36246 Counterbalance: A Rural Tobacco Point of Sale Intervention Using a Statewide Census of Vermont Tobacco Retailers

Rebecca Brookes, B.A., Division of Health Promotion and Disease Prevention, Vermont Department of Health, Burlington, VT


Consistent evidence shows that youth exposed to point of sale (POS) tobacco marketing are more likely to use tobacco. POS expenditures account for 95% of the industry’s total marketing budget. POS policies can address tobacco industry marketing to youth and young adults.

While residents of U.S. rural areas are more likely to smoke, use smokeless tobacco, smoke while pregnant, and be heavy smokers than urban dwellers, there is little evidence regarding effective rural POS interventions. Vermont is one of the most rural states; therefore, requires a revised strategy from POS interventions that are gaining momentum in urban areas.

Program background: 

In fall 2014, the Vermont Department of Health Tobacco Control Program (VDHTCP) launched the CounterBalance campaign to address youth exposure to tobacco POS. The campaign’s goals are to:

  • Raise public awareness, specifically among parents, about the impact of POS advertising on youth initiation.
  • Enable localities and community coalitions to create healthier retail environments through community design and policy change.
  • Lay the groundwork for statewide change in the retail environment

CounterBalance is a three-year campaign to increase awareness of POS tobacco advertising and support for environmental change. CounterBalance uses a combination of tobacco control strategies, including community mobilization, mass-media and digital health communication, surveillance, policy and regulatory activity, and strategic partnerships.

A critical part of this initiative is measuring and exposing the extent of tobacco POS marketing on Vermont’s youth.

Working with Counter Tools staff, Store Audit Team leads and staff from Community Coalitions, Youth Coalitions, and District Offices were trained on cloud-based store audit and mapping tools. Store Audit Teams completed 767 audits.


  • Low-income census tracts have nearly twice as many tobacco retailers per 1,000 residents as higher- income neighborhoods
  • In low-income census tracts, retailers are twice as likely to be located within 1,000 feet of a school or park.
  • Retailers within 1,000 feet of a school are more likely to offer discounts in nearly all product categories, especially cigarillos and smokeless products.
  • Retailers in Vermont’s most rural areas are more likely to be small markets, and therefore messages relating to convenience stores may not resonate.   

In May 2015, VDHTCP published data and findings on retailer audits to coincide with a major flight of TV/digital ads, and retailer video testimonials were added to the website.

Customized talking points and toolkits were developed for Community Coalitions and state partners to address community-specific findings.

Evaluation Methods and Results: 

CounterBalance measures have been built into all VDH surveillance systems, including the Adult Tobacco Survey, Youth Risk Behavior Survey, local opinion leader survey, and periodic opinion polls through ICF Macro.

During the 2014-2015 education and awareness phase, online metrics track engagement with the issue.

Conclusions:  CounterBalance is a statewide approach to a rural tobacco POS strategy, using a combination of strategic partnerships and community mobilization, mass media, online and digital engagement

Implications for research and/or practice: 

CounterBalance may provide a template for rural POS initiatives.