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Differential impact of the Canadian point-of-sale tobacco display bans on quit attempts and smoking cessation outcomes by sex, income and education: longitudinal findings from the ITC Canada Survey
  1. Bukola Usidame1,
  2. Yanmei Xie1,
  3. James F Thrasher2,3,
  4. Paula Lozano4,
  5. Michael R Elliott5,
  6. Geoffrey T Fong6,7,
  7. Nancy L Fleischer1
  1. 1 Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
  3. 3 National Institute of Public Health, Cuernavaca, Mexico
  4. 4 Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois, USA
  5. 5 Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  6. 6 Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  7. 7 Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  1. Correspondence to Dr Bukola Usidame, Epidemiology, University of Michigan, Ann Arbor, Michigan 48109, USA; bukolau{at}


Significance This study examines the differential effects of Canadian point-of-sale (POS) tobacco display bans across provinces on quit attempts and smoking cessation, by sex, education and income.

Methods We analysed survey data from five waves (waves 4–8) of the International Tobacco Control Canada Survey, a population-based, longitudinal survey, where provinces implemented display bans between 2004 and 2010. Primary outcomes were quit attempts and successful cessation. We used generalised estimating equation Poisson regression models to estimate associations between living in a province with or without a POS ban (with a 24-month threshold) and smoking outcomes. We tested whether these associations varied by sex, education and income by including interaction terms.

Results Across survey waves, the percentage of participants in provinces with POS bans established for more than 24 months increased from 5.0% to 95.8%. There was no association between POS bans and quit attempts for provinces with bans in place for 0–24 months or more than 24 months, respectively (adjusted relative risk (aRR)=0.99, 95% CI: 0.89 to 1.10; 1.03, 95% CI: 0.88 to 1.20). However, we found a differential impact of POS bans on quit attempts by sex, whereby bans were more effective for women than men for bans of 0–24 months. Participants living in a province with a POS ban for at least 24 months had a higher chance of successful cessation (aRR=1.49; 95% CI: 1.08 to 2.05) compared with those in a province without a ban. We found no differences in the association between POS bans and quit attempts or cessation by education or income, and no differences by sex for cessation.

Conclusion POS bans are associated with increased smoking cessation overall and more quit attempts among women than men.

  • advertising and promotion
  • cessation
  • disparities
  • public policy
  • socioeconomic status

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

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  • Contributors NLF, BU and JT conceptualised the study. YX conducted the statistical analyses. NLF and MRE supervised the statistical analyses. BU and NLF drafted the manuscript. NLF serves as the guarantor for this study. All authors contributed to the study design, interpretation of results and final revision of the manuscript.

  • Funding Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health (NIH) (grant number R37CA214787). The ITC Canada Project was supported by grants from the US National Cancer Institute (R01 CA100362, R01 CA090955 and P01 CA138389) and the Canadian Institutes of Health Research (MOP-57897 and MOP-79551). GF was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research and a Senior Prevention Scientist Award from the Canadian Cancer Society Research Institute.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests GF and JT have been expert witnesses/consultants for governments defending their country’s policies/regulations in litigation.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.