Dimensions underlying legislator support for tobacco control policies

Awareness of tobacco industry tactics among tobacco control communities in Thailand and its association with attitudes towards tobacco industry and perceptions of e-cigarettes

BACKGROUND

Tobacco industry denormalisation is a key strategy recommended by the WHO Framework Convention on Tobacco Control as it is associated with reducing smoking behaviours and positively influencing public and policymakers' opinion towards tobacco control. However, studies of awareness of tobacco industry tactics among public health players and policymakers in low-income and middle-income countries are limited.

METHODS

We conducted an online survey of individuals who had been involved in tobacco control in Thailand. Multivariate ordinal logistic regression analysis was used to determine the association between awareness of tobacco industry tactics and different attitudes towards tobacco industry and perceptions towards e-cigarettes, controlling for role in tobacco control and demographics among 441 respondents.

RESULTS

Of the respondents, 11.3% had never heard of any tobacco industry tactics, whereas 11.1% had heard of all tactics asked in the survey. Tobacco industry tactics which were less known by participants were intimidation (30.6%) and illicit trade (37.4%). Participants who were more aware of tobacco industry tactics were more likely to have negative attitudes towards the tobacco industry and e-cigarettes. Compared with active experts of the Provincial Tobacco Products Control Committee and provincial public health officials who work in tobacco control programmes, advocates who worked for civil society organisations in tobacco control were more aware of tobacco industry tactics and had less favourable perceptions of e-cigarettes.

CONCLUSION

This study emphasises the importance of educating public health professionals and policymakers about tobacco industry behaviour, especially in the era of e-cigarettes.

An Examination of Factors Affecting State Legislators' Support for Parity Laws for Different Mental Illnesses

Mental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators' support for state parity laws for four mental illnesses- major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators.

Community Program Activities Predict Local Tobacco Policy Adoption in Florida Counties

The Bureau of Tobacco Free Florida's community program funds county-level grantees who promote local policy change through activities that educate the public, policy-makers, and decision-makers. There is robust literature linking tobacco control policies such as smoke-free air laws and tax increases to reductions in tobacco use. There is less evidence documenting the local activities programs conduct to achieve local policy change. In the current study, we used a quantitative model to assess the relationship between community tobacco control activities and local tobacco policy adoption. Grantee activities and policy adoption for each county are recorded in a database. To evaluate the community program, we compiled inputs and used a fixed-effects negative binomial regression to examine the relationship between grantee activities and policy adoption across all 67 community-based programs in Florida from 2010 to 2017 and analyzed the data in 2018. Measures included categories of policies (organization policies and jurisdiction policies) and community-based activities associated with tobacco control programs. Organization policy (school and business policy) and jurisdiction policy (county or city ordinances, proclamations, and resolutions) were dependent on partner meetings (incident rate ratio [IRR] = 1.03, confidence interval [CI] = 1.00-1.07 and IRR = 1.04, CI = 1.01-1.07, respectively) and local decision-maker communication (IRR = 1.01, CI = 1.00-1.03 and IRR = 1.05, CI = 1.03-1.07, respectively). Jurisdiction policy was also dependent on media advocacy (IRR = 1.07, CI = 1.02-1.12) and state policy-maker education (IRR = 1.16, CI = 1.06-1.26. Community outreach was negatively associated with jurisdiction policy (IRR = 0.97, CI = 0.94-0.99), and data collection was negatively associated with organization and jurisdiction policy (IRR = 0.97, CI = 0.95-1.00 and IRR = 0.97, CI = 0.95-1.00, respectively). Results from the study demonstrate that the type and timing of community grantee activities may influence local tobacco control policy adoption.

State Legislators' Support for Behavioral Health Parity Laws: The Influence of Mutable and Fixed Factors at Multiple Levels

Policy Points When communicating with state legislators, advocates for state behavioral health parity laws should emphasize that the laws do not increase insurance premiums. Legislators' opinions about the impacts of state behavioral health parity laws and the effectiveness of behavioral health treatment have more influence on support for the laws than do their political party affiliation or state-level contextual factors. Reducing legislators' stigma toward people with mental illness could increase their support for state behavioral health parity laws CONTEXT: Comprehensive state behavioral health parity legislation (C-SBHPL) is an evidence-based policy that improves access and adherence to behavioral health treatments. However, adoption of C-SBHPL by state legislators is low. Little is known about how C-SBHPL evidence might be most effectively disseminated to legislators or how legislators' fixed characteristics (eg, ideology), mutable characteristics (eg, beliefs about the policy's impact), and state-level contextual factors might influence their support for behavioral health policies. The purpose of our study is (1) to describe the associations between legislators' fixed and mutable characteristics, state-level contextual factors, and support for C-SBHPL; and (2) to identify the mutable characteristics of legislators independently associated with C-SBHPL support.

