Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
How Science becomes Policy - presentation
1. How science becomes policy
Trent Johnson, MPH
Program Manager
Stanford University School of Medicine
Guest Lecture: Cal Poly San Luis Obispo
Feb 15, 2024
2. Acknowledgments
Our work is funded by:
§California Tobacco Control Program Contract
§National Cancer Institute, National institutes of Health
§The Tobacco Related Disease Research Program
3. Learning objectives
1. About me
2. What is scientific evidence?
3. Translating scientific evidence into policy recommendations
4. Why does science fails to translate into policy?
5. Understanding multiple data streams which inform policy
6. Case study of successful policy passage
4. Education & Professional experience
§B.A. in communications
§Internship in chemistry and ag communications
§First job in ag communications/ marketing
§Masters of Public Health
§Internship in Health Impact Assessment
§Project Manager -> Project Director -> Program Manager
5.
6.
7. Is everything we eat associated with cancer?
A systematic cookbook review
§ 50 common
ingredients from
random recipes in a
cookbook
§ Forty ingredients
(80%) had articles
reporting on their
cancer risk across 264
studies
Source: Schoenfeld & Ioannidis, Am J Clin Nutr 2013;97:127–34.
8. Simulations show that for most
study designs and settings, it is
more likely for a research claim
to be false than true.
10. Types of evidence-based resources
§ National Cancer Institute (NCI):
§ Evidence-Based Cancer Control Programs (EBCCP)
§ Centers for Disease Control and Prevention
(CDC)
§ The Guide to Community Preventive Services (The
Community Guide)
§ U.S. Preventive Services Task Force (USPSTF)
§ Prevention TaskForce
§ Substance Abuse and Mental Health Services
Administration (SAMHSA)
§ Evidence-Based Practices Resource Center
11. Steps in The Community Guide
Systematic Review Process
1.Create Coordination Team: Create a team of staff, CDC program partners, CPSTF
members, and other subject matter experts
2.Select Intervention: Select an intervention within the topic
3.Conceptualize: Define the intervention; craft the analytic framework; identify
outcomes
4.Search: Systematically search for and retrieve evidence
5.Screen: Narrow retrieved set of papers
6.Abstract: Evaluate studies for quality and collect information from papers
7.Analyze: Analyze data from included studies
8.Make CPSTF Recommendations: Translate evidence into CPSTF recommendations
and findings
9.Disseminate: Disseminate CPSTF findings and evidence gaps
19. Conceptual framework: evidence-based policy-making process and ‘unwanted’ factors
influencing discordance. a Ideal process, b and c Discordance 1, d Discordance 2
20. Conceptual framework: evidence-based policy-making process and ‘unwanted’ factors
influencing discordance. a Ideal process, b and c Discordance 1, d Discordance 2
21. Why science fails to translate into policy
§Influence of lobbyists (industry opposition)
§ Free will (Adults should be able to make their own decisions)
§ Anti-business, economics, jobs
§Political interest:
§ Too politically risky
§ No political will
§Moral values
26. FIGURE 2. Percentage of prefilled cartridge* e-cigarette unit sales,† by
flavor§— United States, September 14, 2014–May 17, 2020
Retail scanner data
27. Percentage of disposable e-cigarette* unit sales,† by flavor§—
United States, September 14, 2014–May 17, 2020
Retail scanner data
33. Policy coverage: Jan 2019 - May 2022
Data sources: Policy Evaluation Tracking System (June, 2022); https://cthat.org
5.8%
4.4%
6.4%
8.6% 9.9%
3.2%
0.2%
23.3%
21.7%
23.8%
28.1% 29.1%
19.5%
2.3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
All residents Youth under
18
White Black Asian/Pacific
Islander
Latinx Rural residents
2019 (n=24 ordinances)
2022 (n=104 ordinances)
34. September 2, 2021 Nardy Baeza Bickel
Fernanda Pires
Juan Ochoa
Kim North Shine
Banning menthol flavors in cigarettes could reduce smoking by 15% by having smokers giving up tobacco
products altogether or switching to e-cigarettes and other nicotine vaping products—avoiding 16,250
tobacco-related deaths per year by 2060, according to a new University of Michigan study.
The report supports the April 2021 announcement by the U.S. Food and Drug Administration of its
intention to ban menthol cigarettes and cigars nationwide. The menthol ban would not a!ect e-cigarettes
or other flavored products. The study, published in the journal Tobacco Control, notes that additional
measures such as increasing taxes on cigarettes and cigars could further reduce smoking and related
deaths.
