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Disentangling the roles of point-of-sale ban, tobacco retailer density and proximity on cessation and relapse among a cohort of smokers: findings from ITC Canada Survey
  1. Nancy L Fleischer1,
  2. Paula Lozano2,
  3. Yun-Hsuan Wu2,
  4. James W Hardin2,
  5. Gang Meng3,
  6. Angela D Liese2,
  7. Geoffrey T Fong3,4,5,
  8. James F Thrasher6,7
  1. 1 Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  3. 3 Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  4. 4 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  5. 5 Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  6. 6 Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  7. 7 Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
  1. Correspondence to Dr Nancy L Fleischer, Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; nancyfl{at}


Objective To examine how point-of-sale (POS) display bans, tobacco retailer density and tobacco retailer proximity were associated with smoking cessation and relapse in a cohort of smokers in Canada, where provincial POS bans were implemented differentially over time from 2004 to 2010.

Methods Data from the 2005 to 2011 administrations of the International Tobacco Control (ITC) Canada Survey, a nationally representative cohort of adult smokers, were linked via residential geocoding with tobacco retailer data to derive for each smoker a measure of retailer density and proximity. An indicator variable identified whether the smoker’s province banned POS displays at the time of the interview. Outcomes included cessation for at least 1 month at follow-up among smokers from the previous wave and relapse at follow-up among smokers who had quit at the previous wave. Logistic generalised estimating equation models were used to determine the relationship between living in a province with a POS display ban, tobacco retailer density and tobacco retailer proximity with cessation (n=4388) and relapse (n=866).

Results Provincial POS display bans were not associated with cessation. In adjusted models, POS display bans were associated with lower odds of relapse which strengthened after adjusting for retailer density and proximity, although results were not statistically significant (OR 0.66, 95% CI 0.41 to 1.07, p=0.089). Neither tobacco retailer density nor proximity was associated with cessation or relapse.

Conclusions Banning POS retail displays shows promise as an additional tool to prevent relapse, although these results need to be confirmed in larger longitudinal studies.

  • Cessation
  • Public Policy
  • Advertising And Promotion

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  • Contributors NLF and JFT conceptualised the study. GM conducted the geographical analyses. PL, NLF and Y-HW conducted the statistical analyses. NLF and JWH supervised the statistical analyses. PL and NLF drafted the manuscript. All authors contributed to the study design, interpretation of results and final revision of the manuscript.

  • Funding This work was supported by a pilot project to NLF from the American Cancer Society Institutional Research Grant to the University of South Carolina College of Pharmacy. Major funders of the ITC Canada Survey Waves 5-8: US National Cancer Institute (P50 CA111236, R01 CA100362), Canadian Institutes of Health Research (MOP-79551, MOP-115016, FDN-148477). Additional support was provided to GTF from a Senior Investigator Award from the Ontario Institute for Cancer Research and a Prevention Scientist Award from the Canadian Cancer Society Research Institute.

  • Disclaimer None of the sponsors played any direct role in the design or conduct of the study; the collection, management, analysis or interpretation of the data; in the preparation of the manuscript, or in the decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.