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 intro- duced 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 (dis- play 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%. Furthermore 38% of teenagers thought the law would make it easier for children not to smoke (McNeill A et al, 2011).
19. In England the proportion of children noticing tobacco at PoS most or every time they visited a shop declined by nearly 14 percentage points from 59.6% in 2011 to 45.7% in 2013. This was before the ban was implemented in small shops in 2015 which tend to be the greatest source of exposure so it is likely that the proportion noticing tobacco has declined still further since then.(Bogdanovica I et al, 2017).
20. The declining trend in exposure to tobacco is found in other surveys too, with the proportion of children aged 11-15 who have “not seen cigarette packets on display” in any retail locations steadily increasing, from 5% in 2012, to 7% in 2014, 14% in 2016 (a noticeably large increase following full implementation of the ban) and 17% in 2018 (NHS Digital, Table 3.25. 2019).
21. Findings from ASH’s Smokefree GB Youth Survey (respondents aged 11-18) also demonstrate the same trend. When asked how often they notice tobacco products for sale in supermarkets and newsagents/off-licenses/corner shops in 2013, 9% of respondents said they saw them ‘Every time’ in supermarkets and 26% in smaller shops. Responses for ‘Never’ were 22% and 10% (for supermarkets and smaller shops, respectively). In 2016, a year-on from the full ban, 5% said they saw them ‘Every time’ in supermarkets and 14% in small shops, and 30% said they ‘Never’ saw them in supermarkets and 18% in small shops. However, in 2019 it was still the
7 minority who said they ‘Never’ saw tobacco displays, at 30% for supermarkets and 21% for small shops. (ASH/YouGov, 2013, 2016, 2019).
22. This reduced exposure has contributed to the denormalisation of tobacco. In the UK in 2014, mid-ban, 73% of 11-16 year old never smokers held the view that “Having cigarette packs behind shutters in shops make cigarettes seem unappealing” and 83% thought “Having cigarette packs behind shutters in shops makes me think that it’s NOT OK to smoke.” The rates of never smoking 11-16 year olds holding each of these views increased by 4 percentage points in 2016, post-ban, to 77% and 87%, respectively (Ford A et al, 2019).
23. Post implementation of the display ban the proportion of 11-15 year olds sourcing cigarettes through shops has reduced, indicating the ban has helped make it more difficult for young people to get hold of cigarettes. During the years 2008-2012, pre-ban implementation, the proportion of current youth smokers reporting that their usual source of cigarettes was from supermarkets remained relatively stable at 12% in 2008, 10% in 2010 and then 11% in 2012. However, in 2014, 2 years on from the partial PoS tobacco ban implemented in large stores such as supermarkets, the proportion decreased to 7%, increasing slightly to 8% for 2016 and 2018, but still significantly lower than pre-ban levels (NHS Digital, 2019).
24. The effect of the PoS tobacco ban is also evident when looking at small shops, where the ban was implemented in 2015. During the years 2008-2014, pre-ban implementation, the proportion of current youth smokers reporting their usual source of cigarettes was smaller shops such as newsagents/tobacconists/sweetshops remained stable between 37% and 36%. However, in 2016, a year on from the introduction of the ban for small shops and thus full implementation, this rate dropped substantially to 22% and continued to decrease to 16% in 2018 (NHS Digital, 2019).
25. These findings are reinforced by a study which found a reduction in the proportion of regular child smokers reporting that they bought cigarettes in shops (from 57% pre-ban in 2010 to 39.8% post-ban in 2016) (Laverty A, 2018).
References (in alphabetical order)
Action on Smoking and Health. Opinion research by YouGov. Youth Smokefree 2013, 2016, 2019.
Action on Smoking and Health. Tobacco Displays at the point of sale. December 2013.
Beard E et al. 'S'-shaped curve: modelling trends in smoking prevalence, uptake and cessation in Great Britain from 1973 to 2016. Thorax. 2019 Sep;74(9):875-881. doi: 10.1136/thoraxjnl-2018-212740. Epub 2019 Aug 7.
8 Bogdanovica I et al. Exposure to point-of-sale displays and changes in susceptibility to smoking: findings from a cohort study of school students. Addiction. 2015 Apr;110(4):693-702. doi: 10.1111/add.12826.
Bogdanovica I et al. Cohort study investigating the effects of first stage of the English tobacco point-of-sale display ban on awareness, susceptibility and smoking uptake among adolescents. BMJ Open 2017;7:e012451. doi: 10.1136/bmjopen-2016-012451
Brown A & Moodie C. Adolescents' perceptions of tobacco control measures in the United Kingdom. Health Promot Pract. 2012 Jan;13(1):41-7. doi: 10.1177/1524839910369222.
Cabinet Office and Department of Health and Social Care. Advancing our health: prevention in the 2020s. July 2019.
Cancer Research UK. Point of Sale Display of Tobacco Products. August 2008
Department of Health. Impact assessment on the prohibition of display of tobacco products at the point of sale in England. October 2011, pp.16.
Feliu A et al. Impact of tobacco control policies on smoking prevalence and quit ratios in 27 European Union countries from 2006 to 2014. Tob Control. 2019 Jan;28(1):101-109. doi: 10.1136/tobaccocontrol-2017- 054119. Epub 2018 Feb 22.
Ford A et al. Impact of a ban on the open display of tobacco products in retail outlets on never smoking youth in the UK: findings from a repeat cross-sectional survey before, during and after implementation. Tobacco Control Published Online First: 14 May 2019. doi: 10.1136/tobaccocontrol-2018-054831
Gravely S et al. Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study. Lancet Public Health 2017; 2: e166–74, March, 2017.
Henriksen L et al. Effects on Youth of Exposure to Retail Tobacco Advertising. Journal of Applied Social Psychology 32(9):1771 - 1789 · July 2006. DOI: 10.1111/j.1559-1816.2002.tb00258.
Joossens L & Raw M. The tobacco control scale 2016 in Europe. Association of European Cancer Leagues, March 2017.
Laverty A et al. Child awareness of and access to cigarettes: impacts of the point-of-sale display ban in England. Tobacco Control 2019;28:526-531.
Lovato C, Watts A, Stead LF. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database Syst Rev. 2011 Oct 5;(10):CD003439. doi: 10.1002/14651858.CD003439.pub2.
9 Mackintosh AM et al. The Association Between Point-of-Sale Displays and Youth Smoking Susceptibility. Nicotine & Tobacco Research, Volume 14, Issue 5, May 2012, Pages 616–620, https://doi.org/10.1093/ntr/ntr185
McNeill A et al. Evaluation of the removal of point-of-sale tobacco displays in Ireland. Tobacco Control 2011;20:137-143.
NHS Digital. Smoking, Drinking and Drug Use among Young People in England 2018. August 2019.
Paytner J, Edwards R. The impact of tobacco promotion at the point of sale: a systematic review. Nicotine Tob Res. 2009 Jan;11(1):25-35. doi: 10.1093/ntr/ntn002. Epub 2009 Jan 27.
Robertson L et al. Point-of-sale tobacco promotion and youth smoking: a meta-analysis. Tobacco Control 2016;25:e83-e89.
Shang C et al. Global Evidence on the Association between POS Advertising Bans and Youth Smoking Participation. Int J Environ Res Public Health. 2016 Mar 9;13(3). pii: E306. doi: 10.3390/ijerph13030306.
Special Eurobarometer 458: Attitudes of Europeans towards tobacco and electronic cigarettes. European Commission Directorate-General for Communication. 2017.
Van Hurck M et al. Impact of removing point-of-sale tobacco displays on smoking behaviour among adolescents in Europe: a quasi-experimental study. Tobacco Control 2019;28:401-408
Wakefield M et al. An experimental study of effects on schoolchildren of exposure to point-of-sale cigarette advertising and pack displays. Health Education Research, Volume 21, Issue 3, July 2006, Pages 338–347, https://doi.org/10.1093/her/cyl005
Do you think the tobacco display ban has encouraged and supported adult smokers to quit?
☐ 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. A range of evidence, set out below, demonstrates that the PoS tobacco display ban has encouraged and supported adult smokers to quit.
10 2. PoS tobacco display and promotion is associated with smoking behaviour (Paytner J, Edwards R, 2009; Robertson L et al, 2016; Ollila H, 2015). Furthermore, as a systematic review shows, this association is reversible (Robertson L et al, 2016)
3. Using data from 129,957 respondents one study concluded that even the 2012 partial PoS ban led to an decline in smoking prevalence which could not be accounted for by other drivers such as seasonal factors, e-cigarette use or price changes (Kuipers MA et al, 2017).
4. These findings are reinforced by international evidence. A study using data from 77 countries between 2007 and 2014 found that PoS display bans reduced overall adult daily smoking, male smoking and female smoking by about 7%, 6% and 9% respectively (Yanyun He et al, 2018).
