11.9 Retail promotion and access

The retail environment is crucial to the marketing of tobacco products. ¹

11.9.0 Marketing of tobacco in retail outlets

In decades gone by, promotion in retail outlets merely supported advertising in the mass media and outdoors. Over the late 1980s and early 1990s, advertising in the media and outdoors (including on the outside of shops) was progressively more restricted, leading tobacco companies to systematically shift their marketing focus and budget to promotion inside retail outlets. ¹ Retail outlets became one of the few places in which the image of brands could be communicated, and relationships with consumers fostered. ^2,3 Throughout the 1990s it was common to see prominent advertisements not only on cigarette dispensing units, but also above and below the serving counter, hanging from the ceiling and elsewhere inside the shop. Carefully considered placement of tobacco products and advertisements maximised visibility (see Figure 11.9.0). ¹

Source: Quit Victoria

The tobacco industry also employed techniques such as strengthening on-pack brand imagery, redesigning point-of-sale hardware to emphasise particular brands, forming alliances with retailers, rewarding retailers through loyalty programs, and promoting brands through retail trade magazines. ^2,4 When retail advertising was restricted by some states, the tobacco industry often found ways to continue maximising retail exposure. ³ For example, restrictions allowed only one packet of each product line to be displayed, and Australian tobacco companies responded by introducing more products lines. ⁵ Peter Jackson product lines almost doubled from 1999 to 2005, and W infield went from 11 product lines in 1998 to 18 in 2004. The ways in which restrictions were undermined highlights the importance of this form of promotion to the tobacco industry. ³

This section summarises research and policy regarding:

• Display of products at the point of sale
• Legislation banning promotion and display in retail outlets
• Rationale for restrictions on advertising and display in retail outlets
• Opposition to restrictions on advertising and display in retail outlets
• Price promotion at the point of sale, including current Australian legislation
• Tobacco retailer density
• Reducing smoker capacity to access tobacco in retail outlets, and
• Public support for reducing retail promotion and access

11.9.1 Display of products at the point of sale

In the face of increasing restrictions on tobacco advertising at the point of sale (POS), displays of tobacco products were for many years in Australia a crucial form of promotion of tobacco products. They alerted customers to the available brands, and the features and appeal of the different brand extensions and variants. These displays enabled tobacco companies to communicate availability and capitalise on strengthened package design. ⁶ Displaying tobacco alongside other universally purchased consumer goods was likely to have created the impression that tobacco was much more socially acceptable and commonly used than was truly the case. ⁷ ‘Powerwalls’ of cigarettes would be displayed in supermarkets (see Fig 11.9.1) and typically dominated small retail outlets such as convenience stores, which are frequented by young people. ^8-10 POS product displays would show in carefully constructed ways a variety of packs deliberately designed to communicate brand values, thus blurring the line between display and promotion. ⁶

11.9.2 Legislation banning promotion and display in retail outlets

Although the Tobacco Advertising Prohibition (TAP) Act 1992 banned most forms of tobacco advertising in Australia, in-store advertising was permitted; however, this exception could be overridden by stronger state legislation. Throughout the late 1990s and early 2000s, all states and territories introduced bans on advertising in retail outlets, with the exception of product displays. The display of tobacco products at POS was then progressively banned in Australian states and territories over the 2000s—see Section 11.4 . 

Source: ASH Australia

11.9.2.1 International advertising and display bans

In the absence of legislation in some countries, POS promotion is ubiquitous. For example, US research published in 2014 found that almost all tobacco retailers (96%) had at least one tobacco marketing material, with an average of nearly 30 marketing materials per store. About one in ten retailers displayed tobacco products at heights of less than three feet (about 90cm) and displayed them within about 30cm of lollies. ¹¹

While about one-third of countries have restricted or banned POS advertising, fewer have banned POS product displays. ¹² Along with Australia, countries such as Canada, India, New Zealand, Norway, Russia, Thailand, and the UK have banned all tobacco advertising and displays at the POS (although some legislation exempts specialist tobacconists). ¹²

In the UK, bans of the promotion and display of tobacco products at POS were introduced in April 2012 in larger shops, with an exemption for smaller retailers. ¹³ Research showed that adolescents who continued to be exposed to POS displays in small shops were more susceptible to smoking, suggesting the need for a comprehensive ban. ¹⁴ In April 2015, the regulations were extended to tobacco specialty shops. ^13,15 Smaller retailers, such as newsagents, convenience stores, petrol stations, hotels, pubs and nightclubs, must now also adhere to bans of the promotion and display of tobacco products at the point of sale. ¹⁶ In the lead up to the ban, many retailers were unprepared for its implementation. Philip Morris and British American Tobacco (BAT) offered free solutions to retailers; Philip Morris offered shutters branded with its Nicocig e-cigarette range under the condition that retailers displayed Nicocig point of sale material in prominent positions, while BAT’s shutters advertise its MOR£ Together trade partnership scheme. ¹⁷

11.9.2.2 Compliance with laws

Research that has assessed adherence by retailers to POS regulations has generally found high compliance in developed countries such as Norway, ¹⁸ Ireland, ¹⁹ the UK, ²⁰ and Australia, ²¹ and lower compliance rates in developing countries such as India ²² and Mexico. ²³ A study in Beirut following a POS advertising ban in Lebanon showed very poor compliance, with widespread advertising still present. ²⁴ A lack of enforcement is a key impediment to the success of promotion restrictions, ¹⁵ which is particularly apparent in lower-income countries.

