OFFICE OF STATEWIDE HEALTH IMPROVEMENT INITIATIVES

Tobacco-Free Living: Point of Sale Implementation Guide STATEWIDE HEALTH IMPROVEMENT PARTNERSHIP (SHIP)

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Tobacco-Free Living: Point of Sale Implementation Guide

Minnesota Department of Health Office of Statewide Health Improvement Initiatives Tobacco Prevention and Control PO Box 64882, St. Paul, MN 55164-0882 651-201-3535http://www.health.mn.gov/tobaccoNovember 2016

Upon request, this material will be made available in an alternative format such as large print, Braille or audio recording. NOTE: Content in this guide is subject to change. Watch Basecamp for news on any updates.

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Contents

Overview .................................................................................................................................. 4

Best Practices ....................................................................................................................... 4

Description of Strategy ........................................................................................................ 5

Scope and Requirements ......................................................................................................... 7

Implementation Steps ............................................................................................................. 8

Foundational Practices ........................................................................................................ 8

Building Effective Policy Strategies ..................................................................................... 8

Sample Work Plan Milestones and Activities .......................................................................... 9

Roles ....................................................................................................................................... 10

Recommended Partners ........................................................................................................ 10

Key Resources and Tools ....................................................................................................... 11

Required Tools ................................................................................................................... 11

Supporting Resources ........................................................................................................ 12

MDH Content Support ........................................................................................................... 12

MDH Technical Assistance and Training ................................................................................ 13

Policy, Systems, and Environment (PSE) TA ...................................................................... 13

Legal Technical Assistance and Training ........................................................................... 14

Assessing Retail Environment Technical Assistance and Training .................................... 15

Attachments .......................................................................................................................... 15

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Overview In 2014, U.S. tobacco companies spent over $8.2 billion marketing and promoting cigarettes and smokeless tobacco products in the retail environment, or at the point-of-sale (or POS). This equates to nearly $1 million per hour, and made up the vast majority (91 percent) of the tobacco companies’ total advertising and promotional budgets ($9.1 billion).

Tobacco POS marketing targets both consumers and retailers. Core marketing activities include price discounts, exterior and interior advertisements, product displays, and providing retailers financial incentives to increase retail marketing and ensure optimal placement within the store.

Exposure to tobacco POS marketing is harmful to health. Heavy POS spending buys the tobacco industry many things: brand recognition and preference, tobacco product cravings and unplanned purchases, a reduction in successful quit attempts, an inflated perception of smoking prevalence and acceptance, and increased initiation and continuation of tobacco use, by youth in particular.

Segments of the population are disproportionally exposed to tobacco marketing in the retail setting, particularly communities of color and low-income communities. Industry tactics include targeted advertising of mentholated products to African-Americans, price promotions and discounts, and a greater density of retailers in poorer communities.

An in-depth review of tobacco-related health disparities is provided in the new Center for Disease Control and Prevention (CDC) Best Practices User Guides: Health Equity in Tobacco Prevention and Control.

Best Practices Point-of-sale (POS) strategies are a complement to foundational, evidence-based tobacco prevention and control approaches. Traditionally, the CDC has promoted four foundational strategies:

• Raising tobacco excise taxes and prices • Passing clean indoor air laws • Offering cessation services • Hard-hitting media campaigns

In recent years, POS strategies have become seen as another promising, evidence-based approach and are recommended as the fifth strategy to pursue once the first four have been established.

POS strategies are an emerging focus for several reasons. First, the 2009 Family Smoking Prevention and Tobacco Control Act lifted preemption and extended new authority to states, tribes, and local government to pass policies to regulate tobacco in the retail environment. Second, sufficient empirical evidence now exists that demonstrates the strong relationship between tobacco sales and marketing in retail stores and tobacco use behaviors. Finally, when states or localities have instituted high tobacco prices, passed strong clean indoor air laws, and

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secured program funding as part of their core tobacco control strategies (as is the case in Minnesota), work on POS is the next step in comprehensive tobacco control and prevention.

