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Abstract
Background Reduction of the availability of tobacco has been proposed as a means of reducing and denormalising tobacco use. Some retailers have stopped selling tobacco. Therefore, we investigated how willing New Zealand convenience store owners were to stop selling tobacco or sell nicotine replacement therapy. Promotion of their stores was offered as an incentive to stop selling tobacco.
Methods We asked convenience store owners in the Auckland metropolitan region of New Zealand to choose one of three actions. The first was to stop selling tobacco for a short period of time; the second was to restrict the hours that they sold tobacco; the third was to display and sell nicotine replacement therapy. All participating retailers completed a short interview about selling tobacco. We also surveyed customers about nicotine replacement and cessation.
Results One-third of eligible retailers agreed to participate. Most who participated (93%) were unwilling to stop or restrict tobacco sales and 2 (7%) had already stopped selling tobacco. Tobacco was perceived as a key product for their businesses. Very few customers who purchased cigarettes noticed nicotine replacement therapy or obtained it from convenience stores.
Conclusions Substantially reducing the availability of tobacco in communities is likely to require legislative approaches, underpinned by sustained community pressure and support for convenience store owners who are willing to change their business model.
- Advertising and Promotion
- Denormalization
- Prevention
- Public policy
- Cessation
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Introduction
Supply limits are an important component of the tobacco ‘end game’ and are a measure that may enable achievement of New Zealand's Smokefree 2025 goals.1 Without adding to current tobacco control measures, modelling suggests that the 5% prevalence goal will not be reached by 2025.2 Reducing the density of tobacco outlets is a supply limit.3 Since 1816, France has restricted the number of tobacco outlets by using licenses.4 Hungary recently reduced the number of tobacco outlets using licensing of tobacco retailers.5
What has research which examines smoking and tobacco outlet density found? Henriksen et al6 found a higher smoking prevalence at schools surrounded by higher densities of tobacco outlets, and Scully et al7 found adolescent tobacco consumption to be greater where the density of tobacco outlets was higher around schools. However, Adachi-Mejia et al8 found no associations between density or proximity of tobacco outlets to adolescents’ homes after adjusting for individual and community factors. The inconsistency is probably due to the range of different locations studied, for example, density of tobacco outlets near homes versus schools. In addition, the confounders included in the studies vary considerably.
The evidence of an association between tobacco outlet density and smoking cessation is also mixed. Halonen et al9 reported a significantly lower likelihood of cessation where the number of tobacco stores near smokers was higher. Reitzel et al10 found that being further away from a tobacco outlet increased the chances that a person would remain abstinent from smoking. Furthermore, a recent US study found that ease of access to cigarettes was a reason in a large proportion of relapses.11 However, a longitudinal study examining the cessation of tobacco use in two English cities found no association between sustained cessation of tobacco use and proximity or density of tobacco outlets.10 ,12 The authors of the UK study cite less accuracy in mapping of retail outlets, ethnic differences, differences in population density and the omission of other environments such as workplace that the smokers trying to quit would have frequented as reasons why the results were inconsistent with previous studies. A recent modelling study exploring the impact of reducing tobacco retail outlets in New Zealand (NZ) suggests that reducing tobacco outlet density might be an effective addition to a comprehensive tobacco control programme.13 It appears that reducing tobacco outlet density has the potential to support smoking cessation.
We are unaware of any intervention studies to evaluate the effect of reducing tobacco outlet density. Nor have we found any observational studies that have measured smoking while change in tobacco outlet density has occurred.
Public support for policy measures in NZ that would reduce the number of tobacco outlets, particularly near schools, is moderately strong (mean scores of 2.6–3.5 on a scale of −5 to 5).14 An online survey of 766 New Zealanders, weighted to represent the national population, presented a range of options. “No tobacco within 500 m of a school” attracted the highest score.14 Other related statements, “Shops selling tobacco products are required to sell products that help smokers quit” and “Reducing the number of stores selling tobacco products” were also well supported by non-smokers.14 Support among smokers was also highest for prohibiting tobacco near schools.
Of relevance to cessation is the availability of cessation support. NZ smokers have shown interest in the provision of cessation support in public spaces,15 and supported having nicotine replacement therapy (NRT) available at convenience stores. Williman et al16 and Jaine et al17 found that some NZ convenience salespeople were willing to sell NRT products.
