Towards tobacco-free retailers: feasibility of an intervention encouraging retailers to stop selling tobacco in Tasmania.

BACKGROUND: Despite calls for greater emphasis on tobacco supply reduction strategies, limited evidence of interventions (regulatory and non-regulatory) to reduce tobacco retailer numbers exists. This study investigated the feasibility of a real-world, non-regulatory intervention to encourage low volume tobacco retailers to stop selling, in a jurisdiction with a tobacco retailer licensing system. INTERVENTION: Between December 2018 and 2019, low volume tobacco retailers (n=164) were exposed to multiple intervention elements (eg, postcard and letter mail-out, onsite visit) focused on the business benefits of stopping selling, in the lead up to their tobacco licence expiry date. The intervention was delivered in Tasmania, Australia in a region characterised by socioeconomic disadvantage, high smoking rates and density of tobacco retailers. METHODS: For this mixed-methods study we collected data through implementation records on 164 retailers and postintervention interviews with 21 retailers to explore intervention implementation, awareness, acceptability, usefulness and actions taken. RESULTS: Retailers were able to recall the intervention, specifically messages focused on the business-related reasons to stop selling tobacco. Of the 107 retailers that the project officer spoke with onsite or via telephone, the majority (72%) accepted phase I components. The intervention introduced some retailers to the concept of ending tobacco sales, which made them stop and consider this option. Of the 164 retailers exposed to the intervention, 18 (11%) retailers ended tobacco sales. CONCLUSION: Our study suggests that a non-regulatory intervention targeting low volume retailers to end tobacco sales may help to reduce the retail availability of tobacco.

Why Tasmanian retailers stop selling tobacco and implications for tobacco control.

INTRODUCTION: The retail availability of tobacco is at odds with the health harms associated with tobacco smoking and undermines tobacco control efforts. Evidence suggests ease of access to tobacco through retail outlets contributes to smoking prevalence. OBJECTIVE: This study aimed to understand why retailers stop selling tobacco and explore possible implications for tobacco control. METHODS: The Tobacco Licensing Database maintained by the Department of Health Tasmania was used to identify and recruit past retailers who no longer held licences. Semistructured interviews were conducted to explore business demographics and the reasons they stopped selling tobacco. Interview findings were analysed using a thematic framework. RESULTS: Twenty former tobacco retailers participated, representing all business types except specialist tobacconists and large supermarkets. Retailers gave multiple reasons for ending tobacco sales, related to business considerations, security, tobacco regulations, ethics and health. Most often, the decision was business-related; health or ethical considerations were rarely a factor. Most retailers felt they played no role in mitigating tobacco-related harm. CONCLUSIONS: This study provides insights into factors that make tobacco sales unattractive or unfeasible for low-volume outlets and may inform supply-focused tobacco control policy. A campaign that emphasises the possible business benefits of ending tobacco sales in favour of other higher-margin products may support retailers to transition away from tobacco sales. The regulatory obligations of selling tobacco are disincentives and create a less favourable retail environment.

The retail availability of tobacco in Tasmania: evidence for a socio-economic and geographical gradient.

OBJECTIVES: To describe the retail availability of tobacco and to examine the association between tobacco outlet density and area-level remoteness and socio-economic status classification in Tasmania. DESIGN: Ecological cross-sectional study; analysis of tobacco retail outlet data collected by the Department of Health and Human Services (Tasmania) according to area-level (Statistical Areas Level 2) remoteness (defined by the Remoteness Structure of the Australian Statistical Geographical Standard) and socio-economic status (defined by the 2011 Australian Bureau of Statistics Index of Relative Socioeconomic Advantage and Disadvantage). MAIN OUTCOME MEASURE: Tobacco retail outlet density per 1000 residents. RESULTS: On 31 December 2016, there were 1.54 tobacco retail outlets per 1000 persons. The density of outlets was 79% greater in suburbs or towns in outer regional, remote and very remote Tasmania than in inner regional Tasmania (rate ratio [RR], 1.79; 95% confidence Interval [CI], 1.29-2.50; P < 0.001). Suburbs or towns in Tasmania with the greatest socio-economic disadvantage had more than twice the number of tobacco outlets per 1000 people as areas of least disadvantage (RR, 2.30; 95% CI, 1.32-4.21; P = 0.014). CONCLUSIONS: A disproportionate concentration of tobacco retail outlets in regional and remote Tasmania and in areas of lowest socio-economic status is evident. Our findings are consistent with those of analyses in New South Wales and Western Australia. Progressive tobacco retail restrictions have been proposed as the next frontier in tobacco control. However, the intended and unintended consequences of such policies need to be investigated, particularly for socio-economically deprived and rural areas.

A risk stratification approach to assessing for true cases of measles in a highly vaccinated population.

OBJECTIVE: In Australia, the notification rate for measles fluctuates greatly between baseline and outbreak periods. We aimed to identify characteristics of notified cases that allow risk stratification in order to improve the efficiency of the public health response in an outbreak setting. METHODS: Retrospective descriptive case series for all measles notifications made to the Victorian Government Department of Health between 1 August and 30 September 2013. RESULTS: A total of 151 notifications were included in the analyses, of which 17 (11%) were confirmed as measles. Applying the clinical criteria of the measles case definition or identifying susceptible cases (determined by vaccination status) correctly identified all measles cases. Requiring cases to meet both criteria reduced sensitivity to 88%, but improved the positive predictive value (48% vs 25%) and retained a high negative predictive value (98.33%). Application of a risk stratification approach based on these features would have saved intensive public health follow-up for 79.5% of notifications in this outbreak. CONCLUSIONS: Immune status and clinical features can reliably be used to predict which notifications are unlikely to become confirmed cases. IMPLICATIONS: Risk stratification and modification of current surveillance practices may provide for a more efficient public health response, particularly during periods of increased case notification.