Policies targeting the sale of tobacco and youth smoking behaviour

Young people are a primary target group for smoking prevention as they are a susceptible group to start smoking. An increasing number of European countries have embraced a smoke-free generation movement, which aims at letting new generations grow up smoke-free and reducing overall smoking prevalence to below 5%. This calls for adoption of more restrictive tobacco control policies. The overall aim of this thesis was to examine policies targeting the sale of tobacco, specifically age-of-sale laws and point-of-sale related measures, and their influence on youth smoking behaviour. Age-of-sale laws potentially prevent youth smoking. However, when compliance is low, adolescents continue to access cigarettes, e.g. through proxy purchases and vending machines. The increase of age-of-sale in the Netherlands to 18 was not associated with reduced access to cigarettes among never-smokers. In Amsterdam, tobacco product visibility and outlet-density were high. Point-of-sale display bans take tobacco products out of sight and were associated with reduced smoking prevalence. A literature review showed that outlet-density may be positively associated with youth smoking, although evidence was weak. Policies targeting the sale of tobacco can make an important contribution to the smoke-free generation goal. However, additional measures are needed to tackle the shortcomings in the examined polices. These may include stronger enforcement of age-of-sale laws, mass-media campaigns targeting parents and proxy buyers, vending machine bans, and plain packaging of tobacco products. More progressive measures such as an increase in the age-of-sale to 21 and tobacco retailer licensing may be promising next steps to reaching a smoke-free generation