Many NZ convenience store owners, hereafter retailers, operate small enterprises open for long hours, competing with supermarkets and providing a relatively small livelihood (NZ$28 000–$42 000 per annum).18 Retailers in NZ generally stock tobacco along with a limited range of grocery items such as milk, bread, flour, sugar, tea, shampoo and breakfast cereals along with lotto tickets, phone and transport pre-pay cards and newspapers. Some have a small selection of unrefrigerated produce. They usually have extensive ranges of confectionery, ice creams and drinks and often sell ready to eat meat pies. About half of all (48%) NZ smokers report that their current pack of cigarettes was purchased at a convenience store.19
A US study found that grocery stores and pharmacies that had voluntarily stopped selling tobacco did so because of public health reasons, declining tobacco sales, difficulties with sales such as license requirements and the inconsistency of store image when tobacco is sold alongside healthy food.20 ,21 Some dairies in NZ have featured in the news because they have stopped selling tobacco. We sought to learn whether retailers were interested in stopping tobacco sales.
Methods
This was a mixed-methods feasibility study of an intervention, using semistructured interviews with tobacco retailers and brief structured interviews with store customers who were current smokers or had quit recently.
Selection of study areas
We purposively selected two areas of Auckland (South and West Auckland) with high deprivation and large numbers of Ma¯ori and Pacific Island peoples, among whom smoking prevalence is at least double that of European New Zealanders. We established criteria for ranking suburbs within these locations based on: census tracts with lowest median incomes, highest proportion of indigenous Ma¯ori and/or Pacific Island peoples, highest absolute numbers of smokers based on census data, a distinct location determined by physical features such as location on a peninsula or between a motorway and the coast, and a network of community contacts.
Identification of retailers
We compiled a database of retailers in the selected suburbs using a database maintained by the Auckland City Council for regulation of food and beverage retailers, and online business directories (Zenbu, Yellow Pages and Finda Business Directory). For consistency, and since this was a feasibility study, we focused on convenience stores, many of them independently operated by the owner. Supermarkets, petrol or service stations and liquor outlets were excluded as they are likely to be owned by large companies and have a slower decision process regarding tobacco sales.
Recruitment and intervention
We approached all 126 small retailers on our list in the third quarter of 2013. We included retailers in 28 census area units within 15 different suburbs. Initial contact was made by the study research assistant, who was Indian and able to converse with Indian-origin retailers in their own language. She greeted the person in the shop, introduced herself and inquired about shop ownership. If the owner was absent, she arranged a suitable time to meet the owner. If the owner was present, she explained the nature of the research and asked if they would be willing to participate, which involved: (1) stopping selling tobacco for a month or two, or (2) stopping selling tobacco for set times during the day, for example, 8:00–10:00 and 15:00–16:00 when children are in transit to or from school or (3) selling an NRT that would be provided to them at no cost. We offered them free promotion for their store via community networks and local media as an incentive to stop or restrict tobacco sales. All retailers were invited to do an interview. To encourage participation, we offered the opportunity to win one of three NZ$100 retail vouchers.
Retailers who opted for trial sales of the NRT (Quickmist nicotine mouth spray) were supplied with five samples and the retailer's choice of promotional materials (eg, branded counter mats, posters and a stand) in October–November 2013. Retailers participated in a short follow-up interview in December 2013 after they had been supplied with the Quickmist spray.
Interviews
Once informed consent was obtained and retailers had chosen their preferred option, we asked about the importance of tobacco to the retailers’ business and their attitudes to reducing tobacco use (box 1).
Interview questions asked of retailers
Is selling tobacco important to you?
If yes, can you tell me why it is important for you to sell tobacco?
What would enable you to stop selling tobacco?
Do you feel obliged to the tobacco industry to sell tobacco?
In 1 day, approximately how many customers buy tobacco from your store?
Do the tobacco-buying-customers also purchase something else from your store?
During what time of the day does maximum sale of tobacco occur?
For how many years have you been running this store?
Do you think retailers can play an important role in reducing tobacco consumption?
If given an opportunity, how would you help in reducing tobacco consumption?
Do you think the Ministry of Health's initiative towards reducing the sale of tobacco in retail stores is a wise step?
Other comments?
