Tobacco retailers attitudes and knowledge of the Smokefree Environments Amendment Act 2011 and other tobacco control measures

Transcription

1 Tobacco retailers attitudes and knowledge of the Smokefree Environments Amendment Act 2011 and other tobacco control measures A report for Regional Public Health, Wellington June 2012 Richard Jaine

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3 CONTENTS Contents... 2 Acknowledgements... 3 Executive Summary... 3 Introduction... 6 Aims and Objectives... 8 Methods... 9 Results Participants Attitudes to selling tobacco Profit from tobacco sales Knowledge of forthcoming changes to tobacco retailing Information needs from Regional Public Health Anticipated impact of SFEA Act changes on business operations Anticipated effects of tobacco control measures Nicotine replacement therapy knowledge, sales and attitudes Tobacco retailer licensing attitudes Understanding of tobacco harms and benefits Providing support for customers Discussion Recommendations for Regional Public Health References Appendix: Interview schedule Appendix: Examples of nicotine replacement therapy

4 ACKNOWLEDGEMENTS Thanks must go to the interviewees for their time and frank and open comments. Without them this research would not have been possible. Thanks to Marie Russell for the hours of travelling and interviewing the participants, as well as many other helpful tasks in completing this report. Thanks to Jo Peace for help with recruiting participants. Thanks to Janet Hoek, Ninya Maubach and Richard Edwards for very useful comments on a draft of this report. Thanks also to Ali Oldershaw and staff at Regional Public Health. Ali was responsible for the concept and proposal for the study and provided useful feedback, comments and assistance throughout the project. Thank you to Regional Public Health for funding the project. 3

5 EXECUTIVE SUMMARY Background and aims The New Zealand government has recently committed itself to the goal of making New Zealand smokefree by In order to achieve this outcome, a range of tobacco control measures has been suggested. The Smoke- free Environments (Controls and Enforcement) Amendment Act 2011 (SFEA Act) has been developed as a step towards this goal and includes changes that will influence the retail environment, including the removal of point of sale (PoS) tobacco displays from 23 July This study aimed to: explore the knowledge and views of tobacco retailers about upcoming SFEA Act changes explore retailers views on selling tobacco and potential tobacco control measures (in particular, selling nicotine replacement therapy (NRT) and the licensing of tobacco retailers) provide Regional Public Health with actions to address retailers perceived needs. Methods This was a qualitative study that involved face- to- face semi- structured interviews with tobacco retailers in the greater Wellington region. Participants were recruited from purposively selected retail outlets (with an element of random selection) to ensure a diverse range of viewpoints and retail experiences; the selection criteria were type of store (i.e. supermarket, service station, dairy), geographical area, and neighbourhood deprivation level. The interviews were audio- recorded and transcribed. The transcripts were analysed by a thematic analysis. Results Eighteen retailers of the 44 eligible retailers agreed to participate (a response rate of 41%); they represented a range of store types and locations. Retailers were aware that changes had been made to tobacco retailing legislation, and knew particularly about the PoS display ban, but knew little detail about the changes. Retailers had very little knowledge of other changes (such as permitted signage and price lists). Most retailers were either ambivalent about selling tobacco or would prefer not to sell tobacco. However, most believed that it was a business imperative and had not seriously considered stopping stocking tobacco. Retailers had a broad range of opinions on the anticipated effectiveness of the upcoming changes to the SFEA Act and on other tobacco control measures. Some retailers thought the removal of PoS tobacco displays would not affect smoking rates while others thought it would. Some believed that, while it would not stop current smokers, it might stop people from starting smoking. Conversely, some retailers thought that if tobacco products are put out of sight, young people might be 4

6 attracted by their forbidden nature and be more inclined to start smoking. Many retailers considered that price increases were the most effective measure to reduce smoking rates. The majority of retailers were not opposed to a theoretical requirement that NRT products be made available wherever tobacco products are sold, nor did they oppose a licensing or registering scheme for tobacco retailers. Some potential barriers to these measures were that NRT is highly subsidised elsewhere, and the financial and time costs of becoming licensed. Conclusions While all retailers were aware that how they can sell tobacco will change, many were unaware of the specific details. RPH could support retailers by providing information on the changes (particularly on permitted signage and acceptable price lists). Newsletters or face- to- face meetings at their premises would be the most acceptable way to do this, according to those interviewed. Although retailers had varied views on tobacco control measures and their effectiveness, they generally supported the current and other potential tobacco control measures suggested during the interviews. A few retailers were interested in providing additional support to customers making quit attempts. RPH could encourage this by identifying and supporting such retailers. Many retailers supported further tobacco control measures such as compulsory NRT sales and tobacco retailer licensing or registering. Further research could examine how retailers perceived barriers might be addressed and these measures implemented. 5

