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Changing Lifestyle Lessons from Tobacco Control | Prof Linda Bauld

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Prof. Linda Bauld's presentation on Changing Lifestyle Lessons from Tobacco Control, presented at the SCPN conference, Wednesday 4th February 2015.

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Changing Lifestyle Lessons from Tobacco Control | Prof Linda Bauld

  1. 1. Changing health behaviours:Changing health behaviours: examples from tobacco controlexamples from tobacco control Linda BauldLinda Bauld
  2. 2. OutlineOutline  Tobacco and cancerTobacco and cancer  Smoking ratesSmoking rates  Tobacco controlTobacco control  Key lessonsKey lessons  New approachesNew approaches
  3. 3. Burden of disease attributable to 20 leading riskBurden of disease attributable to 20 leading risk factors, UK 2010factors, UK 2010 Murray, Lancet 2013;381:997-1020Murray, Lancet 2013;381:997-1020
  4. 4. Harms from smoking in the UK, each yearHarms from smoking in the UK, each year To the fetus: 5300 fetal/perinatal deaths5300 fetal/perinatal deaths 2,200 premature births; 19,000 low birth weight babies2,200 premature births; 19,000 low birth weight babies Increased risk of developmental anomaliesIncreased risk of developmental anomalies To children:To children: 40 sudden infant deaths40 sudden infant deaths 165,000 new cases of asthma, bronchitis, ear disease, meningitis165,000 new cases of asthma, bronchitis, ear disease, meningitis Increased risk of becoming a smokerIncreased risk of becoming a smoker To adults and wider society:To adults and wider society: 100,000 deaths100,000 deaths Morbidity costing £5 billion (of £100 billion) in NHS costs (2006)Morbidity costing £5 billion (of £100 billion) in NHS costs (2006) £14 billion cost to society£14 billion cost to society Exacerbation of poverty, fires, litter…Exacerbation of poverty, fires, litter… Sources:Sources: RCP 2010/Allender et al 2009/Policy Exchange 2010/HSCICRCP 2010/Allender et al 2009/Policy Exchange 2010/HSCIC
  5. 5. Wednesday, February 11, 2015 View <Headers and Footers> to alter this text 5 Source: Cancer Research UK, 2014
  6. 6. Wednesday, February 11, 2015 View <Headers and Footers> to alter this text 6 Source: Cancer Research UK
  7. 7. Wednesday, February 11, 2015 View <Headers and Footers> to alter this text 7 Source: Cancer Research UK, 2014
  8. 8. Adult smoking prevalence by age and gender,Adult smoking prevalence by age and gender, UK 2013UK 2013 Integrated household survey 2014Integrated household survey 2014
  9. 9. Smoking in young people inSmoking in young people in ScotlandScotland
  10. 10. Progress?Progress?  Significant progress has beenSignificant progress has been made in reducing smoking ratesmade in reducing smoking rates in Scotland and the rest of thein Scotland and the rest of the UKUK  How has this occurred?How has this occurred?  What can we transferWhat can we transfer to other areas ofto other areas of cancer prevention?cancer prevention?  Progress has beenProgress has been slowslow
  11. 11. Comprehensive approachesComprehensive approaches  Action at individual,Action at individual, community andcommunity and societal level is neededsocietal level is needed  Several usefulSeveral useful frameworks for tobaccoframeworks for tobacco control existcontrol exist  Examples include thoseExamples include those developed by the Worlddeveloped by the World Bank and the WHOBank and the WHO
  12. 12. Tobacco ControlTobacco Control       Taking-up smoking Decision to quit Quit attempt Relapse Reduce the appeal & supply of tobacco products Encourage more quit attempts each year Support quality quit attempts Protect against secondhand smoke
  13. 13. Key policy and practice to prevent smokingKey policy and practice to prevent smoking::  Help smokers to quitHelp smokers to quit  Harm reductionHarm reduction  Stop tobacco advertisingStop tobacco advertising  Smoke-free policiesSmoke-free policies  Youth accessYouth access  Health promotion campaignsHealth promotion campaigns  Increase priceIncrease price  Standardised packagingStandardised packaging Patients:Patients: Populations:Populations:
  14. 14. Commercial interestsCommercial interests  Tobacco is a legal product that remains highlyTobacco is a legal product that remains highly profitableprofitable  The transnational tobacco companies haveThe transnational tobacco companies have attempted to consistently undermineattempted to consistently undermine tobacco control programmes and policies fortobacco control programmes and policies for decadesdecades  They continue to do soThey continue to do so  Article 5.3 of the FCTC gives useful guidance onArticle 5.3 of the FCTC gives useful guidance on non engagement to counter some of theirnon engagement to counter some of their influenceinfluence
  15. 15. Commercial interests: smokefreeCommercial interests: smokefree  The Department ofThe Department of Health published aHealth published a review ofreview of commissioned studiescommissioned studies examining the impact ofexamining the impact of smokefree legislation insmokefree legislation in England in March 2011England in March 2011
