The tobacco epidemic today Tob Control: first published as 10.1136/tobaccocontrol-2011-050396 on 16 February 2012. Downloaded from The impact of tobacco control research on policy: 20 years of progress Kenneth E Warner, Jamie Tam Department of Health ABSTRACT (2) to examine how research and policy have Management & Policy, School of Objectives To assess progress in tobacco control policy interacted and influenced each other. We address Public Health, University of research and the relevance of research to policymaking. the first objective by presenting findings from Michigan, Michigan, USA Methods Over 100 experts were surveyed about their a survey of tobacco control experts regarding Correspondence to opinions on the body of research existing in 1992 and progress in research over the past two decades on Professor Kenneth E Warner, 2011 concerning 11 areas of tobacco control policy, the a series of core policy areas. We also consider Department of Health state of policy implementation in both years, the extent respondents’ assessments of progress in the adop- Management & Policy, School of to which research has affected policy adoption and how tion and implementation of these policies, the role Public Health, University of fl Michigan, 1415 Washington experience with policy has influenced research. Case of research in in uencing policy adoption and how Heights, Ann Arbor, Michigan, studies of how research and policy implementation have policy experience can influence research. We then USA; [email protected] interacted were developed. consider the often-complicated relationships Results The body of research was not judged between research and policy in three policy Received 16 August 2011 Accepted 19 December 2011 ‘substantial’ in any of the policy areas in 1992. In 2011, 6 domains. We conclude with discussion of the role of of the 11 areas were evaluated as substantial. None research in the Framework Convention on Tobacco ranked as substantial regarding policy implementation in Control (FCTC). 1992, but by 2011 half were so ranked for developed We define tobacco control policy research as countries; in low-income and middle-income countries research describing the nature, adoption, or conse- policy implementation moved from very low to moderate. quences of tobacco control policies, commonly Respondents judged the role of research in actual undertaken to inform or support policymakers and policymaking as ‘substantial’ regarding clean indoor air, advocates, as Pinney observed. We exclude other taxation and cessation treatment policy. Case studies forms of research that have had an enormous fl illustrate how research can directly affect policy in uence on tobacco control policy. The seminal copyright. (taxation), how policy and research can have iterative epidemiological publications linking smoking to e effects (clean indoor air), and how research and policy lung cancer4 6 ultimately motivated the first interact in the case of novel policies (graphic cigarette modern-era tobacco control policies. However, pack warnings). The role of research in the formulation of that research was undertaken to evaluate an the Framework Convention on Tobacco Control is also exposureerisk connection, not to prompt policy examined. development. Similarly, the original epidemiological Conclusions Policy research goals established in 1992 research on the health effects of secondhand smoke have been largely realised. For select tobacco control (SHS) exposure played a critical role in the evolu- policies, research has made truly important contributions tion of clean indoor air laws,7 but its goal was to http://tobaccocontrol.bmj.com/ to saving lives. Evidence-based policy adoption will determine if SHS exposure caused lung cancer. continue to be essential to minimising the toll of tobacco, More recently, documents research on tobacco especially in the world’s poorer countries. industry knowledge and behaviour has discredited the industry,89thereby supporting policy devel- opment, though the analysis was not focused on d INTRODUCTION policy per se. Similarly, tobacco litigation and d In the first issue of Tobacco Control in 1992, legal research related to it has resulted in judge- ’ ments and settlements that have achieved the Dr Ronald Davis, the journal s founding editor, 10 identified ‘the tracking and evaluation of tobacco status of policy. Epidemiology, non-policy ’ 1 tobacco document research and legal research control policy and legislation as a journal priority. on October 1, 2021 by guest. Protected ’ fi ‘ illustrate the importance of forms of research not The journal s rst supplement, Policy Research: fi Strategic Directions’,2 published that same year, strictly de ned here as policy research. Were we to described the state of the art in several areas of include these as policy research per se, there would tobacco policy research and defined a research be no useful distinction between policy research agenda for the coming decades. In the forward, and any other form of tobacco and health research. John Pinney claimed that ‘there is a strong consensus