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OBJECTIVE: Tobacco sales in alcohol-licenced premises present a very problematic trigger for tobacco sales-a trigger that is particularly problematic for attempting quitters and people who smoke occasionally. This study reports on the attitudes, beliefs, and experiences of owners or managers of alcohol-licenced venues that sell tobacco exclusively through vending machines. METHODS: The study involved a telephone survey of alcohol-licenced venue owners or managers in New South Wales, Queensland, and Western Australia. Associations between outlet characteristics and current selling of tobacco exclusively via vending machines were examined, and responses to the open-ended question asking why the venue was likely or unlikely to stop selling cigarettes were manually coded. RESULTS: For most alcohol-licenced venues that sold tobacco exclusively through a vending machine, the profit from these sales was not considered important for the business. However, only a small minority (4%) of these venues reported that they were likely to stop selling tobacco. The most commonly cited concerns about stopping were customer dissatisfaction and potential loss of customers. CONCLUSION: The study provides the first evidence on the attitudes of owners/managers to the importance of tobacco sales, revealing that the vast majority of those owners/managers do not believe that tobacco sales are important for their venue. IMPLICATIONS FOR PUBLIC HEALTH: The presence of tobacco vending machines implicitly promotes tobacco products and therefore contravenes Australia's obligations under the World Health Organization Framework Convention on Tobacco Control. The results provide powerful evidence that restrictions on tobacco sales can be implemented without major financial damage to those vendors.

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BACKGROUND: Philip Morris International has made efforts to expand the sale of its heated tobacco product, IQOS, into new domestic markets globally. In Australia, where heated tobacco products are prohibited, the company recently attempted to overturn Australian legislation in order to permit their sale. In light of this recent move, this study presents a case study of the company's strategies to legalise and distribute IQOS in the Australian market. METHODS: To assess Philip Morris' lobbying activities and corporate strategies, a case study approach was used by triangulating data from three sources: interviews with former Philip Morris employees, news articles reporting Philip Morris' lobbying activities or plans for IQOS in Australia, and submissions to relevant government inquiries and reviews from 2015 to 2020. RESULTS: Philip Morris has actively lobbied Australian policy-makers to overturn bans on nicotine-containing products. Information obtained from key informants and Philip Morris' government submissions indicates that the company's goal is for heated tobacco products in Australia to be regulated in a new product category, exempt from tobacco control laws. Informants revealed that Philip Morris was also working to establish a network of upmarket pubs, clubs and bars where they could sell IQOS once legalisation was achieved. CONCLUSIONS: Philip Morris has strongly lobbied the Australian government to legalise heated tobacco products, while simultaneously making plans to sell IQOS at young adult-friendly premises such as bars, clubs and pubs if its proposed legislative changes are made. This case study provides valuable insights for other countries where Philip Morris may be replicating similar strategies to weaken tobacco control legislation.

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Investigating and exposing tobacco industry tactics to oppose and interfere with tobacco control policymaking is crucial to advancing public health. Whilst past investigations of tobacco industry activities have largely focused on secondary sources of information, such as publicly available tobacco industry documents, the collection of first-hand evidence from key informants has been an under-utilized method in tobacco industry monitoring. This article provides a detailed account of a methodological approach to systematically recruit former tobacco company employees as key informants for a study that aimed to gather information on the marketing tactics tobacco companies use in the Australian retail channel. Given the success of our study methodology in uncovering new information about tobacco company practices, we propose that key informant interviews with former industry employees should be a priority method for research investigating the role of commercial actors in influencing public health outcomes. To offer guidance to researchers who may wish to undertake a similar methodological approach, we also provide a reflective account of the elements of success and the lessons learned from this research.

