Yan Wang

Context: The association between preemption of local youth tobacco access laws and cigarette purchases remain uncertain, particularly considering existing state/local tobacco laws. Objective: To assess state preemption and local laws related to youth access to tobacco in relation to cigarette purchases and expenditures from 2004–2021 and explore differential impacts among sociodemographic subpopulations, particularly communities with more youth. Design: Longitudinal. Setting: The United States Participants: Two thousand nine hundred forty-two counties. Methods: Data on state youth access preemption and state smoke-free, cigarette taxes, and licensing laws (CDC's STATE system); local youth access laws (American Nonsmokers' Rights Foundation); county-level cigarette purchases and expenditures (NielsenIQ Consumer Panel); and sociodemographics (American Community Survey) were obtained. Multilevel linear models examined the associations between state preemption and local laws related to youth access and county-level cigarette purchases and expenditures, controlling for state smoke-free, taxation, and licensing laws, county-level sociodemographics, and state as a fixed effect. Analyses assessed interactions between preemption and sociodemographic subgroups. Results: Greater state smoke-free law coverage (Purchases: ß = −102 980, P < .001; Expenditures: ß = −143 617, P < .001) and higher cigarette taxes (Purchases: ß = −530 968, P < .001; Expenditures: ß = −783 441, P < .001) were associated with fewer purchases and lower expenditures; neither preemption nor local laws were associated. However, interactions were found between preemption law status and percentage of residents younger than 18 years (Purchases: ß = 5 477 332, P < .001; Expenditures: ß = 15 400 000, P = .01), such that there were greater purchases and expenditures in counties with more youth residents, but the increases were steeper in counties in states with (vs. without) preemption on youth access. Conclusions: While smoke-free laws and cigarette taxes remain strongly associated with fewer cigarette purchasing, state preemption may be linked to disproportionately higher purchasing in counties with larger youth populations. Policies limiting preemption and strengthening local authority, alongside comprehensive state measures, may complement comprehensive state tobacco control measures in communities with larger youth populations.

Background: Cisgender women account for 23% of new HIV diagnoses in the United States, but there are significant socio-structural barriers to engagement and retention in the preexposure prophylaxis (PrEP) cascade, particularly for women of color. Objective: In response to the lack of evidence-based interventions to improve PrEP initiation, adherence, and persistence among women in the United States, we developed and piloted a clinic-based, socio-structural intervention to measure (1) the feasibility of delivering the adapted intervention and (2) clinic team and patient perspectives on the intervention, in preparation for a future trial on engagement and retention in the PrEP cascade among women. Methods: We previously applied the ADAPT-ITT (Assessment, Decision, Adaptation, Production, Topical experts, Integration, Training, Testing) model to develop a culturally appropriate, evidence-based intervention, responsive to Black women’s HIV prevention needs. In the present study, we set out to complete the Training and Testing phases: namely, to hire and train a PrEP navigator and to train clinic staff to deliver the adapted intervention. We completed a 4-month pilot to assess the feasibility of delivering the intervention and collecting outcomes of interest and initial outcome trends (compared to baseline). We further assessed the clinic team and patient perspectives on the intervention to understand the potential for future scale and delivery. Results: The clinic team participants found the adapted Women’s PrEP project (W-PrEP) intervention both highly feasible and relevant to patients, with minimal impact on clinic flow. Patient participants reported that the W-PrEP intervention was highly relevant and appreciated the education and counseling from the PrEP navigator—many learning about PrEP for the first time from the navigator and health care provider. The outcome measures were both feasible to collect and appropriate to capture the primary outcomes of interest. Finally, the W-PrEP intervention increased the proportion of patients counseled about PrEP from 65% to 76% of patients seen ( P <.001). Conclusions: The intervention and outcome data collection was feasible, and open-ended clinic team and patient perspectives showed positive feedback about the intervention and relevance. The associated increase in PrEP counseling is promising but necessitates further evaluation of the effects of the W-PrEP intervention on the PrEP cascade (eg, initiation, persistence, adherence) in a larger randomized trial.

State preemption of local laws may impede tobacco control, yet little research has examined local policy activity before, during, and after preemption. This study addresses this gap. We summarized state laws preempting local smoke-free workplace, youth access, and licensure laws (CDC’s STATE) and local legislative activity before, during, and after preemption (Americans for Nonsmokers’ Rights Foundation) across 1999–2021. Preemption existed for smoke-free workplaces in 18 states, youth access in 21, and licensure in 13. Regarding smoke-free workplace laws, local laws were passed in 5 of 11 states with preemption throughout; among seven states with partial-period preemption, local laws were enacted before preemption or after repeal in three states but during preemption in two. Regarding youth access, localities adopted laws (e.g., addressing purchase/use/possession or e-cigarettes) in 11 of 18 states with preemption throughout; among the three states with partial-period preemption, localities passed laws before preemption in one state and during preemption in two. For licensure, localities passed laws (e.g., licensing requirements/penalties) in eight of nine states with preemption throughout and three of four states with partial-period preemption. Although state preemption reduced local activity, some localities advanced tobacco control during preemption, underscoring the need for localities to exercise autonomy permitted under preemption.