Put It Away!

Tobacco is the leading preventable cause of death in the United States, contributing to the premature deaths of nearly half-a-million Americans each year. 1  Before it kills, tobacco also exacts a massive toll of sickness. The direct cost of providing medical care to people with tobacco-related diseases is estimated to be between $50 and $75-billion dollars per year. 2  That’s at least five times what it would cost to cover the prescription drugs of everyone on Medicare. 3

Because of the health hazards of tobacco, its sale to minors is prohibited in every state. However, that prohibition has not been enough to prevent underage youth from starting to smoke. Indeed, 90 percent of smokers first tried cigarettes when they were minors. 4  Every day in the United States 3,000 underage youth become regular smokers, that adds up to more than 1.2-million underage youth every year. Currently it is estimated that at least 4.5-million underage youth smoke cigarettes. The vast majority of youth who smoke wish they had never started. Part of the problem is that youth dangerously underestimate the addictive power of nicotine and overestimate their ability to quit. 5  Once they begin smoking, youth are likely to remain smokers for decades. 6

Children often fail to fully comprehend the hazards of tobacco; therefore it is the community’s responsibility to keep cigarettes and other tobacco products out of their reach. These self-service displays include racks, shelf and kiosks where customers have access to tobacco without the assistance of a store employee. They are so commonplace that most people hardly even notice them; yet they present a clear and present danger to children. Not only do these self-service displays enable shoplifting; stores that allow self-service are more likely to sell tobacco to underage youth. 7
 

• Self-service displays should be eliminated.

• Tobacco must be kept out of the reach of children.

Policy Approach

A ban on self-service displays is a necessary step within the youth access enforcement component of a comprehensive approach to tobacco control. 8  The removal of self-service displays serves two important purposes: it closes an avenue for violations of existing laws against the provision of tobacco to minors, 9  and it is a visible means of demonstrating that the community recognizes the hazardous nature of tobacco. A survey of Oregonians found almost unanimous agreement that it is important for communities to keep stores from selling tobacco to minors. 10  As the Institute of Medicine noted ‘‘placing the products out of reach reinforces the message that tobacco products are not in the same class as candy or potato chips.’’ 11

While some retailers have voluntarily removed self-service tobacco displays, it is unrealistic to expect voluntary efforts to eliminate all such displays. The most efficient and effective way to eliminate self-service tobacco displays is by regulation. As part of its overall regulatory response to the problem of children and tobacco, the US Food and Drug Administration proposed a national ban of self-service tobacco displays, but the regulations were put on hold before finally being overturned by the US Supreme Court. 12  The Oregon State Legislature does not convene in 2000, and recently it has proven a difficult venue in which to pass tobacco control legislation. 13  In contrast to the difficulties experienced at the state and national level, many local communities and counties have successfully implemented self-service tobacco display bans. 14  The Multnomah County Board of County Commissioners recently demonstrated its interest in tobacco control by enacting a ban on smoking in most indoors workplaces and public facilities. 15  Therefore, an achievable goal would be an ordinance banning self-service tobacco displays in retail establishments open to minors in Multnomah County, Oregon.

Self-service display bans are effective on several levels. In the first place, they clearly remove the opportunity for shoplifting. One Colorado store that had been losing 300 packs of cigarettes per month reported that thefts virtually ceased once the self-service displays were removed. 16  There is an additional benefit beyond that obvious consequence; requiring clerk assistance raises an additional barrier to illegal tobacco sales. Indeed, in practice communities that ban self-service displays report a sharp drop in the rate of tobacco sales to minors. In Santa Barbara County, California stores with self-service displays were ten times as likely to sell tobacco to minors. In compliance checks in three communities, the only one where kids couldn’t buy cigarettes was Carpinteria, which had banned self-service displays. 17  In Larimer County, Colorado, more than a third of minors successfully bought cigarettes in compliance checks before self-service displays were banned. Shortly after the ban, the rate of successful undercover buys dropped to 14%. A year later, less than 6% of stores sold tobacco to underage youth. 18

