Title: A comprehensive evaluation of the impact of recent English tobacco control policy using secondary data
Funder: Department of Health and Social Care

Abstract: Background It is vital to evaluate the impact of tobacco control legislation in England to ensure that it is achieving its desired effects. The evaluation framework should incorporate a theoretical model of how legislation is intended to work and in whom; identification and monitoring of all potentially important outcomes; and appropriately designed analyses to measure policy impact on these outcomes, validated across a wide range of datasets. Aims This study aims to provide a comprehensive evaluation of a wide range of policies and legislation including - July 2007: Smoke-free legislation - October 2007: Minimum age of 18 for purchase of tobacco - October 2011: Vending machine ban - April 2012: Point-of-sale display ban in large vendors - April 2015: Point-of-sale display ban in small vendors - October 2015: Ban on smoking in cars carrying under 18s; minimum 18 age of sale for e-cigarettes; prohibition of proxy purchase of tobacco or e-cigarettes for under 18s - Repeated over time: Tobacco control mass media campaigns and participation events (e.g. Stoptober, No Smoking Day) We will also explore the effects of the prohibition of tobacco advertising, implemented between 2003 and 2005, on uptake of smoking in young people. By investigating the effect of these measures on smoking behaviour to date, and modelling their long term impact on health outcomes and healthcare costs, the study will complement a Career Development Fellowship funded by Cancer Research UK, which will use a similar approach to evaluate the impact of future tobacco control legislation, specifically standardised packaging and the new EU Tobacco Products Directive. Research plan Initially we will develop logic models which identify hypothesised causal pathways and outcomes for recent interventions, to depict how recent tobacco control policies should work and for whom, and how different interventions will interrelate. We will develop an online tool which can be used to easily monitor trends in key outcome measures of tobacco control impact from a wide range of publicly available data sources. The tool will allow users to select outcomes, time periods, geographies and populations to generate graphs. We will use these data to assess the impact of the above policy measures on the short and medium term outcomes identified in the logic model. We will use statistical analyses including interrupted time series, difference-in-difference analysis, and cohort analysis to quantify the effectiveness of policy and legislative measures whilst controlling as adequately as possible for secular trends in smoking behaviour. We will estimate the long term effects of changes in smoking behaviour by combining the evidence on policy effects identified in previous stages of the project, and existing studies, to model longer term healthcare cost savings and population health benefits expected from the policies examined. Research team The multi-disciplinary research team is part of the UK Centre for Tobacco and Alcohol Studies (UKCTAS). The team in Nottingham has substantial experience in the use of the proposed datasets, and has conducted and published widely on tobacco control policy evaluations using the proposed statistical methods. The research teams in Sheffield and York have vast experience in building and using health-economic models that take the effects on behaviour in the short/medium term and translate these into expected outcomes over the lifecourse. Potential impact UKCTAS regularly engages with policymakers and charities, professional bodies and other organisations involved in tobacco control advocacy to disseminate the results of its research, and we will use our outputs to provide strategic direction for the tobacco control policy agenda. Our group has significant experience of translating research into policy and practice, and we are confident that this research will have an impact on future tobacco-related policies.

Lay abstract: Smoking is the biggest avoidable cause of death and disability in England. A range of laws and policies aimed at preventing this harm, such as the 2007 smoking ban in public places and the ban on smoking in cars carrying under 18s in 2015, have been introduced in England to try to prevent young people from becoming smokers, and encourage existing smokers to quit and to protect others from the harmful effects of cigarette smoke. When many different tobacco control interventions are introduced in a short space of time, it can be difficult to establish which ones are having the biggest impact on smoking and smoking-related diseases. In this study, we will consider theories of how laws and policies implemented between 2003 and 2015 are likely to work, whom they are most likely to affect, and what their influence will be on smoking and related ill-health. We will test these theories by applying complex statistical methods to a large number of publicly available data sources, such as surveys, which will help us to understand which laws and policies are most effective and why. We will also publish our findings and trends in key outcomes, such as smoking prevalence and quit attempts, on a website, so that stakeholders can assess visually whether tobacco control laws are having the desired effect, both overall, and in target groups such as the relatively disadvantaged. The study combines the expertise of researchers in Nottingham, Sheffield and York who are all part of the UK Centre for Tobacco and Alcohol Studies. The Centre has well-established links with policy makers at local, national and international levels, which will ensure that our results make a difference to how tobacco control laws and policies are introduced in the future. The Nottingham team has the relevant expertise in using the large range of datasets and the statistical methods required, as well as the web design skills required to build the monitoring tool. Researchers in Sheffield and York have expertise in building models of how resulting changes in smoking behaviour will impact on future population health and costs.

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