Tobacco and Alcohol Environmental Scan

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A map of the area where the environmental scan occurred. Blue pins denote retail stores. Red pins denote schools.

Observations from a Community Tobacco and Alcohol Environmental Scan: Advertisement and Sale Practices in the Upper Valley of New Hampshire

This article was written by Bryan L’Heureux, MPH Candidate, University of New England, describing the study he conducted on behalf of ALL Together in the Fall of 2017.  Full Environmental Scan Report.

Background and Methods

There exists an interconnectedness between our environment and our health. In many cases, things that we are exposed to every day, such as the air we breathe or the water we drink, can directly affect our health. However, our environment can also influence decisions we make and the behaviors we participate in, which can then indirectly effect our health. This type of environmental influence sometimes occurs through the sale and advertisement practices we are exposed to within our communities and surroundings. With stricter restrictions on the ways tobacco companies are allowed to advertise via radio and television, it is not surprising that over 92% of tobacco advertising occurs at the point-of-sale within the retail environment1. That being said, one of the most vulnerable populations to advertisements are our youth and adolescents, who, conveniently, are also potential new customers in the eyes of tobacco manufacturers2. Keeping that in mind, when looking at retail density as it relates to the location of schools within the population of interest, the Upper Valley of New Hampshire, it is curious to note that there are clusters of retailers selling and advertising tobacco and alcohol in these areas. For this reason, in an effort to decrease tobacco initiation and alcohol misuse, it very important to be aware of practices used within our community that can influence behaviors related to negative health outcomes, such as tobacco initiation and alcohol misuse.

Conducting an Environmental Scan

In an effort to become more aware of the sale and advertisement practices used to sell tobacco and alcohol in the Upper Valley region of New Hampshire, I conducted an environmental scan of retailers in the community with the support of Upper Valley ALL Together and Dartmouth-Hitchcock. ALL Together, which is the Substance Misuse workgroup of the Public Health Council of the Upper Valley, is a community resource for prevention, intervention, treatment, recovery, and advocacy around substance misuse and suicide prevention. The goal of this scan was to identify practices that have the potential to influence initiation of tobacco use and/or alcohol misuse in an effort to make a collective change toward heathier advertisement and sale methods in our community’s retail environment.

The environmental scan itself consisted of a survey meant to identify risk factors as well as protective factors for tobacco and alcohol initiation as they pertain to advertisements at the retail level. For the purposes of this scan, only retailers on the New Hampshire side of the Upper Valley were observed. This scan consisted of nine towns; Lebanon, West Lebanon, Hanover, Canaan, Enfield, Grantham, Orford, Piermont, and Plainfield. I spent approximately 5-10 minutes in each retailer, simply making observations pertaining to location and types of products/advertisements in

each store. For example, in each store I tried to observe if there was tobacco on counters, near candy, toys or energy drinks, if there is alcohol in the same cooler as non-alcoholic beverages, if there are advertisements with cartoons or celebrities, if there are themed displays, or if alcohol is displayed with items that would promote binge drinking. In all, forty-five stores were observed, providing meaningful data about the environment of tobacco and alcohol advertisements/sales in the Upper Valley.

Snapshot of the Region: Alcohol

Through the observations made during the survey, it is clear there are a number of things our community is doing right in terms of selling and advertising alcohol. For example, out of the stores that sold alcohol (n=41, 91%), 59% of those stores kept alcoholic beverages either in a different cooler or out of eyesight from the non-alcoholic beverages. With only 41% of the stores keeping alcohol in the same cooler as non-alcoholic beverages, it is clear that while there is some room for improvement, our community is doing relatively well in this area. Furthermore, in terms of

An alcoholic beverages case with ping pong balls hanging on the door.

advertising these products, only 7.3% of the stores sold items that promote drinking games/binge drinking (such as red solo cups and ping pong balls) with alcoholic beverages. A number of stores did however have displays for alcoholic beverages that could be confused as non-alcoholic or utilized themed displays in their advertisement practices (31.7% and 19.5%, respectively). Working with these retailers to make small changes in these areas would be small changes that may have a large impact on the way youth perceive alcohol and the culture around drinking in general.

Snapshot of the Region: Tobacco

In the Upper Valley, of the stores surveyed, 90% (n=40) sell tobacco. The chart below delves into the various types of tobacco that are sold in the region, however, it does not distinguish between the various types of smokeless tobacco, such as snuff, snus, chew etc. due to the similar appearance in the products making it difficult to differentiate between the products when completing the scan.

