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:

     Reduce the affordability of smoking by increasing taxes on tobacco products

     Reduce tobacco promotion

     Help people to give up smoking

     Protect people from tobacco smoke

    Use mass media to warn people of the dangers of smoking

     Regulate the content of tobacco products

Our researchers involved in policy evaluation:

Contribution of our researchers

Reduce the affordability of smoking

Tobacco tax increases are considered the most effective public health intervention for reducing tobacco use, particularly among the young and most disadvantaged (Amos, Bauld et al 2011), and the intervention with most potential for reducing socio-economic disparities in smoking. It is also the only tobacco control intervention that increases government revenue. For many years, HM Treasury has increased tobacco taxes in order that the price of tobacco would increase, thereby encouraging smokers to quit or reduce their consumption. However, our recent research (Gilmore, Tavakoly et al, 2013) indicates that the tobacco industry may be undermining this strategy. When tobacco taxes increase each year, the tobacco industry absorbs the tax increase on its cheapest brands so that the price of these brands remains the same or falls. As a result, the price of many of the cheapest brands has actually fallen in real terms over recent years and the price gap between the most and least expensive cigarettes has increased. We have also shown that poor smokers are more likely to use these cheaper cigarettes (Gilmore, Tavakoly et al. 2014) and it seems likely, therefore, that the tobacco industry’s pricing strategy may be contributing to the widening gap in smoking between rich and poor. A further problem is the availability of non-UK duty paid tobacco, particularly illicit tobacco which is sold much more cheaply than legal products. Its existence discourages government from increasing tobacco taxes for fear this will increase illicit use.  We have recently been awarded a HTA NIHR research grant to enable us to further our understanding of these issues.

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.

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)

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 and attempts to influence marketing regulations (Savell, Gilmore & Fooks, 2014)

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.

 

Help people to give up smoking:

Effectiveness of UK Stop Smoking Services

The UK Stop Smoking Services (SSS) provide access to free at-the-point-of-use help to quit. Trained advisors give support and counselling, and can prescribe a variety of stop smoking medications.  They were set up in 1999 to reduce deaths particularly from cancer and coronary heart disease.

We have recently been involved in the NIHR Health Technology Assessment programme funded evaluation of the English services: ELONS (Evaluating Long–term Outcomes of NHS Stop Smoking Services).  This involved secondary analysis of routine data on 4 week outcomes and a prospective study which followed up 3057 clients in nine contrasting areas of England four and twelve months after they were enrolled with the services. Carbon Monoxide measurements were taken at both stages to provide a biochemical validation of not smoking.

The evaluation identified that eight percent had still not smoked one year after quitting.  More than 724,247 people accessed the services in England between April 2012 and March 2013 thus the Stop Smoking Services prevented more than 18,000 premature deaths in one year alone.  Clients were very satisfied with the services according to a client satisfaction survey. 

The best chances of success come from seeing specialists who are trained to give the best support. Some smokers need this extra help to quit and so continued investment in these services is vital if more people are to stop smoking for good.

Other evaluations of SSS that we have been involved with include reviews of the Scottish Cessation Services (Black, Sewel et al. 2014) and earlier reviews of long term outcomes of the English services focussing on behavioural support type (Bauld, Boyd et al. 2012, Bauld, Ferguson et al. 2012, Hiscock, Murray et al. 2013), cost effectiveness (Bauld, Boyd et al., 2012) and outcomes for more disadvantaged smokers.  (Hiscock, Judge, & Bauld, 2011).

 

Surveys of Stop Smoking Service personnel’s views of e-cigarettes

The University of Bath have been involved in the analysis of three surveys, conducted by the National Centre of Smoking Cessation and Training (NCSCT) of SSS personnel’s views of e-cigarettes (in 2011, 2013 and 2014).  Analysis of these surveys is contributing to ongoing development of UK guidelines.

Analysis of the 2011 and 2013 surveys (Hiscock, Goniewicz et al. 2014) suggested that SSS personnel were divided in their opinion of e-cigarettes with the largest group being unsure about whether they were helpful.  Although in general respondents to the later survey were slightly more positive there were growing concerns about dependence on e-cigarettes and undermining of other forms of tobacco control.  Analysis of the 2014 survey is ongoing.

 

Quitting smoking and mental wellbeing

The ELONS prospective study (see above) was used to collect data on wellbeing at three time points: at the start of the quit attempt and during follow up postal surveys at four weeks and one year.  Wellbeing was measured through the five item WHO-5 Wellbeing Index.  Analysis is ongoing

 

Protect people from tobacco smoke

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).

 

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.

