1. Policies to reduce smoking prevalence in England
Robert West
University College London
April 2013

2. Declaration of interest
I receive research funds and undertake consultancy for companies that develop and manufacture smoking cessation medications
I am co-director of the National Centre for Smoking Cessation and Training
I am a trustee of the stop-smoking charity, QUIT
My salary is covered by Cancer Research UK

3. Annual smoking prevalence since 2007
31.9%
14.7% decline%
27.2%
24.1%
17.8% decline%
20.0%
17.9%
19.6% decline%
14.4%
A-C1: Professional to clerical occupation C2-E: Manual occupation

4. Smoking prevalence since 2007 by age
No change since 2008 in
55+ age group
A-C1: Professional to clerical occupation C2-E: Manual occupation

5. Behaviour Change Wheel
Michie S, van Stralen M, West R (2011) The Behaviour Change Wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.

6. Intervention functions
Education
Increasing knowledge or understanding
Persuasion
Using communication to induce positive or negative feelings or stimulate action
Incentivisation
Creating expectation of reward
Coercion
Creating expectation of punishment or cost
Training
Imparting skills
Restriction
Using rules that limit engagement in the target behaviour or competing or supporting behaviour
Environmental restructuring
Changing the physical or social context
Modelling
Providing an example for people to aspire to or imitate
Enablement
Increasing means/reducing barriers to increase capability or opportunity

7. Tobacco control interventions
Education
Educate on health effects of smoking, benefits and best ways of quitting
Persuasion
Make people feel bad about smoking and good about quitting
Incentivisation
Reward not starting or quitting
Coercion
Increase the social or financial cost of smoking
Training
Train in skills of avoiding smoking or of quitting
Restriction
Apply rules that restrict where and when smoking is permitted
Environmental restructuring
Reduce opportunities for tobacco marketing and availability of cigarettes
Modelling
Set up non-smoking role models
Enablement
Provide behavioural support and medication to help quitting

8. Policy options Comms/marketing
Using print, electronic, telephonic or broadcast media
Guidelines
Creating documents that recommend or mandate practice. This includes all changes to service provision
Fiscal
Using the tax system to reduce or increase the financial cost
Regulation
Establishing rules or principles of behaviour or practice
Legislation
Making or changing laws
Env/Soc Planning
Designing and/or controlling the physical or social environment
Service provision
Delivering a service

9. Policy options for tobacco control
Comms/marketing
Improve impact and targeting of communications campaigns
Guidelines
Provide clear evidence-based guidance to Local Authorities and promote effective adoption
Fiscal
Increase the financial cost of smoking through tax and enforcement
Regulation
Regulate to improve access to acceptable and effective nicotine substitutes
Legislation
Legislate to reduce exposure to tobacco industry marketing
Env/Soc Planning
Control density and location of tobacco outlets
Service provision
Improve healthcare systems to increase the impact of brief advice and cessation support

10. Options for increasing rate of decline in smoking prevalence in England
Policies (over and above what is currently being done)
Estimated prevalence reduction per annum
Cost to exchequer per annum
5% real cost increase (versus no increase)1
0.15%-0.25%
Net gain
Double effective GP opportunistic advice2
0.05%-0.10%
<£5m
Double use of nicotine for harm reduction3
0.04%-0.08%
Promoting effective use of OTC NRT4
0.02%-0.03%
Improve effectiveness of NHS support5
Autumn quitting event (Stoptober) 6
0.01%-0.02%
Standard packaging
to be determined
not known
Point of sale ban
Total over and above current -0.5%
1. 5% real cost increase: participation elasticity of .2 applied to 20% of population who are smokers (+-.05%)
2. Widespread promotion of Very brief Advice Online training and implementation of audit of QOF. Effect size estimated from Smoking Toolkit Study and the Pipe Model (
3. Assumes industry bears the marketing cost under a favourable regulatory framework. Effect size estimated from Smoking Toolkit Study and the Pipe Model ( Cost to exchequer is setting up, liaison and evaluation.
4. Assumes industry bears the marketing cost. Effect size estimated from Smoking Toolkit Study and the Pipe Model ( based on increasing effectiveness of OTC from zero (current level) to level similar to prescription NRT.
5. Based on bringing average success rates to level found in top 30% of services. Effect size estimated from Smoking Toolkit Study and the Pipe Model (
6. Based on demonstrated increase in quit attempt rate from event in Effect size estimated from Smoking Toolkit Study and the Pipe Model (