The Jefferson County Department of Health (JCDH) launched an initiative to post tobacco advisory signs at point of purchase through incentivizing voluntary signage placement.

With the goal of increasing awareness, reducing smoking rates and youth initiation, six 11”x17” signs were developed depicting risks associated with tobacco use such as cancer, impotence and respiratory problems in children. In addition, each sign promotes Alabama’s Quitline number as a resource for smokers to use and to increase cessation attempts. Placing signage where tobacco products are purchased is the ideal place to influence the minds of tobacco users.

The tobacco industry has strongly advertised in the retail environment; convenience stores and small grocery stores are among venues heavily targeted. Leading the initiative, the Tobacco Retail Warnings Specialist focused on convenience stores. As the primary outlet in underserved neighborhoods, they are an ideal location to convey healthful information in an environment where its reach may otherwise be limited.

The design of the six tobacco advisory signs was influenced by focus groups’ feedback, the FDA proposed images for cigarette packets, and evidence based research. A Behavioral Risk Factor Surveillance System (BRFSS) report released in December 2011 revealed that 78 percent of people surveyed in Jefferson County were in favor of having tobacco advisory signage posted in their neighborhood convenience store, pharmacy, or grocery store. Furthermore, studies have shown that smokers in countries with posted tobacco advisory signage were much more likely to understand the adverse health effects associated with smoking and reported they actually believe the health hazards portrayed by the signage to be true.

The Tobacco Retail Warnings Specialist initially canvassed 61 convenience stores randomly chosen within Jefferson County. Out of the 61 convenience stores, finalized signs were placed in 50 of them. Through one on one visits, each retail store’s owner or key decision maker was informed about the initiative, its importance and incentive to support it. A toolkit was presented highlighting smoking related health statistics, research, and other information to get buy-in from the owner as a long term supporter of posting the signage. All participating owners were asked to sign a pledge of support stating their willingness to voluntarily comply. After a three month follow up to the 50 original convenience store owners that agreed to voluntarily post signage, there has been a 94 percent retention rate at the time of follow-up visits.

In order for a successful environmental systems change, this initiative proposed to use the exiting food inspection platform as a vehicle for sustainability. Although JCDH does not have jurisdiction over all tobacco retail establishments, 80 percent of them also carry food permit. With such a high percentage of retailers holding JCDH issued food permits and thus undergoing routine health inspections by JCDH inspectors, the food permits provides the ideal avenue through which those retailers could be incentivized to voluntarily support the tobacco advisory signage initiative. In October 2011, the Jefferson County Board of Health unanimously voted to adopt a policy to incentivize convenience stores and other venues selling tobacco products (with a JCDH issued food permit) to voluntarily post tobacco advisory signage. The incentive includes awarding two points to the participating venue’s overall health rating given no critical violations are assessed during routine health inspections. The two incentive points are awarded if signage is posted at the point of purchase or in other conspicuous areas. Because the compliance is voluntary, point of purchase placement was strongly recommended but not mandated. Monitoring of initiative through continues site visits and quarterly reports will provide compliance rates to further advance police change. The Tobacco Retail Warnings Specialist provided technical assistance to the JCDH health inspectors. This technical assistance educated the inspectors on how to assess proper placement of signage with warrants awarding the incentive points and address any fundamental questions the retailers may have.

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