Adopt & Adapt: Implementing Local Tobacco 21 Policy in Cincinnati

This case study examines the challenges and facilitators to implementation and enforcement of Tobacco 21 and Tobacco Retail Licensing policies in Cincinnati, Ohio, from 2019 to 2022. Cincinnati was part of a cohort of communities supported by Interact for Health to develop, implement, and enforce local Tobacco 21 and related policies. The City of Cincinnati policies were initially passed in 2018 after robust coalition-building efforts and the Cincinnati Health Department was tasked with implementation and enforcement. These processes met early challenges including enactment of state and federal Tobacco 21 laws prior to local implementation, the impact of the COVID-19 pandemic and response on local public health efforts, and retailer identification and monitoring limitations. Over time, the Cincinnati Health Department overcame these challenges to successfully implement and enforce the policies through nurturing partnerships with retailers, streamlined retailer tracking, and ongoing education efforts. Adaptability and flexibility were key to gaining traction in a challenging environment. The relationships built with retailers via education and one-on-one support helped ease the transition for local businesses, retailer and public support for the policies grew, and youth reported lower access to and use of tobacco. This case study is based on a 3-year evaluation that highlighted the voices of retailers, an often underrepresented partner in tobacco policy implementation, enforcement, and evaluation.