Point-of-sale tobacco control work is a newer strategy for many communities across the United Sates. Many have focused on other strategies such as raising the cigarette excise tax, implementing smokefree air laws, providing access to cessation services, and hard-hitting media campaigns. However, none of these strategies alone is a silver bullet. They all work together as pieces of the tobacco control puzzle, and work on one strategy can complement or energize work on another strategy. For example, whether or not your community is legally able or has the readiness to pass point-of-sale tobacco control policy, assessing the retail environment can help bring awareness to the presence of and norms around tobacco in your community and may lead to progress on other types of tobacco policy.

No matter what type of policy you are pursuing, engaging stakeholders is a key part of the public health policy change process. Mountain Brook, Alabama provides an excellent example of successfully engaging with key community members and community stakeholders in order to pass a more comprehensive smokefree policy in the town.

While the state of Alabama does not have comprehensive smokefree laws statewide (as of July 2018), cities and counties are permitted to enact their own, stronger laws to protect the health of their residents, and many have done so. Local health departments and coalitions have also begun tackling point-of-sale tobacco control work by assessing the retail environment in their communities. While embarking on this new work as part of a youth tobacco prevention grant, a group working with Children’s of Alabama, a children’s hospital in Birmingham, realized that the town of Mountain Brook, which is just over the mountain (literally) from Birmingham, did not have a comprehensive smokefree policy in place and still allowed smoking in bars and restaurants.

We spoke with John Stone, Manager of Community Action at Children’s, and Susan Walley, Associate Professor of Pediatrics at the University of Alabama – Birmingham and a Pediatrician at Children’s about the process they went through to get a smokefree law passed in Mountain Brook.

The Policy

The Policy was passed on September 26, 2016, and as of November 1st, 2016, Mountain Brook no longer allows smoking in bars and restaurants. The only places it is still allowed are in private clubs, cigar bars, and private residences, including private property. The ordinance also includes e-cigarettes.  See the full text of the policy here.

The Partners: Engaging Community Stakeholders

Key to their success was wide-reaching engagement of stakeholders in the community.  As Stone stated, “The network of people is really what made this a success. I cannot stress strongly enough the importance of community partnerships to help push this though. At the end of the day, it was the parents and business owners that really helped us.” Some of those partners included:

  • Dale Wisely, the Director of Student Services in the Mountain Brook City School System. In his role, Dr. Wisely is very in tune with the rates of substance abuse among students, including all types of tobacco products and e-cigarettes. He knew that e-cigarette use among students was on the rise and was interested in raising awareness of that issue. The school system was starting to pay attention to these rising rates as well, making work on the smoke-free policy a natural fit for them to pursue. The goal was to help reduce student tobacco use by reversing the norm set by allowing smoking in public places like bars and restaurants.
  • All In Mountain Brook, an advocacy group of citizens and parents. This group introduced the smokefree ordinance at the Mountain Brook council meeting.
  • Ashley Lyerly, the Regional Director of Public Policy for the American Lung Association, who helped the group by providing model smokefree ordinance language, communicating with city council members as well as the chamber of commerce, and educating about the positive impacts of smokefree policies.
  • Jefferson County Department of Health who provided expertise and support for community education and strategic planning.
  • Local health providers, who served as champions for the policy. This included a dentist who sent a letter of support to the city council detailing his standpoint based on the health effects of using tobacco on oral health that he sees in his practice.
  • City Council members, all of whom were crucially interested in the health of the community.
  • Local business owners, including the owner of one of the most popular bars in town, who was also a member of the chamber of commerce. It was important to the group working towards the policy to also be supportive of local merchants and their potential concerns about the policy’s effect on their business as well as the health of the community. The group was able to use anecdotal evidence from Birmingham to show that the ordinance could actually have a positive, rather than a negative effect on local businesses. When Birmingham went smoke-free, patronage of places that used to allow smoking went up following implementation of the policy, and data show that across the country, smokefree bar and restaurant laws do not have an adverse effect on business and sometimes even increase revenue. The group from the Children’s Hospital engaged business owners in conversation around this effect, discussing the hours that patrons frequented the bar and what effect a smokefree policy might have on the business’s bottom line. Ultimately, they were able to convince the business owner to support the policy, and in doing so, also got the Chamber of Commerce on their side.

The group also focused on educating the community at large about the proposed policy through education forums for both parents and students at school, for restaurant owners, for health professionals, as well as for the city council.

Policy Implementation

The policy was announced in local newspapers and the community was able to learn about it through supportive Op-Eds. Since Mountain Brook in a small community, news also spread by word-of-mouth. 

Lessons Learned

In many communities, we as public health practitioners often assume that helping children (e.g. by making sure that they are not subjected to secondhand smoke) is a strong motivating factor when it comes to policy support. While that is often the case, sometimes financial pressure and community norms can be even stronger motivating factors.

The group from the Children’s Hospital found that it is also critically important to get key community opinion leaders who hold a lot of influence on board. In order to do that, you have to find out what motivates them. In the case of restaurant and bar owners, for example, their primary motivation may be protecting their bottom line so that their business can continue to survive and to thrive. They may care about the health of children, but they also have to consider the health of their livelihood. 

Community image can also be a motivating factor. Most communities would like to pride themselves on supporting health and wellness. However, competition with other neighboring or peer communities can be an incentive for change as well. Noting that other neighboring communities already have stronger smokefree policies in place and that your city is falling behind can serve as motivation to pass a policy to match the competition.

The policy that Mountain Brook ultimately passed was a compromise that citizens felt was best for the community in terms of balancing progress in protecting residents’ health and the concerns of the business community. While retail assessments had not yet been competed in Mountain Brook, it was useful to have data from Birmingham to present to the city council on tobacco sales in the neighboring community.  Going forward, they will have data for retail assessments for their focus community.   

What’s next?

This year, they are collecting store assessment and mapping data in Mountain Brook along with other communities across the state. They hope to revisit the city council once they have the survey data collected to let the city council know what the point-of-sale landscape looks like. They are hoping it will serve as an eye-opener to see how many tobacco outlets there are and how prevalent tobacco marketing is in the community as they work towards the long-term goal of point-of-sale policies.  Community norms around tobacco are often set by what community members see in their day-to-day lives, and that includes whether people are smoking in public and what they see in stores.

The group is also considering how to address and harness growing concern over vaping. While there are not yet any vape shops in Mountain Brook, they hope to capitalize on the discussions to bring awareness to other tobacco control issues as well.

– Read more Stories from the Field –

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