Title: Tobacco controls and the changing profile of smokers
Funder: Department of Health and Social Care

Abstract: BACKGROUND The last decade has seen the implementation of a variety of tobacco control legislation in England. These have been designed and implemented by policy makers to reduce incentives for people to take up smoking or to encourage them to quit, with the aim of minimising public harm from smoking and from exposure to second-hand smoke. After a decade of active policy making, now is the time to take stock of the effects of recent legislation and identify the impact on public health. AIMS This research aims to answer the following questions: 1) Has the prevalence and attitudes towards smoking in England changed with the implementation of recent tobacco regulations? Do effects vary across individual characteristics? 2) What are the characteristics of individuals who start, stop or continue smoking? 3) Has second-hand smoke exposure among pregnant women, children and young people decreased with recent tobacco regulations? 4) How does the UK compare with other European countries in terms of smoking consumption and tighter tobacco regulations? How do inequalities in smoking in the UK compare with those in other countries? 5) To what extent does the current literature and available data inform our understanding of e-cigarette use? RESEARCH PLAN First, we will analyse changes in smoking trends nationally, with the potential to compare trends in England with trends in Scotland, due to varying policy implementation schedules in each country. Second, we will provide a profiling of smokers, estimating which characteristics (such as education) are associated with smoking behaviours. Third, we will analyse trends in exposure to second-hand smoke, particularly among young people, using data on cotinine concentration in saliva. Fourth, we will position the UK among European countries in terms of tobacco consumption and regulations, and we will explore how effective more strict tobacco controls have been in reducing tobacco prevalence compared to more relaxed scenarios. Finally, e-cigarette consumption research and data are scrutinised, identifying plans and approaches for future measurement and explore this evolving area in smoking research. RESEARCH TEAM The project will be managed within the Evaluation Team at NatCen, but it will have a multidisciplinary approach, including researchers and analysts from the Children, Families and Work Team and the Health Team at NatCen. The study will be led by Javiera Cartagena-Farias, a Senior Researcher in the Evaluation team who specialises in quantitative analysis of large datasets and the use of micro-econometrics techniques. Javiera will work in collaboration with Rossella Icardi (Researcher), who has worked on secondary analysis projects including impact evaluations, and Allison Dunatchik (Researcher) who specialises in quantitative research methods, welfare analysis and family policy analysis. The team above will be supported and advised by members of the Health team at NatCen (Sally McManus, Co-Head), who is also a member of the Public Health Research Consortium (PHRC), and the Research Director for the Survey of Smoking, Drinking and Drug Use among Young People (Elizabeth Fuller). Neil Smith, Research Director, will also provide advice and support, contributing with his research expertise in the study of health inequalities. In addition, Robert West (UCL), Anne-Marie MacKintosh (Stirling) and Martine Stead (Stirling) will advise from an academic perspective. IMPACT Our findings may suggest whether policies reached the desired effect. Additionally, as the profile of smokers rapidly changes, this research will update our understanding of who smokes and, in turn, will inform the policy approaches of the future. This research will enable effective action by policy makers, with potential benefits for the health and wellbeing of smokers and the public at large, as well as reducing the burden of smoking-related ill health on the health system.

Lay abstract: Although the proportion of the population who smoke cigarettes has fallen by more than half in the last 40 years in Britain, from 46% in 1974 to 19% in 2013 (ONS, 2013), smoking remains one of the key preventable causes of early death in the UK (Marmot Review, 2010). Many initiatives have been implemented in recent years to create public awareness of the risks of tobacco consumption and to reduce levels of smoking. This research aims to explore the consequences of several policy changes regarding tobacco consumption and supply in England, which have been implemented over the last decade. We propose a multi-pronged analysis, which will allow us to analyse the context of these policies from a variety of perspectives. First, we will conduct an analysis of trends in smoking prevalence over time, smoking intensity and attitudes towards smoking. This analysis will provide understanding of how changes in smoking trends over time may potentially be attributed to recent tobacco control legislation. Second, we will conduct a comprehensive profiling of new smokers and quitters; understanding that recent tobacco controls could have heterogeneous effects depending on the characteristics of individuals, such as socio-economic status, ethnicity, age and educational level. This will also allow us to document inequalities in smoking, how these inequalities have developed over time and to what extent recent policy has affected inequality in smoking. Third, we will investigate how recent legislation has affected exposure to Second-hand smoke &ndash; particularly among vulnerable populations such as pregnant women, children and young people. Fourth, to place recent changes in legislation into a broader context, we will provide an international review of changes to tobacco control legislation in European countries. In doing so we will be able to explore how trends in smoking prevalence and social-inequalities in smoking in the UK compare to those in other countries. Finally, we will explore an increasingly important and contentious topic within smoking research - e-cigarettes. We will provide a review of the current literature and data on e-cigarette, identifying gaps in the research as well as approaches for standardising the measurement of e-cigarette use in surveys.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: STROKE;RESPIRATORY;CANCER AND NEOPLASMS;CARDIOVASCULAR