Effects of State Preemption of Local Tobacco Control Legislation on Disparities in Tobacco Use, Exposure and Retail - Project Summary/Abstract Section A key Health and Human Services (HHS) Healthy People 2030 Tobacco-Use Objective is to eliminate state preemption of local tobacco control. Cigarette smoking is the leading cause of preventable death in the US, accounting for ~480,000 deaths annually, including ~30% of all cancer deaths. Evidence-based tobacco control practices between 1964 and 2012, such as restrictions on smoking indoors, were estimated to have saved 8 million lives in the US. Thus, the implementation of evidence-based tobacco control practices—including those addressing secondhand smoke exposure, tobacco advertising, retail licensure, youth access, and taxation (the “big 5”)—will in turn decrease tobacco use and associated health outcomes, including cancer. However, preemption is a barrier to local tobacco control efforts. Little published research has rigorously quantified the impacts of state preemption of local tobacco control, particularly: 1) across states and over time; 2) across the “big 5” evidence-based tobacco control practices; 3) across a range of key outcomes (e.g., youth and adult tobacco use, secondhand smoke exposure [SHSe], tobacco retail outcomes [sales, retailer density]); and 4) with regard to potential differential impacts among different socio-demographic groups, including race, ethnicity, socioeconomic status (SES), and rurality, using nationally representative data across the whole US population. This study builds on our prior research showing that smoke-free air preemption was associated with increased adult smoking prevalence, particularly in counties representing people with higher average SES, and will advance the literature by filling the aforementioned gaps. Our objective is to advance our understanding of whether—and to what extent—enactment or repeal of state preemption on local tobacco control is associated with increases in tobacco use, SHSe, and tobacco retail outcomes, as well as differences across socio-demographic groups (race, ethnicity, SES, rurality). Our central hypothesis is that state preemption will be associated with higher tobacco use, SHSe, and tobacco retail outcomes, and that the effect will differ among socio-demographic groups. Our rationale is that, by altering local authority to adopt evidence-based tobacco control practices, state preemption may affect tobacco use and related health outcomes, including cancer, across US communities. We will analyze nationally representative data from 1999 to 2021 to examine the impacts of enactment or repeal of state preemption of the “big 5” tobacco control practices (i.e., smoke-free, advertising, licensure, youth access, and taxation). Our specific aims are to examine state preemption on tobacco control in relation to changes in measures of: 1) individual-level past 30-day tobacco use prevalence (cigarettes and e-cigarettes) in adolescents and adults and nonsmokers’ SHSe, and potential differential impacts across race, ethnicity, SES, and rurality; and 2) measures of sales of tobacco products and tobacco retail density over time, and potential differential impacts across race, ethnicity, SES, and rurality. We will employ multilevel models and crosswalk/merge (state/local tobacco control practices, outcomes, socio-demographic) data from various sources at different geographic levels.