5. There is also evidence from an Australian study that a PoS display ban reduced impulse purchasing and cravings, thereby supporting adult smokers both to quit and to maintain an ongoing quit attempt. When shopping for items other than cigarettes, 1 in 4 adult smokers had purchased cigarettes on impulse as a result of seeing a PoS display. Furthermore, 38% of smokers who had tried to quit in the past 12 months and 33.9% of recent quitters experienced an urge to buy cigarettes as a result of seeing a PoS display (Wakefield M et al, 2008).
6. That PoS tobacco displays are a barrier to quitting is further evidenced by the fact that 1 in 5 smokers trying to quit, and 1 in 8 recent quitters, reported avoiding stores where they usually bought cigarettes in case they might be tempted to purchase them. Nearly a third of smokers agreed that the removal of PoS displays would make it easier for them to quit (Wakefield M et al, 2008).
7. The strong association between PoS tobacco promotion and impulse purchases is supported by several other studies (Carter OB et al, 2009; Germain D et al, 2010; Siahpush M et al, 2016), with one study comparing two countries which had implemented a PoS display ban of tobacco at the time, Australia and Canada, with two countries which had not, UK and US, finding that impulse purchasing of cigarettes was lower in those that had implemented a PoS display ban (Li L et al, 2013).
8. The impact of the PoS display ban in reducing adult exposure, thereby supporting adult quitting and quit attempts, is also shown by the results of the ASH Smokefree GB survey. When asked “How strongly, if at all, do you agree or disagree” with the statement “I often notice cigarette packs on display in shops”, in 2011, pre-ban, 52% of respondents in England agreed with the statement, with just 24% disagreeing. In 2013, a year on from the partial ban, 30% of respondents agreed, with a majority, 44%, disagreeing. By 2016, a year on from the full ban, just 15% of respondents agreed, with 62% disagreeing (ASH/YouGov, 2011, 2013, 2019).
11 9. These findings also demonstrate the PoS display ban has had greater impact on smokers than non-smokers. Breaking down answers to the above question according to smoking status, we can see that in 2011, pre-ban, smokers were more likely to agree that they often notice cigarette packs on display (54%) and less likely to disagree (18%) than non-smokers (51% and 26%, respectively). In 2016, these findings change, with smokers less likely to agree that they often notice cigarette packs on display (11%) and more likely to disagree (67%) than non-smokers (16% and 61%, respectively). This trend has been maintained, with the latest available data showing that in 2018, smokers remained less likely to agree that they often notice cigarette packs on display (12%) and much more likely to disagree (71%) than non-smokers (14% and 66%, respectively) (ASH/YouGov, 2011, 2016, 2018).
References (in alphabetical order)
Action on Smoking and Health. Opinion research by YouGov. Smokefree GB Survey 2013, 2016, 2018, 2019.
Carter OB et al. The effect of retail cigarette pack displays on unplanned purchases: results from immediate postpurchase interviews. Tob Control. 2009 Jun;18(3):218-21. doi: 10.1136/tc.2008.027870.
Germain D et al. Smoker sensitivity to retail tobacco displays and quitting: a cohort study. Addiction. 2010 Jan;105(1):159-63. doi: 10.1111/j.1360-0443.2009.02714.x.
Kuipers MA et al. Impact on smoking of England's 2012 partial tobacco point of sale display ban: a repeated cross-sectional national study. Tob Control. 2017 Mar;26(2):141-148. doi: 10.1136/tobaccocontrol-2015- 052724.
Li L et al. Impact of point-of-sale tobacco display bans: findings from the International Tobacco Control Four Country Survey. Health Educ Res. 2013 Oct;28(5):898-910. doi: 10.1093/her/cyt058.
Ollila H. Best practices on implementation of the tobacco advertising and display ban at point of sale (Article 13 of the WHO FCTC) A four-country study: Ireland, Norway, Finland and the United Kingdom. July 2016
Office for National Statistics. Adult smoking habits in the UK: 2018. July 2019.
Paynter J, Edwards R. The impact of tobacco promotion at the point of sale: a systematic review. Nicotine Tob Res. 2009 Jan;11(1):25-35. doi: 10.1093/ntr/ntn002. Epub 2009 Jan 27.
Robertson L et al. Point-of-sale tobacco promotion and youth smoking: a meta-analysis. Tobacco Control 2016;25:e83-e89.
Siahpush M et al. Point-of-Sale Cigarette Marketing, Urge to Buy Cigarettes, and Impulse Purchases of Cigarettes: Results From a Population-Based Survey. Nicotine Tob Res. 2016 May;18(5):1357-62. doi: 10.1093/ntr/ntv181.
12 Wakefield M et al. The effect of retail cigarette pack displays on impulse purchase. Addiction. 2008 Feb;103(2):322-8.
Yanyun He et al. Global evidence on the effect of point-of-sale display bans on smoking prevalence. Tobacco Control 2018;27:e98-e104.
What impact do you think the display ban has had on:
(a) The general population;
(b) Retailers;
(c) Manufacturers;
(d) Other stakeholders (please specify);
Please provide details and evidence for your answers.
(a) The general population
1. There is evidence that the tobacco display ban has had a positive impact on the general population.
2. As evidenced above, the general population are now substantially less likely to notice tobacco displays in shops which helps denormalise tobacco use, discourages uptake and motivates and supports smokers wanting to quit.
3. Public support for banning PoS display of tobacco products has been high since before the regulations were implemented, with a majority of the population supporting the measure. Furthermore, support has increased over time, following the implementation of the display bans. In 2011, pre-implementation, 50% of the population supported prohibiting PoS display of tobacco products, with only 26% opposing. In 2013, a year on from the partial ban in large shops, 61% supported the measure, with only 16% opposing. In 2016, a year on from the full ban, 70% supported the measure with only 10% opposing. Today, in 2019, 73% support the measure, with only 9% opposing (ASH 2017, ASH 2019).
4. There is also growing public support for government to do more to limit smoking. In 2019 more than three quarters (77%) of adults in England supported activities to limit smoking or thought Government should do more. Support for Government to do more to limit smoking increased from 29% in 2009, to 38% in 2016, reaching
13 46% in 2019.[2] The proportion of respondents who think that Government is doing too much has fallen from 20% in 2009 to 7% in 2019. (ASH 2017, ASH 2019)
(b) Retailers
5. ASH commissioned a survey from the market research agency NEMS in August 2019 to provide quantitative input from a range of independent retailers to this consultation. The survey, carried out by telephone, found that 71% of small retailers selling tobacco did not think the display ban had an impact on their business, 5% thought the impact had been positive and 19% that it had been negative. The 558 respondents to the survey across England were convenience stores, off-licences, newsagents, independent fuel services and tobacconists, with 61% supporting the display ban. (ASH/NEMS 2019)
6. Retailer compliance with PoS display bans of tobacco has been found to be very high. A UK study, conducted 7-14 days post implementation of the 2015 ban, found that 98% of small retail outlets selling tobacco in four communities in Scotland (selected to achieve representation of different levels of urbanisation and social deprivation) had removed tobacco from permanent display and that “non- compliance was restricted almost entirely to minor contraventions.” (Eadie D et al, 2016).
7. One argument raised against PoS legislation prior to its implementation was that PoS ban would increase the transaction time for tobacco consumers considerably as they try to decide which brand they will buy, thereby impacting on queuing time, which was said to be the biggest reason for the loss of repeat customers. These claims have not been shown to be evidence-based. Smokers are very brand loyal with Australian research showing that less than 10% change the brand they smoke annually (Cummings KM et al, 1997; Wakefield M et al, 2002). A survey commissioned by Cancer Research UK confirms this, with most smokers (90%) always buying the same brand of tobacco and a very small minority (6%) reporting making a brand purchase decision based on the shop display (Cancer Research UK, 2008).
8. Concerns about the financial burden which PoS display ban of tobacco implementation would place on retailers have also proved to be unfounded. The Association of Convenience Stores (ACS) estimated the cost to each retailer of implementing the ban to be up to £10,000 (Scottish Grocers’ Federation, 2009). The Government’s own Impact Assessment disagreed with this, placing the one-off cost at £450 for small shops and £850 for large shops (DH, 2011). In Ireland, the average cost to the retailer was around £300, and the tobacco industry funded over 90% of the cost in 40% of shops (WHO, 2017). Similarly, in Canada, 98% compliance was achieved with minimal cost to retailers (Blau J & Greaves L, 2005).
14 9. Looking at the ban’s implementation in the UK, retailers in Scotland described being offered and benefitting from a range of financial and other incentives post-ban, with most retailers receiving tobacco manufacturer support for converting their storage units to be compliant (Stead M et al, 2018).
(c) Manufacturers
10. The Government recently set out its ambition for England to go smoke-free by 2030 giving the industry an ultimatum to make smoked tobacco obsolete by 2030 (DHSC, 2019).
11. The primary objective of the display legislation is to reduce smoking uptake by children and young people and support adults smokers to quit. To be effective the legislation by necessity will have a negative impact on tobacco sales by tobacco manufacturers.
12. As cited above, tobacco manufacturers voluntarily offered retailers financial incentives and support to make their storage units compliant with new legislation following the PoS ban. Furthermore, manufacturers, via their sales representatives, offered retailers incentives for maintaining stock levels and availability, positioning brands in specified spaces in the public-facing storage units (despite them being covered up), increasing sales, trailing new products and participating in specific promotions, such as verbally recommending specific brands to customers (Stead M et al, 2018).
