Fifty years since Smoking and health - Royal College of Physicians

8. Controlling access to tobacco
products as a tobacco control strategy
Professor Richard Edwards
University of Otago, New Zealand
Controlling access to tobacco products
Much of the focus of tobacco control over recent decades has been on reducing
demand for tobacco products. This is particularly the case for adult smoking, for
which interventions – such as mass media campaigns, health warnings, tobacco tax
increases, and controls on marketing – aim mainly to create triggers and a supportive
environment for smokers to cut down and, ideally, to quit smoking. This contrasts
with alcohol (and even more so with illicit drugs, where supply is generally the main
intervention focus), where there is also attention to controlling the supply, for example
through restricted opening hours and places of sale, and licensing of alcohol retailers.
The major exception in the tobacco control arena is in the area of initiation, as laws to restrict
the age of purchase of cigarettes are now the norm. However, reviews of international
evidence suggest that these interventions have a modest effect, and even then only if
rigorously enforced. 2,3 In England, legislation to raise the legal age of purchase from 16 to
18 years from October 2007 contributed to a substantial fall, by over 20 percentage points,
in the proportion of regular smokers aged 11–15 who reported that they usually obtain
cigarettes from a shop. However, in 2010 58% still reported shops to be their usual source of
cigarettes (see Fig 1 overleaf). 1
Other indicators, such as reported diffi culty in purchasing cigarettes, trying to purchase
cigarettes, and refusal of shops to sell cigarettes, also improved after the 2007 English
legislation. Still, in 2010 42% of underage smokers who had tried to purchase cigarettes
reported that they were always successful, and 89% of regular and 53% of occasional
smokers reported that they had asked someone else to buy cigarettes for them (proxy
purchase), and this was usually (around 90%) successful. A high proportion of purchases of
cigarettes were for packets of 10 (41%). 1 A great deal more needs to be done, therefore, to
enforce existing legislation and further reduce availability of cigarettes to young people.
© Royal College of Physicians 2012 23