Changing Lifestyle Lessons from Tobacco Control | Prof Linda Bauld

Changing health behaviours:Changing health behaviours:
examples from tobacco controlexamples from tobacco control
Linda BauldLinda Bauld

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

Burden of disease attributable to 20 leading riskBurden of disease attributable to 20 leading risk
factors, UK 2010factors, 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 year
To the fetus:
5300 fetal/perinatal deaths5300 fetal/perinatal deaths
2,200 premature births; 19,000 low birth weight babies2,200 premature births; 19,000 low birth weight babies
Increased risk of developmental anomaliesIncreased risk of developmental anomalies
To children:To children:
40 sudden infant deaths40 sudden infant deaths
165,000 new cases of asthma, bronchitis, ear disease, meningitis165,000 new cases of asthma, bronchitis, ear disease, meningitis
Increased risk of becoming a smokerIncreased risk of becoming a smoker
To adults and wider society:To adults and wider society:
100,000 deaths100,000 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 society
Exacerbation of poverty, fires, litter…Exacerbation of poverty, fires, litter…
Sources:Sources: RCP 2010/Allender et al 2009/Policy Exchange 2010/HSCICRCP 2010/Allender et al 2009/Policy Exchange 2010/HSCIC

Wednesday, February 11, 2015
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5
Source: Cancer Research UK, 2014

6
Source: Cancer Research UK

7
Source: Cancer Research UK, 2014

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

Smoking in young people inSmoking in young people in
ScotlandScotland

Progress?Progress?
 Significant progress has beenSignificant progress has been
made in reducing smoking ratesmade in reducing smoking rates
in Scotland and the rest of thein Scotland and the rest of the
UKUK
 How has this occurred?How has this occurred?
 What can we transferWhat can we transfer
to other areas ofto other areas of
cancer prevention?cancer prevention?
 Progress has beenProgress has been
slowslow

Comprehensive approachesComprehensive approaches
 Action at individual,Action at individual,
community andcommunity and
societal level is neededsocietal level is needed
 Several usefulSeveral useful
frameworks for tobaccoframeworks for tobacco
control existcontrol exist
 Examples include thoseExamples include those
developed by the Worlddeveloped 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 highlyTobacco is a legal product that remains highly
profitableprofitable
 The transnational tobacco companies haveThe transnational tobacco companies have
attempted to consistently undermineattempted to consistently undermine
tobacco control programmes and policies fortobacco control programmes and policies for
decadesdecades
 They continue to do soThey continue to do so
 Article 5.3 of the FCTC gives useful guidance onArticle 5.3 of the FCTC gives useful guidance on
non engagement to counter some of theirnon engagement to counter some of their
influenceinfluence

Commercial interests: smokefreeCommercial interests: smokefree
 The Department ofThe Department of
Health published aHealth published a
review ofreview of
commissioned studiescommissioned studies
examining the impact ofexamining the impact of
smokefree legislation insmokefree legislation in
England in March 2011England in March 2011

Tobacco Industry ResponseTobacco Industry Response

Commercial interests: plain packagingCommercial interests: plain packaging
 In 2012 the UK governmentsIn 2012 the UK governments
launched a joint publiclaunched a joint public
consultation on the plainconsultation on the plain
packaging of tobacco productspackaging of tobacco products
 They published a systematicThey published a systematic
review we conducted with thereview we conducted with the
Public Health ResearchPublic Health Research
Consortium to underpin a UKConsortium to underpin a UK
wide consultation on the issue.wide consultation on the issue.

Tobacco industry response to publicTobacco 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 disorderSmoking and mental disorder
Royal College of Physicians 2013Royal College of Physicians 2013

AdvocacyAdvocacy
 Coalition building andCoalition building and
consensus on evidenceconsensus on evidence
and action hasand action has
contributed to progresscontributed to progress
in reducing smokingin reducing smoking
ratesrates
 A single voice isA single voice is
important and has beenimportant and has been
lacking in other areas oflacking in other areas of
public healthpublic health
 ASH (and ASH Scotland,ASH (and ASH Scotland,
ASH Wales) have led theASH Wales) have led the
advocacy effortadvocacy effort
 They lead the SmokefreeThey lead the Smokefree
Action CoalitionAction Coalition
(including key charities,(including key charities,
research organisations,research organisations,
regional bodies etc)regional bodies etc)
which provides essentialwhich provides essential
supportsupport

EvidenceEvidence
 Building the evidence-Building the evidence-
base and continuing tobase and continuing to
develop itdevelop it has beenhas been
crucial to informingcrucial to informing
programmes and policiesprogrammes and policies
at individual, communityat individual, community
and societal leveland societal level

Vision: A Tobacco-free Scotland byVision: 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 (andSome tobacco control advocates (and
researchers) argue that if we simply keep doingresearchers) argue that if we simply keep doing
what we know ‘works’ we will continue to seewhat we know ‘works’ we will continue to see
reductions in smokingreductions in smoking
 However, reductions of between 0.5-1% eachHowever, reductions of between 0.5-1% each
year are arguably not enough. For each furtheryear are arguably not enough. For each further
1% reduction, 3000 premature deaths are1% reduction, 3000 premature deaths are
preventedprevented

New DevelopmentsNew Developments
 Controversial approaches such as financialControversial 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, 2013
http://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 *

ConclusionsConclusions
 Change takes timeChange takes time
 ComprehensiveComprehensive
approaches are neededapproaches are needed
 Powerful vestedPowerful vested
commercial interests willcommercial interests will
undermine theseundermine these
approachesapproaches
 Progress in some groupsProgress in some groups
may exacerbatemay exacerbate
inequalitiesinequalities
 Advocacy is keyAdvocacy is key
 Rely on the evidenceRely on the evidence
(and continue to build it)(and continue to build it)
 Vision is importantVision is important
 Controversial newControversial new
developments anddevelopments and
solutions may well besolutions 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

Changing Lifestyle Lessons from Tobacco Control | Prof Linda Bauld

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