Dr Christina Watts, Dr Natalia Lizama and Professor Suzan Burton
Many of us know someone who only smokes when they drink. Perhaps they’re a former smoker, are currently trying to quit, or only feel compelled to smoke when they’re at the pub.
This isn’t merely anecdotal – there is strong evidence that people who drink alcohol are more likely to smoke, and drinking in social settings like bars, pubs and clubs increases tobacco consumption.
For people who smoke and drink alcohol, especially those who only smoke occasionally, alcohol and tobacco typically go hand in hand.
As a participant in one of our early studies said,
Why is this the case?
It can be partly attributed to social factors – seeing other people smoking – as well as due to the disinhibiting effect of alcohol.
People who are trying to quit smoking are particularly susceptible to those factors, and it’s much harder to maintain the willpower not to smoke after drinking alcohol.
Our research, recently published in The Australian and New Zealand Journal of Public Health, highlights how the presence of cigarette vending machines exacerbates the problem.
Vending machines make it easy to buy cigarettes. The World Health Organization Framework Convention on Tobacco Control states that vending machines “constitute by their very presence a means of advertising or promotion.”
So, the presence of a cigarette vending machine causes people who smoke to smoke more and can lead to the failure of quit attempts.
That effect is particularly insidious, because alcohol-licenced premises comprise a large proportion of tobacco retailers in Australia. In NSW, they account for over a third of all tobacco retailers.
From a public health perspective, stopping tobacco sales in alcohol-licensed premises is a no-brainer.
Firstly, the synergistic effect of alcohol consumption and tobacco use means that combining these elements greatly increases the risk of certain cancer types, such as oesophageal, mouth and throat cancers.
Secondly, the disinhibition that typically results from alcohol consumption can prompt people who already smoke to smoke more than usual.
For people who smoke and are trying to quit, this disinhibition can thwart smoking cessation attempts and lead to relapse.
With smoking at an all-time low in Australia, do licensed premises still perceive tobacco sales from vending machines to be important to their businesses?
And with declining tobacco sales, are they likely to stop selling tobacco?
Our research sought to answer these questions, and our results are concerning for efforts to reduce tobacco harms in Australia.
Pubs and clubs are unlikely to voluntarily stop selling tobacco
We surveyed 818 alcohol-licenced venue owners or managers in NSW, QLD and WA, and asked how important tobacco sales are to their business, and the likelihood of them stopping selling tobacco.
Tobacco sales through vending machines were generally not considered important to those businesses, with the majority of participants rating the importance of sales as less than four (the midpoint on the seven-point scale).
However, only a very small minority of owners/managers (3.7%) reported they would be likely to stop selling tobacco.
When asked why, the most common reason was that these owners/managers wanted to satisfy customer needs.
Many said they didn’t want to risk losing customers who, if they no longer sold tobacco, might leave to buy it and not return.
As one respondent noted,
“Because we try to cater for everyone still. If people leave to go get something, then they probably won’t come back.” (WA, Pub)
Low-hanging fruit – the case for removing tobacco vending machines
Our research shows the need for policy reform to phase out tobacco vending machine sales in Australia.
Without legislative changes, the vast majority of alcohol-licensed premises will continue to sell tobacco.
This idea is by no means unrealistic or impractical: a ban on tobacco vending machines was implemented in the ACT in 2004.
National action to remove these machines throughout Australia is therefore well overdue.
Some alcohol-licenced venues sell tobacco only through vending machines, so a ban on vending machine sales would immediately reduce the availability of tobacco, thus supporting people to reduce and/or stop smoking.
While some outlets sell cigarettes over the counter, and a ban on vending machines wouldn’t affect that sales method, our research has shown that many alcohol-licensed premises don’t really want to sell tobacco (especially over the counter, because it interferes with their core business of selling drinks and food).
Many venues would be happy to stop selling if a ban was put in place so they don’t risk losing their customers to a competitor who sells tobacco.
Policy solutions to reduce the number of tobacco retailers, particularly alcohol-licenced premises, are therefore urgently needed.
A ban on cigarette vending machines is an easy and important first step to reduce tobacco supply in Australia.
Further tobacco retail reforms are needed to reduce tobacco availability
Removal of tobacco vending machines in alcohol-licensed premises is an important and relatively easy way to reduce tobacco retail availability in Australia.
However, that action is only one part of what should be a more comprehensive approach to tobacco control in alcohol-licenced settings.
Ideally, these venues would not sell tobacco at all.
This would help denormalise smoking, reduce the triggers for smoking relapse, and decrease the opportunity for concurrent consumption of tobacco and alcohol.
Ending tobacco sales in alcohol-licenced premises should occur in tandem with policy to make all such venues entirely smoke-free (as many already are).
This would benefit people who are trying to smoke less, are trying to quit or have recently quit.
It would also protect the health of workers and patrons who are constantly exposed to second-hand smoke in the smoking areas of alcohol-licenced premises.
We must call time on the outdated operation of tobacco vending machines; and leverage this action to inspire further policy change to reduce the enormous harms from smoking.
You can read the open access article “Tobacco sales through vending machines: Insights from owners and managers of Australian alcohol-licenced premises with different licencing schemes” here.
Dr Christina Watts is a Research Fellow at the Daffodil Centre, Dr Natalia Lizama is an Adjunct Research Associate at Curtin University, and Suzan Burton is a Professor at Western Sydney University.
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