Tobacco retail reform The next steps for tobacco control
Chair: Kelly Williams, Cancer Council NSW Presenters: Dr Tim Dewhirst, Dr Louise Marsh, Lindsay Robertson, Prof Suzan Burton
Session code: 165
www.worldcancercongress.org Supply and demand: How tobacco retail merchandising influences smoking behaviour Tim Dewhirst, University of Guelph, Canada Tobacco Retail Merchandising
• Tobacco firms now spend most of their promotional dollars via the retail sector in many jurisdictions, including Canada and the U.S.
• The tobacco product category is characterised by intensive channel intensity (i.e., high density)
Tobacco Retail Merchandising
• Enhances the social acceptability of tobacco products and serves to normalise tobacco use
• Contributes to the perception, among adolescents, that tobacco can be acquired more easily
• Robust findings that higher exposure and awareness of tobacco POS displays is associated with greater smoking initiation
Tobacco Retail Merchandising
• Impulse purchases may also play an important role for existing and former smokers
Tobacco Retail Merchandising
• Impulse purchases encouraged by discount prices (i.e., a good deal being offered) or mere visibility of smoking cues that prompt physiological cravings
Characteristics of tobacco retailers in New
Zealand: A jurisdiction without tobacco retailer notification
Dr Louise Marsh, The Cancer Society Social and Behavioural Research Unit, University of Otago, Dunedin.
Tobacco retailing in New Zealand
• Currently zero licensing of tobacco retailers
• Licensing of alcohol retail outlets
• Smokefree Aotearoa 2025
• Māori Affairs Select Committee recommendations
Methods
• Smokefree Enforcement Officers provided data on tobacco outlets • Physical addresses mapped using Geographical Information System (GIS) software • Also mapped: • Secondary schools • Socioeconomic deprivation • Alcohol-licensed premises
Results
• SEOs use variety of methods to collate tobacco retailer data
• 5008 tobacco outlets identified • 1 outlet per 617 adults • 1 outlet per 129 smokers • 32% of outlets licensed to sell alcohol
Retailer categories
Retailers by neighbourhood depriva on
• 46% of secondary schools had 1 or more outlets within 500m walk • 76% of secondary schools had 1 or more outlets within 1000m walk
• Mean 1.4 outlets within 500m, and 5.7 outlets within 1000m Retailers Tobacco Only Tobacco and Alchool Retail based policy op ons • Mandatory notification, registration or licensing • Prohibiting particular types of outlet from selling tobacco • Prohibiting the sale of tobacco in certain zones • Restricting the sale of tobacco to a limited number of controlled outlets • Gradually reducing the number of stores selling tobacco e.g. sinking lid • Prohibiting the sale of tobacco where alcohol is sold
Marketing cigarettes in a dark market: Tobacco retailers in NSW
Suzan Burton,1 Kathy Chapman,2 Sam Egger,2 Rae Fry,2 Greg Soulos,2 Anita Tang, Scott Walsberger,2 Kelly Williams2
1University of Western Sydney, 2Cancer Council NSW
Why look at tobacco retailers in Australia?
Australia is said to be a model for tobacco company learning:
One of the best things we can offer the world is what we do best, which is how to work, maximize, proac vely drive our market posi on in a market that’s completely dark… We need to export that…we know we have a lot of expatriates who come down to Australia for learning…they can come here and learn these techniques and take them back to Europe or La n America or to the United States or to Africa…’ Marke ng Director of BAT Australia, 2001
So we planned an audit to look at tobacco retailing in NSW...
Tobacco retailing in New South Wales (NSW)
• Plain packaging: (no logos, standard pack colours and fonts, with large pictorial health warnings)
• No tobacco display or POS promotion permitted (except one price sign of a specified size)
• Tobacco retailers are required to be listed with the NSW Ministry of Health (MoH). No cost for listing.
• Negative licensing: permission to sell tobacco may be withdrawn after repeated breaches of sales or display legislation.
A complete list of tobacco retailers in NSW?
In theory there is a complete list of tobacco retailers.
In practice, the list contains:
- multiple listings for the same outlet (up to 12),
- retailers who no longer sell tobacco,
…and omits outlets which do sell tobacco.
Sampling NSW tobacco retailers • Data collected in 8 out of 10 CCNSW regions, covering 77.4% of the postcodes and 80.3% of retailers listed on the MoH retailer registry
• Within each region, postcodes were randomly selected up to 20% of postcodes and 20% of retailers outside Sydney, and 15% of each within Sydney. Final target sample of 100 postcodes.
