Point of sale tobacco displays in the UK: Implications for marketing of tobacco products and adolescent smoking behaviour

• Main Author: Spanopoulos, Dionysios
• Published: University of Nottingham 2013
• Subjects: 362.296
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.606363

Background: Since the implementation of Tobacco Advertising and Promotion Act (TAPA) in the UK, Point-of-Sale (PoS) tobacco displays have been an increasingly important medium of tobacco marketing in the country. However there is little UK evidence on how PoS displays promote tobacco products, brands and their prices, or the associations between PoS displays and adolescent smoking and susceptibility. The Health Act 2009 prohibited PoS displays in larger shops in April 2012, with an exemption for smaller retailers until 2015, but the health implications of this partial ban currently being implemented in England have not yet been addressed. Methods: An observational survey of PoS tobacco displays was conducted of a sample of small retailers selling tobacco in Nottingham, UK. Digital pictures of 117 tobacco displays were taken and analysed to assess the content of PoS tobacco displays and in particular the tobacco products and prices on display. A self-completion questionnaire survey was also carried out among students attending 11 secondary schools in and around Nottingham city, and logistic regression models used to investigate the relation between exposure to and awareness of PoS tobacco displays, and awareness of brands on displays, with adolescent ever-smoking and measures of smoking susceptibility. These associations were examined in more detail, for small and larger shops separately, to assess the impact of the first phase of the ban implemented in large shops under the terms of Health Act 2009. Results: The retailers' survey indicated that PoS tobacco displays were placed in close proximity and in the same field of vision with products attractive to children such as chocolates and sweets and often could be seen from outside the shops. Moreover, PoS displays communicate value in a jurisdiction where tobacco prices are particularly high. In the shops surveyed, 43% of all cigarette packs on display 2 were small packs containing 10 cigarettes, retailing on average at a mere £2.86; moreover, 60% of all RoII -Your-Own (RYO) tobacco packs on display were small packs of 12.5 g retailing on average at £3.06. Furthermore, 44% of all cigarettes packs and 40% of all RYO packs on display were price-marked, and price-marking was particular prevalent amongst the cheapest brands. According to the results of the school survey, the odds of ever-smoking were doubled in those visiting shops almost daily relative to less than once a week (OR 2.23 95% Cl 1.40 to 3.55), and the odds of susceptibility to smoking were increased by around 60% (OR 1.6295% Cl 1.25 to 2.10) with daily visits. In those who noticed tobacco on di splay every time during store visits, the odds of susceptibility were increased more than three times relative to those who never noticed tobacco (OR 3.15 95% Cl 1.52 to 6.54). For each additional tobacco brand recognised at the PoS, the adjusted odds of being an ever-smoker increased by 5% (OR 1.05 95% Cl 1.03 to 1.06) and of susceptibility by 4% (OR 1.0495% Cl 1.02 to 1.05). More frequent visits to shops displaying cigarettes were associated with higher awareness of tobacco brands. The association between frequency of visiting stores and susceptibility was due predominantly to exposure in small shops. Conclusions: PoS displays communicate value by displaying a high proportion of lower cost brands, and smaller and hence lower-cost packs, and by displaying price discounts on packs. Exposure to and awareness of PoS displays, and awareness of brands in displays, was associated with increased smoking susceptibility, predominantly through exposure in small shops. Removal of PoS displays will prevent price promotion at the PoS, but the findings of this research also suggests that minimum pricing of 20-pack cigarettes, prohibition of sale of cigarettes in packs less than 20, and plain packaging to prevent price-marking, are also necessary if price is to be used effectively as a tobacco control measure. This research adds to international evidence that PoS tobacco displays can promote smoking among young people and suggests that a one-off, 3 comprehensive tobacco display ban would be the recommended approach to prevent this effect. 4