James Macinko

Most tobacco control research in the United States has focused on federal- and state-level policies. However, tobacco control policies vary substantially within states. In this study, authors aimed to examine the impact of local tobacco control policy intensity on smoking behavior in California from 2014 to 2019. 

Authors linked data from the 2014 to 2019 California Health Interview Surveys (CHIS) with local-level tobacco control policy scores. Logistic regression models were used to assess the association between local policy intensity and cigarette smoking.

Findings: Adoption of local tobacco control policies was associated with: 

• 2.1 percentage point (pp) reduction in overall smoking prevalence
• 2.3 pp reduction among individuals living in multiunit housing or neighborhoods with low socioeconomic status, and
• 3.5 pp reduction among African American populations. 

Longer durations of policy implementation and stricter measures were associated with greater reductions in smoking, particularly among individuals living in low socioeconomic status neighborhoods and multiunit housing than among their counterparts.

Local tobacco control policies are associated with lower smoking rates, especially among disadvantaged populations. Strengthening and expanding these policies may be an effective strategy to further reduce tobacco-related disparities.

Ignition interlock devices installed after conviction for driving under the influence of alcohol (DUI) have been shown to reduce subsequent DUI arrests (specific deterrence). However, there is little evidence on how interlock-device penalties might affect general deterrence, that is, deterring people from driving after consuming alcohol prior to a DUI conviction.

A discrete choice experiment was conducted and data were analyzed in 2023 with 583 U.S.-based adults who consume alcohol at least once in the past week to assess the deterrent effects of five different penalties (fine, jail time, interlock device, license suspension, alcohol treatment) for alcohol-impaired driving under randomized sequential scenarios of high (20% chance of being caught) and low (1%) police enforcement. Participants resided in 46 states.

Findings: Deterrent effects of an interlock penalty, operationalized as having to install an interlock device for 1 year, are large and on par with a 20-fold increase in police enforcement activity (from 1% chance of being caught to 20%), or a $2,000 increase in the DUI fine under the status quo enforcement regime. On average, a 1-year interlock penalty had the same deterrent effect as a 10-day increase in jail time.

Wider use of interlock devices as a DUI penalty could have large deterrent effects, independent of their ability to physically prevent the motor vehicle of an intoxicated driver from starting. The deterrent effect documented here adds to evidence on interlock devices' overall effectiveness as well as their potential to shift DUI penalties away from criminalization (jail time) and toward immobilization and rehabilitation.

Summary: Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. Authors offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions.

The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary health care in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior health care experience.

Findings: Authors describe the progression of the two institutions' partnership to carry out the project (described above) and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health.

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• Journal Article: Evolving Academic and Research Partnerships in Global Health: A Capacity-Building Partnership to Assess Primary Healthcare in the Philippines

Summary: While California as a whole has made significant progress over the past three decades in reducing rates of cigarette smoking, progress across communities in the state has been uneven. Using the 2014–2019 California Health Interview Survey (CHIS) combined adult data and existing state, county, and city tobacco control policies and neighborhood-level data on social drivers of health, this brief examines variations in local tobacco policies and their relationship with smoking behaviors, particularly among priority populations disproportionately impacted by tobacco.

Findings: In 2019, more than 60% of California cities still had weak or no local tobacco policies. Inequities in protection by tobacco control policies persist across priority populations, especially in areas with low neighborhood socioeconomic status (NSES). Reductions in adult cigarette smoking were greater in cities with strong local tobacco policies than in those with weak or no policies. Strong local policies were also associated with decreased smoking rates among adult (18+) populations disproportionately impacted by the tobacco epidemic, thereby reducing social inequalities in cigarette smoking. This study also found that the positive effect of local tobacco control policies on current adult smoking rates was further enhanced when the state-level tobacco policy (i.e., raising the tax from $0.87 to $2.87 per pack) was enacted in April 2017. 

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• Policy Brief: State and Local Tobacco Control Policies Are Associated with Decreasing Cigarette Smoking Rates and Disparities
• Infographic

Read Related Publications:

• Policy Brief: The Changing Landscape: Tobacco and Marijuana Use Among Young Adults in California
• Policy Brief: Health at Risk: Policies Are Needed to End Cigarette, Marijuana, and E-Cigarette Secondhand Smoke in Multi-Unit Housing in Los Angeles