At the heart of this decade-long partnership is a shared commitment to reducing tobacco-related health disparities and empowering Virginia communities with the tools and data they need to make meaningful change. Together, DBHDS and Counter Tools have maintained an accurate list of more than 7,000 tobacco retailers, despite the lack of statewide tobacco retailer licensing, supported Virginia’s Synar program to prevent youth access to tobacco, and provided community service boards (CSBs) with the resources to advocate for healthier retail environments.

Below is a look back at the milestones that have shaped this partnership and advanced Virginia’s tobacco prevention and control efforts.

2015

The partnership begins with a statewide ground truthing project to verify tobacco retailer locations. When comparing commercially available data to the ground truthed data, only 18% of the original list proved accurate, highlighting the need for better data to support prevention and enforcement efforts. This work established Virginia’s first reliable tobacco retailer database.

2016 – 2017

DBHDS begins using Counter Tools’ software, Store Mapper and Store Audit Center, enabling them to conduct store assessments and complete merchant education. Through Virginia’s COUNTER ACT campaign, which is completed while a store assessment is conducted, over 2,000 retailers voluntarily committed to reducing in-store tobacco advertising and ensuring compliance with youth access laws.

2018

DBHDS integrates Counter Tools’ Point-of-Sale Toolkit (POST) to standardize data collection across regions. This effort strengthened statewide surveillance and offered clearer insights into the retail landscape influencing tobacco use behaviors.

2019

The partnership expands to include alcohol surveillance, with store assessment data shared with the Virginia Alcoholic Beverage Control Authority to support enforcement efforts. DBHDS continues assessing 100% of tobacco retailers statewide on a two-year cycle, an unmatched level of coverage. Virginia’s minimum legal sales age is increased to 21.

2020 – 2021

Counter Tools develops custom data visualizations to highlight tobacco retailer characteristics such as product availability, pricing, youth appeal, and retailer density and proximity. Local CSBs received training on effective communication strategies to pair with these visuals, strengthening their ability to educate communities on the importance of reducing tobacco-related disparities.

In addition, Counter Tools and DBHDS expand Virginia’s surveillance efforts by adding questions about the alcohol retail environment to the state’s custom POST assessment form. The alcohol retailer list was refined by consolidating store types from more than 40 categories to 8, improving data quality and enabling more meaningful analysis. This enhanced dataset powered the development of a new dashboard that integrates multiple data sources, including outlet type (on- vs. off-premise), Virginia DMV crash data, and proximity to college campuses, helping CSBs better understand alcohol retailer density and its public health impact.

2022

DBHDS and Counter Tools co-present at the Alcohol Policy Conference in Arlington, VA, sharing how GIS mapping and density analyses inform both alcohol and tobacco prevention efforts across the state.

2023

New POST questions are added to the store assessment form on lottery products through talks with the problem gambling prevention coordinator at DBHDS. Support for CSBs continues through the use of POST to maintain an accurate, up-to-date retailer list, which is critical in the absence of statewide tobacco retailer licensing.

2024 – 2025

Over 6,000 store assessments are analyzed to update statewide infographics on the retail landscape. Collaboration expands to include partners from problem gambling prevention and Virginia Commonwealth University, enhancing the Store Mapper to include locations selling gambling products and documenting nearby daycare centers. Counter Tools also delivers a webinar on zoning and density strategies to support communities considering local ordinances following the passage of HB 94. Additional collaboration with the Office of Hemp Enforcement leads to new POST questions capturing data on hemp-derived cannabis products.

To continue supporting the Synar program in Virginia, Counter Tools provides maps for each of the CSBs to conduct the Synar coverage study and calculates the overall coverage rate for Virginia. The year culminates with a joint presentation at the National Conference on Tobacco or Health in Chicago, showcasing Virginia’s innovative approach to healthy retail strategies.

Hear what DBHDS has to say

Behavioral Health Wellness Consultant J.D. Carlin shares his reflections on DBHDS’ work with Counter Tools:

How are you using the store assessment data?

DBHDS uses the store assessment data in a variety of ways including:

• Maintaining accurate retailer lists;
• Supporting enforcement and compliance efforts;
• Guiding merchant education and retailer engagement;
• Providing data-driven insights to policy and decision-makers;
• Supporting community-level efforts to impact their local landscape; and
• Expanding education and assessment efforts to include new public health issues.

Biggest impact from our partnership?

Gosh, is there only one! Likely, the biggest impact is that our partnership allows us to create a comprehensive, data-driven statewide system that strengthens tobacco (and other public health issues) prevention efforts while also reducing health disparities.

What do you look forward to as our partnership continues to grow?

DBHDS looks forward to expanding prevention efforts in a variety of ways. Three that will be a focus are how we assess additional products and public health issues; what more advanced mapping, dashboards and analytics can do for our use of data; and what we can do to provide additional support for local efforts.

Looking Ahead

Over the past decade, the Virginia Department of Behavioral Health and Developmental Services–Counter Tools partnership has built a model for how data, technology, and community engagement can work together to drive tobacco prevention and control. The work continues to inform public health strategies, strengthen partnerships, and inspire local action to create healthier communities across Virginia.

We are proud of all that’s been accomplished together and look forward to continuing the fight against tobacco industry influence in the years ahead.

Register here!

Community support for this change was fueled by growing concerns about the health effects and rising use of electronic nicotine products among youth. One of the biggest drivers of youth tobacco use is the retail environment, where harmful substances such as tobacco and nicotine products are marketed and sold, often in appealing flavors directly targeted towards youth.

To strengthen the case for change, Counter Tools partnered with The Coalition to support their advocacy work by providing tobacco retailer density and proximity maps of Lufkin, Texas.

