Strengthening Tobacco 21 implementation and enforcement to reduce tobacco-related health disparities: A stakeholder engagement project.

INTRODUCTION: As a part of a priority-setting stakeholder engagement project to strengthen the impact of the federal Tobacco 21 (T21) law, we conducted a qualitative study to solicit input from a nationwide sample of tobacco control stakeholders regarding the implementation, enforcement, and equity implications of the T21 law. METHODS: Following the T21 policy evaluation guidance developed by the Centers for Disease Control (CDC), we identified T21 experts in four domains: policy, evaluation, subject matter, and implementation from a national search of stakeholders (invitations, n=1279) to account for geographical variation. This study presents results from five focus groups conducted in December 2021 among stakeholders (n=31) with experience in T21 policy, evaluation, subject matter, and implementation. RESULTS: Participating T21 stakeholders reported on eight themes from four main topic areas: 1) Implementation, 2) Enforcement, 3) Equity outcomes, and 4) Recommended changes from stakeholders. Stakeholders shared insights on both passive and active implementation methods used in their communities, and highlighted major barriers such as the absence of a standardized tobacco retail licensing mandate and insufficient resources. Regarding T21 enforcement, stakeholders believed that current deterrents for retail violations might not be effective. They noted that vape and tobacco shops and online sales of tobacco products are emerging major challenges in T21 enforcement. Stakeholders also discussed possible health inequities that may be exacerbated by heterogenous implementation of the T21 law. CONCLUSIONS: To strengthen T21 and mitigate potential exacerbation of existing health inequities, greater alignment of federal, state, and local efforts to reduce heterogeneity of implementation and enforcement of the T21 law is recommended.

Estimating the cost of a smoking employee.

OBJECTIVE: We attempted to estimate the excess annual costs that a US private employer may attribute to employing an individual who smokes tobacco as compared to a non-smoking employee. DESIGN: Reviewing and synthesising previous literature estimating certain discrete costs associated with smoking employees, we developed a cost estimation approach that approximates the total of such costs for U.S. employers. We examined absenteeism, presenteesim, smoking breaks, healthcare costs and pension benefits for smokers. RESULTS: Our best estimate of the annual excess cost to employ a smoker is $5816. This estimate should be taken as a general indicator of the extent of excess costs, not as a predictive point value. CONCLUSIONS: Employees who smoke impose significant excess costs on private employers. The results of this study may help inform employer decisions about tobacco-related policies.