Louise Marsh

A Systematic Review on the Impact of Point-of- Sale Tobacco Promotion on Smoking

INTRODUCTION The tobacco retail environment is a crucial marketing medium for the industry. A 2009 review found evidence of a positive association between exposure to point-of-sale (POS) tobacco promotion and increased smoking and smoking susceptibility, though limitations in the evidence base were identified. AIM AND METHODS We reviewed and critically appraised recent evidence documenting the influence of POS tobacco promotion, and POS tobacco display bans, on smoking-related behavior and cognitions. We reviewed original quantitative and qualitative research that examined the relationship between POS tobacco promotion and smoking prevalence, individual-level smoking and quitting and tobacco purchasing behavior, smoking susceptibility, and smoking-related cognitions. RESULTS Twenty peer-reviewed studies (18 quantitative and 2 qualitative) met the inclusion criteria; each study reported findings consistent with a positive association between exposure to POS tobacco promotion and smoking or smoking susceptibility. Several studies met key criteria for causality: 4 indicated a dose-response association, 2 prospective studies were identified, and evidence from intervention studies supported the reversibility of the association. Findings were consistent across different study designs, settings, and measures. CONCLUSIONS The existing evidence supports a positive association between exposure to POS tobacco promotion and smoking. This review provides evidence to support the continuation of POS tobacco display bans in those jurisdictions where such legislation has been introduced and strengthens the evidence encouraging similar policies in jurisdictions without a POS display ban.

Brief report: Text bullying and traditional bullying among New Zealand secondary school students

This descriptive study examined text and traditional bullying in New Zealand (NZ), and the relationship between text bullying and traditional bullying, and feeling unsafe at school. A self-report online survey assessed the frequency of bullying among 1169 15 year old secondary students, for five categories of bullying: text messages, rumors, exclusion, teasing, and physical bullying. Results show that in the school year assessed 47% reported having been bullied sometimes or often and 37% reported bullying others; 11% reported being text bullied, while 7% reported text bullying others. Students involved in text bullying were significantly more likely to be involved in traditional forms of bullying and were less likely to feel safe at school.

Point-of-sale tobacco promotion and youth smoking: a meta-analysis

Introduction Previous systematic reviews have found consistent evidence of a positive association between exposure to point-of-sale (POS) tobacco promotion and increased smoking and smoking susceptibility among children and adolescents. No meta-analysis has been conducted on these studies to date. Methods Systematic literature searches were carried out to identify all quantitative observational studies that examined the relationship between POS tobacco promotion and individual-level smoking and smoking-related cognitions among children and adolescents, published between January 1990 and June 2014. Random-effects meta-analyses were used. Subgroup analyses were conducted according to extent of tobacco POS advertising environment in the study environment. Sensitivity analyses were performed according to study size and quality. Results 13 studies met the inclusion criteria; 11 reported data for behavioural outcomes, 6 for cognitive outcomes (each of these assessed smoking susceptibility). The studies were cross-sectional, with the exception of 2 cohort studies. For the behavioural outcomes, the pooled OR was 1.61 (95% CI 1.33 to 1.96) and for smoking susceptibility the pooled OR was 1.32 (95% CI 1.09 to 1.61). Conclusions Children and adolescents more frequently exposed to POS tobacco promotion have around 1.6 times higher odds of having tried smoking and around 1.3 times higher odds of being susceptible to future smoking, compared with those less frequently exposed. Together with the available evaluations of POS display bans, the results strongly indicate that legislation banning tobacco POS promotion will effectively reduce smoking among young people.

Youth tobacco access: trends and policy implications

Objective We examined whether the supply routes via which New Zealand adolescents aged 14–15 years accessed tobacco had changed during a period of dynamic policy activity. Setting We analysed data from seven consecutive years (2006–2012) of the New Zealand Action on Smoking and Health (ASH) Year 10 survey, a nationwide cross-sectional annual survey. Participants All New Zealand schools teaching Year 10 students are invited to participate in the survey; school-level participation rates have ranged between 44% and 58% and more than 25 000 students have responded to the survey in each year. The results presented draw on the subsample who reported smoking when surveyed (N∼9200). The data were weighted by age, ethnicity and school socioeconomic status (SES) to remove effects of systematic over-response by New Zealand Europeans and under-response by those in lower SES groups from trend analyses. Primary and secondary outcome measures The survey measured adolescents’ main reported tobacco supply source. Results Smoking prevalence declined significantly (8.1%) over the period examined (linear tend coefficient: −0.74; 95% CI −1.03 to −0.45, significant p<0.01). Friends showed a significant decline in relative importance as a supply source while caregivers and other sources showed a significant increase over the period examined. Conclusions The findings show that social supply, particularly via friends, caregivers and others, such as older siblings, is a key tobacco source for adolescents; commercial supply is much less important. The findings raise questions about the additional measures needed to reduce smoking among youth. Endgame policies that make tobacco more difficult to obtain and less appealing and convenient to gift merit further investigation.

Characteristics of tobacco retailers in New Zealand.

Using data on known tobacco outlets throughout NZ, GIS was used to map outlets, deprivation and secondary schools. A total of 5008 tobacco outlets were identified, giving a density of one outlet per 617 people or one outlet per 129 smokers. One-half of secondary schools had an outlet within 500 m. Tobacco outlets were more densely located in areas of higher socioeconomic deprivation. One third of all tobacco outlets had a licence to sell alcohol. This study indicates the widespread retail availability of tobacco and the need for a mandatory system of registration for better enforcement of smokefree legislation.