The evidence that reducing the availability of tobacco from retail outlets ultimately affects youth smoking rates is mixed. 19  However, some communities that have used comprehensive programs to reduce youth access to tobacco to very low levels have seen a decline in the proportion of youth that smoke cigarettes. In Woodridge, Illinois, two years after the passage of a comprehensive program to reduce sales to youth, the proportion of regular smokers in 7^th and 8^th grades dropped from 16% to 5%. A comparison of the effects of varying youth access enforcement actions in neighboring communities (that all sent their students to the same high school) found that after seven years, high school smoking rates were 8.1% in communities with regular enforcement versus 15.5% in communities without regular enforcement. 20  A randomized study of youth access prevention measures in 14 communities in Minnesota reported a 28% reduction in the prevalence of daily smoking by adolescents in communities implementing the active intervention program, which was considerably larger than the declines seen in those communities which did not receive the study intervention. 21

The experience of these pioneering communities demonstrates that banning self-service tobacco displays is legal, affordable and practical. Enforcement of the ban would be driven by citizen complaints; therefore, it would not require any new bureaucracy and the expense of enforcement would be minimal.

In other communities, retailers and retail associations (often backed by tobacco industry funding) have argued against the bans. 22  Retailers point out that they are paid fees by the tobacco companies to place cigarettes in prominent self-service displays, and that removing the displays may mean forgoing the promotional payments. 23  However, a ban that removes the displays and associated payments from all retailers countywide actually enhances fair competition. Requiring that customers ask a clerk for cigarettes is not a significant burden on adult smokers, and it makes it easier for clerks to monitor purchases and prevent sales to underage youth. While recognizing the viewpoint of retailers, the interests of youth must be protected; allowing the continued temptation of self-service displays is simply not fair to youth.

The experiences of other communities demonstrate that ban self-service displays is legal, practical and effective. Although it may not curtail youth smoking by itself, such an ordinance is a simple step that is an integral part of a comprehensive approach to tobacco control. Removing self-service displays reinforces the message that tobacco is a hazardous product.

Media Advocacy Plan

Summary

Our overall goal is to reduce youth use of tobacco. A long-term, comprehensive program is necessary to reduce youth tobacco use. One element of a successful program is restricting youth access to tobacco. Our policy approach is a ban on self-service tobacco. The main outcome objectives for this policy are to reduce shoplifting of tobacco by youth and to reduce illegal sales to youth. Another benefit of a self-service tobacco ban is that it indicates to the youth and the community as a whole that tobacco is a dangerous product that should be regulated and kept out of the reach of children.
 

Media Frames

One of the current frames used for tobacco issues is ‘tobacco prevention must be aimed at youth.’ Use of this frame helps our cause because the main argument for a self-service tobacco ban is prevention of youth tobacco use. Another frame used is ‘youth need tobacco prevention education’. This frame does not help because it implies that the solution is educating each youth about tobacco and not advancing policies or changing community norms.

Looking at the specific issue of youth access to tobacco, the current frame is often ‘stores sell tobacco to minors in violation of the law’. Stories with this frame rarely talk about changing laws or enforcement patterns as a solution to the problem. The issue of self-service tobacco rarely gets any media attention. (See Appendix A for examples of recent media coverage of youth tobacco issues.)

We will emphasize two frames in our campaign for a self-service tobacco ban. The first frame is ‘keep tobacco out of the reach of children’. This frame says we are trying to protect children from tobacco and responsible adults (e.g., policy makers and store owners) need to take action. The second frame is ‘banning self-service tobacco is simple, effective, and inexpensive’. It is essential that the media focus on our policy solution. The concept of a self-service tobacco ban is easy to understand. Experience in other jurisdictions has shown that a self-service tobacco ban is effective: theft of cigarettes and illegal sales to minors both decrease. And, the self-service tobacco ban is inexpensive, both for the store owners who will remove the displays and the government that has to enforce the law.