METHODS

We conducted a multimodal (post mail, email, telephone) survey of US state legislators in 2017 (N = 475). The dependent variable was strong support for C-SBHPL, and the independent variables included legislators' fixed and mutable characteristics and state-level contextual factors. We conducted multivariable, multilevel (legislator, state) logistic regression.

FINDINGS

Thirty-nine percent of the legislators strongly supported C-SBHPL. After adjustment, the strongest predictors of C-SBHPL support were beliefs that C-SBHPL increases access to behavioral health treatments (aOR = 5.85; 95% CI = 2.41, 14.20) and does not increase insurance premiums (aOR = 2.70; 95% CI = 1.24, 5.90). Stigma toward people with mental illness was inversely associated with support (aOR = 0.86; 95% CI = 0.78, 0.95). After adjustment, ideology was the only fixed characteristic significantly associated with support for C-SBHPL. State-level contextual factors did not moderate associations between mutable characteristics and support for C-SBHPL.

CONCLUSIONS

Legislators' mutable characteristics are stronger predictors of C-SBHPL support than are most of their fixed characteristics and all state-level contextual factors, and thus should be targeted by dissemination efforts.

Opening windows and closing gaps: a case analysis of Canada's 2009 tobacco additives ban and its policy lessons

BACKGROUND

In 2009, Canada adopted legislation (Bill C-32) restricting the sale of flavoured tobacco products, one of the first in the world. This study examines the agenda-setting process leading to the adoption of Bill C-32.

METHODS

This research was conducted using a case study design informed by Kingdon's Multiple Streams framework and Heclo's policy learning approach. In-depth interviews were conducted with key informants from government, health-based non-governmental organizations (NGOs), trade associations and the cigar manufacturing sector (n = 11). Public documents produced by media (n = 19), government (n = 11), NGOs (n = 15), as well as technical reports (n = 8) and formal stakeholder submissions (n = 137) were included for analysis. Data were coded with the objective of understanding key events or moments in the lead up to the adoption of Bill C-32 and the actors and arguments in support of and opposition to Bill C-32.

RESULTS

The findings point to the importance of a small but active group of NGOs who worked to publicize the issue and eventually take advantage of an open policy window. Our analysis also illustrates that even though consensus was developed about the policy problem and civil society was able to garner political support to address the problem, disagreement and dissent pertaining to the technical dimensions of the policy solution created loopholes for the tobacco industry to exploit.

CONCLUSIONS

NGOs remain a critical factor in efforts to strengthen tobacco control policy. These organizations were able to mobilize support for the tobacco flavouring ban adopted at the Federal level in Canada, and although the initial Bill had major limitations to achieving the health objectives, the persistence of these NGOs resulted in amendments to close these loopholes.

Exploring Support for 100% College Tobacco-Free Policies and Tobacco-Free Campuses Among College Tobacco Users

BACKGROUND

Tobacco-free campus policy is identified as an effective means to address tobacco use on college campuses; however, the prevalence of tobacco-free policies (TFPs) in the United States remains low. This study explores college tobacco users' support for a university's TFP and tobacco-free campuses (TFCs) in general.

METHODS

A standardized and structured questionnaire was administered to 790 college tobacco users recruited in a university located in a tobacco-growing region of the United States, during April-May 2011, to collect information on support for TFPs and TFCs and sociodemographic-political characteristics. Descriptive and multivariable logistic regression analyses were conducted to identify key factors associated with support for TFPs and TFCs.

RESULTS

Approximately 2 of 5 tobacco users favored TFPs and TFCs. Multivariable logistic regression models showed that demographic factors were mostly not significantly associated with attitudes of the college tobacco users. Instead, while knowledge about harmful effects of exposure to secondhand tobacco smoke significantly increased support for both TFPs and TFCs, parental and peer smoking and exposure to tobacco industry promotions significantly decreased the likelihoods of support compared with respective referent groups.

CONCLUSION

Study findings suggest that campus advocacy and education campaigns for campus tobacco policies to pay attention to tobacco use behavior of familial relations, tobacco industry activities, and other political determinants of tobacco users' attitudes. Thus, this study should inform national initiatives to promote TFPs nationwide such as the Tobacco-Free College Campus Initiative.

