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Khayat A, Levine H, Berg CJ, Abroms LC, Duan Z, Wang Y, LoParco CR, Elbaz D, Cui Y, Bar-Zeev Y. IQOS point-of-sale marketing: a comparison between Arab and Jewish neighborhoods in Israel. Isr J Health Policy Res 2024; 13:39. [PMID: 39152466 PMCID: PMC11328467 DOI: 10.1186/s13584-024-00626-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 08/03/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Philip Morris International's IQOS, with its heatsticks (HEETS), is the heated tobacco product with the largest global market share. IQOS and/or electronic cigarettes use rate is higher among Arabs vs. Jews in Israel. This paper aims to compare IQOS point-of-sale marketing strategies, and regulatory compliance in Arab vs. Jewish neighborhoods in Israel. METHODS We integrated data from two separate studies including a cross-sectional survey with IQOS retailers (December 2020-April 2021) and audits of points-of-sale that sold IQOS/HEETS (April 2021-July 2021) in 5 large cities in Israel, after marketing restrictions including a points-of-sale display ban and plain packaging became effective in Israel (January 2020). The survey included 69 points-of-sale (21 Arab, 48 Jewish neighborhoods) and the audits included 129 points-of-sale (48 Arab, 81 Jewish neighborhoods). Comparisons of IQOS marketing strategies between points-of-sale in Arab and Jewish neighborhoods were conducted using Chi-Square test, Fisher's exact test or Mann-Whitney test, as appropriate. Thematic analysis was used to analyze open-ended questions. RESULTS The survey showed that most marketing strategies, such as promotions to customers, were uniform across points-of-sale in Arab and Jewish neighborhoods. The most noteworthy differences were that a higher proportion of retailers from Arab neighborhoods were invited to IQOS parties (47.6% vs. 21.7%, p < 0.05) and reported personal communication with a Philip Morris International's representative (80.0% vs. 51.2%, p < 0.05). Additionally, Philip Morris International's representatives assisted points-of-sale in both Arab and Jewish neighborhoods in implementing the display ban by providing free compliant cabinets and product placement instructions, and directly interacted with customers. The audits showed that points-of-sale in Arab neighborhoods were more compliant with the display ban (25.5% vs. 8.8%, p < 0.05), but less compliant with plain packaging (62.5% vs. 79.3%, p < 0.05). CONCLUSIONS There were not many notable differences in IQOS marketing across points-of-sale in Arab vs. Jewish neighborhoods, but Philip Morris International utilized marketing elements of cultural significance, especially for points-of-sale in Arab neighborhoods, such as more personal communication and invitation to social events. Continuous surveillance of tobacco points-of-sale marketing and legislation compliance is needed, with a special focus on demographic/location-based differences.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem - Hadassah Medical Center, Ein Kerem, PO Box 12272, 911200, Jerusalem, Israel.
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem - Hadassah Medical Center, Ein Kerem, PO Box 12272, 911200, Jerusalem, Israel
| | - Carla J Berg
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Yan Wang
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassidy R LoParco
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Daniel Elbaz
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem - Hadassah Medical Center, Ein Kerem, PO Box 12272, 911200, Jerusalem, Israel
| | - Yuxian Cui
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem - Hadassah Medical Center, Ein Kerem, PO Box 12272, 911200, Jerusalem, Israel
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Khayat A, Levine H, Berg CJ, Abroms LC, Duan Z, Wang Y, LoParco CR, Elbaz D, Cui Y, Bar-Zeev Y. IQOS point-of-sale marketing: a comparison between Arab and Jewish neighborhoods in Israel. RESEARCH SQUARE 2024:rs.3.rs-3953025. [PMID: 38464035 PMCID: PMC10925470 DOI: 10.21203/rs.3.rs-3953025/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Philip Morris International's (PMI) IQOS, with its heatsticks (HEETS), is the heated tobacco product with the largest global market share. IQOS and/or electronic cigarettes use rate is higher among Arabs vs. Jews in Israel. This paper aims to compare IQOS point-of-sale (POS) marketing strategies, and regulatory compliance in Arab vs. Jewish neighborhoods in Israel. Methods We integrated data from two separate studies including a cross-sectional survey with IQOS retailers (December 2020-April 2021) and audits of POS that sold IQOS/HEETS (April 2021-July 2021) in 5 large cities in Israel, after marketing restrictions including a POS display ban and plain packaging became effective in Israel (January 2020). The survey included 69 POS (21 Arab, 48 Jewish neighborhoods) and the audits included 129 POS (48 Arab, 81 Jewish neighborhoods). Comparisons of IQOS marketing strategies between POS in Arab and Jewish neighborhoods were conducted using Chi-Square test, Fisher's exact test or Mann-Whitney test, as appropriate. Thematic analysis was used to analyze open-ended questions. Results Most marketing strategies, such as promotions to customers, were uniform across POS in Arab and Jewish neighborhoods. The most noteworthy differences were that a higher proportion of retailers from Arab neighborhoods were invited to IQOS parties (47.6% vs. 21.7%, p<0.05) and reported personal communication with a PMI representative (80.0% vs. 51.2%, p<0.05). Additionally, PMI representatives assisted POS in both Arab and Jewish neighborhoods in implementing the display ban by providing free compliant cabinets and product placement instructions, and directly interacted with customers. POS in Arab neighborhoods were more compliant with the display ban (25.5% vs. 8.8%, p<0.05), but less compliant with plain packaging (62.5% vs. 79.3%, p<0.05). Conclusions There were not many notable differences in IQOS marketing across POS in Arab vs. Jewish neighborhoods, but PMI utilized marketing elements of cultural significance, especially for POS in Arab neighborhoods, such as more personal communication and invitation to social events. Continuous surveillance of tobacco POS marketing and legislation compliance is needed, with a special focus on demographic/location-based differences.
