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Bacon C, Malone S, Prewitt K, Hackett R, Hastings M, Dexter S, Luke DA. Assessing the sustainability capacity of evidence-based programs in community and health settings. FRONTIERS IN HEALTH SERVICES 2022; 2:1004167. [PMID: 36925881 PMCID: PMC10012779 DOI: 10.3389/frhs.2022.1004167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Abstract
Background Within many public health settings, there remain large challenges to sustaining evidence-based practices. The Program Sustainability Assessment Tool has been developed and validated to measure sustainability capacity of public health, social service, and educational programs. This paper describes how this tool was utilized between January 2014 and January 2019. We describe characteristics of programs that are associated with increased capacity for sustainability and ultimately describe the utility of the PSAT in sustainability research and practice. Methods The PSAT is comprised of 8 subscales, measuring sustainability capacity in eight distinct conceptual domains. Each subscale is made up of five items, all assessed on a 7-point Likert scale. Data were obtained from persons who used the PSAT on the online website (https://sustaintool.org/), from 2014 to 2019. In addition to the PSAT scale, participants were asked about four program-level characteristics. The resulting dataset includes 5,706 individual assessments reporting on 2,892 programs. Results The mean overall PSAT score was 4.73, with the lowest and highest scoring subscales being funding stability and program adaptation, respectively. Internal consistency for each subscale was excellent (average Cronbach's alpha = 0.90, ranging from 0.85 to 0.94). Confirmatory factor analysis highlighted good to excellent fit of the PSAT measurement model (eight distinct conceptual domains) to the observed data, with a comparative fit index of 0.902, root mean square error of approximation equal to 0.054, and standardized root mean square residual of 0.054. Overall sustainability capacity was significantly related to program size (F = 25.6; p < 0.001). Specifically, smaller programs (with staff sizes of ten or below) consistently reported lower program sustainability capacity. Capacity was not associated with program age and did not vary significantly by program level. Discussion The PSAT maintained its excellent reliability when tested with a large and diverse sample over time. Initial criterion validity was explored through the assessment of program characteristics, including program type and program size. The data collected reinforces the ability of the PSAT to assess sustainability capacity for a wide variety of public health and social programs.
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Affiliation(s)
- Caren Bacon
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Sara Malone
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Kim Prewitt
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Rachel Hackett
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Molly Hastings
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Sarah Dexter
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Douglas A Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Rao Seshadri S, Kaulgud R, Jha P. 'You cannot touch taxes easily': making the case for tobacco taxation in India. Health Policy Plan 2021; 36:322-331. [PMID: 33367775 DOI: 10.1093/heapol/czaa171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/12/2022] Open
Abstract
India represents over 1.3 billion people with >100 million adult smokers. The catastrophic health costs of smoking are staggering; and estimates show that even modest increases in taxes on cigarettes and bidis would both raise substantial revenues for the government and save ∼69 million years of healthy life over the next four decades. Karnataka represents a good example of tobacco control efforts and their impact. This case study examines the factors that have contributed to tobacco control policy in Karnataka based on 23 semi-structured interviews with key informants engaged in tobacco policymaking and decision-making, tobacco control/taxation research and advocacy. Their narratives indicate that: (i) Domestic taxation policy is complicated by the complex tax structure and centralized control over taxation with the introduction of Goods and Services Tax; (ii) Implementation of legal frameworks is a challenge, due to conflicts with powerful industry and farmer lobbies. A vigorous civil society backed by the Courts is necessary to garner political support; (iii) Action on taxation is hampered by weak leadership and mixed messaging; and (iv) There is a need for innovative policy solutions to promote both demand- and supply-side measures for tobacco control. Tobacco control advocates need to recognize the political economy of tobacco control and generate strong, reliable and scientifically sound evidence to support their arguments. Working for incremental 'wins' in terms of more stringent application of existing legal frameworks can make a substantial difference even in contexts where enhancing tobacco taxes is a challenge. Promoting multisectoral action is critical, at both policy and the ground levels, by expanding ownership and responsibility for tobacco control to sectors beyond health. Finally, the health sector needs to recommit to its role as a champion for tobacco control. Failure to do so would amount to a failure on multiple fronts-public health, economic, fiscal and ethical.
