Implementation strategies can help create public health policies to counter tobacco marketing at point of sale

Research recently published from the University of North Carolina at Chapel Hill has identified strategies and resources that can be successful in creating health policy to counteract tobacco point of sale (POS) marketing and be used in other public health arenas.  The article appeared in the journal Translational and Behavioral Medicine in September.

Jennifer Leeman, DrPH

Jennifer Leeman, DrPH

The tobacco industry spends $8.2 billion each year on POS marketing, which includes in-store displays and discounts to encourage purchases.  Evidence-based policy interventions can reduce exposure to POS marketing, but little is known about the best way to implement those interventions to be successful in communities. Counter Tools, currently led by Interim Executive Director Nina Baltierra, is a non-profit spinoff founded by researchers at the University of North Carolina at Chapel Hill that provides resources and trainings to community partners focused on reducing exposure to POS marketing of tobacco products. Drs. Kurt Ribisl and Allison Myers launched Counter Tools in 2012. Today Counter Tools has public health partnerships in 19 US states.

The Comprehensive Cancer Control Collaborative of NC (4CNC) analyzed data from one year for evidence-based police interventions (EBPIs) implemented by 30 community partnerships in one southern state. The researchers at 4CNC partnered with Counter Tools in order to study EBPI implementation by coordinators and partnerships, who were equipped with the resources and trainings provided by the non-profit.

The study was co-led by Jennifer Leeman, DrPH, the director of 4CNC, and Allison Myers, PhD, who is currently serving as an RWJF Health Policy Fellow at the National Academies of Medicine. The 4CNC project is a Special Interest Project funded by the Centers of Disease Control and Prevention through the Prevention Research Center (PRC) program as part of its eight center Cancer Prevention and Control Research Network (CPCRN). UNC-Chapel Hill is also home to CPCRN’s Coordinating Center.

Leeman, Myers, and their colleagues found that the coordinators of the community partnerships had greater confidence to lead efforts to counter tobacco marketing and that the partnerships increased their efforts to engage strategic partners and to document and raise awareness of the tobacco marketing problem.

“Changes to local policy are essential to creating community environments that support healthy behaviors,” said Leeman. “Working with Counter Tools(c) provides 4CNC with the opportunity to better understand the types of training, tools, and other supports needed to promote successful policy change.”

The 4CNC researchers found that community coordinators’ self-efficacy—their individual performance—overall increased from the beginning to the end of the study. The coordinators were able to describe store environment effects on tobacco use and identify retailers using POS marketing, as well as present data to their partnerships and describe how to raise community awareness.

Alison Myers, PhD

Alison Myers, PhD

The partnerships themselves also completed many tasks important in the process of EBPI implementation, including completing store audits to document the POS marketing occurring in their communities in addition to meeting to engage partnerships and holding events to raise community awareness of the marketing practice.

Because the study only lasted one year, coordinators were unable to enact new EBPIs at the time. However, partnerships were already well on their way towards EBPI enactment, and it is likely with more time that policy changes could be implemented in the participating communities. In the future, it would be crucial for these partnerships to continue their role in promoting EBPI implementation.

“We envision continuing this work in other areas of public health policy beyond tobacco,” said Myers. “4CNC and Counter Tools are well positioned to offer leading edge implementation strategies to support health promotion policy enactment in healthy food access, alcohol retailer density, and other place-based determinants of health.”

By Clara To, UNC Center for Health Promotion and Disease Prevention, the UNC-Chapel Hill Prevention Research Center