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Liu J, Roberts J, Winickoff JP, Hanby EP, Reynolds MJ, Gundersen DA, Emmons KM, Tan AS. Education, organizational changes, and enforcement challenges of the 2019 flavored tobacco sales restriction in Massachusetts. Drug Alcohol Depend 2024; 262:111394. [PMID: 39024798 DOI: 10.1016/j.drugalcdep.2024.111394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES In November 2019, the Massachusetts legislature passed An Act Modernizing Tobacco Control and became the first state to restrict retail sales of all flavored (including menthol) cigarettes, e-cigarettes, and other tobacco products (the Act). Additional tobacco control policies and health insurance coverage for tobacco treatment were included as part of the Act. Implementation of these policies occurred between November 2019 and June 2020. This study explored challenges and facilitators during the implementation of the Act experienced by public health officials, school personnel, and healthcare providers. METHODS We conducted in-depth interviews with a purposive sample of 9 public health officials and advocates, 9 school personnel, and 8 healthcare providers from March to December 2021. We conducted thematic analysis of interview transcripts using inductive codes of key themes emerging from the interviews. RESULTS Interviewees highlighted three key themes that impacted the implementation of the Act: 1) Education of those impacted by the Act, 2) Organizational-level changes to incorporate the Act, and 3) Enforcement challenges. Examples of challenges to the implementation of the Act included COVID-19 pandemic restrictions, navigating tobacco industry tactics around naming flavors, and confusion regarding health insurance coverage for tobacco use cessation programs. Examples of facilitators were enforcement leading to retailer compliance, committed advocacy efforts of leadership/champions, and strong coordination within and between organizations. CONCLUSIONS These findings of Massachusetts's experience in policy implementation can inform the preparation to implement similar tobacco control policies in other states.
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Affiliation(s)
- Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Jane Roberts
- Dana-Farber Cancer Institute, Survey and Qualitative Methods Core, Boston, MA, United States
| | - Jonathan P Winickoff
- MassGeneral Hospital Division of General Academic Pediatrics, Boston, MA, United States; MGH Tobacco Research and Treatment Center, Boston, MA, United States; American Academy of Pediatrics Julius B. Richmond Center, Itasca, IL, United States
| | - Elaine P Hanby
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, United States
| | | | - Daniel A Gundersen
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Social and Behavioral Sciences Department, Boston MA, United States
| | - Andy Sl Tan
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, United States; University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, United States; Abramson Cancer Center, Tobacco and Environmental Carcinogenesis Program, Philadelphia, PA, United States.
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Nagasawa T, Saito J, Odawara M, Kaji Y, Yuwaki K, Imamura H, Nogi K, Nakamura M, Shimazu T. Smoking cessation interventions and implementations across multiple settings in Japan: a scoping review and supplemental survey. Implement Sci Commun 2023; 4:146. [PMID: 37993908 PMCID: PMC10666296 DOI: 10.1186/s43058-023-00517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/28/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Smoking is the leading risk factor for death worldwide. In Japan, although several evidence-based interventions (EBIs) for smoking cessation have been disseminated or adopted, there is a gap between scientific evidence and the actual implementation. This scoping review aimed to describe the knowledge gaps in local-level smoking cessation interventions in Japan, their implementation outcomes, implementation barriers and facilitators, and the use of implementation strategies. METHODS This study comprised two approaches: (1) a comprehensive scoping review of primary and grey literature, and (2) a supplemental survey of organizations in the grey literature. For the scoping review, we included original studies or reports on smoking cessation interventions targeting adults aged 18 years and older, or providers of cessation support at various settings (community, workplace, school, and clinical settings) in Japan. The extracted data included basic characteristics, intervention categories, implementation outcomes, factors influencing implementation, and implementation strategies for each intervention. Responses to the supplemental survey were extracted same used for the scoping review. To gain a deeper understanding, semi-structured interviews were conducted with some of the organizations in the survey. RESULTS A total of 600 interventions with 691 intervention components, based on EBIs in the 2020 US Surgeon General Report, from 498 articles were included in the data extraction; 32 of the 88 organizations responded to the survey. Regarding the overall knowledge about smoking cessation intervention components, behavioral counseling, and cessation medication in clinical settings were mostly reported (34.7%). Implementation outcomes were measured in 18 articles (3.0%) and penetration was mostly reported. Regarding influential factors, "available resources," and "knowledge and beliefs about the intervention" for barriers, and "relative priority" for facilitators were mostly reported. Implementation strategies were measured in 29 articles (4.8%), and "Train and educate stakeholders" was mostly reported. CONCLUSIONS Most EBIs reported in the Japanese literature included smoking cessation treatments in clinical settings. While a few articles focused on the implementation indicators in Japan, significant knowledge and experience were extracted from the grey literature, especially in the workplace and community settings. Future research should focus more on implementation to reduce the knowledge gap regarding smoking cessation interventions.
