Adding a voice to the story: Retailer collaboration in tobacco control policy and evaluation

Abstract Information: In 2019, the City of Cincinnati Health Department implemented local Tobacco 21 and Tobacco Retailer Licensing policies. From the onset of the three-year evaluation, our evaluation team identified retailers as stakeholders and storytellers who warranted increased attention in tobacco control policy. Although tobacco retailers have often been omitted from tobacco policy conversations, they are important stakeholders in reshaping the retail tobacco landscape. Although retailer interests can be perceived as opposed to tobacco control policies, we invited retailers to participate in the evaluation process as collaborators and respected partners. Through surveys and open-ended interviews, retailers shared stories, feedback, and ideas that went on to shape implementation and enforcement of the policies. They provided vital and unique perspectives that would have been lost without their participation. Retailer compliance with and support for the policies increased through the evaluation period and retailers described a positive and trusting relationship with the Cincinnati Health Department. In general, retailers felt they were key partners in protecting the young people in their neighborhoods from using tobacco and wanted fewer young people to use tobacco. In telling their stories, retailers directed the attention of the evaluation team and the Cincinnati Health Department to crucial equity issues in implementation and enforcement such as technology access and knowledge. Retailers are important partners in advancing health around tobacco and other prevention policy areas like healthy eating.

Relevance Statement: Communities throughout the United States are generating strategies to enforce Tobacco 21 policies, with tobacco control evaluation providing important insight into the most successful approaches. To date, retailer voices have largely been left out of tobacco control policy evaluation, despite the influence of retailer action on the successes of retail tobacco policies. Our evaluation of the City of Cincinnati Tobacco 21 and Tobacco Retailer Licensing prioritized retailer voices to better understand the on-the-ground experiences of implementation and enforcement. The Tobacco 21 evaluation utilized a participatory, logic-model driven approach within a socioecological framework. Retailer survey and interview data were a critical component of understanding the mezzo level environment – the neighborhood and communities where the effects of Tobacco 21 played out each day. Retailer perspectives complemented enforcement data including license and signage inspection and compliance check outcomes. The feedback provided by retailers supported successful implementation and enforcement of the new policies. It also produced substantive changes that fueled policy success including improvements to the licensing website, increased one-on-one visits with retailers, and better support for technology access. As key stakeholders, retailers can bring richness to evaluation data and identify key action areas to increase equity and promote policy success. In our presentation, we will share strategies for connecting with stakeholders that may be considered hard to reach or opponents of programs and policies. We will discuss the findings from retailer surveys and interviews, including that support increased over time and that retailers generally supported tobacco use prevention for people under 21. Next, we will discuss the ways in which retailer feedback shaped implementation, enforcement, and evaluation. Finally, we will connect our experience with health policy evaluation more broadly including healthy eating policies and other policies that impact the retail environment. This presentation adds to the body of knowledge in evaluation practice by highlighting the need to bring in underrepresented voices in evaluation and the benefits and lessons learned through expanded inclusion. Implementers and evaluators working in public health can benefit from shifting the perception of retailers from opponents to partners in prevention policy.