Co-creating Policy for a Tobacco-free Generation Pollock Halls, 24th June, 2019

Chair: Judith Mackay OBE

9.00 COFFEE & REGISTRATION

9.30 Welcome Joe FitzPatrick, Minister for , Sport and Wellbeing

9.45 Point-of-sale legislation Sally Haw

10.10 Implementing smoke-free prisons Kate Hunt

10.35 Smoke-free environments Sean Semple

11.00 COFFEE

11.25 Plain packaging and dissuasive cigarettes Crawford Moodie

11.50 Building Collaborations Sheila Duffy

12.15 Tobacco control policies and smoking prevalence in Catherine Best the EU

12.30 LUNCH

1.45 Workshop Session 1 (details of parallel sessions overleaf)

1 1.45 Workshop Session 1:

WS1 Point of Sale Legislation: Outcomes for young people and implications for policy

WS2 Point of sale legislation: Retailer expectations, implementation and impact on the retail environment

WS3 Implementing smoke-free prisons: Experience from

WS4 Smoke-free environments: Where to next?

WS5 Plain packaging

3.15 COFFEE

3.30 Workshop Session 2 (details of parallel sessions overleaf)

WS6 Point of sale legislation: Influence of e-cigarettes and the changing policy landscape

WS7 Local availability and pricing of tobacco products: the next frontier in tobacco control?

WS8 Implementing smoke-free prisons: Experience from Scotland

WS9 Smoke-free environments: Where to next?

WS10 Plain packaging

5.00 The tobacco industry and e-cigarettes: Update from Hong Kong Judith Mackay

5.30 Summing up from the Chair Judith Mackay

5.40 CLOSE

6.00 Drinks reception in the Main Concourse, Pollock Halls

2 Workshop Options

WS1 Point of Sale Legislation: Impact on young people and implications for policy Led by Sally Haw1 and Andy MacGregor2 with contributions from Mirte Kuipers3 1 Faculty of Health Sciences and Sport 2 Scottish Centre for Social Research, Edinburgh 3 Amsterdam Public Health Research Institute, Netherlands

In many countries point-of-sale is the last place where tobacco can be legitimately advertised or promoted. A ban on tobacco displays at point of sale was introduced in in Scotland in April 2012. In this workshop we will discuss the main findings from the DISPLAY Study, a 5-year longitudinal study, on the impact of the ban on young people’s brand awareness; perceptions of tobacco accessibility and smoking acceptability; and smoking susceptibility. Using data from Europe on country-level tobacco control policies, we will discuss with participants the important role that tobacco display bans play in the prevention of smoking and how legislation can be integrated into countries’ tobacco control strategies.

WS2 Point of sale legislation: Retailer expectations, implementation and impact on the retail environment Led by Douglas Eadie1, Linda Bauld 2 and Catherine Best 1 1 Institute for Social Marketing, University of Stirling 2 Usher Institute for Population Health Sciences and Informatics,

Retailers are a key stakeholder group in tobacco control policies relating to how tobacco is displayed and sold. For display bans to be effective, retailers need to understand what is required and to implement the legislation correctly. We will discuss findings from the DISPLAY Study about retailers’ initial expectations of the ban, how they complied with it, and what impact the ban had on the tobacco retail environment and on young people’s exposure to tobacco marketing cues in shops. Novel methods were used to examine changes in the retail environment, including longitudinal interviews, discrete observation and the development of a tobacco visibility index.