within the tobacco control field that SURVEY METHODS research that informs and supports policymakers Using Qualtrics survey software,11 we conducted and advocates can greatly enhance our efforts at an online survey to assess progress in tobacco policy preventing smoking and promoting cessation’.3 research (a copy is available at https://sites.google. With this anniversary issue of the journal, we com/site/tcpolicyresearch/). We queried respon- consider how policy research has fared in the dents about their opinions on: the quantity and intervening two decades. Our objectives were (1) to quality of the research existing in 1992 concerning assess progress in tobacco control policy research each of 11 areas of tobacco control policy; the and the relevance of research to policymaking and quantity and quality of research on the same Tobacco Control 2012;21:103e109. doi:10.1136/tobaccocontrol-2011-050396 103 The tobacco epidemic today Tob Control: first published as 10.1136/tobaccocontrol-2011-050396 on 16 February 2012. Downloaded from policies in 2011; the state of implementation of each of the areas were evaluated as having a substantial body of research (in policies in both years in developed countries and, separately, in descending order from the highest score: clean indoor air laws low-income and middle-income countries; the extent to which and policies; taxation; warning labels; advertising and promo- research has played a direct role in the adoption of each of the tion bans; cessation treatment policy; and public education and policies; and finally how experience with policy has influenced information). The remaining five areas were considered to have the nature and quantity of research for each of the policy areas. a moderate body of research evidence. The areas evaluated as Potential respondents, comprising 163 unique individuals, having the greatest growth in quality and quantity of research included: (1) Tobacco Control editors and Editorial Advisory Board (defined as the difference in the 2 years’ average scores) were members from the original volume of the journal (1992); (2) the warning labels, which increased by nearly a full point (0.95), and same groups from the 2011 volume; and (3) coauthors of the clean indoor air laws and policies, up 0.82 points. 1992 ‘Policy Research’ journal supplement papers. We eliminated as potential respondents 23 individuals who are deceased or long Progress in policy adoption since 1992 removed from tobacco control as well as those for whom we We asked respondents about ‘the extent of policy adoption’ in could not identify email addresses. Of the remaining 140, 105 the 11 policy areas in developed countries (DCs) and low-income (75%) completed the survey. and middle-income countries (LMICs) in 1992 and in 2011. The word ‘extent’ allowed respondents to consider how effectively SURVEY FINDINGS policies were employed to achieve tobacco control. Thus, for In all, 55% of survey respondents have been involved in tobacco example, respondents were certainly aware that virtually all control for more than 25 years, and 82% for more than 15 years. DCs taxed cigarettes and required warning labels on packs by Three-quarters had a good working knowledge of developments 1992. Yet they ranked the extent of policy adoption as less than in tobacco control research and policy throughout the 20-year ‘moderate’ for each (see table 2), likely reflecting the then period. Two-thirds are currently involved in tobacco control weakness of text-only package warnings and the modest size of research, with 15% involved previously. Half are actively cigarette taxes. involved in running tobacco control programmes or developing For DCs, only five policies approached or achieved a ranking of or implementing policies. In all, 60% of respondents have spent ‘moderate’ in 1992. In descending order from the most exten- most of their careers in North America, 29% in Europe, sively adopted, they are: school health education, public educa- Australia, or New Zealand and 11% in Asia, Africa, or South tion and information, youth access laws, taxation and warning America. labels. None of the 11 policy areas came close to being ranked ‘substantial’. By 2011, however, respondents ranked policy copyright. Progress in policy research since 1992 adoption ‘substantial’ for half of the policy areas, with 82% Table 1 presents respondents’ rankings of the quantity and ranking clean indoor air policy as ‘substantial’, 66% for warning quality of the research pertaining to each of 11 policy areas in labels and 60% for advertising and promotion restrictions and 1992 and at the time of the survey (April to May 2011). Our taxation. None of the policy areas was ranked as ‘non-existent or experts concluded that the bodies of research for nine of the limited’ by 2011. areas were only ‘moderate’ in quantity and quality in 1992 (with For LMICs, in neither year did respondents evaluate policy an average score near 1.0, with the range being ‘non-existent or adoption as ‘substantial’ for any policy area. In 1992, respon- limited’, scored 0, to ‘substantial’, scored 2).