7 INTRODUCTION The New Zealand government has recently committed itself to the goal of making New Zealand smokefree by In order to achieve this outcome, a range of tobacco control measures has been suggested. 2 The Smoke- free Environments (Controls and Enforcement) Amendment Act 2011 (SFEA Act) has been developed as a step towards this goal and includes changes that will influence the retail environment, including the requirement to remove Point of Sale (PoS) tobacco displays from 23 July 2012 (see Box for a summary of the changes). Summary of Smoke- free Environments (Controls and Enforcement) Amendment Act 2011 changes Removal of displays Retailers must not allow any tobacco product to be visible to the public except when delivering the tobacco products to the premises where they are being sold or to the customer at the point of sale. Price lists Tobacco price notices will no longer be able to be openly displayed. Price lists that only identify what tobacco products are available and their price can be provided to a customer upon request. Product identification tags Tags intended to help a seller locate a particular tobacco product are permitted as long as the customers cannot easily read these tags. Signage Retailers can display a sign indicating that tobacco products are available in the store. Any other references to tobacco or smoking will be prohibited. The current SMOKING KILLS and No Sales to Under 18s signs will be prohibited. Retail and trading names Retail or trading names that contain words, phrases, trademarks or company names that have the effect of advertising the availability of tobacco products will be prohibited. Penalties for breach Retailers can receive instant fines for some offences (e.g. selling tobacco products to people under 18 years and other offences). There is also an increase in the penalty for selling tobacco products to people under 18 years. Source: Guidelines for Implementing the Prohibition on the Display of Tobacco Products 2012: Information for sellers of tobacco products and Smoke- free Enforcement Officers, Ministry of Health 3 It is important that the agencies charged with educating and communicating with retailers, and with ensuring compliance, understand the level of knowledge, the attitudes and concerns of retailers 6

8 affected by the changes to the SFEA Act, including the removal of PoS tobacco displays. Such information can help agencies ensure the smooth implementation of the changes, and provide an opportunity to explore retailers attitudes to tobacco products and other potential proposed retail interventions. Regional Public Health (RPH) is the public health unit for the greater Wellington region (covering the Capital and Coast, Hutt Valley and Wairarapa District Health Boards) and is the agency that works with retailers in the region to ensure compliance with the legislation. Although most retailers will continue to sell tobacco products after these changes, there is not a clear understanding of retailers attitudes to tobacco in New Zealand. New Zealand specific research on retailers attitudes to tobacco is limited. A Medline search using the terms tobacco, retailer/commerce, attitudes and New Zealand identified very few published articles in this area. 4,5 International evidence specific to retailers attitudes to tobacco is also limited. A similar Medline search found only three articles specifically related to retailer attitudes. A study from North Carolina, USA, found the majority of business owners (who were not necessarily tobacco retailers) supported restrictions on smoking in their businesses. 6 A Canadian study found 90% support from tobacco retailers that they should not be able to sell tobacco to minors. 7 The third study examined tobacco company incentive programmes offered to retailers and retailers perceptions of these programmes. 8 One previous locally conducted research project was an exploratory qualitative study. 9 This study assessed retailers views on the tobacco industry and explored possible tobacco control interventions in the retail environment, particularly removal of PoS displays. Of the seven retailers who took part, three were dairy /convenience store owners, one was a former dairy owner who had stopped selling tobacco and three were senior managers from retail supply and distribution organisations. The study, conducted before there had been any significant public debate about the issue, found mixed views about removing point of sale displays, with many of the retailers unconcerned about or even in favour of removing PoS displays. Another qualitative study investigated the views and experiences of retailers who had voluntarily removed PoS displays, 10 and found that their experience was overwhelmingly positive and at odds with the predictions of the tobacco industry and retailer groups campaigning against the removal of PoS displays. Those predictions include financial losses to retailers (including the cost of removing and replacing store furniture), that retailers would experience increased thefts and safety issues, and that there is a lack of evidence that removing PoS displays will be effective. 11 Examples of potential interventions in the retail environment include: requiring that nicotine replacement therapy (NRT) (and other cessation support) is available wherever tobacco products are sold controlling the numbers of tobacco retailers ensuring tobacco retailers are a certain distance from schools or other areas where children congregate requiring staff who sell tobacco to be over 18 years of age prohibiting the sale of tobacco in areas where alcohol is consumed 7

9 registering or licensing tobacco retailers. Using NRT doubles an individual s chance of successfully quitting. 12 However, despite its increasing availability through Quit Card Providers (who can provide subsidised NRT), only small numbers of smokers use NRT during a quit attempt. In 2009 only 22% of New Zealand smokers used NRT to support their most recent quit attempt 13 (although this percentage may now be higher). Those in the older age groups were more likely to use NRT during a quit attempt. Pacific people were only one- third as likely to have used NRT compared to the total population. 13 In 2009, only 2.2% of smokers accessed NRT through supermarkets (compared to almost 50% through Quitline). Having NRT available wherever tobacco products are sold may increase the use of NRT during a quit attempt. Again, New Zealand specific research on NRT within the retail environment is limited. A Medline search using the terms nicotine replacement therapy, retailer/commerce, and New Zealand identified only one article. In a 2010 study of 22 New Zealand staff in dairies, cafes and small supermarkets, only one retailer sold NRT and four others had sold NRT in the past. 5 However, 18 of the 22 participants felt dairies should have a role in promoting smoking cessation products and services (although most preferred indirect methods). Three were willing to provide brief verbal advice and eight were prepared to become Quit Card providers. Half of the participants agreed that wherever tobacco products are sold it should be legally required to have quit smoking products available. Support for the licensing of tobacco retailers has had mixed support. Reasons for support include making tobacco less available, reducing underage smoking and that it was logical given that a license was needed to sell alcohol. 9 Reasons for opposing licensing tended to focus on the business aspect; it would disadvantage small independent stores, and specialist tobacconists would dominate. The removal of PoS tobacco displays, and other changes in the Smoke- free Environments (Controls and Enforcement) Amendment Act 2011 constitute a significant change in tobacco retailing. The extent to which retailers are prepared for these important changes is unknown. Agencies responsible for ensuring compliance with the legislation need to understand retailers concerns as the changes are introduced. Research could assess retailers readiness for the imminent changes, and suggest what information or support is needed. Understanding retailers attitudes, preferences and expectations can guide development of future tobacco control measures. AIMS AND OBJECTIVES The aims were: to explore the knowledge and views of tobacco retailers about upcoming changes to the SFEA Act, including the removal of PoS tobacco product displays to explore retailers views about their experiences of selling tobacco, and their thoughts on other potential tobacco control retail interventions, particularly selling NRT and licensing of tobacco retailers to formulate specific actions RPH can take to address any concerns identified, including effective communications and actions that address retailers perceived needs. 8

