Introduction:
Visibility of tobacco products at retail tobacco outlets has been associated with increased susceptibility to smoking. To address this, the Netherlands has recently enacted point-of-sale policies severely restricting tobacco visibility in the retail environment, including advertisements, product displays, and tobacco vending machines. This study assessed the impact of these policies on tobacco visibility at retail outlets.

Material and Methods:
We conducted a multi-wave observational audit of all tobacco outlets in four Dutch cities (Amsterdam, Haarlem, Eindhoven and Zwolle) between 2019 and 2022 (before and after policy implementation), assessing visibility of tobacco as well as compliance with the regulations specific to the outlet type (tobacco/vape specialist shops were exempted). We described compliance and changes in visibility by location, visibility type and outlet type.

Results:
The proportion of non-exempt tobacco outlets with any tobacco advertising or product visibility declined from 73% to 27% after policy implementation (i.e., 73% of tobacco outlets were compliant). Compliance was low in small shops (53%) and high in petrol stations (88%) and supermarkets (94.3%). Tobacco products were the biggest source of tobacco visibility after implementation, which were still visible in 78% of non-exempt outlets with any tobacco visibility after policy implementation. Finally, we found that 93% of tobacco vending machines were removed. Maps showed that non-compliance is concentrated in Amsterdam’s city center and more evenly distributed in other cities.

Conclusions:
Tobacco product and advertising visibility declined substantially after the implementation of bans on product and advertising visibility in the retail environment. Enforcement is needed especially in small outlets.