"We're building the plane while we're flying it": perspectives on local cigar policy implementation from qualitative...

Nearly 300 US municipalities have enacted policies regulating cigar pack size and price to reduce youth access to and use of inexpensive cigars. This study characterizes the policy implementation processes of these local policies and identifies associated barriers and facilitators.

Between June and November 2023, we conducted 36 semi-structured qualitative interviews with professionals involved in adopting and implementing local cigar regulations. Interview transcripts were coded and thematically analyzed using a template organizing style and iterative immersion-crystallization analysis of coded segments. Themes were categorized using the Inventory of Factors Assessing Successful Implementation and Sustainment determinant framework, encompassing domains such as external factors, internal organizational factors, retailer-specific factors, and policy-specific factors.

Participants described distinct education and enforcement activities post-policy adoption, often managed by separate, autonomous organizations and individuals. Key facilitators identified included state funding (external), interagency collaborations and unofficial capacity-building efforts (internal), and clear, enforceable ordinances with less retailer pushback (policy-specific). Conversely, significant barriers included state-level influences (external), lack of standardized protocols, resource disparities, and varied implementer perspectives (internal). Retailer-specific barriers included limited English proficiency and a willingness to risk violations. Policy-specific challenges involved confusing cigar definitions and insufficient deterrent penalties.

Local cigar policy implementation often involves multiple autonomous organizations and individual implementers. The salience of identified barriers across various contexts may have important implications for policy impact. Understanding the facilitators and barriers to policy implementation may enable other localities to proactively develop strategies to increase success.