Implementation strategies to promote community-engaged efforts to counter tobacco marketing at the point of sale


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.

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Author information



Corresponding author

Correspondence to Jennifer Leeman DrPH.

Ethics declarations


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.

Ethical approval

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.

Informed consent

As noted above, this study was not human subject research.

Additional information


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.

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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).

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  • Implementation strategies
  • Health promotion policy
  • Tobacco
  • Point-of-sale