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ISSUE ADDRESSED: The widespread retail availability of tobacco contributes to increased tobacco consumption and undermines quit attempts. Given the ready availability of tobacco in alcohol-licensed venues which young adults frequent, tobacco sales in these venues are likely to influence the purchase and consumption of tobacco by young adults. This study aimed to investigate Australian young adults' tobacco purchasing motivations and behaviours in alcohol-licensed venues. METHODS: A cross-sectional survey was conducted with a sample of 18- to 30-year-old Australians (n = 307) who had purchased tobacco at an alcohol-licensed venue within the previous 6 months. Purchaser characteristics, levels of alcohol consumption and whether the purchase was planned were assessed, along with anticipated responses to tobacco sales ceasing at the venue. RESULTS: The majority of participants (57%) reported their recent cigarette purchase at an alcohol-licensed venue as unplanned. Area of residence was the only characteristic associated with an unplanned purchase, with those living in urban areas significantly less likely to have made an unplanned purchase than regional participants (OR = 0.51, 95% CI [0.29, 0.89]). During the occasion when the tobacco purchase was made, the majority of participants (51%) had consumed five or more standard alcoholic drinks. If tobacco sales ceased at the venue, 22% indicated they would stay and not smoke. CONCLUSIONS: Unplanned tobacco purchases appear to be influenced by the alcohol-licensed settings, rather than socio-demographic factors associated with the individual. SO WHAT?: Policies that restrict the sale of tobacco in alcohol-licensed venues are likely to reduce tobacco consumption among young adults and support smokers to quit.

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In countries with bans on tobacco advertising and promotion, tobacco companies have focused their promotional expenditure on business-to-business relationship marketing activities aimed at retailers. However, evidence of such activities has been obtained through secondary sources only, including surveys and interviews with tobacco retailers and analyses of tobacco industry documents. To understand the breadth of promotional strategies employed in the retail sector to enhance tobacco sales, 10 semi-structured interviews were conducted with a sample of key informants who formerly worked for tobacco companies operating in Australia. A qualitative iterative approach was used to develop a thematic analysis of tobacco brand promotion and retailer marketing. Participants described tobacco retail marketing and promotion strategies that were categorised into three primary themes: (1) the provision of financial incentives, such as price promotions, cash payments and rebates; (2) the provision of experiential incentives, such as all-expenses paid vacations, exclusive parties and events, and (3) targeted marketing and education, which enabled retailers to market to consumers on behalf of tobacco companies. Such strategies had the ultimate objective of increasing market share and driving sales. For countries to comprehensively restrict all tobacco marketing, legislation must be introduced to outlaw these activities in tobacco advertising and promotion legislation.

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OBJECTIVE: To investigate the potential impacts of several tobacco control interventions on adult daily smoking prevalence in the Australian state of Queensland, using a system dynamics model codeveloped with local and national stakeholders. METHODS: Eight intervention scenarios were simulated and compared with a reference scenario (business as usual), in which all tobacco control measures currently in place are maintained unchanged until the end of the simulation period (31 December 2037). FINDINGS: Under the business as usual scenario, adult daily smoking prevalence is projected to decline from 11.8% in 2017 to 5.58% in 2037. A sustained 50% increase in antismoking advertising exposure from 2018 reduces projected prevalence in 2037 by 0.80 percentage points. Similar reductions are projected with the introduction of tobacco wholesaler and retailer licensing schemes that either permit or prohibit tobacco sales by alcohol-licensed venues (0.65 and 1.73 percentage points, respectively). Increasing the minimum age of legal supply of tobacco products substantially reduces adolescent initiation, but has minimal impact on smoking prevalence in the adult population over the simulation period. Sustained reductions in antismoking advertising exposure of 50% and 100% from 2018 increase projected adult daily smoking prevalence in 2037 by 0.88 and 1.98 percentage points, respectively. CONCLUSIONS: These results suggest that any prudent approach to endgame planning should seek to build on rather than replace existing tobacco control measures that have proved effective to date. Additional interventions that can promote cessation are expected to be more successful in reducing smoking prevalence than interventions focussing exclusively on preventing initiation.

