Department for Health

Tobacco policy evaluation

Smokers indoorsA policy is best considered as a rule or principle used to guide decisions and actions to achieve a desired outcome. Tobacco control policies aim to reduce or eliminate the harm caused by tobacco.

Tobacco control policy evaluations produce an evidence base of policy efficacy to reduce smoking prevalence, consumption and the exposure to second-hand smoke. This evidence is crucial to inform future directions in tobacco control.

Our researchers have conducted policy evaluation work in the first five of the World Bank’s six strands of tobacco control:

     Protect people from tobacco smoke

     Help people to give up smoking

     Reduce the affordability of smoking by increasing taxes on tobacco products

     Use mass media to warn people of the dangers of smoking

     Reduce tobacco promotion

     Regulate the content of tobacco products

Our researchers involved in policy evaluation:

Contribution of our researchers

Protect people from tobacco smoke (A full list of relevant references is provided at the bottom of this page)

On 1 July 2007, England introduced a law making virtually all enclosed public places and workplaces smoke-free. We have made contributions to the evaluation of this legislation. Funded by the Department for Health, we have evaluated impacts on hospital admissions for heart attacks (Sims et al, 2010), asthma (Sims et al, 2013) and second-hand smoke exposure in children (Sims, Bauld & Gilmore, 2012; Jarvis et al, 2011) and adults (Sims et al, 2012). Ongoing work evaluating the impact on heart attack mortality continues..

We also examined the impact of the legislation on different ethnic and age groups, thereby exploring the implications for smoking-related health inequalities (Lock et al, 2010).

Additional research has focused on assessing smokers’ knowledge of the potential harm to others caused by second-hand smoke, how this may have changed over time in England and the role this plays in implementing behaviours to reduce second-hand smoke exposure in the home (Evans et al, 2011).

Earlier work examined attitudes to and the health impacts of second-hand smoke exposure amongst a highly exposed workforce (Pilkington et al, 2006 and 2007).

Help people to give up smoking- special focus on inequalities

The NHS Stop Smoking Services (SSS) provides a range of forms of behavioural support and pharmacotherapy to smokers motivated to quit.  They were set up in 1999 to reduce deaths particularly from cancer and
coronary heart disease. Clients are routinely followed up until four weeks post their quit date. Data collected in studies designed to collect long term (1 year) follow up data have been analysed at the University of Bath using UKCTCS funding. Papers have focussed on the cost effectiveness of the services(Bauld et al., 2012) and outcomes for disadvantaged groups who have high smoking rates but low quit rates(Hiscock, Judge, & Bauld, 2011).

To provide context for smoking cessation, we have contributed to a review of smoking and socioeconomic status (Hiscock, Bauld, Amos, Fidler & Munafo, 2011) and a PHRC funded statistical analysis of English smoking prevalence trends among affluent and disadvantaged people (Hiscock, Bauld, Amos & Platt, 2012).

We are currently involved in the NIHR Health Technology Assessment programme funded ELONS (Evaluating Long–term Outcomes of NHS Stop Smoking Services) prospective study in 8 PCTs which has a particular
focus on the type of intervention received (group or one to one) and the advisor providing the intervention. Preliminary secondary analysis of routine data on these topics has already taken place (Murray et al., 2012) and further work is exploring whether these factors have a differential impact on disadvantaged and more affluent clients. We have also contributed to a statistical review of the Scottish Cessation  Services.

E-Cigarettes are a new potential aid to quitting smoking. The UK is currently developing guidelines for these, and we are currently contributing to this through an analysis of a survey of smoking cessation practitioners’ views.

Reduce the affordability of smoking

Funded by the European Commission, Seventh Framework Programme, we have undertaken extensive work on industry pricing and influence on tobacco taxation policy (for more details on the latter see Corporate Policy Influence). Our review of the existing literature on these topics is summarised in Chapter 5 of the IARC Handbooks of Cancer Prevention: Tobacco Control. Volume 14  (Smith K, Gilmore A, Chaloupka F, Delipalla S. 2011) We have subsequently undertaken work to address the research gaps identified.

