An absence of tobacco evidence11-Dec-2009
Friday, 11, Sep 2009 12:00
The evidence that cigarette prices and adverts affect young smokers is terribly weak. The government needs to base policy on evidence, not dogma.
By Patrick Basham
Tobacco policy currently rests on two claims: tobacco advertising and promotion are the major reasons why young people begin to smoke; and young people are particularly sensitive to the price of cigarettes. From these two claims follow the central elements of tobacco policy, namely that all forms of tobacco advertising and promotion, including tobacco displays, should be banned, and tobacco should be heavily taxed in order to prevent or at least reduce under-age tobacco use.
Unfortunately, neither of these claims nor policies meets the standards of evidence-based policymaking. Both are, instead, products of advocacy-based 'research' carried out by anti-tobacco lobby groups.
In evidence-based policymaking, as in evidence-based clinical medicine, practices and decisions are based on rigorous, systematic reviews of 'best practice', that is, therapies and interventions that work the best in reducing morbidity and mortality. Evidence, and evidence alone, not theory or tradition, drives practice.
The empirical record about tobacco advertising's affect on young people is decidedly mixed. Large independent studies have failed to find a statistically significant connection between tobacco advertising, consumption, and youth smoking. Indeed, the two major UK government-commissioned studies on tobacco advertising and marketing failed to find a causal link between advertising and young people starting to smoke.
This lack of evidence is confirmed by the fact that countries that have had advertising bans for a quarter century or more have not experienced statistically significant declines in youth smoking. Consumption and prevalence data from 145 countries finds little evidence that the entire range of tobacco control measures, including advertising restrictions and bans, has a statistically significant effect on smoking prevalence in any country.
Yet, the government pushes ahead with increasingly draconian restrictions on tobacco advertising through legislation to ban the display of all tobacco products. Even though the Department of Health claims that there is substantial evidence to show that such bans will reduce youth smoking, this is not the case.
The evidence in support of tobacco display bans, just as for tobacco advertising bans, is embarrassingly thin. Most studies show that tobacco displays have no statistically significant effect on youth smoking.
The most frequently quoted studies actually found that seeing tobacco displays had no effect on youth intentions to smoke. None of the so-called evidence about tobacco displays provides compelling behavioural evidence that any young person started smoking after seeing tobacco displays.
The evidence from the experience of other countries who have tried display bans does not support the claim that they reduce youth smoking. The government has repeatedly claimed that Canada, where several provinces have banned tobacco displays, shows that such bans result in fewer tobacco sales and fewer youth smoking.
The government knew that this claim, and the evidence that it was based on, was not true. Recently released DoH correspondence shows that the government was told in a March 2009 email that removing tobacco displays in Canada 'has not caused a decline in tobacco sales or discourage[ed] kids from smoking'.
Yet, the anti-tobacco lobby continues to push for even more far-reaching tobacco control legislation. This past week, Action on Smoking & Health (Ash) trumpeted a new study about the influence of tobacco packages as proof that putting all tobacco products in plain packages was now required. Ash's Deborah Arnott told the BBC that: "This research shows that the only way of putting an end to this misleading marketing is to require all tobacco products to be sold in plain packaging."
What Arnott did not tell the BBC was that she and Martin Dockrell, Ash's campaign manager, were not only two of the authors of the very study they so fulsomely praised, but Ash, along with the DoH, paid for the study.
Considerable previous research has shown that plain packaging of cigarettes will do nothing to reduce youth smoking. A study from Canada's York University, which asked young people about what effect plain packaging would have on their smoking decisions, found that 90 percent of daily smokers said they would smoke more or the same if cigarettes were in plain packages.
What then of high taxes to discourage or prevent youth smoking?
The claim that high tobacco taxes will reduce smoking is an odd one since we have been taught that smoking is addictive. If smoking is addictive, logic dictates that smokers will be insensitive to price increases.
But the claim also runs counter to what most experts say about how young people smoke. Most young smokers are experimental smokers who do not buy their cigarettes, but instead get them from friends or family, which makes them much less sensitive to high tobacco prices.
Data from the US National Household Survey on Drug Abuse recently showed that over 85 percent of 12-18 year old smokers consume the three most expensive brands of cigarettes, a fact that is also difficult to square with the claim that young people are price sensitive.
A series of American longitudinal studies has found tax increases have a statistically insignificant effect on preventing young people smoking. Last year, in a study of tobacco control policies in 27 European countries, it was found that, for adolescents, price was unrelated to smoking prevalence.
Tax increases do succeed, however, in increasing the risk of smoking. Jerome Adda and Francesca of University College London found that a one percent increase in tobacco taxes increases smoking intensity by 0.4 percent, which leads the smoker to inhale more dangerous chemicals and causes cancer deeper in the lung.
The result of public health policymaking absent of evidence is tobacco policy that repeatedly fails to address youth smoking. While the government is entitled to its own opinion about the most effective ways to reduce smoking, it is not entitled to its own evidence.