Piloting a Point-of-Sale Approach to Promote Tobacco Control

Introduction: The retail environment is the primary avenue for tobacco marketing, accounting for over 90 percent of promotional expenditures. Since many avenues of exposure are limited under legal restrictions the tobacco industry has capitalized on the unregulated retail environment. Substantial research shows tobacco marketing increases youth tobacco use, impedes current users’ efforts to quit, and contributes to smoking relapse. The 2009 Tobacco Control Act gives states and communities the power to regulate cigarette marketing, opening the door to implement point-of-sale strategies. A point-of-sale strategy for tobacco control programming directly impacts the effects of tobacco marketing. When forming a point-of-sale intervention it is critical to first understand the local tobacco retail environment in order to educate key decision makers about tobacco marketing and motivate them to take action.

Methods: Designing a point-of-sale strategy began by reviewing previously implemented approaches, especially those with a low risk of litigation. Interventions were selected after an in-depth review of the 2014 “Point-of-Sale Strategies: A Tobacco Control Guide” released by Center for Public Health Systems Science at Washington University and Tobacco Control Legal Consortium. Follow-up steps included selecting strategies based on feasibility, utility, and ability to withstand a legal challenge; pulling model policies for comparison; and developing a pilot program in a strategic location. Potential locations for the pilot were analyzed through an assessment of local support, population, tobacco retail stores per capita, and proximity of tobacco retailers to schools.

Results: The point-of-sale approach was narrowed to two actions: restricting location of tobacco retail outlets and requiring retail stores to post Quitline information. The location assessment resulted in forming city profiles to assist in choosing a city to implement the pilot program in. The program includes assessments of tobacco retail stores, building local buy-in, and engaging local leaders and legislators. The goal of the pilot is to inform movement of a statewide law on tobacco licensing. Finally a timeline was prepared for stakeholders, partner expectations for involvement were created, expected oppositional groups were identified, and information about barriers to implementation was collected.

Conclusions: Point-of-sale restrictions are established tobacco control activities, but each approach benefits from tailoring for location and players. Working within local context builds momentum for broad policy change.