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Affiliation(s)
- Amal Khayat
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
| | - Hagai Levine
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
| | - Carla J Berg
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Lorien C Abroms
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | | | - Yan Wang
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Cassidy R LoParco
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Daniel Elbaz
- Hebrew University of Jerusalem Faculty of Medicine
| | - Yuxian Cui
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Yael Bar-Zeev
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
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Shadel WG, Martino SC, Setodji CM, Dunbar M, Jenson D, Wong JC, Falgoust G. Doing more with less: A proposal to advance cigarette packaging regulations in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104308. [PMID: 38184903 PMCID: PMC10939880 DOI: 10.1016/j.drugpo.2023.104308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
Cigarette packages are potent marketing tools. Following guidance from the WHO Framework Convention on Tobacco Control, many countries have sought to diminish this marketing power by mandating that (1) large graphic health warnings be affixed to the packages (i.e., text warnings combined with graphic images of the health consequences of smoking) and (2) all packages be fully "plain" in their design (i.e., all packages use the same drab/bland color and font type; no brand logos, other colors, or designs are permitted). Yet, the United States lags other countries in implementing regulations designed to blunt the marketing power of cigarette packages. This is not because of a lack of effort on the part of the Food and Drug Administration, the main governmental body charged with regulating tobacco products in the United States. Rather, it is because the regulatory options that that have been advanced in the country (e.g., graphic health warnings) have not been found - yet - to be legally feasible by its courts. This commentary works through some of the conceptual, practical, and legal issues regarding packaging regulations in the United States. It considers the political and bureaucratic risks involved with issuing new regulations. The overall intent is to prompt our field to think creatively about what is realistic in this regulatory space and to offer a novel perspective that may help move the United States tobacco control community forward in its efforts to reduce the promotional power of cigarette packages.
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Affiliation(s)
- William G Shadel
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States.
| | - Steven C Martino
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Claude M Setodji
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Michael Dunbar
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, MN 55105, United States
| | - Jody Cs Wong
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Grace Falgoust
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
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Usidame B, Xie Y, Thrasher JF, Lozano P, Elliott MR, Fong GT, Fleischer NL. Differential impact of the Canadian point-of-sale tobacco display bans on quit attempts and smoking cessation outcomes by sex, income and education: longitudinal findings from the ITC Canada Survey. Tob Control 2023; 32:599-606. [PMID: 35017260 PMCID: PMC9271527 DOI: 10.1136/tobaccocontrol-2021-056805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/27/2021] [Indexed: 11/04/2022]
Abstract
SIGNIFICANCE This study examines the differential effects of Canadian point-of-sale (POS) tobacco display bans across provinces on quit attempts and smoking cessation, by sex, education and income. METHODS We analysed survey data from five waves (waves 4-8) of the International Tobacco Control Canada Survey, a population-based, longitudinal survey, where provinces implemented display bans between 2004 and 2010. Primary outcomes were quit attempts and successful cessation. We used generalised estimating equation Poisson regression models to estimate associations between living in a province with or without a POS ban (with a 24-month threshold) and smoking outcomes. We tested whether these associations varied by sex, education and income by including interaction terms. RESULTS Across survey waves, the percentage of participants in provinces with POS bans established for more than 24 months increased from 5.0% to 95.8%. There was no association between POS bans and quit attempts for provinces with bans in place for 0-24 months or more than 24 months, respectively (adjusted relative risk (aRR)=0.99, 95% CI: 0.89 to 1.10; 1.03, 95% CI: 0.88 to 1.20). However, we found a differential impact of POS bans on quit attempts by sex, whereby bans were more effective for women than men for bans of 0-24 months. Participants living in a province with a POS ban for at least 24 months had a higher chance of successful cessation (aRR=1.49; 95% CI: 1.08 to 2.05) compared with those in a province without a ban. We found no differences in the association between POS bans and quit attempts or cessation by education or income, and no differences by sex for cessation. CONCLUSION POS bans are associated with increased smoking cessation overall and more quit attempts among women than men.
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Affiliation(s)
- Bukola Usidame
- Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yanmei Xie
- Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - James F Thrasher
- Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
- National Institute of Public Health, Cuernavaca, Mexico
| | - Paula Lozano
- Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Michael R Elliott
- Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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van Deelen TRD, Kunst AE, van den Putte B, Veldhuizen EM, Kuipers MAG. Ex ante evaluation of the impact of tobacco control policy measures aimed at the point of sale in the Netherlands. Tob Control 2023; 32:620-626. [PMID: 35512850 PMCID: PMC10447367 DOI: 10.1136/tobaccocontrol-2021-057205] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/29/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Netherlands aims to implement stricter tobacco control policies targeting the retail environment. This paper is an ex ante policy evaluation of the potential impact of the current tobacco display and advertising ban as well as future tobacco sales bans on tobacco outlet visibility and availability. METHODS Between September 2019 and June 2020, all potential tobacco retailers in four Dutch cities (Amsterdam, Eindhoven, Haarlem and Zwolle) were visited and mapped using Global Positioning System. For each retailer selling tobacco, we completed a checklist on the visibility of tobacco products and advertising. Expected reductions in tobacco outlet visibility and availability were calculated per policy measure in absolute numbers (percentage or percentage point decrease) as well as density and proximity. RESULTS Out of 870 tobacco outlets, 690 were identified with visible tobacco products/advertising. The display ban in supermarkets and small outlets (respectively) is expected to decrease the number (-15; -42 percentage points), outlet density per 10 000 capita (-0.9; -2.6) and proximity in metres (+27 m; +400 m) of outlets with visible products/advertising. The upcoming bans on vending machines and sales in supermarkets are expected to decrease the number (-12%; -31%), density (-0.7; -1.9) and proximity (+12 m; +68 m) of tobacco outlets. Further changes in the number, density and proximity (respectively) of tobacco outlets may be achieved with future sales bans in petrol stations (-7%; -0.4; +60 m) and particularly with a ban on sales in small outlets (-43%; -2.7; +970 m). CONCLUSION A display ban and a sales ban in small outlets will contribute most to reducing tobacco outlet visibility and availability, assuming that no market shift towards other tobacco outlets will take place.
