Assessing the Impact of State Preemption Laws

Project Summary/Abstract
Tobacco use remains the leading cause of preventable death, contributing to 480,000 deaths in the U.S.
annually. Smoking alone causes 90% of all lung cancer-related deaths and 80% of all chronic obstructive
pulmonary disease-related deaths. Another 16 million people in the U.S. live with a disease caused by
smoking. Despite unknown long-term health effects, the increasing popularity of e-cigarettes (10.8 million
adults are current users) is a growing concern, especially given that this is the most popular form of tobacco
among youth. In recent years, there has been an increase in the number and variety of laws that preempt local
public policies. Preemption occurs when a higher level of government restricts or withdraws the authority of a
lower level of government to act on a particular issue, thereby prohibiting lower levels of government from
enacting more stringent laws. Preemptive laws are common on a variety of health issues, including tobacco.
For example, about 32 states had at least one form of preemption of local tobacco control ordinances as of
September 30, 2018. The laws vary by states in many aspects, including whether e-cigarettes are included.
Numerous stakeholders have concerns about the potential negative impacts of these laws. For instance, the
American Medical Association, the Institute of Medicine, and Healthy People 2020 have recognized
preemption law(s) as a barrier to public health. However, to date, there is no existing rigorous empirical
evidence on how, or if, these preemption laws affect local policy innovation and key health outcomes. The
proposed study will address these critical knowledge gaps by using a rigorous quasi-experimental design to
assess the impact of state preemption laws on tobacco and e-cigarette use. Specifically, we propose an
original systematic legal analysis to characterize and code state tobacco preemption laws as well as their
dimensions (Aim 1), assess the impact of state preemption laws on county smoke-free indoor policy (Aim 2),
cigarette smoking (Aim 3) and e-cigarette use (Aim 4). Aims 3 and 4 will also assess the heterogeneous
impact of state preemption laws among (a) subgroups (defined based on gender and race/ethnicity) and
whether the effects of these laws vary between (b) rural and urban communities. Our interdisciplinary team has
extensive experience in substance abuse epidemiology, quantitative analysis, policy and legal research. The
proposed research will address a severely understudied area with high public health significance: state
preemption laws functioning as a significant barrier to public health. This is an area of critical importance, as
the number and variety of preemption laws are increasing in the U.S. The results of this highly innovative study
will provide timely empirical evidence and have a sustained impact in informing future decision making on
preemptive policies and laws.

Grant Number: 5R01CA249052-05
NIH Institute/Center: NIH
Principal Investigator: Sunday Azagba