1. Tobacco-Free Ireland 2025: What kinds of investments are needed? Professor Luke Clancy WCTOH 2015

3. Cigarette Smoking Prevalence Jan – Dec 2014 Do You Smoke one or More Cigarettes per week?

4. Cigarette prevalence by Gender 12 month moving average

7. Proportion of Cigarette Smokers by Socio- economic group Jan – Dec 2014

9. SimSmoke Modelling David Levy

11. Example: Ireland SimSmoke Male Prevalence with Individual FCTC Policies Policies/Year20102011202020302040 % Change in Smoking Prevalence from Status Quo Independent Policy Effects Tax 70% of Retail Price-3.3%-4.3%-5.5%-6.6% Complete Smoke Free & Enforcement-0.2%-0.3% Comprehensive Ad Ban & Enforcement-0.5%-0.6%-0.7% High Intensity Tobacco Control Campaign-6.3%-7.3%-8.2%-8.9% Strong Health Warnings-1.2%-1.5%-1.6% Strong Youth Access Enforcement-0.4%-2.5%-4.2% -6.0% Cessation Treatment Policies-2.2%-4.3%-5.5%-5.9% Combined Policy Effects All above, including Youth Access-13.5%-19.9%-24.6%-28.1%

12. Predictions from SimSmoke Ireland Even with full compliance with MPOWER no country that we examined can reach elimination by 2040 We need more and better policies particularly on the supply side

14. HCP Smoking

15. Referral by HCPs to Cessation Services

16. Online & social media 1 1-1 clinics 3 On the phone 2 Support groups 4 1.Third party contractor 2.Health Service staff and third party contractor 3.Health Service staff 4.Health Service staff Trained cessation support staff Standard Treatment Programme Track and Support Quitters for 12 months The QUIT Team

17. EU Role in Tobacco Control  EU Directives  EC Recommendations  DG Sanco  Mass Media Multimillion Budget  Research funding

18. The Tobacco Industry FCTC Article 5.3

19. https://www.youtube.com/watch?v=6UsHHOCH4q8

20. Tobacco giant issues legal threat over plain packaging Benson and Hedges owner warns of legal action unless Ministers halt legislation T ue, Feb 17, 2015 Japan Tobacco’s packaging objections look set for courts ‘Big Tobacco’ watches closely as plain packaging precedent may affect larger EU markets W ed, Feb 18, 2015 Reilly to restrict tenders from firms linked to tobacco group Arthur Cox threatened action against State over plain cigarette packaging Fri, Feb 27, 2015 James Reilly’s plan to move on firms with tobacco contracts could hit snag Sat, Feb 28, 2015

21. Not a single elected politician in the Dáil or Seanad voted against the Standardised Packaging of Tobacco Act 2015

22. Illicit Trade

23. The Future of Nicotine Dependence

24. Gerry’s 3 ads create dissonance Prompt quit attempt 80-90% will quit alone Promote Services TV – Why to QUIT Radio Copy - complete emphasis on QUIT Team, we can help, twice as likely Digital - Twice as likely, quit now, calculator. Focus on visits and signing up Hopeful, supportive RADIO AND DIGITAL – HOW TO QUIT The Media Package

26. Modelling -SimSmoke Plan: Estimate the likely impact of alternative interventions in specific situations and on specific populations. Assess and rank strategies for reaching goals prior to commitment of resources. Develop more systematic surveillance and evaluation network Understand: The complex network of policies affecting surrounding tobacco use and problems. Forecast: The future dynamics of tobacco use and problems, effects of past policies, and the potential effect of future policies

27. Using MPOWER Policies Taxes –as a percent of retail prices, effects depend on size of tax increase and initial price. through elasticities (uses constant elasticities, vary by age, but not gender), no effect yet on smuggling. Goal = specific ad valorem and excise tax at 70% of price Smoke-Free Air Laws depend on: – Where applied: Worksites (3 levels) Restaurants and bars Other public places – Enforcement now has a stronger role

28. Business Post Daily Ireland versus Big Tobacco 22:55, 21 February 2015 by Susan Mitchell

29. Impact of Future Policies Once the model is validated, it is used to predict the effect of future policies relative to the status quo (policies maintained at 2010 levels) The policies are implemented in 2011 and main- tained. The effect of future policies depend on the change from the level of policies in 2010. – Tax goal = excise taxes raised to 70% of price with value added taxes added on. – Other future policies are in terms of FCTC-consistent policies as embodied in MPOWER specifications plus well enforced youth access policy

30. Public Support well above the European Average Taxes 65% Banning vending machines 83% Banning flavours 82% Increased actions against smuggling 82% Levy on manufacturers for health costs 73% Banning logos colours from tobacco products 81%