Pennsylvania policymakers’ knowledge, attitudes and likelihood for action regarding waterpipe tobacco smoking and electronic nicotine delivery systems
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University of Pittsburgh, Pittsburgh, United States
Brian A. Primack   

University of Pittsburgh, 230 McKee Place, Suite 600, 15213 Pittsburgh, United States
Publish date: 2018-04-24
Submission date: 2017-10-11
Final revision date: 2018-03-28
Acceptance date: 2018-03-29
Tob. Prev. Cessation 2018;4(April):14
Use of waterpipe tobacco smoking (WTS, or hookah smoking) and electronic nicotine delivery systems (ENDS, such as e-cigarettes) is rapidly increasing. However, legislatures have been slow to update policy measures related to them. Therefore, we aimed to assess knowledge, attitudes and likelihood to take future action regarding WTS and ENDS among Pennsylvania legislators.

We approached all Standing Members of key Pennsylvania House and Senate health and welfare committees to complete a survey about substances of abuse, including WTS and ENDS. Closed-ended knowledge, attitude and action items used a 100-point scale. Responses to open-ended items were assessed using thematic analysis by three independently working researchers.

We received responses from 13 of 27 eligible policymakers (48%). Participants answered a mean of only 27% (SD=20%) of knowledge items correctly. When asked to rank by priority eight issues in substance abuse, WTS ranked eighth (least urgent) and ENDS ranked fifth. Participants reported low likelihood to introduce legislation on WTS (mean=29, median=25) and/or ENDS (mean=28, median=10). Thematic analysis revealed that participants readily acknowledged lack of understanding of WTS and ENDS, and were eager for additional information.

Policymakers exhibit a lack of knowledge concerning newer forms of tobacco and nicotine delivery systems and consider them to be relatively low legislative priorities. However, respondents expressed a desire for more information, suggesting the potential for public health entities to promote effective policy development via improved dissemination of information.

Wills TA, Knight R, Williams R, Pagano I, Sargent JD. Risk factors for exclusive e-cigarette use and dual e-cigarette use and tobacco use in adolescents. Pediatrics. 2015;135(1):e43-e51. doi:10.1542/peds.2014-0760.
Walton KM, Abrams DB, Bailey WD, et al. NIH electronic cigarette workshop: developing a research agenda. Nicotine Tob Res. 2015;17(2):259-269. doi:10.1093/ntr/ntu214.
Dugas EN, O’Loughlin EK, Low NC, Wellman RJ, O’Loughlin JL. Sustained waterpipe use among young adults. Nicotine Tob Res. 2014;16(6):709-716. doi:10.1093/ntr/ntt215.
Primack BA, Freedman-Doan P, Sidani JE, et al. Sustained waterpipe tobacco smoking and trends over time. Am J Prev Med. 2015;49(6):859-867. doi:10.1016/j.amepre.2015.06.030.
Arrazola RA, Singh T, Corey CG, et al. Tobacco Use among Middle and High School Students - United States, 2011–2014. Vol 64. Atlanta; 2015.
Administration USF and D. Section 916 of the Federal Food, Drug, and Cosmetic Act - Preservation of State and Local Authority. Published 2015. Accessed January 31, 2018.
Alternative nicotine products: electronic cigarettes. National Conference of State Legislatures. Published May 2016. Accessed January 31, 2018.
Colditz JB, Ton JN, James AE, Primack BA. Toward effective water pipe tobacco control policy in the United States: synthesis of federal, state, and local policy texts. Am J Heal Promot. 2017;31(4):302-309. doi:10.4278/ajhp.150218-QUAL-736.
European Association for the Study of Obesity. Policymaker Survey 2014 - EASO.; 2014. Accessed, October 2017.
Rouch G, Thomson G, Wilson N, et al. Public, private and personal: qualitative research on policymakers’ opinions on smokefree interventions to protect children in “private” spaces. BMC Public Health. 2010;10:797. doi:10.1186/1471-2458-10-797.
Reips U-D, Funke F. Interval-level measurement with visual analogue scales in Internet-based research: VAS Generator. Behav Res Methods. 2008;40(3):699-704. doi:10.3758/BRM.40.3.699.
Welch PJ, Dake JA, Price JH, Thompson AJ, Ubokudom SE. State legislators’ support for evidence-based obesity reduction policies. Prev Med (Baltim). 2012;55(5):427-239. doi:10.1016/j.ypmed.2012.09.008.
Payton E, Thompson A, Price JH, Sheu JJ, Dake JA. African American legislators’ perceptions of firearm violence prevention legislation. J Community Health. 2015;40(3):439-447. doi:10.1007/s10900-014-9954-3.
York NL, Pritsos CA, Gutierrez AP. Legislators’ beliefs on tobacco control policies in Nevada. J Community Health. 2012;37(1):89-95. doi:10.1007/s10900-011-9421-3.
StataCorp. Stata Statistical Software: Version 12. 2015.
Sorian R, Baugh T. Power of information: closing the gap between research and policy. Health Aff. 2002;21(2):264-273. doi:10.1377/hlthaff.21.2.264.
Dodson EA, Stamatakis KA, Chalifour S, Haire-Joshu D, McBride T, Brownson RC. State legislators’ work on public health-related issues: what influences priorities? J Public Heal Manag Pract. 2013;19(1):25-29. doi:10.1097/PHH.0b013e318246475c.
Jensen GWR. Legislative Office for Research Liaison. http://intergovernmental.pasen.... Published 2011. Accessed January 31, 2018.
Legislative office of research liaison records, 1983-2009. Pennsylvania House of Representatives archives. Accessed January 17, 2017.
Makkar SR, Howe M, Williamson A, et al. Impact of tailored blogs and content on usage of Web CIPHER – an online platform to help policymakers better engage with evidence from research. Heal Res Policy Syst. 2016;14(1):85. doi:10.1186/s12961-016-0157-5.