An instrument for assessing the quality of tobacco-control policies: The ACT-L Scale

Background. Efforts to prevent and decrease tobacco use and tobacco-related disease include improving the quality of tobacco-control laws to make them more stringent in controlling tobacco advertising, youth access, and expos ure to environmental tobacco smoke (ETS). However, because there are no ins truments to empirically evaluate the quality of such laws, it has been diff icult to demonstrate that their quality is associated with decreased youth access or tobacco-related morbidity. We present the first instrument for em pirically assessing the quality of tobacco-control policies. Methods. Recommendations for the content of an ideal, comprehensive tobacco -control policy were used as the 55 items in the Assessment of the Comprehe nsiveness of Tobacco Laws Scale (ACT-L Scale). Raters evaluated 71 tobacco- control laws with the scale; 70 of these were actual California laws and 1 was a model law from Americans for Non-smokers' Rights (ANR). Results. Interrater (r = 0.64-0.89) and internal-consistency (r = 0.63-0.88 ) reliability of the scale and subscales were high, and validity was establ ished by demonstrating that the ANR model law received a significantly high er total score (mean = 18.75) than all actual laws (mean = 2.04). Californi a tobacco-control laws were poor in all areas (youth access, ETS, tobacco a dvertising). Conclusions. The ACT-L scale can be used to compare and evaluate the qualit y of tobacco-control laws, highlight areas in which further policy efforts are needed, quantify improvement in such policies, and empirically demonstr ate the positive health impact of high-quality tobacco-control laws. (C) 19 98 American Health Foundation and Academic Press.