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3. Sources, availability and marketing of cigarettes to young people

Key points

• 13 and 15 year olds have little difficulty buying cigarettes from shops in Scotland, indicating a widespread disregard for the law of age of purchase at 16.
• Research shows that vigorous enforcement of age of purchase laws can help reduce youth smoking rates.
• Raising the age of purchase has not been shown to reduce youth smoking rates as an isolated measure but may contribute as part of a comprehensive package of wider control measures including vigorous enforcement.
• Raising the price of cigarettes through increasing taxes has been shown consistently to reduce youth smoking rates. This is arguably the most effective measure that can be taken to discourage smoking by young people.
• Packets of 10 cigarettes are particularly popular with teenage smokers.
• Smuggling of cigarettes currently accounts for a significant proportion of cigarettes in circulation, particularly in disadvantaged areas.
• There is good evidence that the marketing of cigarettes has been successful in encouraging young people to smoke. Whilst advertising and sponsorship have now been banned, opportunities still exist for other forms of marketing. Positive images of smoking are still found in the media including the youth media (eg magazines and films).
• A series of recommendations are made, aimed at making cigarettes less affordable, accessible and attractive to children and young people.

3.1 Young people can only smoke if they are able to buy or otherwise obtain cigarettes. It is currently an offence to sell cigarettes to anyone under the age of 16. Cigarettes have also become increasingly expensive due to a progressive rise in the tax imposed on them. In this Chapter, we look at where young people obtain cigarettes and consider the evidence for various measures designed to make it less easy for young people to obtain them.

Availability and underage sales

3.2 Tobacco is widely available for sale from retail outlets across Scotland. The SALSUS surveys found that 13 and 15 year olds have little difficulty buying cigarettes from a range of shops and from vending machines ^6,10. Among regular smokers, almost all (86%) 15 year olds and almost two-thirds (62%) of 13 year olds reported buying cigarettes from shops. Newsagents, tobacconists or sweet shops were the most commonly reported type of shop reported by 79% of 15 year olds and 53% of 13 year olds. Supermarkets and garage shops were also a common source, particularly for 15 year olds. It is therefore clear that the law on the age of purchase of cigarettes is widely disregarded.

3.3 Many 13 and 15 year olds also reported buying cigarettes from friends, relatives and other people, with these sources appearing more important for younger children. Thus, 21% of 13 year olds and 14% of 15 year olds reported buying cigarettes from friends or relatives. Smokers also reported being given cigarettes and the most common source for both regular and occasional smokers was friends. Among regular smokers, 43% of 13 year olds and 38% of 15 year olds reported this source ¹⁰ .

3.4 Evidence from the US suggests that more stringent under-age sales policies are associated with lower youth smoking rates ²⁸. Reviews also concur that the vigorous enforcement of the minimum legal purchase age combined with high compliance by retailers is more effective in reducing illegal sales than unenforced voluntary agreements or education of retailers ²⁹. However, as shown by intervention studies the impact of vigorous enforcement of minimum legal purchase age on actual smoking behaviour is weaker, probably because young people obtain cigarettes from a variety of different sources ³⁰.

3.5 Recently, the Lord Advocate has granted permission for trading standards officers in Scotland to carry out test purchases of cigarettes using underage customers ³¹. Vendors who sell cigarettes to these customers are then liable to prosecution. This offers a potentially powerful means of putting pressure on vendors to comply with the existing age of purchase.

3.6 There is good evidence that vigorous enforcement of under-age sales legislation does reduce cigarette sales to minors and can have some impact on smoking rates among minors. We therefore recommend that measures are taken to ensure that much greater efforts are made to enforce the prevailing legal age of purchase. These should include the following:

• active use of test purchasing by underage customers with appropriate action taken against offending vendors, including heavy fines that provide a genuine deterrent.
• encouraging vendors to require proof of age before selling to young customers;
• conducting an information campaign for retailers and trading standard officers, to explain the law on age of purchase, and emphasise the addictiveness of smoking and the consequent need to discourage young people from smoking.

