The Next Step in Smoking Prevention: the Reduction of Tobacco Retail Outlets, a Comprehensive Policy Evaluation
试验速览
- 阶段
- 不适用
- 状态
- Enrolling By Invitation
- 入组人数
- 1,450
- 试验地点
- 1
- 主要终点
- Impulse purchases of tobacco
研究概览
简要总结
Few countries have legislation to reduce the number and types of tobacco retail outlets. The Netherlands plans to ban tobacco sales in supermarkets in 2024. The overall aim of this proposed research is to evaluate the implementation of new legislation to reduce the number and types of tobacco outlets in the Netherlands, up until and including the ban on sales of tobacco in supermarkets.
In a comprehensive policy evaluation, the investigators plan to examine (1) the impact of the policy on the number and types of tobacco outlets, (2) the impact on attitudes and behaviors of smoking adults and non-smoking youth, and (3) the influence of the tobacco industry on the policy process and the retail environment. In addition, the investigators plan to focus on differential effects in disadvantaged neighborhoods, where both smoking rates and tobacco outlet density are typically highest.
The investigators bring together a unique combination of economic, psychological, and journalistic research methods. The investigators examine the impact of the new legislation on the amount and type of tobacco outlets and on the number of smokers by using routinely collected monitoring data. The investigators examine the impact of the legislation on smoking susceptibility of non-smoking youth and on impulse tobacco purchases by smoking adults with yearly quantitative surveys (two surveys before the policy implementation and two after) and with qualitative interviews and discussion sessions. The investigators examine whether these impacts differ for disadvantaged versus non-disadvantaged neighborhoods. The investigators examine what strategies the tobacco industry uses to influence the new legislation, policy processes, and the tobacco retail environment by performing a journalistic investigation, using for example documents obtained by Freedom of Information Act requests, (possibly) leaked documents from insider meetings, and interviews with insiders.
Our research will provide a comprehensive evaluation of the effects of the implementation of the proposed legislative measures. Based on our results, the investigators will formulate recommendations for the Dutch Cancer Society, the Dutch government, and for other countries who consider reducing the number of tobacco outlets; highlight potential areas for further development and improvement within the legislative framework and provide recommendations on how to counter the lobby from the tobacco industry.
详细描述
Problem description: Tobacco use is the primary cause of several cancers; among them lung cancer, which is the leading preventable cause of death in the Netherlands. Yet, tobacco use remains high in the Netherlands, with an adult smoking prevalence of 20%, which is even higher in groups with a lower socioeconomic position. Therefore, reducing the smoking prevalence in all groups in society is one of the three priorities in the Dutch National Prevention Agreement. This Agreement was made with the Dutch government and more than 70 societal organizations, including the Dutch Cancer Society. It consists of a range of voluntary agreements and policy measures to reduce smoking prevalence to 5% or less by 2040. Among these measures is the proposal to reduce the number of outlets that sell tobacco. The government has announced a stepwise approach to ban the sales of tobacco products from various types of outlets. The first step is planned for 2022, with a ban on cigarette dispensing machines. This is followed by a ban on the online sale of tobacco in 2023. In 2024, the largest change is planned with a ban on the sales of tobacco for supermarkets, which currently accounts for approximately 40% of tobacco outlets in the Netherlands. The last step is to phase out the sale of tobacco at petrol stations and convenience stores, so that in the end only specialist tobacco shops can sell tobacco products. The reasoning of the Dutch government for this legislation is to protect young (non-)smokers and adult (former) smokers from exposure to tobacco products and with that from the temptation to smoke and to make impulse purchases, ultimately making it easier to quit smoking and less likely to (re-)initiate smoking. It also adds to the denormalization of smoking as it makes tobacco products disappear from common sight. The proposed measures however lack clear goals, such as a target number of tobacco outlets, nor is there any particular attention given to reducing socioeconomic inequalities in smoking through these measures. Moreover, the tobacco industry is known to try to stop, delay, or weaken legislation before it is implemented, and may try to influence the tobacco retail environment.
Research direction: The investigators will do a comprehensive policy evaluation of the new Dutch legislation on tobacco outlets. The investigators examine:
- The effects of the legislation on the number of tobacco sales outlets.
- The effects of the reduced number of sales outlets (if any) on the number of smokers.
- The effects on smoking susceptibility among non-smoking youth.
- The effects on impulse tobacco purchases of smoking adults.
- How these impacts differ for those living in disadvantaged versus non-disadvantaged neighborhoods.
- The strategies that the tobacco industry uses to influence the national legislation on tobacco outlets.
- And the strategies that the tobacco industry uses to influence the tobacco retail environment in the Netherlands.
Aim: The overall aim of this proposed research is to evaluate the implementation of new legislation to reduce the number and types of tobacco outlets in the Netherlands, up until and including the ban on sales of tobacco in supermarkets.
Primary research questions are:
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 12 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Dutch-speaking
- •aged 12 to 17 years old at enrollment
排除标准
- •they have smoked (part of) a cigarette at least once a month during the last six months
- •not providing informed consent to participate
- •Smoking adults
- •Inclusion Criteria:
- •Dutch-speaking
- •smoking at least monthly at enrollment
- •having smoked at least 100 cigarettes in their lifetime
- •Exclusion Criteria:
- •not providing informed consent to participate
结局指标
主要结局
Impulse purchases of tobacco
时间窗: October 2022; October-November 2023, 2024, 2025
This is measured amongst smoking adults with the question "When you are shopping in a store in your neighborhood for something other than cigarettes, how often do you decide to buy cigarettes?" (1=Often, 2=Rarely, 3=Sometimes, 4=Often, 5=Always) (Siahpush et al., 2016).
Smoking susceptibility
时间窗: October 2022; October-November 2023, 2024, 2025
This is measured amongst non-smoking adolescents with a three-item index, averaging responses to "Would you try smoking a cigarette if one of your best friends offered it to you?", "Do you think you would smoke in the next 6 months?", and "Are you curious about smoking?" (1=Definitely Not, 2=Probably Not, 3=Probably Yes, 4=Definitely Yes) (Strong et al., 2015).
Number of smokers
时间窗: 2018-2025
The investigators use data at the individual level. The investigators propose to use existing data from the lifestyle monitor of CBS (15,000 observations annually) and the polling station survey among students (8,000 observations every four years). For each individual the investigators link the area where they live.
次要结局
- Number and type of tobacco outlets(2018-2025)
- Illegal (online) sales of tobacco(October 2022; October-November 2023, 2024, 2025)
- Use and marketing of 'reduced risk' products(October 2022; October-November 2023, 2024, 2025)