5' Policies to reduce smoking

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5. Policies to reduce smoking

• Royal College of Physicians of London
• Tobacco Advisory Group

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Government reduction targets
Government White Paper, 'Smoking Kills', 1998
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Government cancer reduction targets
Improvements in cancer mortality due to specific
intervention
Reduction in tobacco
consumption - 7.3
Total
Target
Improvement in provision
cancer
of treatment services - 4
reduction -
mortality
20
in 1997
Increase in fruit and
vegetable consumption - 4
Breast screening with incremental
improvement in quality - 2
Reduction in heavy alcohol consumption - 1
Cervical screening with incremental
improvement of quality - 1
Colorectal screening - 0. 5
Reduction in domestic radon levels - 0.2
phased introduction of new modalities
estimates produced for the under 65 age group
and
assumed to apply equally to under 75 age group
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Tobacco control policies

• Comprehensive and unified approach tackling main
  drivers of harm
• Increase the motivation to quit
• Tackle the pressures to smoke
• Help with smoking cessation
• Reduce harm to continuing smokers

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Tobacco control policy

• 1. Motivate smokers to quit
• Mass media PR campaigns
• High taxation
• Risk communication and consumer information
• Smoke-free public places

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Tobacco control policy

• 2. Tackle motivators to smoke
• Ban tobacco advertising
• Ban misleading reassuring branding
• Bold, stark warnings on cigarette packs
• Control of additives that may make the product
  more addictive or otherwise appealing

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Tobacco control policy

• 3. Help smokers to quit
• Make checking smoking status routine
• Brief advice to quit at all consultations
• Additional support for those willing to try
• Specialist services available
• Specialist help available also in settings such
  as prisons, social care, pre-natal
• Phamacotherapies should be offered

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Tobacco control policy

• 4. Regulate for reduced harm
• Ingredients additives
• Manufacturing techniques
• Marketing claims
• Fire-safety
• Consider smokeless tobacco

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Mass media communications

• Effective in motivating smokers to quit
• Must be believable, relevant to target group
• Campaigns need to be well resourced
• Helplines reinforce quitting message

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Tobacco advertising

• the banning of advertising was followed by a
  fall in smoking on a scale which cannot be
  reasonably attributed to other factors
• The balance of evidence thus supports the
  conclusion that advertising does have a positive
  effect on consumption.
• Clive Smee, Chief Economist, UK Department of
  Health 1994
• Estimated benefit
• 3000 lives per year
• 40 million avoided NHS expenditure

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Taxation

• Strategy recommended by World Bank
• Price increases reduce demand
• Revenue exceeds NHS costs

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Prevent smuggling

• 80 illegal trade by organised crime
• Mostly freight containers not white van man
• - Tax rate is only one (minor) factor
• Pack of 20 sells for 2.50 rather than 4.40
• Tobacco companies benefit from smuggling and have
  little incentive to control it.

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Smoke free environments

• Over 80 of people support smoking restrictions
  at work in public places
• Smoking bans reduce smoking prevalence by around
  4
• Voluntary restrictions provide little protection
  for customers or staff

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Consumer protection

• Large health warnings min. 30 pack
• Tar, nicotine yields max. yields
• Ban misleading descriptors (lights etc)
• Less hazardous ways of taking nicotine
• Measures to protect children e.g. siting of
  vending machines

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Health warnings on packs
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Youth smoking prevention

• Easy to be counter-productive
• Youth measures can help to define the product as
  adult
• Young people may instinctively reject adult
  imposed authority
• Best approach is to discourage smoking in adult
  society

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Smoking cessation

• Key component of NHS modernisation review
• Wanless review highlights importance of smoking
  cessation
• Recognised in National Service Frameworks
• Service then implementation should be routine

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Impact of strong tobacco control policies
Smoking prevalence in the USA