Electronic cigarette and smoking paraphernalia point of sale displays: an observational study in England

Changing awareness and sources of tobacco and e-cigarettes among children and adolescents in Great Britain

INTRODUCTION

It is illegal in the UK to sell tobacco or nicotine e-cigarettes to people under the age of 18 years, as is displaying tobacco cigarettes at the point of sale. This paper examined changes in exposure to display of these products in shops and sources of these products among children and adolescent users over time METHODS: Data from representative repeated online cross-sectional surveys of youth in Great Britain (11-18 years) were used (2018-2022; n=12 445). Outcome measures included noticing product displays and sources of e-cigarettes and tobacco cigarettes. Logistic regressions examined the associations of these outcome variables over time and with sociodemographic variables.

RESULTS

Of 12 040 participants with complete data, 10.1% used some form of nicotine product (4.2% cigarettes, 2.9% e-cigarettes, 3.0% both) at least occasionally. The likelihood of noticing tobacco cigarettes on display fell over time for both supermarkets (2018: 67.1% to 2022: 58.5%) and small shops (2018: 81.3% to 2022: 66.3%), but the likelihood of noticing e-cigarettes in supermarkets rose (2018: 57.4% to 2022: 66.5%). Sources of tobacco cigarettes did not differ over time, but e-cigarette users were more likely to get their e-cigarettes from small shops in 2022 (51.2%) vs 2019 (34.2%) (OR 2.02, 95% CI 1.24, 3.29).

CONCLUSION

This study provides evidence that current policies to limit awareness of and access to both tobacco and e-cigarettes among adolescents in the UK may not be effective. UK policies on the advertising, promotion and sale of both tobacco and e-cigarettes need to be reinforced to deter use among children and adolescents.

An observational study of the marketing practice of e-cigarette specialty stores in two large cities in China: Is there potential to normalize the use of e-cigarettes?

INTRODUCTION

Supervision measures in China have designated offline retail as the only legal channel for the sale and advertising of e-cigarettes. Specialty stores, exclusively selling vaping devices and e-liquids, are professionally designed to showcase company images and provide the best examples of e-cigarette marketing strategies. The goal was to analyze the retail marketing practice of e-cigarette specialty stores and provide a scientific reference for future e-cigarette point-of-sale regulation.

METHODS

On-site observations were conducted in specialty stores among the popular business districts of Chengdu and Shanghai, China, from January to May 2021. 'Dianping', known as 'Chinese Yelp', was used to identify 8 business districts in Shanghai and 5 in Chengdu as observation sites. Two trained observers visited each store in the identified business districts. The data were collected with a checklist, which consisted of 5 sections with 37 items, including basic information, marketing practice, age restriction and health warnings.

RESULTS

In total, 161 e-cigarette specialty stores, including 82 specialty stores in Shanghai and 79 in Chengdu, were identified. Of these stores, 156 were single-brand retailers and 5 were multi-brand retailers. Each store displayed e-cigarette products, which were visible from outside the store. The most common e-cigarette products were rechargeable kits and nicotine-containing e-liquids, which were available at all specialty stores. Frequent forms of promotion were free e-liquid samples (100%) and slogans (57.8%). Signage stating prohibition of minor use and purchase was presented at 141 (87.6%) specialty stores. Relatively few specialty stores (31.7%) displayed health warnings.

CONCLUSIONS

E-cigarette specialty stores featured highly visible product displays, varied product selections, abundant marketing materials, free trial services, absent entry restrictions for minors, and a lack of health warnings. Policymakers should move to reduce youth exposure to e-cigarette products and marketing in the retail environment by strengthening regulations on product display and marketing.

Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

OBJECTIVES

To estimate the impact of electronic cigarette (e-cigarette) retail display exposure on attitudes to smoking and vaping (susceptibility to tobacco smoking and using e-cigarettes, and perceptions of the harms of smoking and e-cigarette use).

DESIGN

Between-subjects randomised experiment using a 2 (e-cigarette retail display visibility: high vs low)×2 (proportion of e-cigarette images: 75% vs 25%) factorial design.

SETTING

Online via the Qualtrics survey platform.

PARTICIPANTS

UK children aged 13-17 years (n=1034), recruited through a research agency.

INTERVENTION

Participants viewed 12 images of retail displays that contained e-cigarette display images or unrelated product images. E-cigarette display images were either high or low visibility, based on a conspicuousness score. Participants were randomised to one of four groups, with e-cigarette display visibility and proportion of e-cigarette images, compared with images of unrelated products, manipulated: (1) 75% e-cigarettes, high visibility; (2) 25% e-cigarettes, high visibility; (3) 75% e-cigarettes, low visibility; (4) 25% e-cigarettes, low visibility.

MAIN OUTCOME MEASURES

The primary outcome was susceptibility to smoking (among never smokers only). Secondary outcomes were susceptibility to using e-cigarettes (among never vapers only), and perceptions of smoking and e-cigarette harm (all participants).

RESULTS

Neither e-cigarette retail display visibility, nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to smoking (visibility: OR=0.84, 95% CI 0.62 to 1.13, p=0.24; proportion: OR=1.34, 95% CI 1.00 to 1.82, p=0.054 (reference: low visibility, not susceptible)).Planned subgroup analyses indicated that exposure to a higher proportion of e-cigarette images increased susceptibility to smoking among children who visited retail stores more regularly (n=524, OR=1.59, 95% CI 1.04 to 2.43, p=0.034), and those who passed the attention check (n=880, OR=1.43, 95% CI 1.03 to 1.98, p=0.031).In addition, neither e-cigarette retail display visibility nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to using e-cigarettes (visibility: OR=1.07, 95% CI 0.80 to 1.43, p=0.65; proportion: OR=1.22, 95% CI 0.91 to 1.64, p=0.18).Greater visibility of e-cigarette retail displays reduced perceived harm of smoking (mean difference (MD)=-0.19, 95% CI -0.34 to -0.04, p=0.016). There was no evidence that the proportion of e-cigarette images displayed had an effect (MD=-0.07, 95% CI -0.22 to 0.09, p=0.40).Perceived harm of e-cigarette use did not appear to be affected by e-cigarette retail display visibility (MD=-0.12, 95% CI -0.28 to 0.05, p=0.16) or by the proportion of e-cigarette images displayed (MD=-0.10, 95% CI -0.26 to 0.07, p=0.24).

CONCLUSIONS

There is no evidence in the full sample to suggest that children's susceptibility to smoking is increased by exposure to higher visibility e-cigarette retail displays, or to a higher proportion of e-cigarette images. However, for regular store visitors or those paying more attention, viewing a higher proportion of e-cigarette images increased susceptibility to smoking. In addition, viewing higher visibility e-cigarette images reduced perceived harm of smoking. A review of the current regulatory discrepancy between tobacco and e-cigarette point-of-sale marketing is warranted.

TRIAL REGISTRATION NUMBER

ISRCTN18215632.