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Affiliation(s)
- Tomomi Nagasawa
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Chuo-Ku, Tokyo, Japan
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Chuo-Ku, Tokyo, Japan
| | - Miyuki Odawara
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Chuo-Ku, Tokyo, Japan
| | - Yuki Kaji
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Chuo-Ku, Tokyo, Japan
| | - Keiichi Yuwaki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Chuo-Ku, Tokyo, Japan
- Department of Cancer Epidemiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Haruhiko Imamura
- Graduate School of Health and Nutrition Sciences, The University of Nagano, Nagano City, Nagano, Japan
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Ota-Ku, Tokyo, Japan
| | - Kazuya Nogi
- Department of Environmental and Occupational Health, Toho University Graduate School of Medicine, Ota-Ku, Tokyo, Japan
| | - Masakazu Nakamura
- Health Promotion Research Center, Institute of Community Medicine, Japan Association for Development of Community Medicine, Chiyoda-Ku, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Chuo-Ku, Tokyo, Japan.
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Nagasawa T, Saito J, Odawara M, Imamura H, Kaji Y, Yuwaki K, Nogi K, Nakamura M, Shimazu T. Smoking cessation interventions and implementations in Japan: a study protocol for a scoping review and supplemental survey. BMJ Open 2022; 12:e063912. [PMID: 36600334 PMCID: PMC9743387 DOI: 10.1136/bmjopen-2022-063912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Despite various tobacco control measures in Japan, smoking remains a leading cause of mortality. This manuscript outlines proposed methodology for scoping review that aims to describe the knowledge gaps for local-level smoking cessation interventions in Japan, their implementation barriers and facilitators, and the use of implementation strategies. METHODS AND ANALYSIS A scoping review will be conducted using the updated guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for Scoping Reviews to systematically search peer-reviewed journal articles and grey literature to identify studies on smoking cessation interventions in Japan. The six-stage scoping review model will involve (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting data; (5) collating, summarising and reporting the results; and (6) consultation exercise. Since there is little information available on the implementation context in the literature, we will use grey literature to identify organisations implementing smoking cessation interventions and conduct a cross-sectional survey among them to supplement the information gap. Based on a literature review, findings will be organised on smoking cessation interventions in local settings (ie, communities, workplaces, schools and hospitals) at the population, provider and individual levels in Japan to understand knowledge gaps. We will adopt the consolidated framework for implementation research to identify implementation barriers and facilitators, and the expert recommendations for implementing change to identify implementation strategies. ETHICS AND DISSEMINATION This study does not require ethical committee approval. The scoping review method will be robust in searching available smoking cessation interventions in Japan. The findings of this study will be compiled as case studies of best practices on smoking cessation interventions and disseminated to relevant stakeholders at the public and private levels through publications, presentations in conferences and stakeholder meetings.
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Affiliation(s)
- Tomomi Nagasawa
- Department of Health Communications, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Miyuki Odawara
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Haruhiko Imamura
- Graduate School of Health and Nutrition Sciences, The University of Nagano, Nagano-shi, Nagano, Japan
| | - Yuki Kaji
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Keiichi Yuwaki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
- Department of Cancer Epidemiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuya Nogi
- Department of Environmental and Occupational Health, Graduate School of Medicine, Toho University, Ota-ku, Tokyo, Japan
| | - Masakazu Nakamura
- Health Promotion Research Center, Institute of Community Medicine, Japan Association for Development of Community Medicine, Chiyoda-ku, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
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Petersen AB, Ogunrinu T, Wallace S, Yun J, Belliard JC, Singh PN. Implementation and Outcomes of a Maternal Smoking Cessation Program for a Multi-ethnic Cohort in California, USA, 2012-2019. J Community Health 2022; 47:257-265. [PMID: 34739686 PMCID: PMC8569845 DOI: 10.1007/s10900-021-01042-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
Smoking during pregnancy remains one of the most significant risk factors for poor birth outcomes. During 2012-2019, the Loma Linda University Health Comprehensive Tobacco Treatment Program (CTTP) used a multicomponent behavioral intervention for tobacco cessation for 1402 pregnant smokers with components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). The CTTP cohort includes a multi-ethnic sample of pregnant women with a mean age of 27 years referred by collaborating community-based healthcare providers in San Bernardino county. Evaluation of program outcomes from 7 years of follow-up (2012-2019) creates a rich cohort dataset for implementation science research to examine the real-world effectiveness of the program. In this report, we provide a cohort profile, and 8-week prolonged abstinence (8-week PA) and relapse findings from the first year of follow-up (n = 233). We found: (1) 28.4% achieved 8-week PA, (2) At a median of 6.2 months of follow-up after achieving 8-week PA, 23.2% of enrolled subjects reported tobacco cessation, and (3) a high rate of loss to follow-up (44%). In addition, our modeling indicated that the odds of relapse/smoking after enrollment was significantly higher in young mothers, non-Hispanic mothers (White, Black/African-American), mothers in the first and third trimester, and rural mothers. Formative quantitative and qualitative research on the CTTP cohort will consider the effects of a range of implementation science (number of intervention sessions, addition of a mHealth component, distance to care) and individual (partner/household smoking, birth outcomes, NICU) outcome measures for the purpose of scaling up the CTTP model.
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Affiliation(s)
- Anne Berit Petersen
- Loma Linda University School of Nursing, 11262 Campus Street, Loma Linda, CA, 92350, USA.
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA, 92354, USA.
| | - Temidayo Ogunrinu
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Shane Wallace
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Jane Yun
- Loma Linda University Health SACHS Clinic, 250 S G St, San Bernardino, CA, 92410, USA
| | - Juan Carlos Belliard
- Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
- Institute for Community Partnerships, Loma Linda University, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Pramil N Singh
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
- Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA, 92354, USA
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