Advertising and promotion of tobacco products around schools in Crete .

1. Advertising and promotion of tobacco products around schools in Crete. C Girvalaki1,3*, C Vardavas1,2,3, I Agaku2, L Lazuras4, P Behrakis2,3, C Lionis1 Results Abstract 1.Clinic of Social Medicine, School of Medicine, University of Crete, Greece, 2.Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA, 3.Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece, 4.South-East European Research Centre (SEERC), Thessaloniki, Greece Objectives: The objective of the study was to assess how the advertising ban impacted on tobacco advertising close to all high schools in Heraklion, Crete and how kiosks, which were exempt from the legislation, affected the success of the ban Methods: This longitudinal study took place in the city of Heraklion, Crete, Greece. During the study, researchers travelled by foot along every road, located and evaluated all tobacco industry advertising at POS (Point Of Sales) or on billboards within a 300 m Euclidian radius of all 13 high schools in Heraklion, before (pre ban, in 2007) and after (post ban, in 2011) the implementation of the 2009 outdoor advertising restriction. Around high schools, only convenience stores and kiosks were found to sell tobacco products and thus POS were classified as either convenience stores or kiosks. The statistical analysis was performed using the statistical package PASW V.19.0. Results: Study results indicated that tobacco industry billboards around schools were eradicated after the ban (from 44 to 0). Additionally, the number of POS with external advertisements dropped from 98% to 66% (p<0.001), more so in convenience stores (from 97% to 35%, p<0.001) than in kiosks (98% to 92%, p=0.192), which were exempt from the ban. The number of convenience stores that had advertisements on the door (79.5% to 20.4%, p<0.001), ads that could be seen from the street (92.3% to 22.4%, p<0.001) or illuminated exterior ads (46.2% to 10.2%, p<0.001) was also significantly reduced. The average number of exterior advertisements per POS fell from 7.4 to 3.9 (p<0.05). This reduction was noted in regulated convenience stores (4.8±3.0 vs 0.9±2.1, p<0.001) and in unregulated kiosks (9.0±6.7 vs 6.5±4.5, p=0.019). Conclusions: The outdoor advertising restriction in Greece has led to the eradication of billboard advertising and a reduced number of tobacco advertisements per POS. However, results of the study indicate that a kiosk regulation is needed as they are a key vector for tobacco advertising along with the compliance among regulated convenience stores. The number of POS with external advertisements in total, dropped from 98% to 66%, (p<0.001). The number of convenience stores with advertisements that could be seen from the street dropped from 92.3% to 22.4 %, p<0.001). The number of convenience stores with illuminated exterior advertisements dropped from 46.2% to 10.2%, (p<0.001). Introduction POS, (Point Of Sales), advertising is a risk factor for adolescent smoking as it increases perceptions of ease-of-access, social approval of smoking, negative attitudes towards tobacco-control policies, triggers smoking impulses in former smokers while it is associated with higher smoking prevalence in schools located in areas with higher density of POS advertising. The outdoor advertising ban in Greece was enforced in 2009. However, outdoor advertisements are still allowed on areas covered by the kiosk roof, which increases exposure to tobacco advertisements. Take home points Methods The number of convenience stores with advertisements on the door reduced from 79.5% to 20.4%, (p<0.001). Results of the present study indicate a significant reduction, both in the number and the characteristics of outdoor advertisements around high schools in Crete after the implementation of the outdoor advertising restriction in 2009. Specifically: • Eradication of billboard advertising • Reduced number of tobacco advertisements per POS in total • Reduced number of tobacco advertisements illuminated, seen from the street or on the door of convenience stores around high schools However, results of the study indicate that unregulated kiosks still act as the main vector for promoting tobacco products in Greece into account that these unregulated kiosks account for more than half of the POS near high schools, one can conclude that a kiosk regulation is needed along with the compliance among regulated convenience stores. For the present study the spatial density of POS located around (<300m) 13 high schools in the municipality of Heraklion, as well as the quantity and types of tobacco industry advertisements, and available cigarette price promotions within the POS were documented. The collection of data took place in November 2011. After selecting the target schools, the location of each school was identified on a city map, based on previously utilised protocol, a 300meter radius circle was calculated, plotted and assessed on Google Earth. The researcher was equipped with a GPS camera (Ricoh Caplio Global Positioning System camera) in order to obtain, where possible, the exact latitudinal and longitudinal coordinates of each POS via satellite. A researcher visited the location of each school and travelled by foot covering all the streets located within the plotted 300m area, documenting all POS, as well as additional detailed information regarding the tobacco advertisements that were located both outside and inside each POS, were recorded using POP store surveillance tool. Correspondence to: Girvalaki Charis: charis.girvalaki@gmail.com Funding was provided by the Behrakis Foundation, through the HEART project (Hellenic Action for Research Against Tobacco)