Tobacco Research

The latest updates from the University of Bath's Tobacco Control Research Group

Topic: Public policy

Extent of tobacco industry's lobbying tactics unveiled by new paper

📥  Industry tactics, Public policy

Policy-makers need to ‘wise-up’ to the methods used by the tobacco industry in attempts to influence marketing regulations, according to the authors of a new study published today.

The systematic review, published in PLOS ONE, from researchers in our Tobacco Control Research Group , looked at evidence from around the world to identify the tactics and arguments tobacco companies use to influence and prevent policy aimed at regulating the marketing of tobacco.

Commenting on the research findings, author Professor Anna Gilmore, of the Tobacco Control Research Group and UK Centre for Tobacco & Alcohol Studies, said: “The tobacco companies have a diverse repertoire of tactics and arguments they repeat time and time again to prevent policies which protect the public from its deadly products. Governments around the world need to wise up to when the industry is lying and protect policy development from the vested interests of the tobacco companies.”

This comes amidst the lengthy delay to new plain packaging legislation in the UK. Last year, the government appeared to distance itself from standardised packaging, saying further evidence was needed to show whether it would be effective. As part of this evidence review, Sir Cyril Chantler is currently looking at the likely effect on public health, particularly for children, if standardised tobacco packaging is introduced, with findings expected in mid-March.

The research will also help policy-makers in low and middle income countries who are fighting an uphill battle against big tobacco companies to introduce regulations under the World Health Organisation’s Framework Convention on Tobacco Control (FCTC).

Study author Emily Savell added: “The WHO’s Framework Convention on Tobacco Control recognises the significant influence that tobacco industry marketing has on smoking prevalence and initiation, and recommends that countries comprehensively ban tobacco advertising, promotion and sponsorship. Understanding how the tobacco industry attempts to shape, delay or stop these policies is therefore vital.”

Significantly the paper found that the same tactics and arguments are being used across multiple jurisdictions, showing that the tobacco industry is repeating its activities in high, middle, and low income countries around the world. This suggests that the tobacco industry believes that what works best to influence policy-makers in developed countries will have a similar effect on policy-makers in developing countries. Importantly the paper also identifies a broader range of corporate tactics and arguments than previous studies have suggested.

The researchers found that whilst tobacco industry arguments made to oppose or derail policy appear diverse, on closer inspection they point to a common theme: that the benefits of health reform are marginal whilst the costs to society are likely to be significant. They identify common arguments put forward by the tobacco industry to oppose public policy interventions including:

  1. That a proposed policy will have negative unintended consequences – for example for the economy or public health.
  2. That there is insufficient evidence that a proposed policy will work.
  3. That there are legal barriers to regulation – including that it infringes the legal rights of a company.
  4. That a proposed regulation is unnecessary because the industry does not market to young people and / or adheres to a voluntary code.

The paper also highlights tobacco industry reliance on third parties, making it difficult for the public and policy-makers to assess the credibility and motivation behind efforts to shape the political agenda.

Although over half of the evidence studied for this new systematic review focused on activity in North America, Europe and Australasia, the geographic base was far more diverse than some previous reviews of industry activity.

Click here to access a copy of this systematic review.

Notes on the paper

- This work is supported by the National Cancer Institute of the United States National Institutes of Health [Grant Number R01CA160695], and the Economic and Social Research Council [Grant Number ES/I900284/1]. The funders played no role in the study design, analysis and interpretation of data, nor writing of the report or the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the views of the funders.

- The UK Centre for Tobacco and Alcohol Control Studies (UKCTAS), is a strategic partnership comprising 13 University teams working on tobacco and alcohol research. UKCTAS is one of six UK Centres for Public Health Excellence funded by the UK Clinical Research Collaboration – comprising the Economic & Social Research Council, The British Heart Foundation, Cancer Research UK, the National Institute for Health Research and the Medical Research Council. More information on the Centre can be found at .

- The systematic review included 48 articles. Each article made reference to tobacco industry efforts to influence marketing regulations; supported claims with verifiable evidence; were written in English; and concerned the period 1990-2013.

