Introduction Previous systematic reviews have found consistent evidence of a positive association between exposure to point-of-sale (POS) tobacco promotion and increased smoking and smoking susceptibility among children and adolescents. No meta-analysis has been conducted on these studies to date.
Methods Systematic literature searches were carried out to identify all quantitative observational studies that examined the relationship between POS tobacco promotion and individual-level smoking and smoking-related cognitions among children and adolescents, published between January 1990 and June 2014. Random-effects meta-analyses were used. Subgroup analyses were conducted according to extent of tobacco POS advertising environment in the study environment. Sensitivity analyses were performed according to study size and quality.
Results 13 studies met the inclusion criteria; 11 reported data for behavioural outcomes, 6 for cognitive outcomes (each of these assessed smoking susceptibility). The studies were cross-sectional, with the exception of 2 cohort studies. For the behavioural outcomes, the pooled OR was 1.61 (95% CI 1.33 to 1.96) and for smoking susceptibility the pooled OR was 1.32 (95% CI 1.09 to 1.61).
Conclusions Children and adolescents more frequently exposed to POS tobacco promotion have around 1.6 times higher odds of having tried smoking and around 1.3 times higher odds of being susceptible to future smoking, compared with those less frequently exposed. Together with the available evaluations of POS display bans, the results strongly indicate that legislation banning tobacco POS promotion will effectively reduce smoking among young people.
- Advertising and Promotion
- Public policy
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Contributors RM and JH conceptualised the initial idea for the study. CC and LR developed the study design further and refined the research question. CC, LR, RM and LM assisted with systematic literature searches and establishing study criteria. LR, CC and RM extracted data. CC conducted the statistical analyses. LR, CC, RM, LM and JH assisted with interpretation of data. LR drafted the initial manuscript. CC, RM, LM and JH revised the manuscript critically for important intellectual content and gave approval of the version to be published. LR takes overall responsibility for the accuracy and integrity of the work.
Funding This work was supported by New Zealand Lottery Health, Asthma Foundation of New Zealand and the Cancer Society of New Zealand.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.