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Affiliation(s)
- Tessa R D van Deelen
- Public and Occupational Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Public and Occupational Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Bas van den Putte
- Amsterdam School of Communication Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Els M Veldhuizen
- Department of Geography and Planning, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirte A G Kuipers
- Public and Occupational Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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van Deelen TRD, Veldhuizen EM, van den Putte B, Kunst AE, Kuipers MAG. Socioeconomic differences in tobacco outlet presence, density, and proximity in four cities in the Netherlands. BMC Public Health 2023; 23:1515. [PMID: 37558979 PMCID: PMC10413623 DOI: 10.1186/s12889-023-16347-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Previous studies found that tobacco outlets were unevenly distributed by area socioeconomic status (SES). However, evidence from continental Europe is limited. This study aims to assess differences in tobacco outlet presence, density and proximity by area SES in the Netherlands. METHODS All tobacco outlets in four Dutch cities (Amsterdam, and medium-sized cities Eindhoven, Haarlem, and Zwolle) were mapped between September 2019 and June 2020. We estimated associations between average property value of neighbourhoods (as an indicator of SES, grouped into quintiles) and (1) tobacco outlet presence in the neighbourhood (yes/no), (2) density (per km2), and (3) proximity to the closest outlet (in meters), using logistic and linear regression models. RESULTS 46% of neighbourhoods contained at least one tobacco outlet. Tobacco outlets were mostly situated in city centres, but the distribution of tobacco outlets varied per city due to differences in urban structures and functions. In the medium-sized cities, each quintile higher neighbourhood-SES was associated with lower tobacco outlet presence (OR:0.71, 95%CI:0.59;0.85), lower density (B:-1.20 outlets/km2, 95%CI:-2.20;-0.20) and less proximity (B:40.2 m, 95%CI 36.58;43.83). Associations were the other way around for Amsterdam (OR:1.22, 95%CI:1.05;1.40, B:3.50, 95%CI:0.81;6.20, and B:-18.45, 95%CI:-20.41;-16.49, respectively). Results were similar for most types of tobacco outlets. CONCLUSION In medium-sized cities in the Netherlands, tobacco outlets were more often located in low-SES neighbourhoods than high-SES. Amsterdam presented a reverse pattern, possibly due to its unique urban structure. We discuss how licensing might contribute to reducing tobacco outlets in low-SES neighbourhoods.
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Affiliation(s)
- Tessa R D van Deelen
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Postbus, Amsterdam, 22660, 1100 DD, the Netherlands.
| | - Els M Veldhuizen
- Department of Geography and Planning, University of Amsterdam, Amsterdam, Postbus, Amsterdam, 15629, 1001 NC, The Netherlands
| | - Bas van den Putte
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Postbus, Amsterdam, 15791, 1001 NG, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Postbus, Amsterdam, 22660, 1100 DD, the Netherlands
| | - Mirte A G Kuipers
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Postbus, Amsterdam, 22660, 1100 DD, the Netherlands
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Bar-Zeev Y, Berg CJ, Khayat A, Romm KF, Wysota CN, Abroms LC, Elbaz D, Levine H. IQOS marketing strategies at point-of-sales: a cross-sectional survey with retailers. Tob Control 2023; 32:e198-e204. [PMID: 35140170 PMCID: PMC9360187 DOI: 10.1136/tobaccocontrol-2021-057083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The point-of-sale (POS) is adapting to marketing restrictions, societal changes and the inclusion of new products, such as heated tobacco products (eg, Philip Morris International's (PMI) IQOS device and HEETS sticks). We aimed to assess (1) PMI's influences on IQOS/HEETS POS marketing and (2) the implications of the new legislation (POS display ban and plain packaging) for retailers. METHODS A cross-sectional survey of 43 IQOS/HEETS POS owners/managers in five Israeli cities assessed POS and participant characteristics, marketing strategies, attitudes towards IQOS, and POS implications of the legislation and COVID-19, including industry reactions. Bivariate analysis explored differences between POS selling of the IQOS device versus POS selling of HEETS only. RESULTS A higher proportion of those carrying IQOS (n=15) (vs HEETS only) had special displays (100% vs 17.9%, p<0.001) and interacted with specific IQOS salespersons (73.3% vs 28.6%, p=0.013). Common promotions were financial incentives based on HEETS sales for retailers (37.5%) and price discounts on HEETS for customers (48.7%). Most indicated positive attitudes towards IQOS (72.1%; eg, 'less harmful'), opposition to the legislation (62.7%), limited government assistance to implement the legislation (62.8%), and industry provision of display cases and/or signage to comply with the legislation (67.4%). CONCLUSION PMI uses similar tactics to promote IQOS at POS as they previously used for combustible products, including direct promotional activities with retailers, and circumvented legislation by using special displays and signage. Governments need to ban these measures and support retailers with clear practical guidance regarding the implementation of marketing restrictions at POS.
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Affiliation(s)
- Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J Berg
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Katelyn F Romm
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Chritina N Wysota
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Daniel Elbaz
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
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Nagelhout GE, Poole NL, Metze M, Willemsen MC, Vermeulen W, van den Brand FA. Reducing the number and types of tobacco retail outlets in the Netherlands: Study protocol for a comprehensive mixedmethods policy evaluation. Tob Prev Cessat 2023; 9:08. [PMID: 37009236 PMCID: PMC10054766 DOI: 10.18332/tpc/161825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
The Netherlands plans to ban tobacco sales in supermarkets in 2024. In a comprehensive policy evaluation, we aim to examine: 1) the impact of the policy on the number and types of tobacco outlets, 2) the impact on attitudes and behaviors of smoking adults and non-smoking youth, and 3) the influence of the tobacco industry on the policy process and the retail environment. In addition, our study focusses on differential effects in disadvantaged neighborhoods, where both smoking rates and tobacco outlet density are typically highest. This study brings together economic, psychological, and journalistic research methods. We investigate the impact of the new legislation on the number and type of tobacco outlets, and on the number of smokers by using routinely collected population monitoring data. We examine the impact of the legislation on smoking susceptibility of non-smoking youth and on impulse tobacco purchases by smoking adults with yearly quantitative surveys and with qualitative interviews and discussion sessions. We describe whether these impacts differ for disadvantaged versus non-disadvantaged neighborhoods. We investigate what strategies the tobacco industry uses to influence the new legislation, policy processes, and the tobacco retail environment by performing a journalistic investigation, by means of documents obtained by Freedom of Information Act (FOIA) requests, (possibly) leaked documents from insider meetings, and interviews with insiders. The methods of our evaluation can be used as a model for other comprehensive public policy evaluations.
