Adoption, Diffusion, and Implementation of Tobacco 21 Policies to Address Health Disparities

Title: ADOPTION, DIFFUSION, AND IMPLEMENTATION OF TOBACCO 21 POLICIES TO ADDRESS HEALTH DISPARITIES (PI: Cristine Delnevo, Rutgers University; UK Subaward PI: Shyanika Rose, University of Kentucky 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. Initially, 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 New York; 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. In the current project, we will extend the product purchase study to additional states, North Carolina and Kentucky, which raised the age of sale to 21 following the Federal Tobacco 21 law passed in December 2019. The relevance of the proposed research to public health is its ability to improve implementation and enforcement of existing and future Tobacco 21 policies and reduce tobacco use disparities. Scope of Work: University of Kentucky Proposed compliance checks in KY tobacco retailers will assess compliance with tobacco age of sale laws. In addition, objective data will be store surroundings, signage, etc. Investigators at the University of Kentucky will assist Rutgers with the specific aims of their grant by assisting with a multi-factorial repeated cross sectional covert purchase study of tobacco retailers in NY, NC, KY and NJ. Given that the intent of Tobacco 21 laws is to reduce access to tobacco to young adults, compliance checks to enforce Tobacco 21 laws will involve recruitment and deployment of tobacco product purchasers in the 21 age group. In compliance with KY law we are unable to have 18-20 year old buyers as in other sites. We will have several conditions that vary by our covert buyers’ demographics and type of tobacco product, enabling us to explore retailer compliance by these features over time. Qualifications: University of Kentucky investigators have extensive experience collecting tobacco surveillance data from tobacco retailers. Goals and Objectives: University of Kentucky agrees to a resultant subcontract to assist investigators with collecting and analyzing data on tobacco age of sale compliance: • Collaborating on study sample, data collection tools, and protocols • Hiring and training data collectors • Collecting data from 50 KY licensed tobacco retailers and 10 Vape shops during Fall of 2021 Detailed list of deliverables: • Contribute to manuscript publications and presentations throughout the project period