We have been examining trends in cigarette prices in the UK, the accuracy of commonly used price indictors and whether cheaper sources of tobacco (cheap manufactured cigarettes and roll your own hand rolled tobacco) are being consumed by the most price sensitive consumers (economically disadvantaged and young smokers) on whom tax increases have traditionally exerted the largest effect on reducing smoking rates.

Related work exposes the concentrated nature of the global and national tobacco markets and the resulting excess profits enjoyed by major tobacco corporations. It also proposes price-cap regulation as a potential solution to the problems that emerge from this lack of competition. (Gilmore A, Sweanor D, Branston R. 2010; Gilmore A, 2012)

Use mass media to warn people of the dangers of smoking

Tobacco control mass media campaigns aim to encourage smokers to stop smoking or avoid smoking in front of others, particularly children. Funded by the National Prevention Research Initiative (NPRI) and in collaboration with the University of Nottingham and King’s College London, an evaluation of the effectiveness of tobacco control mass media campaigns in England is underway.

We have characterised publically-funded tobacco control campaigns in England between 2004 and 2010 to explore whether they are in line with recommendations from the literature in terms of their content and intensity. We are now examining the impact of tobacco control television advertisements on smoking prevalence, cigarette consumption and second-hand smoke exposure.
 

Reduce tobacco promotion

Promotion covers everything from the physical product and its packaging, to marketing activities. In the UK the promotion of tobacco products is becoming increasingly restricted; for example advertising and sponsorship is banned, recently a ban on the display of tobacco products in shops has come into force, and the possibility of introducing plain packaging is currently being discussed. Consequently the tobacco industry works hard to develop innovative ways to promote their products.

In order to track new developments in tobacco industry promotional activity, we (on behalf of the UKCTCS) have launched a Facebook page. The Facebook page, Tobacco Marketing Uncovered (UK), provides people with a place to post photos or comments about new and innovative tobacco marketing they see in the UK, such as new products, new packaging, displays in shops, and promotions at events. This Facebook page gives us the opportunity to track and monitor new developments in tobacco industry promotion within the UK, in order to better inform our research.

Working with international collaborators we helped develop a method to examine cigarette labelling. This has then been used to evaluate packs collected from a wide variety of countries at different stages of economic development. This work showed the extent to which the pack is used, in various ways, to market the product and mislead consumers, thereby underlining the need for generic (plain) packaging (Mir H, Buchanan D, Gilmore a et al 2011).

This work is part of our efforts, again with international collaborators, to develop methods to measure the contextual environmental determinants of smoking and other risk factors for cardiovascular disease (Chow et al, 2010).  This work is being undertaken in a range of urban and rural populations in countries at all stages of economic development.

Publications by our researchers

Protect people from tobacco smoke

Sims, M., Maxwell, R., Gilmore, A. (2013) Short-term impact of the smokefree legislation in England on emergency hospital admissions for asthma among adults: a population-based study. Thorax. Epub ahead of print. doi:10.1136/thoraxjnl-2012-202841

Sims, M., Mindell, J. S., Jarvis, M. J., Feyerabend, C., Wardle, H. and Gilmore, A. (2012) Did smokefree legislation in England reduce exposure to secondhand smoke among nonsmoking adults? Cotinine analysis from the Health Survey for England. Environmental Health Perspectives, 120 (3), pp. 425-430. doi: 10.1289/ehp.1103680

Sims, M., Gilmore, A. and Bauld, L. (2012) England's legislation on smoking in indoor public places and workplaces: impact on the most exposed children. Addiction, 107 (11), pp. 2009-2016. doi: 10.1111/j.1360-0443.2012.03924.x