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Affiliation(s)
- Gera E Nagelhout
- IVO Research Institute, The Hague, the Netherlands
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Nikita L Poole
- IVO Research Institute, The Hague, the Netherlands
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Marcel Metze
- The Investigative Desk, Amsterdam, the Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- National Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, the Netherlands
| | | | - Floor A van den Brand
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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Blake KD, Gaysynsky A, Mayne RG, Seidenberg AB, Kaufman A, D'Angelo H, Roditis M, Vollinger RE. U.S. public opinion toward policy restrictions to limit tobacco product placement and advertising at point-of-sale and on social media. Prev Med 2022; 155:106930. [PMID: 34954242 PMCID: PMC8896313 DOI: 10.1016/j.ypmed.2021.106930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/03/2023]
Abstract
The Family Smoking Prevention and Tobacco Control Act granted the U.S. Food and Drug Administration authority to regulate tobacco advertising and promotion, including at the retail level, and preserved state, tribal, and local tobacco advertising and promotion authorities. Public health experts have proposed prohibiting point-of-sale tobacco advertisements and product displays, among other tobacco advertising restrictions. We examined the prevalence and correlates of public support, opposition, and neutrality toward proposed tobacco product placement and advertising restrictions at point-of-sale and on social media utilizing the National Cancer Institute's 2020 Health Information National Trends Survey (HINTS) (N = 3865), a cross-sectional, probability-based postal survey of U.S. addresses conducted from Feb 24, 2020 to June 15, 2020 (Bethesda, MD). Frequencies and unadjusted, weighted proportions were calculated for support, neutrality, and opposition toward the three policies under study, and weighted, adjusted multivariable logistic regression was employed to examine predictors of neutrality and opposition. Tests of significance were conducted at the p < 0.05 level. Sixty-two percent of U.S. adults supported a policy prohibiting tobacco product advertising on social media; 55% supported a policy restricting the location of tobacco product advertising at point-of-sale; and nearly 50% supported a policy to keep tobacco products out of view at the checkout counter. Neutrality and opposition varied by sociodemographic characteristics including age, sex, education, rurality, and presence of children in the household. Understanding public opinion toward tobacco product placement and advertising restrictions may inform policy planning and implementation.
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Affiliation(s)
- Kelly D Blake
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
| | - Anna Gaysynsky
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA; ICF Next, Rockville, MD, USA
| | - Rachel Grana Mayne
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Andrew B Seidenberg
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Heather D'Angelo
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Maria Roditis
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Robert E Vollinger
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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10
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Kong AY, King BA. Boosting the Tobacco Control Vaccine: recognizing the role of the retail environment in addressing tobacco use and disparities. Tob Control 2021; 30:e162-e168. [PMID: 32967986 PMCID: PMC9377406 DOI: 10.1136/tobaccocontrol-2020-055722] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 01/18/2023]
Abstract
Much of the progress in reducing cigarette smoking and tobacco-related morbidity and mortality among youth and adults is attributable to population-level strategies previously described in the context of the Tobacco Control Vaccine. The retail environment is used heavily by the tobacco industry to promote and advertise its products, and variations in exposure to and characteristics of the retail environment exist across demographic groups. It is therefore also an essential environment for further reducing smoking, as well as ameliorating racial, ethnic and socioeconomic tobacco-related disparities. This commentary provides an overview of the importance of incorporating strategies focused on the tobacco retailer environment (availability; pricing and promotion; advertising and display; age of sale; and retail licensure) as part of a comprehensive approach to tobacco prevention and control. To reach tobacco endgame targets, such innovative strategies are a complement to, but not a replacement for, long-standing evidence-based components of the Tobacco Control Vaccine.
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Affiliation(s)
- Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Uznay F, Gumus S. Uncovering TAPS strategies of the tobacco industry at PoS in low- and middle-income countries: the case of Turkey. Eur J Public Health 2020; 30:996-1001. [PMID: 32388567 DOI: 10.1093/eurpub/ckaa067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aims to uncover strategies executed by the tobacco industry against tobacco advertising, promotion and sponsorship (TAPS) bans at points of sale (PoS) in Turkey. METHODS The data are based on a field study conducted in the city of Izmir. There are 10 750 PoS in all of Izmir; the 6200 PoS in the 11 central districts were considered as potential subjects. Using a proportional sampling method (95% confidence interval, 5% margin of error), it was calculated that 384 PoS could adequately represent the whole. Face-to-face interviews were conducted with PoS administrators, using survey form consisting of 53 questions. Descriptive statistics methods have been used to analyze the data. RESULTS Of a total of 384 PoS visited; 96.4% featured at least one type of display/TAPS ban violation, 94.5% featured display settings creating brand dominance on display units, 76.7% received promotional payments and 14.8% received free tobacco products for featured display settings. Additionally, 29.2% of PoS had tobacco product displays visible from outside, 26.8% sold tobacco products on the counter, 24.7% featured advertising items on display units, 19.3% sold tobacco products as single stick and 11.7% had price tags with fonts larger than the legally fixed 20 pt. CONCLUSIONS An official institution specializing in tobacco control must be established to continually inspect the tobacco market. Tobacco products must stay hidden, in closed cupboards or under the counter, and communication between PoS and tobacco industry must be limited. In addition, tobacco products must be distributed by government institutions rather than the industry.
