Willingness of tobacco retailers in Oyo State to participate in tobacco control programmes.

INTRODUCTION: Tobacco control strategies have not incorporated retailers, despite being the focus by the tobacco industry to promote its products. Few studies exist on their possible roles in tobacco control. This study, therefore, assessed retailer awareness of tobacco control laws and willingness to be involved in control activities.
METHODS: A cross sectional study was carried out on all 218 tobacco retailers in Ibarapa Central and Ibarapa East Local Government Areas of Oyo State. The willingness of tobacco retailers to participate in tobacco-use control was evaluated using a questionnaire.
RESULTS: The majority of the respondents were females (95%), and 30-39 years old with respect to age. Almost two-thirds (65%) of the respondents reported the sale of tobacco as a profitable business, and a third reported that their income would decrease if they stopped tobacco sales. Up to 35% of retailers were aware of laws restricting smoking in public places and 45% aware of a ban on the sale of tobacco products to minors. Retailers were willing to: support anti-tobacco legislations (84%), counsel smokers to quit smoking (84%), and display anti-tobacco messages in their shops (77%).
CONCLUSIONS: The sale of tobacco products is a profitable venture for retailers. Willingness to participate in tobacco control was high among the retailers. There is a need to raise awareness and co-opt tobacco retailers as change agents in tobacco control efforts.

INTRODUCTION

Nigeria became a signatory to the WHO FCTC in 2005, and the Nigerian Tobacco Control Bill was passed in 2011 and signed in 2015[1]. This bill contained provisions for smoke free places, tobacco advertising, promotion and sponsorship, packaging and labelling, as well as sales to minors[2].

In ensuring compliance with these provisions, especially regarding point of sale advertisement and sales to minors, retailers are important stakeholders[3]. Their importance as stakeholders is borne out by tobacco industry investment of about 97.2% of its marketing budget in the retail environment[5-7]. The tobacco industry sees them as important market stakeholders who help to increase the potential for initiation and in maintaining tobacco use[5]. Unlike in developed countries, the retail environment is poorly monitored in developing countries such as Nigeria[5,8]. This often results in poor compliance with tobacco control laws, especially in rural settings. A recent study, by the Nigerian Tobacco Control Research Group across cities in Nigeria, documents the violation of advertising bans at points of sales[4]. In rural settings, observations suggest that sale of tobacco products to minors and open display of the products, including use of promotional material provided by the tobacco industry, still persist[4].

In developing countries, the promise of incentives and attractive profits by the tobacco industry motivates retailers not only to sell and promote tobacco products but also to display promotional material[5,9,10]. Thus, monitoring the retail activities will go a long way in reducing exposure of minors to tobacco[5]. In addition, the willingness of retailers to be involved in preventing initiation and promoting cessation activities has not been well explored[5]. This study was a formative research to assess retailer awareness of tobacco legislation and willingness to be involved in tobacco control activities.

METHODS

The study was conducted in Igbo-Ora and Eruwa, which are two major towns, located 22 km apart in Ibarapa Central and Ibarapa East Local Government Areas in Oyo State, Nigeria. Igbo-Ora and Eruwa are also the administrative headquarters of Ibarapa Central and East, with total populations of 102 979 and 118 226 people, respectively. Igbo-Ora is a rural area while Eruwa is a semi-urban area[11]. The major occupation for both areas is subsistence farming. Other occupations include traders, artisans, and civil servants (local government, teaching and health). The traders are mostly petty dealers, who have their shops within or adjoining the residential areas.

A cross-sectional design was used to study 218 people in Igbo-Ora and Eruwa, engaged in the retail of cigarettes and other tobacco-related products either alone or with other items. All consenting retailers in these areas were included in the study because of their small numbers, and data collection was completed within 2 weeks.

An interviewer-administered questionnaire was used to obtain information on: socio-demographic characteristics, sale and profitability of tobacco products, awareness of tobacco legislation, and willingness to be involved in tobacco control programs. The instrument was developed from the Global Adult Tobacco Survey (GATS)[12], Global Youth Tobacco Survey (GYTS)[13], and information obtained through literature review[14,15]. The questionnaire was translated to Yoruba and back-translated to English, but was administered in Yoruba by trained health assistants. Data were analyzed using the Statistical Package for Social Sciences (SPSS) v20[16]. Adjusted odds ratio was used to determine association between profitability, income reduction and willingness to participate in tobacco control strategies. Level of significance was set at 5%.