The Minnesota Comprehensive Tobacco Control Framework 2016-2021 lays out an ambitious path to address tobacco use. Several point-of-sale policies are included in the 17 Bold Steps outlined in the document.

Working together, public health professionals, community advocates, and local governments have the power to initiate and implement policy and environmental interventions that change the way tobacco is sold and marketed in the retail environment. Stronger retail tobacco control policies can prevent youth from ever starting and can make it easier for current tobacco users to quit.

Description of Strategy The intent of this strategy is to improve the tobacco retail environment by reducing the community’s exposure to tobacco products and marketing. This can be accomplished through local ordinance changes. Grantees will pursue and implement evidence-based approaches that will lead to decreased youth access and exposure to tobacco marketing practices.

The goals of this strategy are to:

• Decrease tobacco exposure and use • Reduce tobacco-related disparities • Increase community awareness of tobacco industry practices • Improve enforcement and compliance with youth access and retail regulatory laws

Applicants will select one of the two approaches in the Tobacco Point-of-Sale strategy – Foundational or Advanced – and create a work plan to reflect milestones and activities to support the policy, systems, and environmental changes.

In this strategy, grantees will be educating and mobilizing community stakeholders to inform and educate the public and decision makers about the public health concerns related to the tobacco retail environment. All grantees must start with the “Foundational Approach” detailed below and must be able to demonstrate existing laws and enforcement practices before proposing to work on any “Advanced Approaches.”

Foundational Approach: Update and Strengthen Existing Local Laws While a local (city or county) retail license is required to sell tobacco products and related devices (including electronic cigarettes) in Minnesota, some local licensing regulations have fallen out of compliance with state and federal laws and need updating. Tobacco retail licensing ordinances (as well as retail licensing fees) drive mandatory compliance monitoring programs, establish strong penalty structures, and will often include additional, more comprehensive tobacco control regulations beyond the minimums specifically required in state law (Chapter 461 of the Minnesota Statutes).

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At a minimum, grantees will work on updating and strengthening local licensing, compliance, and enforcement laws and practices to ensure that they meet state requirements, provide clear and comprehensive definitions, and include robust and self-sustaining compliance programs. Examples include:

• Ensuring that all retailers (including e-cigarette-only vendors) obtain a license and renew it annually.

• Imposing a license fee that is sufficient to cover all the costs associated with administration, implementation, and enforcement of the licensing regulations.

• Providing that violation of any federal, state, or local tobacco control law is also a violation of the terms of the license.

• Establishing a penalty structure that helps ensure compliance with the licensing requirements, reduces repeat offenses, and funds additional inspections and related enforcement activities.

• Authorizing the license to be suspended or revoked for violations.

More details can be found on pages 7-8 in the document Point of Sale Strategies: A Tobacco Control Guide.

Advanced Approaches: Reduce the Availability and Appeal of Tobacco through Point of Sale Restrictions Grantees will also have the option, subject to MDH approval, to work on Advanced Approaches to improve the tobacco retail environment through local ordinances changes. Strategies could include:

• Reducing (or restricting) the number, location, density, and types of tobacco retail outlets, such as limitations of tobacco sales by schools or in pharmacies.

• Increasing the cost of tobacco products through non-tax approaches such as minimum product pricing, minimum pack sizes, and prohibiting coupon redemption and other price discounting.

• Establish content-neutral sign regulations that limit external facing signage. • Restricting the sale of menthol and other flavored products to adult-only, tobacco

product shops. • Raising the minimum legal age to purchase tobacco to 21. • Requiring a minimum age to sell (minimum clerk age) to 18. • Prohibiting the distribution and use of samples in retail environment.

More details can be found on pages 15-29 in the document Point of Sale Strategies: A Tobacco Control Guide.

Opportunities for Layering with Community Strategies: Healthy Eating and Active Living In addition to these Foundational and Advanced Approaches, grantees with the capacity and opportunity may propose incorporating healthy eating or active living community strategies into their tobacco point-of-sale work. Layering examples could include, but are not limited to:

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• Using standard tools to assess the retail environment and accessibility. • Pursuing local ordinances that establish content-neutral sign regulations that limit

external facing signage. • Regulating not only the location, density, and proximity of tobacco retailers but also

address active living and healthy eating concepts into community comprehensive plans. • Recruiting retailers to voluntarily reduce tobacco products and marketing, which could

qualify them for a financial incentive to promote healthy foods in their stores.