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Study finds ‘serious flaws’ in EU report on illicit tobacco – January 2014

 

Supporting snus as a harm reduction tool: the need for caution

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📥  Harm reduction, Industry tactics, Public policy

There has been a long, polarising debate among public health experts in Europe about the potential benefits of tobacco harm reduction, and whether the wider availability of smokeless tobacco (particularly snus, a Swedish smokeless tobacco) and e-cigarette will lead to population level benefits or harms.  While no public health professionals would dispute that, for an individual smoker, a complete and permanent switch from cigarettes to snus or e-cigarettes will lead to health benefits, some have concerns that the wider availability of snus and e-cigarettes be detrimental to public health. Harm could occur if, for example, their use encouraged continued smoking rather than cessation, or snus and e-cigarette use acted as a gateway to smoking. While there is little evidence of the latter in Europe, some are specifically concerned that transnational tobacco companies (TTCs) (which make the vast majority of their current profits from cigarettes) will promote snus or e-cigarette use in a way that sustains and promotes, rather than reduces, smoking. Findings of our study, published today in PLOS Medicine and freely available here show that these concerns are not unfounded.

What we did

Our research centred on TTCs’ smokeless tobacco interest and investment in Europe, with a focus on British American Tobacco, and to a lesser degree Philip Morris. We qualitatively analysed a combination of historic internal tobacco industry documents dating from 1971 to 2009, available through the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu/), and more contemporary materials including tobacco company investor presentations dating from 2008 to 2012.

What we found

TTCs started investing in the snus from 2002, leaving an insignificant number of snus manufacturers fully independent of cigarettes interests. However BAT has been scoping other SLT opportunities as early as the 1970s, driven by the threat of increased regulation (e.g. smoke-free policies) and growing health concerns about smoking, both likely to result in less cigarette sales.  BAT considered SLT an opportunity to create a new form of tobacco use among a) smokers who were considering quitting, b) a new generation of ‘better educated’ consumers no longer interested  in taking up smoking,  and c) smokers in smokefree places. Young people were a key target.

When TTCs actually entered the Scandinavian snus market in 2002 (the only snus market in Europe), three issues converged: cigarette volumes started declining in Western Europe, discussions started at EU level about smokefree legislation, and crucially, unlike the 1970s, the public health community showed significant support for tobacco harm reduction. 

Despite these investments, we found little evidence in TTC’s corporate reporting that snus is or was a core part of their business strategy and recent snus test markets have failed. Since 2009, the focus of TTC’s investment in less harmful products has shifted to pure nicotine, and moved to e-cigarettes in 2012.

Why does it matter?

Although it is still early days to understand the TTCs motives behind their move away from tobacco into nicotine, a recent BAT investor presentation suggested that non-smokers rather than smokers could be the target of BAT’s reduced harm products. Our research on TTCs’ interest in SLT, shows that TTCs’ rhetoric about snus and harm reduction is inconsistent with historical and recent TTC documents and action, both of which suggest that TTCs may have little intention of promoting SLT use in a way envisioned by public health, as this would eat into their existing cigarette profits. TTCs’ snus investments have been defensive instead, turning snus from a threat (a product that may have competed with cigarettes) into a major opportunity (one that enables the TTCs to claim a joint agenda with public health and to rehabilitate their image via claims of wishing to reduce harm). By investing in snus, and perhaps more recently nicotine, cigarette companies are slowly eliminating competition between cigarettes and snus, thus helping maintain the current market balance in favour of highly profitable cigarettes while ensuring TTCs' long-term future should cigarette sales decline further and profit margins be eroded.

Importantly, what are the policy implications?

Currently snus sales are prohibited in all EU countries (except in Sweden) under legislation that regulates all tobacco products in Europe (Tobacco Products Directive 2001/37/EC). As the current legislation was adopted in 2001, the European Commission had proposed a revised text, which the European Parliament will vote on next month.  The proposal maintains the sales ban on snus. Similarly, our study suggest that legalising snus sales in Europe may have considerably less benefit than envisaged and could have a number of harmful consequences.

Perhaps more concerning are the recent TTC investments in pure nicotine. Should such investments continue, competition between cigarettes and clean nicotine products will be reduced, and with it the potential for harm reduction to benefit public health.  Also, it may enable TTCs to present themselves as purveyors of nicotine rather than tobacco products, and use this to undermine Article 5.3 of the Framework Convention on Tobacco Control which aims to protect public health policy from commercial and other vested interests of the tobacco industry.