11.9.2.3 Auditing issues

Audits of retail tobacco marketing are increasingly used to monitor tobacco industry strategies and their influence on tobacco use. A systematic review of store audit methods found that their reliability is generally good, although the authors highlighted a range of un-standardised measures being cited and recommended  improvements in conduct and reporting. ²⁵

11.9.3 Rationale for restrictions on advertising and display in retail outlets

11.9.3.1 Fulfilling international obligations

Advertising and display bans are in line with evidence on the effects of promotion at POS on uptake and smoking (see below) and are helping Australia to fulfil its international obligations as a signatory to the WHO Framework Convention on Tobacco Control (FCTC). Australia became a Party to the FCTC on February 27, 2005. Article 13 obliges Parties to introduce and enforce a comprehensive ban on tobacco advertising, promotion and sponsorship, or to restrict these practices are far as is practically possible. It goes on to state that:

“Display of tobacco products at points of sale in itself constitutes advertising and promotion. Display of products is a key means of promoting tobacco products and tobacco use, including by stimulating impulse purchases of tobacco products, giving the impression that tobacco use is socially acceptable and making it harder for tobacco users to quit. Young people are particularly vulnerable to the promotional effects of product display. To ensure that points of sale of tobacco products do not have any promotional elements, Parties should introduce a total ban on any display and on the visibility of tobacco products at points of sale, including fixed retail outlets and street vendors”. ²⁶

11.9.3.2 Evidence on the effects of retail advertising and display on uptake

Young people who begin smoking early and persistently are at high risk for chronic nicotine dependence. ²⁷ Studies exploring the effects of tobacco promotion at the POS have consistently found significant associations between exposure to these promotions and smoking uptake among susceptible children and adolescents. ²⁸ Research in the US has shown that living in areas with greater volumes of retail cigarette advertisements is associated with young people having positive attitudes about smoking. ²⁹

Experimental research with Australian adolescents found that tobacco product pack displays and cigarette advertising influenced their beliefs about the ease of purchasing cigarettes, increased their ability to recall cigarette brands, and weakened their resolve not to smoke in the future. ³⁰ A Canadian study found that schoolchildren from neighbourhoods with high levels of in-store tobacco promotions and few government-sponsored health warnings had higher rates of smoking than schoolchildren from neighbourhoods with shops that had few such promotions. ³¹ Year 10 students aged 14–15 years in New Zealand who visited shops more than once per week were more susceptible to smoking and experimenting with smoking than those students who visited shops less than weekly. ³²

In 2012, the US Surgeon General concluded that advertising and promotional efforts of tobacco companies cause the initiation and progres­sion of tobacco use among young people. ³³ A meta-analysis of exposure to POS tobacco promotion and increased smoking and smoking susceptibility among children and adolescents published in 2016 showed that young people more frequently exposed to POS promotion had about 1.6 times higher odds of having tried smoking and approximately 1.3 times higher odds of being susceptible to future smoking, compared with those less frequently exposed. ³⁴ There was no difference between places where the only form of POS promotion is the tobacco product display and those that allow more extensive POS tobacco promotions, suggesting that any type of in-store tobacco promotion—whether signage, posters, or the pack display—is associated with increased odds of smoking and smoking susceptibility. ³⁴

Taken together, the evidence suggests that restricting POS advertising and display would be an effective strategy for discouraging young people from trying smoking, ^33,35 and to be effective, bans should cover both in-store advertising (such as brand or price promotions) and the display of tobacco products. ³⁴

11.9.3.3 Evidence on the effects of retail advertising and display on smoking, relapse, and unplanned purchases

Along with encouraging the uptake of smoking, retail promotion can also prompt unplanned purchases and smoking among current smokers, and relapse among recent quitters.

POS pack displays can lead to unplanned cigarette purchases, and influence brand selection. ³⁶ In a telephone survey of 2996 adults in Victoria, 25.2% of smokers reported having purchased cigarettes at least sometimes on impulse as a result of seeing a cigarette display. ³⁷ In a Western Australian intercept survey of 206 adult daily smokers who had been observed making a tobacco purchase, 22% of participants had made an unplanned cigarette purchase. ³⁶ POS displays influenced nearly four times as many unplanned as planned purchases (47% vs. 12%). ³⁶

A study of Australian adult smokers found that exposure to POS product displays was associated with a higher likelihood of smoking within the same four-hour period, and with higher levels of smoking, even when the person did not purchase cigarettes. ³⁸ A systematic review published in 2014 supported a positive relationship between exposure to POS tobacco promotion and smoking. It reported findings from several studies demonstrating a dose–response relationship (i.e., the greater the exposure the greater the smoking), as well as a temporal relationship between exposure and smoking outcomes. The authors conclude that these findings support the continuation and/or introduction of retail display bans. ³⁹  

For people who are attempting to quit, retail promotion can serve as a potential barrier to success in cessation attempts. POS displays can create temptation and lead to impulse purchases, increasing chances of relapse. ^{36, 40-42}  Victorian survey research found that 38% of smokers who had tried to quit in the past 12 months and 34% of recent quitters experienced an urge to buy cigarettes as a result of seeing retail cigarette displays. ³⁷ One-third of smokers thought the removal of cigarette displays from stores would make it easier for them to quit. ³⁷ Another Australian study examined sensitivity to displays measured as more frequently noticing displays, impulsively purchasing tobacco, and deciding on brand of purchase based on what products were on display. This found that increased sensitivity to retail tobacco displays reduced the likelihood of a smoker successfully quitting: pack displays were found to make quitting more difficult for smokers most sensitive to the presence of displays. ⁴⁰

11.9.3.4 Evidence on the effects of advertising and display bans on consumers

Research has also supported the efficacy of comprehensive bans on retail promotion.

