perceived consequences of any legislation passed; and (4) interactions between municipal, state, and FSPTCA provisions. Synthesis of information from document analyses and in-depth interviews will directly inform optimal policy-making on multiple levels to reduce WTS.