Changes in Retail Tobacco Promotions in a Cohort of Stores Before, During, and After a Tobacco Product Display Ban

Abstract

We used a longitudinal design to investigate the impact of a government policy banning the display of tobacco products at the point of sale. The extent of tobacco promotions in 481 randomly selected stores was documented at 4 points in time (2005–2009). Tobacco promotions were greatly reduced after implementation of the display ban. A ban on the display of tobacco products and other signage and promotions at retail is a critical tobacco-control policy to reduce people's exposure to tobacco marketing.

Exposure to point-of-sale (POS) tobacco promotions is associated with adolescent smoking initiation,^1–6 impulse cigarette purchases,^7,8 and relapse among those trying to quit.⁹ Furthermore, youths exposed to POS promotions exhibit higher levels of brand recognition and positive imagery of tobacco products.¹⁰ POS promotions are more prominent in low-income neighborhoods,^11–13 stores near schools,¹² areas near schools with high smoking prevalence,¹⁴ and shopping areas frequented more often by adolescents.¹⁵

In Ontario, Canada, a phased-in ban on the retail display of tobacco products was implemented over 2 years. Initial restrictions on promotions (powerwall enhancements, countertop displays, most signage) took effect on May 31, 2006, followed by a full POS display ban on all tobacco products on May 31, 2008. To investigate the impact of this government policy, we conducted a longitudinal study of tobacco promotions in a cohort of stores over a 4-year period before, during, and after full implementation of the tobacco retail display ban.

METHODS

We randomly selected 20 cities across Ontario for data collection in 2005. In each city, we randomly selected 24 stores (convenience stores, gas stations, and grocery stores), resulting in a total of 481 stores (1 city had 23 stores; 2 cities had 25) for the first wave of data collection. A detailed description of the city and store selection process has been previously published.¹² We conducted 4 waves of data collection: 1 year before any restrictions on POS tobacco promotions (2005); 1 year after initial restrictions on tobacco promotions, but before the display ban (2007); 3 months after the tobacco retail display ban, including a ban on most signage and the visible display of tobacco products (2008); and 1 year after the display ban (2009). Trained data collectors used a detailed checklist to document tobacco promotions.

We developed a 15-item tobacco promotion index, in which stores received 1 point for each type of promotion present (e.g., powerwall features, signage) and 1 additional point for each countertop cigarette display.¹² We conducted analyses using mixed-model repeated measures, with index score as the outcome, to examine the associations between tobacco promotion index scores and (1) store type (independent or chain convenience, gas station, grocery), (2) school proximity (1 or more schools located within 100 feet of the store), and (3) median household income and education (percentage of individuals aged 20 years and older not having a high school diploma) in the store's neighborhood. We based the final model on a sample of 475 stores (6 stores were missing neighborhood income values).

RESULTS

Table 1 shows the frequencies of key POS tobacco promotions over the 4 waves of data collection. After the complete display ban was implemented, 99.8% of stores had completely hidden their cigarettes, usually behind cabinets with flaps. Overall, tobacco promotion index scores dropped from a mean of 7.0 (SD = 4.0) in 2005 to 2.6 (SD = 1.5) in 2009.

TABLE 1.

Percentage of Stores With Select Tobacco Promotions Over 4 Waves of Data Collection: Ontario, Canada, 2005–2009

	Wave of Data Collection
Promotion Type	2005 (n = 481), %	2007 (n = 433), %	2008 (n = 403), %	2009 (n = 374), %
Visible cigarettes	100.0	100.0	0.02	0.04
Countertop displaysa	46.2	0.0	0.0	0.0
Indoor signsa	30.8	3.5	0.1	0.2
Side panels on powerwalla	14.3	0.5	0.0	0.0
Outdoor signsa	20.7	0.7	0.2	0.08

Note. A total of 107 stores shut down at some point during data collection and therefore incomplete data was collected for at least one wave.

^aProhibited as part of the May 2006 restrictions. Note that the “indoor signs” measure does not include the indoor signs that continued to be allowed after the May 2008 total display ban (signs not exceeding maximum size, with black text on white background, not visible from outside the store, with no brand identified, and no more than 3 such signs).

In 2009, after the complete display ban, we observed some tobacco promotions that were still permitted: plain price signs on covered powerwall cabinets (66% of stores), displays of nonbranded tobacco accessories (e.g., lighters) on or near the powerwall (36% of stores), and cigarette product binders seen on the counter or voluntarily shown by the clerk (3%).

Tobacco promotion index scores declined over time (Table 2), with independent and chain convenience stores having the largest declines in scores. The difference between independent convenience stores and chain convenience stores was significant (P < .05) in 2005 but not significant in 2007, 2008, and 2009. In 2008, stores in neighborhoods with higher median income levels had higher index scores, although the magnitude of difference was very small. The change in the association between store neighborhood median income and index score seen in 2008 was markedly larger than that seen at any of the other waves, but it still amounted to only a 0.32-point increase in index scores.

TABLE 2.

Results of Multivariate Model Examining Effects of Independent Variables on Tobacco Promotion Index Scores: Ontario, 2005–2009

Effect	F (df)	P
Wave	325.6 (3, 1183)	< .001
Store type	258.3 (3, 468)	< .001
School proximity	1.14 (1, 468)	.29
Neighborhood income	5.20 (1, 468)	.023
Neighborhood education	2.63 (1, 468)	.11
Wave × store type	25.4 (9, 1183)	< .001
Wave × income	5.14 (3, 1183)	< .002

Note. Data were based on a sample of 475 stores.

At the final wave of data collection, when clerks were asked to recommend a light brand or cheap brand, no pattern of response was found, and data collectors found many clerks unable to suggest a brand. This finding suggests that store clerks were not being coached to recommend specific brands.

DISCUSSION

In 2009, promotions once common in Ontario (e.g., signs, countertop displays, and powerwalls) had become virtually nonexistent, with tobacco products not visible in more than 99% of stores after the regulatory change.

Our findings, in addition to compliance results from others^15,16 and those of Quedley et al.¹⁷ showing the limitations of a partial ban, demonstrate the importance and effectiveness of a complete ban on retail tobacco displays. Removing tobacco products from sight at retail stores can be surprisingly easy when a government communicates its serious commitment to a total display ban and holds its ground despite protests by tobacco company front groups (including convenience store associations) and when the health community is vocal in supporting the policy. Indeed, we previously reported that stores were complying with restrictions on signage, countertop displays, and powerwall enhancements before these restrictions came into effect.¹⁸ A ban on the display of tobacco products and other signage and promotions at the point of sale is a critical tobacco-control policy for reducing people's exposure to tobacco marketing, and it reinforces tobacco-control messages and other interventions that encourage people not to start or continue to use tobacco products.