Tobacco licensing schemes

3.7 A number of countries or jurisdictions within countries have established a form of licensing of vendors of tobacco products. There are negative licensing schemes in New Zealand, in Australia (Queensland, Victoria and New South Wales) and in Canada (Ontario). Under these schemes, tobacco retailers can be prohibited by Court Order from selling tobacco products if found guilty of multiple breaches of the relevant legislation, for example, by selling to minors. Over the past six years, four Australian jurisdictions have introduced positive licensing schemes. Tasmania licenses the company or individual selling tobacco. South Australia, the Australian Capital Territory and the Northern Territory license the individual premises at which tobacco is sold. We were unable to obtain any information about the impact of these schemes.

3.8 There is very little published evidence available to demonstrate whether negative or positive licensing schemes are effective as a deterrent. Recent research in New Zealand found that many young people are still accessing tobacco, despite negative licensing being in place, as current legislation and enforcement appear insufficient to deter tobacco retailers ³². Establishing and maintaining a positive licensing scheme would require a costly and resource intensive administrative effort. Given the lack of evidence for its effectiveness, such a scheme could not be justified on cost grounds at the present time. On the other hand, a negative licensing scheme would require no new infrastructure but simply the amendment of existing legislation. It would provide an added sanction against retailers who repeatedly flout the law. We therefore recommend the introduction of a negative licensing scheme for the sale of tobacco in Scotland. This would result in retailers found guilty of repeated offences being prohibited from selling tobacco for a specified period. However, it would only be of value if it were linked to the active and widespread enforcement recommended in 3.6.

Changing the age of legal purchase of tobacco

3.9 Under the Children and Young Persons (Scotland) Act 1937 and the Children and Young Persons (Protection of Children from Tobacco) Act 1991, it has been illegal to sell tobacco products in Scotland to customers under the age of 16 since 1937. This follows similar legislation passed in England in 1933. In the 1930s, smoking was considered a fairly harmless behaviour. It was not until the 1950s that the link with lung cancer was made. Since then, the list of serious conditions to which both active and passive smokers are at risk has grown enormously. It is also now established that nicotine is a highly addictive drug. In the light of our current knowledge, does it still make sense to maintain the age of legal purchase at 16 and, if not, what evidence is there that raising the age would prevent young people from smoking?

3.10 Many other countries have set the legal age of sale at 18, including most states in the US. Six out of the eight Canadian provinces have set it at 19, as have at least three American states. Jamaica, Japan, Kuwait and the Republic of Korea have a minimum purchase age over 18. There are many potential benefits of raising the age of purchase: reduced uptake of smoking among young people, reduced prevalence of regular smoking, reduced numbers of cigarettes smoked by regular under-age smokers, increased smoking cessation among young smokers, easier refusal of sales by retailers and a change in social norms. The possible harms include further glamorising of smoking in terms of it being viewed as an adult behaviour thereby potentially encouraging some young people to smoke. It may also further alienate young regular smokers.

3.11 Unfortunately, there do not appear to be any adequately conducted studies of whether or not raising the legal age results in a reduction in the prevalence of smoking by people younger than the legal age ^33,34,35. In 1997, Guernsey (population 64,000) introduced a series of measures aimed at reducing smoking prevalence among young people, including raising the age of legal sale from 16 to 18 ³⁶. Smoking prevalence among 15 year olds fell from 32% to 18% between 1997 and 2002. However, as a number of measures were introduced simultaneously, the new age limit has not been strictly enforced and no formal evaluation of the impact of the measures was carried out, it is not possible to quantify the contribution of raising the legal age to this reduction.

3.12 Although there is no clear evidence from other countries that raising the age of legal sale in and of itself reduces the prevalence of smoking, we consider that to leave it unchanged would be inconsistent with the range of other tobacco control measures that are now in place or are proposed. Given what is now known about tobacco, it seems entirely unjustified that such a dangerous and addictive substance, clearly labelled as lethal, should still be sold to minors. We consider that raising the age of purchase, as a part of a range of measures, would reinforce the message to the population in general and young people in particular that tobacco is a highly dangerous substance which should be avoided. If properly enforced, we think it is likely that the measure would contribute to a reduction in consumption of tobacco by young people.

