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

描述（由申请人提供）：虽然美国的吸烟率正在下降，但一种新兴的烟草使用形式，水烟吸烟（WTS）正在增加。在大学生中，WTS几乎和吸烟一样普遍，在高中生和非大学生中也很普遍。由于多达50%的WTS使用者不吸烟，它影响了许多本来对烟草不了解的人。这一点尤其令人担忧，因为一次典型的WTS会话产生的烟雾量可能是一支香烟的100多倍。尽管清洁室内空气政策和法规在美国迅速传播，但其中90%以上的法律都没有解决WTS问题，这可能会加剧WTS的增加。此外，最近颁布的FDA家庭吸烟预防和烟草控制法案（FSPTCA, HR 1256）并未明确将WTS纳入其规定。因此，我们设计了这个项目，以产生迫切需要的深入信息，以告知和澄清联邦和州在这一领域的政策。各州经常充当联邦政策的试验室，由于各州和市政当局直接管理烟草销售企业，有效的WTS政策将需要州和联邦的联合权力。作为美国的缩影——无论是地缘政治还是烟草控制政策——宾夕法尼亚州都是研究这些课题的理想州。因此，我们设计了一个两阶段的项目，这将使我们能够为未来的烟草控制立法提供详细的、基于证据的建议，这些建议将考虑到WTS的复杂动态，并使我们能够主动与有关WTS的政策领导人接触。首先，我们将全面分析PA批准的8个官方卫生区（hd）的所有相关现行烟草政策。对于每个HD，我们将同时审查市和县一级的法律，包括它们如何与州和联邦政策相互作用。我们将系统地评估这些文本中的语言如何适用于WTS，涉及烟草管制的每一种主要方式，包括使用限制、青少年获取、价格（如税收）、调味和标签。其次，我们将探讨WTS及其相关的法律问题与有影响力的个人谁曾经和/或可能在未来参与烟草相关立法在宾夕法尼亚州，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。我们将使用结构化模板进行深度访谈，以探讨特定问题，如：(1)与WTS相关的知识、态度和信念；(2)明确具体的意图和现实

DESCRIPTION (provided by applicant): 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 naive. 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.