Jarvis, M. J., Sims, M., Gilmore, A. and Mindell, J. (2012) Impact of smoke-free legislation on children's exposure to second-hand smoke: cotinine data from the Health Survey for England. Tobacco Control, 21 (1), pp. 18-23. doi: 10.1136/tc.2010.041608

Evans, K., Sims, M., Judge, K. and Gilmore, A. (2012) Assessing the knowledge of the potential harm to others caused by secondhand smoke and its impact on protective behaviours in the home. Journal of Public Health, 34 (2), pp. 183-194. doi: 10.1093/pubmed/fdr104

Sims, M., Maxwell, R., Bauld, L. and Gilmore, A. (2010) Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction. British Medical Journal, 340, c2161. doi: 10.1136/bmj.c2161

Lock, K., Adams, E., Pilkington, P., Duckett, K., Gilmore, A. and Marston, C. (2010) Evaluating social and behavioural impacts of English smokefree legislation in different ethnic and age groups: implications for reducing smoking-related health inequalities. Tobacco Control, 10 (5), pp. 391-397. doi:10.1136/tc.2009.032318

Gilmore, A., Sims, M., Judge, K., Bauld, L. and Jacobson, B. (2009) Smoking bans. New Scientist, 202 (2706), p. 24. doi: 10.1016/S0262-4079(09)61181-7

Pilkington P, Grey S, Gilmore A. Health impacts of exposure to second hand smoke (SHS) amongst a highly exposed workforce: survey of London casino workers. BMC Public Health 2007, 7: 25

Pilkington P, Grey S, Gilmore A, Daykin N. Attitudes towards second hand smoke amongst a highly exposed workforce: survey of London casino workers. J Public Health 2006; 28: 104 - 110. epub 23rd February 2006

McKee M, Hogan H, Gilmore A. Why we need to ban smoking in public places now. J Publ Health Med 2004; 26: 325-6
 

Help people to give up smoking- special focus on inequalities

Bauld, L., Boyd, K. A., Briggs, A. H., Chesterman, J., Ferguson, J., Judge, K., & Hiscock, R. (2012) One-Year Outcomes and a Cost-Effectiveness Analysis for Smokers Accessing Group-Based and Pharmacy-Led Cessation Services. Nicotine & Tobacco Research, 13(2), pp. 135-145. doi: 10.1093/ntr/ntq222

Murray, S., Hiscock, R., Bauld, L., Brose, L. S., McEwen, A., & on behalf of the ELONS collaboration. (2012) Uptake, short term quitting and CO validation in a subset of English Stop Smoking Services: an analysis of routine data for the ELONS project. (Research Report)

Hiscock, R., Bauld, L., Amos, A., & Platt, S. (2012) Smoking and socioeconomic status in England:the rise of the never smoker and the disadvantaged smoker. Journal of Public Health, doi: 10.1093/pubmed/fds012.

Hiscock, R., Bauld, L., Amos, A., Fidler, J., & Munafo, M. R. (2011) Socioeconomic status and smoking: a review. Annals of the New York Academy of Sciences. doi: 10.1111/j.1749-6632.2011.06202.x

Hiscock, R., Judge, K., & Bauld, L. (2011) Social inequalities in quitting smoking: what factors mediate the relationship between socioeconomic position and smoking cessation? J Public Health (Oxf), 33(1), pp. 39-47. doi: 10.1093/pubmed/fdq097

Reduce the affordability of smoking

van Walbeek C, Gilmore A, Belcher E, Ross H. Price and tax measures and illicit trade in the FCTC: what we know and what research is required. Nicotine and Tobacco Research Published Online First: 17 September 2012. doi:10.1093/ntr/nts170

Joossens L, Gilmore A et al. Illicit cigarettes and hand-rolled tobacco in 18 countries: a cross-sectional survey. Tob Control. Published Online First: 10 December 2012. doi:10.1136/tobaccocontrol-2012-050644 http://tobaccocontrol.bmj.com/content/early/2012/11/14/tobaccocontrol-2012-050644