13. The above evidence demonstrates tobacco manufacturers continue to value promotion at the point of sale and have sought the continuation of this practice despite legislation aiming to prevent it, thereby reinforcing the need for such legislation and for consideration about how it might be strengthened to support delivery of the 2030 smoke-free ambition.
(d) Other stakeholders
14. The primary enforcement agency of PoS regulation (and other regulation such as age of sale, both of tobacco and e-cigarettes) is Trading Standards who are a key stakeholder.
15. As noted earlier, compliance with the PoS display ban of tobacco is very high. (Eadie D et al, 2016) However, effective implementation of the PoS display ban still requires adequately resourced enforcement, yet Trading Standards, have faced severe cuts over the years. The National Audit Office has calculated that the number of full-time
15 equivalent Trading Standards staff has decreased by 56% in seven years, from 2,534 in 2009 to 1,561 in 2016, with 81% of teams reporting that funding reductions have had a negative impact on their ability to protect consumers in their area (NAO, 2016).
16. There is no direct financial gain to Councils and Trading Standards from their enforcement activity which results in reduction of illicit trade and underage sales, so it is hardly surprising that funding has been cut. In 2009 spending on trading standards was £213 million; in 2018/19 it is due to fall to just over half that, at £108 million (Labour Communities & Local Government, 2018).
17. To ensure these and the other tobacco retail regulations are most effectively enforced and, more broadly, to ensure the illicit market in tobacco continues to decline, additional funding for regional trading standards operations is needed to support enforcement activity at local level. Such regional activity has been shown to be effective where it has been funded (NAO 2013-14)
18. The tobacco manufacturers should be required to provide funding to government to pay for this in line with the ‘polluter pays’ principle as suggested in the ASH report Smoking Still Kills endorsed by over 120 health organisations, (Smoking Still Kills 2015) and subsequently suggested as an option the Green Paper Advancing our health: Prevention in the 2020s – consultation document.
References (in alphabetical order)
Action on Smoking and Health. Annual online survey by YouGov for ASH. Total sample size in 2019 for England was 10338 adults (and 12393 for GB). Fieldwork was undertaken between 12th February 2019 and 10th March 2019. The surveys are carried out online and the figures have been weighted and are representative of all English adults (aged 18+). ASH 2019.
Action on Smoking and Health. NEMS Small retailer survey. ASH 2019.
Action on Smoking and Health. Smokefree: The First Ten Years, Tackling the smoking epidemic in England: the views of the public. ASH 2017.
Action on Smoking and Health. Smoking Still Kills. 2015.
Blau J & Greaves L. Saskatchewan Coalition for Tobacco Reduction: Evidence to Ontario Standing Committee on Finance and Economic Affairs. 27th April 2005. Regina: Saskatchewan Coalition for Tobacco Reduction
Cancer Research UK, BRMB Omnibus Survey: Smokers’ attitudes to branding and point of sale displays. 2008
16 Cummings KM et al. Discrepancies in cigarette brand sales and adult market share: are new teen smokers filling the gap? Tob Control. 1997;6 Suppl 2:S38-43.
Department of Health and Social Care. Advancing our health: prevention in the 2020s. July 2019.
Department of Health. Impact assessment on the prohibition of display of tobacco products at the point of sale in England. October 2011, pp.16.
Department of Health. Towards a Smokefree Generation A Tobacco Control Plan for England. July 2017.
Eadie D et al. Are Retail Outlets Complying with National Legislation to Protect Children from Exposure to Tobacco Displays at Point of Sale? Results from the First Compliance Study in the UK. PLoS ONE 11(3): e0152178.
Labour Communities & Local Government. Local Government Health Check Report 4: Trading Standards. 2018.
National Audit Office. Protecting consumers from scams, unfair trading and unsafe goods. December 2016.
Office for National Statistics. Adult smoking habits in the UK: 2018. July 2019.
Royal College of Physicians. Hiding in plain sight: Treating tobacco dependency in the NHS. June 2018.
Scottish Grocers’ Federation. Tobacco and Primary Medical Services (Scotland) Bill. 2009
Stead M et al. Tobacco companies’ use of retailer incentives after a ban on point-of-sale tobacco displays in Scotland. Tobacco Control 2018;27:414-419
Wakefield M et al. The cigarette pack as image: new evidence from tobacco industry documents. Tob Control. 2002 Mar;11 Suppl 1:I73-80.
World Health Organization. Evidence brief: Tobacco point-of-sale display bans. 2017.
Is the display ban an effective way to protect children and young people from taking up smoking and supporting those who wish to quit?
☐ Yes, I think it is
☐ No, I don’t think it is
☐ I don’t know if it is or is not
17 Please give reason(s) for your answer.
1. The primary objective of the display ban is to protect children and young people from taking up smoking and support those who wish to quit. The Government is required, as set out in the regulations, to assess the extent to which the objectives of the regulations have been achieved. The answers to the previous questions on the impact of the ban on adults and children and young people demonstrate that these objectives are being achieved.
2. The Government is also required to assess the extent to which the objectives of the regulations remain appropriate to assess the extent to which they could be achieved with a system which imposes less regulation. Following a review it will fall to the Secretary of State to consider whether the Display Regulations should remain as they are, or be revoked or be amended. A further instrument would be needed to revoke the Display Regulations or to amend them.
3. For context it is important to note that the Government recently set out its ambition for England to go smoke-free by 2030 and gave the industry an ultimatum to make smoked tobacco obsolete by 2030 (Cabinet Office and DHSC, 2019). Clearly therefore the objectives remain appropriate. There is no evidence to show that they could be achieved with a system that imposes less regulation, nor would it be appropriate given the ambition that England should be smoke-free by 2030.
Why and how the display ban should be strengthened
4. The Government also stated that achieving a smokefree England by 2030 would be “extremely challenging” and that “Further proposals for moving towards a smoke-free 2030 will be set out at a later date.” (Cabinet Office and DHSC 2019)
5. The evidence supports further strengthening the display regulations being one of these “Further proposals”.
6. In 2019 83% of children aged 11-15 reported seeing cigarette packs on display, which is still the vast majority. As shown in by the evidence cited above, this exposure increases the susceptibility of young people to starting to smoke. If we are to significantly reduce the proportion of children seeing cigarettes on display then the regulations must be strengthened not weakened. (NHS Digital, Table 3.25. 2019).
7. The NEMS survey for ASH found that 56% of small tobacco retailers in England had their tobacco gantries paid for and maintained by tobacco manufacturers. (ASH/NEMS 2019) This demonstrates that although covered up, the gantries in their current position at the point of sale still have value to the companies as a promotional tool for tobacco.
18 8. Options to be consulted on should include requiring tobacco gantries to be out of sight, for example under rather than behind the counter, so that when they are restocked or a customer is buying a pack, the packs arrayed in the gantry are not visible to customers in general and children in particular.
9. Regulation 5 of the Tobacco Advertising and Promotion (Display) (England) Regulations 2010 also needs revision to prohibit the display of tobacco in bulk tobacconists which are accessible to retail customers. Such bulk tobacconists include duty free sold in airports where cigarette packs are displayed wall to wall in segmented shopping areas. Duty free shops are part of many people's leisure experience when they go on holiday and are popular shopping destinations for families. Allowing tobacco to be prominently displayed helps the tobacco industry to maintain positive associations with tobacco brands.
References (in alphabetical order)
Action on Smoking and Health. NEMS Small retailer survey. ASH 2019.
Cabinet Office and Department of Health and Social Care. Advancing our health: prevention in the 2020s. July 2019.
NHS Digital. Smoking, Drinking and Drug Use among Young People in England 2018. August 2019.
Were there any economic losses or gains (for individuals, businesses and wider society) associated with implementing the display ban on tobacco products?
☐ Yes, I think there were some economic losses or gains
☐ No, I don’t think there were any economic losses or gains
☐ I don't know if there were any economic losses or gains
Please give reason(s) for your answer, including any quantitative values and provide evidence.
1. Measures like the display ban which are successful in contributing to the reduction of smoking prevalence and preventing the uptake of smoking deliver an economic benefit insofar as they prevent smoking related death and disease which, in addition to the human cost, places a significant economic burden on society. The Tobacco Control Plan for England published by the Department for Health and Social Care in 2017 estimated that tobacco costs society around £11 billion a year (DH, 2017).
19 2. The Government’s impact assessment estimated the measure would result in a £120.5 million net benefit to society (DH, 2011).
3. The Government’s economic impact assessment estimated the measure would result in a £120.5 million to society. (DH, 2011) As well as benefits from reduced death and disease caused by smoking, this will specifically benefit the NHS by reducing the demand for treatment for diseases caused by smoking.
4. Smoking is estimated to cost the NHS £2.5 billion each year (DH, 2017). As a result of the death and disease caused by smoking, smokers place a disproportionate burden on the health service compared to the general population, with around 26% of the inpatient population smoking (RCP, 2018) compared to 14.4% in the general population (ONS, 2019). Any measure which can reduce the population of smokers will, therefore, deliver a benefit to the NHS.
