A comprehensive evaluation of the impact of English tobacco control policy on smoking cessation activities

We aim to assess the impact of recent tobacco control policies on the number of smokers who succeed in stopping smoking in England. Smoking is the single greatest cause of preventable illness and premature death in the UK, and increasing the numbers of smokers who succeed in stopping smoking is the most important way of reducing morbidity and premature death in this country.
This is the fundamental aim of many recent national tobacco policies. For example, larger and harder hitting health warnings have been introduced on cigarette packs. Financial incentives now encourage family doctors to help smokers who want to quit. Medications that aid smokers to quit, such as nicotine replacement products (NRT) have been made more accessible, for example, NRT can now be prescribed to adolescents and people with heart disease, and taxation has been reduced on over the counter sales of these treatments. Finally, a new treatment to help smokers quit has been launched, varenicline. How effective these policies and initiatives have been in increasing smokers’ attempts and success at quitting, and ultimately at improving health, has not been evaluated in any comprehensive way.
We will use several existing sources of data, including specialised and national surveys, electronic primary care patient records, sales and prescriptions for NRT, and hospital admission data, that all provide different measures of smoking behaviour in England to find out how effective each of these specific policies have been.
This work will help in establishing which policies are successful and effective and should be maintained, and which are ineffective and should be dropped.

Increasing smoking cessation is probably the single most important means of reducing the burden of lung cancer, heart disease and stroke in the UK in the next 20 years. In the last decade, in England, a wide range of policies aimed at both motivating smokers to make attempts to quit and at increasing the success within these have been introduced to try to achieve this. Since 2002, approaches have included introducing larger health warnings on cigarette packs, broadening the indications on NRTs, the launch of varenicline, reducing taxation on OTC NRTs and a new, and subsequently revised, GP contract to encourage GPs to identify, advise and refer smokers to NHS Stop Smoking Services. None of the above policies have been comprehensively evaluated to determine their effects on a full spectrum of relevant outcomes and their relative impact for different populations, such as the more socio-economically disadvantaged. We therefore propose to combine existing sources of data to comprehensively evaluate the success of tobacco policies listed above. The datasets that we propose to use are: Smokers Toolkit, a series of panel surveys of smokers; The Health Improvement Network (THIN), a large Primary Care dataset; data on all dispensed prescriptions and NRT OTC sales; the Omnibus and General Household Surveys, and Hospital Episode Statistics. These datasets encompass smoker?s potential responses, like their smoking behaviour and attitudes, population-based data with information on relevant demographic and social contextual variables to determine differential impacts in different population groups, and data that captures other relevant outcomes, such as smoking-related disease and broader influences on smoking in the population. We will use these datasets to derive monthly, quarterly and annual indices of smoking cessation activity, overall and in specific groups defined by race/ethnicity, age, gender, social class and regional factors. We will assess their external validity and sensitivity to change, and will link these comprehensive aggregate measures into a single database, updating this regularly as new data becomes available. We will use these data to estimate the impact of individual tobacco control initiatives upon these outcomes using time series analysis in Stata. We will assess the feasibility of a sustainable and accessible database resource linking aggregate measures of smoking cessation activity in the English population, creating the framework and data for evaluating future policy and doing this more cost effectively than previous efforts.