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Affiliation(s)
- Fatih Uznay
- Department of Agricultural Economics, Faculty of Agriculture, Ege University, Bornova, Izmir, Turkey
| | - Sevtap Gumus
- Department of Agricultural Economics, Faculty of Agriculture, Ege University, Bornova, Izmir, Turkey
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Chen-Sankey JC, Unger JB, Bansal-Travers M, Niederdeppe J, Bernat E, Choi K. E-cigarette Marketing Exposure and Subsequent Experimentation Among Youth and Young Adults. Pediatrics 2019; 144:peds.2019-1119. [PMID: 31659003 PMCID: PMC6836725 DOI: 10.1542/peds.2019-1119] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Electronic cigarette (e-cigarette) use has become increasingly prevalent among US youth and young adults in recent years. Exposure to e-cigarette marketing may stimulate e-cigarette use. In this study, we estimated the longitudinal association between e-cigarette marketing exposure and e-cigarette experimentation among US youth and young adult never tobacco users. METHODS The analysis included nationally representative samples of youth (ages 12-17; n = 8121) and young adult (ages 18-24; n = 1683) never tobacco users from wave 2 (2014-2015) and wave 3 (2015-2016) of the Population Assessment of Tobacco and Health Study. In the study, researchers measured past-month exposure to e-cigarette marketing through various places (eg, Web sites and events) at wave 2 and e-cigarette experimentation at wave 3. Statistical analysis included multivariable regressions to examine the associations between wave 2 e-cigarette marketing exposure and wave 3 e-cigarette experimentation. RESULTS At wave 2, 70.7% of youth and 73.9% of young adult never tobacco users reported past-month exposure to e-cigarette marketing; at wave 3, 4.9% and 4.5% of youth and young adults experimented with e-cigarettes, respectively. Youth and young adults exposed to e-cigarette marketing at wave 2 were more likely (adjusted odds ratio = 1.53, 95% confidence interval = 1.07-2.17; and adjusted odds ratio = 2.73, 95% confidence interval = 1.16-6.42, respectively) to have experimented with e-cigarettes at wave 3 than those not exposed. Marketing exposure through each place at wave 2 was associated with e-cigarette experimentation at wave 3. CONCLUSIONS E-cigarette marketing exposure predicted subsequent e-cigarette experimentation among youth and young adult never tobacco users. Increased restrictions on marketing through various channels may help minimize their exposure to e-cigarette marketing messages.
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Affiliation(s)
- Julia Cen Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland;
| | - Jennifer B. Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Maansi Bansal-Travers
- Division of Cancer Prevention and Population Sciences, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, Ithaca, New York; and
| | - Edward Bernat
- Department of Psychology, University of Maryland, College Park, Maryland
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
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Barker DC, Schleicher NC, Ababseh K, Johnson TO, Henriksen L. ENDS retailers and marketing near university campuses with and without tobacco-free policies. Tob Induc Dis 2018; 16. [PMID: 30687532 PMCID: PMC6342456 DOI: 10.18332/tid/94600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION This study characterizes the retail environment for Electronic Nicotine Delivery Systems (ENDS) near public universities in California, assesses marketing in the first random sample of ENDS retailers, and compares ENDS retailer density and retail marketing near campuses with and without tobacco-free policies. METHODS Two data sources were used to construct a sampling frame of possible ENDS retailers, which were mapped within 1–4 miles of 33 campuses of the University of California and the California State University systems. To assess retailer density, a telephone survey of possible ENDS retailers (n=1186) determined who sold e-cigarettes or e-liquids (completion rate=72.9%). To assess retail marketing, trained data collectors completed observations in a random sample (n=438, mean M=13.3 stores per campus, SD=11.2) in the Fall of 2015 RESULTS In a telephone survey, 59.1% of retailers reported selling e-cigarettes or e-liquids. Half of the campuses had 10 or more ENDS retailers nearby. Most ENDS retailers were convenience stores (42.5%), and more were head shops (8.4%) than smoke shops (6.8%) or vape shops (6.2%). Nearly half (43.6%) of ENDS retailers sold products marketed as zero-nicotine and 13.9% sold NRT. ENDS advertising was visible in 72.4% and on the exterior of 28.1% of retailers. However, the presence of exterior advertising for ENDS was significantly lower near campuses with established tobacco-free policies than near campuses with recent or no tobacco-free policies (OR=0.45, 95% CI: 0.22–0.94). CONCLUSIONS The large number of tobacco retailers that sell ENDS near colleges suggests a need for better monitoring and regulation of ENDS availability and marketing. The widespread availability of zero-nicotine products suggests a need to examine whether nicotine-free products are as advertised and safe to use. Longitudinal research is needed to understand how retail marketing for ENDS responds to change in tobacco-free policies at nearby campuses.
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Affiliation(s)
- Dianne C Barker
- Public Health Institute, 555 12 Street 10 Floor, Oakland, CA 94607
| | - Nina C Schleicher
- Stanford Prevention Research Center, Stanford School of Medicine, 3300 Hillview Avenue, suite 120, Palo Alto, CA 94304, USA
| | - Kimberly Ababseh
- Stanford Prevention Research Center, Stanford School of Medicine, 3300 Hillview Avenue, suite 120, Palo Alto, CA 94304, USA
| | - Trent O Johnson
- Stanford Prevention Research Center, Stanford School of Medicine, 3300 Hillview Avenue, suite 120, Palo Alto, CA 94304, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford School of Medicine, 3300 Hillview Avenue, suite 120, Palo Alto, CA 94304, USA
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Beverage marketing in retail outlets and The Balance Calories Initiative. Prev Med 2018; 115:1-7. [PMID: 30055198 DOI: 10.1016/j.ypmed.2018.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/24/2018] [Accepted: 07/21/2018] [Indexed: 11/20/2022]
Abstract
We quantified the placement and promotion of beverages in groceries, supermarket and convenience stores in the communities targeted by The Balance Calories Initiative, a campaign launched by the top three American beverage companies to help Americans reduce consumption of sugar from beverages by 20% by 2025. The companies promised to drive interest in low- and no-calorie beverages through promotional efforts such as product placement, featured merchandising, couponing and other incentives, with more intensive efforts in low-income communities in communities in Alabama, Mississippi, and Southern California. We also measured two comparison communities not specifically targeted by The Balance Calories Initiative, observing 69 retail outlets in 5 localities in 2016-2017. We found that sugar-sweetened beverages (SSBs) were the most common beverage in all outlets, and the brands of the companies pledging changes in marketing strategies the most dominant. SSBs were placed in an average of 25 separate locations in groceries vs. 15 for low/no-calorie beverages and 11 for water. No differences were noted between East LA stores observed 2 years after the initiative vs. stores in the North Mississippi Delta, Montgomery or the comparison stores. Given prior evidence that exposure to point-of-sale displays influences purchases, reducing the number and location of displays of SSBs should be considered to reduce SSB consumption.