Please consult with MDH staff for details about layering possibilities and available tools.

Scope and Requirements There are a few requirements that grantees should be aware of before selecting this strategy:

• At the minimum, grantees are required to work on updating and strengthening of local tobacco ordinances to comply with state and federal laws and best align with licensing, compliance, and enforcement best practices. This is the Foundational Approach.

• Grantees must demonstrate that the local licensing authority has proposed or updated their tobacco ordinance to reflect state and federal laws and strengthened their basic licensing regulations and practices (the Foundational Approach) before they may pursue Advanced Approaches. Grantees should add this step to their work plans.

• A grantee who selects the Foundation Approach, but later wants to pursue Advanced Approaches, may do so with prior MDH approval.

• Advanced Approaches must include community education and engagement activities to build public support and awareness.

• Grant funds may not directly fund local compliance checks. It is intended to be used for creating and promoting the adoption of adequate licensing fees to sustain the licensing program.

• Grantees working on this strategy may not lobby in order to influencing policy making. As the local public health authority, the grantee will be providing expertise and education assistance such as data, fact sheets, reports, and related resources in order to impact policy makers, other decision makers, specific stakeholders, and the general community.

Grantees will be expected to include the following activities into their work plans:

• Identifying and analyzing youth and adult tobacco use rates. • Assessing the retail environment by performing retailer audits and mapping activities

using Counter Tools. • With the assistance of Public Health Law Center, identifying gaps and opportunities to

update and improve local tobacco laws. • Participating in TA and Training opportunities, led by the American Lung Association and

Association for Nonsmokers – MN, in order to strengthen community engagement and

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education skills such as gauging public support and opinion, key informant interviews, securing partnerships, and working with stakeholders.

Implementation Steps Foundational Practices Start with these foundational practices steps before beginning to implement this strategy.

• Assess and identify health inequities and disparities to determine the priority populations and communities to work with.

• Engage affected communities. • Communicate and build capacity of decision-makers and community members. • Prioritize needs and identify how to implement PSE changes by selecting activities. • Sustain partnerships and efforts.

The general steps to implement these foundational practices include:

1. Assemble a team to conduct a community assessment.

2. Review existing data and collect additional data, as needed, related to population demographics and disease and risk factor data disparities and inequities.

3. Determine the existence and location of community stakeholders, organizations and resources.

4. Assess the opportunities and gaps in the community and with partners. 5. Assess the adequacy of current local tobacco policies with the guidance of Public Health

Law Center.

6. Summarize and analyze the assessment data to select priority populations and communities to work with on this strategy.

7. Utilize these findings to establish a POS community outreach and engagement plan using vetted key messages and tools.

The starting point for these foundational practices will vary, depending upon how much work has previously been done in your communities through SHIP and/or other grants, programs, and public health work. Some grantees may have already identified priority populations and communities with health inequities and others may be just beginning the process. Build on existing work wherever possible.

Building Effective Policy Strategies Effective local tobacco control policies are fundamental to the success of reducing tobacco use and exposure. As you begin planning and preparing, the following tobacco policy guide will help you develop your strategy.

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The Policy Strategies: A Tobacco Control Guide, assists tobacco control staff in laying the ground work and building effective policy strategies. Specific examples include:

• Planning and drafting policy • Crafting talking points and messaging • Generating media coverage • Creating policy briefs to educate decision makers • Working with community groups • Providing evidence-based testimony • Holding face-to-face educational meetings • Countering opposition

There are a number of resources available to increase your knowledge, skills, and abilities in point-of-sale policy work. Some resources are listed in the Key Resources and Tools section.