 

Focus on disadvantaged smokers

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

Disadvantaged groups have high smoking rates (Hiscock, Bauld, Amos & Platt, 2012) but low quit rates even when they attend targeted Stop Smoking Services (Hiscock, Judge, & Bauld, 2011; Hiscock, Dobbie & Bauld forthcoming).  Some of the most disadvantaged smokers, such as the unemployed and prisoners, may benefit less from open group behavioural support than other smokers (Hiscock, Murray et al. 2013).  They are more likely to smoke cheap tobacco (cheap cigarettes and roll your own) compared with more affluent smokers (Gilmore, Tavakoly et al. 2014).

 

Publications by our researchers

Reduce the affordability of smoking

Gallus, S., Lugo, A., Ghislandi, S., La Vecchia, C. and Gilmore, A. B. C., 2014. Roll-your-own cigarettes in Europe : Use, weight and implications for fiscal policies. European Journal of Cancer Prevention, 23 (3), pp. 186-192.

Branston, J. R. and Gilmore, A. B., 2014. The case for Ofsmoke : the potential for price cap regulation of tobacco to raise £500 million per year in the UK. Tobacco Control, 23 (1), pp. 45-50.

Gallus, S., Lugo, A., La Vecchia, C., Boffetta, P., Colombo, P., Chaloupka, F. J., Currie, L., Fernandez, E.,Fischbacher, C., Gilmore, A., Godfrey, F., Joossens, L., Leon, M. E., Levy, D. T., Nguyen, L., Rosenqvist, G.,Ross, H., Townsend, J. and Clancy, L., 2014. Pricing policies and control of tobacco in Europe (PPACTE) project : Cross-national comparison of smoking prevalence in 18 European countries. European Journal of Cancer Prevention, 23 (3), pp. 177-85.

Gilmore, A. B., B. Tavakoly, R. Hiscock and G. Taylor 2014. "Smoking patterns in Great Britain: the rise of cheap cigarette brands and roll your own (RYO) tobacco." Journal of Public Health: fdu048.  

Gilmore, A. B., Tavakoly, B., Taylor, G. and Reed, H., 2013. Understanding tobacco industry pricing strategy and whether it undermines tobacco tax policy : The example of the UK cigarette market.Addiction, 108 (7), pp. 1317-1326.

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 2013. doi: 10.1111/add.12159

van Walbeek, C., Blecher, E., Gilmore, A. and Ross, H., 2013. Price and tax measures and illicit trade in the framework convention on tobacco control: What we know and what research Is required. Nicotine & Tobacco Research, 15 (4), pp. 767-776.

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., Lugo, A., La Vecchia, C., Gilmore, A. B., Clancy, L. and Gallus, S., 2012. Illicit cigarettes and hand-rolled tobacco in 18 European countries: a cross-sectional survey. Tobacco Control, Online First.

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

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

Smith K, Gilmore A, Chaloupka F, Delipalla S. 2011Tobacco 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,.

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 2010doi:10.1136/tc.2010.039982

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

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

Savell E, Gilmore AB, Fooks G. 2014 How does the tobacco industry attempt to influence marketing regulations? A systematic review. PLoS One 9(2): e87389, Doi: 10.1371/journal.pone.0087389.PMCID: PMC3914831.

Hopkinson, N.S., Britton, J., Gilmore, A., Moxham, J. and Ashton, J.R., 2014. Please confirm that the regulations on standardised ("plain") packaging of cigarettes and tobacco products will be published soon. BMJ, 348, g3779.

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

 

Help people to give up smoking

Gilmore, A. B. and Hartwell, G., 2014. E-cigarettes: threat or opportunity? : Threat or opportunity?European Journal of Public Health, 24 (4), pp. 532-533.

Gilmore, A. B. C. and Peeters, S., 2014. Re: E-cigarettes and the marketing push that surprised everyone.British Medical Journal

Black, C. Sewel, K. Hiscock R. 2014. Smoking cessation services review, NHS Health Scotland.

Hiscock, R., Goniewicz, M. McEwen, A. Murray, S. Arnott, D. Dockrell, M. Bauld, L 2014. "E-cigarettes: online survey of UK smoking cessation practitioners." Tobacco Induced Diseases 12(1): 1-9.

Kerssens, J. Denny, C. Galbraith, L. Haw, S. Bauld, L. Hiscock R. 2013 Who are smoking cessation services in Scotland reaching? A secondary analysis of routine data.  UKNSCC; 27th-28th June; London

Hiscock, R. Murray, S. Brose, L. S. McEwen, A. Leonardi Bee, J. Dobbie, F. Bauld, L. 2013. "Behavioural therapy for smoking cessation: The effectiveness of different intervention types for disadvantaged and affluent smokers." Addictive Behaviors 38(11): 2787-2796.