Political climate and smoke-free laws in rural Kentucky communities

The purpose was to determine factors associated with rural communities' political readiness to enact smoke-free laws. Data from baseline assessment of a longitudinal intervention study to promote smoke-free policy in rural Kentucky communities; key informants (n = 144) and elected officials (n = 83) from 29 counties participated in cross-sectional telephone interviews. Controlling for population size and county-level smoking rate, the following factors predicted elected officials' perception of the likelihood of a local smoke-free law passing in the next 12 months: (1) support from the local board of health; (2) support from local leaders; and (3) smoke-free hospitals. Communities with lower adult smoking prevalence were more ready for smoke-free laws. Rural health advocates can increase political readiness for smoke-free laws by educating and engaging Board of Health members and local leaders, promoting the voluntary adoption of smoke-free policies in rural hospitals, and investing in effective population-based approaches to evidence-based tobacco treatment in rural communities.

Legislators' beliefs on tobacco control policies in Nevada

The purpose of this study was to identify Nevada legislators' views on comprehensive smoke-free (SF) policy development. The Nevada Clean Indoor Air Act (NCIAA) is a weak law that prohibits smoking in most indoor public places, excluding stand-alone bars and casino gaming areas. Nevada's state senators and assembly members were contacted to participate in the study. A literature review guided modifications of an instrument previously used to measure county-level officials' policy views in Kentucky. Descriptive statistics were conducted for selected variables, while independent t tests and one-way analysis of variance were used to examine differences between various groups. 23 of 63 legislators participated. Even though the majority of officials recognized smoking as a health hazard and nicotine as addictive, there was not overwhelming support for strengthening the NCIAA, raising cigarette excise taxes or providing cessation benefits to citizens. Officials believed that the NCIAA was having a negative economic impact on smaller gaming businesses, but not on the casino industry. Democrats were more likely than Republicans to agree that raising the excise tax by $1 is important for needed state revenues. 63% of legislators believed that they would be persuaded to strengthen the NCIAA regardless of its financial impact on small businesses, if their constituents supported such a move. No other state relies on gaming revenues as much as Nevada. Given that legislators are strongly influenced by their constituents' views, policy advocates need to establish grassroots support for strengthening the current NCIAA and also tobacco control laws in general.

Policymakers and the example of smoking to children: A qualitative study

Background

The normality of smoking that children are exposed to is associated with increased risk of smoking uptake. To better understand policymaking that could address this issue, our aim was to identify and document the views of New Zealand policymakers regarding the example of smoking behaviour to children, and the policy responses they preferred.

Method

We analysed public documents for relevant statements, and conducted semi-structured anonymous interviews with 62 purposively selected policymakers. We identified views of New Zealand policymakers regarding: the example to children of adult smoking behaviour, and the policy responses they preferred.

Results

In both public statements and anonymous interviews, policymakers demonstrated that they perceived a clear relationship between the example of smoking and children taking up smoking. However, they showed a general unwillingness to support further smokefree legislation in areas frequented by children. Rather, they preferred to educate adults about their impact as models for youth behaviour.

Conclusions

Health advocates in New Zealand and elsewhere may require more evidence of the effect of relevant legislation and of public support, and wider alliances, to significantly move policies specifically to reduce the example of smoking.

Predictors of government officials' support for youth tobacco control policies

Preventing youth access to tobacco products is a crucial public health goal. This study examines support by elected city and county officials in Colorado for enacting youth tobacco control policies in the State of Colorado. Participating city and county officials (n = 684) were surveyed regarding their attitudes and opinions on tobacco-related issues and policy control efforts. The officials surveyed were generally supportive of efforts to restrict youth access to tobacco. A number of predictors of support for youth tobacco control policies were identified, including official's perceptions of community norms, their political party, the presence of citizen anti-tobacco events, educational background of the officials, and their attitudes about tobacco. Recommendations for theory and citizen action are provided.

Participation and argument in legislative debate on statewide smoking restrictions

Background

In this paper we review the relationship between participation in legislative hearings, the use of ideological arguments, and the strength of public health legislation using a theoretical construct proposed by E. E. Schattschneider in 1960. Schattschneider argued that the breadth and types of participation in a political discussion could change political outcomes.

Methods

We test Schattschneider's argument empirically by reviewing the efforts of six states to pass Clean Indoor Air Acts by coding testimony given before legislators, comparing these findings to the different characteristics of each state's political process and the ultimate strength of each state's legislation.

Results

We find that although greater participation is associated with stronger legislation, there is no clear relationship between the use and type of ideological arguments and eventual outcomes.

Conclusion

These findings offer validation of a long-standing theory about the importance of political participation, and suggest strategies for public health advocates seeking to establish new legislation.

A pilot qualitative study of New Zealand policymakers' knowledge of, and attitudes to, the tobacco industry

BACKGROUND

The actions of policymakers are critical to advancing tobacco control. To evaluate the feasibility of using anonymous in-depth interviews to ascertain policymakers' knowledge about, and attitudes to, the tobacco industry, we undertook a pilot study involving New Zealand policymakers.

METHODS

Five politicians (from different political parties) and five senior officials, who were involved in tobacco control policy, were recruited for semi-structured, anonymous, face-to-face interviews.

