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Research, policy development, evaluation and advocacy work at The University of Nottingham has achieved significant impact in helping to prevent the harm to health caused by smoking, which is the largest avoidable cause of death and disability, and of social inequalities in health, in the UK. This impact has been achieved through contributions in two areas of prevention: (1) conventional population- and individual-level interventions to prevent smoking uptake and promote smoking cessation; and (2) novel population-level measures to encourage substitution of smoked tobacco with alternative, low hazard nicotine products as a harm reduction strategy.
Smoking is the single most important preventable cause of mortality and inequalities in health in the UK. Tobacco use causes over 100,000 deaths each year in the UK, with around 10,000 of these due to non-smokers' exposure to secondhand smoke. The total cost of smoking to society is estimated to be over £13 billion. The UoE Tobacco Control Research Group's (TCRG) research and knowledge exchange activities have significantly influenced tobacco control policy and practice in the UK (http://www.cphs.mvm.ed.ac.uk/groups/tcrg or http://tinyurl.com/nwxcpnh). More specifically, their research on smoking and non-smoking by young people has influenced smoking prevention and cessation policy at the national level in Scotland and England and at regional/local levels. Their evaluation studies of the national smoke-free legislation in Scotland and England provided important evidence on the legislation's positive public health impact, thereby undermining the case for repealing or diluting the legislation. Their research on reducing smoking in the home has influenced national policy and practice on this issue in Scotland including national mass media campaigns.
Oxford's research has helped reduce smoking prevalence and tobacco-related mortality worldwide. Our epidemiological studies have documented the varied ways in which smoking causes death in many countries, as well as the large benefits of smoking cessation, and have strongly influenced the WHO/Bloomberg 2008 MPOWER package, the key document guiding governmental tobacco policy worldwide. Oxford University researchers have also coordinated the systematic reviews that underpin effective evidence-based policies for encouraging smoking cessation both in the UK and worldwide, for example providing evidence supporting NICE guidance for smoking cessation.
There is no `magic bullet' for helping intractable smokers to quit. Rather, the story of this research is one of multiple studies that have built the knowledge base incrementally, allowing Professor of Clinical Psychology Peter Hajek and his team at the Wolfson Institute of Preventative Medicine to produce a targeted, evidence-based model of a specialist treatment that has fed directly into the establishment of the NHS smoking cessation service (NHS-SSS) and national smoking cessation policy (including NICE guidance), and changed clinical practice. The NHS-SSS treats 800,000 smokers per year. The approach is influential globally and has now been used in treating several million smokers and preventing hundreds of thousands of premature deaths.
Ground-breaking experimental research at the University of Bristol assessing the effectiveness of standardised tobacco packaging legislation has been strongly influencing international tobacco policy and legislation since 2011. Work by scientists in the School of Experimental Psychology was the first to show, using direct, objective measures, that standardised tobacco packaging modifies relevant behaviours. Australia became the first country in the world to implement standardised packaging legislation in 2012 after reviewing the University of Bristol research in their High Court in response to legal challenges from the tobacco industry. That same year, the European Commission's update of the Tobacco Products Directive cited the same University of Bristol research to support the claim that standardised packaging would strengthen the effectiveness of graphic health warnings on tobacco products. The UK government has also used the University of Bristol research to inform the consultation on standardised packaging of tobacco products.
Smoke-free laws are public policies that prohibit tobacco smoking in workplaces and other public spaces. Since the end of March 2006, smoking has been prohibited by law in all enclosed public spaces throughout Scotland, with the specific aim of protecting non-smokers from the effects of second-hand smoke. Studies led by the University of Glasgow have provided the most robust available evidence that smoke-free laws have a significant impact on rates of heart disease, childhood asthma, complications in pregnancy, and stroke. This evidence has been used to support policy debate and decision making in Scotland, the rest of the UK, and around the world, providing guidance for other countries to implement similar legislation. This research has also provided a focal point for an extended and high profile global public debate over smoking legislation, and underpins health advice and campaigns published by the World Health Organization (WHO), World Heart Federation and other international bodies.
Epidemiological research at Queen Mary, commissioned by the Department of Health, demonstrated a clear and causal link between exposure to environmental tobacco smoke and both ischaemic heart disease and lung cancer. The evidence contributed significantly to public and political debates on whether to ban smoking in public places. It informed the rebuttal of heavy tobacco industry lobbying and had a pivotal influence on changes in the law in Scotland (2006), England and Wales (2007), and Northern Ireland (2007), as well as in many countries outside UK, which led to highly significant reductions in environmental pollution from secondhand smoke. Many health benefits were subsequently attributed to the ban, notably a 17% reduction in incidence of acute myocardial infarction.
University of Aberdeen research had impact on public policy as it was instrumental in the introduction of legislation in Scotland to restrict smoking in public places. The implementation of the legislation has impacted on the health of the public and benefited the economy through reduced use of health services.
Exposure to environmental tobacco smoke (ETS) — passive smoking — had been estimated to cause more than 1,000 deaths per year in Scotland and significant morbidity. International evidence was used to model the health and economic impacts of potential legislation to eliminate smoking in public places in Scotland, under a range of scenarios. The net present value of all the benefits and costs over 30 years was demonstrated to be positive under all the scenarios examined, with a central estimate of +£4.6 billion (ranging from +£0.056 billion to +£7.4 billion).
The research results provided convincing evidence to support the passage of legislation. Following the implementation of smokefree public places in Scotland, evidence of the resulting health benefits have been accruing from 2008. These include significant reductions in admissions for acute coronary syndrome and for childhood asthma, reductions in complications of pregnancy (pre-term delivery and small for gestational age) and improvements in bar workers' health.
The claimed impact, as defined by REF guidance, therefore includes: public health and welfare have improved; public behaviour and the control of disease has changed.
ASSIST (A Stop Smoking in School Trial) is reducing smoking rates among teenagers by 22%. `DECIPHer' Impact Ltd was set up to rollout the ASSIST programme which has been adopted widely in England and Wales with 26 licences being commissioned. The company has achieved £240K annual turnover. As a result, an estimated 1674 young people have not taken up smoking. The Lancet estimates that if ASSIST were implemented across the UK, 40,000 teenagers a year would not start smoking.
ASSIST has been commended by the English and Welsh Governments and recommended in National Institute for Health and Care Excellence (NICE) guidelines.