5. Concerns were raised about the economic burden PoS display ban of tobacco would place on individual retailers but, as evidenced above, the cost of implementation was substantially lower (£450 for small shops and £850 for large shops) than the ACS estimation (up to £10,000 per shop) (DH, 2011; Scottish Grocers’ Federation, 2009) with this cost frequently being covered by tobacco manufacturers (Stead M et al, 2018). Furthermore these were one-off costs incurred to implement the display legislation.
6. Over two thirds (69%) of retailers in a previous survey for ASH acknowledged that they do not make much profit from cigarettes compared to other products. When comparing profit margins on tobacco products to tobacco products this point is made clear, with the average profit margin on tobacco products at just 6.6% compared to an average of 24.1% for non-tobacco products (ASH, 2016). The average weekly profit made by small retailers on tobacco products is just 1.6% of total sales income, whereas profits from non-tobacco products accounts for 17.6% of sales income.
7. Retailers are also unlikely to suffer economic losses as a result of reduced footfall – the majority of transactions (79%) in small shops are for non-tobacco products only, with a small minority of transactions including tobacco alongside other products (13%). Just 8% of small shop transactions are for tobacco products only. All everyday products drive footfall in small shops, not just tobacco (ASH, 2016).
8. There has also been no evidence of economic losses to retailers or Government through a growth in the illicit tobacco market as a consequence of the tobacco display ban. Indeed the volume of illicit tobacco on the UK market has continued to decline in the years since it was implemented (HMRC, 2019).
9. The regulations were revised to minimise any costs in particular to small retailers by giving them a longer time to implement the regulations and loosening the regulations
20 on the size of any temporary display from 0.75sq metres to 1.5 square metres and extending the circumstances for which temporary displays are allowed.
10. The survey carried out in August for ASH by NEMS found that 71% of small retailers selling tobacco did not think the display ban had an impact on their business, with 5% thinking the impact had been positive and 19% that it had been negative. The 558 respondents to the survey across England were convenience stores, off-licences, newsagents, independent fuel services and tobacconists, with 61% supporting the display ban. (ASH/NEMS 2019)
11. There is therefore no justification for any relaxation of the regulations.The objectives remain appropriate, are being met by the regulation, and could not be met by other means or less regulation. There is no justification for repealing or loosening the regulations indeed as set out above consideration should be given for strengthening them.
References (in alphabetical order)
Action on Smoking and Health. Counter Arguments – How important is tobacco to small retailers? October 2016.
Action on Smoking and Health. NEMS Small retailer survey. ASH 2019.
Department of Health. Impact assessment on the prohibition of display of tobacco products at the point of sale in England. October 2011, pp.16.
Department of Health. Towards a Smokefree Generation A Tobacco Control Plan for England. July 2017.
HM Revenue and Customs. Measuring tax gaps 2019 edition: Tax gap estimates for 2017-18. June 2019.
Scottish Grocers’ Federation. Tobacco and Primary Medical Services (Scotland) Bill. 2009
Stead M et al. Tobacco companies’ use of retailer incentives after a ban on point-of-sale tobacco displays in Scotland. Tobacco Control 2018;27:414-419.
21
Section 2: The Tobacco and Advertising (Specialist Tobacconists) (England) Regulations 2010
These regulations apply to the display of tobacco products in Specialist Tobacconists and came into force on 6th April 2015.
These regulations provide exemptions for specialist tobacconists to the general prohibition of the display of tobacco products. They allow tobacco products to be displayed within specialist tobacconists as long as they are not visible from outside the shops. Additionally, the legislation permits tobacco advertising provided it is in, or fixed to the outside of prem- ises of a specialist tobacconist and complies with prescribed conditions.
The full Tobacco and Advertising (Specialist Tobacconists) (England) Regulations 2010are published on Legilsation.gov.uk.
Objectives
To protect children and young people from the health harms of smoking.
Create a supportive environment for adults who are trying to quit smoking by implementing the prohibition of tobacco product 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 specialist tobacconists 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. The display ban is partially effective as specialist tobacconists are unable to display tobacco products on the exterior of their premises and as a result are not able to promote tobacco products to children or young people passing by.
Do you think the display ban in specialist tobacconists has encouraged and supported adult smokers to quit?
22 ☐ 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) and evidence for your answer.
2. The display ban is partially effective as specialist tobacconists are unable to display tobacco products on the exterior of their premises and as a result are not able to promote tobacco products to smokers or ex-smokers passing by.
Has the display ban within specialist tobacconists had any further impacts not covered in the questions above?
☐ Yes, I think there have been further impacts
☐ No, I don't think there have been further impacts
☐ I don’t know if there have been any further impacts
Please give reason(s) and evidence for your answer if yes or no.
3. Given the relatively small change required by specialist tobacconist as a result of the PoS display ban there is unlikely to have been any further significant impact. Specialist tobacconists are only required to ensure that their products and advertisements are not visible from outside the premises.
Is the display ban in specialist tobacconists an effective way to protect children and young people from taking up smoking and supporting those who wish to quit?
☐ Yes, I think it is effective
☐ No, I don’t think it is effective
☐ I don’t know whether it is or is not effective
Please give reason(s) and evidence for your answer.
4. In response to the consultation on the regulations ASH recommended that specialist tobacconists should comply with the same rules as other retailers, or if they are to be
23 allowed exemptions from the regulations they should be required to prohibit access to under 18s.
5. Our preference is that the exemptions for specialist tobacconists should be removed. The exemptions were allowed for specialist tobacconists before the Government announcement of its ambition to end smoking in England by 2030. In the light of that ambition these exemptions are inappropriate and should be removed so that specialist tobacconists treated like other tobacco retailers.
6. Smokers having difficulty quitting who enter specialist tobacconists are exposed to the display of tobacco products as well as to advertising of some tobacco products (although not cigarettes or hand-rolling tobacco).
7. Research cited above from Australia study that 38% of smokers who had tried to quit in the past 12 months and 33.9% of recent quitters experienced an urge to buy cigarettes as a result of seeing a PoS display (Wakefield M et al, 2008).
8. However, if the exemptions are allowed to remain then specialist tobacconists should have to be licensed and prohibit under 18s from entering the premises. Between 2014 and 2016 more than 127,000 children a year aged 11-15 started to smoke in the UK, according to analysis by Cancer Research UK - this amounts to around 350 young people a day. (APPG on Smoking and Health, 2019). The majority of adult smokers start as children and once started it is difficult to stop, with two thirds of those who try smoking going on to become regular smokers (Birge M et al, 2017).
9. The products and services on offer inside specialist tobacconists can only be sold to those aged 18 and over. Other retailers and premises with the same intended audience such as sex shops and betting shops have to be licensed and are prohibited by their licence conditions from allowing under 18s on their premises (Sex shop and cinema licence (England and Wales) ). There is no justification for the same restrictions not being applied to specialist tobacconists, if they retain their exemption from the display ban.
10. In case of a breach of such a regulation, the law should not bear down on the under 18 year old entering the premises, but on the operator. Not allowing under 18s to enter the premises of a specialist tobacconist could be part of a license condition specific to specialist tobacconists under a system where all tobacco retailers are required to have a license.
References (in alphabetical order)
Action on Smoking and Health. Opinion research by YouGov. Smokefree GB Survey, 2019.
24 APPG on Smoking and Health. Delivering the vision of a ‘Smokefree Generation’ The All Party Parliamentary Group on Smoking and Health response to ‘Prevention is better than cure’. February 2019.
Birge M et al. What Proportion of People Who Try One Cigarette Become Daily Smokers? A Meta-Analysis of Representative Surveys. Nicotine & Tobacco Research, Volume 20, Issue 12, December 2018, Pages 1427–1433, https://doi.org/10.1093/ntr/ntx243
Wakefield M et al. The effect of retail cigarette pack displays on impulse purchase. Addiction. 2008 Feb;103(2):322-8.
Were there any economic losses or gains (for individuals, businesses and wider society) associated with carrying out this regulation in the community?
☐ Yes, I think there were economic losses or gains
☐ No, I don’t think there were economic losses or gains
☐ I don't know if there were economic losses or gains
Please give reason(s) and evidence for your answer.
11. There were economic gains from the contribution made by the ban on displays on the outside of tobacconists.
12. However, specialist tobacconists did not suffer economic losses. First, given the relatively small change required by specialist tobacconists to make premises compliant with the regulations, there are unlikely to have been any significant economic burdens placed on them as a result. Secondly, specialist tobacconists, like other small retailers, were given three years longer than large shops before they had to implement the regulations.
25
Section 3: The Tobacco and Advertising (Display of Prices) (England) Regulations 2010
These regulations impose requirements on the display of prices of tobacco products in small and large shops and came into force on 6th April 2015.
