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Impact of removing point-of-sale tobacco displays on smoking behaviour among adolescents in Europe: a quasi-experimental study
  1. Maureen M Van Hurck1,2,
  2. Paulien A W Nuyts1,
  3. Karin Monshouwer3,4,
  4. Anton E Kunst1,
  5. Mirte A G Kuipers1
  1. 1 Department of Public Health, Amsterdam Public Health research institute, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, Amsterdam, The Netherlands
  3. 3 Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
  4. 4 Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
  1. Correspondence to Mirte A G Kuipers, Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam 22660, The Netherlands; m.a.kuipers{at}


Background An increasing number of European countries implemented a point-of-sale (PoS) display ban on tobacco products. This study assessed the association between PoS display bans in Europe and adolescent smoking and perceived accessibility of tobacco, 2–6 years after PoS display ban implementation.

Methods In a quasi-experimental design, we compared individuals in countries that did and countries that did not implement a PoS display ban, before and after implementation. We used repeated cross-sectional data of 174 878 15-year-old and 16-year-old adolescents from 25 countries from the 2007, 2011 and 2015 European Survey Project on Alcohol and Other Drugs surveys. Multilevel logistic regression models examined smoking behaviour (regular smoking vs other) and perceived access (easy vs difficult) as a function of display ban implementation and controlled for survey year, gender, parental education and implementation of other tobacco control policies. Interaction with gender was tested.

Results The implementation of a PoS display ban was associated with a 15% larger drop in the odds of regular smoking (OR 0.85, 95% CI 0.79 to 0.91), but was not significantly associated with perceived accessibility of tobacco (OR 0.97, 95% CI 0.892 to 1.03). Associations were similar in males and females (cross-level interactions of gender with display ban were not statistically significant for either outcome).

Conclusion The implementation of PoS display bans in Europe was associated with a stronger decrease in regular smoking among adolescents. This decrease does not appear to be driven by a decreasing accessibility of tobacco, but might be caused by further de-normalisation of tobacco as a result of PoS display bans.

  • advertising and promotion
  • prevention
  • public policy

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  • Contributors MAGK and AEK conceived and designed the study. KM provided access to and advice on the data. MMVH and MAGK prepared and analysed the data. MMVH drafted the manuscript. PAWN, KM, AEK and MAGK contributed to the interpretation of the data and critically revised the manuscript at various stages for important intellectual content. All authors have read and approved of the final manuscript.

  • Funding This study was funded by H2020 Health (grant no: 635056).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval National ethics committees in each country, according to national law.

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