The Impact of Tobacco Laws Introduced Between 2010 and 2016

The impact of tobacco laws introduced between 2010 and 2016 Survey form Introduction We are conducting a post-implementation review looking at the tobacco legislation introduced between 2010 and 2016. The review considers how effective tobacco legislation has been in: discouraging young people from taking up smoking and vaping encouraging existing smokers to quit protecting others from the harmful effects of cigarette smoke The legislation introduced during this time includes bans on: displaying tobacco products and prices in shops selling nicotine-inhaling products, including e-cigarettes, to under 18s buying nicotine-inhaling products on behalf of someone under 18 (proxy purchas- ing) smoking in cars containing children We want your opinions and evidence on the legislation. Your views will help us to assess whether the legislation has achieved its objective. Instructions Please complete this application form in word format. You will be able to change the sizes of the answer boxes as appropriate for your answer. You do not have to respond to every question. You can choose to respond to only those questions that are relevant to you. Please return this form by email when completed to: [email protected] If you wish to respond in writing, please print and complete this form, attaching any addi- tional sheets as necessary and send it to the address below. If you would prefer not to use the form, or are unable to do so, please write with your answers and comments to: 2 Tobacco Legislation Consultation 2019 Healthy Behaviours Department of Health and Social Care 2N04 Quarry House LS2 7UE 3 Consultation questions Section 1: The Tobacco Advertising and Promotion (Display) (England) Regulations 2010 These regulations apply to the display of tobacco products in small and large shops (display ban) and came into force on 6th April 2012 in larger shops and 6th April 2015 for all other outlets. The regulations prohibit the display of tobacco products in small and large shops, allowing trading to continue but preventing them from being used as promotional tools. All retailers are required to cover up cigarettes and hide all tobacco products from public view. The full Tobacco Advertising and Promotion (Display) (England) Regulations 2010 are published on Legislation.gov.uk Objectives To protect children and young people from health harms of smoking. Create a supportive environment for adults who are trying to quit smoking by implementing the prohibition of tobacco products displays. The regulations recognise that retailers need to be able to serve customers and restock products, and that staff need to know where products are kept. Do you think the display ban of tobacco in small and large shops has helped to reduce the number of children and young people smoking? ☐ Yes, I think it has ☐ No, I don’t think it has ☐ I don’t know if it has or has not Please give reason(s) for your answer. 1. Action on Smoking and Health (ASH) is a public health charity set up by the Royal College of Physicians in 1971 to advocate for policy measures to reduce the harm caused by tobacco. ASH receives funding for its programme of work from the British Heart Foundation and Cancer Research UK. ASH does not have any direct or indirect links to, or receive funding from, the tobacco industry, or receive funding from any other commercial organisation. 4 2. ASH welcomes the opportunity to submit evidence to the consultation on the impact of tobacco laws introduced between 2010 and 2016. We have included links to the evidence we cite in the body of the response and full references below. 3. As the Government’s Impact Assessment notes: “Single actions will not, on their own, succeed in substantially driving down rates of smoking prevalence. The decision to end tobacco displays is one action within the overall comprehensive strategy.” (DH, 2011, pp. 16). 4. The Tobacco control regulations are part of an overall comprehensive strategy of tackling tobacco by the British Government, first set out in the White Paper Smoking Kills in 1998, and ratcheted up by successive Governments since then to great effect. In 2007 for the first time the UK was ranked top in Europe for its implementation of tobacco control policies and it has remained the top ranking country since then. (Joossens L & Raw M, 2017) 5. It is this comprehensive regulatory approach which has been shown to be effective in delivering substantial declines in smoking prevalence and uptake, and the effectiveness of the approach as a whole is greater than the sum of its parts. (Gravely S et al, 2017; Beard E et al, 2019) In 2007 smoking rates in the UK were the same as the European average, ten years later the UK’s smoking rates were a third lower than average, and we had the lowest tobacco use in Europe. (Feliu et al, 2018; Special Eurobarometer 458, 2017). 