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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 29-April-2011, Vol 124 No 1333

Promotion of nicotine replacement therapy and smoking cessation services at grocery stores
Background—For New Zealand (NZ) to be smoke-free by 2025, current smokers need to make more quit attempts and use effective support when doing so. Nicotine replacement therapies (NRT) are safe and double an individual’s chance of successfully quitting,1 yet in 2009 only 22% of NZ smokers aged 15-64 used NRT to support their most recent quit attempt.2
The 2010 Māori Affairs Select Committee’s (MASC) Inquiry into the tobacco industry recommended “That nicotine replacement therapies be required to be sold everywhere tobacco is sold, thereby ensuring smokers can choose a safe option whenever they crave nicotine.3 In 2009, two-thirds (67%) of NZ smokers regularly bought tobacco from ‘dairies’ (small independent grocery stores selling mainly tobacco, confectionary and basic grocery items). Yet, those who used NRT typically obtained it from a pharmacy either via the government subsidised Quitcard scheme (75%) or purchased at full price (14%).2 Only 2% bought it from a supermarket.2 The potential of using dairies to promote NRT and quit smoking services was investigated in a small cross-sectional exploratory survey.
Method—Between January and February 2010 a researcher identified and aimed to visit ten dairies that sold and displayed tobacco and were within 20 km of the researcher’s offices at the Tamaki campus, University of Auckland. The retailer at the counter at the time of each visit was invited to take part in a 15-minute face-to-face survey. Action on Smoking and Health NZ provided a list of dairies, cafés and small supermarkets that sold but did not display tobacco (n=18) or did not sell tobacco (n=17). These stores were contacted by telephone as they were situated in rural and urban locations throughout NZ. The retailer who answered the telephone was invited to take part in the survey.
The interviewer-administered, paper-based semi-quantitative survey included questions on; knowledge of quit smoking products, opportunities and barriers to selling NRT, attitudes towards the in-store promotion of quit smoking products and services, and attitudes towards possible legislative measures around the sale of tobacco. The study design was approved by the NZ multi-region ethics committee (MEC/09/89/EXP).
Results—Retailers from nine dairies that sold and displayed tobacco agreed to participate in the survey, as did retailers from five stores that did not display tobacco and eight stores that did not sell tobacco. The 22 participating retailers had an average age of 44 years (SD=13), 13 were female, two were Māori, 12 were Asian and 9 were of NZ European ethnicity. Four retailers were current smokers and six were ex-smokers. Half of the retailers were the store owner/manager. Thirteen of the 22 retailers mentioned NRT when asked to name all the smoking cessation products they knew of. One retailer currently sold NRT patches and gum, and four others had tried to sell NRT in the past. Obstacles to selling NRT included weak consumer demand and a lack of manufacturer and distribution support for NRT.
Eighteen of the 22 retailers felt dairies should have a role in promoting quit smoking products and/or services but preferred indirect measures such as displaying posters advertising NRT or Quitline, providing educational pamphlets or giving out free product samples. Three retailers said they would be willing to offer brief verbal advice to customers and eight said they would be prepared to undertake a short (30-minute) online training course to become a Quitcard provider. Opponents said they didn’t have the time, lacked the required knowledge or training, or felt they might offend customers.
Eleven of the 22 retailers, including five that sold tobacco, agreed that stores that sell tobacco should be legally required to provide and promote quit smoking products and services. The remaining 11 retailers felt it should remain the owner’s choice.
Discussion—This is the first study undertaken in NZ to seek small retailers’ views about promoting quit smoking products and services in-store. Some limitations should be noted. First, only a small select group of retailers was interviewed, and other retailers may have different views and experiences. Second, the decision to interview the retailer present on the day was a pragmatic one and the 11 store assistants who were interviewed may have had limited knowledge of store practices or ability to influence them. Finally, all retailers were interviewed while at work and so their responses were generally brief.
The Government’s response to the MASC recommendation was that NRT “be available as widely as possible where it is accompanied by safe and clinically appropriate advice”.4 That the retailers interviewed experienced a lack of customer demand for NRT is perhaps not surprising given the availability of subsidised NRT through pharmacies and the limited promotion of NRT through general sale.5,6 Approximately 16% of those who use NRT buy it at full price.2
A 2011 survey found that people who bought NRT from supermarkets did so because the NRT was immediately available and they felt supermarkets were an easily accessible and non-judgemental environment.7 Dairies possess these same qualities and retailers in dairies appear motivated to promote smoking cessation services and potentially sell smoking cessation products if the marketing and distribution of such treatments are improved.
Future research should explore how NRT should best be promoted in dairies to make it a viable product line.7 It would also be important to assess the extent that tobacco companies can influence retailers’ practices around the sale of NRT.8
Jonathan Williman
Research Fellow
j.williman@ctru.auckland.ac.nz
Krystel Fernandes
Summer student
Natalie Walker
Programme Leader, Addictions
Chris Bullen
Director
Clinical Trials Research Unit, School of Population Health, University of Auckland, Auckland
Acknowledgements: This work was supported by a University of Auckland summer studentship to KF. (The study was designed, conducted and analysed by the researchers independently of funders.) The authors also thank the interviewed retailers for agreeing to participate in this study; ASH (NZ) for assisting with the list of stores that did not display or did not sell tobacco products; and the CTRU staff that helped support this study and reviewed earlier drafts of this publication.
References:
  1. Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2008;(1):CD000146.
  2. Ministry of Health. Tobacco Use in New Zealand: Key findings from the 2009 New Zealand Tobacco Use Survey. Wellington: Ministry of Health; 2010.
  3. New Zealand Parliament. Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori, Report of the Māori Affairs Committee. Wellington: New Zealand Parliament; 2010.
  4. New Zealand Parliament. Government Response to the Report of the Māori Affairs Committee on its Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori. Wellington: New Zealand Parliament; 2011.
  5. Norris P, Nelson L, Ling KL, et al. Advertising of medicines on New Zealand television. N Z Med J. 2005;118(1215).
  6. Wijesinghe PR, Norris P. Increased advertising of medicines on New Zealand television since 2001. N Z Med J. 2008;121(1271):121–2. http://www.nzma.org.nz/journal/121-1271/2992/content.pdf
  7. Williman J, Walker N. SPINS: Supermarket Promotion to Increase NRT purchases. Report prepared for the New Zealand Ministry of Health. Auckland: Clinical Trials Research Unit, School of Population Health, University of Auckland; 2011.
  8. Edwards R, Thomson G, Hoek J, Gifford H. The attitudes and knowledge of retail sector staff to selling tobacco products. Report prepared for the Cancer Society of New Zealand and ASH New Zealand. Wellington: University of Otago; 2007.
     
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