Australian POS tobacco product display bans, introduced in New South Wales and Queensland, showed that young people aged 12 to 24 years were significantly less likely to recall POS product displays 6 and 24 months after bans were implemented. ⁴³ This group were also significantly less likely to report tobacco brand awareness, over-estimate peer smoking, or be current smokers. After the bans, young smokers were also less likely to report being triggered to think about smoking by seeing POS displays. ⁴³ The authors suggest that POS display bans can help to denormalise smoking among youth. ⁴³ Research in Ireland confirmed this denormalising effect, showing that post- implementation of POS display bans, the proportion of teens who thought more than 20% of their peers smoked significantly decreased, and 38% of teens thought the bans would make it easier for children not to smoke. ¹⁹ Survey research in Norway found that younger respondents were most likely to report being tempted to buy after seeing tobacco displays. The removal of POS tobacco displays was perceived by all age groups as an obstacle to young people's access to tobacco products, affected their attachment to cigarette brands, and helped denormalise tobacco. ¹⁸ An experimental study using a virtual store environment found that enclosing tobacco product displays deterred youth from attempting to purchase tobacco. ⁴⁴ An analysis of global evidence on the association between POS advertising bans and youth smoking has concluded that in countries with such bans, current smoking, daily smoking, and regular smoking participation in the past month is significantly lower, suggesting that banning tobacco promotion at the POS can reduce youth smoking. ⁴⁵

In relation to adults, a study comparing the effects of POS marketing restrictions in countries that had implemented them (Australia and Canada) with countries that had not (the US and the UK) found that the bans lead to lower exposure to tobacco marketing and fewer impulse purchases. ⁴⁶ A virtual store experiment asked adult participants to complete a shopping task under three different POS tobacco display conditions (open/visible, enclosed/not visible, and enclosed with pro-tobacco ads) and surveyed their perceptions and awareness. ⁴⁷ Results showed that urges to smoke were significantly reduced among smokers and recent quitters when POS displays were enclosed/not visible. Purchase attempts by smokers were also diminished in this condition, demonstrating that POS tobacco displays influence purchase behaviour, and banning them may reduce cues to smoke and unplanned tobacco purchases. ⁴⁷ A survey of young adults in London found that one in four former smokers felt that POS display bans had helped them quit, while 17 per cent of current smokers said that the bans helped them cut down. ⁴⁸  Data on smoking prevalence from 77 countries, including 20 countries with POS display bans, showed that such bans reduced daily adult smoking rates by approximately 7%. ⁴⁹

Best practices for regulation of retail environments have been summarised as (1) comprehensive bans on tobacco advertising, promotion and sponsorship at POS, and (2) a complete ban on the display of tobacco products at POS. ¹⁵

11.9.4 Opposition to restrictions on advertising and display in retail outlets

POS promotion has also been used by the tobacco industry to develop relationships with retailers. Retailers have been led to believe that their businesses will be harmed if they choose not to prominently display tobacco products. ⁶ Retailers in England described a relationship where manufacturers were competing to exert control over their retail environment through a combination of contractual obligations, incentives, and pressure from company representatives concerning pricing, display and other promotion of tobacco products (see also Chapter 10, Section 10.5). ⁵⁰

11.9.4.1 Tobacco industry opposition

The tobacco industry has fiercely opposed the growing global adoption of POS display bans. Philip Morris International (PMI) has argued that such bans are “ineffective and unnecessary” and “impede competition, impose significant costs and other burdens on retailers, encourage price competition (and cheaper cigarettes), and foster illicit trade in tobacco products”. On their website they continue to argue against plain packaging and other traditional regulatory measures, ⁵¹ despite volumes of evidence that regulatory measures like POS display bans are effective in reducing smoking uptake and overall prevalence.

Tobacco companies and retailers have attempted to overturn laws restricting display of tobacco products on several occasions. In 2012, a POS advertising ban in a New York village was quickly rescinded after seven tobacco companies and the New York Association of Convenience Stores filed a lawsuit arguing that the regulations violated their First Amendment free speech rights and the New York State Constitution. ⁵² The lawsuit also alleged that no credible evidence supports claims that tobacco marketing increases youth initiation of tobacco use. ⁵² In 2013, New York City passed comprehensive tobacco control legislation, which originally included display restrictions. However, these restrictions were subsequently dropped, with speculation that this was due to fierce opposition “by a coalition of retail stores and [a likely] powerful constitutional challenge”. ⁵³

