Tobacco outlet availability in Dutch rural and urban areas

Abstract Background The Netherlands aims to reduce the availability of tobacco outlets by implementing a sales ban for vending machines (2022) and supermarkets (2024). The government intends to further phase out tobacco sales by petrol stations and small outlets after 2030. This study aims to understand its impact on tobacco outlet availability in the Netherlands, with particular attention to rural areas. Methods An audit of tobacco retailers was held between Sept 2019-June 2020 in four cities (Amsterdam, Eindhoven, Haarlem, and Zwolle) and between March-Apr 2022 in seven rural municipalities (Aa en Hunze, Ermelo, Dinkelland, Montferland, Simpelveld, Veere, and Waadhoeke). Each identified retailer was visited and mapped using Global Positioning System (GPS). Tobacco outlet availability was calculated in terms of density per population and km2, and residents’ proximity to the nearest outlet. Results In the rural areas, we found a total of 98 tobacco outlets, of which supermarkets (n = 57), petrol stations (26), small outlets (13) and tobacco specialist shops (2). In the four cities, we found a total of 870 outlets. Tobacco outlet density was much lower in rural areas than the four cities: 0.09 vs. 2.2 per km2 and 5.05 vs. 6.2 per 10,000 capita. The average shortest distance from an address to a tobacco outlet was much higher in rural areas (1.23km) compared to cities (0.31km). After implementation of all sales bans, tobacco outlet availability will reduce to 2 outlets in rural areas and 61 in urban areas which represents 0.1 and 0.4 per 10,000 capita, respectively. The distance will increase in cities (to 1.42km), but particularly in rural areas (to 5.28km) where 5 of the 7 municipalities did no longer include a tobacco outlet. Conclusions The proposed restrictions on tobacco sales will strongly decrease tobacco outlet availability, and might even disappear in some rural areas. These results call into question how the tobacco industry would respond to the proposed restriction. Key messages This study is the first ex-ante policy evaluation to assess the impact of current and future tobacco control policies at the POS on tobacco outlet availability in the Netherlands. The proposed restrictions on tobacco sales will strongly decrease tobacco outlet availability, and might even disappear in some rural areas.


Background:
The Netherlands aims to reduce the availability of tobacco outlets by implementing a sales ban for vending machines (2022) and supermarkets (2024). The government intends to further phase out tobacco sales by petrol stations and small outlets after 2030. This study aims to understand its impact on tobacco outlet availability in the Netherlands, with particular attention to rural areas. Methods: An audit of tobacco retailers was held between Sept 2019-June 2020 in four cities (Amsterdam, Eindhoven, Haarlem, and Zwolle) and between March-Apr 2022 in seven rural municipalities (Aa en Hunze, Ermelo, Dinkelland, Montferland, Simpelveld, Veere, and Waadhoeke). Each identified retailer was visited and mapped using Global Positioning System (GPS). Tobacco outlet availability was calculated in terms of density per population and km2, and residents' proximity to the nearest outlet.

Results:
In the rural areas, we found a total of 98 tobacco outlets, of which supermarkets (n = 57), petrol stations (26), small outlets (13) and tobacco specialist shops (2). In the four cities, we found a total of 870 outlets. Tobacco outlet density was much lower in rural areas than the four cities: 0.09 vs. 2.2 per km2 and 5.05 vs. 6.2 per 10,000 capita. The average shortest distance from an address to a tobacco outlet was much higher in rural areas (1.23km) compared to cities (0.31km). After implementation of all sales bans, tobacco outlet availability will reduce to 2 outlets in rural areas and 61 in urban areas which represents 0.1 and 0.4 per 10,000 capita, respectively. The distance will increase in cities (to 1.42km), but particularly in rural areas (to 5.28km) where 5 of the 7 municipalities did no longer include a tobacco outlet.

Conclusions:
The proposed restrictions on tobacco sales will strongly decrease tobacco outlet availability, and might even disappear in some rural areas. These results call into question how the tobacco industry would respond to the proposed restriction.

Key messages:
This study is the first ex-ante policy evaluation to assess the impact of current and future tobacco control policies at the POS on tobacco outlet availability in the Netherlands. The proposed restrictions on tobacco sales will strongly decrease tobacco outlet availability, and might even disappear in some rural areas.
Abstract citation ID: ckac130.220 Public perceptions uncovered: engaging in decision-making regarding non-pharmaceutical interventions

Background:
To control the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide, that heavily impacted the daily lives of citizens. Occasionally, the public expressed discontent about NPIs, as NPIs did not always corresponded with their preferences. The question is if and how public engagement (PE) could aid in development and implementation of NPIs, in order to improve legitimacy, quality and compliance.

Methods:
An online survey was conducted from 27 October to 9 November 2021, with a representative sample of the public in the Netherlands on gender, age, education, place of residency and migration background. In total 4981 respondents participated. Perceptions and preferences about PE in decision-making on NPIs to control COVID-19 was collected. Four NPIs were used: Nightly curfew (NC); Digital Covid Certificate (DCC); Closure of schools and daycares (CSD); and 1.5meter social distance.

Results:
Around 25% of respondents expressed a desire to engage in decision-making, as it would increase understanding and quality of NPIs, and their trust in the government. Especially for the NPIs DCC and NC, respondents found it valuable to engage, by providing their perspective on certain trade-offs in values in decision-making (e.g. opening up society vs division in society by vaccination status). The public could play a role by giving feedback on bottlenecks during decision-making, however overall responsibility should stay with experts and policy-makers. Desire for engagement was lowest for CSD. Around 50% of the respondents did not want to engage, as they felt they were not knowledgeable enough to do so and did not perceive a need to engage. The other 25% had a neutral disposition.

Conclusions:
Engagement was not self-evident for most respondents, yet the ones willing to engage revealed important possibilities for future outbreaks. Next, a deliberative process for PE in decision-making could be executed, in order to implement our findings in practice.

Key messages:
Although engagement was not self-evident, respondents who were willing to engage revealed important possibilities to shape future public engagement practices in decisionmaking in COVID-19 control. Respondents were mostly willing to engage in NPIs with no consensus in the trade-offs of relevant values in decisionmaking, such as the Nightly Curfew and the Digital Covid Certificate.
15th European Public Health Conference 2022 iii401