Scotland is about to ban tobacco displays in shops, and this study will track whether that actually stops young people from smoking. The Tobacco and Primary Medical Services (Scotland) Act 2010 removes point-of-sale advertising from all retailers by 2015, but no one has measured its real-world effect on teenagers' exposure, attitudes, or behaviour. The DISPLAY study fills that gap by following four communities—selected for different levels of urbanisation and deprivation—over four years, collecting data before and after the ban takes effect. If the legislation works, fewer young people will start smoking, reducing the long-term burden of lung cancer, heart disease, and other smoking-related illnesses. The study also tests whether partial implementation in supermarkets alone has any effect before the full ban kicks in. Beyond health, the findings could shape how governments design future public health regulations—showing whether removing visual cues from shops changes behaviour, or whether young people simply shift to other sources like black-market tobacco. If the ban fails, the results will still matter, revealing where enforcement or additional measures are needed.
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Aim: The aim of the study is to assess the impact of the TPMS (Scotland) Act 2010 (that bans of point of sale (POS) advertising) on young people’s exposure to tobacco advertising, their attitudes towards smoking and their smoking behaviour. Design & Setting: We propose a before and after study of four communities with data collection at baseline before implementation of legislation in April 2013 and longitudinal follow-up for four years. Data collected in early 2015 will also provide baseline data to assess the impact of full implementation in all retail outlets. Community is defined as the catchment areas of schools selected for study. Schools will be purposively selected to reflect two levels of urbanisation (urban vs. small town) and two levels of social deprivation (high vs. medium, low). There are four main components to the study. In each community there will be: 1. An annual mapping study of tobacco retail outlets: Data for all outlets selling tobacco in each of the study communities will be extracted annually from the Register of Tobacco Retailers established under the Tobacco and Primary Medical Services (Scotland) Act. In Geographical Information Systems (GIS), the geo-coded outlet data will be combined with data from the marketing audit study (see below) and then analysed to provide an assessment of changes in tobacco vending and advertising over the study period. Further, tobacco retailing exposure measures will be constructed for each of the study participants at each time point. 2. An annual tobacco advertising and marketing audit of: i) A Panel of tobacco retailers (overt): A panel of 7 retailers per community will be recruited to monitor point of sale displays and related marketing activity. Data collected will include: visibility/placement of tobacco products; external and internal promotions; variety of/most prominent brands and pack sizes available; visibility of pricing information and price of key brands: tobacco control signage. Photographs of the interior will be taken and depth interviews will be conducted with retail managers/owners. ii) Tobacco retail outlets most used by young people (covert): All outlets identified in the mapping exercise will be visited by interviewers trained in covert observation. Data will be collected using an abbreviated version of the form used with the retailer panel. There will be additional data collection for both i) and ii), in May 2013 to assess compliance in supermarkets, and in May 2015 to assess compliance in all retail outlets 3. An annual school survey: This will have repeat cross-sectional design, in two phases. In phase 1 (2013-14), data will be collected from a sample of S2 and S4 pupils to explore the impact of partial implementation in supermarkets alone on awareness and attitudes. In phase 2 (2015-17), the survey will be repeated with a whole school sample (S1-S6), which will be of sufficient size to explore the impact of a complete ban in all retail outlets on both intermediate outcomes and longer term smoking behaviour outcomes. 4. Annual Focus groups: These will be conducted with school survey participants, purposively selected to include young people who are most at risk of becoming adult smokers. The topic guide will cover: local smoking behaviours and cultures; access to tobacco products including direct, indirect/proxy and black-market; awareness of and views on tobacco promotion including point of sale, other direct marketing methods, packaging, branding; awareness and perceptions of the impact of the legislation; views about preventing youth smoking. Outcomes: Using available evidence we have developed a logic model, which classifies outcomes according to the time-frame within which we expect them to occur. Short-term outcomes (within 6 months) include: Prevalence and density of POS advertising in tobacco retail outlets (mapping and audit studies). Intermediate outcomes (within 1 year) include: Awareness of point of sa
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