Branston R. Gilmore A. The case for OFSMOKE: the potential for price cap regulation of tobacco to raise £500M per year in the UK. Tob Control Published Online First: 14 January 2013. doi:10.1136/tobaccocontrol-2011-050385

Gilmore A, Tavakoly B, Taylor G, Reed H. Understanding tobacco industry pricing strategy and whether it undermines tobacco tax policy: the example of the British cigarette market. Addiction. doi: 10.1111/add.12159

Gilmore AB. Understanding the vector in order to plan effective tobacco control policies: an analysis of contemporary tobacco industry materials. Tobacco Control 2012;21:2 119-126 doi:10.1136/tobaccocontrol-2011-050397

Smith K, Gilmore A, Chaloupka F, Delipalla S. Tobacco Industry Pricing, Price-Related Marketing and Lobbying Strategies. In: IARC. IARC Handbooks of Cancer Prevention: Tobacco Control. Volume 14. Effectiveness of Price and Tax Policies for Control of Tobacco. Lyon, France: International Agency for Research on Cancer, 2011.

Gilmore A, Sweanor D, Branston R. The case for OFSMOKE: how tobacco price regulation is needed to promote the health of markets, government revenue and the public. Tobacco Control. 2010; 19:423-430

Chaloupka, F.J., Straif, K., Leon, M.E. 2010. Effectiveness of tax and price policies in tobacco control. Tobacco Control 2011;20:3 235-238 Published Online First: 29 November 2010 doi:10.1136/tc.2010.039982

Garman K, Tavakoly B, Gilmore A. (2010) UK: price-based promotions target poor. Tobacco Control, 19: 263-266 doi:10.1136/tc.2010.038653

Tobacco promotion

 Mir H, Buchanan D, Gilmore A, McKee M, Yusuf S, Chow K. Cigarette pack labelling in 12 countries at different levels of economic development. Journal of Public Health Policy. 2011; 32:146-64

Chow, C. K., Lock, K., Madhavan, M., Corsi, D. J., Gilmore, A. B., Subramanian, S. V., Li, W., Swaminathan, S., Lopez-Jaramillo, P., Avezum, A., Lear, S. A., Dagenais, G., Teo, K., McKee, M. and Yusuf, S., 2010. Environmental profile of a community's health (EPOCH): an instrument to measure environmental determinants of cardiovascular health in five countries. Plos One, 5 (12), e14294

Other relevant papers

Sims, M., Tomkins, S., Judge, K., Taylor, G., Jarvis, M. J. and Gilmore, A. (2010) Trends in and predictors of second-hand smoke exposure indexed by cotinine in children in England from 1996 to 2006. Addiction, 105 (3), pp. 543-553. doi: 10.1111/j.1360-0443.2009.02805.x

Jarvis, M. J., Mindell, J., Gilmore, A., Feyerabend, C. and West , R. (2009) Smoke-free homes in England: Prevalence, trends and validation by cotinine in children. Tobacco Control, 18 (6), pp. 491-495. doi: 10.1136/tc.2009.031328

Gilmore, A., Sims, M. and Jarvis, M. (2010) Passive smoking in UK children. In: Britton, J. and Edwards, R., eds. Passive Smoking and Children. London: Royal College of Physicians, pp. 21-39

Owusu-Dabo E, Lewis S, McNeill A, Gilmore A, Britton J. Support for smoke-free policy, and awareness of tobacco health effects and use of smoking cessation therapy in a developing country BMC Public Health 2011, 11:572doi:10.1186/1471-2458-11-572

Owusu-Dabo E, Lewis S, McNeil A, Anderson S, Gilmore A, Britton J. Status of implementation of Framework Convention on Tobacco Control ( FCTC) in Ghana. BMC Public Health 2010, 10:1 http://www.biomedcentral.com/1471-2458/10/1
 

 
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