The regulations permit only three types of tobacco price displays within retailers:
1) Poster style lists (up to A3 in size) which can be permanently on show but must not ex- ceed 1,250sq centimetres in size
2) A list including pictures of products, which must not be left on permanent show, but can be shown to any customer aged 18 or over who asks for information on tobacco products sold; and
3) Price labels, which can be placed on shelving, storage units or tobacco jars. One price label is permitted for each product either on the covered shelf where the product is stored or on the front of the storage unit.
The full Tobacco and Advertising (Display of Prices) (England) Regulations 2010 are pub- lished on Legislation.gov.uk.
Objectives
To protect children and young people from the harms of smoking
Create a supportive environment for adults who are trying to quit smoking by ensuring that price lists and labels cannot be exploited as forms of tobacco promotion.
The regulations do recognise that shops and businesses need to display necessary information on what tobacco products they sell and for what price.
Have the restrictions on the display of prices of tobacco products helped reduce the number of children and young people smoking?
☐ Yes, I think they have
☐ No, I don’t think they have
☐ I don’t know if they have or have not
26 Please give reason(s) and evidence for your answer
1. Insofar as the restriction on the display of prices of tobacco products is part of the wider ban on the display of tobacco products at PoS, the regulation has been effective in reducing the number of children and young people smoking, as demonstrated in our answers above.
2. However, this objective could be better met with the simplification of the regulations relating to the display of prices for tobacco products as detailed below.
Have the restrictions on the display of prices of tobacco products helped encourage and support adult smokers to quit?
☐ Yes, I think they have
☐ No, I don’t think they have
☐ I don’t know if they have or have not
Please give reason(s) and evidence for your answer.
3. Insofar as the restriction on the display of prices of tobacco products are a part of the wider ban on the display of tobacco products at the PoS, they have been effective in encouraging and supporting adult smokers to quit.
4. However, the current regulations are too lenient in allowing multiple opportunities for the promotion of products through the display of prices. They are also more complex than is necessary and simpler regulation could also be more effective and less burdensome on retailers.
5. The price of cigarettes has historically been an important marketing device for tobacco companies (Spanopoulos D et al, 2012; Henricksen L, 2012), especially in targeting more price sensitive smokers from lower socio-economic groups who experience higher rates of smoking and consequently find themselves at the sharp end of health inequalities (ONS, 2019; Marmot M et al, 2010).
6. Currently, there are three ways in which tobacco product prices can be made visible to customers: (i) illustrated price lists available on request, (ii) a permanently displayed price list, (iii) prices and product names on the shelves.
27 7. This leaves too much opportunity for the product name and price to be marketed to the public. Multiple lists are also unnecessary from a consumer perspective:
o 90% of adult smokers know what brand they will buy before they go into shops (Cancer Research UK, 2008).
o With the introduction of standardised plain packaging, lists containing pictures of products no longer help with identification and this requirement should be removed.
o In Ireland, no provision was made for marking storage units on the outside and compliance has been high. This requirement is unnecessary and should be removed.
8. The regulations also leave room for tobacco industry promotion of their brands through retailers, e.g. by incentivising retailers to only display their products on lists, or to put them at the top of lists.
9. The number of price lists which could be displayed in a shop is also a concern, with the regulations allowing “one price list for each separate area where tobacco products are both located and can be paid for” or “where there is more than one till…one price list for each such till.”
10. This allows numerous price lists to be on display, unnecessarily drawing attention to the presence and availability of tobacco products to individuals among whom exposure is detrimental. As evidenced above, exposure in children and young people is directly associated with smoking behaviour, and exposure amongst adults might undermine quitting efforts (by encouraging impulse purchasing, as evidenced above).
11. This allowance may also encourage tobacco industry investment in multiple storage units to increase the number of locations at which prices can be displayed, amplifying these detrimental effects.
12. Whilst, overall, the display ban of tobacco products at PoS has been effective in reducing awareness of tobacco products on sale (as evidenced above), it is possible that excessive allowances relating to the display of price lists have dulled this effect, stemming its full potential.
13. In order to ensure the regulations deliver the benefits intended and meet their stated objectives, they should require: (i) only one price list on permanent display in any shop in addition to label and price markings according to regulations inside tobacco displays
28 but NOT outside (ii) all products available for sale should be listed, in alphabetical order.
References (in alphabetical order)
Cancer Research UK, BRMB Omnibus Survey: Smokers’ attitudes to branding and point of sale displays. 2008
Henriksen L. Comprehensive tobacco marketing restrictions: promotion, packaging, price and place. Tobacco Control 2012;21:147-153.
Marmot M et al. Fair Society Healthy Lives (The Marmot Review). February 2010.
Office for National Statistics. Adult smoking habit in the UK: 2018. July 2019.
Spanopoulos D et al. Retail price and point of sale display of tobacco in the UK: a descriptive study of small retailers. PLoS One. 2012;7(1):e29871. doi: 10.1371/journal.pone.0029871.
What impact do you think the restriction of display of prices of tobacco products has had on the following:
(a) The general population
14. As evidenced above, product price and its display on tobacco packaging has always been an important promotional tool for tobacco manufacturers. Whilst the regulations together have reduced the awareness of tobacco products on sale in shops among adults and children, as evidenced above, this effect may have been dulled as a result of the excessive allowances made to the display of multiple price lists.
15. As also evidenced above, public support for the PoS display ban of tobacco has always been high and has increased since the ban’s implementation. This suggests any effect on the general population has been positive, and that no negative impact has occurred as a result.
(b) retailers
16. The retailer survey carried out by NEMS in August 2019 for ASH found that 72% of small retailers selling tobacco did not think the restrictions on the display of prices at point of sale had an impact on their business, 4% thought the impact had been positive and 20% that it had been negative. (ASH/NEMS 2019)
29 17. As evidenced above, smokers are extremely brand loyal and there is unlikely to have been any increased burden on retailers, via lengthily transaction times or otherwise, as a result of regulations changing the way prices are displayed.
References
Action on Smoking and Health. NEMS Small retailer survey. ASH 2019.
Action on Smoking and Health. Response to consultation on proposed tobacco control regulations for England (under the Health Bill 2009). January 2010.
(c) manufacturers
18. These regulations significantly curb tobacco manufacturers’ ability to use the prices displayed on cigarette packets or otherwise as promotional tools. This has reduced impulse purchasing, decreased smoking susceptibility and helped to reduce smoking prevalence, as evidenced above.
19. However, opportunities remain for tobacco manufacturers to take advantage of the allowances made for the display of prices of tobacco products, such as incentivising retailers to display only their products, or to display them at the top of lists, or to incentivise the housing of multiple tobacco storage units which would enable more price lists to be displayed. The regulations could therefore be improved and simplified by enacting the above recommendations.
(d) other stakeholders (please specify)
N/A
Please give reason(s) and evidence for your answers.
Is restricting the display of prices of tobacco products an effective way to protect children and young people from taking up smoking and support those who wish to quit?
☐ Yes, I think it is effective
☐ No, I don’t think it is effective
30 ☐ I don’t know if it is or is not effective
Please give reason(s) and evidence for your answer.
20. The restriction on the display of prices of tobacco products is part of the wider ban on the display of tobacco products at PoS, which has been effective in protecting children and young people from taking up smoking and supporting those who wish to quit, as demonstrated in our answers above.
21. However, this objective could be better met with the simplification of the regulations relating to the display of prices for tobacco products as detailed above.
Were there any economic losses or gains (for individuals, businesses and wider society) associated with carrying out this regulation in the community?
☐ Yes, I think there were economic losses or gains
☐ No, I don’t think there were economic losses or gains
☐ I don't know if there were economic losses or gains
Please give reason(s) and evidence for your answer.
22. In curbing the ability for price to be used a promotional tool encouraging people to purchase and consume tobacco and insofar as this has reduced impulse purchasing, decreased smoking susceptibility and helped to reduce smoking prevalence, this regulation will have delivered a significant economic benefit to society, and particularly the NHS, through a reduced health burden and associated costs.
31
Section 4: The Smoke-free (Private Vehicles) Regulations 2015
The regulations came into force as of 1st October 2015 and apply in England. Regulation 5; penalties and discounted amount also applies in Wales. These regulations make it an offence for:
A person to smoke in a private vehicle when someone under the age of 18 is present
A driver not to stop a person smoking when someone under the age of 18 is present.
The regulations are thought to have minimal impact in business. Police Authorities are the designated enforcement offices, with the power to issue Fixed Penalty Notices (FPN) to anyone found to be non-compliant with the law.
The full Smoke-free (Private Vehicles) Regulations 2015 are published on Legisla- tion.gov.uk.
Objectives
To prevent adverse effects of second-hand smoke (SHS) on children in private vehicles, where the level of SHS can be significantly more concentrated that elsewhere. Intervention was deemed necessary as children are unable to exert their choice to leave the vehicle unlike adults.
Have the Smoke-free (Private Vehicles) Regulations helped prevent people from smoking in vehicles with children?
☐ Yes, I think they have
☐ No, I don’t think they have
☐ I don’t know if they have or have not
Please give reason(s) and evidence for your answer.
