Opportunities and pitfalls in tobacco control: lessons from the UK

Contribution presented at the 3^rd Calisia Conference on Family Health, Kalisz, Poland, 18-20 June 2023
In 1998, the UK launched its first ever comprehensive tobacco control strategy. This ambitious programme, funded by Central Government, brought together an evidence-based package of policies to prevent smoking uptake, to encourage smokers to try to quit, and to help them succeed. These policies included mass media campaigns, provision of free evidence-based behavioural support and nicotine replacement therapy and bupropion for people trying to quit, tax increases, a ban on advertising of tobacco products, a partial indoor smoking ban, and measures to combat tobacco smuggling. This set the UK on a new trajectory of reduced smoking prevalence.
New policies were added as evidence became available that they would be effective and had public support. From 2007 to 2011 this included a ban on tobacco promotion displays in shops, a total public indoor smoking ban, and introduction of a new pharmacotherapy, varenicline reimbursed by the National Health Service.
From 2011 to 2020, further measures were introduced including a requirement that all tobacco products be sold in standardised packing without branding and with large pictorial health warnings on packs, raising the legal age of sale from 16 to 18, targets for general practitioners to provide brief advice on stopping smoking, and the availability of e-cigarettes, subject to strict regulation regarding the products and their promotion.
This evolving strategy succeeded in halving cigarette smoking prevalence in England, taking it from 30 percent in 2000 to around 15 percent in 2020. According to official statistics the rate has declined further and in 2022 stood at 12.7%.
Evidence suggests that availability of e-cigarettes contributed to this decline: these products being the most popular aid to quitting, approximately doubling the chances of success, while use among never-smokers remained very low at around 1 percent.
However, in the past two years, the situation has changed with regard to e-cigarettes. The advent of cheap disposable nicotine vaping devices has led to an increase in use of e-cigarettes among young people, including non-smokers. E-cigarette use among never-smokers is still relatively rare at around 3 percent but it is rising, and use among people aged 16-14 years has increased to almost 25 percent.
Although e-cigarettes are almost certainly much less harmful to health than tobacco cigarettes, they are not without harm and the use of disposable devices is resulting in a significant threat to the environment. Therefore, it will be important to find a way of addressing this issue without causing an increase in smoking. Options that are being considered is banning disposable e-cigarettes, bans on attractive flavours, and preventing shops from placing e-cigarettes on display.

DISCLOSURE

The author reports no conflict of interest.