Anywhere, anytime: Retail access to tobacco in New South Wales and its potential impact on consumption and quitting

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Abstract

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. This study aimed to explore the number and distribution of tobacco outlets, smokers’ perceptions about the availability of tobacco and the role availability may play in tobacco consumption and quitting attempts in Australia. The study comprised two parts: Part A involved mapping retail tobacco outlets in the Hunter Region of NSW, Australia. Part B involved a statewide telephone survey of 539 current smokers aged 18 years and over in NSW. Part A identified 1270 retail tobacco outlets, giving a density of one outlet per 384 persons aged over 15 years, or one outlet per 77 smokers. Associations between socioeconomic status of areas and retail availability of tobacco were not found. Of the survey respondents in Part B, 87.5% indicated that they would be within walking distance of a retail tobacco outlet during their daily activities. Those who were younger, male and single were more likely to purchase tobacco at convenience-type outlets. We therefore conclude that some groups of smokers appear vulnerable to the availability of tobacco and a reduction in the availability of tobacco is likely to benefit smokers who wish to quit.

Research highlights

► 88% of smokers reported daily retail availability of tobacco in walking distance. ► One tobacco outlet for every 77 smokers. ► No clear association between socio-economic status and availability of tobacco. ► Reduced availability of tobacco is likely to benefit smokers who wish to quit. ► High availability appears to affect consumption and quitting behaviours.

Introduction

Research literature and regulatory policy have identified factors which influence the uptake and consumption of tobacco (e.g. the influence of family/peer social norms on the demand side, and the impact of price and product promotion on the supply side). However, relatively little attention has been given to the promotion of smoking via widespread retail availability of tobacco products (Wakefield & Germain, 2006). Ubiquitous supply may represent the primary form of tobacco promotion in countries where tobacco marketing is very restricted (Lavack & Toth, 2006). In Australia, reports by government committees and tobacco control experts have long identified the need to regulate the supply of tobacco as essential for reducing rates of smoking (Senate Community Affairs References Committee, 1995, VicHealth Centre for Tobacco Control, 2003).

If tobacco availability were reduced, research on product access (Clarke, 1998, Johnson, 2002) would predict reduced consumption due to travel, incurring a costlier product. Reduced availability is also likely to contribute to the de-normalisation of tobacco. Theories such as the Theory of Planned Behaviour (Ajzen, 1985), would suggest that high availability would lead to increased smoking behaviour via increasing the perceived acceptability of smoking (social norms) and increasing perceived behavioural control for purchasing behaviour. High availability of goods is also likely to lead to reduced price through increased price competition (Hausman & Leibtag, 2005), and therefore increased purchasing. Two United States (US) studies reported an association between youth smoking prevalence and access to tobacco products, particularly for disadvantaged groups (Chaloupka and Pacula, 1999, Pokorny et al., 2003). While the effect of reduced availability appeared to be smaller than that of increased price (Chaloupka & Pacula, 1999), availability appears worth exploring in the context of a multi-faceted tobacco control policy. This is particularly so if it is able to target prevalence among disadvantaged groups for whom declines in smoking rates have been less marked (White, Hill, Siahpush, & Bobevski, 2003). Evidence from other products including alcohol and fast food, supports the view that higher retail availability is associated with higher sales and adverse health outcomes (Ashe et al., 2003, Burton et al., 2005, Godfrey, 1989, Jekanowski et al., 2001, Mosher, 1985, Weitzman et al., 2005, Zhu et al., 2004).

The potential for high retail tobacco availability to increase smoking uptake and reduce smoking cessation is supported primarily by research in the US and the UK which identified a range of socio-specific contextual effects promoting smoking among neighbourhood populations with poorer education and lower income (Duncan et al., 1999, Ellen et al., 2001, Reijneveld, 2002, Ross, 2000). These studies found that living in certain geographically-defined areas had an effect on the probability of being a smoker, independent of the demographic characteristics of the residents of those areas, suggesting that both structure and social contagion influence smoking behaviour (Ellen et al., 2001). The frequent visual cues to smoke provided by retail displays may also act to induce both purchasing and smoking behaviour (Wakefield & Germain, 2006), even to the point of impulse purchasing, i.e. purchasing tobacco when the smoker had not intended to do so.

A small group of studies in the US have identified a relationship between tobacco outlet density and aggregated data on the socioeconomic conditions of neighbourhoods (Hyland et al., 2003, Laws et al., 2002, Schneider et al., 2005). These data suggest that there is a greater density of tobacco outlets in disadvantaged neighbourhoods. Such data support the view that greater access may potentially facilitate higher smoking rates in vulnerable populations either by increasing smoking uptake rates among youth or relapse rates among those attempting to quit smoking. It has been noted that promoting availability of tobacco products in specific areas has been tobacco companies’ response to marketing restrictions (Reid, Peterson, Lowe, & Hughey, 2005).

Four US studies have utilised both individual and aggregate data to explore the relationship between retail access to tobacco and neighbourhood demographic characteristics in defined areas (Chuang et al., 2005, Novak et al., 2006, Peterson et al., 2005, Reid et al., 2005). One study of those aged 11–23 years found that youths in areas with the highest tobacco outlet density were 13% more likely to be smoking than those in low-density areas, and that retail tobacco outlets were disproportionately located in disadvantaged neighbourhoods (Novak et al., 2006). However, the varying results suggest that the relationships between factors may be complex and partly dependent on relative levels of inequality and the retail geography across different locations (Chuang et al., 2005, Peterson et al., 2005). A recent New Zealand study found that individuals living in the quartiles of neighbourhoods with the best access to supermarkets and convenience stores had a higher odds of smoking compared with individuals in the worst access quartiles (Pearce, Hiscock, Moon, & Barnett, 2009). However, the association between neighbourhood accessibility to supermarkets and convenience stores was not apparent once deprivation and rurality were incorporated in the model (Pearce et al., 2009). The data on retail access to tobacco and smoking behaviour are therefore complex to interpret. It may be that the addition of population survey data on smoking and quitting behaviour may help to clarify the role of retail access to tobacco.