• Volunteer data collectors recruited for 95 postcodes (17.0% of the retailers and 15.7% of the postcodes on the MoH list)
• Data collected from 1,739 retailers (96.9% of the target retailers) Data collection
Data collection between November 2012 and February 2013
• Data collection: - price of the leading tobacco brand (Winfield 25s) for both a single and twin pack; - breaches of display regulation (e.g. display of cigarettes or promotional material, absence of warning signs, multiple or over-sized price signs) - status of the outlet (listed with Ministry of Health) checked against the MoH list.
Also looked and audited unlisted retailers. Analysis Minimum Winfield prices at each outlet were modelled as a function of: 1) Location (Postcode): - SES - % less than 18 - % born in Australia - Remoteness
2) Outlet characteristics - type (e.g. supermarket, tobacconist, convenience store etc.) - legislation breach (i.e. compliance with display regulation) - listing (i.e. compliance with listing regulation)
Multiple linear regression with generalised estimating equation adjustment for the clustering of retailers within postcodes. Pack price and store characteristics Factor N (%) Price per pack ($) Adjusted^ difference in means, $, (95 CI) All 1579 (100) 18.01 Store-level variables Outlet type Supermarket 154 (9.8) 16.51 ref. General grocery store 34 (2.2) 17.73 1.17 (0.88, 1.45) Convenience store 323 (20.5) 18.08 1.36 (1.15, 1.57) Petrol/service station 237 (15.0) 18.09 1.58 (1.31, 1.84) Newsagent 162 (10.3) 17.72 1.10 (0.83, 1.37) Licensed premises and/or vending 520 (32.9) 18.83 2.22 (1.93, 2.50) Tobacconist 77 (4.9) 16.09 -0.34 (-0.62, -0.06) Other/Not specified 72 (4.6) 17.58 1.05 (0.67, 1.43) p-value: <0.001 Legislation breach No breaches 1234 (78.2) 18.09 ref. One or more breaches 345 (21.8) 17.73 -0.13 (-0.39, 0.13) p-value: 0.320 Listing with MoH Listed 1419 (89.9) 18.01 ref. Unlisted 160 (10.1) 18.04 0.01 (-0.25, 0.27) p-value: 0.956 ^ Adjusted for outlet type, remoteness of postcode, SES of postcode, % of postcode population less than 18 years, % of postcode born in Australia, legislation breach and listing with MOH Pack price and postcode characteristics Postcode-level variables SES Lowest SES 215 (13.6) 17.40 ref. 2 291 (18.4) 17.86 0.41 (0.09, 0.74) 3 292 (18.5) 18.18 0.40 (0.10, 0.70) 4 493 (31.2) 18.19 0.36 (0.07, 0.64) Highest SES 288 (18.2) 18.13 0.37 (0.07, 0.67) p-value: 0.027, p-trend: 0.147 % less than 18 years 0 to <16 322 (20.4) 18.44 ref. 16 to <22 536 (33.9) 18.05 -0.24 (-0.53, 0.05) 22 to <25 358 (22.7) 17.88 -0.45 (-0.88, -0.03) 25+ 363 (23.0) 17.71 -0.62 (-0.92, -0.32) p-value: <0.001, p-trend: <0.001 % born in Australia 0 to <60 542 (34.3) 18.01 ref. 60 to <70 236 (14.9) 18.03 0.38 (0.08, 0.67) 70 to <90 546 (34.6) 18.04 0.20 (-0.07, 0.48) 90+ 255 (16.1) 17.93 0.32 (-0.06, 0.69) p-value: 0.055, p-trend: 0.079 Remoteness Major cities of Australia 1174 (74.4) 18.08 ref. Inner regional Australia 289 (18.3) 17.80 -0.13 (-0.47, 0.20) Outer regional and remote Australia 116 (7.3) 17.87 -0.16 (-0.47, 0.15) p-value: 0.560 What we found: • Very wide distribution: on average 17.7 tobacco retailers per postcode;
• Many unlisted retailers: approximately one for every 11 listed retailers;
• Unlisted retailers and those in low SES areas were more likely to violate display laws.
• Discounted cigarettes were widely available – at 25.3% of retailers - through the purchase of twin packs (7.3% cheaper than the average single pack price)
• Prices were significantly lower: 1) In tobacconists and supermarkets ($1.92, $1.50 below mean price respectively) 2) In lower SES areas (61c lower in lowest SES areas) 3) In postcodes with more people under 18 (30c lower)
• In contrast with food and petrol prices, prices were not higher (and were in fact lower) outside major cities, despite tobacco retailer numbers being approximately three times higher in cities.
21 What it means for policy: • Shows the need for enforcement of display regulations
• Suggests that the effect of price on tobacco consumption is being partly countered by lower prices in areas where smokers are most likely to be price sensitive.
• Supports previous calls for disclosure of tobacco company trade promotions, and a review of policy on cigarette prices, including consideration of floor prices and bans on volume discounts.