Question 11 was asked because a current newspaper article indicated that a reduction in the number of tobacco retail outlets had been proposed in a discussion paper by a Ministry of Health official.
All responses were recorded on paper during the interviews, and then the data were entered into a Microsoft Excel spreadsheet for analysis.
Customer survey
A research assistant conducted street intercept surveys of customers of the selected convenience stores. Each customer who approached or left the store was invited to take part. Eligible customers were those who were over 18 years of age, who currently smoked or who had stopped smoking within the past 12 months. Customers who were approached but did not engage or terminated the interview prematurely were deemed unable to be assessed for eligibility.
Questions were about age, ethnicity, smoking cessation, source of cigarettes and Quickmist. The responses were recorded on paper. The questions and closed response options were drawn from questions in the New Zealand Health Survey with the exception of two questions about noticing or buying Quickmist, which required a yes or no response. Those who had tried Quickmist were prompted to elaborate with an open response.
Data analysis
We calculated frequencies and percentages for closed responses. Qualitative content analysis using the general inductive method was applied to the open responses of retailers, with two researchers independently coding the data, identifying themes and resolving inconsistencies by discussion and mutual agreement.
Ethical review
The study protocol and materials were reviewed and approved by the Northern A Health and Disability Ethics Committee (Ethics ref: 13/NTA/114).
Results
We identified and approached 126 tobacco retailers, of whom 83 (56%) did not participate; of these, 71 said they were not interested. Four of the 83 reported that tobacco was too important for their business. One could not be interviewed due to language difficulties. Two others cited business difficulties. Finally, five owners were not able to be contacted after three attempts.
Two participating retailers had already stopped selling tobacco. Another participating retailer wanted to stop selling tobacco but was unable to do so due to influential business associates. Two retailers still selling tobacco, including the retailer who expressed a desire to stop selling tobacco and one who did not want to stop selling it, reported two strategies to deter customers from buying tobacco: higher prices and reduction of the stock keeping units (the range of brands available). Thirty-nine retailers (93%) were unwilling to stop selling tobacco for even a short period of time.
Forty-two retailers (33%) agreed to sell NRT and be interviewed (figure 1). Most participants (88%) were of Indian ethnicity, and just under half had been operating their store for less than 5 years. A similar proportion had been running their store for 10 or more years.
Flow chart for intervention with retailers.
Reliance on tobacco for revenue and customers
The most common reasons given for continuing to sell tobacco were gross profit and customer demand for tobacco. Three-quarters (74%) of the 42 retailers reported that a high proportion of customers bought tobacco. Almost all (93%) reported that customers who bought tobacco usually purchased something else with their tobacco.
Reliance on tobacco for bringing in customers also emerged as a dominant theme expressed by retailers.When customers come to buy tobacco, they buy something else as well. This runs our business. We can't stop the sale of tobacco.
Selling tobacco is a part of our job. In the first six months of my business, I didn't sell tobacco, but I started selling due to customer demands. I feel pressurised to sell.
There was unwillingness to be the retailer who stops selling tobacco first because they believed they would lose customers.I am happy to do what everyone else is doing but not take initiative.
If we don't sell it, no one would come to our store. We would lose customers.
Some retailers reported little or no profit from tobacco.There is no profit in selling tobacco. But still 50% of my customers buy tobacco from me.
Profit in selling tobacco is not there really.
Others reported a reasonable income from tobacco.It generates 10% income, so I will continue selling it.
Whether or not tobacco generates much profit for the business may depend on a range of factors such as the particular location of the store and the relative proportions of premium versus budget brands that are sold. Retailers continue to sell tobacco despite little or no profit because they believe that customers will not come into their store and will go to other dairies nearby if they do not sell tobacco. This could result in loss of purchases of other products which generate more profits and may be bought with tobacco.
Others regarded tobacco as an indispensable product for small retailers, and some suggested that this perception is promoted by the tobacco industry.We were told by everyone that if we don't sell tobacco, our business will not run well.
Tobacco people don't force us to sell tobacco but they show us that we can't function without tobacco companies.
While it is not clear from the retailers’ responses exactly how the tobacco companies show the retailers that they cannot function without tobacco, they may do this in two ways. First, convenience stores stock a varied range of products. Getting the stocking, pricing and particular range of products to an optimum for profit generation is complex. Modelling and analysis software is available to do this for business owners but is often expensive, and smaller business owners may rely on their suppliers to do this type of analysis for them. Alternatively, the tobacco sales representatives may just reiterate and reinforce the perception that tobacco is essential for maintaining customers.