For more detail, check out our paper Transnational tobacco company interests in smokeless tobacco in Europe: analysis of internal industry documents and contemporary industry materials

 

Emergency asthma admissions drop by nearly 2000 a year following smokefree law

📥  Public policy

Numbers of adults admitted to hospital for emergency treatment for asthma have dropped by over four per cent since smokefree legislation was introduced in England, Bath researchers have found.

The researchers from the UK Centre for Tobacco Control Studies, based at the University of Bath, found there was an immediate 4.9 per cent reduction in emergency hospital admissions for asthma in the adult population. This implies almost 1900 admissions were prevented during the first year after legislation was introduced and a similar number in the subsequent two years.

In order to investigate the law that made enclosed public places and workplaces smoke-free in England from 1 July 2007 onwards, the study, funded by the Department of Health and published this week in the journal Thorax, identified monthly numbers of emergency admissions for asthma from April 1997 to December 2010 in the population aged 16 and over. Admission rates in the ten years before the introduction of smokefree legislation were then compared to those in the period after it came into force, taking into account underlying trends in admissions and variations in other factors liable to influence asthma admission rates, such as seasonal flu and temperature.

Dr Michelle Sims, the first author of the paper, said: “Second hand smoke exposure has significant adverse health effects on the adult respiratory system with current evidence suggesting that it contributes to the onset and exacerbation of asthma.

There is already evidence that smokefree legislation in England is associated with reductions in secondhand smoke exposure among non-smoking adults and fewer emergency hospital admissions for heart attacks and childhood asthma. Our findings show that these health benefits extend to adult asthma.”

The prevalence of asthma in England is among the highest in the world with approximately 5.9 per cent of the population having the condition.

There are furthermore stark regional differences in emergency hospital admissions for asthma across England that have widened in recent years.

Professor Anna Gilmore, who led the study, said “Our findings add to the expanding body of evidence that smokefree policies are associated with positive health outcomes.”

Only four previous studies have examined whether the introduction of smokefree legislation was associated with immediate reductions in asthma admissions among adults and collectively these findings are inconclusive. This paper, the largest study of its kind and addressing limitations of previous studies, makes a unique contribution to the evidence on smokefree laws and asthma.

The full results are reported in the paper Short-term impact of the smokefree legislation in England on emergency hospital admissions for asthma among adults published in the journal Thorax.

NOTE

The paper is an independent report commissioned and funded by the Department of Health’s Policy Research Programme.  The views expressed are not necessarily those of the funders.

 

New research suggests that government cap cigarette prices and raise an extra £500m per year in doing so

📥  Industry tactics, Public policy

An independent regulatory agency to cap the wholesale prices of tobacco would curb the excessive profits made by tobacco manufacturers and should raise an extra £500 million per year of tobacco tax revenue for the Treasury, say researchers from the University of Bath. The creation of an ‘Ofsmoke’ agency to regulate the industry, similar to those in force for utility companies, would increase tax revenue and help protect public health, according to the article recently published in the journal Tobacco Control.

The study starts by highlighting how cigarette manufacturers currently make roughly double the profits of most other companies. Imperial Tobacco for example is reported as having profit margins in the UK of 67 per cent, meaning 67p out of every £1 it receives from tobacco sales is profit, making it one of the most profitable companies in the UK.

Dr Robert Branston, from the Centre for Governance and Regulation at the University of Bath’s School of Management; and Professor Anna Gilmore, from the University’s Department for Health and the UK Centre for Tobacco Control Studies, say that capping the pre-tax cigarette manufacturers’ prices would safeguard society from the market failure behind manufacturers’ pricing power and associated high profits. Regulation would set a maximum price that cigarette companies could charge for their product, based on an assessment of genuine operational costs. Retail mark-up would not be affected and nor would the price that consumers pay, but the excess profit currently accrued by cigarette manufacturers would be transferred to the Treasury through increased tobacco taxes.  The system would be set up at no cost to the consumer or taxpayer, funded instead through a levy or licence fee paid by tobacco companies.

