A Qualitative Study to Explore Perception of Impacts of Preemption of Tobacco Regulation on Counties in Appalachian Tennessee.

Bottom-up processes, starting at the local government level, are valuable for more-stringent tobacco control measures. The existence of industry-backed state-level tobacco control preemption in states has impeded policy progress within the state and localities/communities. A national public health goal under Healthy People 2020 is to eliminate state-level preemption across the United States. This study explored individual-level perceptions of the impact of state-level preemption in Appalachian Tennessee-a high-smoking, low-income region. During 2015-2016, a community-engagement project to develop a Population Health Improvement Plan (PHIP) involving over 200 stakeholders and 90 organizations was conducted in Appalachian Tennessee to identify policies/programs to address tobacco use. Using a multifaceted framework approach that focused on prevention, protection, and cessation, interviews and meeting discussions were audio-recorded and transcribed. Content analysis using NVivo 11 was conducted to generate themes. Although the central focus of the PHIP was not preemption, the issue emerged naturally in the discussions as a major concern among participants. Cultural and normative factors in Appalachian Tennessee were identified as key rationales for participants' aversion to state preemption. Thus, repealing preemption would facilitate culturally tailored and region-specific policies/programs to the high tobacco use among Appalachian Tennessee communities where statewide/nationwide policies/programs have not had the intended impacts.

Multilevel governance, public health and the regulation of food: is tobacco control policy a model?

Campaigns against risk factors for non-communicable diseases (NCDs) caused by smoking and obesity have become increasingly common on multiple levels of government, from the local to the international. Non-governmental actors have cooperated with government bodies to make policies. By analysing the policies of the World Trade Organization, the World Health Organization, the European Union, and the United Kingdom and United States governments, we identify how the struggles between public health advocates and commercial interests reached the global level, and how the relatively successful fight to 'denormalize' tobacco consumption has become a model for anti-obesity advocates. It highlights three factors important in policy change: framing the policy problem, the policymaking environment and 'windows of opportunity'-to analyse the struggle between 'harm regulation' and 'neoprohibition' approaches to an international obesity prevention regime.

Cancer prevention through stealth: science, policy advocacy, and multilevel governance in the establishment of a "National Tobacco Control Regime" in the United States.

The role of the US federal government in developing tobacco control through a cooperative, interactive program with state and local private and public organizations has been underestimated. This article investigates how the government initiated and sustained a program of "capacity building" through the scientific authority of the National Cancer Institute, beginning in the 1980s. There are several major questions to be answered: (1) How did this program manage to be adopted and sustained despite the well-documented hindrances to effective tobacco control policy at the federal level? (2) How did a tobacco control policy program become incorporated into the scientific research agenda of the National Cancer Institute? (3) How have science, social factors, and government at various levels interacted in this capacity-building program? The study emphasizes how the US federal government, blocked by a tobacco-friendly Congress from enacting effective tobacco control legislation, utilized its scientific research role and, with the cooperation of other levels of government and large, private antitobacco organizations, established an ongoing policy effort.

Multilevel Governance and Shared Sovereignty: European Union, Member States, and the FCTC.

The Westphalian idea of sovereignty in international relations has undergone recent transformation. "Shared sovereignty" through multilevel governance describes the responsibility of the European Union (EU) and its Member States in tobacco control policy. We examine how this has occurred on the EU level through directives and recommendations, accession rules for new members, tobacco control campaigns, and financial support for antitobacco nongovernmental organizations. In particular, the negotiation and ratification of the Framework Convention on Tobacco Control (FCTC) and the participation in the FCTC Conference of the Parties illustrates shared sovereignty. The EU Commission was the lead negotiator for Member States on issues over which it had jurisdiction, while individual Member States, through the EU presidency, could negotiate on issues on which authority was divided or remained with them. Shared sovereignty through multilevel governance has become the norm in the tobacco control policy area for EU members, including having one international organization negotiate within the context of another.

Predictors of Canadian legislators' support for tobacco control policies.

It is clear that regulatory strategies can be effective in reducing tobacco use. Because legislators ultimately determine whether many of these policies are enacted, they are a key focus for tobacco policy research. This study identifies political and personal predictors of Canadian legislators' support for tobacco control policies. Data are from a 1996-97 survey of federal, provincial and territorial legislators. Multivariate regression analysis was used to assess relationships between five groups of variables (political factors including political ideology, personal characteristics, tobacco experiences, tobacco knowledge, interest group saliency) and support for tobacco control based on an 11-item scale. Support for tobacco control varied by political party. Support was higher among legislators who thought government had a duty to promote healthy lifestyles, knew second-hand smoke could cause lung cancer, knew tobacco caused more deaths than alcohol, and said they wanted more contact with medical associations about tobacco issues. Support was lower among current smokers and those with tobacco industry jobs in their ridings. The findings indicate that political party membership cannot be ignored in enlisting legislator support for tobacco control. It also appears that legislators who oppose tobacco control measures may not be opposed to tobacco control per se, but are more generally opposed to a government role in health promotion. Thus, public health professionals and tobacco control advocates need to be more attentive to the way tobacco control issues are framed for particular legislators. Further, meetings with health groups about tobacco issues would be welcomed by many legislators; non-governmental organizations and other health advocates could work to increase tobacco knowledge among legislators.