  16. 16. Tobacco Industry ResponseTobacco Industry Response
  17. 17. Commercial interests: plain packagingCommercial interests: plain packaging  In 2012 the UK governmentsIn 2012 the UK governments launched a joint publiclaunched a joint public consultation on the plainconsultation on the plain packaging of tobacco productspackaging of tobacco products  They published a systematicThey published a systematic review we conducted with thereview we conducted with the Public Health ResearchPublic Health Research Consortium to underpin a UKConsortium to underpin a UK wide consultation on the issue.wide consultation on the issue.
  18. 18. Tobacco industry response to publicTobacco industry response to public consultationconsultation
  19. 19. Inequality: progress may widen gapsInequality: progress may widen gaps 0 10 20 30 40 50 60 70 0 1 2 3 4 5 6&7 % population % smoking More affluent Multiply disadvantaged 80% of smokers have 1+ indicators of low socio-economic status. 25% of smokers are multiply disadvantaged, compared with 62% and 9% of non smokers respectively.
  20. 20. Smoking prevalence by socio-economic statusSmoking prevalence by socio-economic status
  21. 21. Smoking and mental disorderSmoking and mental disorder Royal College of Physicians 2013Royal College of Physicians 2013
  22. 22. AdvocacyAdvocacy  Coalition building andCoalition building and consensus on evidenceconsensus on evidence and action hasand action has contributed to progresscontributed to progress in reducing smokingin reducing smoking ratesrates  A single voice isA single voice is important and has beenimportant and has been lacking in other areas oflacking in other areas of public healthpublic health  ASH (and ASH Scotland,ASH (and ASH Scotland, ASH Wales) have led theASH Wales) have led the advocacy effortadvocacy effort  They lead the SmokefreeThey lead the Smokefree Action CoalitionAction Coalition (including key charities,(including key charities, research organisations,research organisations, regional bodies etc)regional bodies etc) which provides essentialwhich provides essential supportsupport
  23. 23. EvidenceEvidence  Building the evidence-Building the evidence- base and continuing tobase and continuing to develop itdevelop it has beenhas been crucial to informingcrucial to informing programmes and policiesprogrammes and policies at individual, communityat individual, community and societal leveland societal level
  24. 24. Vision: A Tobacco-free Scotland byVision: A Tobacco-free Scotland by 2034 (5% prevalence)2034 (5% prevalence) Scottish government strategy, target then promoted by CRUK for the UK – similar target in the Republic of Ireland
  25. 25. New DevelopmentsNew Developments  Some tobacco control advocates (andSome tobacco control advocates (and researchers) argue that if we simply keep doingresearchers) argue that if we simply keep doing what we know ‘works’ we will continue to seewhat we know ‘works’ we will continue to see reductions in smokingreductions in smoking  However, reductions of between 0.5-1% eachHowever, reductions of between 0.5-1% each year are arguably not enough. For each furtheryear are arguably not enough. For each further 1% reduction, 3000 premature deaths are1% reduction, 3000 premature deaths are preventedprevented
  26. 26. New DevelopmentsNew Developments  Controversial approaches such as financialControversial approaches such as financial incentives and tobacco harm reduction,incentives and tobacco harm reduction, including electronic cigarettes, may be importantincluding electronic cigarettes, may be important
  27. 27. Cutting downCutting down Source: West, 2013, www.smokinginengland.info
  28. 28. E-cigarette market in the UKE-cigarette market in the UK
  29. 29. Electronic cigarette use in 13 and 15 year-olds in Scotland, 2013Electronic cigarette use in 13 and 15 year-olds in Scotland, 2013 http://www.isdscotland.org/Health-Topics/Public-Health/Publications/2014-11-25/SALSUS_2013_Smoking_Report.pdfhttp://www.isdscotland.org/Health-Topics/Public-Health/Publications/2014-11-25/SALSUS_2013_Smoking_Report.pdf * Of which 3% had tried once, 1% a few times *
  30. 30. ConclusionsConclusions  Change takes timeChange takes time  ComprehensiveComprehensive approaches are neededapproaches are needed  Powerful vestedPowerful vested commercial interests willcommercial interests will undermine theseundermine these approachesapproaches  Progress in some groupsProgress in some groups may exacerbatemay exacerbate inequalitiesinequalities  Advocacy is keyAdvocacy is key  Rely on the evidenceRely on the evidence (and continue to build it)(and continue to build it)  Vision is importantVision is important  Controversial newControversial new developments anddevelopments and solutions may well besolutions may well be requiredrequired
  31. 31. Thank youThank you Linda.Bauld@stir.ac.ukLinda.Bauld@stir.ac.uk Acknowledgements:Acknowledgements: John Britton, Robert West, Martine Stead,John Britton, Robert West, Martine Stead, Alison Cox and colleagues at Cancer Research UKAlison Cox and colleagues at Cancer Research UK

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