Similar challenges have been less successful in countries outside of the US. In Scotland, Imperial Tobacco lost a two year battle that aimed to prevent a ban on POS displays. ^{54, 55} In March 2010, Philip Morris Norway initiated legal action against the Norwegian Government alleging that its POS display ban was incompatible with the 1994 European Economic Area Agreement (freedom of trade). The Oslo District Court ruled, in June 2012, that the POS display ban does not contravene this agreement, and concluded that it is a necessary measure to protect public health. ⁵⁶ A Nova Scotia tobacco store owner lost a constitutional challenge against restrictions on advertising and displaying tobacco products, with the judge ruling that any infringement on freedom of expression rights is necessary for the public good. ⁵⁷ Protection of public health was also a dominant consideration for the Argentinian Supreme Court, when Nobleza Piccardo, a BAT affiliate and one of the main tobacco companies in Argentina, opposed a provincial government’s prohibition on tobacco product advertising and promotion. ⁵⁸ Nobleza Piccardo argued that the provincial laws violated free speech and commercial freedoms. The company also claimed the laws were unconstitutional since provincial governments had no jurisdiction to change the scope of existing federal laws. The Supreme Court rejected these arguments, and held that nothing in the Constitution gave national congress exclusive power to legislate on health matters. The Court further ruled that the prohibitions upheld the right to health and the right to life, and were reasonable restrictions on commercial freedom because they were proportionate to public health concerns around tobacco use and conformed with international standards. ⁵⁹ The Court also found that restricting advertising did not infringe freedom of expression because commercial speech is not entitled to the same level of protection as freedoms of political or social speech. ¹²

A retail display ban was adopted in the Canadian province of Saskatchewan in 2002, and all Canadian provinces and territories have since banned retail displays. The Saskatchewan legislation was subjected to and survived a lengthy legal challenge by the tobacco industry to the Supreme Court of Canada. ⁶⁰ The promotion and advertising of tobacco products is restricted under the Part IV, Division 1 of the Canadian Tobacco Products and Vaping Act. ⁶¹

11.9.4.2 Retailer opposition

Tobacco industry and retail groups have frequently predicted or claimed far-reaching consequences of POS display bans for retailers. These have included:

Costly implementation. Head of the British Institute of Inkeeping (BII) Scotland surmised that “for a three-till shop the average cost [of implementing a display ban would] be between £13000 and £15000”. ⁶² The Association of Convenience Stores (ACS) in the UK similarly estimated that it would cost retailers £10,000+ per store to implement a display ban. ⁶³ Post-ban, the average cost in Ireland was calculated at just £300, with 90% of conversion costs for four out of every ten retailers being covered by the tobacco industry. ⁶³

Increased serving times. There were also estimates in the UK that queuing and serving times would double, leading to lost customers. These concerns were not realised following implementation, with no significant increase in service times. ⁶⁴

Substantial revenue losses. Following the removal of POS tobacco advertising and displays, Irish retailers claimed that cigarette sales fell 40% as a result of the legislation. However, research found no statistically significant change in cigarette pack sales, in any retail category, following implementation of the legislation. ⁶⁵

Shops closures. There were predictions and claims in Canada of widespread shop closures following the implementation of display bans; however, these were not borne out by subsequent analyses. ^{64, 65}

11.9.5 Price promotion at point of sale

11.9.5.1 Regulation of price boards

Although the display and advertising of tobacco products at POS is banned in most Australian jurisdictions, some legislation does permit signage that lists the available brand names and prices of tobacco products. For example, in Victoria, one unlit price board of no bigger than 150cm by 150cm is allowed, which must include a graphic health warning either on or beside it. ⁶⁶   Table 11.5.9.1 shows restrictions on price displays for each Australian state/territory.

11.9.5.2 Price promotion by price board

Price boards can serve as a form of advertising, with brands and prices strategically arranged to target particular groups or consumers. Following the 2011 POS display ban, an audit was undertaken in Victoria that examined the prevalence and contents of tobacco product price boards. It found that most stores arranged their lists of brands in a manner other than alphabetical or price order. Rather, brands listed at the top of the price board were over-represented by premium brands, were more frequently owned by the same tobacco company, and more likely to reflect the brand segment smoked by the socio-economic status of the store neighbourhood. The authors suggest that POS bans should also encompass bans on price board displays, in order to prevent tobacco companies using the boards as a means of advertising particular brands or discounts. ⁶⁷ Several leading Australian health organisations have also called for a ban on tobacco price boards. ⁶⁸

11.9.6 Tobacco retailer density

While display bans place tobacco products out of sight, they do not limit the availability of tobacco products for purchase. Even in Australian states that require licencing of tobacco retailers, there are no limits regarding the number of stores or licences in a given area. ^69-71 Studies exploring the effects of alcohol retailer density on drinking behaviours in the US have linked greater density around college campuses to higher rates of drinking ⁷² and drink driving. ⁷³ However, as noted by researchers in New South Wales, “Relatively little attention has been given to the retail availability of tobacco products despite the likelihood that ubiquitous supply may represent a primary form of tobacco promotion in Australia” ⁷⁴ (p.799). Their study on retail outlet density and smoker perceptions and behaviour found that approximately 88% of smokers reported daily retail availability of tobacco within walking distance, with a conservative estimate of one tobacco outlet for every 77 smokers. The study concluded that some groups of smokers appear vulnerable to the availability of tobacco, and that a reduction in the availability of tobacco would likely benefit smokers who wish to quit. ⁷⁴