The study finds that the potential increase in UK annual tobacco tax revenues were approximately £500 million using 2009 and 2010 data, even allowing the costs of putting the system in place.  The money raise would fund, twice over, UK wide anti-tobacco smuggling measures and smoking cessation services in England including the associated pharmacotherapies to help people stop smoking.

Dr Robert Branston, Deputy Director of the University’s Centre for Governance & Regulation, said: “A handful of companies dominate the market and cream off massive profits. With such a deadly product, competition isn’t attractive, so we’ve identified regulation as an attractive alternative that stands to benefit both government and public health.

“Clamping down on the extreme profitability of cigarettes would reduce the incentive for tobacco companies to fight public health measures and mean they have fewer funds at their disposal. It would also raise the small matter of £500m for the nation.

“A move to regulation would make it easier to expand tobacco control policies as companies would be partially insulated against their impact on revenue and, therefore, less able to argue against them.”

He went on to say that regulation could also be a way of preventing tobacco companies from using price as a marketing strategy and might even help restrain the behaviour of companies when it comes to supporting cigarette smuggling and marketing to young people.

Professor Anna Gilmore, Director of the University’s Tobacco Control Research Group said, “The tobacco industry is likely to argue that this type of direct economic regulation is an extreme reaction, but it’s hard to argue that nothing should be done given the extent of market power that these firms are enjoying and the number of deaths the sector causes.

“If it came to a choice between increasing income tax or capping the excess profits of companies whose products kill one in two users, I could hazard a guess which one the public would prefer”

Deborah Arnott chief executive of health charity Action on Smoking and Health said, “Tobacco multinationals are unique, they make excessive profits despite the fact their products kill half all their customers. They can continue to charge premium prices and make excess profits because their products are cheap to make, highly addictive and competition in such a highly regulated market is so limited. Capping their profits is not extreme it’s essential.”

The paper is based on the UK but researchers are confident that the system could be applied to any country where tobacco companies enjoy significant market power and are therefore able to make excessive profits.

To read the full text click here.

 

Impact of smoking ban on the most exposed children

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📥  Public policy

High levels of secondhand smoke exposure in children are known to have adverse consequences for arterial health. However, there is no information about the proportion of children in England that are exposed to these levels, whether it has changed over time and whether it has changed in response to the introduction of smoke-free legislation in 2007. 

Evidence suggests that legislation making enclosed public places and work-places smoke-free has reduced secondhand smoke exposure in non-smoking adults. There have however been concerns that smokers may smoke more at home if they cannot smoke in public places.  This displacement of smoking to the home could increase exposure among children.    In a paper published in Addiction, we report on trends in the proportion of children with high exposure, above a threshold level known to be detrimental to arterial health.  Understanding the impact of legislation is important because children who are not so heavily exposed may, by displacement of adult smoking to the home, be exposed to more secondhand smoke and are then pushed over this threshold. 

We analysed data from the Health Survey for England conducted between 1996 and 2008. These surveys measured cotinine, an indicator of tobacco smoke exposure, in the saliva collected from 16,000 children aged between 4 and 15.

We found that the proportion of children exposed to damaging levels of second-hand smoke has fallen over time. Amongst children in England, the percentage fell from 24% in 1996 to 13% in 2008. Despite the reduction over time, a large proportion of children continue to be highly exposed to second-hand smoke. In 2008, 49% of children living in homes allowing smoking inside and 34% of those with at least one parent who smokes had levels of exposure known to have adverse consequences for arterial health.

The research also reveals that legislation did not increase the proportion of children exposed to damaging levels of secondhand smoke. This strengthens evidence from England and other countries of the United Kingdom that legislation to prohibit smoking in public places and work-places does not displace adult smoking to the home.

 The study was funded by the Department of Health.

 The published paper can be accessed here:

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03924.x/abstract

Commentary on the paper can be accessed here:

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.04014.x/pdf

 

500,000 against plain packaging? The figures just don’t add up.

