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Smoking and Health 2021 a Coming of Age for Tobacco Control? a Report by the Tobacco Advisory Group of the Royal College of Physicians

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Smoking and Health 2021 a Coming of Age for Tobacco Control? a Report by the Tobacco Advisory Group of the Royal College of Physicians Smoking and health 2021 A coming of age for tobacco control? A report by the Tobacco Advisory Group of the Royal College of Physicians May 2021 Smoking and health 2021 A coming of age for tobacco control? A report by the Tobacco Advisory Group of the Royal College of Physicians May 2021 Acknowledgements The Tobacco Advisory Group acknowledges the help of the UK Centre for Tobacco and Alcohol Studies and Cancer Research UK (CRUK) for supporting some of the original research and literature reviews contained in this report; and thanks Lynsey Hanvey, Karen Porter and Keith Whitlock in the Royal College of Physicians Publications Department for their work in producing the report. The Royal College of Physicians The Royal College of Physicians (RCP) plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. The RCP provides physicians in over 30 medical specialties with education, training and support throughout their careers. As an independent charity representing over 40,000 fellows and members worldwide, the RCP advises and works with government, patients, allied healthcare professionals and the public to improve health and healthcare. Citation for this document Royal College of Physicians. Smoking and health 2021: a coming of age for tobacco control? London: RCP, 2021. Copyright All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording or other electronic or mechanical methods, without the written permission of the copyright owner. Applications to reproduce any part of this publication should be addressed to the publisher. Copyright © Royal College of Physicians 2021 ISBN 978-1-86016-847-5 eISBN 978-1-86016-848-2 Royal College of Physicians 11 St Andrews Place Regent’s Park London NW1 4LE www.rcplondon.ac.uk Registered Charity No 210508 Contents Contributors vi 4. Preventing uptake of smoking by children 39 Declaration of contributors’ interests viii 4.1 Introduction 39 Members of the Tobacco Advisory Group ix 4.2 Trends in young people’s smoking 40 Foreword x 4.3 Drivers of youth smoking 41 Abbreviations xi 4.4 How has progress to date in reducing smoking Executive summary and recommendations xii uptake been achieved? 42 1. Introduction 1 4.5 The role of e-cigarettes 43 4.6 Future directions in reducing young people’s 1.1 The evolution of tobacco control 1 uptake of tobacco 43 1.2 Tobacco industry response to tobacco control 2 1.3 Objectives of this report 3 5 Tobacco advertising and promotion 48 5.1 The evolution of tobacco promotion and its 2 Impact of tobacco control policy regulation in the UK 49 on smoking prevalence from 2000 5.2 Effect of media smoking imagery on smoking and modelling to 2050 5 behaviour 50 2.1 Introduction 5 5.3 Smoking in films 51 2.2 Effects of the WHO Framework Convention on 5.4 Smoking in UK television and on-demand media 57 Tobacco Control policies on smoking behaviour 6 5.5 Alibi marketing 59 2.3 Effects of FCTC policies on socio-economic 5.6 Smoking and the arts 60 inequalities 7 5.7 Point-of-sale advertising 61 2.4 UK tobacco control policy and smoking 5.8 Standardised tobacco packaging 64 prevalence 8 5.9 Pack inserts 65 2.5 Inequalities in smoking in the UK 9 5.10 Flavours and flavour capsules 66 2.6 Projecting future trends in smoking prevalence 10 5.11 Dissuasive cigarettes 66 3. Education: policymakers, the public and the healthcare workforce 18 6 Public space smoking restrictions 73 3.1 Introduction 18 6.1 Introduction 73 3.2 The evolution of advocacy, lobbying and 6.2 The evolution of public and workplace campaigning for policy change 19 on smoking in the UK 73 3.3 Health warnings and product labelling 21 6.3 Effects of smoke-free policies 74 3.4 Mass media and social marketing campaigns 24 6.4 Smoke-free policies in hospital settings 75 3.5 Medical guidelines 26 6.5 Effectiveness of further restrictions – outdoor public and commercial places and social housing 77 3.6 The healthcare workforce 28 6.6 Use of vaping in public places to facilitate smoking bans 78 © Royal College of Physicians 2021 iv 7 Economics of tobacco 82 10 Tobacco industry tactics to undermine 7.1 Introduction 82 tobacco control 136 7.2 The price elasticity of demand for tobacco 10.1 Introduction 137 products 83 10.2 Tobacco industry interference in UK 7.3 Historic overview of tobacco prices and tobacco control 137 affordability in the UK 85 10.3 Undermining UK tobacco control policy: 7.4 Tobacco industry tactics to mitigate tax rises 87 current and future concerns 142 7.5 Future directions for tobacco price and taxation policy 89 11 Ethical aspects of