UK Tobacco Control Research Articles

What does Brexit mean for UK tobacco control?

In January 2020 the UK left the European Union (EU), although a transition period extends EU rules/regulations until the end of 2020 while a longer-term relationship agreement is negotiated. After almost 50 years of membership the UK economy is tightly integrated into that of the EU single market, and many UK laws and regulations have their origins in the EU, including those concerning tobacco. This paper provides an overview of potential implications of Brexit for UK tobacco control. We examine the key areas of the supply, cost, taxation, and regulation of tobacco products, and the impact of commitments in regards to the border between Ireland and Northern Ireland (NI). We find that Brexit provides an opportunity for improved tobacco control with potential for particular enhancements in the areas of taxation and product regulation. However, commitments in regards to NI mean these benefits either won't extend to NI (which will continue to follow EU rules), or could lead to the whole UK having to follow most EU rules/regulations despite no longer being involved in the decision making process. The details of any future deal will be important, especially since virtually all UK tobacco products come from the EU, and hence would be subject to disruption/considerable new tariffs (i.e. taxation on imports) without a trade deal. We conclude that political will by the UK government to secure conditions which protect the UK's world leading tobacco control measures will be key to whether Brexit helps or hinders tobacco control in the UK. In this regards the signs are mixed.

Impact of UK Tobacco Control Policies on Inequalities in Youth Smoking Uptake: A Natural Experiment Study.

IntroductionUK countries implemented smoke-free public places legislation and increased the legal age for tobacco purchase from 16 to 18 years between 2006 and 2008. We evaluated the immediate and long-term impacts of these UK policy changes on youth smoking uptake and inequalities therein.Aims and MethodsWe studied 74 960 person-years of longitudinal data from 14 992 youths (aged 11–15 years) in annual UK household surveys between 1994 and 2016. Discrete-time event history analyses examined whether changes in rates of youth smoking transitions (initiation, experimentation, and escalation to daily smoking or quitting) or their inequalities (by parental education) were associated with policy implementation. Parallel analyses examined smoke-free legislation and the change in legal age. We interpret the results as a combined effect of the two pieces of legislation as their implementation dates were too close to identify separate effects. Models were adjusted for sex, age, UK country, historical year, tobacco taxation, and e-cigarette prevalence, with multiple imputation for missing data.ResultsFor both policies, smoking initiation reduced following implementation (change in legal age odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.55 to 0.81; smoke-free legislation OR: 0.68; 95% CI: 0.56 to 0.82), while inequalities in initiation narrowed over subsequent years. The legal age change was associated with annual increases in progression from initiation to occasional smoking (OR: 1.26; 95% CI: 1.07 to 1.50) and a reduction in quitting following implementation (OR: 0.57; 95% CI: 0.35 to 0.94). Similar effects were observed for smoke-free legislation but CIs overlapped the null.ConclusionsPolicies such as these may be highly effective in preventing and reducing socioeconomic inequalities in youth smoking initiation.ImplicationsUK implementation of smoke-free legislation and an increase in the legal age for tobacco purchase from 16 to 18 years were associated with an immediate reduction in smoking initiation and a narrowing of inequalities in initiation over subsequent years. While the policies were associated with reductions in the initiation, progression to occasional smoking increased and quitting decreased following the legislation.

Understanding the tobacco retail environment; next frontier for UK tobacco control

Understanding the tobacco retail environment; next frontier for UK tobacco control

Where now for tobacco control--the place for harm reduction and product regulation in UK tobacco control policy: a perspective from India

The article by Gilmore et al. makes the case for tobacco control strategies that may usefully complement the UK’s tobacco advertising ban and smoke-free legislation. They rightly argue that despite the UK being ranked as having the strongest tobacco control policies in Europe, 10 million of its people continue to smoke and more needs to be done. This review is timely not only for the UK, but also because interest in and commitment to introducing tobacco control policies have gathered pace globally. In South East Asia, Bhutan (2004), Thailand (2006) and India (2008) are some of the countries that have successfully enforced a smoking ban in public places. Bhutan is the first country in the world to impose a total ban on tobacco products—sale and use. China introduced a smoking ban in public buildings in Beijing from May 2008 as a run-up to the Olympic Games. Singapore has had smoke-free legislation since 1970, but has strengthened it recently. Hong Kong enacted the smoking ban law in 1982 but could enforce it only since 2007. Countries like Indonesia (2006), Kazakhstan (2003), Malaysia (2004), Bangladesh (2006), Pakistan (2003), Philippines (2002), Vietnam (2005), Brunei Darussalam (1988) have banned smoking in public places, but implementation is far from complete. India’s smoking ban was a remarkable achievement in terms of political will and national commitment, given that she ranks second after China in tobacco production. The Cigarettes and other Tobacco Products Act of 2003 included prohibition of smoking in public places, prohibition of advertisements and regulation of trade and commerce, production, supply and distribution. The difficulties of implementing such a wide ranging Act are illustrated by the fact that it has taken a further 5 years to enforce just one section of this law relating to smoking in public places. Gilmore et al. draw attention to the anomalies of current UK regulation, which paradoxically provides the public greater access to smoked tobacco than to smokeless tobacco or medicinal nicotine. They argue for harm reduction strategies that shift tobacco users from more to less dangerous forms as a useful step to helping users quit their habit. Harm reduction strategies are intellectually appealing in the Indian context too, because of the likely benefit in terms of exposure to second hand smoke. Nevertheless, such strategies are likely to generate little enthusiasm at present, because of the concern regarding oral cancer due to widespread use of chewed tobacco. This has a deep rooted cultural basis, with little evidence that it could be easily replaced by less harmful alternatives such as snus. The authors acknowledge the challenges of culture and context to the replicability of strategies even if their success is proved in other parts of the world. For harm reduction strategies to succeed, the ability of target populations to comprehend the relative risks of alternative approaches may be critical, but the authors make no comment on this. Although literacy has increased to 65%, India is home to the highest number of illiterate people in the world. The impact of this on the success of harm reduction strategies needs to be evaluated.

The place for harm reduction and product regulation in UK tobacco control policy

Tobacco use remains the leading cause of preventable death in this country and more needs to be done to reduce smoking rates. Harm reduction is one policy option. Smokers smoke for the nicotine, but die from the other toxins in cigarette smoke. Harm reduction in tobacco control aims to reduce the harm arising from nicotine use by shifting smokers, who are unable to quit, to using far less hazardous sources of nicotine, notably medicinal nicotine, in place of cigarettes. This article argues that for harm reduction to work in the UK, a nicotine product regulation authority is first needed. This would regulate nicotine products in proportion to harm to ensure that, contrary to the current paradoxical arrangements, the most harmful source of nicotine, the cigarette, becomes the most highly regulated (and thus the least easily accessible, available and attractive). It goes onto explore how a harm reduction strategy might be further developed, exploring controversies and potential pitfalls. It argues that the public health community needs to own and drive this debate because failure to do so would let the tobacco industry gain the upper hand and see thousands of more unnecessary deaths from tobacco use.