College Alumni and Faculty Publish on Tobacco Regulation in Appalachia

Dr. Hadii Mamudu, Full Professor for the Department of Health Services Management and Policy in the East Tennessee State University College of Public Health, has authored an article in International Journal of Environmental Research and Public Health.  The article, “A Qualitative Study to Explore Perception of Impacts of Preemption of Tobacco Regulation on Counties in Appalachian Tennessee” discusses the impact of state-level tobacco regulation preemption in Appalachian Tennessee—a high-smoking, low-income region

Fenose Osedeme, doctoral student in the College of Public Health, conducted important research for this article. Drs. Liang Wang and Mary Ann Littleton are both faculty and Emerita faculty co-authors respectively. College of Public Health alumni Daniel Owusu and Crystal Robertson and Adjunct Professor Dr. Donley Studlar of East Tennessee State are additional co-authors.  The research was funded by the Tennessee Department of Health.

Tobacco use continues to be the leading preventable cause of morbidity and mortality in the United States. Disparities, however, exist in the prevalence of tobacco use across population subgroups and geographic areas, with the disproportionate burden on people with lower socioeconomic status and rural regions such as Central Appalachia. Thus, achieving the Healthy People 2020 goal of a 12% national adult smoking rate and reducing/eliminating health disparities requires the adoption of population-specific policies; hence, the relevance of examining local tobacco control as it relates to statewide/national policies and programs.

Bottom-up processes, starting at the local government level, are valuable for more-stringent tobacco control measures. Preemption is the passage of a law at the federal or state level, which makes it illegal for lower levels of government to enact stronger laws.  The existence of industry-backed state-level tobacco control preemption in states has impeded policy progress within the state and localities/communities.

During 2015–2016, a community-engagement project to develop a Population Health Improvement Plan involving over 200 stakeholders and 90 organizations was conducted in Appalachian Tennessee to identify policies/programs to address tobacco use. The process started with meetings with local health councils in seven counties (Carter, Greene, Hancock, Hawkins, Johnson, Unicoi, and Washington) and the Sullivan County Anti-Drug Coalition to identify gaps in local policies and programs to address the high tobacco use (combustible and noncombustible) in the region.

Evidence from this study indicates that preemption creates constraints for localities about how they can spend federal and state resources to reduce tobacco use, with limited attention to where the resources can make major impacts. Participants in the project overwhelmingly indicated that the state preemption of tobacco regulation has impeded their ability to develop innovative policies and programs to address the high prevalence of tobacco use and tobacco-induced diseases in Appalachian Tennessee.  A comparison with a nearby Appalachian state, West Virginia, that lacks the strong preemption of Tennessee shows how local jurisdictions can take measures to combat tobacco use.