The US tobacco industry spends $8.2 billion annually on marketing at the point of sale (POS), a practice known to increase tobacco use. Evidence-based policy interventions (EBPIs) are available to reduce exposure to POS marketing, and nationwide, states are funding community-based tobacco control partnerships to promote local enactment of these EBPIs. Little is known, however, about what implementation strategies best support community partnerships’ success enacting EBPI. Guided by Kingdon’s theory of policy change, Counter Tools provides tools, training, and other implementation strategies to support community partnerships’ performance of five core policy change processes: document local problem, formulate policy solutions, engage partners, raise awareness of problems and solutions, and persuade decision makers to enact new policy. We assessed Counter Tools’ impact at 1 year on (1) partnership coordinators’ self-efficacy, (2) partnerships’ performance of core policy change processes, (3) community progress toward EBPI enactment, and (4) salient contextual factors. Counter Tools provided implementation strategies to 30 partnerships. Data on self-efficacy were collected using a pre-post survey. Structured interviews assessed performance of core policy change processes. Data also were collected on progress toward EBPI enactment and contextual factors. Analysis included descriptive and bivariate statistics and content analysis. Following 1-year exposure to implementation strategies, coordinators’ self-efficacy increased significantly. Partnerships completed the greatest proportion of activities within the “engage partners” and “document local problem” core processes. Communities made only limited progress toward policy enactment. Findings can inform delivery of implementation strategies and tests of their effects on community-level efforts to enact EBPIs.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Office of the Surgeon General. (2014). The health consequences of smoking—50 years of progress: a report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.
Henriksen, L., Feighery, E. C., Schleicher, N. C., Cowling, D. W., Kline, R. S., & Fortmann, S. P. (2008). Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools? Preventive Medicine, 47(2), 210–214.
Henriksen, L., Schleicher, N. C., Feighery, E. C., & Fortmann, S. P. (2010). A longitudinal study of exposure to retail cigarette advertising and smoking initiation. Pediatrics, 126(2), 232–238.
Kim, A. E., Nonnemaker, J. M., Loomis, B. R., Baig, A., Hill, E., Holloway, J. W., et al. (2013a). Influence of tobacco displays and ads on youth: a virtual store experiment. Pediatrics, 131(1), e88–e95.
Robertson, L., Cameron, C., McGee, R., Marsh, L., & Hoek, J. (2016). Point-of-sale tobacco promotion and youth smoking: a meta-analysis. Tobacco Control, Epub ahead of print. doi:10.1136/tobaccocontrol-2015-052586.
Robertson, L., McGee, R., Marsh, L., & Hoek, J. (2015). A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine & Tobacco Research, 17, 2–17.
Federal Trade Commission. (2016). Federal Trade Commission Cigarette Report for 2014. Retrieved from https://www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2014-federal-trade-commission-smokeless-tobacco-report/ftc_cigarette_report_2014.pdf ).
Center for Public Health Systems Science. (2014). Point-of-sale report to the nation: the tobacco retail and policy landscape. St. Louis, MO: Center for Public Health Systems Science at the Brown School of Social Work at Washington University in St. Louis and the National Cancer Institute, State and Community Tobacco Control Research.
Lee, J. G., Henriksen, L., Rose, S. W., Moreland-Russell, S., & Ribisl, K. M. (2015). A systematic review of neighborhood disparities in point-of-sale tobacco marketing. American Journal of Public Health, 105(9), e8–18.
Pollay, R. W. (1996). The last straw? Cigarette advertising and realized market shares among youths and adults. Journal of Marketing, 60, 1–6.
Slater, S. J., Chaloupka, F. J., Wakefield, M., Johnston, L. D., & O'Malley, P. M. (2007). The impact of retail cigarette marketing practices on youth smoking uptake. Archives of Pediatrics & Adolescent Medicine, 161(5), 440–445.
Reitzel, L. R., Cromley, E. K., Li, Y., Cao, Y., Dela Mater, R., Mazas, C. A., et al. (2011). The effect of tobacco outlet density and proximity on smoking cessation. American Journal of Public Health, 101, 315–320.
Kim, A. E., Loomis, B. R., Busey, A. H., Farrelly, M. C., Willett, J. G., & Juster, H. R. (2013b). Influence of retail cigarette advertising, price promotions, and retailer compliance on youth smoking-related attitudes and behaviors. Journal of Public Health Management & Practice, 19, E1–E9.
Adams, M. L., Jason, L. A., Pokorny, S., & Hunt, Y. (2013). Exploration of the link between tobacco retailers in school neighborhoods and student smoking. Journal of School Health, 83, 112–118.
Chan, W. C., & Leatherdale, S. T. (2011). Tobacco retailer density surrounding schools and youth smoking behaviour: A multi-level analysis. Tobacco Induced Diseases, 9(1), 9.
