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BACKGROUND: Point of sale (POS) is the next frontier in tobacco control. Tobacco advertising and marketing have a direct impact on adolescent susceptibility to smoking and youth smoking prevalence. With CDC funding, the city of Providence (RI) partnered with the RI Department of Health and successfully implemented a city tobacco retail license that addressed all emerging products, including electronic cigarettes, established strong local retail enforcement, banned all flavored tobacco products, and eliminated tobacco product discounts and coupons in retail stores. The present study is the first to evaluate the impact of these policies. We assess whether there was a reduction in youth smoking prevalence before (Fall 2010) and after (Fall 2012) POS policies were implemented.
METHODS: Data come from the Youth Risk Behavior Survey (YRBS) administered in Providence high schools in fall 2010 (75% overall response rate; analytic sample n = 1,921) and fall 2012 (67% overall response rate; analytic sample n = 1,221). Multivariable logistic regression models for current smoking (yes/no) controlled for age, sex, race/ethnicity, and two groups with elevated smoking rates (LGBT youth and youth with disabilities). Linear trend analysis assessed changes in smoking prevalence over two years. Weighted results are representative of all Providence high school students in grades 9-12 (SAS 9.4).
RESULTS: In both survey years, about half of the students were female and age > 16 years; a majority were Hispanic (58.3% and 61.4%, respectively). There was a significant linear decrease in the percentage of students who currently smoked cigarettes (2010: Current smoker: 5.8%, 95% CI: 4.8 - 7.0; 2012: Current smoker: 3.7%, 95% CI: 2.6 – 5.2). The decrease was significant for boys (7.7% to 4.2%; 47% decrease), but not for girls (4.0% to 3.1%). In the regression model for 2010, current smoking was higher among males (Adjusted Odds Ratio [aOR]: 2.10, 95% CI: 1.33-3.32), LGBT youth (aOR: 2.44, 95% CI: 1.23-4.85); and youth with disabilities (aOR: 3.06, 95% CI: 1.78-5.27). In the regression model for 2012, current smoking was higher only for LGBT youth (aOR: 7.13, 95% CI: 2.96-17.21).
CONCLUSIONS: Providence is the best model for youth smoking prevention. In this high poverty ‘minority majority’ city, current smoking rates significantly decreased among high school students before and after the implementation of POS policies; but not for LGBT youth, although the sample size was small. The results are of considerable interest to policy makers nationally considering the development and implementation of similar POS policies.