Summary of the impact

Research by the Institute for Social Marketing (ISM) contributed directly to the development of the 2009 Health Act (England and Wales) and the Tobacco & Primary Medical Services (Scotland) Act 2010, the latter the most significant change in Scottish tobacco control legislation since the 2005 ban on public smoking. Both acts restrict the display of tobacco at the point of sale (PoS) in order to make tobacco products less attractive and accessible. Instrumental in the passage of both Acts was ISM research showing how PoS influences consumer behaviour and that it has a clear effect on adult and youth smoking.

Underpinning research

The ISM Centre for Tobacco Control Research (CTCR), funded by Cancer Research UK, conducts tobacco control research in three areas: preventing uptake of smoking and supporting cessation; investigating and challenging the harmful effects of tobacco marketing; and guiding appropriate public health policy. As the first research centre dedicated to tobacco control in the UK, it provides vital evidence to help policy makers respond quickly and appropriately to dynamic developments in tobacco control.

The Youth Tobacco Policy Survey (YTPS) is one of two major research studies funded through CTCR. The study assesses the impact on UK adolescents of policy-driven changes in tobacco marketing. It has already tracked the short-term impact of the Tobacco Advertising and Promotion Act (TAPA), introduced from 2003 to 2005. The study now examines longer-term effects of the TAPA and has been extended to cover other policy changes that may impact on youth tobacco consumption. It is currently monitoring the short to medium term response of adolescents to smokefree public places legislation (implemented in Scotland in 2006 and in England, Wales and Northern Ireland in 2007), increased age of purchase and introduction of pictorial health warnings (both 2008), and the PoS display ban in large shops and supermarkets (implemented in 2012 in England, Wales and Northern Ireland and in 2013 in Scotland; smaller shops in the UK must comply by 2015). Two baseline surveys were conducted before the initial implementation of the ban on tobacco advertising in February 2003. Four follow-up surveys have been completed post-ban (summer 2004, summer 2006, summer 2008 and summer 2011), the latter provides baseline measures on PoS. The next follow-up survey is due to take place in summer 2014.

The report `Point of Sale Display of Tobacco Products' included original analyses of the first four waves of primary data from the YTPS to examine the effects of the TAPA's restrictions on in-store advertising. Data were analysed for 4,400 11-16 year olds from across the UK. Multi-variate analyses were conducted to explore whether the TAPA restrictions were associated with changes in awareness of tobacco brands and marketing and susceptibility to smoking. Awareness of tobacco marketing and brands was associated with greater susceptibility to start smoking when other factors were controlled for; in other words, in-store promotions increase the likelihood of smoking uptake. Analyses also indicated that TAPA had led to a decrease in awareness of tobacco marketing and brands, suggesting that further restrictions on PoS would strengthen this positive trend. The report also included an international review of evidence on PoS effects on smoking behaviour. Taken together, the review and the primary data indicated that tobacco marketing has a dose-response relationship on the onset and continuance of smoking, and that PoS plays a key role in this.

Key researchers in the Point of Sale research were Professor Gerard Hastings, Director of ISM and CTCR and ISM Research Fellows Anne Marie MacKintosh and Crawford Moodie.

References to the research

The research was funded by the following two awards:

Cancer Research UK Centre for Tobacco Control Research. Cancer Research UK. October 2007 — September 2012. £1,125,547.

Cancer Research UK Centre for Tobacco Control Research (POS Report). Cancer Research UK. July — October 2008. £10,361.

Details of the impact

The work and expertise of ISM in tobacco control have contributed directly to the development of the 2009 Health Act (England and Wales) and the Tobacco & Primary Medical Services (Scotland) Act 2010. The latter is the most significant change in tobacco control legislation in Scotland since the 2005 ban on smoking in enclosed public places. Both acts include restrictions on the display of tobacco at the point of sale (PoS) to make tobacco products less attractive and accessible.

Instrumental in the passage of both pieces of legislation was ISM's research showing that PoS is a sophisticated marketing function used by tobacco manufacturers to influence consumer behaviour and has a clear effect on adult and youth smoking. The display ban was implemented successfully in large shops and supermarkets between April 2012 and April 2013. Smaller shops must comply by 2015.

PoS marketing concerns all activities that take place in the store to promote tobacco, including advertising, furniture, décor, staff clothing and product displays. The 2002 UK Tobacco Advertising and Promotion Act (TAPA) limited the amount of tobacco advertising allowed in shops to one A5-sized poster. However the TAPA did not regulate the display of products, a gap which was subsequently exploited to circumvent the TAPA regulations. Sophisticated and stylish gantries now dominate many small shops (where underage smokers typically buy tobacco) and elaborate sales booths were a prominent feature in supermarkets. The Guidelines for Article 13 of the World Health Organization's Framework Convention on Tobacco Control, an international public health treaty covering over 170 countries, recommends the removal of all PoS tobacco marketing. Since 1999, ISM (through its Centre for Tobacco Control Research) has monitored the nature, extent and effects of tobacco marketing in the UK through the YTPS. Findings from this research, published in a 2008 Cancer Research UK report `Point of Sale Display of Tobacco Products' and in several peer-reviewed publications, were influential in demonstrating the public health case for a ban on PoS displays in the UK. The 2008 report was widely cited between September 2008 and May 2009 in submissions and responses to the UK and Scottish consultations on the proposed legislation. Media interviews given by Professor Gerard Hastings contributed to the public debate around the issue. Hansard records of debates on the legislation in the House of Commons and House of Lords show that the ISM report was considered one of the key pieces of evidence in the passage of the legislation:

