Influences on Tobacco Control Funding Decisions: Explaining State Variation in Appropriations

摘要

This policy research on state tobacco control funding decisions provides a conceptual framework and quantitative model for explaining this outcome. Studying resource allocation for tobacco control is important because of the impact increased funding can have on health outcomes. One published study on state variation in tobacco control appropriations reported little explanatory value of tobacco burden of disease factors. The current research used both qualitative and quantitative methods to identify factors that were useful in explaining this outcome following the state settlements with the tobacco industry. Key informant interviews with state policy experts yielded a comprehensive list of 26 influences on state tobacco control funding decisions. In a modified Delphi process, experts completed ratings of importance and the 11 factors that received the highest ratings were: budget situation, state priorities, tobacco industry economic and political activity, the role of the governor, the role of a legislator who champions tobacco control, public opinion, dedicated tobacco control funds, tobacco control advocacy, leadership, and coalitions. A conceptual diagram was developed to portray the relationships of these factors with state tobacco control funding. To test the explanatory value of these factors, a multiple linear regression model was developed with existing cross-sectional data on all 50 states. Five measures were significantly associated with the outcome and explained 49% of the variance. The 26 states with Gross State Product from tobacco had lower allocations for tobacco control (Tobacco Economy). The 27 states with laws preempting stricter local ordinances were less likely to allocate funds for tobacco control (Tobacco Industry Political Activity).