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

虽然美国的吸烟人数正在下降，一种新兴的烟草使用形式，水烟， 吸烟（WTS）的人数正在增加。WTS现在几乎和大学生吸烟一样普遍， 它在高中和非大学成人人群中也很普遍。因为多达50%的 WTS使用者不吸烟，它影响了许多本来会是烟草天真的人。这是 特别值得关注的是，因为典型的WTS会话可以提供超过100倍的烟雾体积， 一根烟。 尽管清洁室内空气的政策和法规在美国迅速传播，更 超过90%的这些法律没有涉及WTS，可能会助长WTS的增加。此外，最近 FDA颁布的《家庭吸烟预防和烟草控制法》（FSPTCA，HR 1256）不 明确将WTS纳入其规定。因此，我们设计了这个项目， 迫切需要的信息，以告知和澄清联邦和州在这一领域的政策。国家往往作为 联邦政策的实验室，因为州和市直接管理的企业， 如果不允许销售烟草，有效的WTS政策将需要州和联邦的联合授权。作为一个缩影， 美国--从地缘政治和烟草控制政策的角度来看，宾夕法尼亚州是研究的理想州 这些话题。因此，我们设计了一个两阶段的项目，这将使我们能够提供详细的证据- 未来烟草控制立法的建议，将考虑到复杂的 WTS的动态，并将使我们能够积极主动地与WTS的政策领导者接触。 首先，我们将全面分析8个国家的所有相关烟草政策， 卫生区（HD）由PA批准。就每间房屋署而言，我们会同时研究 市和县一级，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关于烟草的每一种主要方式， 受管制，包括使用限制、青少年使用、价格（例如，税收）、调味料和标签。 其次，我们将探讨WTS及其相关的法律的问题与有影响力的个人谁拥有 过去和/或将来可能参与宾夕法尼亚州与烟草有关的立法， 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 深入访谈的结构化模板，以探讨特定问题，如（1）知识，态度， （2）澄清具体条款的意图和现实，和/或 先前立法的豁免（3）通过的任何立法的预期后果;以及（4）相互作用 市州和FSPTCA规定之间的差异综合文件分析和 深入访谈将直接为多个层面的最佳决策提供信息，以减少WTS。

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.