Institute of Medicine. (2007). Ending the tobacco problem: a blueprint for the nation. Washington, DC: The National Academies Press.
Myers, A. E., Hall, M. G., Isgett, L. F., & Ribisl, K. M. (2015). A comparison of three policy approaches for tobacco retailer reduction. Preventive Medicine, 74, 67–73.
Ackerman, A., Etow, A., Bartel, S., & Ribisl, K. M. (2016). Reducing the density and number of tobacco retailers: policy solutions and legal issues. Nicotine & Tobacco Research. doi:10.1093/ntr/ntw124.
Leeman, J., Myers, A. E., Ribisl, K. M., & Ammerman, A. S. (2015a). Disseminating policy and environmental change interventions: Insights from obesity prevention and tobacco control. International Journal of Behavioral Medicine, 22, 301–311.
National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Heatlh. (2014). Best practices for comprehensive tobacco control programs. Atlanta, GA: Centers for Disease Control and Prevention Retrieved from http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/comprehensive.pdf.
Committee on the Use of Social Science Knowledge in Public Policy. Using science as evidence in public policy. National Academy of Sciences; 2012.
Satterlund, T. D., Cassady, D., Treiber, J., & Lemp, C. (2011). Barriers to adopting and implementing local-level tobacco control policies. Journal of Community Health, 36, 616–623.
Gantner, L. A., & Olson, C. M. (2012). Evaluation of public health professionals' capacity to implement environmental changes supportive of healthy weight. Evaluation and Program Planning, 35(3), 407–416.
Leeman, J., Teal, R., Jernigan, J., Reed, J. H., Farris, R., & Ammerman, A. (2014). What evidence and support do state-level public health practitioners need to address obesity prevention. American Journal of Health Promotion, 28, 189–196.
Armstrong, R., Waters, E., Crockett, B., & Keleher, H. (2007). The nature of evidence resources and knowledge translation for health promotion practitioners. Health Promotion International, 22, 254–260.
Leeman, J., Calancie, L., Hartman, M., Escoffery, C. T., Herrmann, A. K., Tague, L. E., et al. (2015b). What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: a systematic review. Implementation Science, 10, 80.
Leeman, J., Calancie, L., Kegler, M.C., Escoffery, C.T., Herrmann, A.K., Tague, L.E., … Samuel-Hodge, C.. Developing theory to guide building practitioners' capacity to implement evidence-based interventions. Health Educ Behav. 2015c, 1–30, DOI: 10.1177/1090198115610572.
DeGroff, A., Schooley, M., Chapel, T., & Poister, T. H. (2010). Challenges and strategies in applying performance measurement to federal public health programs. Evalation and Program Planning, 33, 365–372.
Clavier, C., Gendron, S., Lamontagne, L., & Potvin, L. (2012). Understanding similarities in the local implementation of a healthy environment programme: insights from policy studies. Social Science & Medicine, 75(1), 171–178.
Kingdon, J. W. (2003). Agendas, alternatives, and public policies. New York: Longman.
Leeman, J., Sommers, J., Vu, M., Jernigan, J., Payne, G., Thompson, D., et al. (2012). An evaluation framework for obesity prevention policy interventions. Preventing Chronic Disease, 9, E120.
Lyn, R., Aytur, S., Davis, T. A., Eyler, A., Evenson, K., Chriqui, J. F., et al. (2013). Policy, systems, and environmental approaches for obesity prevention: a framework to inform local and state action. Journal of Public Health Management and Practice, 19(3 Suppl 1), S23–S33.
Weber, M. D., Simon, P., Messex, M., Aragon, L., Kuo, T., & Fielding, J. E. (2012). A framework for mobilizing communities to advance local tobacco control policy: the Los Angeles County experience. American Journal of Public Health, 102, 785–788.
de Leeuw, E., Clavier, C., & Breton, E. (2014). Health policy—why research it and how: Health political science. Health Research Policy and Systems, 12, 55.
Weiss D, Lillefjell M, Magnus E. Facilitators for the development and implementation of health promoting policy and programs - a scoping review at the local community level. BMC Public Health. 2016; 16(1): 140. doi:10.1186/s12889-016-2811-9
Douglas, M. R., Carter, S. S., Wilson, A. P., & Chan, A. (2015). A neo-strategic planning approach to enhance local tobacco control programs. American Journal of Preventive Medicine, 48(1 Suppl 1), S13–S20.
Rhoades, R. R., & Beebe, L. A. (2015). Tobacco control and prevention in Oklahoma: best practices in a preemptive state. American Journal of Preventive Medicne, 48(1 Suppl 1), S6–S12.