1. A survey by the Chartered Institute of Environmental Health (CIEH) and Improving Performance in Practice (iPiP) concluded that the regulations have been effective in preventing people from smoking in vehicles with children:
32 1) Compliance with the Smoke-free (Private Vehicles) Regulations 2015 is very high, with no contraventions of the legislation found in any of the 255 vehicles inspected as part of the survey at 8 locations in two distinct geographical areas in England
2) In more than 93% of vehicles surveyed, no evidence was observed of smoking having recently taken place.
3) Awareness of the existence of legislation prohibiting smoking in private vehicles is high
4) The majority of people interviewed by the insights gathering team felt the legislation had made a difference. (CIEH & iPiP, 2016)
2. Recent data published by NHS Digital confirms the success of the regulations in preventing people from smoking in vehicles with children. In 2014, a year before the ban, 34% of pupils (aged 11-15) reported being exposed to secondhand smoke in the last year and 66% reported never being exposed. In 2016, 26% reported being exposed in the last year, whilst 74% reported never being exposed. In 2018, 23% reported being exposed in the last year, whilst 77% reported never being exposed (NHS Digital, 2019). There have been steady declines in exposure across all frequencies (every day or most days, once or twice a week, once or twice a month, less often than once a month) since 2014 (NHS Digital, 2019).
3. Findings from ASH’s Smokefree GB Survey, conducted by YouGov, further confirm the high compliance with regulations and their success. In 2019, just 3% of all respondents said “people can smoke in the vehicle at any time” when asked about the vehicle they travel in most often. 9% said “people can smoke in the vehicle but NOT when children are travelling” and over two thirds (68%) said “people cannot smoke in the vehicle at all”. (ASH/YouGov, 2019).
4. A higher proportion, 73%, of respondents with any children in their household said “people cannot smoke in the vehicle at all” compared to 66% of respondents with no children in their household and 11% of respondents with any children said “people can smoke in the vehicle but NOT when children are travelling” compared to 8% of respondents with no children (ASH/YouGov, 2019).
References (in alphabetical order)
Action on Smoking and Health. Opinion research by YouGov. Smokefree GB Survey, 2019.
Chartered Institute of Environmental Health & Improving Performance in Practice. Smoke-free (Private Vehicles) Regulations 2015: Demonstration projects using compliance measures in controlled locations. September 2016.
33 NHS Digital. Smoking, Drinking and Drug Use among Young People in England 2018. August 2019.
Royal College of Physicians. Passive smoking and children. March 2010.
What impact do you think the Smoke-free (Private Vehicles) Regulations have had on the following:
Please give reason(s) and evidence for your answers.
(a) The general population
5. Whilst the regulations have been largely effective in preventing people from smoking in cars with children adults are not protected, and should be.
6. Even smoking one cigarette in a car leads to a high level of secondhand smoke, and strategies such as holding the cigarette at an open window, and using air conditioning still leave hazardous levels of smoke inside the car (APPG on Smoking and Health, 2011).
7. The evidence is clear that exposure to secondhand smoke is harmful; and that even brief exposure can be harmful to health, particularly to those with pre-existing conditions such as respiratory or cardio-vascular disease (US Department of Health and Human Services, 2014; US Department of Health and Human Services, 2010; National Toxicology Program, 2016). Analysis of Hospital Episode Statistics in England showed an immediate and significant drop in hospital admissions for heart attacks as a result of smokefree legislation in the first year after implementation, resulting in 1,200 fewer emergency admissions (DHSC, 2011).
8. Furthermore the highway code recommends that drivers avoid smoking while driving as it is a distraction and can lead to accidents, as confirmed by multiple studies (Highway Code, accessed August 2019; Young K et al, 2003; Wen CP et al, 2005; APPG on Smoking and Health, 2011).
9. The current smokefree vehicle regulations cover vehicles used by members of the public or a section of the public (whether or not for reward or hire); private rental vehicles; vehicles in the course of paid or voluntary work by more than one person (even if those persons use the vehicle at different times, or only intermittently), as well as private vehicles carrying children under 18. Smoking is only allowed in private vehicles not carrying children under 18.
10. The regulations would be simpler and easier to understand and therefore more easily complied with if smoking was prohibited in all vehicles. Extending the legislation in this
34 way has majority support from the general public which also means, as with the ban on smoking in cars with children, they would be largely self-enforced (CIEH & iPiP, 2016).
11. Police and local authorities can authorise officers to enforce the law, and a fixed penalty of £50 may be given to anyone who smokes in a private vehicle with someone under 18 present, or to the driver for failing to prevent someone smoking if a child is present. Since implementation of the law in England and Wales there have been very few reported breaches and most of these have been dealt with by the police issuing verbal warnings (CIEH & iPiP, 2016). However, as cited above, there is little need for enforcement with fixed penalty fines, as overall compliance with the law is already extremely high (CIEH & iPiP, 2016).
12. Extending the regulations would be likely to significantly increase the proportion of private vehicles which are smokefree to the benefit of occupants. The evidence from seatbelt legislation is that after legislation was introduced seatbelt wearing increased from 25% to 91% (WHO & FIA, 2009). from the ban is for private vehicles not carrying anyone under the age of 18.
13. The 2010 Royal College of Physician’s report Passive Smoking and Children included a recommendation that smoking be prohibited in all cars (RCP, 2010), the report notes, and ASH agrees, that this “is probably the simplest and most easily enforceable option.”
14. The growth in support for prohibiting smoking in all private vehicles has grown substantially over time and extending the regulations to include all vehicles has majority support from the general public. The evidence from the growth in public support for smokefree laws and prohibiting smoking in cars carrying children demonstrates support is likely to grow still further after implementation, particularly among smokers.
Growth in public support for smokefree laws
15. Much like the other pieces of regulation consulted on here, the ban on smoking in cars with children under 18 has also contributed to the denormalisation of tobacco use, raised awareness of its harms and, consequently, increased support for tobacco control.
16. In 2007 when smokefree legislation came into effect in England, 78% of all respondents to ASH’s Smokefree GB survey, conducted by YouGov, were in favour of the legislation. In the ten years to 2017 support grew to 83%. The overall change is entirely due to changing attitudes among smokers, with support among smokers rising from 40% to 55%, while support among non-smokers has been stable.
35 17. Public attitudes to prohibiting smoking in cars carrying children under 18 were first tested in the ASH Smokefree England survey in 2008, when it was supported by 77% of respondents, including 86% of non-smokers, but only 48% of smokers. When the survey was conducted in early 2015, a few months before implementation of the legislation, support had risen to 85% overall with 87% of non-smokers and 74% of smokers expressing their support. (ASH, 2017).
18. The most recent data since implementation from the 2019 survey show that it is supported by 89% of respondents including 79% of smokers. (ASH/YouGov, 2019).
Growth in public support for prohibiting smoking in all private vehicles
19. In 2009 when respondents were first asked their views about a law prohibiting smoking in all cars only 45% were in support with 37% opposing. (ASH, 2017) By 2019 support had risen significantly to 64% of all respondents with 16% opposing. (ASH/YouGov, 2019).
20. These data are from our annual survey of public opinion which has been carried out since 2007 by YouGov plc. The data set out above has been published in a 2017 report Smokefree: the first ten years, summarising the results of the surveys, supplemented by 2019 results from our most recent survey (ASH, 2017). Total sample size in 2019 for England was 10338 adults (and 12393 for GB). Fieldwork was undertaken between 12th February 2019 and 10th March 2019. The surveys are carried out online and the figures have been weighted and are representative of all English adults (aged 18+).
(b) retailers
21. The regulations do not relate to the retail sale of tobacco and so are unlikely to have had any impact on retailers.
(c) manufacturers
22. It is unlikely the regulations would have had any significant impact on manufacturers other than providing further confirmation to the public about how harmful smoking is.
(d) other stakeholders (please specify)
36 23. There are specific subgroups of the adult population most immediately at risk from the harm caused by secondhand smoke (for example pregnant women and those with respiratory or cardiovascular disease) but they all form part of the general population and have been included in that section above.
References (in alphabetical order)
Action on Smoking and Health. Opinion research by YouGov. Smokefree GB Survey, 2007 - 2019.
Action on Smoking and Health. Smokefree: The first ten years. July 2017.
APPG on Smoking and Health. Inquiry into smoking in private vehicles. November 2011.
Chartered Institute of Environmental Health & Improving Performance in Practice. Smoke-free (Private Vehicles) Regulations 2015: Demonstration projects using compliance measures in controlled locations. September 2016.
Department for Health and Social Care. Impact of Smokefree Legislation in England: Evidence Review. March 2011.
Highway Code. General rules, techniques and advice for all drivers and riders (103 to 158), accessed 28th August 2019.
National Toxicology Program. Report on Carcinogens, Fourteenth Editionl. Research Triangle Park (NC): U.S. Department of Health and Human Services, Public Health Service, 2016
U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014
U.S. Department of Health and Human Services. A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010
Wen CP et al. Excess injury mortality among smokers: a neglected tobacco hazard. Tob Control. 2005 Jun;14 Suppl 1:i28-32.
WHO & FIA. Seat-belts and child restraints: a road safety manual for decision-makers and practitioners. February 2009.
