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

摘要 将获得烟草产品的最低合法年龄(MLA)提高到21岁将减少获得烟草产品的机会，并可能 防止或推迟青少年和青壮年开始吸烟。然而，现代烟草行为 年轻人的使用日益复杂，其特点是香烟使用量减少，增加 非香烟烟草产品的使用和多聚烟草的使用。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的迅速扩散 政策方面，关于烟草21法律的过程、内容或结果的数据很少。现有的证据表明 将MLA提高到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/民族群体是否有效在很大程度上是 未知。使用多数据流框架以及REACH、有效性、采用、实施和 维护(RE-AIM)框架作为我们的概念框架，我们实施和评估健康政策 影响烟草21采用、实施和维护的因素。这个项目使用了混合的 方法了解将工作重点提高到21岁的政策的实施和影响， 寻求扩大证据基础，重点放在多样化的背景下的种族/族裔群体 烟草环境。具体地说，我们将：(1)开展15个州的比较案例研究，使用 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 可能导致通过或否决《烟草21》立法的因素；(2)反复交叉 烟草产品采购部门研究，以检查全州烟草21法律在新的执行情况 泽西；以及，(3)通过模拟13到25岁的烟草使用行为来描述烟草21法律的影响 使用来自全国毒品使用和药物使用调查的数据的21个州的禁烟和不吸烟州的年龄 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差异。

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.