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📥  Industry tactics, Public policy

Plain packaging for cigarettes would require cigarettes to be sold in packets of a standard colour and shape with brand names written in a standardised font and pictorial health warnings covering a substantial proportion of the packet. The public consultation on plain packaging in the UK came to a close on the 10th August 2012. A few days later the Tobacco Manufacturer’s Association (TMA) publicly claimed that ‘half a million oppose plain packaging.' There are three significant issues with this figure:

1. Conjecture

In the misleadingly titled press release ‘half a million oppose plain packaging’, the TMA included a disclaimer that in fact the final figure was unknown as the Department of Health (to whom the consultation submissions were made) had not yet informed them of the number. “We await final confirmation of the number of responses from the DoH.” Nevertheless in his blog, the director of Forest, (an industry-funded pro-smokers’ rights organisation), Simon Clark, said that there were ‘at least 500,000 in opposition.’ Forest ran the Hands Off Our Packs (HOOPs) campaign.

2. Double Counting

The TMA release stated that 236,033 of the ‘half a million in opposition’ were signatures to the HOOPs petition, with the remainder based on “estimated responses into [sic] the consultation including signatures, postcards, letters, emails, online responses, consultation response forms etc…” The TMA did not disclose whether duplicate responses were accounted for in reaching their figure of 500,000. For example, it is highly probable that at least some of the 236, 033 signatories of the HOOPs petition would also have submitted other forms of response: either a formal response to the consultation or a signature on a parallel campaign such as the TMA-funded postcard campaign run by the Tobacco Retailers Alliance specifically for retailers.

3. Falsifying signatures

The DoH made a number of its documents public following a recent Freedom of Information request . Amongst the documents are several letters written to Simon Clark. On the 14th June 2012 the DoH’s Tobacco Programme Manager wrote to inform Clark of an instance whereby the manager saw a member of the HOOPS campaign staff falsifying at least a page of signatures to the petition in the street. A follow up letter was sent on the 20th June 2012 asking Clark to comment on the methods HOOPS employed to gather signatures and how Forest was “verifying that the petition only includes the names and addresses of actual people, who have signed the petition of their own accord?”

This second letter was written following a complaint from the Chair of the Royal College of Physicians’ Tobacco Advisory Group. The Chair described how he had been told by his students at the University of Nottingham that friends of theirs at the University were being paid by HOOPs to gather signatures for the petition. On the 16th July an email was sent to Clark by the DoH’s Tobacco Programme Manager in response to a question Clark had directed at then Health Minister Andrew Lansley. The Tobacco Programme Manager took the opportunity to ask Clark whether he had received the two letters and mentioned new complaints that had been sent to the DoH about the HOOPs campaign. The three further complaints were again concerned with the methods used to gather signatures, with members of the public voicing concerns that HOOPs campaigners were:

  • targeting parents in play grounds telling them that plain packets would be completely plain with no health warnings;
  • gathering signatures in loud nightclubs;
  • targeting adolescents in the street telling them that the government was trying to ban cigarettes

Clark has published a number of blog posts in response to the release of these documents, defending the credibility of the HOOPs campaign and diverting attention away from the HOOPs scandal by directing criticism at the Plain Packs Protect campaign.

 

Smokeless tobacco illegally sold via the internet

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📥  Public policy

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We discovered that snus, a smokeless tobacco banned in all EU countries except Sweden, is easily obtainable online - contravening three pieces of EU legislation. Are Swedish authorities doing enough to prohibit exports to other EU countries?

The sale of snus, a Scandinavian smokeless tobacco product, was banned in the EU in 1992; an action reaffirmed in the 2001 Tobacco Products Directive which is currently under review. Only Sweden was given an exemption to this ban, provided it ensured that snus would not be placed for sale on the markets of other EU countries.

We carried out online snus test purchases in ten EU countries, and found that snus was easily purchased in all sample countries; of the 43 purchases attempted, only two failed due to credit card issues. In the majority of successful purchases, taxes were levied inappropriately in the country of the vendor rather than the country of destination as required by EU legislation.

The results also indicated that most online vendors operate from Sweden, and deliberately target non-Swedish EU citizens, despite Swedish legislation making it illegal to sell snus outside Sweden.

We analysed the websites from which our purchases were made and revealed that age verification measures to prevent under-aged sales are inadequate. Also vendors frequently use promotions (many price-based such as bulk-buy discounts) to encourage the use of snus despite EU legislation banning tobacco advertising over the internet.