37 Young K et al. Driver distraction: a review of the literature. Monash University Accident Research Centre - Report #206 – 2003
Do you believe prohibiting smoking in private vehicles is an effective way to protect children and young people from harms of tobacco and second-hand smoke?
☐ Yes, I think it is
☐ No, I don’t think it is
☐ I don’t know if it is or is not
Please give reason(s) and evidence for your answer.
24. The harms of secondhand smoke and its effect on children is well known (RCP, 2010; DH, 2014).
25. An Australian study found that children exposed to secondhand smoke in their parents’ car had double the risk of a persistent wheeze compared with children who had not been exposed. (Kabir Z et al, 2009) Similarly, a study in Ireland found significantly higher levels of wheezing and non-significantly increased risks of bronchitis and asthma in children exposed to secondhand smoke in cars compared with those not exposed. (Evans J, Chen Y, 2009)
26. In Canada, a study examining exposure to SHS in both the home and in cars found that, when considered separately, both home and car exposure were significantly associated with chronic bronchitis in children and adolescents aged 12-19 years. (Martin J et al, 2006)
27. In addition to the physical risks faced by children exposed to secondhand smoke in cars, there are wider social issues to consider.
28. Observational studies examining the prevalence of smoking in cars by socioeconomic area suggests that children in lower socioeconomic groups are likely to be more frequently exposed to SHS than other children, compounding the already unacceptable health inequalities faced by these children. (Moore GF et al, 2014)
29. Furthermore, children who are regularly exposed to smoke in cars are up to six times more likely to smoke themselves. (Jarvie JA, Malone RE, 2008)
38 30. As evidenced above, the regulations have been effective in reducing child exposure to SHS in the car, with high rates of compliance observed.
References (in alphabetical order)
Department of Health. Smoke-free (Private Vehicles) Regulations 2014 Impact Assessment. July 2014.
Edjoc RK et al. Correlates of former smoking in patients with cerebrovascular disease: a cross-sectional study. BMJ Open 5:1, 2015, pages e005753-e005753.
Jarvie JA, Malone RE. Children's Secondhand Smoke Exposure in Private Homes and Cars: An Ethical Analysis. AJPH, September 2011.
Kabir Z et al. Second-hand smoke exposure in cars and respiratory health effects in children. European Respiratory Journal 2009 34: 629-633; DOI: 10.1183/09031936.00167608
Martin J et al. Observed smoking in cars. A method and difference by socioeconomic area. Tob. Control 2006;15;409-411. doi:10.1136/tc.2006.015974
Moore GF et al. Prevalence of smoking restrictions and child exposure to secondhand smoke in cars and homes: a repeated cross-sectional survey of children aged 10–11 years in Wales. BMJ Open 2015;5:e006914. doi: 10.1136/bmjopen-2014-006914
Royal College of Physicians. Passive smoking and children. March 2010.
Were there any economic losses or gains (for individuals, businesses and wider society) associated with carrying out this regulation in the community?
☐ Yes, I think there were economic losses or gains
☐ No, I don’t think there were economic losses or gains
☐ I don't know if there were economic losses or gains
Please give reason(s) and evidence for your answer.
31. The objective of the regulation is to prevent smoking in private vehicles carrying children to protect children from the harms of SHS, which is expected to reduce the incidence of illness. The Government Impact Assessment estimated a net benefit of £30.8 million to £63.8 million as a result of the regulation (DH, 2014).
39 32. The evidence set out above supports the analysis that the regulation has delivered significant economic benefits through a healthier population (and subsequent increased productivity), reduced burden and costs on our health services.
33. There is no evidence to show that the objectives could be achieved with a system that imposes less regulation. Indeed, the objectives could be better achieved with comprehensive legislation which eliminated the exemption for private vehicles which don’t carry children under 18. Furthermore, such an extension would help deliver the the Government’s ambition that England should be smoke-free by 2030 and increase the net benefit.
References
Department of Health. Smoke-free (Private Vehicles) Regulations 2014 Impact Assessment. July 2014.
40
Section 5: The Nicotine Inhaling Products (Age of Sale and Proxy Purchasing) Regulations 2015
These regulations came into force as of 26 March 2015 for proxy purchasing and 1 Octo- ber 2015 for all other provisions. These regulations apply in England and Wales.
The regulations prohibit both the sale of Nicotine Inhaling Products (NIPs) including e-ciga- rettes to under 18s, as well as the purchase of these products on behalf of a minor (proxy purchasing).
The full Nicotine Inhaling Products (Age of Sale and Proxy Purchasing) Regulations 2015 are published on Legilsation.gov.uk.
Objectives
To limit the sale of nicotine inhaling products (NIPs) such as electronic cigarettes (and related products including refill cartridges and nicotine liquids) to adults only, with only certain limited exceptions for medicinal products.
Limit the availability of NIPs to under 18’s, restricting scope for children and young people to become addicted to nicotine, minimising potential gateway effect into smoking.
Do you think the Nicotine Inhaling Products Regulations have helped to prevent the sale of nicotine inhaling products, including e-cigarettes, to under 18s?
☐ Yes, I think they have
☐ No, I don’t think they have
☐ I don’t know if they have or have not
Please give reason(s) and evidence for your answer.
1. According to the latest data from NHS Digital for 2018, published 20th August 2019, e- cigarette use among pupils aged 11-15 has remained the same since 2016. Regular e- cigarette use in 2018 remains extremely low at 2% (the same as 2016) as does occasional use, at 4% (the same as 2016). The proportion of those that have ever tried e-cigarettes and those that have never tried them also remains the same as 2016 levels (15% and 75%, respectively) (NHS Digital, 2019).
41 2. The ASH Smokefree GB Survey conducted by YouGov covers a wider age range from 11-18 year olds. Our survey found that in 2019, more than three quarters of 11-18 year olds have never tried (76.9%) or are unaware of e-cigarettes (6.6%).In 2019 15.4% of 11-18 year olds had tried vaping, compared to 16.0% in 2018. This is an increase from 2015 when 12.7% of 11-18 year olds had tried e-cigarettes. Children under 16 are less likely to try e-cigarettes than 16-18 year olds. 8.5% of 11-15 year olds have tried vaping, compared to 26.7% of 16-18 year olds (ASH, 2019).
3. Vaping is much less common among young people who have never smoked. A large majority of never smokers aged 11-18, 93.8% in total, have either never used an e- cigarette (87.8%) or are unaware of them (6.0%). Of young people aged 11-18 years old who have never smoked, 5.5% have ever tried e-cigarettes, 0.8% are current vapers, only 0.1% vape more than once a week, and not a single never smoker reported vaping daily (ASH, 2019.
4. Young people vape mainly just to “give it a try” (52.4%), with only 1% saying it was because they think e-cigarettes “look cool” (ASH, 2019). In conclusion, data from the 2019 ASH YouGov Smokefree youth GB survey suggest that while some young people, particularly those who have tried smoking, experiment with e-cigarettes, regular use remains low.
5. NHS digital data further confirms the success of the regulations. Since 2016, the proportion of children sourcing their e-cigarette and materials from a shop has declined, from 37% in 2016 to 29% in 2018 (NHS Digital, 2019).
6. Compliance with the regulations is high and has improved over time. In an immediate review of compliance carried out by the Chartered Trading Standards Institute (CTSI) between January and March 2016 (with regulations coming into force 1st October 2015), illegal sales of nicotine inhaling products (NIPS) occurred in 39% of test purchases (CTSI, 2016).
7. However, in a follow-up survey, compliance improved substantially with an overall non- compliance rate of 25% (CTSI, 2016), demonstrating the effectiveness of the regulations.
8. According to the most recently available data, provided by CTSI’s annual tobacco control survey for 2017/18, levels of compliance and activity remained broadly similar to 2016/17 levels: “the same proportion of councils received complains and enquiries and undertook visits with trading standards officers; the average number of complaints and enquiries also remained the same, as did the average number of visits.” Enforcement activity also remained similar, with “verbal or written warning being most common and the number of prosecutions being low.” (CTSI, 2018)
42 9. Whilst the regulations have therefore been effective, enforcement and compliance could be improved if there were better resourcing of trading standards teams and the reversal of the severe cuts they have faced (NAO, 2016; Labour Communities & Local Government, 2018). The MHRA reduced the fees required of e-cigarette companies because it only took account of the MHRA’s regulatory costs and not the costs of enforcement which is borne by Trading Standards. The fees should be reviewed again taking into account that they should also fund the costs of enforcement by trading standards. (MHRA 2016)
References (in alphabetical order)
Action on Smoking and Health. Fact sheet: Use of e-cigarettes among young people in Great Britain. June 2019
Chartered Trading Standards Institute. Rapid Review of business compliance conducted by Trading Standards Services in England. 2016
Chartered Trading Standards Institute. Updated: NIPS2 Review of business compliance conducted by Trading Standards Services in England. November 2016
Labour Communities & Local Government. Local Government Health Check Report 4: Trading Standards. 2018.
MHRA, Government response to the consultation on statutory fees for producers of e-cigarette products. 2016.