Sample Work Plan Milestones and Activities

Community Assessment and Planning Phase: Approx. 6 - 12 months Document public health problem; assess community needs and readiness, policy and legal gaps

• Assess the adequacy of current local tobacco policies with the guidance of Public Health Law Center.

• Gather local health data (e.g., tobacco use rates) & policy compliance data. • Assess the community environment with the Counter Tools Minnesota Store Mapper. • Assess the consumer environment with the Counter Tools Store Audit Center. • Determine community needs, particularly the needs of disparate populations. • Gather all the data collected and with the guidance of MDH and tobacco TA

providers, begin policy planning for the next phases of the strategy.

Community Education and Engagement Phase: Approx. 6 months - 12 months Build community capacity and implement the policy campaign & Recruit community members to build a local coalition to mobilize support for policy goal

• Conduct one-on-one meetings to recruit key community members. • Conduct presentations to enlist support of key organizations. • Attend community events to educate and recruit the public. • Convene a local coalition to initiate campaign activities. • Meet with key stakeholders and decision makers. • Engage the media to educate the public and decision makers. • Educate and inform decision makers on tobacco control and prevention best

practices.

Policy Adoption and Implementation Phase: Approx. 12 months Ensure that provisions of adopted policy are implemented and enforced as intended

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Community Assessment and Planning Phase: Approx. 6 - 12 months Document public health problem; assess community needs and readiness, policy and legal gaps

• Build and maintain relationships with city and county licensing staff through regular contact to foster collaboration in policy implementation efforts.

• Engage the media to educate the public about provisions of adopted policy. • Monitor policy implementation and enforcement. • Conduct another round of store audits to document change over time.

Roles For those grantees working to update and strengthen their local licensing laws and practices only (Foundational Approach), this work can be accomplished across governmental units with relatively little coalition support depending on the environment.

For those pursuing Advanced Approaches, a grantee (or subcontractor) will lead the mobilization and education efforts. Grantees may choose to subcontract the direct work. However, local public health will be expected to support the subcontractor by providing public health expertise and assist with making internal connections. Grantees should expect this approach to be more time intensive, the actual time depending on the type of POS change undertaken. Grantees supporting a subcontractor should budget a couple of hours a week knowing that this will vary depending on the phase of the policy. Grantees completing the work themselves should expect to spend on average of about 20 hours a week on POS work.

MDH will lead technical assistance and training efforts and coordinate grantee efforts across the state. MDH’s TA providers will provide proactive and reactive assistance for the grantees such as assessment and planning tools, grantee skill development, community engagement tactics, and implementation troubleshooting. MDH and TA providers will support grantees through monthly POS grantee connect calls, periodic webinars, and by incorporating POS discussion into regional Making It Better trainings.

Recommended Partners Developing meaningful partnerships and engaging community members is critical to advancing health equity and reducing tobacco-related health disparities. There is not a one size fits all community engagement plan. However, these may be some helpful tools and questions to help guide the work.

CDC’s Health Equity Guide on developing partnerships and coalitions and meaningful community engagement.

In addition, identify other groups funded to work on tobacco prevention and control work that would be interested in collaborating. Examples could include, but are not limited to:

• MDH Tobacco-Free Communities (TFC) grant program

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• MDH American Indian grant program (includes SHIP and TFC) • MDH Eliminating Health Disparities Initiatives (EHDI) grant program • Grants from other funders Blue Cross and Blue Shield and ClearWay Minnesota • Other existing tobacco, alcohol, or other drug prevention task forces

Are other like organizations or groups with compatible missions possible partners? Examples could include, but are not limited to:

• Community Leadership Team (CLT) • Twin Cities Medical Society • Health and wellness organizations or groups • Crime or violence prevention groups • Youth organizations and clubs: DARE, Future Farmers of America (FFA), Boys and Girls

Club, 4-H, scouts, YMCA/YWCA, National Honor Society, student council, sports teams, Fellowship of Christian Athletes (FCA), and others

• Volunteer organizations: American Lung Association, American Cancer Society, American Heart Association, Women of Today, March of Dimes, Mothers Against Drunk Driving (MADD), or other similar organizations

• Neighborhood associations • Social service organizations • Other foundations, religious organizations, health systems, non-profits, and businesses

Are there any individuals with unique perspectives and with a vested interested in the health and well-being of their community such as physicians, educators, elders, and parents?

