Abstract
Background
Tobacco use is a leading risk factor for preventable mortality and causes around 5,000 deaths in New Zealand (NZ) each year. In 2011, the Government committed to making NZ smokefree by 2025, through reducing smoking prevalence and tobacco availability to minimal levels. However, the retail environment for tobacco remains relatively unregulated, with no restrictions on where tobacco can be sold, or requirements for tobacco retailers to be licensed. This thesis examines the potential for regulating the tobacco retail environment to reduce smoking prevalence and achieve NZ’s 2025 goal.
Methods
This research comprises five distinct projects. The first is a narrative literature review on tobacco retailing and smoking, and potential policy options to regulate the tobacco retail environment. The second project is a systematic review and meta-analysis examining the association between point-of-sale tobacco marketing and smoking. The third and fourth projects involve qualitative research with tobacco control sector key informants and tobacco retailers, in which stakeholders’ views of the tobacco retail environment and regulatory options are examined. The final project is a survey with a complex design to investigate smokers’ perceptions of the relative effectiveness of five policy options to reduce tobacco availability.
Results
The available evidence suggests that greater access to tobacco retail outlets and exposure to tobacco retail products at the point-of-sale are significant risk factors for youth smoking initiation, and for relapse after a quit attempt among adults. Key informants within the tobacco control sector believe that licensing of tobacco retailers is an important intermediate step in achieving the 2025 goal, and envisage tobacco being available only at a small number of specialised outlets in the long-term. Retailers’ perceptions of potential tobacco retail policies were mixed; some were supportive of measures to reduce tobacco availability and the 2025 goal, though several expressed ambivalence towards licensing policies. Retailers tended to be more supportive of tobacco retail policies where the rationale was to protect children from tobacco-related harm, and where this intention was explicit. Among NZ smokers, of the five policy options to reduce tobacco availability that were tested, two were perceived as most effective: i) tobacco only sold at half the existing liquor stores, and ii) tobacco only sold at pharmacies. Each of these policies was rated more likely to prevent youth smoking initiation, and at least as likely to help smokers to quit, relative to a benchmark policy of continued tobacco taxation.
Conclusions
In order for the Government to achieve its own goal of reducing tobacco availability to minimal levels by 2025, regulation of the tobacco retail environment is needed. The recent implementation of legislation banning point-of-sale tobacco displays demonstrates that policy interventions in this environment are feasible. The tobacco control sector strongly supports licensing of tobacco retailers and measures to reduce tobacco availability. Retailers are unlikely to strongly oppose these policies, particularly if the public health rationale is clear. Based on smokers’ perceptions, policies that substantially reduce tobacco availability and remove it from smokers’ usual places of purchase could be at least as effective as tax increases, in terms of reducing smoking initiation and supporting cessation.