• Suggests that the current regulation is not fit for purpose (to understand number and location of outlets, and support enforcement efforts) Using the results to encourage action:
Thanks to our 166 Cancer Council NSW volunteers, who made collection of this and other data possible
New Zealand tobacco retailers’ a tudes toward tobacco retail policies
Lindsay Robertson, Louise Marsh, Janet Hoek, Rob McGee, Richard Egan
Licensing of tobacco retail outlets
“Just another council compliance...someone, once a month, coming to check it. Are you all compliant? Fine. Same as the building warrant… I have no idea of why that would help.”
“Um … that to me, would just be a money grabbing tax. For nothing. For no real purpose.”
“As long as it’s not money gathering… yeah, so long as there’s good reason for doing it, I don’t really have an issue.... as long as ...there’s good intention, reason behind it.” Restric ng the number of tobacco retail outlets
Restric ng sales around schools… “Yeah I’d be happy with that ….. ‘cos I think the government should be focusing on new smokers, not existing. That would be a good idea.”
Retailer Associa ons’ vs retailers’ views
Ideas on framing retail policies • Be clear about purpose of policy (vs ‘government money-making’)
• Emphasise aims of denormalising tobacco use & preventing youth smoking
• Frame intended impacts as long-term
• Highlight potential advantages of not selling tobacco
Acknowledgements
• Funding was provided by Asthma Foundation of NZ and NZ Lotteries Health
• Thanks also to the Cancer Society; the Cancer Society Social & Behavioural Research Unit & Aspire collaboration
• Thanks to the research participants ‘We don’t sell tobacco anymore’: Retailers who stop selling
Suzan Burton,1 Eleonora Feletto,2 Sam Egger,2 Rae Fry,2 Kelly Williams 2 Clare Sutton, Lachlan Bagus
1University of Western Sydney, 2Cancer Council NSW, 2 Cancer Council Vic, 3Macquarie University
Who stops selling? Retailers no longer selling
All audited retailers no All audited retailers selling tobacco n % n % Supermarket 175 8.9% 9 4.0% Convenience/ grocery store 431 21.9% 41 18.2%
Petrol/service station 270 13.7% 18 8.0%
Newsagent 189 9.6% 18 8.0%
Licensed premises 707 36.0% 113 50.2%
Tobacconist 82 4.2% 1 0.4%
Other 110 5.6% 25 11.1%
TOTAL 1964 100% 225 11.5% Who stops selling?
Follow up of the 98 retailers who stopped selling in the two largest geographic areas of the audit (Sydney and Hunter regions):
• 3 (3%) say they had never sold; • 15 (15.5%) were now selling; • 23 (29.1% of those no longer selling who had ever sold) had changed business type, to a type not associated with tobacco retailers.
Leaving 56 retailers in comparable business types who had stopped selling tobacco out of 809 audited in those areas (6.9%) -
- against an unknown number of new retailers who had entered the market over the same period.
So very few retailers who are continuing in the same business stop selling – and they disproportionately represent small market share outlets (bars and convenience stores). Why they stopped selling
We interviewed 13 of the 56 retailers in comparable businesses who had stopped selling (23.2%).
Those who stopped selling tobacco were usually prompted to do so by: • Low profit from tobacco retailing, plus: • Changes in legislative policy or • Changes to the business (renovation, relocation, and/or repositioning)
Only one stopped selling primarily due to the health effects of tobacco.
All but one said there were other tobacco outlets nearby (so no obvious difference to tobacco distribution). Why it’s important
• Despite falling levels of smoking, no evidence of a decrease in the very wide supply of cigarettes in NSW.
• Shows that a zero-cost license results in very few retailers deciding to stop selling tobacco – and those that do disproportionately represent low market share retailer types.
• Contrasts with other fee based licensing schemes, which have resulted in falling numbers of tobacco retailers.
Retail Licensing Models: Regulating the Supply of Tobacco
Tim Dewhirst, University of Guelph, Canada
Retail Licensing Models: Regulating the Supply of Tobacco
Learning from international tobacco retail licensing approaches (e.g., California, New York, Singapore) and accounting for WHO FCTC obligations: • Limiting how, where, and when retailers can sell tobacco products • Licenses must be renewed annually, with reporting requirements and sufficient fees to support effective programs
Retail Licensing Models: Regulating the Supply of Tobacco
• Public notification scheme for those violating sales conditions, as well as punitive mechanisms including fines, suspending or revoking tobacco licenses
• Training to be undertaken by tobacco purveyors (retailer qualifications) and minimum age requirements
• Coordination of tobacco regulations (across jurisdictions)
Not limited to cigarettes: other forms of tobacco
Cigarette Packaging and Health Warnings
Questions? Comments?