Increasing the Percentage of Store Clerks with Valid Permits to Reduce Tobacco Sales to Minors

The QI tools used included a flowchart to examine the current process, a fishbone diagram to identify potential causes and solutions, a prioritization matrix to identify which potential solutions would be the most cost and time effective, and a formal flowchart protocol to show the correct steps for conducting a tobacco compliance check, including how to proceed with clerks who did not have permits. TCHD also developed two form letters explaining the importance of the permit and the consequences of not having a current permit. In Tooele County, it is considered a class B misdemeanor to sell tobacco products without a tobacco handler permit. A team of health educators at TCHD implemented the project, with the lead for TCHD's tobacco control program and an intern doing much of the initial legwork. The intern collected all baseline data, which indicated that there was a problem when only 42% of clerks were discovered to have permits. The intern also developed an online tobacco handler course in English and Spanish, increasing the availability and accessibility of the exam. A health educator and the QI coordinator developed the form letters. The online exam, two form letters, and the formal protocol for conducting compliance checks have all been standardized and are used by TCHD. Data collected 10 months after the baseline data were collected indicated an increase of 31.5% in the number of tobacco clerks holding current permits. TCHD achieved and surpassed the aim statement.

This QI initiative was measured using a telephone and in-person survey. The store managers/owners were contacted and asked to report on the permit status of their employees.