Industry Strategies for Attracting Youth to Cigarettes, E-cigarettes, and HTPs: Retailer Density and Marketing at Points-of-Sale in Vietnam and the Philippines.

Background: Each year, tobacco-caused diseases kill 3 million people in the Western Pacific Region (WPR). Point-of-sale (POS) tobacco advertising, promotion, and sponsorship (TAPS) are utilized by tobacco and nicotine product companies to attract new customers, including youth; POS TAPS are associated with youth tobacco susceptibility, experimentation, and current use. E-cigarettes and heated tobacco products (HTPs) are sold in the WPR, yet limited research exists on TAPS for these products. We examined POS cigarette, e-cigarette, and HTP sales and TAPS in Vietnam and the Philippines to understand current marketing strategies and assess compliance with existing regulations.   Methods: An observational study was conducted in urban and rural areas of several cities in Vietnam and the Philippines. A walking protocol was employed to identify all cigarette, e-cigarette, and HTP retailers within 100m of schools (Vietnam: n=371; Philippines: n=353). To represent areas without sales restrictions, retailers within 100m of post-offices (Vietnam: n=325) or 100-200m from schools (the Philippines: n=353) were also observed. An observation form documented product displays, advertising, and promotion. Descriptive statistics and ANOVA were used for analyses.  Results: Cigarette retailers were common in areas with sales restrictions (Vietnam: n=712, mean=1.9; Philippines: n=2070, mean 5.9) and without (Vietnam: n=751, mean=2.3; Philippines: n=4496, mean=12.7). E-cigarette (n=113) and HTP (n=123) retailers were found in the Philippines; fewer e-cigarette (n=12) and no HTP retailers were found in Vietnam. In areas without sales restrictions, compliance with TAPS regulations was low (Vietnam: 0%; Philippines: 0-10.8%). Marketing tactics varied across product types.

Conclusions: Cigarette sales and marketing are widespread in these two WPR countries; e-cigarettes and HTPs were also found. Compliance with sales and TAPS regulations is poor; stricter enforcement and more comprehensive regulations are recommended to prevent youth initiation. Other WPR countries may also consider monitoring, regulatory, and enforcement efforts to understand and limit youth initiation.