Summary

Our unit evaluates the impact of tobacco control interventions in England and internationally. This work has included evaluations of key tobacco control policies in England using routine data sources. We have worked with the WHO to create a nurturing care brief to highlight the links between tobacco control and childhood development, and have produced a free online 3-week course titled “Tobacco Control: Agile Policy, Research and Practice”

Research focus

Quantifying the impact of tobacco control interventions on health outcomes in middle-income countries, assessing the impact of introducing smoke-free public places on child health and inequalities in health outcomes.

Research topics

• legislation eliminating smoking from public places on tobacco use and important child health outcomes, including prematurity, low birth weight and hospital admissions for asthma
  
• legislation increasing the legal age for the purchase for tobacco from 16 to 18 years
  
• removing tobacco imagery from youth-rated movies
  
• providing financial incentives to doctors to offer cessation advice to patients in primary care
  
• modelling the impact of tobacco control interventions on smoking prevalence and cardiovascular disease mortality in India and China
• evaluating the impact of smoke-free laws on infant health in Brazil
• tobacco taxation on prices and health outcomes, such as infant mortality

Our unit also studies the epidemiology and legislative components of non-cigarette tobacco products, namely waterpipe tobacco smoking. We are part of the Cochrane Tobacco Addictions Group.

Country focus: England, India, China, Brazil

Project example

International work includes modelling the impact of tobacco control interventions on smoking prevalence and assessment of the relative benefits of tobacco control compared to pharmacological CVD therapies. The unit has received funding from the World Health Organization (China country office) to examine the impact of different tobacco control policies in China.

One study aimed to assess the impact of smoke-free legislation on neonatal and infant mortality in Brazil. We looked at the impact of three different types of legislation: basic (allowing smoking areas), partial (having segregated smoking rooms) and comprehensive (not allowing smoking in public buildings). For this study we used monthly longitudinal data from January 2000 to December 2016 for all Brazilian municipalities. We found that partial smoke-free legislation was associated with an immediate 3.3% step reduction in municipal infant mortality rate but no step reduction in neonatal mortality. Implementing comprehensive legislation was associated with 5.2% and 3.4% immediate step reductions in infant and neonatal mortality respectively, followed by an annual decline in infant mortality rate. We estimated that an additional 10,091 infant deaths could have been prevented if all smoke-free legislation introduced since 2004 had been comprehensive. These findings build on other studies demonstrating comprehensive smoke-free legislation offers greater benefits in protecting children’s health, and so pushing for more comprehensive smoke free legislation remains a priority globally.