WS3 & WS8 Implementing smoke-free prisons: Experience from Scotland Led by Kate Hunt and Ashley Brown Institute for Social Marketing, University of Stirling

In jurisdictions where smoking in prisons is still allowed, levels of smoking amongst prisoners are very high, typically 70–75%. With the successful implementation of smokefree legislation in 2006-7 in the UK, few groups of workers remained exposed to secondhand smoke (SHS) at work, but prisons received partial exemption. On 30th November 2018, Scotland’s prisons became smokefree (whilst prisons in England became smokefree in a phased manner between 2016 and 2018). Although other countries had introduced smokefree prisons, there was a lack of research evidence. This workshop will describe the 3-Phase Tobacco in Prisons study (TIPs) which has collected and disseminated data on prisoner and staff views on smoking and smoking bans in prisons, levels of SHS, and provision of services across Scotland’s prisons, both prior to announcement in July 2017 that Scotland’s prisons would go smokefree (Phase 1) and in the lead-up to implementation in November 2017 (Phase 2). Data collection on outcomes of the smokefree policy (Phase 3) is ongoing. The workshop will discuss partnership working and the use of research evidence in the process of initiating and introducing this policy.

3 WS4 & WS9 Smoke-free environments: Where to next? Led by Sean Semple Institute for Social Marketing, University of Stirling

This workshop will look at Scotland’s leading research on measuring exposure to second-hand smoke (SHS) in a variety of environments including the workplace, home and car. Participants will learn about how data from these measurements has been used to contribute to the Scottish Government mass media campaign ‘Take it right outside’ and helped shape some of the key messages in that campaign. The workshop will also discuss how real-time measurements have been used in behaviour change work to encourage parents to make their home smoke-free: work developed with smokers in Aberdeen and Lanarkshire and more recently studied in Catalonia, Greece and Italy. The use of SHS measurement to help drive changes around smoking in cars in Scotland will be presented, together with some insights into the use of SHS measurement to evaluate the recent introduction of smoke- free prisons in Scotland. The session will also reflect on the development of instruments to quantify SHS exposure and how these may provide future opportunities to change smoking behaviour as we look towards a tobacco-free generation in Scotland by 2034.

WS5 & WS10 Plain packaging Led by Crawford Moodie Institute for Social Marketing, University of Stirling

The ‘Standardised Packaging of Tobacco Products Regulations’ and ‘Tobacco and Related Products Regulations’ have significantly altered the appearance of cigarette packaging across the UK. The legislation, which became mandatory in May 2017, after a twelve-month transition period, requires cigarettes and rolling tobacco to come in packs with a drab brown base colour, large pictorial health warnings on the front and back of packs, and text warnings on the secondary surfaces. This session will consider the rationale for standardised packaging, legislative differences between countries which have fully implemented this policy, and opportunities for strengthening this policy. While regulators and public health have tended to focus on how the exterior of the cigarette pack could be used to deter consumers, there has been very little consideration of how the pack interior, for instance, pack inserts or indeed the cigarettes themselves, could be used to discourage use. The session will also consider research on pack inserts promoting cessation and dissuasive cigarettes.

WP6 Local availability and pricing of tobacco products: the next frontier in tobacco control? Led by Jamie Pearce1 and Niamh Shortt1 with contributions from Fiona Caryl2, Helena Tunstall1 and Richard Mitchell2 1 Centre for Research on Environment, Society & Health, School of Geosciences, University of Edinburgh. 2 Institute of Health & Wellbeing,

The Scottish Government’s 5-year action plan “Raising Scotland's tobacco-free generation: our tobacco control action plan 2018” identifies: a) restrictions on the number and density of tobacco retailers; and b) further pricing measures as priority areas for action and potential legislation. This workshop will evaluate the evidence linking local availability, pricing and smoking-related outcomes. This will include presenting new findings from CRUK and NHS-Scotland funded research on how availability and pricing varies across communities in Scotland. Discussion will also consider the implications of a variety of policy scenarios designed to reduce the availability of tobacco products.

4 WP7 E-cigarettes: A changing policy landscape?

Led by Sally Haw1, Catherine Best2 and Andy MacGregor3 with contributions from Luke Clancy4 1 Faculty of Health Sciences & Sport, University of Stirling 2 Institute for Social Marketing, University of Stirling 3 Scottish Centre for Social Research, Edinburgh 4 Tobacco-free Research Institute, Dublin, Ireland

The rapid growth of e-cigarette use in Scotland, the rest of the UK and Europe raises some challenging issues for tobacco control. In this workshop we will bring together data on patterns of use in adults and young people in Scotland and the UK and compare it with available data from Europe and elsewhere. With workshop members we will consider the implications of patterns of use amongst young people and adults for the promotion of e-cigarettes, prevention of e-cigarette initiation and the reduction of tobacco-related harm in adolescent and adult smokers.