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Affiliation(s)
- Shreelata Rao Seshadri
- Azim Premji University, School of Development, Bikkanahalli Main Road, Sarjapura, Bangalore 562125, India
| | - Radhika Kaulgud
- Azim Premji University, School of Development, Bikkanahalli Main Road, Sarjapura, Bangalore 562125, India
- SOCHARA, Ist Block Koramangala, Bangalore 560034, India
| | - Prabhat Jha
- Center for Global Health Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
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Grattan LE, Schmitt CL, Porter L. Community Program Activities Predict Local Tobacco Policy Adoption in Florida Counties. Am J Health Promot 2020; 34:722-728. [PMID: 32030993 DOI: 10.1177/0890117120904005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Bureau of Tobacco Free Florida's community program funds county-level grantees who promote local policy change through activities that educate the public, policy-makers, and decision-makers. There is robust literature linking tobacco control policies such as smoke-free air laws and tax increases to reductions in tobacco use. There is less evidence documenting the local activities programs conduct to achieve local policy change. In the current study, we used a quantitative model to assess the relationship between community tobacco control activities and local tobacco policy adoption. Grantee activities and policy adoption for each county are recorded in a database. To evaluate the community program, we compiled inputs and used a fixed-effects negative binomial regression to examine the relationship between grantee activities and policy adoption across all 67 community-based programs in Florida from 2010 to 2017 and analyzed the data in 2018. Measures included categories of policies (organization policies and jurisdiction policies) and community-based activities associated with tobacco control programs. Organization policy (school and business policy) and jurisdiction policy (county or city ordinances, proclamations, and resolutions) were dependent on partner meetings (incident rate ratio [IRR] = 1.03, confidence interval [CI] = 1.00-1.07 and IRR = 1.04, CI = 1.01-1.07, respectively) and local decision-maker communication (IRR = 1.01, CI = 1.00-1.03 and IRR = 1.05, CI = 1.03-1.07, respectively). Jurisdiction policy was also dependent on media advocacy (IRR = 1.07, CI = 1.02-1.12) and state policy-maker education (IRR = 1.16, CI = 1.06-1.26. Community outreach was negatively associated with jurisdiction policy (IRR = 0.97, CI = 0.94-0.99), and data collection was negatively associated with organization and jurisdiction policy (IRR = 0.97, CI = 0.95-1.00 and IRR = 0.97, CI = 0.95-1.00, respectively). Results from the study demonstrate that the type and timing of community grantee activities may influence local tobacco control policy adoption.
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Affiliation(s)
- Lauren E Grattan
- Social Policy, Health and Economics Research, 6856RTI International, Research Triangle Park, NC, USA
| | - Carol L Schmitt
- Social Policy, Health and Economics Research, 6856RTI International, Fort Collins, CO, USA
| | - Lauren Porter
- Bureau of Tobacco Free Florida, Florida Department of Health, Tallahassee, FL, USA
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Topuridze M, Berg CJ, Dekanosidze A, Torosyan A, Grigoryan L, Bazarchyan A, Sargsyan Z, Hayrumyan V, Maglakelidze N, Sturua L, Haardörfer R, Kegler MC. Smokers' and Nonsmokers' Receptivity to Smoke-Free Policies and Pro- and Anti-Policy Messaging in Armenia and Georgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155527. [PMID: 32751714 PMCID: PMC7432748 DOI: 10.3390/ijerph17155527] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 12/02/2022]
Abstract
Garnering support for smoke-free policies is critical for their successful adoption, particularly in countries with high smoking prevalence, such as Armenia and Georgia. In 2018, we surveyed 1456 residents (ages 18–64) of 28 cities in Armenia (n = 705) and Georgia (n = 751). We examined support for cigarette and electronic nicotine delivery systems (ENDS)/heated tobacco product (HTP) smoke-free policies in various locations and persuasiveness of pro- and anti-policy messaging. Participants were an average age of 43.35, 60.5% female, and 27.3% current smokers. Nonsmokers versus smokers indicated greater policy support for cigarette and ENDS/HTP and greater persuasiveness of pro-policy messaging. Armenians versus Georgians generally perceived pro- and anti-policy messaging more persuasive. In multilevel linear regression, sociodemographics (e.g., female) and tobacco use characteristics (e.g., smoking less frequently, higher quitting importance) correlated with more policy support. Greatest policy support was for healthcare, religious, government, and workplace settings; public transport; schools; and vehicles carrying children. Least policy support was for bar/restaurant outdoor areas. The most compelling pro-policy message focused on the right to clean air; the most compelling anti-policy message focused on using nonsmoking sections. Specific settings may present challenges for advancing smoke-free policies. Messaging focusing on individual rights to clean air and health may garner support.