Ethical approval for the study was obtained from the University of Ibadan-Ibarapa Programme Ethical Unit, while informed consent was obtained from the respondents. After the interview, retailers were counseled on the adverse effects of smoking, educated on the laws restricting sale of tobacco to minors and the use of tobacco in public spaces.

RESULTS

Socio-demographic characteristics and work history

The majority of the respondents (95%) were females, most (77%) were married and 44% had primary education. Respondents had sold tobacco products for a median duration of 5 (1-40) years, and more than two-thirds (65.1%) reported it as a profitable venture (Table 1).

Table 1

Socio-Demographic characteristics and work history

VARIABLES (N=218 )	FREQUENCY	PERCENTAGE
Location
Igbo-Ora	118	54.1
Eruwa	100	45.9
Sex
Male	10	4.6
Female	208	95.4
Age of respondent
<30	43	19.7
30-39	76	34.9
40-49	47	21.6
≥50	52	23.8
Level of education
No formal education	39	17.9
Primary	95	43.6
Secondary	71	32.5
Tertiary	13	6.0
Tobacco sale a profitable venture
Yes	142	65.1
No	76	34.9
Income reduction if tobacco sale stops
Yes	73	33.5
No	145	66.5

Awareness and willingness of retailers to participate in tobacco control strategies

The awareness of tobacco control legislation was found to be poor among the respondents. Although only 27% of respondents had seen information on the dangers of tobacco use or on quitting the use of tobacco products, 76% of them said they would be willing to display anti-tobacco messages in their shops (Table 2).

Table 2

Awareness and willingness of retailers to participate in tobacco control strategies

VARIABLES (N=218 )	FREQUENCY	PERCENTAGE
Ban on smoking in public places
Aware	76	34.9
Unaware	142	65.1
Ban on sales of tobacco products to minor
Aware	97	44.5
Unaware	121	55.5
Willingness to support legislation on ban of sales to minors
Yes	184	84.4
No	34	15.6
Willingness to counsel smokers to quit smoking
Yes	184	84.4
No	34	15.6
Willingness to display anti-tobacco messages
Yes	167	76.6
No	51	23.4

Tobacco sales profitability and willingness to participate in control strategies

Retailers who reported that tobacco sale was profitable were about 2 times (OR= 0.432; 95%CI= 0.207-0.901) less likely to express a willingness to display anti-tobacco messages in their shops and 3 times (OR= 0.349; 95%CI= 0.138-0.885) less likely to support tobacco control legislation, compared to retailers who reported non-profitability. Retailers who reported income reduction if tobacco sale was stopped were about 2 times (OR=0.467; 95%CI=0.246-0.889) less likely to be willing to display anti-tobacco messages in their shops and 9 times (OR=0.106; 95%CI=0.045-0.249) less likely to support legislation on the ban of sales to minors (Table 3).

Table 3

Association between profitability and willingness to participate in tobacco control strategies

VARIABLES (N=218 )	Willing to support legislation on ban of tobacco sale to minors		Odds ratio	95% C.I	Willing to display anti-tobacco messages		Odds ratio	95% C.I
	Yes N (%)	No N (%)			Yes N (%)	No N (%)
Age
Less than 40 years	108(90.8)	11(9.2)	2.971	1.367-6.457*	98(82.4)	21(17.6)	2.029	1.073-3.837*
40 and above	76(76.8)	23(23.2)			69(69.7)	30(30.3)
Gender
Male	6(60.0)	4(40.0)	0.253	0.067-0.949*	5(50.0)	5(50.0)	0.284	0.079-1.023
Female	178(85.6)	30(14.4)			162(77.9)	46(22.1)
Educational status
No formal education	32(82.1)	7(17.9)	0.812	0.325-2.027	27(69.2)	12(30.8)	0.627	0.291-1.350
Formal education	152(84.9)	27(15.1)			140(78.2)	39921.8)
Feels that tobacco sale is a profitable venture
Yes	114(80.3)	28(19.7)	0.349	0.138-0.885*	102(71.8)	40(28.2)	0.432	0.207-0.901*
No	70(92.1)	6(7.9)			65(85.5)	11914.5)
Feels income would decrease if he/she stops selling tobacco
Yes	47(64.4)	26(35.6)	0.106	0.045-0.249*	49(67.1)	24(32.9)	0.467	0.246-0.889*
No	137(94.5)	8(5.5)			118(81.4)	27(18.6)