3.13 We therefore recommend that the current offence of selling tobacco products to anyone under the age of 16 should be amended by raising the minimum age to 18. There should be sufficient delay between amending the legislation and its implementation to prepare both customers and retailers for a smooth transition. We also recommend that the impact of this change should be carefully evaluated.

The impact of price

3.14 There is strong evidence that tobacco taxation is a particularly effective way of reducing tobacco consumption among young people ^37,38,39,40. Tax policy is thus one of the main tools for preventing nicotine addiction ⁴¹. The World Bank has calculated that a 10% increase in the price of cigarettes on average reduces demand by 4% in high-income countries such as the UK⁴². The effect of a 10% price increase on the 77 billion cigarettes sold in the UK would be to reduce consumption by about 3 billion cigarettes per year. However, young people may be up to three to four times more price sensitive than older adults. A recent systematic review amongst 13 to 24 year olds also concluded that price affected both the number of young smokers and the amount of tobacco consumed ⁴³.

3.15 In his 2000 Budget Statement, the Chancellor raised cigarette taxes by 5 per cent above inflation with 25 pence on a packet of 20 cigarettes ⁴⁴. He announced that some of the additional money accruing from the duty increases on tobacco would go towards the NHS. The Scottish Executive received £26 million of the extra tobacco taxation money and announced it would invest the money in a major health improvement and public health programme ⁴⁵. By the 2004 Budget, tax increases had levelled out, and the Chancellor only raised tobacco duty rates in line with inflation (including VAT), meaning that a typical packet of 20 cigarettes increased in price by 9.2 pence ⁴⁶. In 2006, the Chancellor raised the duty on cigarettes by only 9p ⁴⁷, an increase lower than the current rate of inflation. As a result, cigarettes will actually be cheaper in real terms for the forthcoming year. This apparent downward trend in budgetary terms is out of step with significant UK tobacco control advances in other areas.

3.16 We recommend that the Scottish Executive urges the UK Government annually to increase the price of tobacco products at a rate faster than inflation.

3.17 We also recommend the Scottish Executive makes representations to the UK Government to urge that health considerations are taken into account in the decision making process of EU policy concerning the taxation of tobacco products, as is required by the Framework Convention on Tobacco Control ( WHO).

Packets of ten cigarettes

3.18 Recent research in the Republic of Ireland indicates that 75% of smokers aged under 17 buy packets of ten cigarettes ⁴⁸. A recent survey of 11-15 year olds in England found that smokers were more successful in buying packets of ten than packets of twenty ⁴⁹. Similar research has not been conducted in Scotland but packets of ten are universally available. Whilst there is apparently no objective evidence to demonstrate the effectiveness of banning packets of ten (also known as 'kiddie' packs) as a means of reducing young people's access to cigarettes, an increasing number of countries are prohibiting the sale of packets of ten as part of wider youth prevention strategies. These include Australia ⁵⁰, New Zealand ⁵¹, Canada ⁵², France ⁵³, 14 states in the US and the District of Columbia ⁵⁴. The Republic of Ireland's Public Health (Tobacco) Act 2002 contains a clause making it an offence for a person to sell cigarettes by retail other than in a packet containing not less than 20 cigarettes ⁵⁵. However, this section of the Act has not yet been implemented.

3.19 The World Health Organisation have also raised concerns about 'kiddie packs', branding them "another strategy of the tobacco industry… It is clear that these packs are made for children, young people and those on low income in an effort to maintain and even enlarge the market for tobacco products" ⁵³.

3.20 Whilst a case can be made for prohibiting the sale of packs of ten in Scotland, such a step could also have negative consequences.

• It could discourage smokers who are trying to "cut down to quit" by requiring them to buy larger packs.
• It could disproportionately affect smokers on low incomes.
• It could stimulate a cross-border black market in smuggled or couterfeit packs of ten.

3.21 In the absence of good evidence for its effectiveness, we consider that banning the sale of packs of ten in Scotland is unlikely to make a useful contribution to preventing smoking by young people at this stage. We have concluded that raising the cost of cigarettes, raising the minimum age of purchase and vigorously enforcing the age of purchase are together likely to have a much greater impact.

