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Assessing the impacts of Revising the Tobacco Products Directive Study to support a DG SANCO Impact Assessment Jan Tiessen, Priscillia Hunt, Claire Celia, Mihaly Fazekas, Han de Vries, Laura Staetsky, Stephanie Diepeveen, Lila Rabinovich, Helen Ridsdale, Tom Ling Prepared for the European Commission Directorate-General for Health and Consumers EUROPE The research described in this report was prepared for the European Commission Directorate-General for Health and Consumers. RAND Europe is an independent, not-for-profit research organisation whose mission is to improve policy and decision making for the public good. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark. © Copyright 2011 European Commission All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the European Commission. Published 2011 by the RAND Corporation 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665 Westbrook Centre, Milton Road, Cambridge CB4 1YG, United Kingdom RAND URL: http://www.rand.org RAND Europe URL: http://www.rand.org/randeurope To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] Preface The European Commission Health and Consumer Directorate-General (DG SANCO) commissioned RAND Europe to provide support in assessing the impacts of revising the Tobacco Products Directive 2001/37/EC. The research conducted by RAND Europe examines the evidence available for the key health, social and economic impacts that could be expected from the implementation of five policy options currently considered by DG SANCO for the revision of the Tobacco Products Directive 2001/37/EC. This research used a variety of qualitative and quantitative methods to assess the economic and health effects of future regulation, including rapid evidence reviews and econometric and health-economic modelling techniques. This report will serve as an input to DG SANCO’s own regulatory impact assessment exercise, which is a mandatory part of the legislative process in the European Union (EU), but the report also provides an up-to-date overview of the evidence and basis for current tobacco product regulation that may be of interest to a wider audience interested in tobacco control policies. RAND Europe’s work is objective, multidisciplinary and based upon the core value of quality. 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For more information about this document or RAND Europe, please contact: Tom Ling RAND Europe Westbrook Centre Milton Road Cambridge CB4 1YG United Kingdom Tel. +44 (1223) 353 329 [email protected] i Assessing the Impacts of Revising the Tobacco Products Directive RAND Europe Contents Preface .......................................................................................................................... i Contents ...................................................................................................................... ii List of figures .............................................................................................................. ix List of tables .............................................................................................................. xiii List of acronyms and abbreviations ........................................................................... xvii Summary ................................................................................................................... xxi CHAPTER 1 Introduction .................................................................................... 1 1.1 The challenge of tobacco ................................................................................... 1 1.2 Tobacco control in the EU ................................................................................ 2 1.3 Tobacco Products Directive 2001/37/EC .......................................................... 3 1.4 RAND Europe’s assignment .............................................................................. 4 1.5 This report ........................................................................................................ 6 CHAPTER 2 Approach and methodology ............................................................. 7 2.1 Approach: supporting an impact assessment ...................................................... 7 2.2 Evidence and literature review ........................................................................... 8 2.2.1 Sources of evidence .............................................................................. 8 2.2.2 Key terms ............................................................................................. 9 2.2.3 Inclusion criteria ................................................................................ 10 2.2.4 Capturing relevant information from the sources identified ................ 10 Qualitative information ................................................................................... 10 Quantitative information ................................................................................. 11 2.3 Modelling of health impacts and healthcare costs ............................................. 11 2.3.1 Data ................................................................................................... 12 2.3.2 Key assumptions of the approach ....................................................... 13 2.3.3 Steps of the approach ......................................................................... 15 2.3.4 Limitations ......................................................................................... 20 2.4 Forecasting future prevalence and modelling macroeconomic impacts ............. 21 2.5 Assessing administrative burden ....................................................................... 23 2.6 Comparing measures and options .................................................................... 26 2.7 Types of impacts assessed ................................................................................. 27 ii RAND Europe Content CHAPTER 3 Background for tobacco use and its health effects........................... 28 3.1 Introduction .................................................................................................... 28 3.2 Tobacco use in the EU .................................................................................... 29 3.2.1 Smoking prevalence is declining in the EU ........................................ 29 3.2.2 Differences among Member States ..................................................... 31 3.2.3 Smoking prevalence among men and women ..................................... 37 3.2.4 Young smokers .................................................................................. 39 3.2.5 Socioeconomic differences ................................................................. 41 3.2.6 Use of different tobacco products ....................................................... 42 3.3 The health effects of tobacco use ..................................................................... 45 3.3.1 Toxicology of tobacco use .................................................................. 45 3.3.2 The link between tobacco use and morbidity and mortality