Western Sydney University Business School

The problem

Cigarette smoking claims over seven million lives each year and is the world’s biggest public health threat. The Australian Burden of Disease Study estimated that in 2011 one in every eight deaths was due to smoking.

Impact summary

• An early component of the research contributed to the first ban of point-of-sale tobacco displays in Australia
• Based on later related research, the NSW Government established a task force to investigate the sale of tobacco and reinforced the registration process for tobacco retailers
• The research stream led to stronger tobacco compliance monitoring and enforcement
• The research led to new regulations enabling, amongst other things, on-the-spot fines for retailers infringing the law
• The research motivated changes in consumer behavior that were associated with reductions in smoking and consequent health benefits.

How they did it

Experts in marketing at Western Sydney University demonstrated how the widespread sale of tobacco, and the effect of point-of-sale tobacco displays, influence consumers to buy and smoke cigarettes. They also demonstrated that removal of the displays reduced the stimulus to make cigarette purchases.

Who it helped

The research had a direct impact on three key groups:

• Cancer Council NSW (CCNSW) used the research findings as the basis for its advocacy against tobacco advertising and the widespread availability of the product
• The NSW government responded to the research by introducing legislative and regulatory changes that ban point-of-sale tobacco displays and strengthening NSW Health’s ability to monitor and enforce compliance
• The NSW community benefitted from a marked decline in smoking rates.

Informing strategy

The research provided evidence to inform one of CCNSW’s strategic priorities, ‘to further the understanding of the environmental and behavioural influences on smoking’.[1] Recommendations from the research were the focus of a 2013 CCNSW advocacy campaign that disseminated a research report, as well as summaries of research findings.

CCNSW also used the results of the ‘retail display’ research as evidence to advocate for legislative change. As a result, NSW became the first Australian state to remove tobacco from display at the point-of-sale. Although the Public Health (Tobacco) Act was passed in 2008, outside the reference period, its full implementation (in 2013) and ongoing effect span the reference period.

Testimonial

Andrew Penman, CEO of CCNSW from 1998 to 2012, said, ‘The research led by [Suzan] Burton has been very influential in shaping public health thinking about how retailing sustains tobacco consumption. Her evidence was critical to the success of submissions to have tobacco taken off display in NSW. It has focused attention on the widespread and poorly controlled distribution of tobacco, prompting review of tobacco retailing in the state. Tobacco and health research groups in other states are now following her lead and giving priority to research into the malign effects of tobacco retailing’.

The response

In response to recommendations arising from the research, the NSW government formed a task force in 2013 to review tobacco retailing. The task force issued its report in 2014. The recommendations from the report led to changes to the Tobacco Retailer Notification Scheme to address the frequent breaches identified in the research. The changes strengthened NSW Health’s tobacco compliance monitoring and enforcement protocols, and led to a review of the Public Health (Tobacco) Act 2008. The changes also led to the introduction of the Public Health (Tobacco) Regulation 2016, which enabled on-the-spot fines for the violation of tobacco display legislation.

As a result of the research and its impact, CCNSW has frequently been asked to provide expert advice to NSW Health about aspects of tobacco retailing legislation that may require amendment.

Consumer behaviour change

As the changes resulting from the research were implemented, a reduction in smoking ensued. NSW Health reported a decline in the smoking rate from 19.4% in 2008 to 15% in 2016 and a consequent fall in mortality rates attributed to smoking.  In contrast, smoking rates from 2006-2008 (before the research-informed legislation was introduced) remained essentially flat.

It is estimated that about half of all persistent smokers die prematurely.[2] Based on a population of 5.6 million adults in NSW in 2016, a 4.4% reduction in smoking would result in nearly 250,000 fewer smokers, or 124,200 fewer deaths due to smoking. Although other factors may have contributed to this outcome, the evidence shows that the removing point-of-sale cigarette displays, together with more power to monitor retailers and penalise breaches of the law, mean smokers can quit more easily and fewer adolescents take up the habit.

Footnotes

[1] CCNSW 2010-2014 Strategic Plan

[2] Doll et al, 2004