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Affiliation(s)
- Marina Topuridze
- Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi 0198, Georgia; (M.T.); (A.D.); (N.M.); (L.S.)
- School of Natural Sciences and Medicine, Ilia State University, Tbilisi 0162, Georgia
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC 20052, USA
- Correspondence:
| | - Ana Dekanosidze
- Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi 0198, Georgia; (M.T.); (A.D.); (N.M.); (L.S.)
| | - Arevik Torosyan
- National Institute of Health Named after Academician S. Avdalbekyan, MoH, Yerevan 0051, Armenia; (A.T.); (L.G.); (A.B.)
| | - Lilit Grigoryan
- National Institute of Health Named after Academician S. Avdalbekyan, MoH, Yerevan 0051, Armenia; (A.T.); (L.G.); (A.B.)
| | - Alexander Bazarchyan
- National Institute of Health Named after Academician S. Avdalbekyan, MoH, Yerevan 0051, Armenia; (A.T.); (L.G.); (A.B.)
| | - Zhanna Sargsyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan 0019, Armenia; (Z.S.); (V.H.)
| | - Varduhi Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan 0019, Armenia; (Z.S.); (V.H.)
| | - Nino Maglakelidze
- Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi 0198, Georgia; (M.T.); (A.D.); (N.M.); (L.S.)
| | - Lela Sturua
- Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi 0198, Georgia; (M.T.); (A.D.); (N.M.); (L.S.)
- Public Health Department Petre Shotadze Tbilisi Medical Academy, Tbilisi 0144, Georgia
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (R.H.); (M.C.K.)
| | - Michelle C. Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (R.H.); (M.C.K.)
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
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Abstract
OBJECTIVES Messages from organizations with high, compared to low, credibility may be more persuasive. Whereas the tobacco industry has long recognized the importance of credibility in promoting its messages and public image, the source credibility of key tobacco control organizations has gone largely unmeasured. To assess credibility of a key tobacco regulator, we developed a scale of the US Food and Drug Administration (FDA) tobacco-related credibility. METHODS We developed and tested 30 items reflective of the dimensions of source credibility (trust, expertise, and public interest) and FDA's tobacco regulatory roles in a sample of 1353 US adults and assessed reliability and validity. RESULTS Factor analysis identified 3 dimensions of the FDA Tobacco Credibility Scale (FDA-TCS): public interest, trust, and expertise. The 3 subscales showed evidence of reliability and convergent validity; all subscales were correlated with general FDA credibility and trust in government. Those who knew that the FDA regulates tobacco scored higher on the trust and expertise subscales. The subscales were also associated with support for potential regulations, suggesting criterion-related validity. CONCLUSIONS The FDA-TCS allows for an understanding of the impact of credibility on responses to the FDA's tobacco control communications and regulatory efforts.