10 METHODS The primary source of data for this study was semi- structured interviews with tobacco retailers in the greater Wellington region. We anticipated that interviews would be required to achieve a saturation of themes. Participants were selected from a tobacco retailer list for the greater Wellington region, provided by Regional Public Health. They were purposively selected (with an element of random selection) to ensure a diverse range of participants including: a range of store types including dairies, convenience stores, mini- markets, service stations, and supermarkets a range of representative locations across Wellington, the Hutt Valley, Porirua, Kapiti Coast and the Wairarapa a range of different deprivation quintiles and population demographics (particularly ethnic composition). The retailer list was divided into type of store (i.e. supermarket, service station, dairy/mini- market/convenience store) and area (i.e. Wellington, Hutt Valley, Porirua, Kapiti Coast, Wairarapa). From these lists, retailers were randomly selected (through random number generation) according to Table 1. To ensure that retailers from areas of higher deprivation and varied ethnic composition were included, we sampled one dairy and one service station from Naenae, Taita or Wainuiomata and two dairies from Porirua East, Cannon's Creek or Waitangirua. Supermarkets were defined as large, branded supermarkets (e.g. New World, Countdown). Service stations were defined as branded service stations (e.g. Mobil, Caltex) and included independent stations such as Challenge and G.A.S. All other retailers fell into the dairy/mini- market/convenience store type (referred to as dairies or dairy from here on). Table 1. Numbers of retailers planned from each category Supermarkets Dairies, etc.* Service stations Total Wellington Hutt Valley Porirua Kapiti Coast Wairarapa Total *includes convenience stores and mini- markets The researchers sought interviews with participants who were in a position of responsibility in the store. For small shops, this was the owner, or in family- run dairies, a senior member of the family who regularly worked in the store. In supermarkets and service stations, the overall manager or duty manager was approached. 9

11 The researchers attempted to contact each potential participant by phone (most commonly) or occasionally face- to- face, in order to set up an interview time with the participant. For some participants several contact efforts were made. The researchers attempted to contact each potential participant by phone (most commonly), or face- to- face, in order to set up an interview time with the participant. Up to four attempts were made to contact each participant once the person had been identified. Then, or if potential participants refused to participate, the next retailer on the randomised list was contacted. Retailers were not recruited if they refused to participate or if no contact details for outlet were available or contact was not made after repeated attempts. Some retailers said they could not participate without clearance from the head office of their company. These tended to be supermarket and service station retailers. Researchers contacted the head offices of the major supermarkets and a major oil company. Both supermarket head offices said it was not appropriate for their retailers to participate (although they were happy to participate themselves). The oil company did not reply. Independent supermarkets were still contacted. Participants were provided with information sheets, and signed written consent forms. The research proposal obtained ethics approval through the University of Otago (Category B ethics). This involved review and sign- off from a senior department member who is independent of the research project. We developed an interview schedule which was refined through discussion among the team members (see Appendix). This was piloted with several participants with no major changes to the schedule. The schedule was used by an experienced qualitative researcher who conducted the face- to- face semi- structured interviews. During the interviews, participants were shown pictured examples of nicotine replacement therapy products and shown the logo of RPH (see Appendix). At the end of the interview the participant was offered a voucher for $30 for The Warehouse, a store that does not sell tobacco. The interviews took approximately minutes each and were carried out between 16 April 2012 and 15 May Each interview was audio recorded and then transcribed verbatim. The transcripts and recordings were then checked for accuracy and analysed to identify the main themes of the interviews. This thematic analysis was carried out as outlined by Braun and Clarke

12 RESULTS PARTICIPANTS We attempted to contact 55 different businesses. Of these, 11 were no longer in service or contact details were unavailable. Of the remaining 44 who were eligible to participate, 18 people agreed to participate (a response rate of 41%). Of the 26 that were not recruited, 14 stated that they needed approval from their respective head offices to participate (these were mostly supermarkets and one brand of service stations), eight refused to participate (most stated that they were too busy), and for the remaining four no contact was made after multiple attempts. We managed to complete 18 of the 20 planned interviews as shown in Table 1 in the Methods section. We failed to recruit a service station from Naenae, Taita or Wainuiomata and one service station from Wellington. The 18 interviewees were from a variety of store types, locations and deprivation- level areas. Table 2. Numbers of retailers recruited from each category Supermarkets Dairies, etc.* Service stations Total Wellington Hutt Valley Porirua Kapiti Coast Wairarapa Total *includes convenience stores and mini- markets Most interviewees had been in the retail business for more than 10 years (range 3 to 35 years) and most had been involved with their current outlet for the majority of that time. Interviewees tended to be owner/operators (particularly for the dairies) or site or operations managers. ATTITUDES TO SELLING TOBACCO Most retailers were either ambivalent about selling tobacco or would rather not sell it. No retailer expressed positive attitudes towards selling tobacco. To be honest, I don t want to sell smokes to any people. (Service station retailer, Interview 2) I m not really interested in cigarettes. If they take it away tomorrow so be it. (Service station retailer, Interview 9) However, almost all retailers stated that it was a business necessity to stock tobacco products. For example, some stated that as it was currently a legal product, if they did not sell it, smokers would buy it elsewhere, and they would lose other sales as a consequence. Several retailers also considered tobacco products to be a reducing market. 11

