Tobacco control policies introduced in the UK since the 1970s have been associated with a marked decline in smoking prevalence. But socioeconomic differentials in prevalence have widened over this period, both in absolute and relative terms. A new generation of tobacco control policies is now being introduced in the UK and in countries at a similar stage of the smoking epidemic. The critical issue for public health is whether the new policies will reduce tobacco use among disadvantaged smokers - and at a rate sufficient to reduce socioeconomic differentials in tobacco use.
The project took advantage of an ongoing cross-country study (Australia, Canada, UK and USA) to examine this question. The International Tobacco Control Policy Evaluation Study (ITC) is a longitudinal study (2002-07) evaluating 5 key policies: on pack warning labels, elimination of 'light/mild' labelling of brands, elimination/reduction of advertising and promotion, price/taxation effects and product regulation/alternative nicotine products. Three of the policies saw major change in the UK during the course of the study: a ban on tobacco advertising and promotion was introduced in February 2003; more prominent on-pack text warnings appeared from January 2003; and misleading product descriptors such as 'light' and' mild' were banned from September 2003. Further regulations introduced on sponsorship, point-of-sale marketing and brand stretching, and tighter restrictions on smoking in work- and public places were included in the 2005 Health Bill.
In line with national targets for adult smoking (with its focus on reducing smoking prevalence in routine and manual groups), the project focused on the socioeconomic differentials in the impact of these policies. It looked at psychosocial factors (attitudes, perceived risk, self-efficacy) as well as smoking behaviours (quitting, reduced consumption, brand switching, etc).
Ad bans, enhanced warning labels and the elimination of misleading product descriptors appear to have a uniform impact across socio-economic groups.
The study found that enhanced warning labels led to increased awareness and processing of warning messages and that the advertising and promotions ban drove substantial reductions in tobacco marketing awareness.
Given the disproportionately high smoking rates in disadvantaged populations, these tobacco control policies are likely to be having a bigger proportional impact in these communities.