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to quit”.

Retailers and the tobacco industry

Proposals for reforming tobacco supply and the retail system aiming at reducing the availability of tobacco products may expect opposition from the tobacco industry and retail organisations, which is obviously linked to the foreseen economic consequences (e.g., Tilson, 2011; Wilson et al., 2013; Laugesen, 2010).

A qualitative small-scale study in 2013 by the Alliance Smoke Free Holland of headquarters and retail managers of drug stores, grocery stores, and convenience shops/newsstands suggests that most retailers have no fundamental or ethical problems selling tobacco and do not feel motivated to stop tobacco sales. If, however, legislation would restrict tobacco sales to specialised tobacco shops, they would of course respect the law. However, tobacco is seen as regular part of their assortment, and some of the interviewees strongly object to limiting sale to tobacconists. Missed revenue is the main reason underlying these objections, not only because of lost tobacco sales but also sales of other products customers may buy when visiting these specialised shops (e.g., books, newspapers). Including tobacco products in their assortment is also important to providing services and convenience to customers.

Tilson (2011) describes the case of the City of Buffalo (New York), where legislation had been developed that uses licensing as an instrument to decrease the number of businesses selling tobacco products and to eliminate tobacco sales from health- and education-oriented institutions. Noteworthy is the fact that rather than charging retailers for obtaining a license, tobacco

manufacturers would be required to pay a substantial fee for each brand and sub-brand sold in the city ($1,000, ≈ €721). This might have ‘softened’ the opposition of the retail sector and increased public support because local business owners are not targeted (Tilson, 2011). Nonetheless, although the proposal was supported by national health groups and the city council, it has ‘stalled’ due to concerns about (expensive) legal challenges by the tobacco industry.

In a discussion of the ‘endgame’ (or sinking lid) strategy, Wilson et al. (2013) report that the major disadvantage of the sinking lid strategy in democratic countries is most likely that it requires strong political leadership and public support to pass the necessary law. While an endgame and sink lid strategy is more drastic than a gradual reduction of points of sale, which may increase thresholds for purchasing but not fully eliminate tobacco products from society, it seems reasonable to assume that the requirements for both tobacco control strategies may show similarities.

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4.2 Untended consequences: possible shift in purchasing behaviour and the market

According to Laugesen (2010), the decreased supply of tobacco products as a standalone policy implies unmet demand (scarcity) and risk of a black market, which can, however, be minimised by companion policies that lower demand in tandem.

It is, however, questionable whether a reduction of retail outlets, and especially a gradual reduction, actually reduces availability or instead enhances the concentration of sales within the remaining retail outlets.

When a shift towards other sources of tobacco reaches one hundred percent, the impact of a measure restricting the number of outlets would not be very effective (unless, for example, it limits smoking cues and prevents smoking uptake). A survey in New South Wales, Australia among current smokers suggested that if density or proximity were to decrease, many would change their purchasing behaviour, and light smokers may reduce or cease smoking (Paul et al., 2010). More specifically, 54% indicated that they would change their shopping patterns, such as buying in bulk or less often, traveling just to buy cigarettes or changing where they shop. Eight percent reported that they would try to quit, and 20% reported that they would cut down. The remainder reported no expected change, that they would look for alternative sources or that they did not know what they would do. Moreover, those smoking less than 10 cigarettes per day, compared to heavier smokers, reported being more likely to quit or cut down due to reduced availability. Given the addictiveness of nicotine, such an ‘effect’ is not unexpected. Whether these intentions will actually translate into behaviour remains to be investigated.

Additionally, a German study (Schneider et al., 2009) on a reduction in the number of tobacco vending machines after the implementation of electronic age locks suggests that reducing accessibility may, in the short term, cause a shift towards other sources of supply, which is compatible with the broader literature on the effects of increasing the legal age when enforcement is insufficient (DiFranza, 2012). However, reducing the number of outlets is not necessarily similar to making sales illegal (as is the case with implementing age limits), except for a ban on sales in specific locations (e.g., health or governmental institutes) or distribution channels (vending machines).

So far, no studies have examined reductions in outlet density along with smoking and purchasing behaviour to investigate whether major shifts in the market occur.

4.3 Economic consequences

A restriction of the number of points of sale may have economic consequences in the short or long term.

To our knowledge, no studies have been performed on this topic abroad, except for a German study analysing the reduction in sales through vending machines, which could be attributed to a variety of tobacco control measures (see §2.5). In this study, it was shown that the decrease in

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