Todd Combs

Standardized Tobacco Assessment for Retail Settings (STARS): dissemination and implementation research

Objective The Standardized Tobacco Assessment for Retail Settings (STARS) was designed to characterise the availability, placement, promotion and price of tobacco products, with items chosen for relevance to regulating the retail tobacco environment. This study describes the process to develop the STARS instrument and protocol employed by a collaboration of US government agencies, US state tobacco control programmes (TCPs), advocacy organisations, public health attorneys and researchers from the National Cancer Institutes State and Community Tobacco Control (SCTC) Research Initiative. Methods To evaluate dissemination and early implementation experiences, we conducted telephone surveys with state TCP leaders (n=50, response rate=100%), and with individuals recruited via a STARS download registry on the SCTC website. Website registrants were surveyed within 6 months of the STARS release (n=105, response rate=66%) and again after ∼5 months (retention rate=62%). Results Among the state TCPs, 42 reported conducting any retail marketing surveillance, with actual or planned STARS use in 34 of these states and in 12 of the 17 states where marketing surveillance was not previously reported. Within 6 months of the STARS release, 21% of surveyed registrants reported using STARS and 35% were likely/very likely to use it in the next 6 months. To investigate implementation fidelity, we compared data collected by self-trained volunteers and by trained professionals, the latter method being more typically in retail marketing surveillance studies. Results suggest high or moderate reliability for most STARS measures. Conclusion The study concludes with examples of states that used STARS to inform policy change.

Tobacco retail policy landscape: a longitudinal survey of US states

Background There are ∼380 000 tobacco retailers in the USA, where the largest tobacco companies spend almost

Success in the city: the road to implementation of Tobacco 21 and Sensible Tobacco Enforcement in New York City

9 billion a year to promote their products. No systematic survey has been conducted of state-level activities to regulate the retail environment, thus little is known about what policies are being planned, proposed or implemented. Methods This longitudinal study is the first US survey of state tobacco control programmes (TCPs) about retail policy activities. Surveyed in 2012 and 2014, programme managers (n=46) reported activities in multiple domains: e-cigarettes, retailer density and licensing, non-tax price increases, product placement, advertising and promotion, health warnings and other approaches. Policy activities were reported in one of five levels: no formal activity, planning or advocating, policy was proposed, policy was enacted or policy was implemented. Overall and domain-specific activity scores were calculated for each state. Results The average retail policy activity almost doubled between 2012 and 2014. States with the largest increase in scores included: Minnesota, which established a fee-based tobacco retail licensing system and banned self-service for e-cigarettes and all other tobacco products (OTP); Oregon, Kansas and Maine, all of which banned self-service for OTP; and West Virginia, which banned some types of flavoured OTP. Conclusions Retail policy activities in US states increased dramatically in a short time. Given what is known about the impact of the retail environment on tobacco use by youth and adults, state and local TCPs may want diversify policy priorities by implementing retail policies alongside tax and smoke-free air laws.

CHANGES IN RELIGIOUS ECOLOGY AND SOCIOECONOMIC CORRELATES FOR NEIGHBORHOODS IN A METROPOLITAN REGION

New York City, a leader in municipal tobacco control in the USA, furthered its goal of reducing the communitys burden of tobacco use in 2014 by implementing Sensible Tobacco Enforcement and Tobacco 21. These policies are intended to restrict youth access and eliminate sources of cheap tobacco. Strong partnerships, substantial local data and support from the public and elected officials were key in overcoming many challenges and ensuring these policies were signed into law.

Tobacco Town: Computational Modeling of Policy Options to Reduce Tobacco Retailer Density

ABSTRACT: Economic and social forces have altered the landscape for religious institutions in many postindustrial cities, with potentially serious implications for communities that ostensibly stand to benefit from their presence. In recent decades, changes in neighborhood racial composition and out-migration to distant suburbs have divested many urban communities of once-vibrant social institutions, among them places of worship. This article undertakes an empirical approach to examine the socioeconomic correlates of church closures in neighborhoods in a Midwestern U.S. metropolitan area. Utilizing an index of nine measures of social and economic viability, the study found that the type of congregational closure is significantly related to viability outcomes. In particular, the closure of geographically based congregations and those characterized by bridging social capital were significantly related to declines in neighborhood viability. Theoretical concepts from religious ecology, place attachment, and social capital/civic engagement structure the analysis.

The Translational Science Benefits Model: A New Framework for Assessing the Health and Societal Benefits of Clinical and Translational Sciences

Objectives To identify the behavioral mechanisms and effects of tobacco control policies designed to reduce tobacco retailer density. Methods We developed the Tobacco Town agent-based simulation model to examine 4 types of retailer reduction policies: (1) random retailer reduction, (2) restriction by type of retailer, (3) limiting proximity of retailers to schools, and (4) limiting proximity of retailers to each other. The model examined the effects of these policies alone and in combination across 4 different types of towns, defined by 2 levels of population density (urban vs suburban) and 2 levels of income (higher vs lower). Results Model results indicated that reduction of retailer density has the potential to decrease accessibility of tobacco products by driving up search and purchase costs. Policy effects varied by town type: proximity policies worked better in dense, urban towns whereas retailer type and random retailer reduction worked better in less-dense, suburban settings. Conclusions Comprehensive retailer density reduction policies have excellent potential to reduce the public health burden of tobacco use in communities.