This is the only peer-reviewed study to date to examine online snus sales in the EU and assess the conduct of online snus vendors. This study provides evidence that the online sale of snus to non-Swedish EU citizens contravenes three pieces of EU legislation – a ban on selling snus outside Sweden, a requirement for the excise on distance sales of tobacco to be collected in the destination country, and a ban on cross-border tobacco advertising. Furthermore, the findings suggest that Swedish legislation which prohibits snus exports to other EU countries is not being enforced.

This research is published in Tobacco Control.  If you already have a subscription to this journal, the following link will direct you to the paper.

http://tobaccocontrol.bmj.com/content/early/2012/01/21/tobaccocontrol-2011-050209.full

 

Smoking ban linked to drop in adults’ second-hand smoke exposure

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📥  Public policy

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Levels of second-hand smoke  exposure among non-smoking adults fell by almost 30 per cent after smoke free legislation was introduced in England in 2007.

The most comprehensive study to date of second-hand smoke exposure among non-smoking adults in England, which was funded by the Department of Health, was published on 13 December 2011 in the journal Environmental Health Perspectives.

Researchers analysed data from seven national surveys conducted between 1998 and 2008. These surveys measured cotinine, an indicator of tobacco smoke exposure, in saliva samples from over 30,000 people aged 16 and over.

They showed that levels of exposure to second-hand smoke in non-smokers had been declining in the ten years leading up to smoke free legislation. But even when this decline was taken into account, the introduction of smoke free public places led to significant, additional reductions in exposure. Average exposure fell by 27 per cent immediately following the legislation.

The results further revealed that while there was a marked reduction in the levels of second-hand smoke exposure among those who lived in a smoke free home, those who lived in a home where there was smoking inside showed no significant change in exposure following the implementation of smoke free public places.

Dr Michelle Sims, the first author of the paper, said: “Smoke exposure fell after the introduction of England’s smoke free legislation above and beyond the underlying long-term decline, demonstrating the positive effect of the legislation.

“Nevertheless, some population subgroups appear not to have benefited significantly from the legislation, suggesting that these groups should receive more support to reduce their exposure.

“There is now a large body of evidence documenting the adverse effects of second-hand smoke exposure.  In adults it is now known to be linked with coronary heart disease, lung and various other cancers, stroke, chronic respiratory symptoms and adverse pregnancy outcomes.”

Other research has shown that smoke free legislation is also associated with reductions in hospital admissions for heart attacks and asthma in the UK and other countries.

Professor Anna Gilmore, who directed the study, said: “The importance of this study is that it examines the impacts of smoke free policies on adults’ exposure using a specific biological-marker of smoke exposure (rather than self-reported exposure) while simultaneously controlling for underlying declines in exposure.

“To our knowledge it is the first study to do this. The fact it shows marked declines in adult exposure provides further evidence of the important public health benefits of smoke-free policies.”

Smoke-free legislation was implemented in England on the 1st July 2007, making virtually all enclosed public places and workspaces smoke-free. The aim of the legislation was to protect non-smokers and children from the negative consequences of second-hand smoke exposure.

The full text of this article can be accessed here:

http://ehp03.niehs.nih.gov/article/info%3Adoi%2F10.1289%2Fehp.1103680

 

Smoking ban linked to drop in admissions for heart attacks

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📥  Public policy

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We have observed a 2.4 per cent drop in the number of emergency admissions to hospital for a heart attack  following the implementation of smokefree legislation in England.

The legislation was introduced on 1 July 2007 and this study was the first to evaluate its impact on heart attacks.

The team, led by Dr Anna Gilmore, Director of the Tobacco Control Research Group, part of the UK Centre for Tobacco Control Studies, found there were 1200 fewer emergency hospital admissions for myocardial infarction, commonly known as heart attacks, in the year after the legislation was introduced.

First author of the paper Dr Michelle Sims said: “After the implementation of smokefree legislation there was a statistically significant drop of 2.4 percent in the number of emergency admissions for myocardial infarction. This implies that just over 1200 emergency admissions for myocardial infarction were prevented over a 12 month period.”

