This document discusses the role of tobacco control researchers in advocacy and influencing tobacco control policies. It makes three key points: 1) Tobacco control researchers conduct research not just to accumulate knowledge, but to improve public health and influence policies. Their research provides evidence to change behaviors, influence public agenda, and counter the tobacco industry. 2) Researchers must disseminate their findings beyond academic publications to policymakers, practitioners, organizations and the media. They should think about how their research could inform policies and build relationships with stakeholders. 3) Advocacy requires generating policy-relevant evidence, disseminating it widely using various strategies and platforms, and building relationships with those who can influence change like policymakers and journalists.

1. From tobacco research to
tobacco control policies: the
role of advocacy
Xisca Sureda, BPharm, PhD.
Assistant Professor, Department of Surgery, Medical and
Social Science, Alcalá University

2. Why do we research in tobacco control?
To be rich?
To accumulate grants and publications?
To increase your impact factor?
To get the attention of other researchers?
To have a lot of free time?

3. Before…
Now…
Australia Cigarettes Plain
Packaging
Tobacco marketing in
the 50s’
Why do we research in tobacco control?
WHAT HAS HAPPENED
IN BETWEEN TO MAKE
THIS CHANGE?

4. Why do we research in tobacco control?
Lancet. 2011;377(9760):139-46.
cites: 663
Br Med J. 1950; 2(4682): 739–748.
cites: 1,147
Addiction. 2008;103(4):580-90.
cites: 115

5. Why we do research in tobacco control?
We do research to…
• Establishing the link between smoking and lung cancer, CVD, etc…
• Developing behavioral and pharmacological smoking treatments
• Determining the effects of second-hand smoke
• Assessing the effects of marketing on cigarette smoking
• Evaluating tobacco control interventions
Etc.

6. Why we do research in tobacco control?
But, we do tobacco research above all…
TO IMPROVE THE HEALTH OF THE POPULATION AND INDIVIDUALS
And for that we need the evidence derived from our research:
• To influence people’s behaviours (smoking behaviours)
• To influence public agenda: what’s important & what’s not in tobacco
control
• To counteract the actions of the tobacco industry and other interests
against tobacco control and, thus against public health
And, at the end…
TO INFLUENCE TOBACCO CONTROL POLICIES

7. What advocacy is?
Advocacy is about making changes to policy and practice that will
improve the lives of the population you are advocating for.
It is the act of speaking or disseminating information intended to
influence individual behaviour or opinion, corporate conduct or
public policy and law.

8. So, who is involved in advocacy?
Can my research influence tobacco
control policies?
YES!!!
HOW???
Can I, as a tobacco researcher,
influence tobacco control policies? YES!!!

9. Why we need research to do advocacy?
THE ROLE OF
TOBACCO
RESEARCHER
BUILT RELATIONSHIPS
GENEREATE
EVIDENCE
DISSEMINATE
THE EVIDENCE
 Which evidence is needed?
 Which is the impact of our
research?
 Who is going to be benefit?
 Which are the policy
implications?
 Where can we disseminate it?
 How can we disseminate it?
 How the information is going
to be used?

10. Why we need research to do advocacy?
• Media needs data to communicate results, to sell the new
• Citizen need data to believe in the problem we want to change
The Guardian, dec 2013

11. Why we need research to do advocacy?
• Practitioners need data to intervene appropriately
• NGO, public health and other professional organizations, and
other advocates needs data to show it to policymakers
• Policymakers need data  our research can inform policies

12. Why we do research in tobacco control?
0
200
400
600
800
1000
1200
1400
1600
0
10
20
30
40
50
60
70
80
1968 1973 1978 1983 1988 1993 1998 2003 2008 2013 2018
Numerofpublications
Prevalence(%)
Prevalence (%) of daily smoking among adult (≥15 years)
men and women, tobacco policies and tobacco-related publications in Spain
Numer of publications Men Women
Sources: Spanish National Health Survey(1987, 1993, 1997, 2001, 2006, 2011, 2017); Web of
Science; Spanish Ministry of Health
Regulation of the promotion of
tobacco products
Increase taxes
Law 28/2005: smoke-free
legislation (public places)
Law 42/2010: comprehensive smoke-free
legislation (hospitality venues)
Health Warning on
tobacco packs
Increase taxes
Prohibition in public transport
Prohibition promotion TV

13. Generate evidence
First drawbacks we have in our research system: investment
10 % in
Epidemiology,
Occupational and
Public Health
“Spanish NIH”

14. Generate evidence
Second drawbacks we have in our research system: What does
the academic structure value us as scientists?
Traditional scientist
the accumulation of
institutionally certified
knowledge as an end in itself
research questions driven by
intellectual curiosity
Contemporary researcher
more socially engaged; believes in
producing applied research
research questions driven by
utility in addressing expressed
needs of policymakers and
practitioners
VS
Source: Erno-Kjolhede, 2000
We need a combination of both: High quality research
but which also influenced policy and practice.

15. Generate evidence
Second drawbacks we have in our research system: What does
the academic structure value us as scientists?
Traditional scientist
the accumulation of
institutionally certified
knowledge as an end in itself
research questions driven by
intellectual curiosity
Requirements to get promoted
within the academic or research
institutions
Professional awards and incentives
The academic and research institutions
should also value:
• social impact of our research
• influential research and influential
activities
• dissemination of results beyond
scientific publication

16. We need to be clear and concrete in what we need to invest the
money/resources (personal, time) in science  which are the
priorities in tobacco control research?
Generate evidence in tobacco control
THINK ABOUT POLICY-RELEVANT RESEARCH!
We need to think about the policy implication of our results when we
apply for a grant or write a paper  What my project/publication is
going to change? // Which are the policy implications?

17. Generate evidence in tobacco control
According to an interview with peer-nominated “highly
influential” Australian public health researchers:
Most of them design and conduct their research targeting policy goals to some
degree. The majority said they tried to identify and respond to
emerging policy opportunities. Strategies included addressing
gaps in the evidence-base, engaging with community groups to
monitor emerging needs, and targeting “the big questions of the
moment” and research areas that seemed likely to become important in
the future. Many researchers planned their research program in
consultation with key stakeholders

18. The smoke-free legislation in Spain (2011): Law 42/2010
El País, August 2015
El diario.es. February 2015
Generate evidence in tobacco control

19. The smoke-free legislation in Spain (2011): Law 42/2010
Aim: To describe smoking visibility and second-hand smoke
(SHS) exposure in outdoor hospitality venues in Madrid, Spain.
Generate evidence in tobacco control

20. The smoke-free legislation in Spain (2011): Law 42/2010
We also measured PM2.5 and airborne nicotine in 92 terraces and showed
that:
• Almost 80% of the outdoor terraces where we measured tobacco
markers were not compliant with the law during fall/winter season
(9.5% in summer).
• When the terraces were completely closed, PM2.5 concentrations
reach values of almost 80 µg/m3. This value can be comparable or even
higher than those values obtained in other studies for indoor
places.
Generate evidence in tobacco control

21. • How can we increase the use of our research in tobacco
control policies?
Generate evidence in tobacco control
Originality and innovative research design:
• Use of mix methods: qualitative and quantitative data.
• Involved citizen when doing research: citizen science//
participatory action research
• Multidisciplinary research teams: combined classical
epidemiology with other fields such as economy, geography,
sociology…

22. Generate evidence in tobacco control
It is an approach that involves researchers and participant working
together to understand a situation and change it for the better
What is Participatory Action Research?
• Equal relationship between researcher and participants
• Research for and with people not about people
The results obtained by the participants are disseminated to the rest of the
community and policymakers in order to co-create future interventions.

23. Why we need research to do advocacy?
THE ROLE OF
TOBACCO
RESEARCHER
BUILT RELATIONSHIPS
GENEREATE
EVIDENCE
DISSEMINATE
THE EVIDENCE
 Which evidence is needed?
 Which is the impact of our
research?
 Who is going to be benefit?
 Which are the policy
implications?
 Where can we disseminate it?
 How can we disseminate it?
 How the information is going
to be used?

24. Disseminate the evidence
Identification of target audiences:
• Scientific community
BUT ALSO…
• Civil Society, community groups
• Professional organization
• Practitioners
• NGOs
• Policymakers
Multiple methods of research dissemination and
promotion (including tactical use of the media)

25. It is necessary to publish our research in scientific journals because…
• Peer review process
• Quality of our research
• Disseminate results among scientific community
• Our system demand us to publish to get promoted
• Also increase our policy influence
Disseminate the evidence
HOWEVER….
We need to get the research out there…media appearances, briefings,
government reports and, also direct conversation with policymakers are
sometimes even better strategies that the scientific publication itself
(Social Science & Medicine 72 (2011) 1047-1055)
we can not be out of the real world!

