Adolescents’ exposure to tobacco promotion in the retail environment

Scientific Research Project Number: MA 2019 20
Place: Amsterdam UMC, location AMC, Department of Public Health


The tobacco epidemic causes a huge burden of mortality and morbidity worldwide. To achieve a smoke-free population in the long run, it is essential that young generations are prevented from experimenting and becoming regular smokers. It is therefore important that children and adolescents grow up in environments where tobacco and smoking are hardly visible.

An important environmental source of exposure to tobacco products is the retail environment. The tobacco industry uses attractive logos, pack designs, and prominent product placement to market their products. Product displays are designed to be attractive and eye-catching and are often located in prominent positions where many people (including young people) are likely to pass and see them. Additionally, small shops are still allowed to advertise tobacco. It is therefore not surprising that the tobacco retail environment has been found to be the most important setting of product promotion for the tobacco industry.

Among a pilot sample of retailers in Amsterdam in 2017, 80% of supermarkets and 100% of tobacco specialist shops had tobacco visibly displayed. This is potentially very problematic, as the visibility of tobacco products and advertising may hinder the de-normalisation of smoking. It has not yet been established how often adolescents are actually exposed to these forms of tobacco promotion. From self-reported survey data from the UK, before the implementation of the tobacco display ban, we know that young people often visited shops where tobacco was sold, and 80% of adolescents recalled having seen tobacco displays. However, studies so far have not taken place in mainland Europe and relied on crude self-reports of adolescents. This means that we do not have data on how frequently adolescents are exposed and therefore have not yet quantified the problem. Moreover, self-reported data are likely to suffer from recall bias and do not accurately represent adolescents’ actual exposure levels.

Previous studies from the US have demonstrated inequalities in the exposure to tobacco retail outlets. For example, neighbourhoods with a higher proportion of African Americans had a higher density of retail outlets and there was more tobacco promotion in these areas. In Scotland, researchers also found that higher neighbourhood deprivation was associated with stronger tobacco promotion. It is therefore believed that the retail environment may have an important role in maintaining or even increasing inequalities in smoking behaviour. Research on variations in the retail environment between groups of individuals has thus far not been conducted in mainland Europe, while the context of social economic inequalities as well as the structure of cities is very different from the UK and the US.

Description of the SRP Project/Problem

The aim of the study is to assess adolescents’ exposure to tobacco displays and advertising (i.e. tobacco promotion) at the point-of-sale and inequalities therein by sociodemographic characteristics.

The study has a cross-sectional design. Data of all retailers in Amsterdam will be collected by 1 Feb 2020. Data of approximately 600 students in six secondary schools in Amsterdam will be collected by 1 May 2020.

Data on all tobacco retailers in Amsterdam are being collected through a systematic audit, in which locations and visibility of tobacco and advertising is observed. Among adolescents a mobile app will be distributed, which includes a survey and track their location for two weeks. The survey will measure their sociodemographic characteristics. With the location functionality we measure how often and how long adolescents pass or visit tobacco retail outlets identified in the audit. The data collection will fully comply with the General Data Protection Regulation, in close collaboration with the AMC’s Data Protection Officer.

Variables on the level of exposure will be constructed by the student by combining data on the frequency of shop visits and the visibility of tobacco products and advertising at those shops.

The proposed analyses are multivariate linear and logistic regression analyses. Potentially apply multi-level modelling.

Research questions

1. To what extent are adolescents in Amsterdam exposed to tobacco promotion at the point-of-sale?

2. To what extent does exposure to tobacco promotion at the point-of-sale vary by sociodemographic characteristics?

Expected results

An English written manuscript of max 3500 words containing: Abstract – Introduction – Methods – Results – Discussion – Conclusion – References – Tables and Figures.

• Oral presentation in English at the VU

• Oral presentation in English at the Department of Public Health

The aim is to submit the paper to an international scientific journal. Our previous experience is that this is feasible with little additional work. Depending on the work of the student during and after the internship, and in consultation with the student, the student may publish as first or second author.

Time period

January–July 2020


Dr. Mirte A.G. Kuipers


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Dr. Mirte A.G. Kuipers, Amsterdam UMC, location AMC, Department of Public Health.,
Tessa van Deelen, Amsterdam UMC, location AMC, Department of Public Health.,