Tobacco sales and marketing at points-of-sale near schools remain widespread in China: an observational study in 2021 and 2023.

Abstract

Background: China prohibits tobacco product sales near schools and, as of 2022, bans non-tobacco-flavoured e-cigarette sale. This study assessed changes in tobacco sales and marketing near schools in ten cities across China from 2021 to 2023.

Methods: We sampled 879 schools (731 urban, 148 rural) using multistage sampling and observed the availability and marketing of tobacco products at retailers within 100 m of urban schools and 250 m of rural schools in 2021 and 2023. McNemar and paired t-tests were conducted with school as unit of analysis.

Results: From 2021 to 2023, there was a significant decrease in prevalence of cigarette retailers around both urban schools (57.2% vs 47.1%, p<0.05) and rural schools (70.3% vs 62.8%, p<0.05). The prevalence of flavoured cigarette retailers significantly decreased around urban schools (42.8% vs 38.9%, p<0.05); however, it remained high (52%) around rural schools. The total number of e-cigarette retailers decreased from 59 to 11. Over 90% of cigarette and e-cigarette retailers displayed tobacco products. While the prevalence of retailers displaying cigarettes inside significantly declined around urban schools (55.5% vs 44.6%, p<0.001), the prevalence of retailers displaying cigarettes next to sweets, drinks or snacks significantly increased (28.0% vs 32.1%, p<0.05).

Conclusions: The number of retailers selling and displaying cigarettes and flavoured cigarettes decreased but remained widespread, and the number of retailers selling e-cigarettes also decreased near schools in 10 cities across China. To protect youth, effective enforcement of regulations prohibiting tobacco sales around schools, a comprehensive advertising ban and restrictions on flavoured cigarettes are necessary.