Changing health behaviours: Changing health behaviours: examples from tobacco controlexamples from tobacco control

Linda BauldLinda Bauld

Outline Outline

Tobacco and cancerTobacco and cancer Smoking ratesSmoking rates Tobacco controlTobacco control Key lessonsKey lessons New approachesNew approaches

Burden of disease attributable to 20 leading risk Burden of disease attributable to 20 leading risk factors, UK 2010 factors, UK 2010 Murray, Lancet 2013;381:997-1020Murray, Lancet 2013;381:997-1020

Harms from smoking in the UK, each yearHarms from smoking in the UK, each yearTo the fetus:5300 fetal/perinatal deaths5300 fetal/perinatal deaths2,200 premature births; 19,000 low birth weight babies2,200 premature births; 19,000 low birth weight babiesIncreased risk of developmental anomaliesIncreased risk of developmental anomalies

To children:To children:40 sudden infant deaths40 sudden infant deaths165,000 new cases of asthma, bronchitis, ear disease, meningitis165,000 new cases of asthma, bronchitis, ear disease, meningitisIncreased risk of becoming a smokerIncreased risk of becoming a smoker

To adults and wider society:To adults and wider society:100,000 deaths 100,000 deaths Morbidity costing £5 billion (of £100 billion) in NHS costs (2006)Morbidity costing £5 billion (of £100 billion) in NHS costs (2006)£14 billion cost to society£14 billion cost to societyExacerbation of poverty, fires, litter… Exacerbation of poverty, fires, litter…

Sources: Sources: RCP 2010/Allender et al 2009/Policy Exchange 2010/HSCIC RCP 2010/Allender et al 2009/Policy Exchange 2010/HSCIC 20132013

Wednesday, February 11, 2015

View <Headers and Footers> to alter this text5 Source: Cancer Research UK, 2014

Wednesday, February 11, 2015

View <Headers and Footers> to alter this text6

Source: Cancer Research UK

Wednesday, February 11, 2015

View <Headers and Footers> to alter this text7

Source: Cancer Research UK, 2014

Adult smoking prevalence by age and gender, Adult smoking prevalence by age and gender, UK 2013 UK 2013 Integrated household survey 2014Integrated household survey 2014

Smoking in young people in Smoking in young people in ScotlandScotland

Progress?Progress?

Significant progress has been Significant progress has been made in reducing smoking rates made in reducing smoking rates in Scotland and the rest of the in Scotland and the rest of the UKUK

How has this occurred? How has this occurred? What can we transfer What can we transfer

to other areas of to other areas of cancer prevention? cancer prevention?

Progress has been Progress has been slowslow

Comprehensive approachesComprehensive approaches

Action at individual, Action at individual, community and community and societal level is neededsocietal level is needed

Several useful Several useful frameworks for tobacco frameworks for tobacco control existcontrol exist

Examples include those Examples include those developed by the World developed by the World Bank and the WHOBank and the WHO

Tobacco ControlTobacco Control

Taking-up smoking

Decision to quit

Quit attempt

Relapse

Reduce the appeal & supply

of tobacco products

Encourage more quit attempts

each year

Support quality quit attempts

Protect against secondhand

smoke

Key policy and practice to prevent smokingKey policy and practice to prevent smoking : :

Help smokers to quitHelp smokers to quit

Harm reductionHarm reduction

Stop tobacco advertisingStop tobacco advertising

Smoke-free policiesSmoke-free policies

Youth accessYouth access

Health promotion campaignsHealth promotion campaigns

Increase priceIncrease price

Standardised packagingStandardised packaging

Patients:Patients:

Populations:Populations:

Commercial interestsCommercial interests Tobacco is a legal product that remains highly Tobacco is a legal product that remains highly

profitableprofitable The transnational tobacco companies have The transnational tobacco companies have

attempted to consistently undermine attempted to consistently undermine tobacco control programmes and policies for tobacco control programmes and policies for decadesdecades

They continue to do soThey continue to do so Article 5.3 of the FCTC gives useful guidance on Article 5.3 of the FCTC gives useful guidance on

non engagement to counter some of their non engagement to counter some of their influenceinfluence

Commercial interests: smokefreeCommercial interests: smokefree

The Department of The Department of Health published a Health published a review of review of commissioned studies commissioned studies examining the impact of examining the impact of smokefree legislation in smokefree legislation in England in March 2011England in March 2011

Tobacco Industry ResponseTobacco Industry Response

Commercial interests: plain packaging Commercial interests: plain packaging In 2012 the UK governments In 2012 the UK governments

launched a joint public launched a joint public consultation on the plain consultation on the plain packaging of tobacco products packaging of tobacco products

They published a systematic They published a systematic review we conducted with the review we conducted with the Public Health Research Public Health Research Consortium to underpin a UK Consortium to underpin a UK wide consultation on the issue.wide consultation on the issue.