Lord Faulkner of Worcester: "I am delighted that the Government have based their proposals in the Bill on research. Some of the most important research has been carried out by Professor Gerard Hastings, director of the Centre for Tobacco Control Research. He investigated the complex relationship between tobacco marketing at the point of sale and young people's intention to smoke. He found that: "In 2006, almost half—46 per cent of UK teens—were aware of tobacco marketing at point of sale". Moreover, the likelihood of a young person stating an intention to smoke may increase by 35 per cent with each brand that they can recall having seen at the point of sale". (Hansard, 4 Feb 2009).

Beneficiaries of the research

Legislators have benefited from the provision of timely and robust research to inform evidence-based policy-making, and the public health community has benefited from a strengthening of the scientific evidence base on the role of marketing in smoking. The legislation itself will ultimately benefit young people and adult smokers by protecting them from one of the forms of tobacco marketing still permitted.

Emerging data (McNeill et al 2011 http://dx.doi.org/110.1136/tc.2010.038141) from Ireland, which prohibited PoS in 2009, indicate that the law is contributing to the de-normalisation of smoking, as evidenced by decreases post-legislation in the proportion of children thinking that more than 20% of teenagers smoke. Over a third of teenagers, nearly two months after legislation implementation, thought that removal of the displays had made it easier for children not to smoke, while six months after implementation, nearly one in five smokers reported that the ban had made it easier to quit. This is supported by research suggesting that the presence of cigarette pack displays makes it more difficult for smokers to quit (eg. Germain et al 2009 http://dx.doi.org/10.1111/j.1360-0443.2009.02714.x). Building on the PoS work, ISM is a partner in a major NIHR study to evaluate the impact of the legislation in Scotland on youth smoking uptake (DISPLAY study 2011-2016, PI: Professor Sally Haw, with the Universities of Edinburgh and St Andrews, and ScotCen).

Sources to corroborate the impact

Mentions of the ISM research in Hansard, demonstrating its influence in the passage of the legislation:

1. Hansard House of Commons Debates, 12 October 2009, Volume No. 497 Part No. 121: Column 105
   http://www.publications.parliament.uk/pa/cm200809/cmhansrd/cm091012/debtext/91012-0017.htm#09101243001635
2. Hansard House of Lords Debates, Wednesday 4 Feb 2009, Volume No. 707 Part No. 27: Column 728 http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/90204-0009.htm#09020496000211
3. Hansard House of Lords Debates, Monday 9 Mar 2009, Volume No. 708 Part No. 43: Column GC393 http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/90309-gc0002.htm
4. Hansard House of Lords Debates, Wednesday 6 May 2009, Volume No. 710 Part No. 70: Columns 576-8 http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/90506-0005.htm
   http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/90506-0006.htm

Mentions of the ISM research in the consultations in England and Wales on PoS legislation, demonstrating the importance attached to the research:

5. Cited in: Welsh Government (2010). Annex 1: Consultation-stage impact assessments of regulations supporting the prohibition of the display of tobacco at the point of sale. Consultation document for Consultation on the draft tobacco control regulations for Wales under the Health Act 2009, 12 April to 6 July 2010. http://wales.gov.uk/docs/phhs/consultation/100412annex1ency.pdf
6. Cited by the Prime Minster's Office in response to an e-petition, summarising the Government's position on PoS:
   http://webarchive.nationalarchives.gov.uk/+/http://www.number10.gov.uk/Page18350

Mention of the ISM research in responses to consultations in New Zealand, demonstrating the research's international impact and value:

7. Selak V (2010). Proposal To Ban Tobacco Retail Displays. North Shore City: Waitemata District Health Board. Online: http://www.waitematadhb.govt.nz/LinkClick.aspx?fileticket=-T6jXfdMuA4%3D&tabid=170&mid=575

Mentions of the ISM research in the news and academic media, demonstrating its influence on the public debate:

8. BBC News (2008). Call to curb tobacco marketing. 5th September. Online:
   http://news.bbc.co.uk/1/hi/health/7598573.stm
9. Smith R (2008). Cigarette packets `should be blank'. The Telegraph, 4th September. Online:
   http://www.telegraph.co.uk/news/uknews/2681981/Cigarette-packets-should-be-blank.html
10. Siva N (2009). UK hopes bill will tackle smoking in children. The Lancet, 274(9701): 1583.
    http://dx.doi.org/10.1016/S0140-6736(09)61934-6