National Audit Office. Protecting consumers from scams, unfair trading and unsafe goods. December 2016.
NHS Digital. Smoking, Drinking and Drug Use among Young People in England 2018. August 2019.
Has anyone else benefitted from the age restriction and proxy purchasing (when an adult buys a product on behalf of a minor) ban on nicotine inhaling products?
☐ Yes
☐ No
☐ I don’t know
Please give reason(s) and evidence for your answer.
43 10. Children and retailers will have benefited from the regulations, as detailed below.
What impact do you think the age restriction and proxy purchasing ban on nicotine inhaling products has had on:
(a) People under 18
11. The Government has regulated e-cigarettes in an appropriate manner such that to date they are primarily viewed as adult smoking cessation devices in the UK . Data from the 2019 ASH YouGov Smokefree youth GB survey suggest that while some young people, particularly those who have tried smoking, experiment with e-cigarettes, regular use remains low.(ASH, 2019). However, continued surveillance is needed.
(b) People over 18
12. The general public over 18 strongly support the age of sale regulations and support has grown since their implementation. In 2014, 68% of the public supported making it illegal to sell e-cigarettes to people under 18, with just 10% opposing the measure. In 2015, support increased, with 75% backing the measure and just 9% opposing it (ASH/YouGov, 2014, 2015).
13. One concern which remains is the effect these regulations may have on people’s perceived harm of e-cigarettes, particularly smokers who might consider using an e- cigarette to stop smoking. By setting the age of sale for e-cigarettes at the same level as cigarettes, there is a risk that the general public perceives this to be suggesting them to be equally harmful.
14. E-cigarettes are now the most popular quitting method and are estimated to have contributed to an additional 18,000 long-term-ex-smokers in England in 2015 (Beard E et al, 2016) and a recent randomized control trial has found them to be twice as effective as NRT for smoking cessation, when combined with behavioural support (Hajek P et al, 2019), thereby demonstrating the public health opportunity they present in reducing smoking prevalence.
15. One solution to this would be to raise the age of sale for tobacco products from 18 to 21. This was one of the recommendations in the APPG on Smoking and Health’s submission to the Green Paper, endorsed by ASH and 17 health and welfare
44 organisations committed to reducing the harm caused by tobacco (ASH, 2019; APPG on Smoking and Health, 2019). To do this would help reinforce the message that tobacco is a product unlike any other, killing 1 in 2 of its long-term users when consumed as intended (Doll et al, 2004). It could also help stimulate more smokers to use e-cigarettes to quit, which the evidence shows is one of the most effective methods, (Hajek P et al, 2019; Beard E et al, 2016) thereby delivering health and economic benefits and contributing to delivery of the ambition for England to be smoke- free by 2030.
16. This would also deliver significant health and social benefits by preventing the uptake of smoking among children and young people and thereby preventing the health burden and associated costs implied (APPG on Smoking and Health, 2019).
17. Raising the age of sale from 18 to 21 is supported by a majority of the public (58%) (ASH/YouGov, 2019) and a majority of retailers (51.6%) (ASH/NEMS 2019)
(c) Retailers
18. The regulations make clear that the intended market for NIPs is adults.
19. Banning the sale of e-cigarettes to under 18s is popular among retailers, with 84.2% supporting the measure. Further a majority of retailers report that the regulation has had no impact (defined as neither negative nor positive) on their business (78%). A further 9.1% of retailers report the regulation having a positive impact on their business and just 1.4% of retailers believe it has had a negative impact. (ASH/NEMS 2019).
20. Similarly, prohibiting proxy purchasing of e-cigarettes is popular among retailers, with 80.6% supporting the measure. A majority of retailers report the regulation has had no impact on their business (79.7%) and a further 7.2% believe it has had a positive impact. Just 2.5% of retailers believe the measure has had a negative impact on their business (ASH/NEMS 2019).
(d) Manufacturers
21. Reputable manufacturers and importers already applied an age of sale of 18, before the regulations were introduced so it would not have had a significant impact.
(e) other stakeholders (please specify)
Please give reason(s) and evidence for your answers.
45 22. As mentioned above, there is a wider risk that the regulations might be reinforcing false perceptions that e-cigarettes are as harmful as cigarettes, thereby preventing smokers from using them to quit. An effective way to combat this while at the same time supporting delivery of the Government’s ambition that England should be smokefree by 2030 would be by raising the age of sale for tobacco to 21, as detailed above.
References (in alphabetical order)
Action on Smoking and Health. ASH submission to DHSC Green Paper consultation on the vision for prevention 2019. March 2019.
Action on Smoking and Health. Fact sheet: Use of e-cigarettes among young people in Great Britain. June 2019
Action on Smoking and Health. NEMS Small retailer survey. ASH 2019.
Action on Smoking and Health. Opinion research by YouGov. Smokefree GB Survey, 2014, 2015.
APPG on Smoking and Health. Delivering the vision of a ‘Smokefree Generation’ The All Party Parliamentary Group on Smoking and Health response to ‘Prevention is better than cure’. February 2019.
Beard E et al. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. BMJ 2016; 354 :i4645
2019, N Engl J Med 2019; 380:629-637, DOI: 10.1056/NEJMoa1808779
Doll et al. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004 Jun 26; 328(7455): 1519. doi: 10.1136/bmj.38142.554479.AE
Hajek P et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. NEJM 2019.
Public Health England. Vaping in England: an evidence update. February 2019
Is the age of sale restriction and ban on proxy purchasing of nicotine inhaling products an effective way to protect children and young people from harms of nicotine-containing products?
☐ Yes, it is effective
46 ☐ No, it is not effective
☐ I don’t know if it is or is not effective
Please give reason(s) and evidence for your answer.
23. As demonstrated above, the regulations are effective in reducing the availability of e- cigarettes to people under 18, and reinforcing the message to adults and young people that e-cigarettes are adult smoking-cessation devices. Furthermore while there is youth experimentation, regular use of e-cigarettes in the UK remains low.
24. As also evidenced above, more can be done to improve upon these results. Trading standards should be properly resourced, to improve compliance, and the age of sale for tobacco should be raised from 18 to 21, to reinforce the message to adult smokers that e-cigarettes are a viable and safer alternative to smoking.
Were there any economic losses or gains (for individuals, businesses and wider society) associated with carrying out this regulation in the community?
☐ Yes, I think there were economic losses or gains
☐ No, I don’t think there were economic losses or gains
☐ I don't know if there were economic losses or gains
Please give reason(s) and evidence for your answer.
25. There are unlikely to have been significant economic losses as a result of this regulation, given the high level of public and retailer support and the evidence that the majority of retailers felt the regulation had not impacted their business.
47
Section 6: About you
Title (Mr, Mrs, Ms, Dr, Professor): Ms
First name: Deborah
Surname: Arnott
Email address (optional): [email protected]
In what capacity are you responding? (Required)
☐ An individual – You are responding with your personal views, rather than as an official representative of a business / business association/ other organisation.
☐ Non-governmental organisation – In an official capacity as the representative of a non-governmental organisation / charity
☐ Business – In an official capacity representing the views of an individual business.
☐ Public sector body – In an official capacity as a representative of a local government organisation / public service provider / trade body or any other public sector body in the UK or elsewhere.
☐ Other – Please specify.
Are you happy for the Department of Health and Social Care to use your email address to send you updates about its policies?
☐ Yes
☐ No
48 Are you happy for the Department of Health and Social Care to use your email address to send you updates about other Department of Health and Social Care consultations?
☐ Yes
☐ No
What is your age? Not relevant
☐ Under 15
☐ 16 - 19
☐ 20 - 24
☐ 25 – 29
☐ 30 – 39
☐ 40 – 49
☐ 50 – 59
☐ 60 – 69
☐ 70 – 79
☐ 80 or over
What is your ethnicity?
☐ White ☐ Mixed / multiple ethnic groups
☐ Asian / Asian British ☐ Black / African / Caribbean / Black British
☐ Other ethnic group. Please specify.
49
Do you consider yourself to be disabled?
The Equality Act 2010 defines a person as disabled if they have a physical or mental impairment, that has a substantial and long-term (i.e. has lasted or is expected to last at least 12 months) and adverse effect on the person’s ability to carry out normal day-to-day activities.
☐ Yes
☐ No
Where do you live?
☐ England ☐ Scotland
☐ Wales ☐ Northern Ireland
☐ Other. Please specify.
About your organisation (if relevant)
Name of organisation:
Action on Smoking and Health (ASH)
Type of business / organisation:
Public health charity
50 How many employees does your business / organisation have?
☐ Less than 10 employees
☐ 10 – 49 employees
☐ 50 – 249 employees
☐ 250 or more employees
Feedback on the consultation
How did you hear about this consultation?
☐ Social Media
☐ Received an email
☐ Word of mouth (family, friend, colleague)
☐ Direct communication from third sector or regulatory organisation
☐ Broadcast news (TV or radio)
☐ GOV.UK or other government website
☐ Newspaper (online or print)
☐ Website (non-government)
☐ Other. Please specify.
51