Colditz Jason B, Ton Jessica N, James A Everette, Primack Brian A
1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
2 University of Pittsburgh Health Policy Institute, Pittsburgh, Pennsylvania.
Am J Health Promot. 2017 Jul;31(4):302-309. doi: 10.4278/ajhp.150218-QUAL-736. Epub 2016 Jan 5.
Water pipe tobacco smoking (WTS) is growing in popularity among U.S. young adults and is associated with health risks similar to those of cigarette smoking. The purpose of this study is to examine existing tobacco control policies (TCPs) in order to investigate how they engage WTS.
A systematic synthesis of content and legal interactions among federal, state, and local TCP documents.
Pennsylvania, which represents a politically and demographically diverse microcosm of the United States.
No human subjects.
Federal and state TCPs were retrieved via public legal repositories. Local policy searches were conducted via county/municipal Web sites, inclusive of 13 localities that had autonomous health departments or existing TCPs based on a National Cancer Institute report. Full-text TCPs were double coded within a grounded theory framework for health policy analysis. Emergent codes were used to compare and contrast policy texts and to examine legal interactions among TCPs.
Examination of policy categories including youth access, use restrictions, and taxation revealed WTS as largely omitted from current TCPs. WTS was sometimes addressed as an "other" tobacco product under older TCPs, though ambiguities in language led to questionable enforceability. State preemptions have rolled back or prevented well-tailored reforms at the local level. Federal preemptions have likewise constrained state TCPs.
Outdated, preempted, and unclear policies limit the extent to which TCPs engage WTS. Health advocates might target these aspects of TCP reform.
水烟吸食在美国年轻人中越来越流行，并且与吸烟存在类似的健康风险。本研究的目的是审视现有的烟草控制政策（TCPs），以调查它们如何应对水烟吸食问题。
对联邦、州和地方TCP文件之间的内容和法律互动进行系统综合分析。
宾夕法尼亚州代表了美国在政治和人口统计学上的多元化缩影。
无人体受试者。
通过公共法律资料库检索联邦和州的TCPs。通过县/市网站进行地方政策搜索，其中包括13个根据美国国家癌症研究所报告设有自主卫生部门或现有TCPs的地区。在扎根理论框架内对TCPs全文进行双重编码，以进行卫生政策分析。使用新出现的编码来比较和对比政策文本，并审视TCPs之间的法律互动。
对包括青少年接触、使用限制和税收等政策类别进行审查后发现，当前的TCPs在很大程度上忽略了水烟吸食问题。在旧的TCPs中，水烟有时被视为“其他”烟草产品，但措辞含糊导致可执行性存疑。州一级的优先权撤销或阻止了地方层面精心制定的改革。联邦一级的优先权同样限制了州的TCPs。
过时、具有优先权且不明确的政策限制了TCPs应对水烟吸食问题的程度。健康倡导者可能会将目标对准TCP改革的这些方面。
