"It Looks Like an Adult Sweetie Shop": Point-of-Sale Tobacco Display Exposure and Brand Awareness in Scottish Secondary School Students.

INTRODUCTION: As further restrictions have been placed on tobacco advertising and promotions, point-of-sale (PoS) displays of cigarettes in shops have become an increasingly important source of young people's exposure to tobacco products. This study explored the relationship between PoS displays of cigarettes and brand awareness among secondary school students in Scotland. METHODS: Cross-sectional school surveys (n = 1406) and focus groups (n = 86) were conducted with S2 (13-14 years) and S4 (15-16 years) students in four schools of differing socioeconomic status in 2013, prior to the PoS display ban in large shops. Adjusted negative binomial regression analysis examined associations between brand awareness and exposure variables (visiting tobacco retailers, noticing displays of tobacco products). RESULTS: Students visiting small shops more frequently (relative rate ratio [RRR] 1.19, 95% confidence interval [CI] 1.01-1.41) and those who noticed cigarette displays in small shops (RRR 1.24, 95% CI 1.03-1.51) and large supermarkets (RRR 1.15, 95% CI 1.01-1.30) had higher brand awareness. The focus groups supported these findings. Participants described PoS tobacco displays as being eye-catching, colorful and potentially attractive to young people. CONCLUSIONS: This mixed-methods study showed that higher cigarette brand awareness was significantly associated with regularly visiting small shops and noticing PoS displays in small and large shops, even when students' smoking status, smoking in their social networks, leisure activities, and demographics were included as confounding variables. This highlights the importance of PoS displays of tobacco products in increasing brand awareness, which is known to increase youth smoking susceptibility, and thus the importance of implementing PoS display bans in all shops. IMPLICATIONS: As increasing restrictions have been placed on tobacco promotion in many countries, PoS displays of cigarettes in shops have become an important source of young people's exposure to tobacco products and marketing. This mixed-methods study showed that prior to the PoS display ban in Scotland, and controlling for other factors, 13- and 15-year olds who regularly visited small shops and those who noticed PoS displays in small and large shops, had a higher awareness of cigarette brands. This highlights the importance of PoS displays in increasing youth brand awareness, which increases smoking susceptibility, and thus the need for comprehensive bans on PoS displays which cover all shops.

Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study.

BACKGROUND: There has been a rapid increase in the retail availability of e-cigarettes in the UK and elsewhere. It is known that exposure to cigarette point-of-sale (POS) displays influences smoking behaviour and intentions in young people. However, there is as yet no evidence regarding the relationship between e-cigarette POS display exposure and e-cigarette use in young people. METHODS: This cross sectional survey was conducted in four high schools in Scotland. A response rate of 87 % and a total sample of 3808 was achieved. Analysis was by logistic regression on e-cigarette outcomes with standard errors adjusted for clustering within schools. The logistic regression models were adjusted for recall of other e-cigarette adverts, smoking status, and demographic variables. Multiple chained imputation was employed to assess the consistency of the findings across different methods of handling missing data. RESULTS: Adolescents who recalled seeing e-cigarettes in small shops were more likely to have tried an e-cigarette (OR 1.92 99 % CI 1.61 to 2.29). Adolescents who recalled seeing e-cigarettes for sale in small shops (OR 1.80 99 % CI 1.08 to 2.99) or supermarkets (OR 1.70 99 % CI 1.22 to 2.36) were more likely to intend to try them in the next 6 months. CONCLUSIONS: This study has found a cross-sectional association between self-reported recall of e-cigarette POS displays and use of, and intention to use, e-cigarettes. The magnitude of this association is comparable to that between tobacco point of sale recall and intention to use traditional cigarettes in the same sample. Further longitudinal data is required to confirm a causal relationship between e-cigarette point of sale exposure and their use and future use by young people.

International trends in electronic media communication among 11- to 15-year-olds in 30 countries from 2002 to 2010: association with ease of communication with friends of the opposite sex.

BACKGROUND: Electronic media has become a central part of the lives of adolescents. Therefore, this study examines trends in adolescent electronic media communication (EMC) and its relationship with ease of communication with friends of the opposite sex, from 2002 to 10 in 30 European and North American regions. METHODS: Data from the HBSC study were collected using self-report questionnaires from 11-, 13- and 15-year-old participants (N = 404 523). RESULTS: EMC use has grown over the years in most of these regions and increases with age. Even though Internet usage is often blamed for its negative effects on teenagers' social interactions in the physical world, in this study EMC was found to predict ease of communication with friends. Especially, the more they use EMC, the easier they find it to talk with friends of the opposite sex. Although these findings suggest that EMC reinforces communication, the interaction between year (2002-2006-2010) and EMC usage was not significant. CONCLUSION: This finding contradicts research that suggests that EMC contributes to loneliness and isolation, and supports other studies that present electronic media as a powerful tool for helping to connect people.