13 We have [tobacco] because our competitors do, because everyone else does. We won t stop [selling] if we were the only ones not selling it, but if more and more stores agreed to ditch it, we would look at is as well. (Supermarket retailer, Interview 10) Some retailers expressed a dislike of selling tobacco to young (but of legal age) customers. Don t like selling it to people that are just of age, I don t really think people are old enough to actually realise, but if it s an older person, they have been doing long enough, they are an adult, it s up to them. (Supermarket retailer, Interview 16) Others thought that it would be easier to not sell tobacco and supported a Government ban on sales. As a complete ban on tobacco sales was not discussed with all participants, it is unclear how widely held these attitudes were. I m a retailer. As I say it s an item that a portion of our customers expect, and as it s still legal to sell it and we will sell it, but certainly it s not something that I m not looking to promote or grow, I d be more than happy if it became illegal to sell some of the cigarettes and tobacco or the price went to $100 a packet, quite comfortable with that. (Supermarket retailer, Interview 8) [Tobacco sales] should be completely stopped by Government smokefree should be 2015 not (Dairy retailer, Interview 12) While some retailers have considered not selling tobacco, most have not seriously considered it. You don t think about it as an option. It comes with the territory [being a retailer]. (Dairy retailer, Interview 14) PROFIT FROM TOBACCO SALES Almost all retailers said that profit from tobacco was low, even though it was a high turnover product. This was particularly the case for supermarkets, although most dairy and service station retailers also agreed. For dairies, other store items, such as confectionery, were seen as more important to profit. Tobacco being a high- turnover, low- profit product, there was also some concern from retailers that they had to maintain a high level of stock. This could cause problems as the stock would pose storage issues, as well as a security risk. The more stock we hold, the more risk we are of being a target. (Dairy retailer, Interview 3) KNOWLEDGE OF FORTHCOMING CHANGES TO TOBACCO RETAILING All retailers had some knowledge of the upcoming changes to tobacco retailing. Most were aware that the major change was the removal of PoS tobacco displays, and knew that these changes were coming into force by the middle of the year. However, beyond these points, most retailers knew few details of the changes. 12

14 I don t know a lot to be fair but what I do know is that it s got to be behind closed doors basically and hidden as far as I know, that s probably about the major change that I know, I don t know if there are any others. (Service station retailer, Interview 15) Knowledge of the changes did not appear to vary by retailer type, although several supermarket and service station retailers stated that they were expecting further information from their head offices. Retailers had generally been provided information on the changes from either the tobacco companies or the head offices of their company. The tobacco company representatives had visited retailers with plans to change the display cabinets. One tobacco company information sheet seen by the interviewer was a two- sided A4 sheet with information about the changes to the law including the name of the Act, a note about its requirements and a message about smoking. Few retailers mentioned other changes (for example, price lists and signage). In particular, no retailer commented on the need to remove signage such as Smoking kills and No sales to under 18s signs. INFORMATION NEEDS FROM REGIONAL PUBLIC HEALTH Retailers thought that newsletters (or other forms of written material) or face- to- face meetings at their premises would be the best option for RPH to provide information. All retailers felt that group meetings would not be possible as retailers work long hours and are often busy. While a newsletter with contact details was most commonly supported, a few retailers thought that it might not be read as they already receive a lot of mail. Retailers agreed that the tobacco company and head office information had been useful, and some thought that it was sufficient. I was just relying on the tobacco company to do all the technical care. (Service station retailer, Interview 15) There was some support for RPH to provide material that may help customers with quit attempts. This included material for the store or even pamphlets of information to give customers who are trying to quit. Retailers were not specific on what information may help. Just some kind of A4 signs or even a print, fully printing on my walls that say stop smoking and advertising the 0800 number of the Quitline. (Dairy retailer, Interview 3) In terms of store type, participants thought that the smaller retailers would be the important target audience for RPH. Although there were no specific information requests, it was considered that assistance in terms of further information about the legislation and how to comply would be most valuable. I don t know that they will be able to assist the majors but I would suggest the smaller operators, the smaller dairies, the individually owned petrol stations that may not have a bit of retail weight behind them would probably benefit from that sort of assistance. (Supermarket retailer, Interview 8) 13