Media Actions and Events

Our media advocacy plan includes eight separate actions or events. After each event, we will assess: 1) did we get the media coverage we needed, 2) were we effective at disseminating the desired message, 3) what can we learn to improve our presentation next time. Subsequent events in our plan may change depending upon the evaluation of each event.

1. Initial Event

The initial media event will take place at a Circle K convenience store in Southeast Portland where management is eliminating their self-service tobacco displays. We will send out a press advisory (see Press Packet material) to the local media, television, radio stations, and newspapers. The advisory will include information about the newsworthiness of the event: event is youth led, youth are present for interviews, excellent video opportunities (award presentation, youth moving cigarettes and throwing out old self service displays), and a call for political action.

Cleveland High School students will present an award of appreciation to the Circle K manger and will physically assist in the transfer of the cigarettes to a behind the counter display. Cleveland students will be available for media interviews. During interviews students will state that it is too easy for children to get cigarettes. Although they appreciate that Circle K made this transition, the only practical way to eliminate self serve tobacco is through legislation. They will stress the need for a countywide policy change to eliminate self-service tobacco. Students will stress that this is a practical and simple approach to solving such an unnecessary problem. A media bite that will be used in this and most other events is ‘tobacco should be kept out of the reach of children’.

2. Calls for Action

Immediately following the Circle K press event, we will use the media to call for action by local officials. Allies and supporters will contribute letters to the editor and op-ed pieces to The Oregonian. We will try to get radio and television talk shows to discuss the issue of self-service tobacco. Media coverage of the Initial Event at Circle K will increase the likelihood that the media will cover our calls for action.

The call for action will press for the local officials to hold community meetings to allow for citizen input on the issue of a self-service tobacco ban. This strategy was successful with local officials during the recent smokefree workplace campaign. A media bite to use here and in the future will be ‘the self-service tobacco ban is simple, effective and inexpensive.’

3. Industry Exposé

We want to make the public and local officials aware that tobacco companies pay stores to use self-service tobacco displays. The kickbacks to stores for having self-service displays should stir up interest in the proposed ordinance. The media can use this as an opportunity to recap the tobacco industry’s history of marketing to youth. Media stories on this issue will help us use the frame ‘the tobacco industry is the enemy’. The tobacco control movement has used this frame effectively in recent years to promote tobacco prevention. The media message is that the tobacco industry pays stores to have self-service tobacco, knowing that self-service tobacco increases the opportunity for shoplifting. The tobacco industry payments to stores help compensate for the cigarettes lost to shoplifting. A media bite we will use is ‘this is just another method the tobacco industry uses to hook our kids on tobacco.’ We will target Willamette Week for this story because we feel that this is an angle on the problem that the Willamette Week would appreciate.

4. Release of Retailer Survey Results

The Multnomah County Tobacco Prevention Coalition will conduct a retailer survey regarding youth access issues and self-service tobacco displays in particular. If the results are similar to the 1998 survey that the coalition conducted, we will find that 97% of stores sell tobacco and about 50% of stores have self-service tobacco. A new comprehensive survey of retailers may not be feasible. In that case, we can do something as minimal as in-person checks at stores for self-service displays. So, the news hook could be that ‘50% of stores still have self-service tobacco’, but we could still use data from the 1998 survey as well.

We will release the results of the survey at a press conference at a store where the owner has recently stopped self-service tobacco and is in support of the ordinance. We will use anonymous quotes from the surveys indicating that stores are given discounts from the distributor if they have self-service tobacco. We will argue that a ban on self-service tobacco is necessary and fair - it is unfair for some stores to get tobacco industry payments for having self-service tobacco when other stores have done the right thing and eliminated self-service tobacco. We will continue to call for action by local officials.
   
5. Meet with Editorial Boards

Once local officials take up the issue of a self-service tobacco ban, it will be important to get prominent voices to express their support for the ordinance. Our goal would be to have The Oregonian and the Willamette Week write editorials in support of the proposed ordinance. We would request a meeting with the Editorial Board of The Oregonian and with the Editor of Willamette Week to present our arguments about why local officials should pass a self-service tobacco ban.

