For any strategy aimed to reduce socioeconomic inequities in health in Europe, it is vital to tackle the large and widening inequalities in smoking. However, there is only limited evidence on effectiveness of tobacco control policies in terms of reducing inequalities. Especially lacking are evaluations of the effects of policies that have actually been implemented in different European countries.
The aim of SILNE is to analyse various “natural policy experiments” within Europe with the aim to generate new empirical evidence on the effectiveness of possible strategies to reduce inequalities in smoking.
The project has three parts. First, time trends in various European countries will be analyzed with the aim to assess whether changes in national tobacco control policies had influenced inequalities in smoking cessation among adults.
Second, comparisons between European countries will be made with the aim to assess whether cross-national differences in specific tobacco control policies were associated with inequalities in smoking initiation among adolescents.
Third, the project will review the published results of controlled intervention studies, and integrate these with our results. The combined evidence base will be disseminated across Europe, especially among those who are involved in the development of tobacco control policies and health-in-all policies.
This innovative project will develop comparative research into a new strategy for the evaluation of natural experiments, combining methods from different disciplines. Top researchers from different European countries will work together, and bring together four large international networks relevant to inequities in smoking.
Within most European populations, smoking prevalence rates differ substantially according to people’s educational level, occupational class and income level. Large inequalities in smoking are now emerging in all European countries, especially in the youngest generations. Tackling inequalities in smoking is therefore vital to any strategy that is aimed at avoiding a further widening of socioeconomic inequalities in health, and making the narrowing of health inequalities a realistic goal.
Several effective interventions and programs are now available to address smoking in Europe. These include bans on smoking in public places and cessation support services for those wanting to quit. In addition, several supply-side measures are potentially effective, including bans on advertisements, increased tax on tobacco, and restrictions on sales of tobacco products to young people. Most of these measures have been implemented, to a greater or lesser extent, in different European countries, stimulated by international initiatives such as the Framework Convention on Tobacco Control (FCTC). Scientific evaluations of tobacco control policies has provided strong evidence of their effectiveness in reducing overall smoking in the general population, e.g. in case of tax policies.
A main challenge for research is to assess which of these tobacco control measures also have the potential to reduce socioeconomic inequalities in smoking, beside their impact on general smoking prevalence. For example, in England, the introduction of stop-smoking services in poor neighborhoods resulted in a decrease in inequalities in quit attempts, although inequalities in smoking cessation rates decreased to a lesser extent. Unfortunately, much of the current evidence is derived from evaluations of controlled experiments in selective populations. As a result, it is still highly uncertain which policies will be effective in reducing smoking inequalities if they are implemented in the general population.
There is therefore an urgent need for evidence on the effectiveness of policies, programs and interventions that have already been implemented at national or local levels. Evaluations of these actions may help to estimate more directly what has been achieved, and what can further be achieved, by real-world actions in the field of tobacco control.
The overall aim of the project is thus to analyse several “natural experiments” available within Europe in order to generate new empirical evidence to inform strategies to reduce socioeconomic inequalities in smoking.
The project has three specific objectives:
The project will improve our understanding of how to effectively address inequalities in smoking. More specifically, the project will strengthen the theoretical and empirical basis for this understanding.
The project will do so by:
The inclusion of social determinants of health is high on the EU agenda as indicated in various policy documents, including the Conclusions on Equity and Health in All Policies, disseminated by the Council of the European Union in June 2010. One of the biggest challenges regarding health inequalities in Europe is a lack of direct evidence on the effects of national policies on health determinants such as smoking, and on the effect of root causes of health inequalities such as educational policies.
The results of the SILNE will be a main step forwards in filling in this information, directly for smoking, and indirectly for other determinants of health inequalities. Dissemination of the results of this project to policy makers, professionals as well as general public is therefore needed, and we will provide tailored information to the different stakeholder groups via different channels, in order to positively influence their knowledge.