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BACKGROUND: Licensing of tobacco retailers has been proposed as a mechanism to encourage retailers to stop selling tobacco. However, previous studies of tobacco licensing and/or of retailers who have stopped selling have been restricted to one legislative environment. This study examines patterns of tobacco retailing across three legislative environments with three different licensing schemes (an annual fee-based licence, a zero-cost, one-off notification scheme and no notification/licensing scheme). METHOD: A telephone survey was conducted of 2928 potential tobacco retailers who could personally choose whether or not to sell tobacco (rather than the decision being made at a head office). RESULTS: Unexpectedly, the annual licence fee to sell tobacco was not significantly associated with a lower rate of selling tobacco or a higher rate of stopping. After allowing for other factors, probability of selling, stopping selling and reported importance of tobacco sales varied across outlet types (p<0.001 for all three outcomes), and according to the remoteness of the retailer (p<0.001, p trend=0.041 and p=0.025 respectively). CONCLUSION: A fee of $A286 was not associated with a lower rate of selling, or a higher rate of stopping. The effect of licensing on retailer numbers will presumably be greater for higher licence fees, but will also depend on the perceived importance of tobacco sales to the retailer. In turn, importance of tobacco sales appears to depend on market factors, including proximity to major urban centres and low-cost competitors. A higher licence fee is likely to have a larger effect on discouraging retailers from selling.

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BACKGROUND: In countries banning advertising and display of tobacco at point-of-sale, little is known about tobacco companies' continuing promotion of products through incentives and benefits to retailers. METHOD: A telephone survey of 4527 randomly selected Australian retailers was conducted in August 2018, and identified 800 current tobacco retailers (response rate: 72.4%) who were asked a series of questions about benefits offered to them by tobacco companies and what retailers agreed to in return. RESULTS: 41.1% of retailers reported being provided with a tobacco cabinet and 38.3% reported having a price list supplied by a tobacco company. One-third (33.3%) reported being offered at least one benefit from a tobacco company for doing something in return. Price discounts were the most frequently reported benefit (19.0%), followed by rebates (8.4%) and gifts (3.0%). Retailers also reported offers of prizes and incentives for increasing sales or demonstrating product knowledge. In return, retailers reported giving companies benefits such as prominence on the price list and/or in the tobacco cabinet and/or influence over the product range and stock levels. CONCLUSION: Tobacco companies are continuing to market tobacco and influence sales through provision of incentives and benefits to retailers. Laws that ban the supply of benefits to consumers should be extended to also prohibit the provision of benefits to tobacco retailers.

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BACKGROUND: Widespread availability of tobacco has been shown to contribute to ongoing smoking and make quitting harder. This study investigates why some retailers in three Australian states decided to stop selling tobacco, others might stop selling and why others continue to sell in a declining market. METHODS: A telephone survey of 4527 randomly selected retailers was conducted in August 2018 (response rate=72.4%). This study examines responses to open-ended questions in the survey probing retailers' attitudes and beliefs regarding selling (or not selling) tobacco. RESULTS: 27.3% of the sample sold tobacco, and 13.3% had formerly sold. Outlets that had stopped selling most frequently mentioned minimal profit and/or sales as the reason for stopping selling (27.7% across all states). This was also the most frequent reason why retailers said they might stop selling. Uniquely in Western Australia (the only state in the study with a fee-based licensing scheme), 12.5% of former tobacco retailers named tobacco licensing as the reason for stopping sales-the second most frequent reason in Western Australia. Of current sellers who were unlikely to stop, the potential to lose sales was the most frequently named reason (31.0% across all states). CONCLUSION: Retailers report being driven by the profitability of tobacco when deciding whether or not to stop selling, although only a small percentage discussed losing incremental sales if they stopped selling. An annual licence fee contributed to some retailers stopping selling, showing that a fee-based tobacco license can contribute to a decline in retail availability of tobacco.