6. Public Testimony and Vote on Ordinance

The announcement of a public hearing or vote is a ‘hook’ for us to get more news coverage and to further disseminate our message. We also want to publicize the hearing and vote to get the supportive public to the meetings and show widespread community support. A public hearing is likely to be covered by the media and it will be important to orchestrate our supporters’ testimony to emphasize our main arguments and the policy solution. Social math that can be used is "The annual medical costs for treating tobacco-related illnesses in Multnomah County is $160 million dollars. That’s twice the Heath Department budget!"

7. Announcing the Effective Date of the Ordinance

Passing the ordinance is not the last step of our policy approach. We want to make sure that the ordinance is enforced, and that enforcement is not a big problem for the retailers or the County government. The self-service tobacco ordinance is just one of many steps that needs to be taken to reduce youth access to tobacco and youth smoking and we want to make sure policy makers will be receptive when we come back to advocate for other policies.

The day before the ordinance goes into effect, we will have a press event. We will find a store owner who previously had self-service tobacco, but now supports the ordinance and is happy to comply with the ordinance because "It is the right thing to do for our kids, and it’s easy to do". We will ask one or two of the local officials who voted in favor of the ban to be a part of the press event and get some good anti-tobacco publicity for themselves.

One media message will be that it is great to say good-bye to self-service tobacco. We will say that the law is simple and we expect compliance to be swift and easy. We will include info on how the ordinance will be enforced, including phone numbers that the public can call to report violators.

Some of the youth who helped pass the ordinance will be trained on assisting in the enforcement. We will have a video camera tape some of their experience in stores, and this tape can be used in the next press event. We will keep track of data on compliance: calls to the County enforcement agency and follow-up; and our own data collection on store compliance. There are two options for the last planned event, depending upon overall compliance with the ordinance.

8a. Compliance is (Nearly) 100%

A few months after the effective date of the ordinance, we hope that compliance is nearly 100%, if not 100%. If compliance is around 100%, we will have a very positive news conference. We would invite local officials and our biggest supporters to publicly thank them and the store owners for complying with the ordinance. One media goal is to have our supporters feel good because they were positively portrayed in the media. Another media goal is to show the public and local officials that implementation of the ordinance was easy and painless. We would hope to use some of the videotape shot by youth who helped enforce the ordinance. We will have a visual showing the number of self-service tobacco displays going from about 50% before the ordinance to essentially zero now.

8b. Compliance is not 100%

If compliance is not 100%, the objective of the news event would include increasing compliance with the ordinance. We would need to know why compliance is not 100%. If the problem is no effective follow-up of phone calls to the enforcement agency, we might work with the supportive local officials to put pressure on the agency and not use the media at first. If the problem is particular stores refusing to comply, the news event might be used to shame the few remaining stores into compliance. In this case, the press event could be held at one of the non-complying stores.

When we are eventually able to get 100% compliance, we will have the press event similar to that outlined in 8a above.

Other News Pegs

Local and national tobacco-related events will provide opportunities for us to tie-in the issue of self-service tobacco. Annual events include Kick Butts Day (April), World No Tobacco Day (May), release of Oregon’s Synar compliance check data (summer), and the Great American Smokeout (November). One-time events we can anticipate in the near future include the Supreme Court ruling on the FDA’s authority to regulate tobacco and the vote on the Central Point, Oregon, referendum that includes a ban on self-service tobacco.

¹ CDC. Smoking-attributable mortality and years of potential life lost-United States, 1984. MMWR 1997;46:444–51.

³ Congressional Budget Office estimated Clinton proposal for a Medicare drug benefit would cost $111 billion over 10 years. The Clinton administration estimated the cost at $45.5 billion over 10 years (reported in the Washington Post, 7/23/1999).

⁴ Oregon Health Division, Oregon Department of Human Services, Oregon Tobacco Facts, April 1999.

