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Table 3 What is being compared? Case example: The licensing of tobacco retailers

From: SUPPORT Tools for evidence-informed health Policymaking (STP) 16: Using research evidence in balancing the pros and cons of policies

The reduction of teenage smoking was a priority for a Minister of Health in a European country. A report of policy options to achieve this was commissioned by the government concerned and a report was prepared by leading public health experts. One of the policy options considered in the report was the licensing of tobacco retailers. The loss of such a license was proposed as a penalty for the illegal selling of tobacco to minors. This option was compared in the report to the status quo, namely the absence of licensing for tobacco retailers. The public health experts did not undertake or use a systematic review, nor did they specify which characteristics of the policy option (or comparator) they considered to be crucial or important.
A number of important issues were not considered in the report. Important differences, for example, might have existed between the status quo of the areas where the policymakers considered implementing the policy and those where the studies were done. Such considerations may have included other policies already in place to reduce the sales of tobacco to minors. It is possible that existing legislation may already have made the sale of tobacco to minors illegal, or contained other methods by which legislation could be enforced (e.g. through fines or other penalties for the illegal sale of tobacco, face-to-face education of retailers (informing them about the legal requirements), or media campaigns (to raise community awareness). There might also have been differences in the ease with which minors could obtain tobacco from other sources (e.g. from parents and friends or through theft).
The experts explicitly considered two policy options for the licensing of tobacco retailers, namely three compliance checks per year (by a teenager attempting to purchase tobacco) to make sure that retailers were not selling tobacco to minors, and one compliance check per year together with internal control (requiring retailers themselves to control that tobacco is not being sold to minors). The penalty for non-compliance in both cases was the loss of the relevant licence. Other ways of enforcing licensing are possible, some of which have been evaluated in other studies. The experts writing this report did not explicitly address whether differences in approaches to licensing enforcement were likely to result in important differences in the effectiveness of the policy.