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Social determinants of health Editorial 5 March 2018 Free

Tobacco retail density: still the new frontier in tobacco control

Reducing the number of tobacco sellers would make it easier for smokers to quit After four decades of intense and innovative tobacco control policies and programs, Australian governments have achieved large reductions in population level smoking rates. The focus of this comprehensive approach has been to reduce consumer demand for tobacco products through high tobacco taxes, emotive mass media campaigns, graphic health warnings on packages, subsidised smoking cessation services and treatments, smoke-free public spaces, and bans on all forms of tobacco advertising.1 However, despite early calls for restrictions on the number and location of tobacco retail outlets,2 Australia is falling behind other jurisdictions in adopting polices that seek to limit the supply of tobacco products. In the United States, for example, both San Francisco and New York have adopted regulations that cap the number of tobacco retailers in each city district, responding to the high concentration of outlets in low income neighbourhoods. The disproportionate concentration of tobacco retailers in areas of greatest socio-economic disadvantage also exists in Australia, as highlighted in the report by Melody and her colleagues in this issue of the Journal.3 In Australia, however, no policies specifically aim to reduce the currently very high number of tobacco retailers. While no jurisdiction has yet to reduce outlet density sufficiently to assess the impact on smoking rates, there is strong evidence that having fewer retailers reduces the level of impulse purchasing of cigarettes. Canadian research found that one-third of smokers, especially younger smokers, would smoke less if they simply had to travel further to buy cigarettes.4 In an Australian study, the mere sight of tobacco retail outlets prompted impulse purchases, even in the absence of point-of-sale displays of tobacco products at the checkout counter.5 Continually resisting not only the urge to smoke but also to purchase cigarettes make it incredibly difficult for smokers to quit. Tobacco control policies that make it easier and also prevent relapse are critical for reducing the more than 18 000 deaths caused by smoking in Australia each year.6 Not only are tobacco retailers more numerous in low income neighbourhoods, tobacco retailers in disadvantaged areas are also less likely to comply with regulations regarding the retail display, sale, and promotion of tobacco in stores.7 Populations at greatest risk of taking up smoking, continuing to smoke, and suffering from the health effects of smoking are therefore not only exposed to more retailers, but are also afforded the least protection by tobacco control laws. Reducing the number of tobacco outlets could be achieved by several complementary policy options. The introduction of a substantive annual tobacco licensing fee in South Australia led to an almost 25% decrease in the number of retailers in that state.8 This is in sharp contrast to New South Wales, where very few tobacco retailers stopped selling after a no-fee tobacco retailer notification scheme was introduced.9 As would-be ex-smokers report frequent relapsing when they consume alcohol, banning tobacco sales in licensed premises would both reduce the number of tobacco outlets and support quitting smokers where they are most vulnerable.5 Such a move is unlikely to encounter substantial resistance, as tobacco sales appear to be of limited financial importance to bars and clubs.10 Other options include permanently banning retailers from selling tobacco if they have been convicted of selling to underage smokers, and offering incentives that encourage retailers to stop selling tobacco, such as a subsidised program to help them sell more fresh fruit and vegetables. In 2009, tobacco outlet density was described as the “new frontier for tobacco control.”11 Nearly 10 years later, Australia — in so many ways a leader in tobacco control — has yet to develop policies for reducing its high density of tobacco outlets. It is essential to challenge the existing retail sales environment, which sees tobacco sold ubiquitously alongside everyday household items. Framing tobacco retail policies as assisting former smokers to remain abstinent is entirely in line with the highly successful approaches Australia already employs to reduce the heath burden of tobacco use. Limiting the number of outlets that sell tobacco products, reducing the concentration of outlets, especially in disadvantaged areas, and limiting which outlets can legitimately sell tobacco products must be priority policy goals. It is time for Australia to break through the tobacco retail frontier and lead the way in regulating the supply of tobacco products.

Becky Freeman · Suzan Burton

17 01239

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