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Pro-tobacco advertisement exposure among African American smokers: An ecological momentary assessment study. Addict Behav 2018; 83:142-147. [PMID: 29174665 DOI: 10.1016/j.addbeh.2017.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/08/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Many African Americans live in communities with a disproportionately high density of tobacco advertisements compared to Whites. Some research indicates that point-of-sale advertising is associated with impulse purchases of cigarettes and smoking. Ecological Momentary Assessment (EMA) can be used to examine associations between tobacco advertisement exposure and smoking variables in the natural environment. METHODS Non-treatment seeking African American smokers were given a mobile device for 2weeks (N=56). They were prompted four times per day and responded to questions about recent exposure to tobacco advertisements. Participants were also asked to indicate the number of cigarettes smoked, and if they made any purchase, or an impulse purchase, since the last assessment. Linear mixed models (LMMs) analyzed between- and within-subject associations between exposure and outcomes. RESULTS Participants reported seeing at least one advertisement on 33% of assessments. Of those assessments, they reported seeing menthol advertisements on 87% of assessments. Between-subject analyses revealed that participants who on average saw more advertisements were generally more likely to report purchasing cigarettes and to purchase cigarettes on impulse. Within-subject analyses revealed that when an individual participant reported seeing more advertisements than usual they were more likely to have reported purchasing cigarettes, making an impulse purchase and smoking more cigarettes during the same period, but not the subsequent time period. CONCLUSIONS Many African American smokers are frequently exposed to pro-tobacco marketing. Advertisement exposure is cross-sectionally associated with impulse purchases and smoking. Future research should assess prospective associations in more detail.
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Cheung YTD, Ho SY, Wang MP, Kwong A, Lai V, Lam TH. Pro-smoking responses and attitudes due to point-of-sale tobacco displays in never smokers: A cross-sectional study in Hong Kong. Tob Induc Dis 2018; 16:32. [PMID: 31516431 PMCID: PMC6659512 DOI: 10.18332/tid/92585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/25/2018] [Accepted: 06/25/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Never smokers' responses to tobacco control policy are often overshadowed by the opposition from smokers and tobacco industry during policy advocacy and legislation. Very few studies have examined never smokers' exposure to point-of-sale (POS) tobacco displays and their effects. Therefore, we investigated the exposure, pro-smoking responses due to and attitudes towards such displays in never smokers in Hong Kong. METHODS We conducted two-stage, randomized cross-sectional telephone-based surveys in 2015 and 2016 of 1833 never-smoking adults. They were asked how often they noticed POS displays in the past 30 days (often, sometimes, never), whether they found POS displays attractive, felt encouraged to smoke, perceived POS displays as advertisements, and if they supported banning them. The distributions of the outcomes were analyzed by descriptive statistics with weighting to the general population. Risk ratios (RR) from Poisson regression models adjusted for sociodemographic characteristics were used to analyze the associations. RESULTS Our results showed that, in never smokers, the younger were more likely to often notice POS displays (RR=0.80, 95% CI: 0.72-0.89, p<0.01). Finding POS displays attractive was associated with primary (RR=2.52, 95% CI: 1.51-4.22, p<0.01) and secondary education (RR=1.68, 95% CI: 1.16- 2.44, p=0.01) versus tertiary education. Often noticing displays was associated with perceived attractiveness (RR=1.90, 95% CI: 1.32-2.75, p<0.01). The positive association between often noticing displays and being encouraged to smoke was marginally significant (RR=4.05, 95% CI: 0.98-16.85, p=0.054). Respondents who often noticed POS displays (RR=0.87, 95% CI: 0.77-0.98, p=0.02) and did not perceive them as advertisements (RR=0.70, 95% CI: 0.61-0.98, p<0.01) showed less support on banning them than those who did not notice them. CONCLUSIONS Frequent exposure to POS displays was associated with greater perceived attractiveness and lower support for banning them. A total ban on POS displays is needed to eliminate the advertising and normalization effect of POS displays.
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Affiliation(s)
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Antonio Kwong
- The Hong Kong Council on Smoking and Health, Hong Kong, China
| | - Vienna Lai
- The Hong Kong Council on Smoking and Health, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Rose SW, Mayo A, Ganz O, Perreras L, D'Silva J, Cohn A. Perceived racial/ethnic discrimination, marketing, and substance use among young adults. J Ethn Subst Abuse 2018; 18:558-577. [PMID: 29424638 DOI: 10.1080/15332640.2018.1425949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Perceived experiences of discrimination have been linked to negative health behaviors including tobacco, alcohol, and marijuana use across various racial/ethnic groups. Tobacco and alcohol marketing exposure have also been linked with substance use. This study examined the independent and interacting effects of perceived experiences of discrimination and exposure to alcohol and tobacco marketing, and receptivity to marijuana marketing on substance use in an online survey of a multiethnic sample of young adults in 6 metropolitan areas (n = 505). African Americans (mean (M) = 1.96, 9% 5CI [1.84, 2.09]) and Hispanics (M = 1.98, 95% CI [1.87, 2.09]) reported higher levels of perceived discrimination than Whites (M = 1.52, 95% CI [1.40, 1.64]), p < .001. African Americans had higher levels of exposure to tobacco and alcohol marketing; Hispanics reported higher levels of exposure to alcohol marketing and receptivity to marijuana promotion. Discrimination and marketing exposure were independently associated with higher odds of all 3 outcomes, controlling for covariates (AOR from 2.1 to 3.4 for discrimination; AOR from 1.4 to 13.8 for marketing). Models showed a significant interaction of discrimination and tobacco marketing on past 30-day cigarette use (F = 5.5; p = .02). Individuals with high levels of tobacco marketing exposure were likely to report high past 30-day cigarette use regardless of level of discrimination, while those with low exposure were only at increased risk of reporting cigarette use at higher levels of discrimination. Both perceived discrimination and marketing exposure play a role in substance use. Interventions should consider discrimination as a significant risk factor underlying vulnerability to substance use among young adults.