6. A range of evidence supports the conclusion that the display ban of tobacco in small and large shops has helped achieve the objective of reducing the number of children and young people smoking. Furthermore that the regulations should be not just retained but enhanced. Declines in smoking prevalence in young people 7. In England smoking rates among children and young people have continued to decline since the implementation of the ban. In 2010, pre-ban, 9% of 11-15 year olds in England were current smokers, and the proportion who had ‘ever smoked’ was 27%. In 2013, the year after the ban on PoS tobacco displays in large shops was introduced, the current smoker rate had fallen to 7%, falling to 6% by 2016, a year on from the full PoS display ban and 5% by 2018. In 2013 21% had “ever smoked”, falling to 19% in 2016 and 16% in 2018. (NHS Digital, 2019). 8. That the display regulations played a role in this decline is supported by the evidence from 25 countries in Europe, that the implementation of PoS display bans was associated with a significantly larger drop in the odds of regular adolescent smoking both in boys and girls than in countries without display bans (Van Hurck M et al, 2018). 5 9. Furthermore a study using data collected from 130 countries between 2007 and 2011 found that countries with PoS tobacco bans had seen a reduction in youth current smoking, daily smoking and regular smoking in the previous months (Shang C et al, 2016). PoS display and child and youth smoking susceptibility 10. Children and young people, like adults, are susceptible to tobacco promotion. There is evidence that exposure to tobacco promotion increases the likelihood that adolescents will start to smoke (Lovato C, Watts A, Stead LF, 2011) 11. Point of Sale (PoS) tobacco displays are a form of promotion, and the way in which the pack was used to promote the product prior to implementation of the display ban has been documented. (ASH Briefing, December 2013) 12. Promotion at point of sale increases youth smoking by increasing susceptibility to smoking and odds of smoking experimentation and initiation (Paytner J, Edwards R, 2009; Robertson L et al, 2016; Mackintosh AM et al, 2012). A 2016 meta-analysis concluded that children and adolescents more frequently exposed to PoS tobacco promotion have around 1.6 times higher odds of having tried smoking and around 1.3 times higher odds of being susceptible to future smoking, compared with those less frequently exposed. (Robertson L et al, 2016). 13. Research also shows young people believe that PoS displays encourage smoking and are considered “cool, fun and attractive” (Brown A & Moodie C, 2010). Research in Australia and USA found that PoS promotion of cigarettes normalises tobacco use for children and creates perception that tobacco is easily obtainable (Wakefield M et al, 2006; Henriksen L et al, 2002). 14. Any measures, therefore, which reduce youth exposure to tobacco promotion and tobacco products are likely to be effective in reducing youth susceptibility to smoking and youth smoking behaviour. Given comprehensive bans on other forms of tobacco advertisement in the UK, PoS displays represented one of the last forms of youth exposure to tobacco promotion. 15. Brand recognition is also an important driver of susceptibility to smoke. Young people professing an intention to smoke are more likely to recall brands that they had seen at PoS (Cancer Research UK, 2008). One UK study involving over 2,000 11-16 years found that recognising a higher number of brands among non-susceptible never smokers doubles the risk of becoming susceptible to smoking and of becoming a smoker (Bogdanovica I et al, 2015). 6 16. A recent study found youth smoking susceptibility (defined as the absence of a firm decision not to smoke) among UK teenagers aged 11-16 decreased following the implementation of PoS tobacco ban, from a high of 28% pre-ban (2011), to 23% mid- ban (2014) and 18% post-ban (2016). The researchers suggest this effect was driven by a reduction in brand recognition, with the mean number of tobacco brands recalled by youth respondents declining from 0.97 pre-ban to 0.69 post-ban (Ford A et al, 2019). Why the display ban is still needed following implementation of standard packs legislation 17. Tobacco companies paid for tobacco gantries not just to promote their pack design but also to make tobacco a product that is highly visible to anyone visiting the store. (ASH December 2013) 18. Displays in shops which are sited immediately behind the counter promote the idea that smoking is normal and removing them helps denormalise smoking. For example, in Ireland there was an immediate impact on young people’s beliefs about smoking when the display ban was implemented, with the proportion of young people believing that more than a fifth of people their age smoked declining from 62% to 46%.

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