3.22 We therefore recommend that the issue of the sale of packs of ten should be referred to the UK Government for consideration in the light of further research into its likely impact. To inform future decisions, we also recommend that the Scottish Executive commissions research to ascertain the extent to which young people in Scotland purchase cigarettes other than in packs of 20.

Smuggled and personally imported tobacco

3.23 The availability of much cheaper smuggled tobacco products - both cigarettes and loose tobacco, sold from vans, at open-air markets and by other means across the UK, undermines the impact of the pricing and sale controls that are currently in place. As smuggled tobacco products are particularly prevalent in more disadvantaged areas, smuggling may have a disproportionate impact on smoking behaviour by young people in these areas ⁵⁶.

3.24 In March 2000, the UK Government announced a package of measures designed to curb smuggling, including the deployment of 1000 additional Customs officers; additional specialist investigators and intelligence staff; additional x-ray scanners; tougher sanctions and penalties; and a public awareness campaign ⁵⁷. In addition, packs of cigarettes and hand-rolling tobacco sold for consumption in the UK are now required to carry a duty-paid mark.

3.25 In 2002-2003, the illicit market in cigarettes fell to 18%, representing 2.5 billion fewer smuggled cigarettes than the previous financial year ⁵⁸. However, by 2003-04, 54% of cigarettes seized in the UK were counterfeit, a 2.6 fold increase in only two years. Counterfeit cigarettes are not manufactured by the company they purport to be and their content is not standardised. Recent tests have shown that some samples have higher levels of lead, arsenic and other harmful chemicals than legitimately manufactured cigarettes ⁵⁹. Smuggled packets of 20 cigarettes are around 40% cheaper than their legal counterparts ⁶⁰. Recent estimates suggest that tobacco smuggling costs over £2.5 billion a year in lost tax revenue ⁶¹ .

3.26 Many people now import large numbers of cigarettes "for their own personal use" when returning from visits to other EU countries (the current guideline upper limit is 3200 cigarettes per person per visit). However, it is not known how many cigarettes are imported in this way or in what proportion of cases individuals successfully bring in more than the upper limit. In addition, a growing number of web sites offer imported cut price cigarettes for sale ⁶² .

3.27 Tobacco smuggling constitutes a serious public health risk by undermining initiatives aimed at reducing tobacco consumption. Smuggled tobacco is most likely to be sold in deprived areas and increasingly children are being targeted ⁵⁶. Purchasing from unregulated internet sites accounts for a growing proportion of UK smuggled tobacco. These sites often use child friendly marketing, and fail to carry health warnings ⁶².

3.28 The trade in smuggled cigarettes is dominated by large-scale container fraud: as many as ten million cigarettes can be hidden in a container apparently carrying legitimate products such as food or furniture. This is very different from the popular perception of cigarette smuggling, namely the "white van trade" in which small-scale operators exploit cross-Channel tax differentials but pay duty in another country. Bootlegging - legally buying tobacco in a low tax country and illegally re-selling it in a high tax country - accounts for about 20% of the cigarettes sold on the UK black market ⁶³ .

3.29 The tobacco industry benefits from smuggling in several ways. Smuggling stimulates consumption both directly (through the street sale of cheap cigarettes) and indirectly (through pressure to lower or keep down taxes) ⁶⁴. Whilst legitimate retailers lose tobacco sales, the tobacco industry maintains their production and sales. Thus, they have no incentive to reduce smuggling. The industry does not lose out when contraband cigarettes are confiscated and destroyed, as these cigarettes need to be replaced, resulting in yet more sales.

3.30 Although customs activity can reduce smuggled cigarettes' share of the domestic market, there is no direct evidence regarding the impact of this activity on tobacco consumption by adults or young people. On the other hand, in Canada the downward trend in teenage smoking prevalence was reversed in provinces where there was a substantial cut in tobacco taxes in order to make smuggled tobacco less attractive. This suggests that the availability of smuggled tobacco may not have much influence on tobacco use by young people.

