Adolescents' perceptions of tobacco accessibility and smoking norms and attitudes in response to the tobacco point-of-sale display ban in Scotland: Results from the DISPLAY study

Abstract

Background: Scotland implemented a ban on open display of tobacco products in supermarkets in April 2013, and small shops in April 2015. This study aimed to quantify changes in perceived tobacco accessibility, smoking norms, and smoking attitudes among adolescents in Scotland, following the implementation of partial and comprehensive point-of-sale tobacco display bans. Methods: From the Determining the Impact of Smoking Point of Sale Legislation Among Youth (DISPLAY) study’s 2013-2017 annual surveys we retrieved data comprising 6,202 observations on 4,836 12-17-year-olds from four schools. Applying generalised estimating equations, associations between time (post-ban: 2016-2017 vs pre-ban:2013) and three outcomes were estimated. Outcomes were perceived commercial access to tobacco, perceived positive smoking norm (friends think it’s OK to smoke), and positive smoking attitude (you think it’s OK to smoke). Analyses were adjusted for socio-demographics, smoking status, family smoking, friend smoking, and e-cigarette use. Results: Crude trends showed an increase over time in perceived accessibility, norms, and attitudes. However, after adjustment for confounders, mainly e-cigarette use, we found significant declines in perceived access (OR=0.72, 95%CI=0.57-0.90) and in positive smoking attitude (OR=0.67, 95%CI=0.49-0.91), but no change in perceived positive smoking norm (OR=1.00, 95%CI=0.78-1.29). Current/past occasional or regular e-cigarette use was associated with higher odds of perceived access (OR= 3.12, 95%CI=2.32-4.21), positive norm (OR=2.94, 95%CI=2.16-4.02), and positive attitude (OR=3.38, 95%CI=2.35-4.87). Conclusion: Only when taking into account that the use of e-cigarettes increased in 2013-2017 did we find that the point-of-sale tobacco display ban in supermarkets and small shops in Scotland was followed by reductions in adolescents’ perceived accessibility of tobacco and positive attitudes towards smoking.