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Adolescents’ perceptions of tobacco accessibility and smoking norms and attitudes in response to the tobacco point-of-sale display ban in Scotland: results from the DISPLAY Study
  1. Mirte AG Kuipers1,
  2. Catherine Best2,
  3. Michael Wilson2,
  4. Dorothy Currie3,
  5. Gozde Ozakinci3,
  6. Anne-Marie MacKintosh4,
  7. Martine Stead4,
  8. Douglas Eadie4,
  9. Andy MacGregor5,
  10. Jamie Pearce6,
  11. Amanda Amos7,
  12. Sally Haw8
  1. 1 Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
  3. 3 School of Medicine, University of St Andrews, St Andrews, UK
  4. 4 Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
  5. 5 Head of Policy Research, Scotcen Social Research, Edinburgh, UK
  6. 6 Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
  7. 7 The Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  8. 8 Faculty of Health Sciences and Sport, University of Stirlings, Stirling, UK
  1. Correspondence to Dr Mirte AG Kuipers, Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam 1100 DD, The Netherlands; m.a.kuipers{at}


Background Scotland implemented a ban on open display of tobacco products in supermarkets in April 2013, and small shops in April 2015. This study aimed to quantify changes in perceived tobacco accessibility, smoking norms and smoking attitudes among adolescents in Scotland, following the implementation of partial and comprehensive point-of-sale (POS) tobacco display bans.

Methods From the Determining the Impact of Smoking Point of Sale Legislation Among Youth (DISPLAY) Study’s 2013–2017 annual surveys we retrieved data comprising 6202 observations on 4836 12–17-year-old adolescents from four schools. Applying generalised estimating equations, associations between time (postban: 2016–2017 vs preban:2013) and three outcomes were estimated. Outcomes were perceived commercial access to tobacco, perceived positive smoking norm (friends think it’s OK to smoke) and positive smoking attitude (you think it’s OK to smoke). Analyses were adjusted for sociodemographics, smoking status, family smoking, friend smoking and e-cigarette use.

Results Crude trends showed an increase over time in perceived accessibility, norms and attitudes. However, after adjustment for confounders, mainly e-cigarette use, we found significant declines in perceived access (OR = 0.72, 95% CI 0.57 to 0.90) and in positive smoking attitude (OR = 0.67, 95% CI = 0.49 to 0.91), but no change in perceived positive smoking norm (OR = 1.00, 95% CI 0.78 to 1.29). Current/past occasional or regular e-cigarette use was associated with higher odds of perceived access (OR = 3.12, 95% CI 2.32 to 4.21), positive norm (OR = 2.94, 95% CI 2.16 to 4.02) and positive attitude (OR = 3.38, 95% CI 2.35 to 4.87).

Conclusion Only when taking into account that the use of e-cigarettes increased in 2013–2017 did we find that the POS tobacco display ban in supermarkets and small shops in Scotland was followed by reductions in adolescents’ perceived accessibility of tobacco and positive attitudes towards smoking.

  • smoking
  • tobacco control
  • adolescents
  • young people
  • point of sale
  • display
  • tobacco marketing
  • social norm
  • tobacco access

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  • Correction notice This article has been corrected since it first published online. The open access licence type has been amended.

  • Contributors SH, CB and MAGK conceived and designed the analysis. CB and MW prepared the data and MAGK analysed the data, interpreted the findings and drafted the manuscript. DC and GO managed the administration of the school survey and data cleaning. SH is principal investigator for the DISPLAY Study and was involved in devising the overall study, and drafting and revising this paper. A-MMK, MS, DE, AMG, JP and AA were co-investigators responsible for devising the overall study design. All authors contributed to the interpretation of the data and provided critical revisions on the manuscript.

  • Funding This project was funded by the UK National Institute for Health Research (NIHR) Public Health Research Programme, project 10/3000/07. The study sponsor had no influence on study design and the collection, analysis, and interpretation of data and the writing of the article and the decision to submit it for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the DISPLAY Study was obtained from the University of Stirling Management School Ethics Committee; Edinburgh University School of Geoscience Research Ethics Committee; NatCen Research Ethics Committee; and St Andrews University Teaching and Research Ethics Committee.

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

  • Data sharing statement No data are available.

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