Determining the impact of smoking point of sale legislation among youth (Display) study: a protocol for an evaluation of public health policy.

BACKGROUND: Tobacco advertising and product promotions have been largely banned in the UK but point of sale (POS) tobacco advertising is one of the few places where tobacco products may be legitimately advertised. POS displays have been shown to increase susceptibility to smoking, experimentation and initiation into smoking. These displays may also influence perceived prevalence of smoking and the perception that tobacco products are easily obtained and are a 'normal' product. A ban of POS tobacco advertising was introduced in Scotland in large tobacco retail outlets of over 280 m2 internal sales floor areas (mainly supermarkets) in April 2013 and will be extended to include smaller tobacco retail outlets in April 2015. However, the impact of POS bans on smoking attitudes, behaviours and prevalence has yet to be determined. METHODS/DESIGN: This study has a multi-modal before and after design and uses mixed methods to collect data, at baseline and then with longitudinal follow-up for 4 years, in four purposively selected communities. For the purposes of the study, community is defined as the catchment areas of the secondary schools selected for study. There are four main components to the on-going study. In each of the four communities, at baseline and in follow-up years, there will be: mapping and spatial analyses of tobacco retail outlets; tobacco advertising and marketing audits of tobacco retail outlets most used by young people; cross-sectional school surveys of secondary school pupils; and focus group interviews with purposive samples of secondary school pupils. The tobacco audit is supplemented by interviews and observations conducted with a panel of tobacco retailers recruited from four matched communities. DISCUSSION: This study examines the impact of the implementation of both a partial and comprehensive ban on point of sale (POS) tobacco advertising on attitudes to smoking, brand awareness, perceived ease of access to tobacco products and youth smoking prevalence. The results will be of considerable interest to policy makers both from the UK and other jurisdictions where they are considering the development and implementation of similar legislation.

Early Adolescent and Peer Drinking Homogeneity: Similarities and Differences Among European and North American Countries.

This study examined associations between perceived peer and adolescent alcohol use in European and North American countries. Self-reported monthly alcohol use and adolescents' report of their peers' alcohol use were assessed in nationally representative samples of students aged 11.5 and 13.5 years (n = 11,277) in Greece, Scotland, Switzerland, and the United States who participated in the 2005/2006 Health Behavior in School-Aged Children survey. Cross-national associations between perceived peer and adolescent alcohol use were examined using logistic regressions and interactions by gender and country. Perceived peer and adolescent alcohol use were positively associated in all countries, but the association was notably weaker in Greece than in Scotland (boys), and in Greece compared to Switzerland (girls). Further examination of the underlying processes that explain stronger and weaker associations between perceived peer and adolescent alcohol use in some settings could guide the development of effective, culture-specific interventions.

Are Retail Outlets Complying with National Legislation to Protect Children from Exposure to Tobacco Displays at Point of Sale? Results from the First Compliance Study in the UK.

BACKGROUND: From April 6th 2015, all small shops in the UK were required to cover up tobacco products at point of sale (POS) to protect children from exposure. As part of a larger 5-year study to measure the impact of the legislation in Scotland, an audit was conducted to assess level and nature of compliance with the ban immediately following its introduction. MATERIALS AND METHODS: A discreet observational audit was conducted 7-14 days post implementation which took measures of physical changes made to cover products, server/assistant practices, tobacco signage and advertising, and communication of price information. The audit was conducted in all small retail outlets (n = 83) selling tobacco in four communities in Scotland selected to represent different levels of urbanisation and social deprivation. Data were analysed descriptively. RESULTS: Compliance with the legislation was high, with 98% of shops removing tobacco from permanent display and non-compliance was restricted almost entirely to minor contraventions. The refurbishment of shops with new or adapted tobacco storage units resulted in the removal of nearly all commercial brand messages and images from POS, dropping from 51% to 4%. The majority of shops stored their tobacco in public-facing storage units (81%). Most shops also displayed at least one generic tobacco message (88%). CONCLUSIONS: Compliance with Scottish prohibitions on display of tobacco products in small retail outlets was high immediately after the legislation implementation date. However, although tobacco branding is no longer visible in retail outlets, tobacco storage units with generic tobacco messages are still prominent. This points towards a need to monitor how the space vacated by tobacco products is utilised and to better understand how the continuing presence of tobacco storage units influences people's awareness and understanding of tobacco and smoking. Countries with existing POS bans and who are considering such bans should pay particular attention to regulations regarding the use of generic signage and where within the retail setting tobacco stocks can be stored.