11.9.6.1 Density as a form of targeting

11.9.6.1.1 Density greater in disadvantaged areas

People who are disadvantaged in terms of their employment type, income, and education level have the highest rates of smoking, ⁷⁵ and also experience poorer outcomes in terms of their health and life expectancy. ⁷⁶ Recent studies have examined the relationship between socioeconomic status (SES) and tobacco retailer density, and found a clear inverse association between the two. That is, the density of tobacco outlets tends to be higher in areas with lower average incomes. ^77-81 For example, a Western Australian study found that the most disadvantaged regional suburbs and towns had more than five times the number of tobacco outlets than the least disadvantaged. ⁷⁹ Researchers in New South Wales (NSW) confirmed this association after controlling for smoking prevalence, and have speculated that this trend may reflect a deliberate marketing strategy by the tobacco industry, rather than an issue of demand. ⁸⁰ Further research in NSW found that disadvantaged areas were significantly more likely to have higher tobacco outlet densities, and that after controlling for a range of demographic factors, density was significantly and positively associated with individuals' smoking status. ⁸²   Similarly, research conducted in regional Victorian towns found that, after adjusting for possible confounders, greater density of tobacco retailers in a suburb was associated with increased odds of occasional smoking among adults (AOR=1.37; 95% CI: 1.10, 1.71) but not daily or experimental smoking. ⁸³ A study in New York found that tobacco retailing around schools was greater in socially disadvantaged areas, ⁸⁴ while other research in the US found higher tobacco outlet density in areas with higher rates of same-sex couples, who also tend to live in lower income areas. This association was greater for male than female same-sex couples, after controlling for area-level characteristics like race, ethnicity and household income. ⁸⁵ Researchers in Scotland similarly found that areas with the lowest average household incomes have the highest density of alcohol and tobacco outlets, while the most well-off neighbourhoods have the fewest. ⁸⁶

The disproportionate number of tobacco outlets in low-SES areas has a number of implications for public health. Greater tobacco outlet density creates greater competition between retailers, ⁸⁷ leading to greater price competition that may have a more significant influence on people with lower incomes. It may contribute to the normalisation of tobacco use, which may exacerbate already high prevalence and acceptability among low-SES groups. ⁸⁷ Finally it may contribute to financial hardship by prompting greater daily consumption and making cessation more difficult. ⁷⁹

11.9.6.1.2 Density greater near young people

Similar to the greater density of tobacco retailers found in low SES area, there are also high densities of outlets close to schools and young people. ^{88, 89} In NSW, the median of tobacco outlet density around schools was shown to be significantly higher than the state median. ⁸² Research in Chicago found a greater concentration of tobacco outlets in neighbourhoods with a larger proportion of residents under 18, ⁹⁰ while a study in Ontario, Canada found that most retailers are within a short walk of a school. ⁷⁸ This proximity to tobacco retailers serves to increase exposure to and opportunity to purchase tobacco products by young people, ⁹¹ which may promote the transition from experimentation to regular smoking. ⁹²

11.9.6.2 Rationale for reducing tobacco retailer density

Reduced tobacco retailer density and proximity are associated with reduced risk of tobacco use behaviours among adults.  Results from a 2021 meta- analysis indicated that there was an estimated 2.48% reduction in risk of tobacco use behaviours with reduced exposure to tobacco retailer density and proximity. ⁹³  Given the relationship between retailer density and smoking behaviours (outlined next), tobacco control advocates have called for limitations to be placed on the number of tobacco retail outlets, particularly around schools. For example, zoning restrictions may be used to restrict the availability and visibility of cigarettes around young people. ^{33, 94} This approach draws on evidence of the positive effect of reductions in the density of alcohol outlets on alcohol-related problems. ^{95, 96}

11.9.6.2.1 Greater density leads to greater exposure

The widespread availability of tobacco can lead to greater exposure to cigarettes and advertising, particularly in areas that have not implemented POS display or advertising bans. The close proximity of schools to tobacco promotion and advertising has been linked to adolescents’ greater awareness of advertising in India. ⁹⁷ In the US, over two-thirds of students reported retail store exposure to pro-tobacco advertisements in 2012. ⁹⁸ Exposure to tobacco marketing via visits to small grocery, convenience, or liquor stores have been linked with a 50% increase in the odds of ever smoking among middle-school students in the US. ⁹⁹ Young people’s recall of POS tobacco displays, pro-smoking beliefs, and smoking behaviours all fell following POS display bans in Australia. ⁴³

11.9.6.2.2 Increased price competition

Research in South-East Queensland found that the price of cigarette packs is lower in low-SES suburbs compared with high-SES suburbs, possibly due to a greater density of outlets and therefore greater competition. ⁷⁷

11.9.6.2.3 Greater exposure leads to greater uptake

Greater density of tobacco retailers has been suggested as an important factor in the uptake of smoking. Areas that are more densely populated with tobacco retailers may promote adolescent smok­ing not only by increasing access but also by increasing environmental cues to smoke. ³³ A study in Scotland found that the density of retail outlets selling tobacco in residential neighbourhoods was associated with a greater likelihood of adolescents having ever smoked and currently smoking. The authors suggested that an appropriate policy response would be to reduce the overall density of outlets selling tobacco, rather than the more traditional approach of concentrating on ‘child spaces’, such as in proximity to schools. ¹⁰⁰  