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AIM: This study aims to describe the perceived ease of accessing tobacco retail outlets in New South Wales (NSW), Australia, and the sociodemographic factors associated with reported higher density of tobacco retail outlets. METHODS: A cross-sectional online survey was conducted with a sample of NSW adults in February 2019. The accessibility of cigarettes was assessed and a binary logistic regression model was used to examine characteristics associated with having four or more retailers within a 5-minute drive of their home. RESULTS: A total of 3213 NSW adults completed the survey. The vast majority of participants, 89.9% (n = 2888), described cigarettes as being easily accessed from where they live. Half of the participants (50.7%) reported having four or more tobacco retail outlets within a 5-minute drive of their home. Never-smokers were significantly less likely than daily smokers to report four or more tobacco retailers within a 5-minute drive of their home, although non-smokers may be less likely to identify tobacco retailers. Females, those living in regional areas of NSW and those with a university qualification were also less likely to report having four or more tobacco retailers within a 5-minute drive of their home. CONCLUSION: The ease of access to tobacco retailers in NSW is incongruent with the significant health risks associated with tobacco use and highlights the need for measures to reduce the supply of tobacco, such as a fee-based tobacco licensing system.

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OBJECTIVE: Despite claims by tobacco companies that plain packaging would lead to lower cigarette prices, recommended and observed real cigarette prices in Australia rose in the 9-11 months after plain packaging was introduced. However, little is known about trends in prices longer term. In this report, we assess whether inflation (Consumer Price Index; CPI) and tax adjusted ('CPI-tax-adjusted') prices of the market-leading Australian cigarette brand changed in the 3-year period after plain packaging, and whether price changes were associated with retailer characteristics. METHOD: Cigarette prices were ascertained from a panel of tobacco retailers at three time points: (1) in November 2012 (n=857) (before full implementation of plain packaging, compulsory in retail outlets from December 2012), (2) between October 2014 and February 2015 (n=789) and (3) between November 2015 and March 2016 (n=579). Generalised estimating equations were used to estimate percentage change in mean CPI/tax-adjusted cigarette prices over time. RESULTS: CPI/tax-adjusted adjusted mean stick prices rose by 13.7% (95% CI 13.0 to 16.0) and 15.2% (95% CI 14.3 to 16.0) at 2.1 and 3.1 years after plain packaging was introduced, respectively. Increases in mean CPI/tax-adjusted stick prices varied by outlet type (p<0.001), socioeconomic status (p=0.013) and remoteness of retailer's area (p=0.028) and whether twin packs were sold (p=0.009). CONCLUSIONS: Contrary to tobacco company predictions of a fall in prices, the price of the market-leading Australian cigarette brand increased significantly in the 3 years after plain packaging was introduced, and these increases were above the combined effects of inflation and increases in excise/customs duty.

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OBJECTIVE: To obtain insight into tobacco retailing by alcohol-licenced premises, in order to understand the financial importance of tobacco sales for such retailers. METHOD: Data were collected by a telephone survey of 1042 clubs, hotels and packaged liquor outlets in New South Wales, Australia. The response rate was 86.1%. Qualitative and quantitative data were obtained. Logistic and linear regression were used to determine factors associated with the probability of selling and stopping selling and the importance of cigarette sales. RESULTS: More than a third (36.4%) of premises contacted did not sell cigarettes. 147 (an estimated 18.1% of those who had ever sold) had stopped selling. There were significant differences in the probability of selling, in the reported importance of cigarette sales and in the probability of stopping selling, between different outlet types and other outlet characteristics (number of gaming machines, proximity of nearest alternative tobacco retailer and remoteness). Outlets where alcohol can be consumed were more likely to rate cigarette sales as 'not important' than 'important'. CONCLUSIONS: Despite claims by tobacco companies that tobacco sales are important for many Australian retailers, tobacco sales appear to be of limited importance for alcohol-licenced premises. This means that opposition to stopping tobacco sales where alcohol is consumed and/or sold may be less than expected.

