Links between the retail environment and young people’s use of e-cigarettes have been investigated for the first time as part of a major study led by the University of Stirling.
The DISPLAY study, funded by the National Institute for Health Research (NIHR), is a six year collaborative project between the universities of Stirling, St. Andrews and Edinburgh and ScotCen Social Research. It aims to assess the impact of the ban on the display of tobacco at point of sale (POS) on teenager’s smoking attitudes and behaviours.
In a series of papers, the DISPLAY team report new research findings on e-cigarettes based on a cross-sectional study involving 3,808 students between 11 and 18 years of age in four high schools in Scotland.
The team found there has been a sharp increase in the marketing of e-cigarettes in shops and that awareness of this marketing is associated with adolescents reporting that they had tried an e-cigarette or intended to try one in the future.
In this age group, greater awareness of cigarette brands was also associated with having tried an e-cigarette.
The tobacco control experts carried out an audit of e-cigarette marketing in almost 100 shops and found that the number of stores with purpose built displays more than doubled over a 12 month period, with displays located close to products of interest to children in more than a third of stores.
The team also examined the effect that e-cigarette visibility has had on young people. In the sample of secondary school children, they found that those who recalled seeing e-cigarette displays in small shops were twice as likely to have tried an e-cigarette or were significantly more likely to report that they intended to try them in the next six months. Most adolescents in the study who reported using e-cigarettes had only tried them once and twice and were not regular users.
Professor Sally Haw, Chair in Public and Population Health, said: “E-cigarettes are much less harmful than tobacco products and show promise as a stop smoking aid for adults. Therefore, it is reassuring that in our school survey we found that e-cigarette use is largely limited to occasional use among a small group of young people who already smoke.
“However, in this study, the first of its kind, we did find a relationship between exposure to e-cigarettes in the retail environment and the reported use of e-cigarettes by young people.”
Dr Catherine Best, Public Health Researcher, said: “The prevalence of e-cigarette displays on our high streets has increased markedly and at a time when tobacco is moving out of public view.
“It is currently unclear whether young people who plan to try e-cigarettes do so because they notice e-cigarettes at point of sale or whether they notice e-cigarettes because they intend to try them in the future. Until this association is established, we need to consider how to balance promoting the benefits of e-cigarettes for adult smokers who want to quit with the need to discourage children from experimenting with these products.”
Professor Haw added: “The Health (Tobacco, Nicotine etc. and Care) (Scotland) Bill completed its passage through the Scottish Parliament in early March and makes e-cigarettes an age restricted product, available only to individuals 18 years of age or older.
“However, the Bill as passed does not ban point of sale marketing. Given that this study established a link between the retail environment and young people’s use of and intention to try e-cigarettes, we need to have a careful and considered debate about the role of POS marketing in the promotion of e-cigarettes.”
Determining the impact of smoking point of sale legislation among youth – a protocol for an evaluation of public health policy (DISPLAY) is a six-year project by health science researchers at the University of Stirling, University of St Andrews, University of Edinburgh and ScotCen Social Research.
The study uses mixed methods to collect data across the period in four representative communities including mapping and spatial analyses of tobacco retail outlets; tobacco advertising and marketing audits of tobacco retail outlets most used by young people; cross-sectional school surveys of secondary school pupils; and focus group interviews with purposive samples of secondary school pupils.
Three papers by Stirling health science researchers are referenced above:
E-cigarette marketing in UK stores: an observational audit and retailers’ viewscan be found in full at BMJ Open 2015. Observational audit of 96 stores selling tobacco products in four Scottish communities was conducted over two waves 12 months apart (2013–2014), and qualitative interviews with 25 small retailers in four matched communities were carried out.
Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study is published in BMC Public Health. The cross sectional study survey was conducted in four high schools in Scotland. A response rate of 87 per cent and a total sample of 3808 was achieved.
Does exposure to cigarette brands increase the likelihood of adolescent e-cigarette use? A cross-sectional study is published in BMJ Open 2016 and can be read in full at BMJ Open 2016 Volume 6 Issue 2. Questionnaires were administered to pupils in Secondary 2 (S2 mean age: 14.0 years) and Secondary 4 (S4 mean age: 15.9 years) across four communities in Scotland. An 86 per cent response rate with a total sample of 1404 pupils was achieved.
National Institute for Health Research Public
This project was funded by the National Institute for Health Research Public Health Programme (Project Number 10/3000/07). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Institute for Health Public Health Programme, NIHR, NHS or the Department of Health.
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).
Health (Tobacco, Nicotine etc. and Care) (Scotland) Bill
The Health (Tobacco, Nicotine etc. and Care) (Scotland) Bill is for an Act of the Scottish Parliament to make provision about tobacco, nicotine and related products, in particular to make provision about retailing, to amend the prohibition on smoking in certain areas and to control advertising and promotion; to make provision about a duty of candour following serious incidents in the course of providing care; to make provision about offences applying to ill-treatment or neglect where care is provided; and for connected purposes.
University of Stirling is ranked fifth in Scotland and 40th in the UK for research intensity in the 2014 Research Excellence Framework. Stirling is committed to carrying out research which has a positive impact on communities across the globe – addressing real issues, providing solutions and helping to shape society.
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