Tobacco Research

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

Tagged: Legislation

Impact of smoking ban on the most exposed children

  , , , ,

📥  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:

Commentary on the paper can be accessed here:


Plain packaging opposition in the UK

  , , , ,

📥  Industry tactics


A public consultation aimed to help the government gather evidence on the potential impacts of plain packaging ran between the 16th April 2012 and the 10th August 2012.

In response to this consultation, the tobacco industry and its allies launched what appears to be coordinated anti-plain packaging campaigns.

A Short History of Plain Packaging illustrates that the tobacco industry has been working on a defence strategy against the threat of plain packaging since the 1990s. In 2010, industry analyst Citigroup noted that plain packaging is the “biggest regulatory threat to the industry, as packaging is the most important way tobacco companies have to communicate with the consumer and differentiate their products.”  Therefore, it's unsurprising that there has been such a strong response from the tobacco industry.

Tobacco companies’ political advertising

Tobacco companies such as British American Tobacco (BAT), Imperial Tobacco, Japan Tobacco International (JTI) and Philip Morris International (PMI) have publicised their views on plain packaging on their corporate websites, including their arguments against plain packaging (e.g. encourages illicit trade, trade mark infringement etc). BAT have included such arguments in two emotive adverts.

Imperial and JTI, who in 2011 collectively held just over eighty per cent of the UK cigarette market share, have also engaged in Corporate Political Advertising to influence both the views of ‘government and of decision makers’. For example, a You Tube ad called 'Britain - 2020 Vision', which misleadingly suggests that in the future all perceived unhealthy products could be sold in plain packaging, has a small disclaimer saying that it was funded by Imperial Tobacco.

The 2020 Vision ad has been promoted on leaflets distributed on petrol forecourts, with the message ‘Say NO to plain packs’. These leaflets are not openly attributable to any organisation. (see images 1 and 2).


Image 1

Image 2

Image 2

Imperial Tobacco has also used Corporate Political Advertising in an attempt to influence UK Members of Parliament (MPs) views on plain packaging. The company funded an advertisement in ‘The House’ magazine (a weekly political magazine delivered directly to MPs, Peers, and civil servants). The advert mimicked the possible plain packackaging for cigarettes  by covering the normal cover pages in dark brown/gold paper and a warning message which read, “WARNING Plain Packaging: Bad for business Good for Criminals”.  The double spread cover page did not disclose it was an Imperial Tobacco anti-plain packaging advertising campaign. However on page 19 of the magazine, a second gold coloured full-page advert claimed that plain packaging would not benefit wholesalers, consumers, business, retailers or the government, but would only benefit criminals. This advert featured the logo of Asian Trader, a trade magazine and, in a smaller font than the rest of the text, at the bottom of the page explained: “This advert has been produced and placed by Imperial Tobacco in association with Asian Trader magazine.”

Furthermore, approximately 24-hours after the British government announced a four-week extension to the consultation on standardised packaging, JTI launched a campaign costing £2 million to “share its views” on the potential outcomes of plain packaging legislation. The campaign is centred on print adverts in national newspapers. According to JTI, this amount of spending is to ensure a wide reach of its messages to JTI’s target audience, “both government and decision makers”.  In July 2012, these ads were included in a number of daily newspapers including The Financial Times (see Image 3).

Front group anti-plain packaging campaigns

Pro-smoking group Forest, which receives funding from tobacco companies, runs the Hands Off Our Packs campaign which argues that plain packaging is the nanny state gone too far. The campaign is run by Angela Harbutt of Liberal Vision.

The Hands Off Our Packs campaign, which has a dedicated website, a Twitter and a Facebook account, has produced anti-plain packaging literature, You Tube ads (featuring retailers),and provides guidance on how to respond to the consultation in support of the continued branding of tobacco products. The website includes a petition to register one’s opposition to plain packaging. Visitors to the website are also encouraged to distribute leaflets and promote the campaign online via social networking sites such as Facebook, Twitter and blogs.

Speaking to the Grocer Magazine in February 2012, Simon Clark, Director of Forest, said that the Hands Off Our Packs campaign "was a response to the Plain Packs Protect campaign launched last month by an alliance of anti-tobacco groups". However, Clark registered the website back in September 2011, indicating that Forest may have planned this campaign long before the Plain Packs Protect campaign was launched in January 2012.

Retailers have been a particular campaign target of industry front groups. Mobilising retailer support to oppose tobacco control measures is a well-documented industry tactic and a prime example of how the industry uses front groups to promote their agenda. For example, the Tobacco Retailers Alliance (TRA), a coalition of retailers that sell tobacco products, was set up by the tobacco industry to promote its own viewpoint but with the explicit intention that it would appear separate from the tobacco industry. When the Tobacco Alliance (which later became the TRA) was established the industry stated that it “would encourage its supporters to act either as individuals or as representatives of their own organisations” in order to appear as a separate entity to the industry. It was also “stressed that the Alliance was needed because in order to be heard the entire tobacco family must speak with a unified voice and with confident command of the facts…”

In 1983, Tony St Aubyn, the then assistant director of the Public Relations subcommittee of the Tobacco Advisory Council stated in a workshop detailing how to set up a tobacco alliance that “Early on we decided that it would be preferable to keep the Alliance at arm’s length from TAC Tobacco Advisory Council, the predecessor to the Tobacco Manufacturers' Association and the industry and with its own identity and address, to emphasize to supporters, as far as is practical, that it had a degree of independence. Thus while the industry determines policy and provides the funds, the day to day management is the responsibility of our PR agents Daniel J Edelman."

Since the launch of the public consultation on plain packaging in April 2012, retail magazines such as the Grocer and Retail Newsagent have consistently featured opposition messages to plain packaging. They have also highlighted campaigns such as the ‘plain packaging postcard campaign’ run by the TRA (funded by the Tobacco Manufacturers' Association) which claims that plain packaging would have a negative impact on business and encourages retailers to ‘have your say’ in response to the government’s consultation. In July 2012, the TRA reported that 30,000 retailers had so far signed postcards, demonstrating how public consultations on tobacco control measures can be flooded with industry influenced opinion.

For full references on this article, please visit


Smokeless tobacco illegally sold via the internet

  , , , , , ,

📥  Public policy


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.


Smoking ban linked to drop in admissions for heart attacks

  , , , , , , , , ,

📥  Public policy


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

  , , , , ,

📥  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: