Background Smoking is the biggest avoidable cause of death and disability in England. A range of laws and policies aimed at preventing this harm have been introduced in England to try to prevent young people from becoming smokers, and encourage existing smokers to quit and to protect others from the harmful effects of cigarette smoke. This Study aimed to evaluate the effects of these policies using publically available data.
Methods We developed logic models for each policy that indicated the anticipated causal pathways for each policy and used these to develop hypotheses for our analysis. Interrupted time series analysis was carried out systematically and using a consistent approach across policies, datasets, outcomes and populations. Outcome measures were adult smoking prevalence, quitting behaviour and consumption. Models were adjusted for sociodemographic factors, e-cigarette prevalence and mass media expenditure. Datasets included the Smoking Toolkit Study (STS) and the Health Survey for England (HSE).
Results Following a point of sale display ban in large shops in April 2012, based on the STS data, there was a significantly steeper declining trend in adult smoking prevalence. This finding was supported by results from the HSE. A similar result was found when analysing quit attempts. Following a point of sale ban in small shops in April 2015, there was a significantly steeper decline in trend in adult prevalence. There was also a significant decline in trend in quit attempts. No significant impact of the smoke-free policy on smoking prevalence was found and we found no evidence of a combined impact of three policies that were implemented in October 2015 (proxy purchase ban, minimum age of purchase for e-cigarettes and smoking ban in cars carrying children) on adult prevalence.
Discussion Both display ban policies were followed by a decline in the trend for smoking prevalence and quitting attempts in adult smokers. A key strength in this study was its consistent and theory-based approach which allowed us to assign impacts to a certain policy with more confidence.This novel approach to policy analysis could also be applied in other public health disciplines.
This study is funded by NIHR PRP (PR-R14-1215-24001). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, arms length bodies or other government department.
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