Numerous studies show that passive smoking increases the risk of coronary heart disease, with recent evidence suggesting that the risk may be increased by as much as 60 per cent, similar to that observed in light active smokers. Exposure to other people’s tobacco smoke also appears to have an acute impact on the heart, within minutes of exposure, and thus trigger acute coronary events.

Measures that reduce exposure to second hand smoke, such as smokefree legislation, are therefore likely to reduce the occurrence of acute coronary events, including myocardial infarction, with almost immediate effect.

This study builds on a growing body of evidence linking the introduction of smokefree legislation with a reduction in hospital admissions for acute coronary events.  It finds a smaller reduction in admissions than many other studies and the authors propose two reasons for this. First, levels of exposure to other people’s smoke in England were already quite low before the legislation was introduced and thus the potential for health benefits following the legislation will be lower. Second, the analysis helped eliminate other reasons for a decline in admissions including accounting for the fact that admissions for heart attacks have been reducing anyway.

Dr Gilmore said: “Given the large number of heart attacks in this country each year, even a relatively small reduction has important public health benefits. This study provides further evidence of the benefits of smokefree legislation.”

The study was funded by the Department of Health and published in June 2010 in the British Medical Journal.

 

Children’s exposure to second-hand smoke on decline

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📥  Public policy

We have found that the second-hand smoke exposure among children has declined markedly in the past 14 years.

Our research, the most comprehensive study to date of second-hand smoke exposure among children in England, was funded by the Department of Health and published on 8 February 2010 in the journal Addiction.

The study, carried out by Dr Anna Gilmore and her team from the University of Bath’s School for Health, reveals that exposure to second-hand smoke among children aged four to 15 has declined steadily since 1996.

We wanted to find out if there were ways to predict the levels of second-hand smoke that children in England are exposed to and whether those levels were changing over time. It was also important for us to understand the levels of childhood second-hand smoke exposure in the years preceding the legislation, to be able to accurately assess the effects of the smoke-free legislation implemented in England in July 2007,

We analysed data from the Health Survey for England conducted between 1996 and 2006 including saliva samples taken from approximately 14,000 children aged between four and 15. The saliva samples were analyzed for a substance called cotinine, an indicator of tobacco smoke exposure.

The results showed that children’s exposure fell by 59 per cent over the 11 year period (from 0.59ng/ml in 1996 to 0.24ng/ml in 2006) indicating that children’s exposure to second-hand smoke has decreased markedly since the mid-nineties. The greatest decline occurred between 2005 and 2006, a period when targeted mass media campaigns on the dangers of second-hand smoke were routinely aired.

The study highlighted that the largest decline was between 2005 and 2006, a time of increased public debate and public information campaigns about second-hand smoke in the lead-up to the 2007 implementation of smoke-free legislation for public spaces.

The research also reveals that second-hand smoke exposure in non-smoking children is highest when one or both parents smoke, when the children are looked after by carers that smoke, and when smoking is allowed in the home. Children from more deprived households were more exposed, and this was still the case even when we took parental smoking status into account.

Declines over this period were greater in children with two smoking parents, with average annual falls of 0.115ng/ml, compared children with a mother who smoked (average annual decline of 0.065ng/ml) and children with non-smoking parents (average annual decline of 0.019ng/ml). As declines were greatest for those children who were most exposed to begin with, the gap in children’s second-hand smoke exposure between children with smoking parents and children with non-smoking parents has lessened.

Dr Michelle Sims, first author of the paper, explained: “The importance of carer and parental smoking and household exposure tells us that reducing exposure in the home is the key to reducing the health risks associated with second-hand smoke exposure in children.”

Dr Anna Gilmore, who led the project, said: “This study shows that the factors which most strongly influence children’s exposure are modifiable. Parents and carers can reduce their children’s exposure to smoke by giving up smoking, or failing this, only smoking outside the house.

“Stopping others from smoking in their house is also important. The fact that children’s exposure has already fallen so markedly shows that making these changes is feasible.”

This research highlights the need for public health interventions aimed at decreasing smoking prevalence and for those who are unable to quit, decreasing smoking in the home.

The published research paper can be accessed here:

http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=e4b569c8-93f0-4cd9-9d36-9d4e28e1c795%40sessionmgr10&vid=2&hid=15