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Qualitative Findings on E-cigarette Disposal and Challenges in State-Level Tobacco Control Implementation
Ginny Chadwick1, Hattie M Kahl, Sangah Clara Lee
1Author Affiliations: Mongan Institute Health Policy Research Center and Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts (Ms Chadwick, Ms Kahl, Ms Stover, and Dr Levy); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Ms Chadwick); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Ms Lee); Boston University School of Public Health, Boston, MA (Ms Stover); and Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO (Dr Kruse); and Harvard Medical School, Boston, MA (Dr Levy).
Context:
States regulate e-cigarettes through tobacco control laws to restrict product accessibility and advance public health objectives. Enforcement of laws results in regulators obtaining e-cigarette products, which are classified as hazardous waste and must be disposed of in accordance with federal standards. As states implement tobacco control laws, they face increasing challenges related to the disposal of e-cigarette products.
Objectives:
This study provides insights into the challenges states face and the strategies they have developed for managing the disposal of e-cigarette products while implementing tobacco control policies.
Design:
We conducted semistructured qualitative interviews guided by the Bullock et al policy implementation framework to examine 5 e-cigarette policies: taxation, licensure, flavor restrictions, minimum legal sales age, and clean indoor air. Emergent topics within the framework, including e-cigarette disposal, were analyzed using a second-cycle, team-based inductive approach.
Setting:
US state government agencies involved in implementing e-cigarette policies.
Participants:
State key informants (KIs) directly involved in or knowledgeable about e-cigarette policy implementation.
Main Outcome Measures:
Qualitative themes describing disposal practices for the management of e-cigarette hazardous waste by state KIs.
Results:
Interviews with state personnel revealed struggles to meet waste management requirements for e-cigarettes. Some KIs reported avoiding or limiting the enforcement of tobacco control laws regulating e-cigarettes because of disposal costs and logistical challenges. KIs proposed solutions that other states could adopt, such as seizure in place and statutory language to recoup costs. Failure to manage e-cigarette disposal undermined public health goals and imposed financial burdens on government agencies.
Conclusions:
Proper disposal management will require industry accountability, new partnerships, and the development of infrastructure and systems. States need comprehensive model language to guide e-cigarette waste disposal.
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