Tobacco policy coverage in California jurisdictions before and after enactment of proposition 56

Proposition 56, a $2 tobacco tax enacted in California in 2016, led to increased funding to Local Lead Agencies which work to reduce tobacco use. We examined whether Proposition 56 was associated with increases in the population covered by local policies addressing four areas: 1) tobacco retail sales (TRS), 2) flavored tobacco products sales (FTP), 3) outdoor secondhand smoke (SHS) restrictions, and 4) smoking restrictions in multi-unit housing (MUH).

2007-2023 data from the Policy Evaluation Tracking System in California were analyzed. The unit of analysis was the California jurisdiction, with outcome the time (in months) to policy enactment in a jurisdiction. Kaplan-Meier estimates and population coverage percentages were calculated by weighing each jurisdiction by its population size. Discrete-time survival models were fitted to test the effect of Proposition 56 on the rate of population coverage for each policy of interest.

By January 2023, 79 % of the California population was covered by a local SHS policy but only 55 %, 47 % and 18 % was covered by a local TRS, FTP and MUH policy, respectively. The rate of increase in TRS and FTP policy coverage was greater post-Proposition 56 than pre-Proposition 56 (p < 0.001), while the rate of increase did not change significantly for MUH and SHS policies.

Proposition 56 was associated with marked increases in the enactment of TRS and FTP, but not SHS or MUH policies. Despite increases post-Proposition 56, additional efforts are needed to increase local adoption of TRS, FTP and MUH policies because coverage remains low.