15 ANTICIPATED IMPACT OF SFEA ACT CHANGES ON BUSINESS OPERATIONS Retailers anticipated both positive and negative impacts on their business operations from the SFEA Act changes. Opinion was mixed as to whether it would affect sales: some retailers thought it would not affect sales, while others thought sales would reduce. Some thought their profits might be affected because people come into their shop to buy tobacco and also buy other items at the same time (such as confectionery or newspapers). If such consumers were no longer coming in to buy tobacco, the sales of the other, more profitable items would be affected. Of course the turnover for us will be lower, but then to be honest it s not a big issue because there s not much profit involved anyway. (Dairy retailer, Interview 18) This change in turnover was perceived as more likely to affect the smaller retailers. Some retailers suggested that the pattern of tobacco purchasing may change. That is, smokers may be more likely to purchase tobacco during their weekly shop at the supermarket, as it may be more convenient than buying from a dairy. This may shift purchasing away from the smaller businesses, but may also have the consequence of dissuading people to purchase tobacco as they may not be able to afford bulk buys. To me at the moment tobacco, [for] the petrol stations, dairies and Four Squares, is a real convenience issue and convenience item. As that becomes less convenient people will do it where they are doing their regular shopping, more often, which ultimately may become a barrier because if they are buying a week s worth of cigarettes in one time or four days worth in one time they will look at the price and they will go, I don t have to do this anymore, which I don t think will be necessarily bad at all. (Supermarket retailer, Interview 8) Other anticipated impacts tended to be practical issues: re- stocking shelves; issues of opening and closing cabinets; speed of service; and security. Some retailers were aware that the way they re- stock will require some changes, as the public should not be able to see tobacco products during re- stocking. For at least one service station, the manager thought this was going to cause great inconvenience to staff, as with high turnover, re- stocking had to take place daily. At present staff can re- stock the shelves while there are customers in the service station; in future, re- stocking will need to be done out of opening hours, to prevent customers seeing tobacco. However, other retailers said that changes to re- stocking procedures would not be an issue, while others were unclear about what would be required to comply with the law. The full law hasn t, from what we understand, been handed down yet. Can our cashier open the door and count the stock, or do we have to shut down? And if we have to shut down, that becomes major. (Service station retailer, Interview 6) Some retailers thought that the opening and closing of cabinets would inconvenience staff and slow service to customers. Others, however, did not consider this as an issue. Most retailers did not consider that security would be either worse or better following the changes. It will reduce the space, efficiency when you are trying to serve other customers. (Dairy retailer, Interview 5) 14

16 There is a lot more work to it, it takes longer to serve a customer, it s noisier. I don t know how it will happen. (Service station retailer, Interview 9) Participants with concerns about space included those in small dairies where the installation of cupboard doors that open outwards would further reduce the already narrow space behind the counter. The participant concerned about noise expected that a roller door would be in place over the tobacco products which would take time to operate and would make a noise while opening and closing. This expectation may be based on experiences with existing roller- door security covers which are in place in some stores, and which are closed and locked when the store is closed. Two dairy retailers had a preference for an overhead cupboard above the counter, much like it had been in the past. These retailers preferred this storage system as your back is not to the customer and you can see what is happening. However, height of the storage could be an issue, particularly with short employees. Almost all retailers did not consider that there would be great financial cost to their store in terms of changing cabinets. Most retailers said that the tobacco companies owned the stand and would be paying to change it and to ensure it complies with the legislation. Only one supermarket retailer said that the store will be organising and paying for the change to the cabinetry, and this was specifically in order to increase the convenience of existing security arrangements, which involve wheeling tobacco cabinets into secure storage during closing hours. No service stations or dairies said that they would have to pay for the change in cabinetry. ANTICIPATED EFFECTS OF TOBACCO CONTROL MEASURES Retailers had mixed opinions about whether the changes would affect rates of tobacco use. While some thought that smoking rates would decrease, many felt that current smokers would not be deterred as a consequence of the SFEA Act changes. Several retailers identified that, while banning PoS tobacco displays may not lead current smokers to quit, it may help prevent children and young people from starting smoking. Personally I don t think it s going to stop the smokers now. I guess it s not about that, it s stopping the ones that aren t smoking it s the uptake. (Supermarket retailer, Interview 16) Conversely, a few retailers felt that the display bans may encourage young people to start, that is, young people will be more drawn to the prohibited and censored nature of the tobacco products. This tended to be the personal attitudes of the retailers, based on anecdotal evidence from how their own children behave in relation to prohibited items. It s going to make people more curious especially young kids. They re already curious enough but they don t go for it and now that it s going to be banned, all shutters will be down they will go for it. (Dairy retailer, Interview 5) There was a strong sense from the retailers that price increases are the most important measure in reducing smoking rates. 15

