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With this context in mind, we now turn to whether the observed effects could be some form of observer effect, or are more likely to reflect increased violations of the laws. To do this, we turn to an analysis of differences in awareness within waves. Some differences could be due to different kinds of stores visited, the most obvious example being between rural and urban participants, but this also applies to other demographics: young people frequent different kinds of stores than older people, and so forth.
We observed such effects: younger smokers tended to be more likely to notice displays and less likely to think the display ban was effective; there is also a regional disparity in noticing. However, this could also be a differential sensitivity effect, in that young people are generally more sensitive to advertising in general [ 27 ], while rural people are exposed to much less advertising and so a small amount of it may stand out.
That displays were noticed more by urban respondents at Wave 5 in Thailand suggests the exposure was likely real as the marketing must have at least stood out from all other types of marketing. However, we cannot discount the possibility that some non-smoking promotion was assumed to be for tobacco, even though this seems unlikely. This suggests greater problems with the display ban in urban areas. However, it may be that in urban areas there is greater likelihood that the turnover makes it more economical to put in place containers that afford high visibility to products when the door is opened.
In our view, the evidence here coupled with evidence from elsewhere points to a reduction in effective enforcement of the bans. Although Thailand has had a ban on all direct and indirect tobacco advertising and promotion, there are some loopholes in enforcement and implementation, especially when compared to countries such as Canada, where a compliance rate of surveyed retail outlets of as high as In our ITC SEA project we do not have cigarette retailer compliance data, and we do not know if what we have found is due to reduced compliance by retailers alone or is supported by more systematic activity of tobacco companies.
The cupboards at POS may have also been kept open more often, both intentionally and unintentionally.
Some level of noticing this has been informally reported by Thailand-based authors, both based on anecdotal reports from others and their own observations when in the field. As both reporting advertising and noticing displays have increased, we wondered if both effects could be due to taking more notice of displays, as seeing packs at POS is one form of advertising.
We checked our data and found there is some positive correlation between noticing displays and noticing store advertising, but it is only low and no higher than in Malaysia, where advertising was still allowed correlations in Thailand ranged from 0. Further, the different patterns of change by some sociodemographics make this unlikely to be a major reason. If so, then there may in fact be more direct violations of the advertising bans. This analysis is consistent with the fact that the tobacco industry is finding innovative ways to advertise and promote, perhaps some within the law, and others possibly illegal.
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We are concerned that organized forces within the industry may be pushing the envelope in Thailand, along perhaps with more localized lack of vigilance about complying with the laws. Without strong enforcement, things can backslide quickly. Overall, higher levels of exposure were reported by Malaysian smokers than their Thai counterparts. There was also some rather large wave—to-wave variability that we are unable to fully explain. Some of the differences may be mode effects as we shifted from face-to-face to phone surveying in Malaysia. The levels of noticing advertising declined considerably at Waves 3 and 4, and at Wave 3, there were contrasting differences between face-to-face interviews and those via telephone e.
While some of this may be due to differences in the characteristics of participants, some is likely due to the mode of survey [ 30 ]. Therefore, caution needs to be exercised when comparing the absolute levels of changes over time and between countries. In spite of some limitations, we have been able to show that the tobacco display ban in Thailand has reduced but not eliminated exposure to tobacco displays at POS.
The higher level of noticing POS displays than advertising suggests displays are generally more salient to smokers. Findings are consistent with those from Western countries. Thai authorities might usefully review enforcement procedures and review the legislation to make it harder for tobacco displays to be used when storage compartments are opened. The tobacco display ban in Thailand appeared to have reduced but not eliminated exposure to tobacco marketing at point-of-sale. There was a rising trend of noticing both tobacco displays and advertising.
The findings highlight the need to reinforce enforcement of the bans. The funding sources had no role in the study design, in the collection, analysis, and interpretation of data, in the writing of the manuscript, nor in the decision to submit the manuscript for publication. The lead author Lin Li presented some of the results and received valuable feedback at the Annual Meeting of the Society for Research on Nicotine and Tobacco in Philadelphia in February We thank Michelle Bishop for her assistance in putting together a graph for the paper.
We are grateful to the anonymous reviewers who provided useful suggestions on an earlier draft of this paper. All authors included on the paper fulfill the criteria for authorship. Quah and all the other authors contributed to data interpretation and revised the draft, and the final version of the paper has been reviewed and approved by all authors. National Center for Biotechnology Information , U. Published online Aug Quah 5. Find articles by Lin Li. Find articles by Ron Borland.
Find articles by Hua-Hie Yong. Anne C. Author information Article notes Copyright and License information Disclaimer. Received Apr 30; Accepted Aug 6. This article has been cited by other articles in PMC. Abstract In September Thailand became the first Asian country to implement a complete ban on the display of cigarettes and other tobacco products at point-of-sale POS. Keywords: tobacco products, advertising and promotion, regulations, point-of-sale, Thailand, Malaysia.
Introduction Tobacco advertising, promotion, and sponsorship TAPS are associated with smoking initiation and use [ 1 , 2 ]. Open in a separate window. Figure 1. Methods 2. Data Source and Participants The data came from the ITC SEA smoker survey, a prospective cohort survey designed to evaluate the psychosocial and behavioral impacts of tobacco control policies in Malaysia and Thailand.
Table 1 Sample characteristics, by country. Measures 2. Sociodemographics and Smoking-Related Variables Sociodemographic variables included sex male, female , age 18—24, 25—39, 40—54, 55 and older , ethnic group majority vs. Tobacco Advertising and Displays at Point-of-Sale At each survey wave, participants were asked if in the last six months they had noticed cigarettes or tobacco products being advertised 1 on store windows or inside stores where they buy tobacco; and 2 on or around street vendors.
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Data Analysis Group differences for categorical variables were examined using chi-square tests. Results 3. Sociodemographic and Smoking-Related Characteristics Table 1 summarizes the sociodemographic and smoking-related characteristics of the sample.
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Figure 2. Reported exposure to cigarette displays in shops in Malaysia and Thailand. Discussion The POS tobacco display bans appeared to have reduced but not eliminated exposure to cigarette pack displays at POS in Thailand, especially in the first year after the policy was introduced. Conclusions The tobacco display ban in Thailand appeared to have reduced but not eliminated exposure to tobacco marketing at point-of-sale. Author Contributions All authors included on the paper fulfill the criteria for authorship. Conflicts of Interest The authors declare no conflict of interest.
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References 1. Paynter J.
Point of sale tobacco displays and smoking among 15 years olds in New Zealand: A cross-sectional study.
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