Assigning Responsibility, Accepting Blame: Implementing Tobacco 21 in the US

• In Event: Emerging Issues in the Politics of Public Health

Abstract

‘Tobacco 21’ policies seem at first like a standard case study in the diffusion of policy ideas. They aim to restrict access for all tobacco products to people aged 21 and over. While most states in the US and the Federal government set the minimum legal age of sale for tobacco products at 18, Tobacco 21 policies have diffused rapidly across the US since 2013. Six states and over 360 localities around the country have now adopted laws enacting Tobacco 21.

But there are loose threads. Why did this policy start to diffuse, given the focus of the national tobacco control community elsewhere? In this paper, we use data drawn from mixed-methods case studies of four communities in Ohio as well as observations drawn from participant-observers involved in tobacco control advocacy in Michigan. We find that Tobacco 21 is actually a case of a conflict and its partial resolution within the tobacco control world, with an expanded set of actors and issues due to the work of local community activists. On the local level, we found two models of tobacco control advocacy in conflict with one another. One is made up of community-based initiatives pushed by local policymakers, acting in networks, and often not part of the larger tobacco control and public health community. The other is the classic, regional- and national-level and often academic tobacco control community driven by policy entrepreneurs. Tobacco 21 appeared on the agenda because of local actors, often women, who were concerned about issues of relevance to their community such as teen mothers who smoked but also were highly sensitive to issues of health equity that have traditionally been surprisingly low profile in tobacco control debates.

Blending of the two has changed the discourse in the tobacco control epistemic community over time and shaped the lessons that have been drawn by advocates and entrepreneurs, notably surrounding the differential racial impact of criminalization models. The result is a new prominence for Tobacco 21 on the tobacco control agenda despite original lukewarm support among national level actors, and advocacy for very different model of policies that emphasizes implementation and acknowledges the potentially damaging effects of criminalization.

Author

• Holly Jarman, University of Michigan