17 I think the only thing to slow people down is a price increase, as just because you can t see it in a shop [customers will] just keep doing what they ve been doing, which is ask for it. (Supermarket retailer, Interview 10) However, several retailers provided anecdotal evidence that after the recent price increases, tobacco sales decrease for a week or two, and then smokers return to buy tobacco; either switching to a lower cost brand or accepting the price increase on their current brand. When the price goes up every single customer is telling us that s the last cigarette, telling every day, and then they back to normal. (Dairy retailer, Interview 7) Other comments suggested that people make trade- offs when the price increases. In particular, customers will maintain the same level of tobacco consumption but cut back in other areas, such as petrol or food. [When the price goes up] they try to cut down in the food, but they are buying the smokes if they want smokes and milk and bread, they cut down on the milk, not on the smokes. (Dairy retailer, Interview 7) Other than the current changes and price increases, retailers did not discuss further tobacco control measures. NICOTINE REPLACEMENT THERAPY KNOWLEDGE, SALES AND ATTITUDES All retailers were familiar with some form of NRT when prompted by the pictures (see Appendix). Most had a general idea that NRT delivered nicotine to the body to help prevent cravings. Retailers held mixed views on NRT s effectiveness; while some thought it worked, some did not, and others were unsure. Most retailers did not currently sell NRT products. Although four of the five supermarkets sold NRT, none of the dairies or services stations did. One dairy and one service station had previously sold NRT. The dairy retailer stopped stocking NRT as it was not selling quickly enough and product had to be discarded once the use by date had expired. This highlights one of the main barriers to selling NRT: that it does not sell well. This is particularly so given that NRT is highly subsidised elsewhere. Predominately most of that product is picked up via the pharmacies as a result of Quitline and such like which is where they get the subsidies. [Our range] was really a supplement to those people that perhaps couldn t get to a pharmacy at the time. (Supermarket retailer, Interview 8) People that want to give up usually tend to go to a chemist for stuff like that, because I know I did. I would not go to a service station to buy something to stop smoking. (Service station retailer, Interview 9) Several independent retailers had considered selling NRT but had not acted on it (for the larger chain stores, decisions about stocking products are made by head offices). Many believed that, if there was a demand for the product, they would sell it. Despite most retailers not stocking NRT, the vast majority had no objection to compulsory stocking of NRT alongside tobacco products. 16

18 I think it would be good if every retail supermarket selling tobacco would have to have nicotine gums too. The reason is they ll be quite proportional for people who like to quit smoking or who are in the process of quitting When they buy the smoke they can see oh there s something new and they can ask you about it and if they feel better they can buy it too. So I would definitely encourage them to go on. (Supermarket retailer, Interview 1) Yes, I m happy with [compulsory stocking of NRT], because sometimes people say I want to quit and you are good luck, what else can you do, but if you have this product here, I say look take some of these try and see if it works. (Dairy retailer, Interview 18) TOBACCO RETAILER LICENSING ATTITUDES Ten of the 18 interviewees would support tobacco licensing in the same way that alcohol is licensed. Not all of the retailers interviewed sold alcohol in the store, but all appeared to understand licensing requirements. Of the remaining eight retailers not in support, three were opposed and five were unsure or undecided. Retailer type did not seem to affect opinion; the three opposed to licensing were from a supermarket, service station and dairy. Those who supported the concept of tobacco retailer licensing often compared it to alcohol, stating that they are similar products (in terms of harm to the community), and therefore should be treated in a similar manner. Although there appeared to be majority support for the concept, many retailers had some reservations about it. In particular, retailers were concerned about resource costs, including the financial cost of a licence and the time cost of applying and training for the licence. I think it will simply add to the cost of selling tobacco, it may become uneconomical if a license procedure was introduced, then you would simply selling it for turnover rather than profit. (Dairy retailer, Interview 17) If it comes to that it comes to that, and if there is enough profit margin, yes, I ll do it. But if it s going to be a huge financial drain on having a licence for it and I have to do all sorts of regulations and I have to go on all sorts of courses, well, out the door it goes. (Service station retailer, Interview 9) One retailer who was opposed to licensing suggested that better enforcement of the current laws was needed, in particular, ensuring that retailers were not selling tobacco to people under 18 years of age. I don t believe it s necessary [It s] unnecessary when all we ve got to do is actually enforce the Act and if we enforce the Act then the bad retailers don t exist. (Supermarket retailer, Interview 8) UNDERSTANDING OF TOBACCO HARMS AND BENEFITS The retailers generally had accurate, but not detailed knowledge of the effects of tobacco use. The interviewees were split on their beliefs about the benefits of tobacco use. Some stated there were no benefits at all from tobacco use, while others suggested that the benefits were limited to stress 17

19 relief, to lose weight or as part of social interaction. No retailers suggested any further benefit beyond these. There s the social element to it maybe, it seems to have a close tie in with alcohol, the more you drink the more your smoke. (Supermarket retailer, Interview 16) Participants mentioned several harms from tobacco in a general sense. This included diseases, cancer and respiratory problems. Some also referred to the warnings on the cigarette packs, saying that they were the harms of tobacco use. Most retailers did not go into further detail than this. While many retailers only identified harms to the individuals, some commented on the harms of tobacco use to families and society. One concern I have is the harm is predominately the lower socio- economic that smoke and if they can t afford to smoke what s the impact of family? Is the father going to be a bit more stressed and mother? What s this going to create? I will buy a packet of cigarettes and I can t afford tea tonight. That s where I think it will hurt probably. (Supermarket retailer, Interview 16) I believe as an employer it s not helpful to our staff that smoke and it costs a lot in terms of absenteeism, smokers are generally less healthy and more prone to sickness I think the issues of respiratory diseases and cancer would be the biggest and really the cost to the country, the cost is huge and I don t think the smokers actually understand what proportion of the health budget they take up and perhaps they are not told often enough. (Supermarket retailer, Interview 8) PROVIDING SUPPORT FOR CUSTOMERS While it was not an explicit topic of the interview schedule, a few retailers commented that they would appreciate having further tools to support customers who are making quit attempts. This included two dairy retailers and one supermarket retailer. All felt that they would like to offer further cessation support to customers. One dairy retailer was keen on supporting those making cessation attempts. He had cut out some Quitline information from magazines and given this to customers who were trying to quit. This retailer also offered to those making cessation attempts to no longer stock their brand of cigarettes, so the customer would know their usual brand was less accessible. These retailers believed the PoS tobacco display bans would help people stop smoking. One retailer even suggested that with the tobacco out of sight, he could refuse to sell tobacco to those trying to give up. Basically we ll be able to say to the customer no. If they see stock on the shelf, they ll request it, they ll ask for it and we can t really say no straight off But not having it on display we can just say no. (Dairy retailer, Interview 3) A benefit that these retailers could see with compulsory selling of NRT alongside tobacco products was that they could direct customers to NRT instead of tobacco products. The retailers would appreciate further information from RPH or increased knowledge about tobacco cessation (perhaps as part of a tobacco licensing scheme). 18