5 Biographies

Catherine Best

Dr Catherine Best was a Statistician on the Determining the Impact of Smoking Point of Sale Legislation Among Youth (DISPLAY) Study. Her research interests are mainly methodological, focusing on data management and statistical methods in population and public health research. She has worked on projects involving survey data analysis, analysis of linked administrative data sets, and the conduct and analysis of randomized controlled trials. In addition to the DISPLAY study, her recent work includes describing the epidemiology and clinical outcomes of psychiatric/self-harm calls to the Scottish Ambulance Service and evaluation of the effectiveness of assistive technology in supporting people with acquired brain injury in their activities of daily living. She has also published a number of systematic literature reviews.

Sheila Duffy

Sheila Duffy became Chief Executive of ASH Scotland in January 2008. She has key responsibility for the organisation's strategic and operational direction, working towards a healthier Scotland, free from the harms and inequalities linked to tobacco use. Currently, Sheila’s priorities are tackling tobacco-related poverty and inequalities and preventing youth uptake of tobacco. In 2013 she spearheaded a successful ASH Scotland campaign for a smoke-free policy for the Glasgow 2014 Commonwealth Games, and helped secure a strong Government commitment to standardised tobacco packaging. She has played a key role in securing Scotland’s tobacco legislation over the past two decades, including ending tobacco point of sale displays, and bringing in smoke-free vehicles with under 18s present.

Joe FitzPatrick

Joe FitzPatrick was appointed Minister for Public Health, Sport and Wellbeing in June 2018. He was born in Dundee in 1967 and was educated at Whitfield High School. He studied forestry at Inverness College where he became the first sabbatical president of the student union before going on to become the elected NUS convener for the north of Scotland. He also worked for the Forestry Commission and later continued his education at Abertay University, gaining a first class honours degree in science. He was an assistant to Shona Robison and Stewart Hosie in the SNP constituency office in Dundee before being elected to Dundee City Council in 1999. He was elected to the Scottish Parliament in May 2007, winning the Dundee City West seat and went on to serve on the Holyrood Finance Committee and as convener of the Local Government and Regeneration Committee. Joe FitzPatrick was appointed Minister for Parliamentary Business in September 2012.

6 Douglas Eadie

Douglas started his professional career as a Research Assistant and latterly a Research Fellow with the Advertising Research Unit at Strathclyde University. After a brief period as a Senior Lecturer in marketing at Strathclyde, he joined the Centre for Social Marketing, moving to the Institute for Social Marketing in Stirling in 2004, where he has contributed to the development of numerous public health campaigns and interventions. This work forms the focus of much of his writing where he has published widely.

Sally Haw

Sally Haw is Professor of Public & Population Health at the University of Stirling. Her research interests focus on public health issues (particularly tobacco control and adolescent risk behaviour), research design (both qualitative and quantitative methods and the use of routine health and behavioural data) and the development of methods to evaluate public health policies and complex interventions. She led the evaluation of Scotland’s smoke-free legislation. Her most recent projects include evaluations of tobacco control mass media campaigns and Scotland’s tobacco point of sale legislation, a study of E-cigarette use and smoking, and a collaborative study with colleagues from Brazil about Right to Health in Prison.

Kate Hunt

Kate is Professor of Behavioural Science and Health at the University of Stirling. With a background in social and biological sciences, Kate’s research has focused on understanding and improving human health and wellbeing, with a particular interest in the social determinants of health, health behaviours and health inequalities. In her current research, she is committed to working in partnership with the public and key stakeholders to ensure that policies and interventions to improve health are culturally informed, and relevant to policy makers and to major public health issues nationally and internationally.