3.31 If, as we believe should happen, the relative price of tobacco should rise and further controls on its availability should be put into place, the incentives to smuggle and deal in illicit tobacco products may increase. This may well have a disproportionate effect in more disadvantaged areas, where the trade in smuggled tobacco is already greater, potentially widening health inequalities ⁵⁶. Effective measures are therefore needed to prevent tobacco smuggling and control more effectively importation "for personal use". We therefore recommend that the Scottish Executive should:

• commission research to ascertain the current extent of use by young people of smuggled or personally imported tobacco;
• ensure that Customs and Excise and the police in Scotland both put a high priority on activities aimed at reducing the influx of smuggled tobacco into Scotland in particular;
• urge the UK Government to maintain and if necessary increase the investment in staff and equipment needed to control the influx of smuggled tobacco;
• urge the UK Government to review the appropriateness of the current limits for the importation of cigarettes from other EU countries for personal use and the effectiveness of the controls thereon;
• urge the UK Government to work collaboratively with the EC and other Member States to help develop a comprehensive international protocol on illicit tobacco as agreed at the first Conference of the Parties of the Framework Convention on Tobacco Control.

Tobacco advertising and marketing strategies

3.32 The tobacco industry worldwide invests vast resources on the marketing of their products. In order to maximise their sales, they focus on efficient systems of distribution, competitive pricing, careful product placement and the use of a wide range of techniques to promote their products.

3.33 Tobacco advertising was banned in the UK and the rest of Europe in 2002 and tobacco sponsorship came to an end in 2005. The impact of this development is yet to become clear. However, the marketing of tobacco products in the UK continues through a variety of communications and promotional devices. Cigarettes are still prominently displayed in thousands of supermarkets, newsagents, petrol stations and other points of sale. Images of smokers (often with the allure of celebrity status) continue to be featured in films, TV and magazines.

3.34 There is a growing body of research on the impact of tobacco advertising on youth smoking. Lovato and colleagues conducted a meta-analysis of nine cohort studies and found "a positive, consistent and specific relationship" between exposure to tobacco advertising and the subsequent uptake of smoking among adolescents ⁶⁵. In all the studies, non-smoking adolescents who were more aware of tobacco advertising or receptive to it were more likely to have experimented with cigarettes or become smokers at follow-up. Other studies have found a positive association between smoking and awareness of and appreciation of tobacco advertising ^{66,67,68,69,70,71,72}. Furthermore, adolescents appear to be more receptive to tobacco advertising than adults ^73,74. Although a causal relationship cannot be inferred, the association is consistently in the same direction and tends to support the hypothesis that advertising encourages young people to continue smoking as well as to start.

3.35 Studies of a variety of other tobacco marketing communications and promotional devices including point of sale advertising, packaging, brand stretching, loyalty schemes, free samples and the internet have shown a similar relationship between youth smoking and tobacco advertising. One major study examined young people's awareness of and involvement with all existing forms of tobacco promotion ⁷⁵. The authors found that smokers had more involvement with tobacco promotions than non-smokers and the heavier the smoker, the greater the involvement. This cumulative impact suggests that integrated marketing communications are an effective way of influencing adolescent smoking behaviour.

3.36 Whilst tobacco advertising and sponsorship have now been prohibited in the UK, tobacco companies will continue to seek to market their products to young smokers in any way they can. This includes prominent displays of cigarettes behind the counter at the point of sale. We understand that Norway and New Zealand are currently considering a requirement that cigarettes are only sold from under-the counter ⁷⁶ ( ASH Scotland 2006, personal communication).

3.37 We welcome the moves by the European Union towards requiring graphic photographs of smoking-related diseases to be displayed on cigarette packets as a means of encouraging smokers to give-up and reducing the attractiveness of cigarettes to young people. We recommend that the UK Government fully supports this initiative.

3.38 We recommend that the Scottish Executive continues to work with the UK Government and other devolved administrations to look at ways to reduce the positive and increase the negative images of smoking in the media and associated publicity materials, including reviewing any additional measures which might be taken to strengthen the ban on tobacco advertising and promotion introduced in 2002.

3.39 We recommend that the Scottish Executive prohibits the display of cigarettes at the point of sale, to be replaced by a simple list of the brands available and their prices.

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