significant association

DISCUSSION

Although the tobacco industry currently views retailers as important stakeholders in the sale and promotion of tobacco products, they can also be potential stakeholders in tobacco control[5]. This is shown by the present study, where retailers demonstrated a willingness to participate in tobacco control programs. However, two-thirds of the retailers of the study reported tobacco sale as a profitable venture, which is not different from the findings of other high and low-middle income countries[15,17]. The high profitability, and other monetary and non-monetary gains, from the sale of tobacco products, reported by more than 60% of the retailers, may serve as a challenge for compliance to tobacco control legislation. Retailers who reported that tobacco sales were profitable and thought their income would decline without such sales are likely to be less supportive of tobacco control initiatives that directly affect them. Therefore, retailer-focused tobacco control efforts need to take this into account in advocating a role for retailers in influencing tobacco-use rates.

The Tobacco (Control) Act 1990 stipulates a ban on smoking in specified public places and sales to minors, among other regulations[8], however less than half of the retailers were aware of these laws. Although the tobacco industry ensures that its promotional material is compliant by scripting messages like ‘no sale to minors’ on the products, retailers remain oblivious to these laws and still sell tobacco products to minors. This loophole, is capitalized by the tobacco industry to increase smoking initiation[10]. This study has therefore shown the need to educate tobacco retailers on aspects of this legislation as it applies to them, as well as the need to design easy to understand pictographs on the subject.

Despite economic gains from the sale of tobacco products, most of the retailers were willing to support legislation banning the sale of tobacco products to minors and to counsel smokers on the negative effects of tobacco. It has been generally assumed that retailers might not be willing to participate in any anti-tobacco programs due to financial gains, and have been therefore excluded from health education and awareness programs[15]. However, some educational interventions have engaged retailers of high profit products that affect health to educate the customers and reduce the use of such products[15]. Similarly, tobacco control initiatives can use education-based interventions to engage retailers in efforts to control smoking especially in public places (near their stores) and sales to minors, as well as counseling customers who want to quit[15]. Recently, many Non-Governmental agencies have stepped up their campaigns against tobacco and thus it is not unlikely that the retailers are being encouraged to change their attitude. This may present a golden opportunity to step up campaigns directed at retailers.

Retailer response regarding willingness to support (comply with) legislation might in part be due to social desirability, because they know the dangers of tobacco use and hence provide the ‘answers expected of them’. Notwithstanding their motivation, this could also be an opportunity for action since any successful tobacco reduction programme begins with an acknowledgement of the harms posed by tobacco.

Finding out the content of anti-tobacco messages that retailers were willing to accept could have provided a proxy for understanding the extent to which they would want to be involved in tobacco control activities beyond compliance to tobacco legislation. Unfortunately, this was outside the scope of this study. In addition, ascertaining the proportion of the total income generated from tobacco sales would also have given a clearer picture of the nature of the perceived profitability, i.e. monetary profitability as against non-monetary profitability such as promotional incentives by the tobacco industry.

CONCLUSIONS

Despite a perceived profitability of tobacco sales, retailers were willing to be involved in tobacco control efforts. Therefore, we encourage the incorporation of retailers into smoking cessation campaigns and other tobacco control efforts. Implementation and monitoring of compliance by the retailers with the Tobacco Control Act will go a long way in reducing exposure of minors to tobacco products and their promotion.

However, while the need to educate the retailers on tobacco legislation has come to the fore, further studies still need to be conducted to determine the modalities by which such interventions can be deployed.