Supportive communication with parents moderates the negative effects of electronic media use on life satisfaction during adolescence.

OBJECTIVES: To examine the impact of electronic media (EM) use on teenagers' life satisfaction (LS) and to assess the potential moderating effect of supportive communication with parents (SCP). METHODS: Data were drawn from the cross-national Health Behaviour in School-aged Children (HBSC) study (2009/2010) in Canada, England, Germany, Hungary, Italy, Israel, The Netherlands, Poland and Scotland. Sample size: 53,973 students aged 11-15 years. RESULTS: More hours per day spent on the computer were associated with lower LS; more EM communication with friends with higher LS. This relationship became negative if EM use reached and exceeded a certain threshold. SCP moderated the effect of EM communication with friends, but not computer use for the total sample. SCP seems to be more important than computer use or EM communication with friends for LS and it seems to buffer negative effects of EM use. CONCLUSIONS: Communication with parents seems to buffer the negative effects of EM use on LS during adolescence. Higher computer use was related to lower LS, but "optimal" frequency of EM communication with friends was country specific.

Drinking motives mediate cultural differences but not gender differences in adolescent alcohol use.

PURPOSE: To test whether differences in alcohol use between boys and girls and between northern and southern/central Europe are mediated by social, enhancement, coping, and conformity motives. METHODS: Cross-sectional school-based surveys were conducted among 33,813 alcohol-using 11- to 19-year-olds from northern Europe (Denmark, Estonia, Finland, Ireland, Poland, Scotland, and Wales) and southern/central Europe (Belgium, Hungary, Italy, Portugal, Slovakia, and Switzerland). RESULTS: Particularly in late adolescence and early adulthood, boys drank more frequently and were more often drunk than girls. Instead of mediation, gender-specific motive paths were found; 14- to 16-year-old girls drank more because of higher levels of coping motives and lower levels of conformity motives, whereas 14- to 19-year-old boys drank more because of higher levels of social and enhancement motives. Geographical analyses confirmed that adolescents from southern/central European countries drank more frequently, but those from northern Europe reported being drunk more often. The strong indirect effects demonstrate that some of the cultural differences in drinking are because of higher levels of social, enhancement, and coping motives in northern than in southern/central Europe. CONCLUSIONS: The results from the largest drinking motive study conducted to date suggest that gender-specific prevention should take differences in the motivational pathways toward (heavy) drinking into account, that is, positive reinforcement seems to be more important for boys and negative reinforcement for girls. Preventive action targeting social and enhancement motives and taking drinking circumstances into account could contribute to tackling underage drinking in northern Europe.

Drinking motives and links to alcohol use in 13 European countries.

OBJECTIVE: The purpose of this study was to test the structure and endorsement of drinking motives and their links to alcohol use among 11- to 19-year-olds from 13 European countries. METHOD: Confirmatory factor analysis, latent growth curves, and multiple regression models were conducted, based on a sample of 33,813 alcohol-using students from Belgium, Denmark, Estonia, Finland, Hungary, Ireland, Italy, Poland, Portugal, Scotland, Slovakia, Switzerland, and Wales who completed the Drinking Motives Questionnaire Revised Short Form (DMQ-R SF). RESULTS: The findings confirmed the hypothesized fourdimensional factor structure. Social motives for drinking were most frequently indicated, followed by enhancement, coping, and conformity motives, in that order, in all age groups in all countries except Finland. This rank order was clearest among older adolescents and those from northern European countries. The results confirmed that, across countries, social motives were strongly positively related to drinking frequency, enhancement motives were strongly positively related to frequency of drunkenness, and conformity motives were negatively related to both alcohol outcomes. Against our expectations, social motives were more closely related to drunkenness than were coping motives, particularly among younger adolescents. CONCLUSIONS: The findings reveal striking cross-cultural consistency. Health promotion efforts that are based on, or incorporate, drinking motives are likely to be applicable across Europe. As social motives were particularly closely linked to drunkenness among young adolescents, measures to impede the modeling of alcohol use and skills to resist peer pressure are particularly important in this age group.