When you're desperate you'll ask anybody: young people's social sources of tobacco

Objectives : This study sought to examine young New Zealand smokers’ access to social supplies of cigarettes.

Adolescents’ perceptions of violence and its prevention

Objective: To explore aspects of aggression, in particular fighting and weapon carrying, among high school students. This was in response to an earlier survey of Dunedin young people and will assist in the development of a broader quantitative study on aggression among high schools students.

Tobacco retail outlet density and risk of youth smoking in New Zealand

Introduction Evidence suggests inconsistent findings on the relationship between density of tobacco outlets around schools and risk of smoking among students. This study examines the density of tobacco outlets around secondary schools in New Zealand (NZ) and current smoking, experimental smoking, susceptibility to smoking, and attempted and successful tobacco purchasing. Methods Smoking data came from the 2012 ASH Year 10 survey, a national survey of youth smoking in NZ. Geographic Information Systems were used to map tobacco retail outlets; a layer of secondary school locations was obtained from Koordinates.com. Logistic regression examined the relationship between density of outlets around schools and smoking behaviours, adjusting for individual-level and school-level confounders. Results Of the 27 238 students surveyed, 3.5% (952) were current smokers, 4.1% (n=1 128) were experimental smokers, and 39.8% (10 454) of nonsmokers were susceptible to smoking. An inverse relationship was found between the density of tobacco retail outlets and current smoking. Current smokers were significantly more likely to attempt to purchase tobacco if the density of tobacco retail outlets around their school was high. Non-smoking students were more likely to be susceptible to smoking if the density of tobacco outlets around their school was high. There was no statistically significant association between density of tobacco outlets and successful purchasing, nor experimental smoking. Conclusions Restricting the permitted density of tobacco retail outlets around schools should be part of comprehensive tobacco control. In this regard, both smokers and non-smokers support the introduction of increased regulation of the tobacco retail environment to achieve our national smoke-free 2025 goal.

Smokers’ Perceptions of the Relative Effectiveness of Five Tobacco Retail Reduction Policies

Introduction: Reducing the widespread retail availability of tobacco could help realize tobacco endgame strategies. We assessed New Zealand smokers’ perceptions of five potential policies designed to reduce the retail supply of tobacco, relative to a “benchmark” policy of annual tobacco tax increases. Methods: A sample of 623 smokers was recruited from an internet panel. Participants evaluated one of six randomly assigned policy scenarios that would reduce tobacco outlet density: (1) no tobacco sold at alcohol on-licensed premises, (2) no tobacco sold within 500 m of a high school, (3) no tobacco sold within 1 km of any school, (4) tobacco sold only at pharmacies, and (5) tobacco sold only at half the existing liquor stores. Continued 10% annual tobacco tax increases served as a benchmark condition. Participants rated the likely effectiveness of one policy on preventing uptake by a 15-year-old susceptible never-smoker and supporting quitting by an adult smoker. Analyses involved pooled t tests and logistic regression. Results: The policy scenarios in which tobacco was only sold at half the existing liquor stores or only at pharmacies were rated more likely to prevent youth smoking initiation, and at least as likely to help smokers to quit, relative to the benchmark policy. Conclusions: This is the first study to compare potential retail interventions against a measure known to reduce smoking prevalence. Policies that substantially reduce tobacco availability and remove it from smokers’ usual places of purchase are perceived as being at least as effective in reducing smoking initiation and supporting cessation, as tax increases. Implications: Tobacco control advocates have proposed a range of policies to reduce tobacco retail outlet density, as part of endgame strategies. There are no published data on the relative effectiveness of different approaches, therefore it is unclear which would be most likely to reduce smoking prevalence. This study provides an insight into smokers’ perspectives on the effectiveness of retail reduction strategies and indicates that some of these could be at least as effective in reducing initiation and promoting quitting as tax increases. Smokers’ perceptions of the relative effectiveness of these policy options may help inform the advocacy efforts of the sector.

Smoke-free policies in New Zealand public tertiary education institutions

The Framework Convention on Tobacco Control mandates the creation of smoke-free environments to protect non-smokers from second-hand smoke and reduce demand for tobacco. We aimed to examine the extent and nature of smoke-free campus policies at tertiary education institutions throughout New Zealand, and examine the policy development process. Stage one comprised an audit and content analysis of smoke-free policies. In stage two, semi-structured telephone interviews were conducted to investigate the process of developing and implementing policies. Qualitative content analysis was undertaken on interview notes. Policies were identified for most institutions (n = 26/29), though varied widely in nature. Only nine mandated 100% smoke-free campuses without exceptions and few prohibited the sale of tobacco on campus, or connections with the tobacco industry. During interviews (n = 22/29), cited barriers to developing a 100% smoke-free policy included enforcement challenges and anticipated opposition from staff and students. However, participants from institutions with 100% smoke-free policies reported having encountered few challenges. Varying levels of compliance with 100% smoke-free policies were reported yet, overall, these policies were viewed as being effective. Smoke-free campus policies could be strengthened to better reflect a completely tobacco-free organization. Other institutions and workplaces could use these findings to develop 100% smoke-free policies.