A number of studies in the US have found higher rates of smoking among young people living ⁹⁰ or going to school ⁸⁸ in areas with a greater density of tobacco retailers. Research published in 2015 exploring uptake of a range of tobacco products among young adults found that tobacco outlet density was significantly associated with recent initiation of cigarettes and other combustibles (e.g., cigars), but this impact varied by product type and age. ¹⁰¹ Greater tobacco outlet density was associated with a higher likelihood of initiating cigarette use among adults aged 25–34 years, and of initiating use of non-cigarette combustible products among 18–24 year olds. ¹⁰¹ Another study found that greater tobacco outlet density in youth activity spaces (not home or school environments) was positively associated with smoking among young people. ¹⁰² Among African American young adults, one study found that gender appears to moderate the relationship between tobacco retailer density and tobacco use, such that the relationship is significant only among young women. ¹⁰³  Research in Japan found a significant dose-response relationship between smoking among marginalised and disadvantaged young people and patronage of convenience stores. ¹⁰⁴ Authors suggest that this relationship may be explained by young people’s friendship networks, where there was a greater smoking tendency among those who gathered outside the home. ¹⁰⁴ It was also reported, however, that smoking behaviour was strongly  influenced by tobacco displays and advertising in convenience stores, which are frequented by students on their journey to or from school. ¹⁰⁴

Smoking experimentation/initiation among young people has also been linked with greater retailer density and exposure to retail advertising. ^94,105-108 A study in the US found that retail density was associated with intention to smoke among African American youth. ¹⁰⁹ Research in New Zealand found that students attending schools surrounded by a high density of tobacco outlets had greater odds of smoking susceptibility, and of those, current smokers were more likely to try to purchase tobacco, compared with students at schools with low density of outlets. ¹¹⁰ The authors suggest that reducing the density of tobacco outlets around schools would be one way of achieving the country’s goal of a smoke-free nation by 2025. ¹¹⁰ Extending research linking exposure to point-of-sale marketing with cigarette smoking among young people, research in Scotland also found that living in an area of high tobacco retail density predicted intention to try electronic cigarettes among adolescents. ¹¹¹

11.9.6.2.4 Greater exposure leads to greater relapse, unplanned purchases

Recent research has explored the effects of tobacco availability and exposure on smoking cessation. A study in Finland found that living within walking distance of a tobacco store reduced the likelihood of smoking cessation among men who were moderate/heavy smokers. ¹¹² Research in Scotland found that adults living in environments with a greater availability of tobacco outlets were more likely to start and/or keep smoking, and less likely to quit. ¹¹³ The high availability of tobacco can serve to undermine cessation by triggering or enabling impulse purchasing. ⁷⁴ As a corollary, research in Australia found that reduced availability of tobacco is likely to benefit smokers who wish to quit. ⁷⁴  Vulnerable groups may be particularly affected by tobacco availability and exposure. A study in California found tobacco retailer densities were “two-fold greater among smokers with serious mental illness than for the general population, and were associated with poorer mental health, greater nicotine dependence, and lower self-efficacy for quitting”(p.1454). ¹¹⁴

Together, these studies highlight that the interests of the many smokers who wish to quit are not well-served by the current ubiquity of tobacco in retail environments.

11.9.6.3 International regulatory precedents

11.9.6.3.1 End to sales in drug stores

Pharmacies in Australia have never sold tobacco products. The Pharmacy Board of Australia’s guidelines state that the sale or supply of tobacco products is considered unprofessional conduct within the meaning of the National Law. ¹¹⁵ However, this is a topic of concern in North America and other places internationally.

The sale of tobacco products has been banned in pharmacies in several locations throughout the world. Proponents of bans argue that selling tobacco products creates a conflict of interest for pharmacists and is inconsistent with the practice of pharmacy, that otherwise provides health care advice and health-related services. Opponents tend to argue that bans will lead to significant losses in revenue and economic hardship for pharmacies. ¹¹⁶  

In Canada, the sale of tobacco is prohibited in pharmacies in all provinces and territories except for British Columbia. A report from the Physicians for a Smoke-Free Canada concluded that despite initial predictions, banning cigarette sales in pharmacies did not result in pharmacy closures in the province of Ontario. ¹¹⁷ Pharmacy sales of tobacco products are also banned in the United Kingdom, France, Italy, ¹¹⁶ and a number of cities in California and Massachusetts. ¹¹⁸ On February 5, 2014, the large US pharmacy chain, CVS, announced that it would stop selling tobacco products on October 1 ^st , and implemented the policy a month early. ^{119, 120} Although there were predictions of enormous revenue losses, a year and a half after the announcement and eight months after implementation, CVS’s stock was double what it had been before the announcement, and was at a record high. ¹²¹

Despite these restrictions, the sale of tobacco in US pharmacies has been widespread. Between 2005 and 2009, pharmacy cigarette sales increased 22.72%, while total cigarette sales decreased 17.43%. ¹²² However, pharmacists are overwhelmingly opposed to these sales. A study in Los Angeles suggested that when given a choice, pharmacists choose not to sell tobacco products, ¹²³ while research in New York found that most pharmacists surveyed would prefer to work in a pharmacy that does not sell tobacco products. ¹²⁴ A majority of consumers surveyed recently also supported either banning sales of tobacco in grocery stores and pharmacies, or implementing display restrictions. ¹²⁵ Pharmacies affiliated with chains, grocery stores, and mass merchants are often unwilling to discontinue the sale of tobacco products, therefore stronger legislation may be needed as a public health measure. ¹²³