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McCullough A, Ranney LM, Simons DJ, Goldstein AO. "The Job Has Become Advocating for the Job": Threats to Funding Dramatically Influence Program Outcomes. Am J Health Promot 2016; 32:861-864. [PMID: 27810950 DOI: 10.1177/0890117116674534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As public health funding is increasingly threatened, a better understanding is needed about how periods of funding uncertainty impact program staff, activities, and outcomes. In North Carolina, 2 years of uncertainty and threats of funding cuts for a statewide youth tobacco prevention initiative contributed to reduced grantee morale and confidence about achieving program goals, displaced focus from core program activities, and caused premature loss of personnel, resulting in substantially reduced program activities and outcomes. The range of negative impacts of funding uncertainty and threats highlights the need for programs to create an infrastructure to support ongoing sustainability planning and activities.
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Affiliation(s)
- Anna McCullough
- 1 Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah M Ranney
- 1 Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel J Simons
- 1 Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam O Goldstein
- 1 Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Berg CJ, Topuridze M, Maglakelidze N, Starua L, Shishniashvili M, Kegler MC. Reactions to smoke-free public policies and smoke-free home policies in the Republic of Georgia: results from a 2014 national survey. Int J Public Health 2016; 61:409-16. [PMID: 26841891 DOI: 10.1007/s00038-016-0793-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/14/2016] [Accepted: 01/20/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES We examined receptivity to public smoke-free policies and smoke-free home status among adults in the Republic of Georgia. METHODS In Spring 2014, we conducted a national household survey of 1163 adults. RESULTS Our sample was on average 42.4 years old, 51.1 % male, and 43.2 % urban. Current smoking prevalence was 54.2 % in men and 6.5 % in women. Notably, 42.2 % reported daily secondhand smoke exposure (SHSe). Past week SHSe was 29.9 % in indoor public places and 33.0 % in outdoor public places. The majority reported no opposition to public smoke-free policies. Correlates of greater receptivity to public policies included being older, female, and a nonsmoker. Past week SHSe in homes was 54.2 %; 38.8 % reported daily SHSe at home. Only 14.3 % reported complete smoke-free home policies; 39.0 % had partial policies. The only correlate of allowing smoking in the home was being a smoker. Among smokers, correlates of allowing smoking in the home were being male and lower confidence in quitting. CONCLUSIONS SHSe is prevalent in various settings in Georgia, requiring efforts to promote support for public smoke-free policies and implementation of personal policies.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Road, NE, Room 524, Atlanta, GA, 30322, USA.
| | | | | | - Lela Starua
- National Center for Disease Control, Tbilisi, Georgia
| | | | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Road, NE, Room 524, Atlanta, GA, 30322, USA
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Poly-Tobacco Use among High School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:14477-89. [PMID: 26580636 PMCID: PMC4661661 DOI: 10.3390/ijerph121114477] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/23/2015] [Accepted: 11/06/2015] [Indexed: 12/02/2022]
Abstract
Although cigarette use by adolescents is declining, emerging tobacco products are becoming increasingly popular and youth may use more than one type of tobacco product. The purposes of this study were: (1) to assess patterns of poly-tobacco use among a representative sample of high school students and (2) to determine how beliefs correlate with poly-tobacco use. Data came from the 2013 North Carolina Youth Tobacco Survey (n = 4092). SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. Among all high school students in NC in 2013, 29.7% reported current any tobacco use, with 19.1% reporting current poly-tobacco use, and 10.6% reporting current use of only one product. Among poly-tobacco users, 59.3% reported that one of the products they currently used was cigarettes. Positive tobacco product beliefs were found to be significantly associated with poly-tobacco use. Communication campaigns, policy efforts, and future research are needed for prevention, regulation, and control of poly-tobacco use among adolescents, which represents a significant public health problem.
