Comparing State Legislative Aides’ Perspectives on Tobacco Policymaking in States With Strong and Weak Policies: A Qualitative Study

Purpose: The study compared perceptions of state legislative aides about tobacco policymaking in states with strong and weak tobacco control policies. Approach: Qualitative in-depth interviews carried out in 2009. Setting: The US states were ranked on a combination of tobacco prevention funding, taxes, and presence of smoke-free policies. States at the top and bottom of the rankings were chosen. Participants: Interviews were conducted with 10 legislative aides in 5 states with strong tobacco control policies and 10 aides in 7 states with weak policies. Method: Twenty semistructured interviews were conducted, coded, and analyzed using a consensus coding process. Results: Tobacco control was a lower priority in states with weak policies, and respondents from these states listed more barriers to tobacco control policymaking than those from states with strong policies. Successful arguments for tobacco control emphasized operational applications, for example, enhanced revenue from tobacco taxes or safety of children and employees. Conclusion: Our findings support propositions posited in the Advocacy Coalition Framework. They point to the preeminence of contextual factors, notably political leanings and economic climate on success of policy change efforts. Lessons learned from participants from states with strong policy nonetheless show promise for success in states with weak policy.