Who are the decision makers and other stakeholders? Examples could include, but are not limited to: law enforcement, tobacco retailer licenser, code enforcement, and city/county planners and administrators.

Key Resources and Tools Required Tools Counter Tools Store Audit Center and Minnesota Mapper software tools provide communities online interactive store mapping and store-auditing tools to assist with their POS work. To gain access to these tools, contact your grant manager. Counter Tools is associated is Counter Tobacco.org, a CDC-funded website with information and resources for organizations working to counteract tobacco product sales and marketing at the point-of-sale.

The Minnesota Tobacco Point-of-Sale Policy Toolkit A series of resources created by the Public Health Law Center that provides Minnesota-specific information on local retail tobacco licensing and point-of-sale options.

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Point-of-Sale Strategies: A Tobacco Control Guide Created by the Tobacco Control Legal Consortium and Washington University Center for Public Health Systems Science, this Guide provides detailed information on advanced approaches to POS.

Regulating Tobacco in the Retail Environment: An Overview of Local Point-of-Sale Strategies This webinar provides an overview of foundational and advanced POS approaches, identify the mechanisms for implementing these strategies at the local level, and help grantees incorporate POS into their work.

Why Point of Sale Matters: The Evidence webinar by Counter Tools and Minnesota Department of Health

Supporting Resources A Practitioner’s Guide for Advancing Health Equity: Community Strategies for Preventing Chronic Disease, POS Strategies to Address Access and Exposure to Tobacco Products by CDC Division of Community Health describes how to design tobacco-free living strategies that address the needs of populations that have disproportionately higher rates of tobacco-use.

Healthy Retail Playbook by ChangeLab Solutions

License to Kill?: Tobacco Retailer Licensing as an Effective Enforcement Tool by the Tobacco Control Legal Consortium is a comprehensive overview of tobacco retailer licensing.

Point of Sale Playbook by ChangeLab Solutions is also a reference guide that outlines policy options for regulating how and where tobacco products are marketed and sold.

Stop Sales to Minors is an online tobacco vendor training by the Association for Nonsmokers-MN.

Tobacco Retailer Licensing Playbook by ChangeLab Solutions is intended as a reference guide to provide an overview of all the steps and considerations involved in building support for tobacco retailer licensing and creating and implementing a solid policy.

Lethal Lure is toolkit and website created by the American Lung Association

MDH Content Support Your Community Specialist is available for consultation while you draft your work plans. Additionally, MDH content staff are available on an ongoing basis to answer questions about the strategies to assist grantees in making selections.

Cassandra Stepan, Local Tobacco Policy Planner Tobacco Prevention and Control Office of Statewide Health Improvement Initiatives cassandra.stepan@state.mn.us 651-201-3665

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MDH Technical Assistance and Training Group Learning and Training Opportunities

Grantees must budget for at least one staff member to attend three regional in-person trainings and one two-day statewide meeting per year. Tobacco-free living topics will be incorporated into these trainings and meeting. Announcements on trainings and meetings will provided in the Making it Better Log.

Additionally, grantees should participate in the monthly connect calls. These calls will be a peer- to-peer learning environment facilitated by the American Lung Association. More formal webinars may replace these calls in order to present timely research, resources, and news. The call schedule can be found on Basecamp.

Individualized Technical Assistance

Local communities are strongly encouraged to work with a technical assistance provider for further guidance and policy planning.

There are four organizations providing technical assistance and training on the tobacco retail environment, local licensing, land use and zoning, as well as advertising, marketing, and product and sales regulations for Minnesota communities through MDH.

Tobacco technical assistance and training has three components – PSE Consultation, Legal Technical Assistance, and Tobacco Retail Environment Assessment. To ensure efficiencies and to address distinct regional needs, PSE consultation services will be divided between two organizations. All grantees will work with the Public Health Law Center in coordination with either ANSR or ALA on policy development as well as Counter Tools regarding retail assessment tools.

