14/10/13 @ 08:06
The science, politics and economics of tobacco control
The science, politics and economics of tobacco control: How can we get best bang for our bucks?
Abstract of paper to be presented at UK Society for Behavioural Medicine, Oxford, December 2013
Robert West, University College London
Other things being equal every sustained percentage point reduction in smoking prevalence can be expected to prevent some 3,000 premature deaths in the UK and probably more than 1 million worldwide. Tobacco control in the UK (and other countries where smoking is the dominant form of tobacco use) aims to reduce the burden of tobacco-related disease primarily by reducing smoking prevalence, either by reducing uptake or promoting cessation or both.
Changing the incidence of any behaviour involves changing one or more of: capability, opportunity and motivation - either relating directly to the target behaviour or to behaviours that support it or compete with it. This in turn can be achieved by a variety of intervention strategies: education, persuasion, incentivisation, coercion, training, restriction, environmental restructuring, modelling and enablement. Implementing these strategies involves one or more types of policy approach: mass media, regulation, legislation, fiscal policy, guideline development, service provision and environmental planning.
Using the framework above (known as the Behaviour Change Wheel), this presentation will review tobacco control intervention options and specific interventions that are being used or considered in terms of effectiveness, affordability, practicability and public acceptability. It will use this to identify intervention strategies that could lead to greater prevalence reduction than is currently being achieved within existing financial resources. It will conclude with a discussion of how to address political barriers to this.
Ten key recommendations include: 1) increasing the financial cost of manufactured cigarettes and hand-rolled tobacco through taxation and control of illicit supply by 5% above inflation; 2) spending at least £20 million each year on national mass media campaigns and events including Stoptober and No Smoking Day; 3) using existing Quality Outcome Framework payments to GPs to ensure that they have both the capability and motivation to deliver effective cessation advice within the limited time available; 4) requiring manufacturers of nicotine replacement products to develop and implement ways of ensuring that smokers purchasing their products use them effectively; 5) creating an appropriate regulatory framework to promote development and use of electronic cigarettes as an alternative to smoking; 6) making the low-cost medicine to aid cessation, cytisine, available to smokers as soon as possible; 7) promoting free or low-cost websites, mobile applications and written materials that have been evaluated and found to be effective rather than commissioning new materials that are untested; 8) promoting minimum standards for Stop-Smoking Service provision and publicising which Local Authorities meet those standards; 9) adopting efficient systems for ensuring smokers attending primary and secondary care have ready access to stop-smoking support; 10) enacting legislation to protect the public from continued attempts by the tobacco industry to promote their products (e.g. through product placement in films and attractive packaging).