Practices and Perceptions of Local Health Officers/Commissioners Regarding Tobacco 21 Policy Advocacy.

Progress has been made in reducing adolescent cigarette smoking. However, the popularity of vaping products has increased concerns regarding tobacco use. One policy recently passed at the national level is Tobacco 21 (T21), which aims to reduce adolescent's access to tobacco products. Since local health officers/commissioners play a crucial role in the development of policies that protect their respective communities from the harms of tobacco, it is important to characterize their views on the T21 legislation and advocacy activities among them. This was a cross-sectional pilot study of three Midwestern states taken prior to a number of key tobacco-related events in 2019. Results show almost 70% of respondents had high interest in influencing public policy, more than 80% thought the public policy makers' actions regarding T21 were highly important to the health and well-being of the public, and 89% had in some capacity acted to support a T21 initiative. Involvement with legislative efforts was not high, despite evidence showing high popularity of the measure among the public. The top perceived benefits included a decrease in tobacco use among adolescents, improvements to community or state health, and delay in tobacco use initiation. Top barriers listed were issues with enforcement, lack of money or resources, competing health priorities, and policy makers' attitudes and values. Respondents overall had significantly lower confidence in performing activities at the state versus local level. Findings suggest there may be a need for more advocacy training on effective advocacy strategies in changing health policy.