Policy, Systems, and Environment (PSE) TA PSE TA providers serve as tobacco prevention and control policy experts and provide individualized consultation to MDH grantees on PSE change phases including strategy development, policy adoption, implementation, and enforcement. PSE TA providers demonstrate deep expertise in tobacco control PSE processes, best practices, and implementation and enforcement strategies and be able to accommodate specific community needs and strengths when assisting grantees.

PSE TA providers provide technical support for all tobacco control PSE strategies chosen by MDH grantees. They have the capacity to provide:

• Provide one-on-one consultation around PSE change to grantees. • Provide strategy-specific resources such as toolkits, templates, factsheets, talking

points, sample policies, and enforcement guides that can be adapted for communities. • Work with grantees to co-create and develop needed materials and resources.

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The Association for Nonsmokers – Minnesota (ANSR)

Esha Seth, MDH TA Lead esha@ansrmn.org (651) 646-3005

The following SHIP grantees should contact ANSR for 1:1 PSE TA services:

• Anoka County • Benton County • Bloomington-Edina-Richfield • Carver County • Chisago County • Dakota County • Hennepin County • Isanti-Mille Lacs-Kanabec- Pine

• Minneapolis • Scott County • Sherburne County • St. Paul- Ramsey • Stearns County • Washington County • Wright County

American Lung Association of the Upper Midwest

Erin Simmons, MDH TA Lead erin.simmons@lung.org 507-382-7421

The following SHIP grantees should contact ALA for 1:1 PSE TA services:

• Blue Earth • Brown-Nicollet- Le Sueur-Waseca • Cass • Countryside • Crow Wing • Des Moines Valley with Nobles County • Dodge-Steele • Faribault-Martin- Watonwan • Fillmore-Houston • Freeborn • Goodhue • Healthy Northland • Health 4 Life

• Horizon • Kandiyohi-Renville • Meeker-McLeod-Sibley • Morrison-Todd-Wadena • Mower • North Country • Olmsted • Polk-Norman-Mahnomen • Quin • Rice • Southwest Health and Human Services • Wabasha • Winona

Legal Technical Assistance and Training The Public Health Law Center provides statewide legal technical assistance and training for MDH grantees. PHLC and the Tobacco Control Legal Consortium has an extensive set of helpful guides, fact sheets, tips and tools, toolkits, reports, sample policies, and webinars.

Scott Kelly, MDH TA Lead scott.kelly@mitchellhamline.edu 651-695-7611

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Assessing Retail Environment Technical Assistance and Training Counter Tools provides all MDH grantees with online interactive store mapping and store-auditing tools to assist with their POS work. To gain access to these tools, contact your grant manager. Associated is Counter Tobacco.org, which is a CDC-funded website with information and resources for organizations working to counteract tobacco product sales and marketing at the point-of-sale.

Jennifer Grant, MDH TA Lead jennifer.grant@countertools.org

919-694-3066 x212

Attachments SHIP Tobacco TA Provider Assignments Map

SHIP POS Phased Model of Change

Why POS Matters Infographic

Kittson Roseau

Lake of the Woods

Koochiching

Marshall

BeltramiPennington

Red Lake

Polk

Norman Mahnomen

Clay Becker

Clear-water

HubbardCass

Itasca

WilkinOtter Tail

Wadena CrowWing

Aitkin Carlton

Pine

Kanabec

MilleLacs

MorrisonTodd

DouglasGrant

TraverseStevens Pope Stearns

Benton

St. Louis

Lake

Cook

BigStone

Swift

ChippewaLac QuiParle

Kandiyohi Meeker Wright

SherburneIsanti

Chisago

Anoka

Yellow Medicine

Lincoln Lyon Redwood

Renville

Pipe-stone

Rock

Murray

Nobles

Cottonwood

Jackson

McLeod Carver

Hennepin

Brown

Watonwan

Martin

Sibley

Nicollet

Blue Earth

Faribault Freeborn

Waseca Steele

Le Sueur

Scott

Rice

Dakota

Goodhue

Wabasha

Dodge

Mower Fillmore Houston

WinonaOlmsted

Ramsey W

ashin

gton

Tobacco PSE TA Providers:American Lung AssociationAssociation for Nonsmokers

Phas

es

Year 1 End of Year 1 Year 2 End of Year 2 Years 3-5

Foun

datio

nal

Prac

tices

• Assess and Identify • Prioritize Needs

• Engage• Communicate and

Build Capacity

• Engage• Communicate and

Build Capacity • Sustain

Obj

ectiv

es

• Document the public health problem.