Almost one-quarter (24%) reported feeling obliged to the tobacco industry to sell tobacco.
Perceptions of customer response to ending tobacco sales
Almost two-thirds of retailers (62%) expressed a willingness to reduce tobacco use despite believing that it was an important product for their business success. This was mainly expressed as a willingness to do things they thought might help people stop smoking.We retailers can play a 0.1% role here by educating them. If I don't sell here, people will buy from others. I don't want to sell it but I do sell because it brings in customers who buy other things from my shop as well.
Some retailers expressed pessimism, particularly regarding the potential they themselves had to assist in cessation. Some expressed fears of aggression from customers if tobacco was unavailable.I don't think the smokers can ever stop smoking. Nothing can be done to make them quit.
If they don't find their smokes, they will react violently.
Some of their perceptions about stopping sales of tobacco arose from their experience when complying with the ban on underage sales.We can't stop under-aged from buying tobacco. They stand outside our shop and ask someone else outside our shop to buy it for them and give 2 cigarettes in return for help.
Some people even punched us previously when we asked for ID.
Others were more positive about interventions for reducing smoking. For example, one retailer felt that putting tobacco out of sight in cabinets had helped.Government's closed door policy for tobacco has helped.
One retailer suggested more stringent restrictions on tobacco availability.The government can make a rule that says all tobacco should be sold in pharmacies with one packet per week per person only. I think this will reduce smoking among people.
The role of government
There was a wide range of attitudes to the role of government policies. Many expressed a willingness to comply with whatever tobacco control laws the government implemented, such as restrictions or bans on sales, in order to reduce tobacco use, while others were negative and sceptical about the government's motives or expressed powerlessness.Government will never stop selling tobacco. They get so much money from the taxes.
You should approach the government for this. We only follow rules and don't make any ourselves.
Competition for customers and potential loss of customers to other stores was a significant barrier to retailers stopping tobacco sales. The solution, as several retailers expressed, was for the government to ban tobacco sales and thereby ensure no disadvantage for some retailers.It is better to stop the sale of tobacco altogether. We will stop if everyone else stops.
Only government laws can enable us to stop selling tobacco.
Not selling tobacco
Three retailers felt it was important not to sell tobacco. Two of them did not sell tobacco and were motivated by their religious beliefs.I belong to Sikh religion and we don't even touch tobacco.
If we sell tobacco, we are doing wrong and if we ourselves are wrong, we can't tell anyone in the church what is right or wrong, because we ourselves are doing the wrong thing.
Another retailer, who did not want to sell tobacco, had a strong antitobacco stance based on the harm it caused.
One of the tobacco-free retailers reported that their business was doing better than ever and had strong community support. The other reported a slight downturn but felt it was worth the sacrifice.Tobacco is harmful and it should be banned overall. There is no point in selling this horrible product.
Retailer experience with NRT sales
Thirty-four retailers (80%) displayed Quickmist in their shop. Of these, 9 (26%) reported that they had sold or given away Quickmist. One sold five at NZ$20 each. Seven others sold one each, asking from NZ$5 up to NZ$39.99 in one case. One gave several away. Just under one-half (43%, 18/42) reported that they needed to draw more attention to the Quickmist for it to sell well. Two retailers who participated in a follow-up interview reported that they had not displayed the Quickmist but one showed it to customers when they talked about it.Unfortunately we can't display the mat because of lotto stuff we have on our counter. We haven't displayed Quickmist but show them to the customers when we talk about it to them.
Customer surveys
Of 452 customers approached, 241 were eligible or did not want to engage in conversation or ended the conversation before eligibility was determined. Seventy-six completed the survey, giving a conservative response rate of 32%.
Participants were predominantly female and Ma¯ori with a relatively even distribution across age groups (table 1). Two-thirds (68%) of those who reported currently smoking had tried to quit in the past 12 months. Most participants bought their last packet of cigarettes at a convenience store (82%). A large majority of participants (95%) had not noticed Quickmist and only one participant had tried it.