RESULTS

Recruitment of appropriate senior policymakers was found to be possible. Interviewees were willing to answer questions fully and frankly about their knowledge and views of the tobacco industry.The preliminary data from this pilot suggest that some New Zealand politicians appeared to see contact with the industry as similar to contact with other groups, whereas the officials indicated at least a different style of relationship. Only one politician knew if their party accepted funding from tobacco companies. All but one of the interviewees thought that promotion of tobacco to under-16 s still occurs, albeit indirectly. The interviewees' knowledge of the investment in tobacco industries by New Zealand government agencies was low or absent.While most of those interviewed showed scepticism about tobacco company public relations efforts, this was absent in some cases. There was a wide understanding that the tobacco industry will use many tactics in the pursuit of profit, and to counteract government efforts to reduce the harm from smoking.

CONCLUSION

In-depth anonymous interviews appear to be feasible and can be productive for exploring sensitive tobacco-related policy issues with policymakers. The preliminary data from this group of New Zealand policymakers suggest important knowledge gaps, but also general distrust of this industry. From a tobacco control perspective, the results may suggest a greater focus by advocates on the funding of political parties by the tobacco industry, and on government agency investment in the tobacco industry.

Motivation of chemical industry social responsibility through Responsible Care

Advocates of corporate social responsibility argue corporations should not only meet the needs of shareholders, but other key stakeholders including the community, customers, suppliers, and employees. Since 1988, the chemical industry has engaged in a major self-regulatory "Responsible Care" industry-wide social responsibility campaign to ensure environmental, public health, safety, and security performance among member companies. Contrary to the arguments of advocates of corporate social responsibility that such efforts meet the needs of stakeholders other than shareholders such as the community, the primary goal of the Responsible Care effort has been to change public concerns and opinion about chemical industry environmental and public health practices while also opposing support for stronger and more expensive public health and environmental legislation and regulation of chemical products, even if warranted.

Predictors of support for environmental tobacco smoke bans in state government

BACKGROUND

Environmental tobacco smoke (ETS) is a major threat to public health, associated with a number of serious diseases, and a leading cause of death. Previous research demonstrates that enactment of government policies mandating clean indoor air is effective in creating more smoke-free public places and decreasing the incidence of smoking. Both researchers and community activists have an interest in understanding the factors that predict support for the regulation of ETS.

METHODS

This study examined predictors of support for regulating ETS by surveying 684 city and county public officials in Colorado who were interviewed by phone and mail (response rate 61%).

RESULTS

Thirty-five percent of public officials reported that it is a "serious" or "very serious" problem that nonsmokers breathe in other people's cigarette smoke, 21% were "neutral," and 42% said that it was "not serious" or "not serious at all." Results indicated that support for policies to control ETS and promote clean indoor air is significantly more prevalent among public officials who: (1) believe that tobacco use is a serious problem in their community, (2) believe that breathing environmental tobacco smoke is a serious problem for nonsmokers, (3) believe that city and county government should get involved with people's decisions about smoking, (4) support smoking-cessation programs for public employees, and (5) have smoked less than 100 cigarettes during their lifetime.

CONCLUSIONS

Both the harms of ETS and legislation to create smoke-free environments remain controversial among local officials. Smoke-free advocates should support officials who believe that ETS is a problem and persuade officials on the harms of ETS and the need for government intervention.

Structural elements in achieving legislative tobacco control in NSW, 1955-95: political reflections and implications

OBJECTIVE

To analyse structural factors revealed by politicians that shaped legislation on tobacco control in New South Wales, 1955-95.

METHODS

Parliamentary debates and other records were collected. Open-ended interviews were conducted with 17 Members of Parliament (MPs) who were significantly involved, and then analysed for structural elements.

RESULTS

Tobacco industry lobbying had a significant but limited influence on policy making, being exerted largely through social interactions with executives and based on concerns about the economic impact on third parties. MPs saw health advocates' chief functions as (1) generating community concern about the issue and support for control measures, and (2) bringing any new information to political attention, providing pro-control arguments and data through the media. Factors that delayed tobacco control policies included: the conservative stance of Premiers and major parties, commitments to unanimous federal action, and rivalry between parties. Factors that facilitated control policies included: reforms that gave the Legislative Council increased power, the use of parliamentary committees, and backbencher and grass roots support.

CONCLUSIONS

Tobacco control policy and legislation has been the product of political structures that gave power to those MPs in the least powerful positions--minor parties, Members of the Legislative Council (MLCs), backbenchers, women and party rank and file--rather than to major parties and their executives.

IMPLICATIONS

Advocates should make the most of their access points to the political process, providing information, arguments and support and demonstrating public opinion in favour of further control.