Progress on tobacco control and its impact in

Progress on tobacco control and its impact in the North East Eugene Milne NE England Deputy Regional Director of Public Health Honorary Professor – University of Durham

What is Fresh? • A regional office for tobacco control in the North East of England • A coordinating body for related efforts across a range of organisations • Until April 2010 also the home of Regional Tobacco Policy Manager (funded by the Department of Health) • Winner of the English Chief Medical Officer’s Inaugural Gold Medal for Public Health in 2009 • Awarded the Irish Cancer Society’s Charles Cully Memorial Medal 2012 • Underpinned by a philosophy of de-normalisation’

Eight key strands: 1. 2. 3. 4. 5. 6. 7. 8. Develop infrastructure, skills, capacity & influence (Alliances) Reduce exposure to second hand smoke (Legislation) Motivate and help smokers to stop (Stop Smoking Services, pregnancy) Media, communications and education (Campaigns) Reduce availability and supply (Illicit tobacco) Tobacco regulation Reduce tobacco promotion (Stores and advertising) Research, monitoring and evaluation (Reports and data)

1. Alliances: Partnerships

2. Second Hand Smoke

The message that smoking damaged other people’s health was one of the most potent in campaigning for legislative change

2. Second hand smoke

3. Supporting Stop Smoking

3. SSS - pregnancy

Smoking cessation in Pregnancy

4. Campaigns & media

4. Campaigns & media Fresh SFNE Media Coverage 2005 -6 2009 -10 % Change Number of articles 305 422 138% Seconds broadcast 4, 715 39, 921 847% Positive opportunities to see (OTS) 41. 2 m 63 m 153% PR value (if bought) £ 531, 549 £ 3. 4 m 640% Positive to negative coverage 25: 1 100. 1 400%

4. Campaigns & media

5. Supply

6. Regulation: North of England Tackling Illicit Tobacco for Better Health A collaboration between Trading Standards HMRC The Police Department of Health Fresh Smoke Free North East Smokefree North West Smokefree Yorkshire and the Humber Part of the multi-component tobacco control programme

6. Regulation: 2009 -2011 • Tobacco consumption – down by 27% • Number of smokers buying illicit tobacco – down from 20% to 18% • Particularly amongst young smokers (16 -24 year old) though this group remains the most likely to buy • Estimated illicit tobacco volume has reduced by 39% • Sources of illicit tobacco have changed • Drop in friends/family/colleagues • Notable increase in purchase from shops • Increasing levels of discomfort with the illicit tobacco trade • (all NE figures from NEMS surveys)

7. Reducing promotion

8. Evaluation • • • Regular data analysis Reports and small area statistics Collaboration with the Public Health Observatory Collaborations with local and national academic institutions Engagement with international and national evaluation: – World Conference on Tobacco or Health Mumbai 2009 – World Conference on Tobacco or Health Singapore 2012

8. Evaluation

8. Evaluation Russell, A. et al. , 2009. Health Promot Int, 24(3), pp. 262 -268.

Circulatory mortality excess

Cancer mortality & excess

Pierce, J. P. , Messer, K. , White, M. M. , Kealey, S. , and Cowling, D. W. (2010). Forty years of faster decline in cigarette smoking in California explains current lower lung cancer rates. Cancer epidemiology, biomarkers & prevention. 19, 2801– 2810.

Male lung cancer mortality

Male excess lung Ca mortality

Male vs Female trends

Female excess mortality

Incidence trends

The Future • How will Fresh fare in the climate of the new NHS? – Strong case for continued support – Reinforced by the Association of North East Councils • Recognition across political parties of the need for continued action • How far can or should legislation go? • Some key areas: – Plain packaging – Smoking in pregnancy – Exposure in cars and in the home – Continued work on illicit supplies • Reinforcing the message for new audiences • Economics and disease prevention • Inequalities

Thank you for listening Questions?