Menthol ban would save 650,000 lives in the next 40 years
35. Public support for policies to regulate flavoured
tobacco and e-cigarette products in rural California
Denise Diaz Payán ,1,2
Nancy J Burke,1,2
Jamie Persinger,3
Juliette Martinez,3
Lisa Jones Barker,3
Anna V Song 4,2
Brief report
► Additional supplemental
material is published online
only.To view, please visit the
journal online (http://dx.doi.
org/10.1136/tobaccocontrol-
2021-057031).
1
Department of Public Health,
University of California Merced,
Merced, California, USA
2
Nicotine & Cannabis Policy
Center, University of California
Merced, Merced, California, USA
3
American Heart Association,
California, Los Angeles,
California, USA
4
Department of Psychological
Sciences, University of California
Merced, Merced, California, USA
Correspondence to
Dr Denise Diaz Payán,
Department of Public Health,
University of California Merced,
Merced, CA 95343, USA;
dpayan@ucmerced.edu
Received 2 September 2021
Accepted 5 January 2022
Published Online First
21 January 2022
ABSTRACT
Introduction Flavoured tobacco control policy
exemptions and electronic cigarette products may
contribute to increased youth access and tobacco use
disparities.
Methods We assessed public support among California
Central Valley residents for four policies to regulate
flavoured tobacco products and e-cigarettes.The
probability-based, multimode survey was conducted with
English-speaking and Spanish-speaking registered voters
(n=845) across 11 counties between 13 and 18 August
2020.Weighted logistic regression analyses measured
odds of policy support, adjusting for predictor variables
(attitudes and beliefs) and covariates.
Results The weighted sample was 50% female and
predominantly Latino (30%) or non-Hispanic white
(46%); 26% had a high school education or less, and
22% an annual household income <US$30000. Overall,
58% support a comprehensive flavoured tobacco
product sales ban, and 59% support a flavoured e-
cigarette product sales ban. In addition, 81% support
limiting the amount of nicotine in e-cigarette pods,
and 91% support mandating vaping health warning
signs at local retailers. Flavour bans were more likely
to be backed by women, seniors, Latinos, non-smokers
and non-vapers. Participants who believe minors have
more access to flavoured products had greater odds of
supporting all policies.Those aware of the association
between e-cigarettes and lung injury were more likely
to support non-ban policies. Participants who believe e-
cigarettes help to reduce tobacco use or e-cigarettes are
relatively less addictive were less likely to support bans.
Discussion Findings add to mounting evidence of
support for policies to regulate flavoured tobacco and
e-cigarette products. Results on attitudes and beliefs
elucidate how these factors influence support.
INTRODUCTION
e-cigarette use was a notable public health concern,7
with popular flavours like fruit, mint, menthol and
candy/desserts.8
While pandemic shelter-in-place
orders disrupted youth access and reduced utilisa-
tion,9
11% of high school students reported current
e-cigarette use in 2021 and 85.8% of those current
users said they used flavoured e-cigarettes.10
Vaping
uptake (with or without characterising flavours)
is also associated with smoking initiation among
youth and emerging adults.11
Flavour exemptions, lack of e-cigarette product
regulation and industry marketing may contribute
to increased access and disparities in tobacco and
e-cigarette product use in the USA. Policy inter-
ventions to curb access and use include flavoured
tobacco product sales bans, which are growing in
popularity with promising results in terms of their
effectiveness at reducing product availability.12–16
Comprehensive action by policymakers and public
health practitioners can help address youth e-ciga-
rette use and existing disparities in tobacco use.17
While the overall population has experienced
decreases in flavoured tobacco product use, a
menthol ban is estimated to have large reductions
in smoking prevalence18
with considerable bene-
fits for populations who disproportionately smoke
menthol cigarettes like African-Americans.19
Limited research exists assessing public support
for policies to regulate flavoured tobacco or e-cig-
arette products, particularly in rural regions. This
study assesses support for policies to regulate
tobacco and e-cigarette products (particularly
flavoured products) using a public opinion survey
conducted in August 2020 with registered voters
in California’s Central Valley. Prior work suggests
attitudes and beliefs about government regulation
(ie, safety concerns) may influence policy support.20
METHODS
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Policy support
36. Public support for policies to regulate flavoured
tobacco and e-cigarette products in rural California
Denise Diaz Payán ,1,2
Nancy J Burke,1,2
Jamie Persinger,3
Juliette Martinez,3
Lisa Jones Barker,3
Anna V Song 4,2
Brief report
► Additional supplemental
material is published online
only.To view, please visit the
journal online (http://dx.doi.
org/10.1136/tobaccocontrol-
2021-057031).