⁵ http://www.cdc.gov/tobacco/initfact.htm
 (This document is no longer available online. The following documents contain similar data and findings:  http://www.cdc.gov/nchs/data/ad/ad224.pdf
http://www.cdc.gov/tobacco/quit_smoking/cessation/00_pdfs/Youth_Tobacco_Cessation.pdf

⁶ Pierce JP, Gilpin E. How long will today’s new adolescent smoker be addicted to cigarettes? American Journal of Public Health. 1996. 86;253-256.

⁷ Institute of Medicine, ‘‘Growing up Tobacco Free: Preventing Nicotine Addiction in Children and Youths,’’ 1994.

⁸ Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—August 1999. Atlanta GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, August 1999.

⁹ Jacobsen P, Wasserman J. The implementation and enforcement of tobacco control laws: Policy implications for activists and the industry. Journal of Health Politics. 1999. 24(3);588-

¹⁰ 97% of survey respondents agreed with the statement. Oregon Health Division, Oregon Department of Human Services, Oregon Tobacco Facts, April 1999.

¹¹ Institute of Medicine, ‘‘Growing up Tobacco Free: Preventing Nicotine Addiction in Children and Youths,’’ 1994.

¹² FDA Talk Paper T97-40. Issued August 27, 1997. http://www.fda.gov/bbs/topics/ANSWERS/ANS00816.html
Read a syllabus of the US Supreme Court decision released on March 21, 2000: http://supct.law.cornell.edu/supct/html/98-1152.ZS.html
Read the majority opinion: http://supct.law.cornell.edu/supct/html/98-1152.ZO.html
Read the dissenting opinion: http://supct.law.cornell.edu/supct/html/98-1152.ZD.html
   
¹³ Holtz AS, Mosbaek C. Oregon’s Measure 44 – A Public Health Initiative. 1999. https://holtzreport.com/ORTobTax.htm

¹⁴ In Oregon, Corvallis (see Seattle Post - Intelligencer; Seattle, Wash.; Jan 2, 1998; p. B3) and Pendleton (City of Pendleton Ordinance No. 3618) are among communities that have banned self-service displays. Larimer County, Colorado health officials recently reported on the passage and beneficial effects of their tobacco ordinances that eliminated self-service displays. See Watson A, Grove N. Larimer County Tobacco and Youth Project. American Journal of Public Health. 1999. 89(4);597-8.

¹⁵ The Oregonian. December 10, 1999.

¹⁶ American Lung Association of Colorado. "Big Tobacco's Seldom Told Plan For Our Children" regarding Stop 'N Save, Clifton, CO. Retrieved 2/13/2000 from http://www.smokescreen.org/alac/Page16.html

¹⁷ Bidell MP, Furlong MJ, Dunn DM, Koegler JE. Case study of attempts to enact self-service tobacco display ordinances: a tale of three communities. Tobacco Control. 2000. 9;71-77.

¹⁸ Watson A, Grove N. Larimer County Tobacco and Youth Project. American Journal of Public Health. 1999. 89(4);597-8.

¹⁹ Rigotti NA, DiFranza JR, Chang YC, Tisdale T, Kemp B, Singer DE. The effect of enforcing tobacco sales laws on adolescents' access to tobacco and smoking behavior. New England Journal of Medicine. 1997. 337:1044-1051.

²⁰ Jason L, Berk M, Schnopp-Wyatt D, Talbol B. Effects of enforcement of youth access laws on smoking prevalence. American Journal of Community Psychology. 1999. 27(2);p143-

²¹ Forster JL, Murray DM, Wolfson M, et al. The effects of community policies to reduce youth access to tobacco. American Journal of Public Health 1998. 88(8);1193-8.

²² Watson A, Grove N. Larimer County Tobacco and Youth Project. American Journal of Public Health. 1999. 89(4);597-8.

²³ Tobacco Documents Online. Roswell Youth and Marketing collection. http://www.tobaccodocuments.org/export.cfm?bibID=91503