So I’ve woken up in the woodland to Day Three of Stoptober. I hope those of you who have given up are managing to hang on to your well deserved title of ‘ex-smoker!’ Giving up is worth the pain and all the longing. After all, any relationship with the dreaded tobacco is doomed from the start.
Turning your back on smoking is not a journey that you travel alone. Policy makers have brought about significant declines in smoking and tobacco-related disease through the use of comprehensive tobacco control (TC) programmes. The introduction of the World Health Organisation’s (WHO) Framework Convention on Tobacco Control (FCTC) and MPOWER (Monitor, Protect, Offer, Warn, Enforce, Raise) policy package have been a driving force behind implementing these programmes worldwide. In order to prioritise TC policies and to develop achievable targets for reducing tobacco use, it would be beneficial to understand in more detail the independent effects of the interventions on smoking behaviour.
So how do tobacco control policies affect smoking behaviours?
A systematic review has been published recently that has attempted to evaluate the independent effect on smoking prevalence of four TC policies outlined in the WHO MPOWER package. These are, increasing taxes on tobacco products, banning smoking in public places, banning advertising and sponsorship of tobacco products and educating people through health warning labels and anti-tobacco mass media campaigns.
Outcomes of interest in the study were smoking prevalence, initiation or cessation rates and price participation elasticity (PPE) (the relative percentage change in smoking prevalence for every 1% change in price). After a search of relevant databases 84 studies were found but because of their heterogeneity, meta-analysis could not be carried out. Instead, a qualitative summary of the results by intervention type was recorded.
This is what they found:
- High strength evidence was found to show that increases in tobacco pricing independently reduce smoking prevalence among youths (PPEs -1.41 to -0.1.) and adults (PPEs -0.45 to 0.10). The larger PPE for youths is most likely due to less disposable income
- Low- to middle-income countries tend to be more price sensitive than high-income countries
- Moderate strength evidence was found to show that smoking bans can have an independent impact on smoking prevalence in the general population. A greater effect was seen in smaller geographic areas with limited previous legislation
- Smoking bans impact on smoking behaviour by reducing smoking opportunities and making smoking less socially acceptable. Their effectiveness depends on the strength and comprehensiveness of prior legislation, level of enforcement and public support
- Moderate strength evidence was found to show that anti-tobacco mass media campaigns can have an effect on reducing initiation of smoking in youths and prevalence in adults.
- Research suggests that adults are more likely to respond to graphic detail about the health consequences of smoking and youths to the information about tobacco industry deception and manipulation
- There was insufficient evidence to quantify the effects of banning advertising or sponsorship and health warning labels
- They only included studies that evaluated the independent impact of a policy. It would be interesting to explore studies with multi-component TC programmes
- The review only looked at smoking prevalence, initiation and cessation. It did not include other intermediate outcomes e.g. tobacco consumption
- Most of the studies included were from high-income countries. These findings do not necessarily reflect low- and middle-income countries
The authors concluded:
Factors influencing the observed impact (of the interventions) likely include the strength of the policy and level of enforcement; promotion around it’s implementation; the content, tone and reach of a mass media campaign; the underlying tobacco control environment and strategic activities of the tobacco industry to dampen the effects of policies and programs. Future studies should attempt to characterise these factors to understand the variation in impact.
It is astounding to think that more than 1 billion people in the world smoke with over 80% of those living in low- and middle-income countries. TC policies have evolved over time and the more information that can be gathered to help improve their effects to bring about a decline in smoking and tobacco related diseases, the better.
This study is available to read in full text. See link below.
Lisa M. Wilson, Erika Avila Tang, Geetanjali Chander, et al., Impact of Tobacco Control Interventions on Smoking Initiation, Cessation, and Prevalence: A Systematic Review, Journal of Environmental and Public Health, vol. 2012, Article ID 961724, 36 pages, 2012. doi:10.1155/2012/961724 [PubMed]