Tobacco Control Compliance Check Program

State: UT Type: Model Practice Year: 2005

The Tobacco Control Compliance Check Program targets approximately 200 retail outlet stores who sell tobacco products within SW Utah Public Health Department's five-county, 17,000+ square mile area. In 2001, the tobacco buy rate to minors was over 20 percent. From program implementation in 2002 to current date, the tobacco buy rate to minors is at four percent. The overall goal of the Tobacco Control Compliance Check Program is to produce a "zero sale" result in each of the retail establishments every time a compliance check is conducted. Objectives in accomplishing this goal include: 1) provide consistent and effective tobacco retailer education classes to all retail stores, 2) perform quarterly compliance checks and 3) Negotiate with stores that do sell the lowering or elimination of fines who actively participate in classes. With continued improvement, implementation and evaluation of the program is intended to keep the buy rate very low and improve the positive and effective partnership with tobacco retail outlets within the district.
Studies by the American Cancer Society and the American Lung Association have shown that the most addicted smokers started before the age of 19. These smokers have the most difficulty in quitting permanently. In 1992, the U.S. Congress adopted the Synar Amendment as part of the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. Implementation of the Act was originally scheduled to go into effect fiscal year 1994. However, implementation was delayed because regulations about how states were to implement were not finalized. In 1996 draft regulations were finalized after a review of comments from the health community, state agencies and the tobacco industry. Some of the regulations of the Synar Amendment were to: conduct annual random, unannounced inspections to ensure compliance with the law, enforce current state tobacco laws in regard to youth access, selling and distributing, develop strategies to lower the buy rate to less than 20 percent and submit annual reports detailing each state's activities. The Southwest Utah Public Health Department has been performing compliance checks since 1996. From 1996 to 2001 youth within the district were able to buy tobacco products at least 20 percent of the time. No identification was required in most stores or flimsy stories were accepted as fact. Youth knew which stores would sell to them and word spread about the store. If a clerk was cited and perhaps fired, youth would follow the clerk to the next store of employment. Retail store owners were on their own to design and implement education programs for their staff. Most of these programs were very limited at best. Some retailers relied on tobacco industry programs. The buy rate in the district remained stable at or near 20 percent for the next six years. The Southwest Utah Public Health Department had worked with partnerships in the past with great success and a partnership with retail owners was designed. The role of the Health Department would be to offer education classes in addition to in-store training to clerks. Those stores who participated would have their fine reduced or eliminated should a sale occur at the time of the quarterly check. This plan would acknowledge that store owners were doing all they could to reduce sales to underage youth. The program started by the Southwest Utah Public Health Department invites the retail store owners to partner with the Health Department. Before this program, the relationship between the Health Department and the retail store owners was adversarial and tensions were high. With the partnership, the efforts of the store owners were recognized and rewarded. Some store owners initially were hard to convince that it was a benefit until a sale was made and the fine was not reduced. This practice is different from other public health approaches in that it offers a definite monetary incentive. Steve at Steve's Mini-Mart commented: "Great program! Good incentives for the retailer side." In addition to this comment, several store owners and managers have expressed thanks for the retailer education classes and partnership the program has formed with them.
Agency Community RolesThe Southwest Utah Public Health Department initiated this partnership practice. The stakeholders, the retail store owners, are encouraged to participate by the incentive of reduction in fines. The information offered in the classes has been tailored over time as questions and concerns have come up.  Costs and ExpendituresThe initial costs of the program were covered by the Master Settlement Agreement funds. This funding has covered the planning and organizing of the partnership but each clerk is required to pay $15 for the class and identification card. The card is good for two years and renewal is required of those who participate in the program. The renewal fee is $15 as well. Fees from the class could be used to cover the costs.  ImplementationIn 2002, the partnership offer was first made in a letter to each retail store owner. The plan was outlined with the information about the classes and the incentive plan. Class times were planned for each month in the two larger counties of our district and were planned for hours when workers could attend. In the smaller counties classes were scheduled once a quarter. Each clerk who attended was given a unique number and identification card. This would allow tracking of the clerk and provided a history for employers. Trained underage youth are sent in to each store to attempt to purchase tobacco products. The youth carry a recording device that monitors the interaction with the clerk and this recording can be used in case of any dispute. Local police officers accompany the staff member of the Southwest Utah Public Health Department in this procedure. If a sale is made, the officer then cites the clerk and a fine is levied. The Health Department then follows up with a letter which delineates the fine to be paid. A scale has been set by the state of Utah which starts at $350 and escalates to $1000 and a suspension of the license to sell tobacco products for up to a year.
From a buy rate of 20 percent in 2001, this program has reduced the rate to 4 percent. This is well within the parameters mandated for the state of Utah. Surveys are administered at the end of each retailer education class. These results show that 98 percent of clerks attending classes have increased their knowledge and awareness of state tobacco laws and regulations. In addition, classes have been specially tailored to answer specific questions and address unique issues that tobacco retailer clerks experience in the district. Before 2002, there was not an effective partnership system organized by the Health Department to appropriately conduct tobacco compliance checks, retailer education classes and local civil hearings. The buy rate of tobacco products from minors stayed at around 20 percent from 1996 to 2001. In the last three years since our program has been implemented we have experienced a steady decrease in that buy rate and the current rate is at 4 percent. While these results cannot completely be attributed to the partnership program because of other variables such as familiarity of the personnel involved in the quarterly checks and phone call warnings of checks from store to store in small communities, the decline in the sale rate has followed the increase in clerk/store participation and partnership activities outlined in the program. This program is definitely worth the resources invested in it. It has significantly reduced youth access to tobacco products within the district and will continue to help us achieve the program's overall goals.
Key Elements Needed to Replicate: 1) A committed and dedicated tobacco prevention and control team willing to collaborate, partner, educate, negotiate and provide the needed leadership of a public health agency to the store owners, managers and clerks in their respective areas and 2) the appropriate equipment, supplies, materials and time needed to plan, implement and evaluate effective tobacco compliance checks, retailer education classes and local health district civil hearings.