Anti-smoking campaigns are widely viewed as a success case in public health policy. However, smoking rates continue to vary widely across U.S. states and the success of anti-smoking campaigns is contingent upon states' adoption of anti-smoking policies. Though state anti-smoking policy is a product of a political process, studies of the effect of policies on smoking prevalence have largely ignored how politics shapes policy adoption, which, in turn, impact state health outcomes. Policies may also have different effects in different political contexts. This study tests how state politics affects smoking prevalence both through the policies that states adopt (with policies playing a mediating role on health outcomes) or as an effect modifier of behavior (tobacco control policies may work differently in states in which the public is more or less receptive to them). The study uses publicly available data to construct a time-series cross-section dataset of state smoking prevalence, state political context, cigarette excise taxes, indoor smoking policies, and demographic characteristics from 1995 to 2013. Political ideology is measured using a validated indicator of the ideology of state legislatures and of the citizens of a state. We assess the relationship between state political context and state smoking prevalence rates adjusting for demographic characteristics and accounting for the mediating/moderating role of state policies with time and state fixed effects. We find that more liberal state ideology predicts lower adult smoking rates, but that the relationship between state ideology and adult smoking prevalence is only partly explained by state anti-smoking policies.

译文

:反吸烟运动被广泛认为是公共卫生政策中的成功案例。但是,美国各州的吸烟率仍存在很大差异,反吸烟运动的成功取决于各州采取反吸烟政策的情况。尽管国家禁烟政策是政治过程的产物,但是对政策对吸烟率影响的研究却很大程度上忽略了政治如何影响政策的采用,进而影响了国家的健康结果。政策在不同的政治环境中也可能产生不同的影响。这项研究测试了州政治如何通过州采用的政策(在健康结果中起中介作用的政策)或作为行为的效果修正器(在更多公众或更多州使用控烟政策的方式不同)来影响吸烟率。对他们的接受程度较低)。该研究使用可公开获得的数据构建了1995年至2013年各州吸烟率,各州政治背景,香烟消费税,室内吸烟政策和人口统计学特征的时间序列横截面数据集。国家立法机关和国家公民的意识形态。我们评估了州政治背景和州吸烟流行率之间的关系,并根据人口特征进行了调整,并考虑了具有时间和州固定效应的州政策的中介/调节作用。我们发现,更加自由的州意识形态预示着成年人吸烟率会降低,但是州意识形态与成人吸烟率之间的关系仅由州反吸烟政策部分解释。

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