Drivers of Tobacco Policy Priorities in the United States: A Best-Worst Scaling Study

OBJECTIVE: The aim of this study was to bolster strategic guidance offered to state tobacco prevention and control programs by quantifying the relative importance of criteria used in policy prioritization and examining variation in importance across policy environments. DESIGN: A best-worst scaling (BWS) experiment was embedded in a survey. We developed 11 criteria pertinent to decision making among state tobacco prevention and control programs using qualitative interviews, quantified the criteria's relative importance using BWS, and analyzed the data using conditional logit and latent class logit models. SETTING: State tobacco control programs. PARTICIPANTS: Qualitative interviews to inform the development of the BWS were conducted with 12 managers of state tobacco prevention and control programs in 2023. The survey and BWS experiment included individuals working in state tobacco control programs and were conducted in 2024 (n = 114/372, 30.6%). MAIN OUTCOME MEASURES: Importance scores of decision-making criteria, on average and across latent classes. RESULTS: The BWS included 11 criteria, encompassing data and evidence, logistics and process considerations, and expected policy support. The most important criteria were addressing needs in priority populations, the availability of existing evidence that a policy works, legislative support, and state data showing a gap in outcomes. Importance varied across 2 latent classes: "Idealists" (72%) ranked addressing needs in priority populations first, while "Realists" (28%) ranked legislative support first. Both classes ranked existing evidence as second most important. CONCLUSIONS: Tobacco policy priorities are influenced by a range of important criteria, including evidence. There is variation in the drivers of decisions based on context. Findings can help researchers develop new approaches to translate research to individuals working in state tobacco control programs and inform the development of tools to support tobacco policy prioritization.