Insights From a Community-Based Strategy to Assess Tobacco and Vape Shop Retailers' Implementation of Tobacco 21 Law in El Paso, Texas.

In 2019, the United States Congress passed Tobacco 21 (T21) legislation that raised the minimum legal sales age for tobacco products from 18 to 21. However, although the federal legislation superseded weaker state laws that were already in place in some states, including Texas, local guidance for retailers was inconsistent. Given that retailers are ultimately responsible for policy implementation, the American Heart Association (AHA) initiated a process of assessing retailers knowledge and perceptions of the law through a survey targeting all tobacco retailers and accompanying ethnography of a subset of vape shops in El Paso, Texas. The process yielded lessons learned for assessment of community-based policy implementation including key considerations for personnel and process that are applicable to other community-based assessment processes. While AHA considered an in-person approach ideal, having an alternate online response option was necessary. In addition, a focused approach and in-depth understanding of the purpose was key to responsiveness of the retailers.

Mixing Meds and Milk: Evaluation of a Performance Gap Intervention for Provider Education in Breastfeeding and Maternal Medication Use.

The need for maternal medications is a known barrier to breastfeeding. Though most medications are compatible with lactation, healthcare providers use abundant caution, often viewing medications and breastfeeding as mutually exclusive. A dual intervention of an educational webinar and access to a mobile app for lactation pharmacology was used to enhance provider familiarity, confidence, and access to knowledge in medication use during breastfeeding. Surveys were administered before, one week after, and three months after the webinar to evaluate performance gap improvement. Usage data of the mobile app was collected over twelve months to monitor topic engagement. Results suggested the interventions temporarily increased provider confidence in maternal medication use during lactation; however, the increase was not sustained at three months. Even with one-time training and lactation-specific mobile app access, simply providing an informational resource is insufficient to support evidence-informed care for lactating patients. Longitudinal training on evidence-based medication safety is critical to care for the lactating dyad.

Systems-Level Evaluation of Safe Routes to School Policies in El Paso, Texas: A Modeling Study on Health and Economic Outcomes.

Safe Routes to School (SRTS) policies are linked to physical health benefits for school-age children; however, few studies have assessed long-term impacts on cardiovascular disease (CVD). This study used systems science methods to predict long-term health and economic impact of SRTS among school-age children in El Paso County, Texas. We developed an agent-based model containing 2 modules: the pedestrian injury module and the CVD module. We simulated 10 000 school-age children under 2 scenarios-SRTS policies implemented and no SRTS policies implemented-and then calculated pedestrian injuries, pedestrian injury-related deaths, coronary heart disease (CHD) and stroke events, and health care costs. When SRTS policies were implemented, the model estimated 157 fewer CHD cases and 217 fewer stroke cases per 10 000 people and reduced CVD-related health care costs ($13 788 per person). The model also predicted 129 fewer pedestrian injuries and 1.3 injury-related deaths per 10 000 people and $2417 savings in injury-related health care costs. SRTS could save an estimated $16 205 per person in health care costs. This simulation shows SRTS in El Paso County could prevent pedestrian injuries among school-age children and protect cardiovascular health in the long term. Our findings provide evidence for practitioners and policy makers to advocate for SRTS policies at the local level.

Smoke-Free Policy Adoption in Horizon City and El Paso Community College: A Strategic Campaign Approach That Turns a "No" Into a "Yes".

Coalitions in Horizon City in El Paso County, Texas and the El Paso Community College (EPCC) had previously attempted to pass smoke-free policies in 2008 and 2016, respectively; however, both policies failed to pass at those times. The coalitions refocused their activities and were successful in passing policies in EPCC in 2020 and in Horizon City in 2021. We employed a participatory case study method to understand what factors changed between the first and second attempts at smoke-free policy adoption in Horizon City and EPCC. Using the Advocacy Coalition Framework as a basis for analysis, we identified the role of coalitions, their beliefs, use of power resources, role of policy brokers, and external events. We identify best practices and make recommendations for coalitions seeking to adopt smoke-free policies in other locations.

The health and economic impact of the Tobacco 21 Law in El Paso County, Texas: A modeling study.

In December 2019, the US federal Tobacco 21 (T21) law passed to raise the minimum legal purchase age for tobacco products from 18 to 21 years. Preliminary evidence suggests that the T21 law will restrict youth access to tobacco products, leading to decreases in tobacco use over their lifetime. This study expands the science through the use of systems modeling by linking decreases in youth tobacco use in El Paso County, Texas, due to the T21 law implementation, to potential cardiovascular health (CVH) benefits and health care cost reductions. Using a smoking behavior and cardiovascular disease agent-based model, we projected the T21 law's long-term effects on smoking prevalence and CVH outcomes in El Paso County, Texas. The estimated smoking prevalence in El Paso County, Texas, decreased by 2.7% among 18-24 year olds and by 5.2% among 25-44 year olds in 20 years with T21 law implementation (p < 0.01 for both population groups). By reducing tobacco use, the T21 law could prevent 5.4 coronary heart disease events per 1,000 adults and 6.1 S events per 1,000 adults over a lifetime. The model estimated a reduction in lifetime health care costs from $42,929 per person without T21 law to $41,985 per person with the policy. This study provides further evidence for policymakers and communities to understand the potential health and economic impacts of the federal T21 law at the local level. Results emphasize the need for comprehensive policy implementation and enforcement to produce its intended impact on health outcomes.