20 Maybe [a tobacco licensing scheme] might be helpful to learn how to, if people say I don t want to smoke and then some knowledge about how to advise them not to smoke. (Dairy retailer, Interview 18) 19

21 DISCUSSION The interviews revealed a range of views on the topics discussed. Retailers knowledge of the upcoming changes to the SFEA Act is rather general, and mostly limited to the removal of PoS displays rather than other aspects of the changes. In particular, retailers did not mention that the changes will require signage such as Smoking kills and No sales to under 18s signs to be removed. They have learnt of the changes mainly through their head offices or the tobacco industry representatives. Attitudes to the effects of the changes on their businesses were mixed. Tobacco was almost universally seen as a high- turnover, low- profit product (and this was irrespective of retailer type). As such, the financial effects of the changes were anticipated to be relatively minor. There were mixed views about how effective these and other tobacco control measures would be at reducing smoking rates. However, many retailers suggested that price increases are the most important intervention. Interestingly, several retailers expressed contradictory views on effectiveness. They stated that they may lose some income from the PoS display bans as fewer people bought tobacco products, yet then stated that the changes are unlikely to reduce smoking rates. Most retailers were not keen on selling tobacco but saw it as a business imperative. This was consistent with previous New Zealand research. 5 There was general support for making NRT product availability compulsory wherever tobacco is sold and for a tobacco retailer licensing or registering scheme. This support for compulsory NRT sales with tobacco products strengthens evidence from Williman et al. 4 which found half the participants supported the idea. Several retailers were aware that NRT is subsidised and could be obtained far cheaper than at retail outlets. They saw this as a barrier to stocking NRT, which some reported did not sell well. There was a high level of support for requiring tobacco retailers to be licensed or registered. However, support for this was given with some reservations. In particular, there was concern about resource costs in terms of finance and time to be licensed. Although this finding is consistent with Edwards et al. 5, this study did not find that retailers believed that a licensing scheme would disproportionately affect small, independent retailers, as Edwards et al. found. Interestingly, a small number of retailers wished to encourage their customers cessation attempts; however, they believed they needed further support or knowledge before they could provide this support. Retailers views did not systematically differ between store types. Although supermarkets were the only retailer type to currently sell NRT, there was no difference in attitudes to compulsory NRT availability with tobacco products by retailer type; small, independent retailers were as likely as large chain retailers to support this. We did not detect any difference in attitudes, knowledge or information needs by geographical area or deprivation level of store location. 20

22 A strength of this study is that it canvassed a range of interviewees based on retailer type, geographical area and deprivation level of store location. It was clear during the analysis that a saturation of themes had been achieved with the 18 interviews. There were very few new themes or opinions emerging during the last few interviews. This study took place in the greater Wellington region, and may not be representative of all New Zealand retailers. However, given the range of retailers interviewed (including some rural retailers) it seems likely that these views would be representative of New Zealand retailers. This study has identified further areas for research. Firstly, this research has provided a baseline measurement of retailer attitudes to the upcoming SFEA Act changes. It would be very useful to follow up with these retailers once the changes have been implemented. This would identify how retailers have received the changes and whether their concerns have been realised or not. It may also identify any unexpected outcomes from the legislation at the retail level. This follow- up could possibly be done through telephone interviews. Future research could further examine attitudes to making NRT available wherever tobacco products are sold. Although this study found general support for the idea, further research could examine potential barriers to implementing this measure (such as subsidised NRT or staff training). Similarly, this study has found considerable support for tobacco retailers to be licensed or registered and further in- depth research into the potential barriers to this would be useful. There are other potential tobacco control measures that were not considered in this research. These include making shops that sell tobacco products restricted to people 18 years and older, plain packaging of tobacco packs and the Government s 2025 smokefree goal. This study has shown it is possible to effectively examine retailers attitudes about such topics through this methodology. RECOMMENDATIONS FOR REGIONAL PUBLIC HEALTH Retailers would benefit from more detailed information on the SFEA Act changes. In particular, in regards to changes other than the removal of PoS displays (e.g. what signage is permitted and what are acceptable price lists). Information could be provided via newsletters or face- to- face meetings at retailers premises. Group meetings for retailers were not a popular option. If retailers had to be prioritised, information would be most useful to dairies and independent retailers. This is not because they were less knowledgeable, but because the other retailers will be likely to get support from their respective head offices. Some retailers wish to support and encourage customers during their quit attempts. RPH should try to identify these retailers and provide further information or quit support material as appropriate. 21