11.9.6.3.2 Voluntary abandonment of tobacco sales

Retailers can play a key role in reducing the availability of tobacco. Research to date on voluntary abandonment of tobacco sales has focused primarily on pharmacies; however, several grocery store chains across the US have also voluntarily stopped selling tobacco products. ¹²⁶ In 1996, Target stopped selling tobacco products, ¹²⁷ and Walmart has also considered eliminating them from its stores. ¹²⁸ Costco has reportedly been slowly phasing out the sale of tobacco from some of its stores, stating that tobacco is a very low margin business, tends to have higher theft, and can be labour intensive. ¹²⁹ In Australia, Aldi does not sell cigarettes. Voluntary initiatives can also serve to increase support for the introduction of mandatory policies. For example, the abandonment of tobacco sales by some pharmacies preceded recent bans on pharmacy tobacco sales in many US cities. ¹²⁶

An intervention encouraging low-volume tobacco retailers to stop selling tobacco was implemented in Tasmania. ¹³⁰ Low-volume retailers (n=164), identified through the tobacco retailer licensing system in Tasmania, were contacted in the intervention. Retailers received postcards, letters and onsite visits about the business benefits of stopping tobacco sales, in the lead up to the expiry date for their tobacco license. Of the contacted retailers, 11% stopped selling tobacco after being exposed to the intervention (not including retailers who stopped due to business closure). Interviews with retailers indicated that the intervention led many to considering stopping tobacco sales who may have otherwise not considered it. Retailers indicated that they resonated with the intervention’s messages about business-related reasons to stop (e.g., licensing fee costs and low profit margin), as well as the case studies about retailers who had stopped selling tobacco and the relationship building with the intervention’s project officer. ¹³⁰

Research in New Zealand found that most convenience store owners were unwilling to voluntarily stop or restrict tobacco sales, as they perceived it as a key product for their businesses. The authors suggest that reducing the availability of tobacco likely requires legislative approaches, accompanied by sustained community pressure and support for convenience store owners who are willing to change their business model. ¹³¹ A systematic analysis of ex-tobacco retailers in NSW explored which retailers stop selling tobacco, and why. Results showed that retailers who stopped selling tobacco were disproportionately likely to be businesses with low sale volume (i.e., businesses where tobacco made up only a very small proportion of total sales). Low profits from tobacco sales contributed to the decision for almost all retailers, but other major changes were also a significant prompt to stop selling. For example, some changed their businesses focus or location, while others cited legislative changes (such as display bans and changes to vending machine requirements) as influencing the decision to stop selling. ¹³²

11.9.6.3.3 Direct government action to reduce density

There have been several attempts by governments internationally to reduce the density and availability of tobacco products. For example, a number of jurisdictions in Canada prohibit tobacco sales in specific places, such as schools, universities, bars, and hospitals. ¹³³ Similarly, several places in the US mandate minimum distances that tobacco retailers must be from schools. ^134,135 In the United Arab Emirates, tobacco products cannot be sold in locations that are within 100 metres of places of worship, and within 15 metres of kindergartens, schools, universities and colleges. Shisha cafes also have to be at least 150 metres away from residential areas, and these cafes can only be open from 10am to 12pm. ¹³⁶

11.9.6.4 Licencing schemes to reduce retailer density

Retailer licensing schemes that limit the type of outlets permitted to sell tobacco, the hours in which it can be sold, and/or the location have also been suggested as a way to reduce tobacco retailer density. Some public health experts have suggested that licensing schemes that reduce tobacco retailer density or limit their proximity to schools or licensed premises are an important next step in tobacco control. Placing restrictions on the circumstances in which a licence can be obtained could serve to reduce the availability of tobacco. This could be achieved for example, by limiting the type of outlets permitted to sell tobacco, the hours in which it can be sold, and the location (for example, limiting the number near schools). ^{69, 70} A comparison of policy approaches in the US for reducing density found that a minimum allowable distance of 500 feet between tobacco outlets had the single greatest impact, while a combined pharmacy and near-schools ban would also significantly reduce density. ¹³⁷

A qualitative study in New Zealand explored retailers' views on existing and potential future tobacco retail policies. About half of the retailers were positive or indifferent about a possible future licensing scheme, and several believed a mandatory licensing system would not have a large impact on them. Restricting the sale of tobacco within 500m of schools was also supported more than policies that would prohibit certain outlets from selling tobacco. The authors conclude that a proposed licensing policy is unlikely to be met with blanket opposition from tobacco retailers. Framing policies in terms of how they can protect young people may be helpful in increasing support for such policies. ¹³⁸

The cost of licences may also prompt retailers to voluntarily stop selling tobacco products, with research in South Australia showing that a significant tobacco licence price increase led to an overall decrease in the number of retailers purchasing licences. ¹³⁹   A study in California following the introduction of tobacco retail permits also found an immediate reduction in the number of stores selling tobacco. ¹⁴⁰

A summary of evidence in relation to tobacco retailer regulation in 2015 concluded that “a combination of licensing, enforcement, education, promotion restrictions at the point of sale, and a well-funded compliance program to prevent sales to minors is a best-practice approach” (p.1). ¹⁴¹  

Smokers taking part in a survey in New Zealand in 2015 suggested that policies that remove tobacco from smokers’ usual places of purchase would be effective in reducing the initiation and cessation of smoking. ¹⁴²

See InDepth 11B for a detailed discussion of licencing of tobacco sellers.