tobacco control 150 7.6 Taxation and price elasticity of smoking cessation 11.1 Introduction 150 medication, non-tobacco nicotine consumer 11.2 Autonomy 151 products and heated tobacco products 90 11.3 Justice 151 7.7 A smoke-free dividend 91 8 Tobacco content, nicotine products and regulation 95 8.1 Introduction 95 8.2 Components, design, and use of tobacco products 95 8.3 Filter ventilation on tobacco cigarettes 100 8.4 Labelling – tar, nicotine and carbon monoxide (TNCO) levels 100 8.5 Reporting requirements on the tobacco industry 100 8.6 Nicotine product regulation 101 8.7 ‘Fire safer’ cigarettes 104 9 Treatment of tobacco addiction 108 9.1 Introduction 108 9.2 The cycle of addiction in a smoker 108 9.3 Triggering quit attempts 111 9.4 Treatment of tobacco dependency in healthcare 114 9.5 Primary care 122 9.6 The role of e-cigarettes and heated tobacco products 125 © Royal College of Physicians 2021 v Contributors Sanjay Agrawal Professor of respiratory medicine, Matthew Evison Consultant in respiratory medicine, University of Leicester Manchester University NHS Foundation Trust Deborah Arnott Chief executive, Action on Smoking Winifred Ekezie Research associate, University of Leicester and Health Becky Freeman Associate professor, University of Richard Ashcroft Professor of bioethics, Sydney, Australia City University, London Geoffrey T Fong Professor of psychology and public Paul Aveyard Professor of behavioural medicine, health and health systems, University of Waterloo, Canada University of Oxford Duncan Gillespie Research fellow, University of Sheffield Linda Bauld Professor of public health, University Anna B Gilmore Professor of public health, University of Edinburgh of Bath Alex B Barker Research fellow, University of Nottingham Dave Hammond Professor, University of Waterloo, Virginia Berridge Professor of history and health policy, Canada London School of Hygiene and Tropical Medicine Zeinab Hassanein Postgraduate student, University Emma Beard Principal research fellow, University of Nottingham College London Summer Sherburne Hawkins Associate professor, Ilze Bogdanovica Principal research fellow, University Boston College, USA of Nottingham Thomas R Hird Research fellow, University of Bath J Robert Branston Senior lecturer, University of Bath Rosemary Hiscock Research associate, University of Bath John Britton Emeritus professor of epidemiology, Janet Hoek Professor of public health, University of University of Nottingham Otago, Wellington, New Zealand Jamie Brown Professor of behavioural science and Marie Horton Senior public health intelligence analyst, health, University College London Public Health England Phil Chamberlain Managing editor of Tobacco Nick Hopkinson Reader in respiratory medicine, Imperial Tactics, University of Bath College London Tim Coleman Professor of primary care, University Sarah Jackson Principal research fellow, University of Nottingham College London Lorraine Craig International tobacco control project Emma Knowles Director of policy and research, dissemination manager, University of Waterloo, Canada Healthcare Financial Management Association Martin Dockrell Tobacco control lead, Public Health Lynn T Kozlowski Professor of community health and England health behaviour, University at Buffalo, USA Richard Edwards Professor of public health, University Mirte AG Kuipers Research fellow, Amsterdam of Otago, New Zealand UMC – University of Amsterdam, Netherlands © Royal College of Physicians 2021 vi Contributors Tessa Langley Associate professor in health economics, University of Nottingham Jo Leonardi-Bee Professor of medical statistics and epidemiology, University of Nottingham Ann McNeill Professor of tobacco addiction, King’s College London Andrew Monahan Policy and research manager, Healthcare Financial Management Association Crawford Moodie Senior research fellow, University of Stirling Graham Moore Professor of social sciences and public health, Cardiff University Marcus Munafò Professor of biological psychology, University of Bristol Rachael Murray Professor of population health, University of Nottingham Richard J O’Connor Professor of oncology, Roswell Park Comprehensive Cancer Center, Buffalo, USA Rob Pryce Research fellow, University of Sheffield Elena Ratschen Senior lecturer, University of York Lion Shahab Professor of health psychology, University College London Niamh K Shortt Professor of health geographies, University of Edinburgh Judith Watt Consultant for Action on Smoking and Health Sarah Williams Tobacco control programme manager, Public Health England Luke B Wilson Research associate, University of Sheffield © Royal College of Physicians 2021 vii Declaration of contributors’ interests J Robert Branston owns 10 shares in Imperial Brands for research purposes. The shares were a gift from a public health campaigner and are not
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