Jefferson County Alabama's Approach to Point of Purchase Tobacco Advisory Signage: When Mandated Signage is not an Option

While CDC has established point of purchase tobacco advisory signage to be an evidence based practice for reducing smoking, recent legal losses have made policy change difficult. In response, the Jefferson County CPPW program has launched a two stage effort, voluntary signage posting and incentivizing the posting of signage. An external environmental analysis of fifteen Jefferson County convenience stores and supermarkets was conducted to assess the placement of tobacco marketing and advertising materials. This information influenced the placement suggestions made to owners as well as the size of the tobacco advisory signage. Two focus groups were conducted to critique images and written text proposed for the signage in accordance to salience, grotesqueness, and overall appeal. The finalized signs were presented to, and ultimately voluntarily selected by business owners to be placed in 50 of 61 convenience store locations throughout Jefferson County who were approached. In October 2011, the Jefferson County Board of Health adopted a policy incentivizing all 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. Signage should be posted at the point of purchase or other conspicuous areas. Among the 50 original convenience store owners that agreed to voluntarily post signage, there has been a 94% retention rate at the time of follow-up visits, conducted about three months after the last of the 50 signs were posted.