Tobacco Control Policy Adoption Dynamics: A Case Study of Missouri Communities

J Community Health. 2018 Aug;43(4):802-809. doi: 10.1007/s10900-018-0487-z.


Tobacco control policies reduce the health and economic burden caused by tobacco. With over half of the United States communities lacking adequate protective policies, an examination of policy adoption factors can provide insights to facilitate policy adoption. A case study approach examines the rate of adoption, prominent media frames, policy leaders' perceptions and coalition activities for smokefree and Tobacco 21 policies adopted in Missouri. Findings show compared to smokefree policy, Tobacco 21 requires a considerably shorter timeframe and fewer resources for adoption. Tobacco 21 coalitions target a small group of stakeholders compared to smokefree coalitions' emphasis on broad community engagement. Both policies are formally opposed, but elected officials perceive less political risk supporting Tobacco 21. As a new tobacco control policy tool, Tobacco 21 has relative advantage that should be considered by community health advocates.

Keywords: Relative advantage; Smokefree policy; Social construction; Tobacco 21; Tobacco control.

MeSH terms

  • Health Policy*
  • Humans
  • Leadership
  • Missouri
  • Oligopeptides
  • Public Health
  • Public Policy
  • Smoke-Free Policy
  • Smoking Prevention
  • United States


  • Oligopeptides
  • pyroglutamyl-arginyl-glutamyl-arginyl-tyrosinamide