11.9.6.5 Reductions in smoking following reductions in retailer density

Following the substantial reduction (83%) in the type and number of tobacco outlets in Hungary in 2013, ¹⁴³ a survey found that about one quarter of respondents reported changing their smoking habits. Thirteen percent of respondents thought they would not buy cigarettes as often and would smoke less. Only a small minority indicated they would visit the tobacconist less frequently but buy larger amounts of cigarettes each time and continue smoking at the same level. These results provide some of the first evidence internationally of the real-world effects of reduced retailer density. ¹⁴⁴

11.9.7 Reducing smoker capacity to access tobacco in retail outlets

11.9.7.1 Full smoker licensing

NSW public health academic Professor Simon Chapman has proposed a multi-faceted licencing system for smokers to be able to purchase cigarettes, which includes the following elements:

• Smart card technology
• A database of smokers
• A maximum purchase limit chosen by the smoker
• A maximum daily limit of 50 cigarettes per day, averaged across two weeks
• A reasonable licence fee
• Periodic renewal
• A financial incentive to surrender the licence
• A 6-month cooling off period that allows smokers to cancel their licence revocation
• A knowledge of risk test for new smokers, similar to the test undertaken when obtaining a driver’s licence
• The possibility of a gradual increase in the minimum age for purchase. ¹⁴⁵

However, opponents of this proposal argue that regulations should remain focused on the promotion and sale of tobacco products rather than the purchaser. By focusing on individual smokers, it is argued, a system that licensed smokers would condemn victims, further stigmatise smokers, and marginalise the poor. ¹⁴⁶

11.9.7.2 Smart cards

Other Australian researchers have suggested the introduction of a “smart card” licencing system that smokers would need to obtain in order to buy cigarettes. Producing the licence would be a precondition to buying tobacco products, while retailers would be required to reconcile their stock purchases against a digital record of retail sales to card-holding smokers. Together, these requirements would aim to reduce unlawful sales to minors, and to use the gathered information in an effective and tailored way to help adult smokers quit. ¹⁴⁷

11.9.7.3 Reducing children’s access

In light of a robust body of evidence showing that almost all smokers start smoking when they are teenagers, ³³ some public health experts and health groups have proposed further limiting young people’s ability to purchase tobacco. For example, by raising the minimum smoking age to 21 or 25, or by creating a ‘tobacco-free generation’ whereby the sale of tobacco is banned for people born in or after a certain year. ^148,149

Additionally, in September 2018 Western Australia became the first Australian state to pass legislation banning persons under the age of 18 from selling tobacco products (s 18A of the Tobacco Products Control Act 2016 (WA)). ¹⁵⁰

See Section 5.21 for a detailed discussion of such proposals. 

11.9.8 Public support for reducing retail promotion and access

Public support for new policies often sways “politicians’ willingness to introduce new tobacco control strategies” (p.5). ¹⁵¹

Data from the National Drug Strategy Household Survey, 2019 suggests that a majority of Australians 14 years and over (about 63%) support proposals for raising the minimum legal age of supply to 21 years and over. ¹⁵² Support is higher among older age groups, with 69.5% of those aged 70 and over in support, followed by those aged 30-39 (66%). Support was also higher among never smokers (69.3%) and ex-smokers (57.7%) than among smokers (44.6%). ¹⁵²

There is extensive support among consumers for the implementation of display bans and other retail restrictions. In Norway, the POS tobacco display ban was supported by a majority of the population, and by one out of three daily smokers. ¹⁸ Likewise, the removal of POS displays in Ireland was well supported by the population. ¹⁹ Interviews with smokers and ex-smokers in New Zealand indicated that tobacco displays tempt smokers attempting cessation, and there was widespread support (including among retailers) for display bans in assisting smokers to quit. ^153,154   Surveys of adolescents have also shown support for New Zealand's smoke-free goal and the interventions that could help attain it, although non-smokers showed greatest support with rates declining with participants’ increased smoking frequency. ¹⁵⁵ Researchers in New York found that, while opinions varied between smokers and non-smokers, price and retail-based tobacco control strategies were consistently supported by the public. ¹⁴⁹

There were also substantial public support in New Zealand for ending sales of tobacco products altogether within 10 years, although smokers were concerned with the availability of effective nicotine substitutes. ¹⁵¹ Similarly, research in Victoria in 2009–10 found that many adults and smokers were supportive of restrictions being placed on the sale of cigarettes in the future, including the complete phase out of sales. ¹⁵⁶ Only a minority of smokers indicated that cigarette sales should never be banned. ¹⁵⁶ Data from the 2019 Victorian Smoking and Health Survey (VSHS) found 52.8% of all respondents, and 31.7% of smokers, thought phasing out the retail tobacco sales would be a good thing. ¹⁵⁷ Only 19.2% of respondents, and 39.6% of smokers, thought phasing out sales would be a bad thing. Phasing out sales within the next five years was supported by 38.2% of respondents, and 27.1% of smokers, while 26.6% of respondents and 18% of smokers supported phasing out within the next ten years. There was higher support for phasing out within the next five years among respondents aged 30 year or over. ¹⁵⁷ According to data from the 2018 EUREST-PLUS International Tobacco Control Policy Evaluation Project Six European Countries Survey, 40% of European smokers and recent ex-smokers support a total ban on tobacco products with the provision of cessation support. In addition, 48.8% support holding tobacco companies responsible for tobacco harm and 50.5% support increasing regulation measures. ¹⁵⁸

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