Inaugural Research Seminar Point of sale displays and beyond: The next steps for tobacco control in retail settings

Retail interventions – what next?

Why might accessibility be important?  Easy access/proximity could promote uptake and consumption, and undermine cessation theory (visual cues, triggering etc) empirical evidence, alcohol + fast food analogy) esp in disadvantaged communities, for sales in bars and pubs  Increased density promoting price competition and impact of associated PoS and other marketing (when allowed)  Ubiquitousness and visibility -> normalising effect

Retail and smoking - lines of evidence Marketing theory - ‘place’ (4 P’s), ‘convenience’ (4 C’s) Outlet distribution studies Large numbers and high accessibility/visibility of tobacco retailers (geocoding, smoker self-reports) Greater density in low income, disadvantaged areas Smoker self-reports 28% would quit or cut down if no outlet in walking distance, 20% NSW smokers report buying on impulse ≥ 1 per week, 40% smoked more in bars if sold cigs (Paul et al, 2010) NSW Light smokers buy preferentially in bars, clubs and convenience stores (Burton et al, 2011) Smoking behaviour observational studies Studies of association of youth smoking and accessibility (age limits, enforcement, retailer education) or perceived accessibility Studies of association of school or area prevalence/individual smoking behaviours (children/adults, smoking status, cessation success) with outlet density and proximity Smoking behaviour intervention studies Intervention studies of youth smoking and accessibility (age limits, enforcement, retailer education) [Intervention studies of youth/adult smoking and other retail interventions]

Pearce et al, 2009 Aim:  Investigate association between geographical accessibility to tobacco retailers and individual smoking behaviour Methods:  Exposure: travel time (car) from population weighted centroid of neighbourhoods meshblock to nearest tobacco outlet  Smoking prevalence (current/heavy) from 2002/3 NZHS  Analysis: adj for SES (individual and area), urbanicity Results:  Association between exposure and outcome in unadjusted models only Discussion  Other sources of tobacco not addressed (liquor stores, bars/restaurants, duty free, internet)  Other locations not considered (e.g. workplace)  Differences in travel time not large e.g. for convenience stores ‘worst’ quartile > 3.9 mins, ‘best’ < 0.98 min  Association investigated with adult smoking only  Cross-sectional exposure and outcome data (?direction of causality) Pearce et al. JECH 2009; 63: 69-77

Possible retail interventions  Sales to minors Sales/use ban, education of retailers, test purchases, public education Sales staff > 18 years, > 18 years only customers in tobacco shops  Marketing and counter marketing Warning signs Ban PoS displays and ads  Licensing Mandatory license lost if conditions breached +/- Fees/auctions for licenses(or incentives not to stock tobacco) +/- Community control +/- Restrictions on numbers/density/moratorium on new licenses  Accessibility Restrict number/density of outlets e.g min distance between outlets, max density, opening hours Restrict proximity (e.g. to schools) Restrict type of venue/retailers (e.g. no events where >xx% underage, no venues where alcohol sold/consumed, specialist tobacconists only)  Others Mandate NRT etc sales + cessation support info available Government retail monopolies Minimum price controls Max purchase per day License smokers

Research agenda  Descriptive and aetiological studies E.g. retailer distribution, association with smoking, source of cigarettes and places purchased, particularly among priority groups, surveys and qualitative studies of impact of retail outlets on smokers/quitters etc  Public/smoker/retailer/policy-maker opinion surveys and qualitative research  Feasibility studies and policy analysis  Effectiveness studies (intervention and observational studies) E.g. impact of different interventions on outlet density/access, purchasing behaviour, uptake, prevalence, cessation etc, in priority populations  Economic evaluations