• Identify issues through community participation.

• Determine community needs, particularly for disparate populations.

• Identify priorities bases strengths, weaknesses, opportunities, and threats.

• Identify policy goals and establish plan.

• Inform and educate community members and key decision makers on findings.

• Build community capacity to create their own solutions based on best practices.

• Community members actively participate in identifying and solving their problems and become better able to address future problems collectively.

• Community members collectively improve leadership, social networks, and quality of life.

• Community members assume greater power and desire to create change.

• Provide technical assistance to communities to adopt and implement changes.

• Ensure that changes are implanted and enforced as intended.

Key

Activ

ities

• Collect all tobacco ordinances, licensing fees, compliance protocol, and penalty structure information from city and county licensing authorities.

• Submit these items to Public Health Law Center to assess adequacy of current tobacco ordinances and procedures.

• When possible, collect tobacco compliance results from licensing authorities.

• Collect lists of licensed tobacco retailers from licensing authorities.

• Use Counter Tools Minnesota Store Mapper to assess community’s tobacco retail environment.

• Conduct store audits to assess the consumer’s environment with Store Audit Center software.

• Gather community health data (e.g., tobacco use rates, chronic disease, demographics).

• Conduct community input and gain perspectives through public opinion polls, focus groups, community input sessions and/or key informant interviews.

• Identify community stakeholders to recruit to local coalition.

• Plan strategic activities to educate decision makers and stakeholders.

• Assess decision makers’ level of policy support.

• Conduct one-on-one meetings to recruit key community members.

• Conduct presentations to enlist support from key organizations.

• Attend community events to educate and recruit the public support.

• Engage Community Leadership Teams (CLTs) in education activities

• Conduct one-on-one meetings with decision makers.

• Engage the media to educate the public and decision makers.

• Educate and inform decision makers on tobacco control and prevention best practices.

• Provide support to communities to adopt and implement changes.

• Build and maintain relationships with city staff by establishing regular contact to foster collaboration in policy implementation efforts.

• Engage the media (op-eds, earned media, etc.) to educate the public about provisions of adopted policy.

• Monitor policy implementation and enforcement.

Tech

nica

l Ass

istan

ce, T

rain

ing,

and

Tool

s

Training• MDH sponsored SHIP

POS kick-off March 2016

Technical Assistance• Public Health Law

Center for licensing review

• Counter Tools Store Mapper and Store Audit Center

Technical Assistance• Schedule a 1.5 hour

TA session with MDH and TA providers concluding data collection.

Tools• Midwest Academy

Strategy Chart• Public opinion poll

survey (alternatives could include focus groups, community input sessions, key informant interviews)

Tools• One-on-one meeting

how-to guide• Coalition building TA • Media advocacy and

spokesperson training• Packaged youth

and community engagement activities

• PowerPoint Presentation templates and educational handouts

Technical Assistance• Public Health Law

Center provides ordinance language and legal support

• Evidence-based guide to effective implementation and enforcement mechanisms

Tools• Template fact sheets,

press releases, social media blurbs

Tools• Model enforcement

plan and troubleshooting

• Outreach communication materials and strategy

• Monitoring and evaluation plan

Phased Model of Change

Tobacco-Free Living: Point of SaleSTATEWIDE HEALTH IMPROVEMENT PROGRAM 2015-2020

1 2 3 4 5Community Assessment

Strategy Direction and Planning

Community Education and Engagement

Policy Adoption and Implementation

Policy Enforcement and Evaluation