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OBJECTIVES: To assess retailer compliance with a licensing scheme requiring tobacco retailers to list their business details with the government, to examine whether listed retailers are more likely to comply with a point-of-sale (POS) display ban and other in-store retailing laws and to explore variations in compliance between different retailer types and locations. METHOD: An audit of 1739 retailers in New South Wales, Australia, was used to assess compliance with tobacco retailing legislation. Auditors actively searched for and audited unlisted retailers and all listed retailers in 122 metropolitan and regional postcodes. Multivariate generalised linear regression models were used to examine associations between compliance and retailer type, remoteness and demographic characteristics (socioeconomic level, proportion of population under 18 years and proportion born in Australia). RESULTS: One unlisted tobacco retailer was identified for every 12.6 listed tobacco retailers. Unlisted retailers were significantly more likely than listed retailers to breach in-store retailing laws (p<0.001). Compliance with the POS display ban was observed in 91.3% of tobacco retailers, but compliance with all retailing laws was only 73.4%. Retailers in socioeconomically disadvantaged areas had lower compliance than those in high socioeconomic areas. CONCLUSIONS: Some tobacco retailers did not list their business details with the government as required, even though there was no financial cost to do so. Unlisted retailers were more likely to violate in-store regulations. The results suggest licensing schemes can be useful for providing a list of retailers, thus facilitating enforcement, but require a system to search for, and respond to, unlisted/unlicensed retailers.

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OBJECTIVE: There is evidence that wide distribution of cigarettes contributes to smoking, and multiple commentators have called for a review of tobacco retailing. This study analyses retailers who stop selling cigarettes, why they do so, and discusses the implications for tobacco control. METHOD: An audit of tobacco retailers in the Australian state of NSW was used to identify retailers who had stopped selling tobacco, and they were then compared with current retailers to determine how many, and what types of outlets stop selling tobacco. Attempts were made to contact and interview all former tobacco retailers identified in three audited regions. In-depth interviews were conducted with 13 ex-tobacco retailers, or 31% of the subset of ex-tobacco retailers. RESULTS: Low-volume outlet types were over-represented as a proportion of retailers exiting the market, and some had resumed selling within 18 months of the audit. Low profits were often cited as a contributor to stopping; however, in all but one case, the decision to stop selling was also influenced by a significant change in business circumstances-either legislative or other business changes. CONCLUSIONS: Few retailers stop selling tobacco while continuing in the same business, and those who stop disproportionately represent retailer types with low sales volume. The results suggest that legislative changes provide a window where retailers could be prompted to exit the market.

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OBJECTIVE: Since price is both a key determinant of smoking and one of the few remaining marketing strategies available in countries without point-of-sale tobacco display, this study examines cigarette price variations in the Australian market and assesses whether those variations are consistent with price being used to increase or maintain smoking among price-sensitive groups. METHOD: An audit of 1739 tobacco retailers was used to collect variations in the price of the best-selling Australian cigarette brand, as well as record retailer compliance with tobacco retailing legislation. We examined variation in pricing across outlet type, demographic variations (socioeconomic level, % in the area under 18 and % born in Australia), remoteness and retailer compliance with tobacco retailing legislation. RESULTS: Multipacks were offered by 27.8% of retailers, with the average pack price in a twin pack $1.32 (or 7.3%) cheaper than a single pack. Prices were significantly lower in some outlet types, in lower socioeconomic postcodes and in those with a higher percentage of people under 18. In contrast with other consumer goods, prices were lower (although not significantly so) outside major cities. CONCLUSIONS: The provision of substantial multi-pack discounts and lower prices in postcodes with a higher proportion of price-sensitive smokers (young people and those from lower socioeconomic groups) is consistent with targeted discounts being used as a tobacco marketing strategy. The results support policy interventions to counter selective discounts and to require disclosure of trade-based discounts.

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