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Reactions to Smoke-free Policies and Messaging Strategies in Support and Opposition: A Comparison of Southerners and Non-Southerners in the US. HEALTH BEHAVIOR AND POLICY REVIEW 2015; 2:408-420. [PMID: 26702405 DOI: 10.14485/hbpr.2.6.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We explored differences in support for smoke-free policies among Southerners versus non-Southerners within a quota-based non-probability sample of adults in the United States. METHODS In 2013, a cross-sectional online survey was conducted among 2501 adults assessing tobacco use, reactions to personal and public smoke-free policies, and persuasiveness of various message frames regarding smoke-free bar/restaurant policies. RESULTS Southerners were no different from non-Southerners in support for most public and private smoke-free policies. The most effective pro-policy messages regarded hospitality, health, and individual rights/responsibilities; the most persuasive anti-policy messages involved individual rights/responsibilities. Compared to non-Southerners, Southerners rated pro-policy messages involving economic impact, religion/morality, and hospitality as more persuasive. CONCLUSIONS Factors other than public opinion accounting for lagging policy adoption must be explored.
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Berg CJ, Ribisl KM, Thrasher JF, Haardörfer R, O'Connor J, Kegler MC. Reactions to Cigarette Taxes and Related Messaging: Is the South Different? Am J Health Behav 2015; 39:721-31. [PMID: 26248181 DOI: 10.5993/ajhb.39.5.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Given the lag in tobacco control policies in the southeastern US, we examined differences in reactions to tobacco taxes and related messaging among Southeasterners vs. non-Southeasterners. METHODS In 2013, a cross-sectional online survey using quota-based sampling was conducted assessing tobacco use, attitudes/knowledge regarding tobacco taxation, and reactions to related messaging (health, youth prevention, economic impact, individual rights/responsibility, morality/religion, hospitality). RESULTS Of 2501 participants, 36.7% were past 30-day smokers; 26.7% were Southeasterners. Compared to others, Southeasterners more likely believed that their state was in the bottom 20 states in tobacco taxes (p < .001) and less likely reported that their taxes were too high (p < .001). Regression analysis indicated that correlates of opposition to increased taxes included being older, having less education, being an infrequent church-attender, and being a current smoker (p's < .001); being a Southeasterner was not associated. Compared to others, Southeasterners were more likely to find pro-tobacco tax messages related to prevention and hospitality as more persuasive (p < .05) and anti-tobacco tax messaging related to the unfairness of tobacco taxes to smokers (p = .050) less persuasive. CONCLUSIONS Given that Southeasterners are receptive to increased taxation, other factors must contribute to lagging policy and must be addressed.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | - Kurt M Ribisl
- Lineberger Comprehensive Cancer Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Jean O'Connor
- Georgia Department of Public Health, Office of Applied Public Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Berg CJ, Solomon M, Barkley A, Bailey E, Goodwin SB, Kegler MC. Tobacco Taxes in the Southeastern US States: Views from Former Legislators. HEALTH BEHAVIOR AND POLICY REVIEW 2015; 2:333-342. [PMID: 26236755 PMCID: PMC4517976 DOI: 10.14485/hbpr.2.5.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We examine influences on southeastern state legislators' actions related to tobacco tax increases. METHODS In 2014, we interviewed 26 former state legislators in southeastern states via phone. RESULTS Themes regarding factors impeding increasing tobacco taxes included: tobacco's legacy in the South, protecting vulnerable populations from increased cigarette costs, concern about economic impact, opposing "sin" taxes, concern about impact on reelection, and perceptions that constituents oppose all taxes. The major theme in support of increasing tobacco taxes was health concern. Prior attempts at passing legislation resulted in political leveraging, deal-making, or compromising. CONCLUSIONS Legislators' misperceptions of constituent opposition and impact on economy, among other impediments to increased tobacco taxes, must be addressed.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
| | - Madeleine Solomon
- Emory Centers for Training and Technical Assistance, Tobacco Technical Assistance Consortium, Emory University Rollins School of Public Health, Atlanta, GA
| | - Amy Barkley
- Campaign for Tobacco-Free Kids, Washington DC
| | - Eric Bailey
- American Cancer Society Cancer Action Network, Washington, DC
| | - Sherell Brown Goodwin
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
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