Wednesday 29 February 2012

Failure, failure, failure

A study published this week in Addiction reveals that the Italian smoking ban had no lasting effect on smoking prevalence and quit rates. The researchers found that there was a brief decline in the number of smokers when the ban came in, but that the smoking rate returned to pre-ban levels shortly afterwards.

Findings: Among males, smoking prevalence decreased by 2.6% (p = 0.002) and smoking cessation increased by 3.3% (p = 0.006) shortly after the ban, but both measures tended to return to pre-ban values in the following years. This occurred among both high and low-educated males. Among low-educated females, the ban was followed by a 1.6% decrease (p = 0.120) in smoking prevalence and a 4.5% increase in quit ratios (p < 0.001). However, these favourable trends reversed over the following years. Among high-educated females, trends in smoking prevalence and cessation were not altered by the ban. Among both males and females, long–term trends in the daily number of cigarettes, which were already declining well before the implementation of the policy, changed to a minor extent.

Conclusion: The impact of the Italian smoke-free policy on smoking and inequalities in smoking was short-term. Smoke-free policies may not achieve the secondary effect of reducing smoking prevalence in the long-term, and they may have limited effects on inequalities in smoking.

This study closely echoes the findings of a paper published last year in PLoS (mentioned on this blog in November) which reported a large increase in the use of nicotine replacement 'therapy' when the smoking ban was introduced in Scotland, but no long-term change in the nation's smoking prevalence. It also echoes another study published this month which found no change in the number of nurses smoking in France after smoking was banned in the workplace.

All of this runs counter to the widely held belief that smoking bans encourage smokers to quit. By contrast, new evidence continues to appear showing the efficacy of snus as a smoking cessation aid.

Among male quitters under the age of 45 years, 45.8 % of those who had used snus on their last attempt to quit were current non-smokers (OR = 1.61, CI 1.04-2.29), while 26,3 % of those who had used NRT were current non-smokers.

59.6 % of successful quitters and 19.5 % of unsuccessful quitters who had used snus as a method for quitting smoking had continued to use snus on a daily basis after quitting.

Conclusion: Norwegian men frequently use snus as a method for quitting smoking whereas women are more likely to use NRT. The findings indicate that switching to snus can be an effective method for quitting smoking.

You may also recall the study from 2010 which revealed that graphic warnings on cigarette packs had no effect on the quit rate (or initiation rate)—again, in contrast to the excitable claims made by 'tobacco control professionals'.

There were few changes post implementation of the picture health warnings in the number of health effects recalled or participant’s perception of risk... There were no differences post implementation of the picture health warnings in the number of smokers reporting forgoing a cigarette when about to smoke one or stubbing out a cigarette because they thought about the health risks of smoking... Among young people, the impact of picture health warnings was negligible.

The evidence is mounting that the neo-prohibitionist approach of incremental bans is a busted flush, whereas the harm reductionist approach is not only more civilised, but is more effective in helping people who want to quit do so, rather than hassling and belittling people who don't. As I've said before, tobacco control is not a results-driven business. No one gets sacked for making the wrong call, they just move onto the next policy and hope nobody notices.

The priority for the neo-prohibitionists this year is plain packaging and the usual tired claims are being wheeled out about "overwhelming evidence"which exists only in their imagination. Will the politicians fall for it one more time or will they demand—at long last—that tobacco control be judged by past performance?

UPDATE: In the comments, "Big" Dick Puddlecote brings my attention to yet another example of failure.

Smoking levels among adults in Northern Ireland have not reduced in the last five years, the health minister has said...

The Executive has introduced smoke-free legislation in public areas such as the workplace, bars and restaurants. It has increased age requirements and developed smoking cessation services. There are also measures to scrap vending machines and remove displays of cigarettes in shops...

Smoking prevalence among adults has remained around 24% since 2007 and for manual workers that rate is 31%.



Dick Puddlecote said...

Underwhelming success being enjoyed in Ireland too, said Edwin Poots as he launched another doomed initiative.


Leg-iron said...

There's a simple reason why NRT usage rose in Scotland after the ban - it's available free on prescription. That would somewhat bias the uptake rate.

As to whether the politicians would be dim enough to fall for it again, they are dim enough to think that those with low-grade degrees are just as good as those with high-grade ones.

They will believe that ads from the 1950s influence smoking uptake by teenagers who have never seen any tobacco ads, and that women are all so weak-willed that they cannot resist pretty packets.

So yes, they are plenty dim enough.

Frank J said...

Is that Ireland thing a try out for a Monty Python sketch? It couldn't be funnier!

Edwin Poots? (that should surely be Hoots)says a 10 year plan to reduce smoking rates? Half way through and? Zilch! Then goes on to praise Australia and California.

This guy has got to be a throw back to the old Comedians TV programme. What a scream!

david said...

Have you seen this Chris?

Relapse prevention in UK Stop
Smoking Services: current practice,
systematic reviews of effectiveness and
cost-effectiveness analysis

dearieme said...

Any sign that the bans reduce the average amount smoked by each smoker?

Anonymous said...

The Irish newspaper article seems not to see the contradictions inherent in the idea of having a ten year plan which has completely failed after five years of the plan. The minister himself seems to be totally confused. His references to Canada and Australia do not explain the failure.

Dan said...

What I don't get is why all these authorities and medics are so fixated on the idea of making people actually quit smoking. Surely even the dimmest troglodyte has by now worked out that smoking tobacco isn't actually doing them much good, yet still for assorted reasons they persist. Trying to shout the message louder won't work; I believe that this concept has now been destruct-tested, so could we please move on?

If people quite like the effects of nicotine, then why not work very hard to make a cigarette or nicotine delivery device which is cheap, effective, and which is more or less safe, and which is actually quite nice to use. If it doesn't involve combustion then all to the good, but above all make the device nice to use. Nicotine is not toxic in the doses smokers take and can even be beneficial, so why not once and for all admit that people like drugs, and making mild ones as non-damaging as possible is a good idea?

dearieme said...

Come off it, Dan, you're just being rational. Nobody will get the thrill of dictatorial power out of that.