Smoking rates in the UK over the last decade have shown a steady but slow decline, with current rates being 28% for men and 26% for women (HEA, 1996). Overall about half of all persisting regular cigarette smokers are killed by tobacco and about 30% of all deaths in middle age are caused by the habit (SCOTH, 1998).
• Main Messages:
There are many initiatives currently being pursued with the aim of further reducing smoking rates but it is highly unlikely that any one initiative by itself will have more than a marginal effect on cigarette consumption. To achieve maximum effect what is needed is a comprehensive tobacco control policy. The Government released a Tobacco White Paper ‘Smoking Kills’ (DOH, 1998) at the end of 1998 and this will assist in forming a comprehensive tobacco control policy for Britain.
The Scientific Committee on Tobacco and Health’s report (SCOTH, 1998) gives recommendations for effective health promotion approaches to tobacco. Most of these are included in the White Paper and are discussed below.
• Research into the most effective health promotion approaches
Tobacco promotion :
The SCOTH report (1998) concludes that tobacco promotion and sports sponsorship aim to encourage smokers to consume more, to undermine motivation to quit, to encourage former smokers to begin again, to encourage adults to start smoking and to hope that the young will experiment and therefore become the pool of new customers. There is a clear case for banning the promotion of tobacco. Research, notably the Department of Health Report (1992), has shown that advertising is an important factor in predisposing people to smoke and one which reinforces the habit amongst those who have started.
Evidence from other countries which have introduced advertising bans shows that they are accompanied by falls in both per capita tobacco consumption and in the number of young people smoking. For example, in Norway there was a reduction of 9% in cigarette sales after the introduction of a ban and in New Zealand the corresponding figure was 5.5% (Department of Health, 1992).
An EU Tobacco Advertising Directive was passed through the European Parliament in 1998 ensuring that legislation to ban tobacco advertising and sponsorship will be implemented in Britain. In the White Paper the Government have indicated they will bring this legislation into force earlier than is required by the EU Directive.
Smoking Cessation :
There are many approaches that have been developed to help people stop smoking. Recent research has assessed the effectiveness of these different approaches. Brief unsolicited advice to stop smoking given by a GP can help an estimated 2% of smokers to quit for at least one year (SCOTH, 1998). Other health professionals can decrease the proportion of smokers by around 2% if they give brief (about 3 minutes) stop smoking information. Increasing the intensity of advice improves the effectiveness, decreasing the proportion smoking by around 3-5% (The University of York, 1998).
A number of women stop smoking during pregnancy without assistance but counselling consisting of at least 10 minutes person to person contact, combined with written materials tailored to pregnancy, can double cessation rates to 15% (The University of York, 1998).
No Smoking Day is a well-established national campaign. For the fifteenth No Smoking Day in 1998 eight out of ten smokers were aware of the day. Approximately 40,000 smokers each year give up permanently as a result of the day (No Smoking day, 1998).
England has a free phone Quitline that gives advice and support to smokers (0800-002200). Research has shown that a smoker’s helpline can assist cessation with a 25% cessation rate at one-year follow-up (Platt et. al. 1997).
Nicotine Replacement Therapy (NRT) approximately doubles the rate of smoking cessation (SCOTH, 1998). Nicotine 2mg chewing gum and nicotine patches are comparable in efficacy. The higher dose nicotine gum is suitable for smokers who smoke more than 20 cigarettes a day (The University of York, 1998). Nicotine replacement therapy will not help smokers who lack motivation to stop.
In the White Paper there is a brief plan of how smoking cessation should be approached in this country. It appears that specialist smoking cessation services will be set up within Health Authorities and NRT may be available free-of-charge to low-income smokers for one week only.
The influence of price :
The influence of price on tobacco consumption is very well known. Cigarette consumption decreases by about 0.5% for a 1% increase in price adjusted for inflation. The effect is greater in low-income groups which may be the groups least susceptible to health education messages (SCOTH, 1998). However, the dilemma is that tobacco tax recovers for the Treasury 17% of the means tested benefits paid to poor smokers by the DSS (SCOTH, 1998). Price increases may also influence young people’s smoking.
The White Paper includes reference to tobacco taxation and the Government has said they will increase tobacco duties by at least 5% in real terms each year.
Passive smoking :
Passive smoking is a cause of lung cancer and ischaemic heart disease in adults, and respiratory disease, cot death, middle ear disease and asthmatic attacks in children (SCOTH, 1998). Increases in smoke free provision are effective ways of protecting public health and may help to establish non-smoking as the social norm in the long term. Workplace smoking policies are an effective way of protecting the health of the workforce.
The White Paper includes details about a new charter that the hospitality industry will be asked to sign up to and this will indicate to the public their choice of non-smoking areas. The workplace will have a new Approved Code of Practice to toughen existing arrangements and protect the welfare of non-smokers.
Young People :
Figures from 1996 show that 13% of young people aged 11-15 were regular cigarette smokers (Office for National Statistics, 1996). In contrast to adult rates the prevalence of smoking amongst young people is going up. Current research indicates that very few health promotion approaches are effective in reducing the smoking rates of young people.
As discussed above, tobacco price and advertising do have an effect on young people. It is important to educate young people about tobacco addiction in schools as this can delay uptake of cigarette smoking by up to 6 years (Little, 1997). School smoking policies result in a fall in the level of consumption both in and out of school and therefore all schools should be encouraged to adopt comprehensive anti-smoking policies (Little, 1997).
The White Paper includes various measures to tackle young people and smoking including, tougher enforcement on underage sales, interest in proof-of-age cards and stronger rules on siting of cigarette vending machines.
• Useful web sites
www.official-documents.co.uk/document/doh/tobacco The SCOTH report
www.ash.org.uk ASH UK
www.virgin.net No Smoking Day
www.respect.co.uk Respect campaign
www.sensei.co.uk/smoke To put smoking out of fashion
www.public.health.wa.gov.au/hp5099.htm It’s worth the effort: A guide to quitting smoking
http://galen.library.ucsf.edu/tobacco Tobacco Control Archives
Department of Health (1992), The effect of tobacco advertising on tobacco consumption: A discussion document reviewing the evidence, London: Department of Health.
Department of Health (1998), Smoking Kills – A White Paper on Tobacco, London: The Stationary Office.
Health Education Authority (1996), Health Update – Smoking, London: HEA.
Little S (1997), Literature review: Adolescent smoking, Wirral: Health Links.
No Smoking Day (1998), Ready, Steady, Stop Press! Campaign update, London: NSD.
Office for National Statistics (1996), Proportion of pupils in England who were regular smokers by sex and age: 1982 to 1996,
Platt S, Tannahill A, Watson J and Fraser E (1997), Effectiveness of antismoking telephone helpline: follow up survey, BMJ, 314, 1371-1375.
SCOTH (1998), Report of the Scientific Committee on Tobacco and Health, London
The University of York (1998), Smoking Cessation: What the Health Service can do, Effectiveness Matters, 3, 1, March 1998.