A number of things are important to point out in terms of the placement of tobacco products in the retail environment as well. For the most part, tobacco products were kept out of reach from the customer, behind the point-of-sale (48%). However, there were also a number of instances where tobacco products and/or advertisements were placed near candy, toys, or energy drinks (17%), or were placed on counters, within reach of the customer (35%). This is an area that can easily be targeted for improvement; store owners can easily and cost effectively change the placement of these products to promote a healthier environment and help mitigate normalcy of these tobacco products for our youth.

Finally, a number of different, common, advertising practices for tobacco products can be observed in the Upper Valley. Cross promotions (a discount/promotional effort meant to get individuals to try different types of tobacco) were seen in 10% of the stores. More commonly were price promotions in general (77%); these advertisements offer a “special price” or utilize mobile coupons. Placement of tobacco advertisements is also an area of concern; as was mentioned above, ensuring that advertisements are not placed in the faces of our youth is important in prevention efforts. 27.5% of the stores in our community place advertisements at or below three feet, showing that while many stores are following good practice, there is still room for improvement. Furthermore, 35% of the stores that sold tobacco had advertisements for these products, including cigarettes, smokeless tobacco, and e-cigarettes, from the road.

Advocating for a Healthier Retail Environment

After collecting this information, I sent a letter specific to each store celebrating what they were doing well, as well as giving them some tips and tricks for ways that they could change the environment of their store to promote a healthier community. This letter called for collective action and change, rather than placing the burden on any one retailer or individual. The hope was that framing the letter in this way would allow the retailers to feel empowered to have a positive effect on the health of the community that they live and do business in.

As a community, we can advocate for limiting retail tobacco/alcohol advertisements, both inside retail stores and at the point-of-sale, as well as advertisements that are visible from the road. Furthermore, we can work with retailers to promote practices, such as keeping these products away from items that are geared toward children and adolescents, such as candy and energy drinks.

Making these small changes can have a large impact on the overall environment of our community and the perceived culture around these products, showing that as a whole, we value healthy decisions and want to do what we can to help young people make the decision not to use tobacco or misuse alcohol.

References:

  1. https://www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2012/150327-2012cigaretterpt.pdf
  2. https://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/index.html

UV Adaptation Workgroup Sets Strategic Direction

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Flood waters from Hurricane Irene left behind fuel spills and other hazards.

In September 2017, the Upper Valley Adaptation Workgroup (UVAW) released a new strategic plan outlining four goals for this bi-state, multi-stakeholder working group of leaders and partner organizations working to build climate resilient communities in the Upper Valley. Goals include:

  1. Be a greater public educational force on climate change impacts.
  2. Serve as a hub to convene stakeholders, build relationships and develop new partnerships for coordinated action around climate change impacts in the region.
  3. Be a resource and support partner for community projects that increase resilience to climate change impacts.
  4. Build UVAW’s organizational sustainability, leadership, and governance structure.

In 2011, UVAW formed as a bi-state volunteer group of community leaders and organizations in the wake of Tropical Storm Irene.  We saw that many groups were working on mitigation to slow the pace of climate change – but no group was working on adaptation to prepare for changes we know are inevitable, and are already happening.

Building the “Playbook”

Downed power lines shows need for adaption to climate change.Shared learning and co-production of knowledge is the only way our communities will be able to adapt to unprecedented change – change we are just beginning to experience, and for which no “playbook” exists.  A regional approach is essential. UVAW is the only region-wide entity dedicated to helping community leaders find out what each other is doing in the field of resilience, get ideas, and generate creative collaboration.

This is our second strategic plan. It reflects continuity in growth through the plan developed in 2013 and six years of experience with numerous regional forums and engagement processes.  For this plan, we reached out broadly to invite regional leaders to help us flesh out our thinking.

We extend a gracious thanks to the 24 internal and external stakeholders from Vermont and New Hampshire who provided valuable input. We asked them about UVAW’s contributions, opportunities, and emerging context in the field of climate resilience across the bi-state region.  Their insights contributed to our thought process as we developed our plan. The depth and breadth of information they gave us will guide us moving forward in extending our hand in partnership and in supporting each other’s initiatives.  Contributors included:

