A heightened understanding of factors influencing policy adoption and implementation may inform methods for maximizing the impact of policies on health outcomes. To acheive this aim, members of our study team will conduct key informant interviews at the state, local, and school levels to investigate how various relevant e-cigarette policies are implemented after the political, legislative, and adoption process is completed. Our primary goal is to probe the processes, barriers, and facilitators of e-cigarette policy implementation to understand why certain policies may or may not be effective, providing a richer understanding of the context of our quantitative analysis. Our efforts go beyond simply noting the presence or absence of a policy – our interviews with state, local and school professionals charged with implementing e-cigarette control policies will provide a) insights on how and how often e-cigarette policies fall short of their stated goals due to variability in enforcement or evasion, and b) a quantitative assessment of how the robustness of e-cigarette policy implementation affects e-cigarettes and other substance use. Implementation barriers and successes identified through qualitative analysis will be compared with Aim 2 analyses to provide greater insight into the context and factors affecting the timing and magnitude of policy impact on behavior and health.

The policy subject(s) of the key informant interviews at the state and municipal levels will include one or two of the following policy categories:

1) restricting the age that individuals can buy or be sold e-cigarettes
2) restricting or prohibiting sales of flavored products
3) limiting stores where e-cigarettes may be used or sold
4) restricting where e-cigarettes may be used (e.g., clean indoor air laws)
5) taxing e-cigarettes.

The school interview policy subjects will be tailored to the policies and programs instituted in a given school aimed to address e-cigarette use among students. Such policies may include implementing tobacco-free school policy components, substance use curriculum, screening for e-cigarette use, enforcement action against e-cigarette use and disciplinary action.

Our goal is to conduct ~2 interviews per state/locality; 102 at the state-level and 50 at the local/school level. Key personell at the state level include employees of agencies which are authorized with the implementation of a given policy, including a state’s health, revenue, licensing and aochol and tobacco control departments. Massachusetts town interviews typically include professionals within a town’s local public health department. Key personell for the Massachusetts school interviews include but are not limited to school resource officers, administrative staff, health educators, and school nurses.

Study team members contributing to the Aim 1 analysis include: Dr. Doug Levy (PI), Dr. Gina Kruse, Dr. Kim Dash, Shari Kessel-Schneider, Ginny Chadwick, Maeve Stover, Cameron Reitan, Candace Kyles, Tracy Desovich, Dr. Nancy Rigotti, Dr. Randi Schuester, Cat Buechler Victoria Lopez, and Yvonne Chien