23 REFERENCES 1. New Zealand Parliament Government Response to the Report of the Māori Affairs Committee on its Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Maori (Wellington, 2011). 2. Blakely, T., Thomson, G., Wilson, N., Edwards, R. & Gifford, H. The Māori Affairs Select Committee Inquiry and the road to a smokefree Aotearoa. New Zealand Medical Journal 123, 7-18 (2010). 3. Ministry of Health Guidelines for Implementing the Prohibition on the Display of Tobacco Products 2012: Information for sellers of tobacco products and Smoke- free Enforcement Officers. (Wellington, 2012). 4. Vega, S. Nicotine replacement therapy in grocery stores; but wait, there s more. New Zealand Medical Journal 124, (2011). 5. Williman, J., Fernandes, K., Walker, N. & Bullen, C. Promotion of nicotine replacement therapy and smoking cessation services at grocery stores. New Zealand Medical Journal 124, (2011). 6. Colgan, S.E. et al. Business policies affecting secondhand smoke exposure. North Carolina Medical Journal 69, (2008). 7. Dovell, R., Mowat, D., Dorland, J. & Lam, M. Tobacco access to youth: beliefs and attitudes of retailers. Canadian Journal of Public Health. Revue Canadienne de Sante Publique 89, (1998). 8. Feighery, E.C., Ribisl, K.M., Clark, P.I. & Haladjian, H.H. How tobacco companies ensure prime placement of their advertising and products in stores: interviews with retailers about tobacco company incentive programmes. Tobacco control 12, (2003). 9. Edwards, R., Thomson, G., Hoek, J., Gifford, H. & Pirikahu, G. The attitudes and knowledge of retail sector staff to selling tobacco products. (Wellington, 2007). 10. Hoek, J., Vaudrey, R., Gendall, P., Edwards, R. & Thomson, G. Tobacco retail displays: a comparison of industry arguments and retailers experiences. Tobacco control doi:10.113, (2011). 11. Thomson, G., Hoek, J., Edwards, R. & Gifford, H. Evidence and arguments on tobacco retail displays: marketing an addictive drug to children? New Zealand Medical Journal 121, (2008). 12. Stead, L., Perera, R., Bullen, C., Mant, D. & Lancaster, T. Nicotine replacement therapy for smoking cessation ( Review ). Cochrane Database Systematic Review (2008). 13. Ministry of Health Tobacco Use in New Zealand: Key findings from the 2009 New Zealand Tobacco Use Survey. (Wellington, 2009). 22

24 14. Braun, V. & Clarke, V. Using thematic analysis in psychology. Qualitative Research in Psychology 3, (2006). 23

25 APPENDIX: INTERVIEW SCHEDULE Introduction: the research sponsor, information sheet, any questions, consent form, recording. Participant background 1. How long have you been working in retail? 2. How long have you been the manager/owner of this store? 3. What proportion of your profit (not sales) comes directly from tobacco? Tobacco products and SFEA Act changes 4. Last year, the Government changed a piece of legislation called the Smokefree Environments Amendment Act. This included some changes to the rules about how tobacco products are sold; are you aware of how these changes will affect how you sell tobacco? (probe: what are the changes, when will they come in) Need to provide standard statement regarding upcoming changes, particularly display bans 5. What do you think of these changes (emphasis on probing responses about the out- of- sight rules, if not previously discussed)? What makes you say that? 6. Do you think any of these changes will affect sales of tobacco products in this store? (probe reasons: What makes you say that?) 7. Do you think any of these changes will affect the profitability of your business? Are there any other ways that these changes could affect your business? (Probe: any non- financial benefits or harms? Any security concerns?) 8. What discussions have you had about these changes? Which groups have offered you advice? What did they suggest to you? (What did you think of their advice? How have you used it?) 9. Regional Public Health (RPH) is the local public health unit covering your area. How do you think Regional Public Health can help you with these changes? 10. To help retailers Regional Public Health have suggested using face- to- face one- on- one meetings, a group session with other retailers, or a newsletter. What do you think of these ideas? 11. Are there any other comments you would like to make about the changes and how these will affect smokers and non- smokers? Attitudes to tobacco use and nicotine replacement therapy (NRT) 12. What do you consider are the main benefits, if any, people get from using tobacco? 24

26 13. What do you consider are the main harms, if any, of tobacco use? 14. How do you feel about selling tobacco? Have you ever considered not selling tobacco? 15. When people want to stop smoking, there are alternative products they can use to still get nicotine (if necessary, Nicotine is the chemical in tobacco that people become addicted to ). What do you know of nicotine replacement therapy such as gum, lozenges or patches? (have pictures of NRT as prompts and standard definition) Do you think NRT helps people to stop smoking, or not? 16. Do you sell any nicotine replacement therapy such as gum, lozenges or patches? (have pictures of NRT as prompts) a. If yes: When did you start selling NRT? What made you decide to sell NRT? Where do you place it in your store? How do smokers find out that you sell NRT? How well has it sold? What are your future plans for selling NRT? b. If no: Would you consider selling NRT? (probe reasons: Why/why not?) 17. How would you feel if stores that sold tobacco products also had to sell NRT? (probe reasons: What makes you say that?) Final Questions 18. How would you feel if those who sold tobacco were required to be part of a tobacco sellers register? Or if they were required to be licensed (in a similar way to alcohol outlets)? 19. Are there any other comments you would like to make about the SFEA Act changes and how tobacco is regulated? 20. Would you be happy to take part in any other research or interviews in the future? END: Offer participants information sheet on RPH and on the SFEA Act changes, and koha 25

27 APPENDIX: EXAMPLES OF NICOTINE REPLACEMENT THERAPY 26