Tobacco retailer density refers to how concentrated tobacco outlets are in a neighborhood, often measured as retailers per 1,000 people. High density increases exposure to advertising and makes tobacco more accessible, leading to higher rates of use among both youth and adults. Proximity measures the distance to the nearest retailer, in feet or miles. The closer the store, the easier it is for young people to be exposed to products and marketing. Research shows that high density and close proximity fuel disparities: youth initiation rises, people who smoke consume more, and quit attempts are less likely to succeed. Reducing density and proximity is key to protecting community health.

These maps visually demonstrated how 61% of tobacco retailers were clustering close to schools and parks within a 2,000-foot radius, raising the risk of youth exposure to marketing and easy access to nicotine. By presenting data in a clear and compelling way, The Coalition was able to strengthen its case and mobilize community support. Data visualizations that highlight the need for change are often the turning point in advocacy, transforming abstract data into a persuasive story to influence policy and create healthier environments.

“The tobacco retailer maps from Counter Tools were a powerful tool in our advocacy
efforts. A quick glance at our map shows the high number of vape shops in our rural
town of only 35,000 people. This was tangible proof that it was time for our community
to act and protect our youth from further exposure to these harmful products.”
Sharon Kruk, Executive Director | The Coalition

With the passing of this ordinance, new e-cigarette and vape retail shops require a special use permit and are zoned to light and heavy manufacturing districts, which are mostly on the outskirts of town and away from residential zones. Importantly, the ordinance sets a 1,000-foot buffer zone around schools and churches, safeguarding youth by preventing vape retailers from clustering near places they frequent. Existing vape shops will not be impacted by this ordinance unless they are closed for more than six months, in which case they would have to apply for a special use permit. Additionally, the ordinance does not apply to stores with vape products bringing in less than 50% of the store’s revenue.

Counter Tools celebrates this milestone alongside The Coalition and community leaders in Lufkin, Texas. Their work sets a positive example for other cities looking to address youth tobacco use at the point of sale. With each local victory, we move closer to a healthier future where all youth can grow up free from the influence of commercial tobacco.

The report concludes that implementing Tobacco 21 and a statewide tobacco retail permitting system is essential for preventing youth tobacco use and advancing health equity in North Carolina. Tobacco disproportionately affects marginalized communities, where aggressive marketing and retailer density contribute to higher tobacco use rates and worse health outcomes. Raising the minimum legal sales age to 21 has already been shown to decrease youth initiation rates in many places across the country, preventing lifelong addiction and tobacco-related diseases. A strong tobacco retail licensing system will provide essential oversight, ensuring retailers comply with regulations and reduce the prevalence of illegal sales. North Carolina can take a proactive approach to reducing health disparities, ensuring all residents, regardless of income, race, or background, have a fair chance at a healthier future.

Kim Bayha, Tobacco Prevention & Control Supervisor of the Office of Chronic Disease Policy & Prevention, spearheads Mecklenburg County Public Health’s tobacco point-of-sale policy work:

“Mecklenburg County Public Health collaborated with Counter Tools to assess our local retail tobacco environment and collect qualitative data to examine equity-centered impacts of Tobacco-21 and Tobacco Retail Permitting policies. Having access to digital tools and technical assistance from Counter Tools staff was invaluable. They provided training, developed a framework for the Health Equity Impact Assessment and led creation of a comprehensive Tobacco Retail Policy Impact Report and interactive dashboard. We can now use these online products to increase awareness about tobacco industry tactics in our local community and advocate for actions to reduce youth access to tobacco and address tobacco disparities. We could not have done this robust work without them.”

To learn more about this issue, view the executive summary and full report.

Recent efforts by the FDA to curb the sale of illegal e-cigarettes include the creation of a federal multi-agency task force in June 2024. Director of the FDA’s Center for Tobacco Products, Dr. Brian King, stated, “This ‘All Government’ approach – including the creation of this new Task Force – will bring the collective resources and experience of the federal government to bear on this pressing public health issue.” The FDA is working to curb the sale of illegal products in part by issuing warning letters and fines to brick-and-mortar stores selling unauthorized products, as well as seizing shipments of these products.

State health departments play a critical role in combating the rise of illegal e-cigarettes on the market, starting with enhancing enforcement of existing regulations. Completing regular inspections and compliance checks of retailers, along with instilling tobacco retailer merchant education programs will help ensure retailers adhere to laws regarding all commercial tobacco products. States can pursue stronger policies (e.g. through tobacco retail licensing or zoning measures) to regulate how tobacco products are marketed and sold and control the overall density, type, and location of retailers within a community, thus helping to prevent youth tobacco use initiation. Some states have enacted e-cigarette registry bills, which aim to prohibit retailers from selling e-cigarettes not authorized by the FDA. In order for this law to be effective, proper surveillance along with adequate funding and meaningful penalties for retailers that violate the law must be in place, which can be achieved through tobacco retail licensing.

The ongoing presence of illegal e-cigarette products continues to undermine efforts by state and federal agencies to instill effective regulatory measures. A multifaceted approach, including stronger enforcement, increased collaboration, and public education is needed to protect public health and is essential to safeguard youth from the dangers of nicotine addiction and other associated health risks. The collective call from public health organizations for comprehensive enforcement further emphasizes the urgency of addressing the issue of illegal e-cigarettes and ensuring only FDA-authorized e-cigarette products remain available on the market, which in turn will increase positive health outcomes for all.

Learn more from Counter Tobacco’s evidence summary on e-cigarettes at the point of sale.

This post was originally published as a feature article for The Geographic Health Equity Alliance (GHEA), a CADCA initiative. GHEA is a CDC funded National Network dedicated to reducing geographic health disparities related to tobacco and cancer.