Academic Journal
State tobacco control policy variation in the United States: Insights from the health policy triangle and multiple streams framework.
| Title: | State tobacco control policy variation in the United States: Insights from the health policy triangle and multiple streams framework. |
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| Authors: | Kyei EF; Center for Substance Use Research and Related Conditions, Capstone College of Nursing, The University of Alabama, 650 University Blvd East, 35401 Tuscaloosa, AL, United States. Electronic address: efkyei@ua.edu., Adekeye OT; Center for Substance Use Research and Related Conditions, Capstone College of Nursing, The University of Alabama, 650 University Blvd East, 35401 Tuscaloosa, AL, United States. Electronic address: otadekeye@ua.edu., Abuga CM; College of Education, The University of Alabama, 650 University Blvd East, 35401 Tuscaloosa, AL, United States. Electronic address: cmabuga@crimson.ua.edu., Mumba MN; Center for Substance Use Research and Related Conditions, Capstone College of Nursing, The University of Alabama, 650 University Blvd East, 35401 Tuscaloosa, AL, United States. Electronic address: mnmumba@ua.edu. |
| Source: | The International journal on drug policy [Int J Drug Policy] 2026 Jul; Vol. 153, pp. 105292. Date of Electronic Publication: 2026 Apr 27. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 9014759 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4758 (Electronic) Linking ISSN: 09553959 NLM ISO Abbreviation: Int J Drug Policy Subsets: MEDLINE |
| Imprint Name(s): | Publication: 1998- : Amsterdam ; New York : Elsevier Original Publication: Liverpool, England : International Journal on Drug Policy |
| MeSH Terms: | Tobacco Products*/legislation & jurisprudence , Health Policy*/legislation & jurisprudence, Tobacco Control/legislation & jurisprudence ; Taxes/legislation & jurisprudence ; Commerce/legislation & jurisprudence ; Smoke-Free Policy/legislation & jurisprudence ; Humans ; United States ; State Government ; Electronic Nicotine Delivery Systems ; Government Regulation ; Licensure |
| Abstract: | Background and Aims: Tobacco control policies vary substantially across U.S. states, producing uneven regulatory environments and public health protections. These differences may shape population exposure to tobacco products, including youth access to electronic nicotine delivery systems. This study compares tobacco control policies across five U.S. states to examine how policy structure, governance context, and political dynamics influence regulatory environments. Methods: A comparative case study design was used to examine tobacco control policy environments in California, New York, Massachusetts, Alabama, and Florida. These states were purposively selected to represent variation in tobacco regulatory approaches and political contexts. Guided by the Health Policy Triangle and Kingdon's Multiple Streams Framework, we analyzed smoke-free laws, flavored tobacco regulations, taxation structures, retail licensing systems, and e-cigarette policies using legal statutes, policy reports, and publicly available prevalence indicators from 2022. Results: California and Massachusetts demonstrated the most comprehensive regulatory frameworks, including strong smoke-free protections, flavored tobacco restrictions, higher excise taxes, and structured retailer licensing systems. Alabama exhibited comparatively limited regulatory infrastructure, with lower cigarette taxes and fewer statewide restrictions on flavored tobacco products. Florida maintained moderate state-level protections but limited local policy innovation through statewide preemption laws. Youth e-cigarette prevalence ranged from 5.6% in California to 17.5% in Alabama, reflecting differences in tobacco control environments across states. Conclusions: Variation in tobacco control environments reflects differences in regulatory design, implementation capacity, and political context. Integrating the Health Policy Triangle and Multiple Streams Framework highlights how institutional structures and policy processes shape tobacco control regulation across decentralized governance systems. (Copyright © 2026 Elsevier B.V. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The authors have no competing interest. |
| Contributed Indexing: | Keywords: Comparative policy analysis; State preemption; Tobacco control policy |
| Entry Date(s): | Date Created: 20260428 Date Completed: 20260611 Latest Revision: 20260624 |
| Update Code: | 20260625 |
| DOI: | 10.1016/j.drugpo.2026.105292 |
| PMID: | 42048728 |
| Database: | MEDLINE |
| ISSN: | 1873-4758 |
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| DOI: | 10.1016/j.drugpo.2026.105292 |