Smoking is the biggest avoidable cause of death and disability in England. A range of laws and policies aimed at preventing this harm, such as the 2007 smoking ban in public places and the ban on smoking in cars carrying under 18s in 2015, have been introduced in England to try to prevent young people from becoming smokers, to encourage existing smokers to quit and to protect others from the harmful effects of cigarette smoke.
When many different tobacco control interventions are introduced in a short space of time, it can be difficult to establish which ones are having the biggest impact on smoking and smoking-related diseases. In this study, we will consider theories of how laws and policies implemented between 2003 and 2015 are likely to work, whom they are most likely to affect, and what their influence will be on smoking and related ill-health. We will test these theories by applying complex statistical methods to a large number of publicly available data sources, such as surveys, which will help us to understand which laws and policies are most effective and why.
We will also develop an online monitoring tool, where we will collate data on key outcomes, such as smoking prevalence and quit attempts, from a range of national data sources. The tool will be ‘one-stop shop’ for information on smoking related measures and will allow the general public, researchers, policy makers and other stakeholders to get an overview of trends both in the overall population, and in target groups such as the relatively disadvantaged.
The study is being conducted by researchers in Nottingham, Sheffield and York who are all part of the UK Centre for Tobacco and Alcohol Studies (UKCTAS). The team has substantial experience in the analysis of secondary datasets and mathematical modelling policy to evaluate public health policy.
It is vital to evaluate the impact of tobacco control legislation in England to ensure that it is achieving its desired effects. This study aims to provide a comprehensive evaluation of a wide range of policies and legislation including:
July 2007: Smoke-free legislation
October 2007: Minimum age of 18 for purchase of tobacco
October 2011: Vending machine ban
April 2012: Point-of-sale display ban in large vendors
April 2015: Point-of-sale display ban in small vendors
October 2015: Ban on smoking in cars carrying under 18s; minimum 18 age of sale for e-cigarettes; prohibition of proxy purchase of tobacco/e-cigs for under 18s
Repeated over time: Tobacco control mass media campaigns and participation events (e.g. Stoptober, No Smoking Day)
1. Development of logic models which identify hypothesised causal pathways and outcomes for recent interventions, to depict how recent tobacco control policies should work and for whom, and how different interventions interrelate.
2. Development of an online tool which can be used to easily monitor trends in key outcome measures of tobacco control impact from a wide range of publicly available data sources. The tool will allow users to select outcomes, time periods, geographies and populations to generate graphs.
3. Use of secondary data to assess the impact of policy measures on the short and medium term outcomes identified in the logic model. Statistical methods will include interrupted time series, difference-in-difference analysis and cohort analysis to quantify the effectiveness of policy and legislative measures.
4. Estimation of long term effects of changes in smoking behaviour by combining the evidence on policy effects identified in previous stages of the project, and existing studies, to model longer term healthcare cost savings and population health benefits expected from the policies examined.
Background: For some decades, smoking has been the biggest avoidable cause of death and disability in the UK. The 1998 Smoking Kills White Paper heralded the introduction of a range of laws and policies aiming to reduce this harm. These include progressive prohibition of tobacco advertising (2003-5), smoke-free legislation (July 2007 in England); minimum age of 18 for purchase of tobacco (October 2007); prohibition of tobacco vending machines (October 2011), point-of-sale tobacco display bans (April 2012 in large vendors, April 2015 in small vendors); prohibition of proxy purchasing, smoking in cars carrying children and minimum age of purchase for e-cigarettes (all October 2015); a range of mass media campaigns and participation initiatives, and progressive increases in tax. In May 2016, standardised packaging (SP) and a range of measures in the new EU Tobacco Products Directive (TPD) including a minimum pack size of 20 cigarettes (50g for hand-rolling tobacco), a standard pack shape, and pictorial and text health warnings covering 65% of the front and back of the pack were also implemented.
This research was carried out to establish whether recent tobacco control measures in England are having the desired effect on public health, and to provide strategic direction for the tobacco control policy agenda. The project aimed to provide a comprehensive evaluation of a wide range of tobacco control policies and legislation implemented in England between 2007 and 2015 using publicly available data sources.
The project is funded by a grant from the NIHR Policy Research Programme (Grant reference PR-R14-1215-24001).
Dr Tessa Langley
Associate Professor in Health Economics
UK Centre for Tobacco and Alcohol Studies
Division of Epidemiology and Public Health
University of Nottingham
Tel: 0115 8231351