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Affiliation(s)
| | - Ashley Mayo
- Truth Initiative Schroeder Institute , Washington , DC
| | - Ollie Ganz
- Truth Initiative Schroeder Institute , Washington , DC.,George Washington University Milken Institute School of Public Health , Washington , DC
| | | | - Joanne D'Silva
- Truth Initiative Schroeder Institute , Washington , DC.,University of Maryland School of Public Health , College Park , Maryland
| | - Amy Cohn
- Battelle Memorial Institute , Arlington , Virginia.,Georgetown University Medical Center , Washington , DC
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Siahpush M, Tibbits M, Soliman GA, Grimm B, Shaikh RA, McCarthy M, Wan N, Ramos AK, Correa A. Neighbourhood exposure to point-of-sale price promotions for cigarettes is associated with financial stress among smokers: results from a population-based study. Tob Control 2017; 26:703-708. [PMID: 28119499 PMCID: PMC5577380 DOI: 10.1136/tobaccocontrol-2016-053339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 12/21/2016] [Accepted: 12/29/2016] [Indexed: 11/04/2022]
Abstract
AIM To examine the association between neighbourhood exposure to point-of-sale (POS) cigarette price promotions and financial stress among smokers in a Midwestern metropolitan area in the USA. METHODS Survey data from 888 smokers provided information on sociodemographic and smoking related variables. Financial stress was measured with the question: 'In the last six months, because of lack of money, was there a time when you were unable to buy food or pay any important bills on time, such as electricity, telephone, credit card, rent or your mortgage? (Yes/No).' Using audit data from 504 tobacco retailers, we estimated a score of POS price promotions for each respondent by summing the different types of promotion in each store in their neighbourhood, as defined by a 1-km roadway buffer. RESULTS Adjusted results provided strong support for an association between higher scores of neighbourhood POS cigarette price promotions and a higher probability of financial stress (p=0.007). CONCLUSION Exposure to POS cigarette price promotions is associated with financial stress. This finding, coupled with previous reports that smokers with financial stress are less likely to attempt to quit or succeed in quitting smoking, suggests that POS cigarette price promotions may act as an impediment to smoking cessation.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa Tibbits
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ghada A Soliman
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Brandon Grimm
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Raees A Shaikh
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Molly McCarthy
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Neng Wan
- Department of Geography, University of Utah, Salt Lake City, Utah, USA
| | - Athena K Ramos
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Antonia Correa
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Rose SW, Anesetti-Rothermel A, Elmasry H, Niaura R. Young adult non-smokers' exposure to real-world tobacco marketing: results of an ecological momentary assessment pilot study. BMC Res Notes 2017; 10:435. [PMID: 28859667 PMCID: PMC5580291 DOI: 10.1186/s13104-017-2758-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background The aims of this pilot study were to assess and characterize non-current smoking young adults’ exposure to tobacco marketing through an ecological momentary assessment protocol. Methods Ecological momentary assessment (EMA) consists of repeated measurement of momentary phenomena and is well-suited to capture sporadic experiences in the real-world, such as exposure to tobacco marketing. EMA has the potential to capture detailed information about real-world marketing exposures in ways that reduce recall bias and increase ecological validity. In this study, young adults (n = 31; ages 18–25) responded to random prompts regarding their momentary exposure to tobacco marketing via text messages on their smartphones for 14 days (n = 1798 observations). Unadjusted and adjusted analyses were conducted using multilevel logistic regression to assess the odds of exposure accounting for correlation of multiple repeated measures within individuals while controlling for variability between individuals. Results Respondents reported, on average, two momentary exposures to tobacco advertising in the 14-day study period. In adjusted analyses, African–American (aOR 3.36; 95% CI 1.07, 10.54) and Hispanic respondents (aOR 5.08; 95% CI 1.28, 20.13) were more likely to report exposure to tobacco advertising. Respondents were also more likely to report exposure when also exposed to others using tobacco products and when they were at stores compared with at home (aOR 14.82; 95% CI 3.61, 60.88). Conclusion Non-smoking young adults report exposure to tobacco marketing particularly at the point-of-sale, with the highest likelihood of exposure among African-American and Hispanic young people. EMA protocols can be effective in assessing the potential impact of point-of-sale tobacco marketing on young adults. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2758-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shyanika W Rose
- Schroeder Institute at Truth Initiative, Washington, DC, USA.
| | | | - Hoda Elmasry
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Ray Niaura
- Schroeder Institute at Truth Initiative, Washington, DC, USA.,College of Global Public Health, New York University, New York, NY, USA
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Bayly M, Scollo M, White S, Lindorff K, Wakefield M. Tobacco price boards as a promotional strategy-a longitudinal observational study in Australian retailers. Tob Control 2017; 27:427-433. [PMID: 28735275 DOI: 10.1136/tobaccocontrol-2017-053753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/24/2017] [Accepted: 05/30/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Price boards in tobacco retailers are one of the few forms of tobacco promotion remaining in Australia. This study aimed to examine how these boards were used to promote products over a period of rapidly rising taxes. METHODS Observations were made in a panel of 350 stores in Melbourne, Australia, in November of 2013 (just before) and in 2014 and 2015 (after 12.5% increases in tobacco duty). Fieldworkers unobtrusively noted the presence and characteristics of price boards, and the brand name, size and price of the product at the top of each board. RESULTS Price boards were common in all store types apart from newsagent/lottery agents. The characteristics of the top-listed product changed notably over time: premium brands accounted for 66% of top-listed products in 2013, significantly declining to 43% in 2015, while packs of 20 cigarettes increased in prominence from 32% to 45%. The prevalence of packs of 20 cigarettes in budget market segments tripled from 2013 (13%) and 2014 (11%) to 32% in 2015, with no change in the proportion of packs that were under $A20 from 2014 (37%) to 2015 (36%). The rate of increase in the average price of the top-listed pack correspondingly flattened from 2014 to 2015 compared with 2013-2014. CONCLUSIONS Price boards promote tobacco products in ways that undermine the effectiveness of tax policy as a means of discouraging consumption. Communication to consumers about prices should be restricted to information sheets provided to adult smokers on request at the point of sale.
