Name
Western Governors University
D223 Healthcare Policy and Economics
Prof. Name
Date
The Tobacco 21 Act, enacted at the federal level in December 2019, increased the minimum legal age for purchasing tobacco products in the United States to 21 years. The primary purpose of this legislation is to reduce the initiation of tobacco use among adolescents and young adults, a population particularly vulnerable to nicotine addiction due to ongoing brain development. By restricting access to tobacco products at an early age, the law aims to prevent long-term health consequences such as cardiovascular disease, respiratory illnesses, and cancer. The Tobacco 21 Act reflects a preventative public health strategy designed to reduce national healthcare costs and improve population-level health outcomes by addressing tobacco use before addiction is established (Products, n.d.).
Colorado’s Reproductive Health Equity Act (RHEA), passed in 2022 as House Bill 22-1279, establishes legal protections for reproductive healthcare decisions, including access to contraception and abortion services. The act explicitly affirms that fertilized eggs, embryos, and fetuses do not possess independent legal rights under state law. This provision prevents legal conflicts that could otherwise restrict reproductive healthcare access. RHEA was enacted to ensure reproductive autonomy, eliminate discrimination related to pregnancy decisions, and protect individuals from government interference in personal healthcare choices. The policy underscores Colorado’s commitment to reproductive justice, particularly in response to shifting national legal interpretations of reproductive rights (Reproductive Health Equity Act [RHEA], 2022).
The following table outlines the level of governance, policy description, and enforcement mechanisms associated with each public healthcare policy.
| Level | Policy Name | Description | Enforcement Mechanism |
|---|---|---|---|
| Federal | Tobacco 21 Act | Prohibits the sale of tobacco products to individuals under 21 years of age | Enforced by the U.S. Food and Drug Administration through inspections and penalties |
| State | Reproductive Health Equity Act (RHEA) | Guarantees access to contraception and abortion without discrimination | Enforced by state and local agencies; includes fines and professional license actions |
Who benefits from the policy?
Adolescents and young adults under the age of 21 are the primary beneficiaries, along with the broader population that experiences reduced exposure to secondhand smoke and lower healthcare costs.
How do they benefit?
The policy decreases early exposure to nicotine, reduces the likelihood of lifelong addiction, and promotes healthier developmental outcomes. Over time, this contributes to decreased prevalence of smoking-related illnesses.
Who is negatively impacted?
The tobacco industry and retailers experience financial losses due to reduced demand among younger consumers.
How are they impacted?
With fewer legal purchasers, tobacco companies face a decline in market growth and reduced long-term profitability.
Impact on health disparities and equity
The Tobacco 21 Act promotes health equity by disproportionately benefiting underserved communities, which historically experience higher rates of tobacco use and tobacco-related disease. Reducing youth initiation helps narrow long-standing health disparities.
Who benefits from the policy?
Women and individuals of reproductive age in Colorado benefit most directly from the protections established under RHEA.
How do they benefit?
The policy ensures safe, legal, and timely access to reproductive healthcare services without fear of legal repercussions or discrimination.
Who is negatively impacted?
Individuals and advocacy groups that oppose abortion or contraception on moral, religious, or ideological grounds may perceive the policy as conflicting with their beliefs.
How are they impacted?
These groups may encounter reduced influence over reproductive healthcare legislation and increased political and social tension.
Impact on health disparities and equity
RHEA advances reproductive health equity by addressing barriers related to cost, geography, and legal restrictions. This is particularly important for marginalized populations who historically face limited access to reproductive services.
The Tobacco 21 Act is grounded in extensive public health research demonstrating that most adult smokers begin using tobacco before the age of 21. Data from California’s Tobacco Control Program revealed a sharp decline in high school smoking rates—from 10% in 2016 to 2% in 2018—after implementing similar age restrictions (Kim et al., 2021). The Centers for Disease Control and Prevention (CDC) identifies smoking as the leading preventable cause of death in the United States, reinforcing the importance of early prevention strategies (CDC, 2021). These findings strongly support the effectiveness of age-based tobacco restrictions.
The enactment of RHEA followed the 2022 U.S. Supreme Court decision overturning Roe v. Wade, which returned regulatory authority over abortion to individual states (Berg & Woods, 2023). In response, Colorado adopted RHEA to protect reproductive rights and ensure continuity of care. Research indicates that restricting abortion access can negatively affect women’s physical, mental, and socioeconomic health outcomes, further validating the necessity of protective legislation (Coen-Sanchez et al., 2022).
| Policy | Supporting Evidence | Suggested Improvements |
|---|---|---|
| Tobacco 21 Act | Reduces nicotine addiction during adolescent brain development and lowers rates of tobacco-related diseases (Kim et al., 2021) | Expand public education campaigns and increase funding for cessation programs in underserved communities |
| Reproductive Health Equity Act | Protects reproductive autonomy and prevents discrimination by clarifying legal rights (Coen-Sanchez et al., 2022) | Broaden insurance coverage and increase funding for clinics serving rural and low-income populations |
Nurses play a critical role in shaping healthcare policy due to their direct involvement in patient care and firsthand understanding of healthcare system challenges. At the federal level, professional organizations such as the American Nurses Association (ANA) provide platforms for nurses to advocate for policies that improve patient safety, workforce conditions, and healthcare quality. Nurses contribute evidence-based perspectives that ensure policies are both practical and patient-centered.
At the state level, organizations like the Colorado Nurses Association (CNA) enable nurses to engage with legislators, participate in advocacy initiatives, and influence healthcare regulations that directly affect clinical practice and patient outcomes.
Despite their expertise, nurses often encounter obstacles when engaging in policy development. Limited formal education in health policy can reduce confidence and preparedness. Resistance to organizational change may discourage participation, while time constraints and insufficient resources limit advocacy efforts. Additionally, the rapidly evolving healthcare environment demands continuous policy updates, underscoring the need for sustained nurse involvement in legislative processes.
Participation in this educational program has strengthened my commitment to active involvement in healthcare policy development, implementation, and evaluation. I plan to join the Colorado Nurses Association to remain informed about legislative initiatives and collaborate with colleagues to advocate for evidence-based reforms. By contributing to policy committees and compliance teams, I aim to support improvements in patient care, professional practice, and health equity. Nurses possess a powerful collective voice, and I am committed to using mine to promote meaningful and sustainable healthcare change.
Berg, J. A., & Woods, N. F. (2023). Overturning Roe v. Wade: Consequences for midlife women’s health and well-being. Women’s Midlife Health, 9(1), 2. https://doi.org/10.1186/s40695-022-00085-8
Centers for Disease Control and Prevention. (2021, October 29). Health effects of cigarette smoking.
Centers for Disease Control and Prevention. (2023, May 26). State system tobacco MLSA fact sheet.
Coen-Sanchez, K., Ebenso, B., El-Mowafi, I. M., Berghs, M., Idriss-Wheeler, D., & Yaya, S. (2022). Repercussions of overturning Roe v. Wade for women across systems and beyond borders. Reproductive Health, 19(1), 184. https://doi.org/10.1186/s12978-022-01490-y
Kim, S. C., Martinez, J. E., Liu, Y., & Friedman, T. C. (2021). US Tobacco 21 is paving the way for a tobacco endgame. Tobacco Use Insights, 14. https://doi.org/10.1177/1179173X211050396
Products, C. for T. (n.d.). Tobacco 21. U.S. Food and Drug Administration.
Reproductive Health Equity Act [RHEA]. (2022). Colorado General Assembly.