In Australia, the influence of availability factors other than price on smoking is virtually unstudied. A multi-level study indicates that the level of neighbourhood disadvantage has an impact on smoking status (Migliorini & Siahpush, 2006). A 2003 study showed that areas in the lowest SES quartile (where smoking prevalence is highest) contained significantly more tobacco outlets per capita than the highest SES quartile, while the highest SES quartile (where smoking prevalence is lowest) had the lowest number of tobacco outlets per capita (Hickling, Quinn, Miller, & Kriven, 2003). The present study aimed to explore the number and distribution of tobacco outlets, and smokers' perceptions about the role tobacco availability may play in consumption and attempts to quit. More specifically the study aimed to provide some initial exploration of the following questions:

  • What is the level of availability of tobacco in NSW, Australia, in terms of the distribution and reach of retail tobacco outlets?

  • Do current smokers exhibit purchasing and consumption patterns that are likely to be influenced by product availability or convenience?

  • Do lower SES areas or individuals have greater retail access to tobacco?

Section snippets

Method

The current study comprised two parts. Part A involved mapping retail tobacco outlets in the Hunter Region of NSW. Part B involved a statewide survey of smokers in NSW. The studies were conducted in 2004–2005. Ethical approval was provided by the University of Newcastle Human Research Ethics Committee.

Number and type of tobacco outlets

A total of 1270 retail tobacco outlets were identified. The corresponding population for the wider Hunter Region in 2005 was 609,780 (ABS, 2006) giving a density of one outlet per 480 persons, or one outlet per 384 persons aged 15 years or above. Based on a 2005 smoking prevalence of 20.1% (daily or occasional) among NSW residents aged 16 years or over (NSW Health, Population Health Division, 2006), 1270 retail tobacco outlets equate to approximately one outlet per 77 smokers.

Tobacco outlets

Discussion

Supermarkets are clearly the dominant usual place of cigarette purchase. However, in relation to relapse, similar proportions of smokers make their first purchase at supermarkets, service stations and corner stores. Tobacco availability is high, and data suggest that the high availability may affect consumption and quitting behaviours for some smokers.

Conclusions

Tobacco is a highly available product in the Australian community. It appears likely that this level of availability and purchasing patterns may contribute to the consumption of tobacco and the maintenance of smoking behaviour and to undermining smokers’ attempts to quit. While more definitive studies would be beneficial, it appears likely that addressing availability should be included in tobacco control activities. Where regulatory changes (such as outlet licensing) are made, regulators and

Acknowledgments

This paper was prepared with infrastructure support from the Hunter Medical Research Institute.

References (37)

  • P.M. Clarke

    Cost–benefit analysis and mammographic screening: a travel cost approach

    Journal of Health Economics

    (1998)
  • C. Duncan et al.

    Smoking and deprivation: are there neighbourhood effects?

    Social Science & Medicine

    (1999)
  • C.E. Ross

    Walking, exercising, and smoking: does neighbourhood matter?

    Social Science & Medicine

    (2000)
  • I. Ajzen

    From intentions to actions: a Theory of Planned Behavior

  • M. Ashe et al.

    Land use planning and the control of alcohol, tobacco, firearms, and fast food restaurants

    American Journal of Public Health

    (2003)
  • Australian Bureau of Statistics. (2001). Census of population and housing – Socio-economic Indexes for Areas (SEIFA),...
  • Australian Bureau of Statistics. (2006). Regional population growth, Australia, 2004–2005: Cat. no. 3218.0....
  • Burton, S. L., Clark, L., Elliott, G., & Siciliano, F. (2005). The impact of retail distribution on tobacco...
  • F.J. Chaloupka et al.

    Sex and race differences in young people’s responsiveness to price and tobacco control policies

    Tobacco Control

    (1999)
  • Y. Chuang et al.

    Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smoking

    Journal of Epidemiology and Community Health

    (2005)
  • I.G. Ellen et al.

    Neighborhood effects on health: exploring the links and assessing the evidence

    Journal of Urban Affairs

    (2001)
  • C. Godfrey

    Factors influencing the consumption of alcohol and tobacco: the use and abuse of economic models

    British Journal of Addiction

    (1989)
  • J.A. Hausman et al.

    Consumer benefits from increased competition in shopping outlets: measuring the effect of Wal-Mart

    (2005)
  • J. Hickling et al.

    Smoking and social inequalities in South Australia

    (2003)
  • D.J. Hill et al.

    Smoking behaviours of Australian adults in 1995: trends and concerns

    The Medical Journal of Australia

    (1998)
  • A. Hyland et al.

    Tobacco outlet density and demographics in Erie county, New York

    American Journal of Public Health

    (2003)
  • M.D. Jekanowski et al.

    Convenience, accessibility, and the demand for fast food

    Journal of Agricultural and Resource Economics

    (2001)
  • R.J. Johnson

    Search costs, lags and prices at the pump

    Review of Industrial Organisation

    (2002)
  • Cited by (0)

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