Toward effective waterpipe tobacco control policy in the US: Synthesis of federal, state, and local policy texts

Colditz J.B., Ton J., James A.E., & Primack B.A. (2016). Toward effective waterpipe tobacco control policy in the US: Synthesis of federal, state, and local policy texts. American Journal of Health Promotion. doi: 10.4278/ajhp.150218-QUAL-736

Purpose: Waterpipe tobacco smoking (WTS) is growing in popularity among U.S. young adults and is associated with health risks similar to cigarette smoking. The purpose of this study is to examine existing tobacco control policies (TCPs) in order to investigate how they engage WTS.

Approach: A systematic synthesis of content and legal interactions among federal, state, and local TCP documents.

Setting: Pennsylvania, which represents a politically and demographically diverse microcosm of the U.S.

Participants: No human subjects.

Method: Federal and state TCPs were retrieved via public legal repositories. Local policy searches were conducted via county/municipal websites, inclusive of 13 localities that had autonomous health departments or existing TCPs based on a National Cancer Institute report. Full-text TCPs were double-coded within a grounded theory framework for health policy analysis. Emergent codes were used to compare and contrast policy texts and to examine legal interactions among TCPs.

Results: Examination of policy categories including youth access, use restrictions, and taxation revealed WTS as largely omitted from current TCPs. WTS was sometimes addressed as an “other” tobacco product under older TCPs, though ambiguities in language led to questionable enforceability. State preemptions have rolled-back or prevented well-tailored reforms at the local level. Federal preemptions have likewise constrained state TCPs.

Conclusion: Outdated, preempted, and unclear policies limit the extent to which TCPs engage WTS. Health advocates might target these aspects of TCP reform.


Summary (as provided by author to SAGE Insight):

Water pipe tobacco smoking (WTS) is associated with serious health risks and has been growing in popularity among a diverse demographic of U.S. young adults. Although federal, state, and local policy interventions have demonstrated efficacy in reducing cigarette use, it was unclear to what extent they engaged WTS as a public health concern.

Our methods included policy text analysis within a grounded theory framework.  We examined state and local tobacco control policies affecting Pennsylvania, as it is a political/demographic microcosm of the US and has had a particularly complex history of tobacco control policies.

The current policy landscape is not ideal, as regulations conflict with one another among levels of governance (i.e., federal, state, local/municipal).  Further, little attention has been paid to WTS within contemporary tobacco control policies (particularly now that electronic cigarette regulation is at the forefront of policy debates).  There are several key places where policy vacuums or loopholes allow permissiveness toward WTS.

It may be helpful to set clear minimum standards for waterpipe tobacco in policy areas such as indoor or public use, taxation, warning or ingredient labeling, and marketing/vending/sale to minors.  These types of regulations would need to be implemented at the federal and state levels, while allowing for localities/municipalities to enact more stringent regulations on a case-by-case basis.

This is an important area of tobacco control policy (TCP) that has fallen by the wayside as recent focus has shifted toward electronic nicotine delivery systems.  As such, it is a particularly timely reminder for policy makers and advocates: as policymakers are updating TCPs to engage e-cigarettes and the like, it is a key opportunity to engage the topic of waterpipes as well.