Influence of point-of-sale tobacco displays and graphic health warning signs on adults: evidence from a virtual store experimental study

Abstract

Objectives: We tested the impact of banning tobacco displays and posting graphic health warning signs at the point of sale (POS).

Methods: We designed 3 variations of the tobacco product display (open, enclosed [not visible], enclosed with pro-tobacco ads) and 2 variations of the warning sign (present vs absent) with virtual store software. In December 2011 and January 2012, we randomized a national convenience sample of 1216 adult smokers and recent quitters to 1 of 6 store conditions and gave them a shopping task. We tested for the main effects of the enclosed display, the sign, and their interaction on urge to smoke and tobacco purchase attempts.

Results: The enclosed display significantly lowered current smokers' (B = -7.05; 95% confidence interval [CI] = -13.20, -0.91; P < .05) and recent quitters' (Β = -6.00, 95% CI = -11.00, -1.00; P < .01) urge to smoke and current smokers' purchase attempts (adjusted odds ratio = 0.06; 95% CI = 0.03, 0.11; P < .01). The warning sign had no significant main effect on study outcomes or interaction with enclosed display.

Conclusions: These data show that POS tobacco displays influence purchase behavior. Banning them may reduce cues to smoke and unplanned tobacco purchases.

Figures

FIGURE 1—

Sampling framework of current smokers and recent quitters in virtual reality study of effects of point-of-sale (POS) tobacco displays and graphic health warnings: United States, December 2011–January 2012.

FIGURE 2—

Association of point-of-sale tobacco displays and graphic health warning signs (GHWSs) among current smokers and recent quitters with (a) urge to smoke and (b) purchase attempts: United States, December 2011–January 2012. Note. For the urge to smoke, there was a significant difference (P < .05) between conditions 1 and 2, 1 and 3, and 5 and 6, and a significant difference (P < .01) between conditions 4 and 6. For purchase attempts, there was a significant difference (P < .01) between conditions 1 and 2, 1 and 3, 2 and 3, 4 and 5, and 4 and 6. Whiskers indicate 95% confidence intervals. Numbers in parentheses are standard errors. aUrge to smoke was captured by asking participants: “On a scale of 0 to 100, rate your urge to smoke after seeing the virtual environment with 0 being ‘no urge’ and 100 being ‘strongest urge I have ever experienced.’”