Rhoades, R. R., Beebe, L. A., Boeckman, L. M., & Williams, M. B. Communities of excellence in tobacco control: changes in local policy and key outcomes. American Journal of Preventive Medicine, 48(1 Suppl 1), S21–S28.
Roeseler, A., Hagaman, T., & Kurtz, C. (2011). The use of training and technical assistance to drive and improve performance of California's tobacco control program. Health Promotion Practice, 12(6 Suppl 2), 130S–143S.
Chamberlain, P., Brown, C. H., & Saldana, L. (2011). Observational measure of implementation progress in community based settings: the stages of implementation completion (SIC). Implementation Science, 6, 116.
Brown, C.H., Chamberlain, P., Saldana, L., Padgett, C., Wang, W., & Cruden, G.. Evaluation of two implementation strategies in 51 child county public service systems in two states: results of a cluster randomized head-to-head implementation trial. Implement Sci. 2014; 9.
Saldana, L., Chamberlain, P., Wang, W., & Hendricks Brown, C. (2012). Predicting program start-up using the stages of implementation measure. Adminstration and Policy in Mental Health, 39, 419–425.
Luke, D. A., Sorg, A. A., Combs, T., Robichaux, C. B., Moreland-Russell, S., Ribisi, K. M., & Henriksen, L. (2016). Tobacco retail policy landscape: a longitudinal survey of US states. Tobacco Control, 25, i44–i51.
Hsieh, H., & Shannon, S. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.
Golden, S. D., Feigher, E. C., Roeseler, A., Rogers, T., & Ribisl, K. M. (2015). Beyond excise taxes: a systematic review of literature on non-tax approaches to raising tobacco product prices. Tobacco Control, 25, 377–385.
McLaughlin, I.. License to kill? Tobacco retailer licensing as an effective enforcement tool. Tobacco Control Legal Consoritum. 2010. Retrieved from tclc-syn-retailer-2010.pdf.
Sterman, J. D. (2006). Learning from evidence in a complex world. American Journal of Public Health, 96, 505–514.
Brownson, R. C., Chriqui, J. F., & Stamatakis, K. A. (2009). Understanding evidence-based public health policy. Amercan Journal of Public Health, 99, 1576–1583.
Rogers, P. J. (2008). Using programme theoory to evaluate complicated and complex aspects of interventions. Evaluation, 14, 29.
Ogilvie, D., Cummins, S., Petticrew, M., White, M., Jones, A., & Wheeler, K. (2011). Assessing the evaluability of complex public health interventions: five questions for researchers, funders, and policymakers. Milbank Quarterly, 89, 206–225.
Leviton, L.C. & Trujillo, M.D.. Interaction of theory and practice to assess external validity. Eval Rev. 2016; 1–36, DOI: 10.1177/0193841X15625289.
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ, 337, a1655.
Zakocs, R. C., & Edwards, E. M. (2006). What explains community coalition effectiveness?: a review of the literature. American Journal of Preventive Medicine, 30, 351–361.
The project described was supported by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute/NIH, through Cooperative Agreement Number U48 DP005017-SIP to the Center for Health Promotion and Disease Prevention at the University of North Carolina at Chapel Hill. The content is solely the responsibility of the authors and does not necessarily represent the official views of the CDC or NIH.
Conflict of interest
Two of the authors (Myers and Grant) are employed by the organization whose implementation strategies are being studied. The lead author (Leeman) and two other authors (Wangen and Queen) declare that they have no conflict of interest.
All procedures performed were in accordance with the ethical standards of the University of North Carolina at Chapel Hill Institutional Review Board and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. UNC’s IRB reviewed study protocols and determined the study to be “Not Human Subjects Research” because data were not being collected on participants’ personal information and participants were only asked for information related to the performance of their jobs.
As noted above, this study was not human subject research.
For Researchers or Research: The study’s conceptual model and measures might contribute to future tests of implementation strategy effects on community partnerships’ performance of core components of the process required to make evidence-informed changes to local policy.
For Practitioners or Practice: The paper presents preliminary data in support of a theory-guided approach to providing training, technical assistance, tools, and other implementation strategies to strengthen community efforts to enact health policy.
For Policymakers or Policy: Study findings address the gap in what is known about how best to support community efforts to enact evidence-supported health policies, such as policies to counter tobacco marketing at the point of sale.
The findings reported have not been previously published and the manuscript is not being simultaneously submitted elsewhere. The authors have not reported data previously, have full control of all primary data, and agree to allow the journal to review data if requested.
About this article
Cite this article
Leeman, J., Myers, A., Grant, J.C. et al. Implementation strategies to promote community-engaged efforts to counter tobacco marketing at the point of sale. Behav. Med. Pract. Policy Res. 7, 405–414 (2017). https://doi.org/10.1007/s13142-017-0489-x
- Implementation strategies
- Health promotion policy