Never-smoking adolescents’ perceived accessibility of cigarettes following an increase in the tobacco age-of-sale from 16 to 18: A quasi-experimental study of two cities in the Netherlands and Belgium

Background: The Netherlands increased the tobacco age-of-sale from 16 to 18 in 2014, paired with mass-media campaigns. We evaluated changes in perceived accessibility of cigarettes between 2013 and 2016 among adolescent never-smokers in the Netherlands compared with Belgium, where the age-of-sale remained 16 and no campaigns were conducted. Methods: Repeated cross-sectional surveys were conducted in 2013 and 2016 among 4112 13–17-year-olds at a total of 22 schools in Amersfoort (the Netherlands) and Namur (Belgium). Multilevel Poisson regression quantified changes over time in prevalence of easy perceived accessibility to cigarettes (i.e., thinking it would be fairly/very easy to get cigarettes). Interaction terms were used to test whether changes differed between the Netherlands and Belgium. Analyses were stratified by age (13–15 and 16–17 years), sex (male and female), family smoking (0 and ≥1 smoking family members), and friend smoking (no and at least some smoking friends). Results: Perceived accessibility to cigarettes decreased in the Netherlands (Prevalence Ratio (PR): 0.82; 95% CI: 0.72–0.93) and Belgium (PR: 0.78; 95% CI: 0.70–0.87), to a similar extent (PR interaction: 1.04; 95% CI: 0.90–1.21). Results by sex, age, and family/friend smoking were similar to those for the total population; there were no significant differences in the decrease in perceived access over time between the Netherlands and Belgium within each of these subgroups. Conclusion: This study found approximately the same rate of decline between 2013 and 2016 in adolescent never-smokers’ perceived access to cigarettes in the Netherlands as in Belgium. This implies that we did not find clear evidence for an effect of the 2014 increase in legal age of tobacco sales from 16 to 18 years in the Netherlands.