Published: 8 December 2015
Authors: Robertson, L., Cameron, C., McGee, R., Marsh, L., Hoek, J.
Introduction Previous systematic reviews have found consistent evidence of a positive association between exposure to point-of-sale (POS) tobacco promotion and increased smoking and smoking susceptibility among children and adolescents. No meta-analysis has been conducted on these studies to date.
Methods Systematic literature searches were carried out to identify all quantitative observational studies that examined the relationship between POS tobacco promotion and individual-level smoking and smoking related cognitions among children and adolescents published between January 1990 and June 2014. Random-effects meta-analyses were used. Subgroup analyses were conducted according to extent of tobacco POS advertising environment in the study environment. Sensitivity analyses were performed according to study size and quality.
Results13 studies met the inclusion criteria; 11 reported data for behavioural outcomes, 6 for cognitive outcomes (each of these assessed smoking susceptibility). The studies were cross-sectional, with the exception of 2 cohort studies. For the behavioural
outcomes, the pooled OR was 1.61 (95% CI 1.33 to 1.96) and for smoking susceptibility the pooled OR was 1.32 (95% CI 1.09 to 1.61).
Conclusions Children and adolescents more frequently exposed to POS tobacco promotion have around 1.6 times higher odds of having tried smoking and around 1.3 times higher odds of being susceptible to future smoking, compared with those less frequently exposed. Together with the available evaluations of POS display bans, the results strongly indicate that legislation banning tobacco POS promotion will effectively reduce smoking among young people.
In contrast to claims made by industry-related organisations, a proposed licensing policy is unlikely to be met with blanket opposition from tobacco retailers. Advocacy efforts may garner more support for tobacco retail policies if the purpose of policies was framed in terms of protecting young people from smoking.
A positive licensing scheme could increase compliance with existing smokefree legislation.
The existing evidence supports a positive association between exposure to POS tobacco promotion and smoking. This review provides evidence to support the continuation of POS tobacco display bans in those jurisdictions where such legislation has been introduced and strengthens the evidence encouraging similar policies in jurisdictions without a POS display ban.