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Affiliation(s)
- Megan Bayly
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Michelle Scollo
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Sarah White
- Quit Victoria, Cancer Council Victoria, Melbourne, Australia
| | - Kylie Lindorff
- Quit Victoria, Cancer Council Victoria, Melbourne, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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Siahpush M, Farazi PA, Kim J, Michaud TL, Yoder AM, Soliman G, Tibbits MK, Nguyen MN, Shaikh RA. Social Disparities in Exposure to Point-of-Sale Cigarette Marketing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1263. [PMID: 28009807 PMCID: PMC5201404 DOI: 10.3390/ijerph13121263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022]
Abstract
While most ecological studies have shown that higher levels of point-of-sale (POS) cigarette marketing are associated with larger proportions of residents from lower socioeconomic and minority backgrounds in neighborhoods, there are no studies that examine individual-level social disparities in exposure to POS cigarette marketing among smokers in the United States. Our aim was to examine these disparities in a Midwestern metropolitan area in the United States. We conducted a telephone survey to collect data on 999 smokers. Cigarette marketing was measured by asking respondents three questions about noticing advertisements, promotions, and displays of cigarettes within their respective neighborhoods. The questions were combined to create a summated scale. We estimated ordered logistic regression models to examine the association of sociodemographic variables with exposure to POS cigarette marketing. Adjusted results showed that having a lower income (p < 0.003) and belonging to a race/ethnicity other than "non-Hispanic White" (p = 0.011) were associated with higher levels of exposure to POS cigarette marketing. The results highlight social disparities in exposure to POS cigarette marketing in the United States, which can potentially be eliminated by banning all forms of cigarette marketing.
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Affiliation(s)
- Mohammad Siahpush
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Paraskevi A Farazi
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Jungyoon Kim
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Tzeyu L Michaud
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Aaron M Yoder
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Ghada Soliman
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Melissa K Tibbits
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Minh N Nguyen
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Raees A Shaikh
- College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA.
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Siahpush M, Shaikh RA, Robbins R, Tibbits M, Kessler AS, Soliman G, McCarthy M, Singh GK. Point-of-sale cigarette marketing and smoking-induced deprivation in smokers: results from a population-based survey. BMC Public Health 2016; 16:302. [PMID: 27121197 PMCID: PMC4848780 DOI: 10.1186/s12889-016-2992-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 03/29/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Strict restrictions on outdoor cigarette marketing have resulted in increasing concentration of cigarette marketing at the point-of-sale (POS). The association between POS cigarette marketing and smoking-induced deprivation (SID) has never been studied. The aim of this study was to examine this association and how it is mediated by cravings to smoke, urges to buy cigarettes, and unplanned purchases of cigarettes. METHODS Data from a telephone survey of 939 smokers were collected in Omaha, Nebraska. POS cigarette marketing was measured by asking respondents three questions about noticing pack displays, advertisements, and promotions such as cigarette price discounts within their respective neighborhoods. SID was measured with the following question: "In the last six months, has there been a time when the money you spent on cigarettes resulted in not having enough money for household essentials such as food? [yes/no]" We used structural equation modeling to examine the study aim. RESULTS There was overwhelming evidence for an association between higher levels of POS cigarette marketing and a higher probability of SID (p < 0.001). This association was partly mediated by cravings to smoke, urges to buy cigarettes, and unplanned purchases of cigarettes during a visit to a neighborhood store (p < 0.001). CONCLUSION Given that POS cigarette marketing is associated with a higher probability of experiencing SID, policies that ban POS cigarette marketing might help some smokers afford essentials household items such as food more easily and thus have better standards of living.
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Affiliation(s)
- Mohammad Siahpush
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Raees A. Shaikh
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Regina Robbins
- />University of Nebraska Omaha, 6001 Dodge St, Omaha, NE 68182 USA
| | - Melissa Tibbits
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Asia Sikora Kessler
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Ghada Soliman
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Molly McCarthy
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Gopal K. Singh
- />The Center for Global Health and Health Policy, Global Health and Education Projects, P O Box 234, Riverdale, MD 20738 USA
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The Association of Exposure to Point-of-Sale Tobacco Marketing with Quit Attempt and Quit Success: Results from a Prospective Study of Smokers in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:203. [PMID: 26861379 PMCID: PMC4772223 DOI: 10.3390/ijerph13020203] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/02/2016] [Indexed: 11/29/2022]
Abstract
The aim was to assess the association of exposure to point-of-sale (POS) tobacco marketing with quit attempt and quit success in a prospective study of smokers in the United States. Data were collected via telephone-interview on exposure to POS tobacco marketing, sociodemographic and smoking-related variables from 999 smokers in Omaha, Nebraska, in the United States. Exposure to POS tobacco marketing was measured by asking respondents three questions about noticing pack displays, advertisements, and promotions in their respective neighborhoods stores. These three variables were combined into a scale of exposure to POS tobacco marketing. About 68% of the respondents participated in a six-month follow-up phone interview and provided data on quit attempts and smoking cessation. At the six-month follow-up, 39.9% of respondents reported to have made a quit attempt, and 21.8% of those who made a quit attempt succeeded in quitting. Exposure to POS marketing at baseline was not associated with the probability of having made a quit attempt as reported at the six-month follow-up (p = 0.129). However, higher exposure to POS marketing was associated with a lower probability of quit success among smokers who reported to have attempted to quit smoking at six-month follow-up (p = 0.006). Exposure to POS tobacco marketing is associated with lower chances of successfully quitting smoking. Policies that reduce the amount of exposure to POS marketing might result in higher smoking cessation rates.
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