Inaugural Research Seminar

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

2. Retail interventions – what next?

3. 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

4. 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]

5. 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

6. 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

7. 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