Tobacco industry response to public Tobacco industry response to public consultationconsultation

Inequality: progress may widen gapsInequality: progress may widen gaps

0

10

20

30

40

50

60

70

0 1 2 3 4 5 6&7

% population

% smoking

More affluent Multiply disadvantaged

80% of smokers have 1+ indicators of low socio-economic status. 25% of smokers are multiply disadvantaged, compared with 62% and 9% of non smokers respectively.

Smoking prevalence by socio-economic statusSmoking prevalence by socio-economic status

Smoking and mental disorder Smoking and mental disorder Royal College of Physicians 2013Royal College of Physicians 2013

Advocacy Advocacy

Coalition building and Coalition building and consensus on evidence consensus on evidence and action has and action has contributed to progress contributed to progress in reducing smoking in reducing smoking ratesrates

A single voice is A single voice is important and has been important and has been lacking in other areas of lacking in other areas of public healthpublic health

ASH (and ASH Scotland, ASH (and ASH Scotland, ASH Wales) have led the ASH Wales) have led the advocacy effortadvocacy effort

They lead the Smokefree They lead the Smokefree Action Coalition Action Coalition (including key charities, (including key charities, research organisations, research organisations, regional bodies etc) regional bodies etc) which provides essential which provides essential supportsupport

Evidence Evidence Building the evidence-Building the evidence-

base and continuing to base and continuing to develop it develop it has been has been crucial to informing crucial to informing programmes and policies programmes and policies at individual, community at individual, community and societal level and societal level

Vision: A Tobacco-free Scotland by Vision: A Tobacco-free Scotland by 2034 (5% prevalence) 2034 (5% prevalence)

Scottish government strategy, target then promoted by CRUK for the UK – similar target in the Republic of Ireland

New DevelopmentsNew Developments

Some tobacco control advocates (and Some tobacco control advocates (and researchers) argue that if we simply keep doing researchers) argue that if we simply keep doing what we know ‘works’ we will continue to see what we know ‘works’ we will continue to see reductions in smoking reductions in smoking

However, reductions of between 0.5-1% each However, reductions of between 0.5-1% each year are arguably not enough. For each further year are arguably not enough. For each further 1% reduction, 3000 premature deaths are 1% reduction, 3000 premature deaths are preventedprevented

New Developments New Developments

Controversial approaches such as financial Controversial approaches such as financial incentives and tobacco harm reduction, incentives and tobacco harm reduction, including electronic cigarettes, may be importantincluding electronic cigarettes, may be important

Cutting downCutting down

Source: West, 2013, www.smokinginengland.info

E-cigarette market in the UKE-cigarette market in the UK

Electronic cigarette use in 13 and 15 year-olds in Scotland, 2013Electronic cigarette use in 13 and 15 year-olds in Scotland, 2013http://www.isdscotland.org/Health-Topics/Public-Health/Publications/2014-11-25/SALSUS_2013_Smoking_Report.pdfhttp://www.isdscotland.org/Health-Topics/Public-Health/Publications/2014-11-25/SALSUS_2013_Smoking_Report.pdf

*

Of which 3% had tried once, 1% a few times *

Conclusions Conclusions Change takes timeChange takes time Comprehensive Comprehensive

approaches are neededapproaches are needed Powerful vested Powerful vested

commercial interests will commercial interests will undermine these undermine these approachesapproaches

Progress in some groups Progress in some groups may exacerbate may exacerbate inequalitiesinequalities

Advocacy is keyAdvocacy is key Rely on the evidence Rely on the evidence

(and continue to build it)(and continue to build it) Vision is importantVision is important Controversial new Controversial new

developments and developments and solutions may well be solutions may well be requiredrequired

Thank youThank you

Linda.Bauld@stir.ac.ukLinda.Bauld@stir.ac.uk

Acknowledgements: Acknowledgements:

John Britton, Robert West, Martine Stead, John Britton, Robert West, Martine Stead,

Alison Cox and colleagues at Cancer Research UKAlison Cox and colleagues at Cancer Research UK