Impact on smoking of England's 2012 partial tobacco point of sale display ban: a repeated cross-sectional national study

BACKGROUND: A partial tobacco point of sale (PoS) display ban was introduced in large shops (>280 m(2) floor area) in England on 6 April 2012. The aim of this study was to assess the medium-term effects of the partial tobacco PoS display ban on smoking in England. METHODS: Data were used from 129 957 respondents participating in monthly, cross-sectional household surveys of representative samples of the English adult population aged 18+ years from January 2009 to February 2015. Interrupted-time series regression models assessed step changes in the level of current smoking and cigarette consumption in smokers and changes in the trends postban compared with preban. Models were adjusted for sociodemographic variables and e-cigarette use, seasonality and autocorrelation. Potential confounding by cigarette price was accounted for by time, as price was almost perfectly correlated with time. RESULTS: Following the display ban, there was no immediate step level change in smoking (−3.69% change, 95% CI −7.94 to 0.75, p=0.102) or in cigarette consumption (β −0.183, 95% CI −0.602 to 0.236). There was a significantly steeper decline in smoking post display ban (−0.46% change, 95% CI −0.72 to −0.20, p=0.001). This effect was demonstrated by respondents in manual occupations (−0.62% change, 95% CI −0.72 to −0.20, p=0.001), but not for those in non-manual occupations (−0.42, 95% CI −0.90 to 0.06, p=0.084). Cigarette consumption declined preban period (β −0.486, 95% CI −0.633 to −0.339, p<0.001), but no significant change in cigarette consumption trend was observed (β 0.019, 95% CI −0.006 to 0.042, p=0.131). CONCLUSIONS: The partial tobacco PoS display ban introduced in England in April 2012 did not lead to an immediate decline in smoking, but was followed by a decline in the trend of smoking prevalence that could not be accounted for by seasonal factors, e-cigarette use or price changes.