Use of reproducible research practices in public health: A survey of public health analysts

We report the development of the Translational Science Benefits Model (TSBM), a framework designed to support institutional assessment of clinical and translational research outcomes to measure clinical and community health impacts beyond bibliometric measures. The TSBM includes 30 specific and potentially measurable indicators that reflect benefits that accrue from clinical and translational science research such as products, system characteristics, or activities. Development of the TSBM was based on literature review, a modified Delphi method, and in‐house expert panel feedback. Three case studies illustrate the feasibility and face validity of the TSBM for identification of clinical and community health impacts that result from translational science activities. Future plans for the TSBM include further pilot testing and a resource library that will be freely available for evaluators, translational scientists, and academic institutions who wish to implement the TSBM framework in their own evaluation efforts.

Developing an evidence-based program sustainability training curriculum: a group randomized, multi-phase approach

Objective Use of reproducible research practices improves the quality of science and the speed of scientific development. We sought to understand use of reproducible research practices in public health and associated barriers and facilitators. Methods In late 2017, we surveyed members of the American Public Health Association Applied Public Health Statistics section and others; 247 of 278 who screened eligible answered the survey, and 209 answered every applicable question. The survey included questions about file management, code annotation and documentation, reproducibility of analyses, and facilitators and barriers of using reproducible practices. Results Just 14.4% of participants had shared code, data, or both. Many participants reported their data (33%) and code (43.2%) would be difficult for colleagues to find if they left their institution. Top reported barriers to using reproducible practices were data privacy (49.8%) and lack of time (41.7%). Participants suggested training (50.9%) and requirements by journals (44.4%) and funders (40.2%) to increase use of reproducible research practices. Conclusions Increasing use of reproducible research practices is important for public health and requires action from researchers, training programs, funders, and journals.

Evaluation of Measurement Tools for Tobacco Product Displays: Is there an App for that?

BackgroundThe emergence of dissemination and implementation (D&I) science has driven a rapid increase in studies of how new scientific discoveries are translated and developed into evidence-based programs and policies. However, D&I science has paid much less attention to what happens to programs once they have been implemented. Public health programs can only deliver benefits if they reach maturity and sustain activities over time. In order to achieve the full benefits of significant investment in public health research and program development, there must be an understanding of the factors that relate to sustainability to inform development of tools and trainings to support strategic long-term program sustainability. Tobacco control programs, specifically, vary in their abilities to support and sustain themselves over time. As of 2018, most states still do not meet the CDC-recommended level for funding their TC program, allowing tobacco use to remain the leading cause of preventable disease and death in the USA. The purpose of this study is to empirically develop, test, and disseminate training programs to improve the sustainability of evidence-based state tobacco control programs and thus, tobacco-related health outcomes.MethodsThis paper describes the methods of a group randomized, multi-phase study that evaluates the empirically developed “Program Sustainability Action Planning Training” and technical assistance in US state-level tobacco control programs. Phase 1 includes developing the sustainability action planning training curriculum and technical assistance protocol and developing measures to assess long-term program sustainability. Phase 2 includes a group randomized trial to test the effectiveness of the training and technical assistance in improving sustainability outcomes in 24 state tobacco control programs (12 intervention, 12 comparison). Phase 3 includes the active dissemination of final training curricula materials to a broader public health audience.DiscussionEmpirical evidence has established that program sustainability can improve through training and technical assistance; however, to our knowledge, no evidence-based sustainability training curriculum program exists. Therefore, systematic methods are needed to develop, test, and disseminate a training that improves the sustainability of evidence-based programs.Trial registrationNCT03598114. Registered 25 July 2018—retrospectively registered.

Implementation Science in Retail Tobacco Control Policy

Tobacco product displays are a pervasive presence in convenience stores, supermarkets, pharmacies, and other retailers nationwide. The influence that tobacco product displays have on purchases and tobacco product initiation, particularly on young people and other vulnerable populations, is well known. An objective measurement tool that is valid, reliable, and feasible to use is needed to assess product displays in the retail setting. This study reports on the relative accuracy of various tools that measure area and/or distance in photos and thus could be applied to product displays. We compare results of repeated trials using five tools. Three tools are smartphone apps that measure objects in photos taken on the device; these are narrowed down from a list of 284 candidate apps. Another tool uses photos taken with any device and calculates relative area via a built-in function in the Microsoft Office Suite. The fifth uses photos taken with the Narrative Clip, a “life-logging” wearable camera. To evaluate validity and reliability, we assess each instruments measurements and calculate intra-class correlation coefficients. Mean differences between observed measurements (via tape measure) and those from the five tools range from just over one square foot to just over two square feet. Most instruments produce reliable estimates though some are sensitive to the size of the display. Results of this study indicate need for future research to test innovative measurement tools. This paper also solicits further discussion on how best to transform anecdotal knowledge of product displays as targeted and disproportionate marketing tactics into a scientific evidence base for public policy change.