7 Andy MacGregor

Andy is the Director of Policy Research at ScotCen Social Research, an integral part of NatCen Social Research, Britain’s leading centre for independent social research. Andy led the qualitative component of the Determining the Impact of Smoking Point of Sale Legislation Among Youth (DISPLAY) Study with Professor Amanda Amos, which obtained the views of secondary pupils before and after the point of sale advertising ban was implemented. His other work in the tobacco control field includes leading the following Cancer Research UK TAG grants: smoking inequalities in those aged 16–24, the evaluation of the tobacco retail register, and a survey of adults in England and Scotland in relation to e-cigarette marketing. He has also carried out many relevant mixed methods and qualitative research projects in the health, central government, local authority and voluntary sectors. He graduated MBChB in medicine in 1990 and MSc in Health Promotion and Health Education in 1993.

Judith Mackay, OBE

Judith Mackay is a British medical doctor, who has lived in Hong Kong since 1967, initially working as a hospital physician, then since 1984 concentrating on public health. She is Senior Advisor, World Lung Foundation/Bloomberg Initiative to Reduce Tobacco Use, and also to the Bill and Melinda Gates Foundation; Director of the Asian Consultancy on Tobacco Control; and Senior Policy Advisor to World Health Organisation. She is an Honorary Professor at the School of Public Health, the University of Hong Kong. She has authored several atlases on health, cancer, cardiovascular disease, tobacco, surveillance and oral health. In addition to many international awards, ranging from the WHO Commemorative Medal and the TIME 100 award to the first BMJ Group Lifetime Achievement Award, she has been identified by the tobacco industry as one of the three most dangerous people in the world.

Crawford Moodie

Crawford is a Senior Research Fellow at the Institute for Social Marketing (ISM) at the University of Stirling. He is a graduate of Glasgow Caledonian University where he completed his undergraduate degree in Psychology in 2003 and his PhD in 2007. Since joining ISM in 2007, Crawford has worked on the impact of the commercial marketing of tobacco, alcohol and gambling on consumer attitudes and behaviour. His research is mostly related to tobacco and in particular tobacco packaging. His primary focus has been on how tobacco packaging has been, and continues to be, used as a promotional tool, and how it could potentially be used to discourage smoking. He has given more than 50 presentations, and has been an author on approximately 70 publications and reports, on tobacco packaging. He has been lead or co- investigator in more than a dozen projects on packaging. He currently supervises, and has previously supervised, a number of PhD students on tobacco and alcohol packaging or marketing.

8 Jamie Pearce

Professor Jamie Pearce graduated in Geography from Durham University before completing his postgraduate studies at the Universities of Leicester and St Andrews. He joined the University of Edinburgh as a Reader in Human Geography in early 2009 and was promoted to Professor in 2011. With colleagues at Edinburgh and Glasgow, he contributed to establishing the Centre for Research on Environment Society and Health (CRESH). The research of the centre is concerned with exploring how physical and social environments can influence population health, including the consumption of unhealthy commodities (alcohol, tobacco, ultra-processed food). His research seeks to identify and understand various social, political and physical mechanisms operating at a range of geographical scales that establish and perpetuate spatial inequalities in health. He has published widely on the geographical drivers of smoking, including the availability and promotion of tobacco products, and including his co-authored book, Smoking Geographies: Space, Place and Tobacco (Wiley-Blackwell). He is also Editor-in-Chief of the journal Health and Place.

Sean Semple

Sean Semple is an Associate Professor in the Faculty of Health Sciences and Sport at the University of Stirling. He joined the Institute for Social Marketing in January 2018 after 20 years working at the University of Aberdeen. He is interested in human exposure science with particular emphasis on the health effects of indoor air pollution, tobacco control research, and occupational epidemiology. He has been involved in second-hand smoke research since 2005 and has published work examining second-hand smoke concentrations in bars, cars, prisons and homes. He helped the Scottish Government develop the ‘Take it right outside’ mass media campaign and his recent research has looked at using air quality feedback as a tool to encourage smokers to make their homes smoke-free.

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