  • Meghan Butts, Upper Valley Lake Sunapee Regional Planning Commission
  • Matt Cahillane, NH Department of Health and Human Services
  • Leigh Cameron, New England Grassroots Environmental Fund (NEGEF)
  • Anne Duncan Cooley, Upper Valley Housing Coalition (through winter 2017))
  • Alice Ely, Public Health Council of the Upper Valley
  • Kevin Geiger, Two Rivers Ottauquechee Regional Commission
  • Beth Gibbons, Institute for Sustainable Communities & the American Society of Adaptation Professionals (ASAP)
  • Sherry Godlewski, NH Department of Environmental Services
  • Anne Goodrich, Upper Valley Strong & Pathways Consulting
  • Mark Goodwin, City of Lebanon Planning Office
  • Lisa Graichen, UNH Cooperative Extension Climate Action Program and NH Sea Grant
  • Julia Griffin, Town of Hanover
  • Peg Elmer Hough and Mindy Blank, Community Resilience Organizations (CROs)
  • Alex Jaccaci, Hypertherm
  • Rosi Kerr, Dartmouth College Office of Sustainability
  • Kate McCarthy, Vermont Natural Resources Council (VNRC)
  • Sarah McKearnan, VT Agency of Natural Resources (through spring 2017)
  • Greg Norman, Office of Community Health, Dartmouth Hitchcock Medical Center
  • Erich Osterberg, Dartmouth College Dept. of Economics
  • Deb Perry, Institute for Sustainable Communities & the Resilient Vermont Project
  • Kevin Peterson, New Hampshire Charitable Foundation
  • Tom Roberts, Vital Communities
  • Beth Sawin, Climate Interactive
  • Michael Simpson, Center for Climate Preparedness and Community Resilience, Antioch New England Graduate School
  • Gaye Symington, High Meadows Fund

Stakeholders Shared Key Adaptation Messages

  1. As we continue to feel impacts from a changing climate, keeping climate adaptation on the front burner, nurturing cross-sector relationships, and engaging the business sector are all imperative. UVAW should continue our efforts in filling these needs in the Upper Valley.
  2. UVAW’s educational forums and community outreach efforts have been very successful and should be continued. Extending UVAW’s role in moving from education to action and bringing new partners to the table are important next steps – by sharing resources and success stories, joining in convening, and identifying the places where we can add unique value without duplicating the efforts of others.
  3. Communities need help – the problems are complex, resources are constrained, capacity is limited, and they cannot do it alone – nor can we. Focusing UVAW’s role on building multi-sector relationships will help translate knowledge and opportunities across geographic, sector, and issue boundaries, and break down silos that hinder the discovery of creative solutions and the development of political and community will to act.
  4. Since our founding six years ago, UVAW has had great success. As we grow and evolve in our community impact, it is also an important time to grow and evolve as an organizational so that we can sustain that work over the long-term.  Our governance and work processes, financial resources, leadership and membership growth, and infrastructure capacity will be part of our workplan as well.

We look forward to continuing conversations and partnerships with our stakeholders over the coming three years, as we implement our strategic goals and help to build the Upper Valley’s commitment to crucial resilience actions that will support community well-being the face of unprecedented change.

Submitted by Sherry Godlewski and Alex Jaccaci, UVAW Co-Chairs

PHC Elects Board Members at Annual Meeting

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Joanne Conroy MD/CEO speaks at PHC Annual Meeting

On November 17, the Public Health Council of the Upper Valley (PHC) Board of Directors held their annual meeting at Hypertherm with over 50 community members and public health advocates in attendance. Dr. Joanne Conroy, CEO and President of Dartmouth-Hitchcock was the guest speaker.  [Conroy Video Clip/Full Talk]

Carol Stamatakis, of Senior Solutions, asks Dr. Conroy a question.

During the business portion of the meeting, departing board member Mardee Laumann of Enfield, NH was recognized for her many contributions. Julia Griffin, Hanover Town Manager, was elected to her second term as PHC Board Chair.

The Board also welcomed new Directors Dan Fraser, Nicole LaBombard, and Laura Cody McNaughton. Dan is a well-known figure in the Upper Valley. He grew up in Norwich, where he now runs the family business, Dan & Whits, and serves on several local boards. Nicole, also an Upper Valley native, works as a Community Health Partnership Coordinator at Dartmouth-Hitchcock Community Health. Laura is the District Director for the Vermont Department of Health’s District Office in White River Junction.

Director’s Report

Alice Ely, Executive Director of the PHC, shared highlights of the PHC’s work over the past year in her annual Directors Report. In 2017, the PHC piloted an oral health screening project in New Hampshire communities. This pilot led to the expansion of the Ottauquechee Health Foundation’s Smiles Project to serve both sides of the Connecticut River.

The PHC also conducted an evaluation of several summer meals programs for school-aged children to better meet the needs of food insecure children and hosted a forum for school personnel and area service providers to better understand student needs and resources already available in the community.

Five flu clinics were also hosted by the PHC in rural communities across our region, providing over 1,100 vaccines.

As one of 13 regional health networks in New Hampshire, and serving 22 communities in Vermont, the PHC has quickly become the region’s largest and broadest coalition of advocates on public and population health issues. The PHC is a dynamic organization with the flexibility to respond to the needs of its grassroot members with financial support provided by individuals and governmental, philanthropic, and health care institutions.

