Discussion and Conclusions

Conducted 6 months after the removal of all tobacco products from open display in New Zealand retail outlets, this study found strong overall support for the new law. Predictably, support depended critically on smoking status—age, gender and ethnicity had weak independent effects on attitudes to the new law or other retail interventions tested, except among Asian participants, who strongly supported regulation. (While these demographic variables are reflected in smoking status, the small sample sizes reduce the likelihood of identifying independent effects of ethnicity.) Daily smokers showed less support for the new law than other groups; however, smokers intending to quit within the next 6 months were more likely to believe the law would facilitate their own quitting. This finding underscores evidence from qualitative studies that found exposure to tobacco imagery could induce lapsing among intending quitters.6–8 Our results are also consistent with earlier work concluding that those most sensitive to the influence of POS displays had lower quit success rates than less sensitive smokers.9

Our study estimated attitudes to the new law and its potential benefits, not behavioural responses; nevertheless, the strong postimplementation support we detected could assist countries still to develop policies on tobacco POS displays. Earlier studies report that young people infrequently exposed to open display of tobacco products have a reduced risk of smoking experimentation.3 Although tobacco remains as available under the new legislation as it was under the previous law, perceptions that young people would find it more difficult to access highlight an unexpected potential benefit of the new statute. Young people who believe tobacco is easy to obtain and widely consumed are at higher risk of smoking experimentation and addiction29 ,30; perceptions that tobacco has become more difficult to access could thus afford greater protection to these susceptible non-smokers. However, longitudinal data or analyses of repeat cross-sectional data are required to assess whether these perceptions translate into modified behaviour among young adults.

Removing tobacco products from open display in stores represents a key plank in retail regulation that could reduce smoking initiation and support cessation attempts.3 ,7 ,11 However, the rapid reductions in smoking prevalence required to achieve ‘endgame goals’ set by New Zealand and other countries, behove consideration of additional measures, particularly, given retail outlets remain permissive tobacco marketing environments.21 ,24 Although trenchant opposition from tobacco companies and retail groups has made policy makers wary of further retail regulation,12 we found strong public support for additional measures.

In particular, smokers and non-smokers alike supported prohibiting tobacco sales from outlets within 500 m of a school. This measure could further reduce young people's access and potential exposure to tobacco, and so diminish the risk that they will experiment with smoking. Extending the protection afforded to young people is particularly important, given those who begin smoking at a young age face more serious health risks and may find quitting more difficult.31

All groups also supported requiring tobacco retailers to offer cessation products for sale. Not only would such a measure greatly increase the accessibility of NRT, it would also recognise that the vast majority of smokers wish to become smoke-free,32 and create an environment more likely to stimulate cessation. Retailer licensing, which all groups, except daily smokers supported, would enable regulation requiring tobacco retailers to meet specific standards and bring tobacco in line with other hazardous products. For example, retailers could be required to provide cessation information to all tobacco purchasers, and in countries that allow the sale of smokeless products, license terms could mandate provision of information about the risks these products pose. Further, licensing could ensure that those selling tobacco products underwent training in cessation advice, a measure that would complement calls for greater availability of NRT.

All smoker groups, except daily smokers, supported reducing the number of retail outlets and decoupling tobacco and alcohol sales, although occasional smokers were ambivalent about the latter measure. Reducing the number of tobacco retail outlets would make tobacco less accessible and ubiquitous, and provide policy makers with an opportunity to reduce the density of outlets in areas of high deprivation. Given arguments that outlet density is correlated with smoking uptake and prevalence,24–26 measures that address the resulting health inequalities should, arguably, be policy priorities.

Because alcohol consumption and smoking are highly paired behaviours, particularly for social smokers, decoupling this association could reduce the risk that occasional smokers will develop a stronger dependence on nicotine, or that non-smokers will experiment with tobacco.27 Specific measures could include a health levy imposed on retailers who sell both tobacco and alcohol, with the tax hypothecated to support tobacco control interventions. If local councils had authority to review and approve retail licenses, communities could have greater community input into retail location, density and product array. Extending smoke-free bar areas to include external spaces would help reduce tobacco consumption, particularly among young people who report that drinking predisposes smoking.27 At the least, more effective regulation could prevent external bar areas being transformed into quasi-internal spaces that have walls, roofs and heaters, and could reduce the appeal of going outside to smoke.

Each of the measures tested would further denormalise what remains a highly potent marketing environment for tobacco. Smokers’ opposition to some of these measures is understandable, since purchasing tobacco would become less convenient; nevertheless, the overall support for all potential measures suggests regulators have a mandate to act. These findings should therefore empower politicians, who mostly wish to act in accordance with public opinion, but who have not kept pace with the public's desire to control tobacco marketing.

Our study has some limitations, particularly our collection of perceptual, rather than behavioural, data. While respondents believed the new law would reduce smoking prevalence among young people, we need evidence from longitudinal cohort studies to test this belief and allow analysis of the policy's longer-term benefits. Additionally, online panels do not provide random, representative samples. However, as smoking status, rather than a demographic attribute, was the strongest determinant of views on the new policy, we believe weighting the sample to match population smoking prevalence levels addresses this potential problem.

In summary, consistent with international studies, our findings show strong support for removing tobacco POS displays. We extended earlier work by estimating support for additional retail interventions designed to further reduce tobacco's pervasive retail presence and found strong support for all but one of the new measures examined. Policy makers should be reassured by these findings, which offer them immediate guidance; replication of our study in other jurisdictions could provide similar assistance to international regulators. Within New Zealand, we suggest policy makers may proceed to creating tobacco-free retail zones around schools, and requiring retailers to offer cessation products in the knowledge they have a strong mandate for these measures, even among daily smokers.