Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Promotion

First Committee Member

Dr. Athena K. Ramos

Second Committee Member

Dr. Daisy (Hongying) Dai

Third Committee Member

Dr. Keyonna M. King


Objectives: This qualitative study seeks to assess the impact of the federal Tobacco 21 (T21) law by analyzing data collected from a nationwide sample of key tobacco control stakeholders towards the implementation, enforcement, and outcomes of the T21 law. Methods: A series of five focus groups were conducted in December 2021 with stakeholders (n=31) who were asked about T21 implementation and enforcement measures used in their own communities. Participating stakeholders included tobacco policy experts, tobacco evaluation experts, subject matter experts, and implementation personnel. Results: We conducted a thematic analysis of the data resulting in eight themes found under four broad topics. Stakeholders are using a variety of strategies to implement T21 in their communities, however there are significant barriers towards T21 implementation. State and local enforcement of T21 varies depending on locality throughout the nation. Stakeholders believe that while T21 has the potential to reduce health disparities, they are also concerned that it may have unintended consequences which may exacerbate inequities. Stakeholders believe that changes in implementation and enforcement can increase T21’s impact. Conclusions: T21 implementation and enforcement policy varies based on locality. Policy changes to strengthen federal, state, and local efforts are needed to reduce barriers and unintended outcomes of the T21 law.

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