Characteristics of customers of the participating convenience stores
Discussion
This study suggests that relying on voluntary withdrawal of tobacco from convenience stores, even with an offer of promotional support from public health advocates, is unlikely to significantly influence the availability of tobacco and reduce smoking prevalence adequately for NZ.13 Retailers themselves indicated that legislation or regulation banning sales of tobacco would be required for them to stop selling tobacco. A similar view was noted in studies of US stores that stopped selling tobacco.20 ,21
Tobacco appears to be a key product for convenience stores. Retailers reported financial reliance on tobacco sales as the main reason they continued selling tobacco. Tobacco was considered essential to bringing customers to the store and retaining their custom in a highly competitive retail environment. A similar perception was found in a recent study of tobacco retailers in the Wellington region of NZ.17
The tobacco industry is active in maintaining the notion that successful convenience businesses depend on tobacco.22 The rationale is that decline in tobacco sales is slow, 1–2% per annum, and that as larger chains stop selling tobacco, convenience stores have the opportunity to gain these customers. This notion may also come from other non-health business advisory sources. For example, information recommending tobacco sales as essential to business viability is provided by at least one Canadian government-backed organisation.23
For NZ retailers, limited time and capital may inhibit transition to a tobacco-free business model, particularly if shops require redesign or refitting. Therefore, gathering and sharing insights and knowledge from retailers who have stopped selling tobacco yet sustain successful businesses would be a useful means for encouraging other retailers to stop selling tobacco.
Only a few customers noticed or tried Quickmist even when it was offered at a low price. To date, the evidence of effectiveness of NRT provided in the absence of support is weak.24 ,25 However, there may be an as yet unmeasured benefit if new NRT formulations or presentation or cessation products are available widely at stores frequented by smokers and prompt interest or curiosity about quitting. This study suggests that if convenience stores are to offer an alternative to tobacco, then better promotion of the availability of these cessation products or links to cessation support in convenience stores is likely to be required.
Strengths and limitations
The strengths of our study included the large number of retailers approached and an interviewer who was of the same ethnic group as the majority of retailers. Limitations included the restriction of the sampling frame to urban Auckland and convenience stores; it is possible that the reliance on tobacco and competition between retailers may be different in other regions of NZ. Other tobacco retailers (such as petrol stations and supermarkets) may be less reliant on tobacco and more willing to remove tobacco. Further, we did not validate retailer reports of numbers of customers purchasing tobacco or their estimates of income from tobacco. Our study is more likely to include participants who have ambiguous or negative feelings about selling tobacco. Finally, the customers interviewed may not have had a chance to see the NRT unless they were regular customers.
Conclusions and recommendations
Most retailers in areas of Auckland with high smoking prevalence perceived that tobacco is crucial for customer retention and business viability and would not stop selling voluntarily. Legislative approaches are likely to be required to bring about reductions in the numbers of convenience stores selling tobacco and NRT.
Further research should explore convenience store business models that do not include tobacco.
What this paper adds
Most convenience store retailers in areas of high smoking prevalence in urban New Zealand who took part in our study were unwilling to stop selling tobacco voluntarily but were amenable to selling cessation support products.
Acknowledgments
The authors thank the retailers for taking their time to speak with them and display a new product in their stores. They are grateful to Sean Liggins and the Cancer Society of New Zealand Auckland Division for his voluntary work in compiling the list of retailers. Thanks also to Ankit Anand who provided support for DS when visiting some convenience stores and John Reichert for interviewing customers. This work was undertaken as part of New Zealand's Tobacco Control Research Tūranga: a programme of innovative research to halve smoking prevalence in Aotearoa/New Zealand within a decade.
References
Footnotes
Twitter Follow Janine Paynter at @JaninePaynter and Chris Bullen at @DrChrisBullen
Contributors JP, MG and CB designed the study. DS visited retailers and conducted interviews. JP and MG conducted the qualitative analysis. JP provided the descriptive statistics and wrote the manuscript which was reviewed by MG, CB and DS.
Funding This work was supported by the Reducing Tobacco-related Harm Research Partnership co-funded by the Health Research Council of New Zealand and the Ministry of Health of New Zealand (HRC grant 11/818).
Competing interests CB has received support for accommodation while a speaker hosted by a manufacturer of smoking cessation drugs.
Ethics approval Northern A Health and Disability Ethics Committee (Ethics ref: 13/NTA/114).
Provenance and peer review Not commissioned; externally peer reviewed.