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Call it quits: the effect of smoking policy

Many strategies have been proposed and implemented on a national level to reduce the number of people smoking, but what difference do these really make?

It has been described as 'the jewel in the crown of the NHS' and a role model for the rest of the world. The NHS stop smoking service has come a long way since its launch just over a decade ago. 

According to recent research by Professor Robert West and his team at University College London, in the ten years up to 2011 the service has reached 8% of smokers in England and helped well over 20,000 of them to achieve 'long-term abstinence' (at least one year without smoking), saving almost 25,000 life-years. On average across the country, just over one third of those who sign up to the service succeed in quitting for at least four weeks. That's a pretty impressive success rate - many times more than manage to quit without it. 

So, does the NHS smoking cessation service provide good value for money? Yes, it certainly does. On average, the cost of each successful one-month quitter is only about £300, but the potential savings to the NHS, measured in quality-adjusted life years (QALYs), is at least five times that figure. 

Despite these encouraging results, there's no doubt that even greater success could be achieved - especially in those places where quit rates are below average. Results are very patchy across the country, with some areas achieving rates double those in others, for all sorts of reasons. 

Whatever the challenges locally, everyone involved in smoking cessation work knows that what happens nationally in terms of tobacco control policy can make a huge difference. The ban on smoking in enclosed (and semi-enclosed) public places and workspaces is testament to that. Introduced in England in 2007 (a year after Scotland), it was followed by a huge surge in people wanting to give up or cut down. There's no doubt that a comprehensive national strategy, effectively tackling such things as price, availability and marketing, could persuade many more smokers to seek help in giving up and increase their chances of succeeding.

So what elements of national policy might help you in your stop smoking work?

Easily the most powerful influence on smoking habits is price. Every hike in duty triggers a gratifying fall in cigarette consumption. Since 1980 the price of cigarettes has doubled in real terms and smoking prevalence has halved. A pack of 20 cigarettes now costs a staggering £8 or thereabouts, three-quarters of which is tax, and increasing numbers of people simply can't afford to keep burning up that kind of money. The health lobby is constantly pressing the Chancellor to keep the increases ahead of inflation, reminding him of the £3 billion a year that smoking-related diseases cost the NHS, plus a similar amount in sickness absence and lost productivity. So far, he has complied, and rakes in about £12 billion a year for the Treasury.

Another powerful influence is - or was until fairly recently - advertising, marketing and promotion of cigarette brands by the tobacco industry. Tobacco advertising on TV and radio was banned in the mid 1990s, and most other forms of advertising, such as posters and press, in 2003. This includes direct marketing and sponsorship, although sponsorship of Formula One car racing lingered on for a while, as did similar sponsorship of snooker and various arts events. 

Even today, 'Big Tobacco' manages to get its branding and messages across to young people, handing out samples for 'market research' at pop festivals, or using social media to spread the word in a thousand subtle ways. They are also quite clever at product placement in movies - helping to perpetuate the cool image of smoking. New rules under the Broadcasting Act will help to clamp down on some of these abuses.

One of the last bastions of brand promotion is on the cigarette packs themselves. The instantly recognisable designs, logos and colour schemes play an important part in 'stretching' the brand to non-tobacco products and recruiting young people to smoking. Since April 2012 it has been illegal to display tobacco products at the point of sale in large stores in England (the ban will apply in small stores from 6 April 2015). However, you only have to take a look at the tobacco counter of your local supermarket to see how widely this law is flouted, with sliding doors left wide open and shelves in full view.

To take restrictions a step further, the previous government passed a law to bring in so-called plain packaging of cigarettes (aka standardised packaging). This would involve the removal of all branding apart from the name of the product in a standard font on a plain background together with a larger health warning. The incoming Coalition government agreed to hold a wide consultation on whether to implement the law, but despite a great deal of evidence-based lobbying from health organisations, it has recently decided to wait and see what happens with similar legislation in Australia. Early indications are that plain packaging does indeed help to turn people off the idea of smoking.

What about availability? The current challenge is tobacco smuggling - accounting for about 10% of cigarettes sold in the UK. There has been a massive crackdown in recent years and hopefully these ultra-cheap cigarettes will be harder to come by as customs officers get better at scanning, searching and tracing the contraband back to the bosses who run the show.

So, where does tobacco policy go next? What else is in the pipeline? 

We can expect more public education programmes along the lines of 'Stoptober', 'Smokefree generation' and No Smoking Day. These help to raise awareness, but otherwise have little effect on cessation rates - although the recent campaign on the risks of secondhand smoke to babies and small children at home or in the car received widespread coverage in the media. 

On this latter issue, the government is coming under increasing pressure to ban smoking in cars with a child on board - legislation which has already been introduced in several parts of Canada, the USA and Australia as well as South Africa and Chile. So far, there's no sign of any positive response on this issue and it hasn't been incorporated into the current national tobacco control strategy, but watch this space.

Finally, as well as the impacts of national policy on local smoking cessation work, we should also consider what might happen as a consequence of local policy. In England, stop smoking services have been transferred to local government along with a whole raft of other public health responsibilities and services. The Localism Act means that local councils have considerable autonomy in deciding what services they will provide and how much to spend on them. The worry is that, as they face deeper and deeper cuts, many will be tempted to wind down their stop smoking service to help make ends meet.

This is all the more reason to prove to them how cost-effective your smoking cessation service can be - and to press the government for national policies that might help you do even better.