APHA Annual Meeting: PHC Was There

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This November, two Public Health Council of the Upper Valley members and several individuals from the Health Promotion Research Center at Dartmouth (HPRCD) presented local work at the American Public Health Association (APHA) Annual Meeting in Atlanta, Georgia. The event, which took place from November 4th – 8th, centered on the overarching theme: Climate Changes Health. Throughout the conference, keynote speakers explored how our changing climate impacts human health both directly and indirectly, and how it creates and perpetuates health disparities across our country and the world. The APHA Meeting also includes sessions that cover many other public health topics. With nearly 12,000 people in attendance, the APHA Meeting allowed attendees to network with, learn from, and educate one another.

Tobacco and Electronic Nicotine Delivery Systems Use

Stephanie Kelly discussing ENDS use in NH youth with Dr. Stan Glantz, professor, tobacco researcher, and activist based at University of California, San Francisco.

Stephanie Kelly, of the HPRCD and PHC’s Oral Health Work Group, attended sessions on oral health and tobacco cessation efforts. Her poster presentation, titled “Tobacco and Electronic Nicotine Delivery Systems (ENDS) Use Among New Hampshire Youth, 2010-2015” discussed how New Hampshire youth’s patterns of e-cigarette use relate to national trends, and how prevalence of e-cigarette use varies by gender and high school grade level. Kelly’s poster was well received by other tobacco researchers, who drew connections between New Hampshire’s data and their own anecdotal experiences. [Stephanie’s Abstract]

 

 

APHA Members Learn About Rural Aging in Community Groups

Emma Hartswick, former PHC Fellow, presenting her work on rural aging in community groups.

Emma Hartswick, a former fellow at the PHC, also attended the conference to share a community listening project she conducted with Upper Valley residents. Her oral presentation, titled “Exploring Successes, Challenges and Next Steps for Rural Aging in Community Groups” featured the voices of local leaders who are working hard to help their neighbors retain their agency and autonomy as they age, despite the added challenges imposed by a rural environment.

When Hartswick began the project in the winter of 2015, her goals were to understand what services Aging in Community groups offered, how they provided them, and what the Public Health Council could do to support their important work. Looking back two years later, our community’s efforts to support older adults impressed people who attended the talk, and many supported our conclusion that large public health and clinical partners should turn to local organizations to set priorities and guide future work.

APHA Provides Exciting New Information

Now working as a Case Manager and Child Development Coordinator for Boston Health Care for the Homeless Program, Hartswick also attended sessions on mental health, substance use, social justice and maternal child health. “There was so much to learn! I’m really excited about the ideas and approaches I can take back to my team now.” Hartswick said she was struck by how interdisciplinary the conference was, with topic sessions often melding key themes from multiple areas.

Jam packed with posters, talks, booths, round tables and panels, the APHA Annual Meeting both sparked new questions and affirmed current ideas. “It was cool to see how many of our PHC priority areas were big topics of the Annual Meeting,” said Hartswick; “it made it feel like we’re heading in the right direction, on the cutting edge, but not alone.”

Flu Season: We Are Ready!

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Flu season is upon us and the Public Health Council of the Upper Valley wants to prevent the spread of this uncomfortable and sometimes fatal illness. Through five free flu vaccine clinics in communities throughout the Upper Valley, we recently provided over 1,100 free flu vaccines to youth and adults.

As with all Public Health Council initiatives, this was a collaborative effort. We want to thank our many partners. Dartmouth-Hitchcock generously donated all the regular and high dose vaccine given. Thirty-four students from the Geisel School of Medicine volunteered over 140 hours of time to administer the vaccines. The Public Health Council’s Medical Director, Bill Boyle, supervised the clinics. We are also grateful to current and former members of our Board of Directors who helped at the clinics. We also received critical support from Plainfield Caring Neighbors, Mascoma Community Health Center, Rivendell Academy students, HealthHUB School Clinic, Upper Valley Medical Reserve Corps, and Vermont Law School for staffing the clinics.

Most importantly, we want to thank the 1,100 people who came to get their flu shot for protecting themselves and their loved ones from this preventable illness.

Flu is deadly, but preventable

The flu results in approximately 12,000 to 56,000 deaths every year in the United States, according to estimates from the Centers for Disease Control and Prevention. In New Hampshire last year, there were 47 influenza-related deaths, including two pediatric deaths. The good news is that flu can largely be prevented with annual vaccines. If you missed one of our vaccine clinics, flu shots are still available from your primary care provider or at various local pharmacies.

The Public Health Council is dedicated to protecting and promoting the health our communities. Whether we are preventing illness, building innovative oral health programs, or expanding summer meals programs for children, we are always bringing people together to find solutions that work for our region. It is our pleasure to serve the Upper Valley.