1. Should we now focus on 'the endgame' for tobacco control in the UK?
Robert West
University College London
November 2012

2. Cigarette smoking prevalence projection to 2030
0.55% pa
Projecting in a straight line from November 2006 would see prevalence fall to approximately 7% by 2020, but this includes the immediate smoke-free decline.
0.83% pa
Source: ONS

3. Annual smoking prevalence since 2007
31.9%
15.4% decline%
27.0%
24.1%
17.8% decline%
19.8%
17.9%
20.7% decline%
14.2%
A-C1: Professional to clerical occupation C2-E: Manual occupation

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

5. Cessation activity

6. Use of support

7. Harm reduction
NRT: Nicotine replacement therapy

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

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
Policy
Estimated prevalence reduction per annum
1. Autumn quitting event (Stoptober)
0.01%-0.02%
2. 5% real cost increase (versus no increase)
0.15%-0.25%
3. Effective use of OTC NRT
0.02%-0.03%
4. Double use of NHS support
0.03%-0.05%
5. Double effective GP opportunistic advice
0.05%-0.10%
6. Double use of nicotine for harm reduction
0.04%-0.08% ?
7. Plain packaging
0.01%-0.02% ?
8. Point of sale ban
Total +0.55%
0.97%-1.02%
1. Autumn quitting event: evidence from Smoking Toolkit Study of 2% of smokers trying to quit of whom 4% would be expected to succeed long term (+- 50%) with current prevalence of 20%
2. 5% real cost increase: participation elasticity of .2 of 20% of population who are smokers (+-.05%)
3. If OTC NRT increased success rate by 50% then apply Smoking Pipe Model (
4. Using data from Smoking Pipe Model (
5. Using data from Smoking Toolkit Study (
6. Using data from Smoking Toolkit Study (
7. Judgement
8. Judgement