Bauld, L., Ferguson, J. McEwen, A. Hiscock, R. 2012. "Evaluation of a drop in rolling group model of support to stop smoking." Addiction 107(9): 1687-1695.

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. 201) 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. 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

 

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., Maxwell, R. and Gilmore, A., 2013. Asthma admissions, smoking bans and administrative databases : Author’s response. Thorax, 68 (12), pp. 1166-1167.

Sims, M., Mindell, J. S. Jarvis, M. J, Feyerabend, C. Wardle, H. 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. 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. 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

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

Sims, M. Maxwell, R. Bauld, L. 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. 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. 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. McNeil, A. Anderson, S. Gilmore, A. Britton, J. 2010) Status of implementation of Framework Convention on Tobacco Control ( FCTC) in Ghana. BMC Public Health, 10:1 http://www.biomedcentral.com/1471-2458/10/1

Gilmore, A.Sims, M. Judge, K. Bauld, L. 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. 2007 Health impacts of exposure to second hand smoke (SHS) amongst a highly exposed workforce: survey of London casino workers. BMC Public Health  7: 25

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

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

Focus on disadvantaged smokers

Hiscock, R. Dobbie F.  Bauld, L Forthcoming. "Smoking cessation and socioeconomic status: an update of existing evidence from a national evaluation English Stop Smoking Services." Biomed Research International.

Gilmore, A, Tavakoly, B. Hiscock, R.Taylor, G. 2014. "Smoking patterns in Great Britain: the rise of cheap cigarette brands and roll your own (RYO) tobacco." Journal of Public Health: doi:fdu048.

Hiscock, R. Murray, S. Brose, L. S. McEwen, A. Leonardi Bee, J. Dobbie F.  Bauld, L 2013. "Behavioural therapy for smoking cessation: The effectiveness of different intervention types for disadvantaged and affluent smokers." Addictive Behaviors 38(11): 2787-2796.

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

Amos, A. L. Bauld, D. Clifford, J. Fidler, S. Hill, R. Hiscock, L. Laverty, S. Platt, Robinson, J 2011. Tobacco control, inequalities in health and action at a local level. York, Public Health Research Consortium.

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


Mass media campaigns

Richardson, S., Langley, T., Szatkowski, L., Sims, M., Gilmore, A., McNeill, A. and Lewis, S., 2014. How does the emotive content of televised anti-smoking mass media campaigns influence monthly calls to the NHS Stop Smoking helpline in England? Preventive Medicine, 69, pp. 43-48.

Richardson, S., McNeill, A., Langley, T. E., Sims, M., Gilmore, A., Szatkowski, L., Heath, R., Fong, G. T. andLewis, S., 2014. The impact of televised tobacco control advertising content on campaign recall : Evidence from the International Tobacco Control (ITC) United Kingdom Survey. BMC Public Health, 14, 432.

Sims, M., Langley, T., Lewis, S., Richardson, S., Szatkowski, L., McNeill, A. and Gilmore, A. B., 2014. Forthcoming. Effectiveness of tobacco control television advertisements with different types of emotional content on tobacco use in England, 2004-2010. Tobacco Control

Sims, M., Salway, R., Langley, T., Lewis, S., McNeill, A., Szatkowski, L. and Gilmore, A. B., 2014.Effectiveness of tobacco control television advertising in changing tobacco use in England : a population-based cross-sectional study. Addiction, 109 (6), pp. 986-994.

Salway, R., Sims, M. and Gilmore, A. B., 2014. Interpreting long-term trends in time series intervention studies of smoke-free legislation and health. International Journal of Statistics in Medical Research, 3 (1), pp. 55-65.

Langley, T., Szatkowski, L., Lewis, S., McNeill, A., Gilmore, A. B., Salway, R. and Sims, M., 2014. The freeze on mass media campaigns in England : A natural experiment of the impact of tobacco control campaigns on quitting behaviour. Addiction, Online First.

Gilmore, A. B. C. and Reed, H., 2014. The truth about cigarette price increases in Britain. Tobacco Control, Online First 12 Augu.

Sims, M. , Langley, T., Richardson, S., Salway, R., Lewis, S., McNeill, A., Szatkowski, L. and Gilmore, A. B., 2013. The effectiveness of mass media campaigns in reducing smoking in England : An observational study. Lancet, 382 (Supplement 3), S15. Langley,

T., Lewis, S., McNeill, A., Gilmore, A., Szatkowski, L., West, R. and Sims, M., 2013. Characterising tobacco control mass media campaigns in England. Addiction, 108 (11), pp. 2001-2008.