Create (Community Research for Action Team)-Guam: Empowering youth to drive tobacco control policy

Among Guam youth, tobacco consumption is highest among Chamorros and other Micronesians. Focus group analyses indicated that higher exposures to tobacco-using adults and environmental cues including advertising contribute to youth tobacco use. We partnered with the Johns Hopkins School of Public Health to map point of sale tobacco advertising in a random sample of tobacco retailers in Guam, using community-based participatory approaches. A community research group comprised of 32 volunteers, more than half of whom were aged 10 to 19 years, were trained to perform observational surveys using hand held computers equipped with Geographic Information System (GIS) technology and use Photovoice to digitally document tobacco point of sale advertising. The density of point of sale advertising was correlated to income, age and ethnic composition of each village to determine if differences exist along these social determinants. Community researchers collected the data, performed the data analysis, and presented findings at a community summit. 198 of 337 (59%) eligible stores were surveyed. 74% had outdoor tobacco advertising; 79% had indoor tobacco advertising. Candy and other items popular with children and youth were within 1 foot of tobacco advertising in over 56% of stores. Preliminary GIS mapping indicated higher densities of point of sale advertising in villages with a larger proportion of Micronesian Islander residents. Directly as a result of the research, a law prohibiting the sales of candy cigarettes was enacted. This project affirms the feasibility of using community-based participatory research to guide public health policy and engage youth in health advocacy.