1
Department of Public Health,
University of California Merced,
Merced, California, USA
2
Nicotine & Cannabis Policy
Center, University of California
Merced, Merced, California, USA
3
American Heart Association,
California, Los Angeles,
California, USA
4
Department of Psychological
Sciences, University of California
Merced, Merced, California, USA
Correspondence to
Dr Denise Diaz Payán,
Department of Public Health,
University of California Merced,
Merced, CA 95343, USA;
dpayan@ucmerced.edu
Received 2 September 2021
Accepted 5 January 2022
Published Online First
21 January 2022
ABSTRACT
Introduction Flavoured tobacco control policy
exemptions and electronic cigarette products may
contribute to increased youth access and tobacco use
disparities.
Methods We assessed public support among California
Central Valley residents for four policies to regulate
flavoured tobacco products and e-cigarettes.The
probability-based, multimode survey was conducted with
English-speaking and Spanish-speaking registered voters
(n=845) across 11 counties between 13 and 18 August
2020.Weighted logistic regression analyses measured
odds of policy support, adjusting for predictor variables
(attitudes and beliefs) and covariates.
Results The weighted sample was 50% female and
predominantly Latino (30%) or non-Hispanic white
(46%); 26% had a high school education or less, and
22% an annual household income <US$30000. Overall,
58% support a comprehensive flavoured tobacco
product sales ban, and 59% support a flavoured e-
cigarette product sales ban. In addition, 81% support
limiting the amount of nicotine in e-cigarette pods,
and 91% support mandating vaping health warning
signs at local retailers. Flavour bans were more likely
to be backed by women, seniors, Latinos, non-smokers
and non-vapers. Participants who believe minors have
more access to flavoured products had greater odds of
supporting all policies.Those aware of the association
between e-cigarettes and lung injury were more likely
to support non-ban policies. Participants who believe e-
cigarettes help to reduce tobacco use or e-cigarettes are
relatively less addictive were less likely to support bans.
Discussion Findings add to mounting evidence of
support for policies to regulate flavoured tobacco and
e-cigarette products. Results on attitudes and beliefs
elucidate how these factors influence support.
INTRODUCTION
e-cigarette use was a notable public health concern,7
with popular flavours like fruit, mint, menthol and
candy/desserts.8
While pandemic shelter-in-place
orders disrupted youth access and reduced utilisa-
tion,9
11% of high school students reported current
e-cigarette use in 2021 and 85.8% of those current
users said they used flavoured e-cigarettes.10
Vaping
uptake (with or without characterising flavours)
is also associated with smoking initiation among
youth and emerging adults.11
Flavour exemptions, lack of e-cigarette product
regulation and industry marketing may contribute
to increased access and disparities in tobacco and
e-cigarette product use in the USA. Policy inter-
ventions to curb access and use include flavoured
tobacco product sales bans, which are growing in
popularity with promising results in terms of their
effectiveness at reducing product availability.12–16
Comprehensive action by policymakers and public
health practitioners can help address youth e-ciga-
rette use and existing disparities in tobacco use.17
While the overall population has experienced
decreases in flavoured tobacco product use, a
menthol ban is estimated to have large reductions
in smoking prevalence18
with considerable bene-
fits for populations who disproportionately smoke
menthol cigarettes like African-Americans.19
Limited research exists assessing public support
for policies to regulate flavoured tobacco or e-cig-
arette products, particularly in rural regions. This
study assesses support for policies to regulate
tobacco and e-cigarette products (particularly
flavoured products) using a public opinion survey
conducted in August 2020 with registered voters
in California’s Central Valley. Prior work suggests
attitudes and beliefs about government regulation
(ie, safety concerns) may influence policy support.20
METHODS
copyright.
on
http://tobaccocontrol.bmj.com/
Tob
Control:
first
published
as
10.1136/tobaccocontrol-2021-057031
on
21
January
2022.
Downloaded
from
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on
http://tobaccocontrol.bmj.com/
Tob
Control:
first
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January
2022.
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on
http://tobaccocontrol.bmj.com/
Tob
Control:
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January
2022.
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http://tobaccocontrol.bmj.com/
Tob
Control:
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21
January
2022.
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from
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on
http://tobaccocontrol.bmj.com/
Tob
Control:
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21
January
2022.
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on
http://tobaccocontrol.bmj.com/
Tob
Control:
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21
January
2022.
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http://tobaccocontrol.bmj.com/
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Control:
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2022.
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Policy support
44. Evaluation plans for 2024
§Statewide retail
observation in random
sample of CA retailers
§Undercover purchase
survey of flavored products
§Secondary data analysis of
retail scanner data
§ Illicit product sales,
NEW/imitation products
The policy cycle