26. Disseminate the evidence
The use of social media (Twitter)

27. Disseminate the evidence
The use of social media (Twitter)
This was retweet by:
• Spanish Society of Public Health
and Health Administration
• Influential scientists
• Colleagues
• Influential advocates in public
health
• Patients Associations

28. Disseminate the evidence
Direct conversation with policymakers
This was retweet by:
General Directorate for Public Health
Spanish Society of Internal Medicine
Delegate of the National Plan on Drugs
Ministry of Health
Influential scientists
Recovery community organizations
Association of community pharmacies

29. Disseminate the evidence
• press release
• social media (especially Twitter)
• journalist specialized in your field or that are
interested in your work  also follow them and tag
them in twitter
• use contacts (journalist, influential
researchers/collegues…)
How can increase the presence of my research in the media?
Sometimes it's the journalists who are looking for you…
Media appearance

30. Disseminate the evidence
Sometimes it's the journalists who are looking for you…
BE PREPARED
Know who is conducting
the interview (look for
articles by the reporter,
search for a bio)
Know your audience

31. Disseminate the evidence
Sometimes it's the journalists who are looking for you…
CONTROL THE INTERVIEW
We can anticipate and know what
they are going to ask us.
We can prepare the answer with
the ideas we want to transmit
One question can have different
answer…we will give the answer
depending on our objectives and
what we want to reach

32. Disseminate the evidence
The importance of media advocacy

33. Disseminate the evidence
The result of that email….
El País, May 2018

34. Disseminate the evidence
The result of that email….
National radio: Cadena Ser/Onda cero/COPE
International radio: 99.9 Radio Mar de
Plata/RADIO COLOMBIA
Television News:
RTVE/Telecinco/Cuatro/Antena 3
National press: ABC

35. Disseminate the evidence

36. Disseminate the evidence
National press
El País. 1.862.000
ABC 601.000
Radio
Cadena Ser. Hoy por Hoy 2.657.000
Onda cero. 573.000
COPE. 2.174.000
Television
Cuatro. 588.000
Telecinco. 1.753.000
RTVE 1. 1.552.000
Antena 3. 2.369.000
Audience
The importance of media advocacy

37. Disseminate the evidence
The importance of media advocacy: get to the community
and policy makers

38. Disseminate the evidence
The importance of media advocacy: get to the community
and policy makers

39. Why we need research to do advocacy?
THE ROLE OF
TOBACCO
RESEARCHER
BUILT RELATIONSHIPS
GENEREATE
EVIDENCE
DISSEMINATE
THE EVIDENCE
 Which evidence is needed?
 Which is the impact of our
research?
 Who is going to be benefit?
 Which are the policy
implications?
 Where can we disseminate it?
 How can we disseminate it?
 How the information is going
to be used?

40. Built relationships
• Build political will/alliances –meeting with decision-makers, develop a
multi-sectoral advocacy team
Help them to deliver research-informed briefs for managers and ministers
when they consider that this can drive to political changes

41. Built relationships
• Built relationships with journalist
• Be well connected and collaborate with different scientific organization
and other researchers/colleagues, professional organizations,
practitioners and community group, celebrities.

42. Not always is easy….

43. Not always is easy….
When you are an advocate for controversial policies you will have arguments
and opinions against you and your results: by the tobacco industry,
hospitality industry, cultural resistance…. Be clear and have your own
arguments to answer
Philip Morris’ “accommodation” programmes:
“The Spanish Model”
El País, February 2011

44. Some tips / reminder to finish…
• Get the necessary and useful data  Think about
policy-relevant research
• Be ready: for getting the data to be published when
it is necessary; to show the data that has already
been published when it is the appropriate moment
• Always be there and accessible to: the media,
policymakers, and other stakeholders (including
community groups)…

45. Some tips / reminder to finish…
• Have the message you have in mind very clear: simple
and less ideas better than more ideas and confusing and
complicated
• Make “key” friends and involve them: media,
citizens, NGOs, politician, public health organizations
• Have the arguments ready for the adversaries

46. Some tips / reminder to finish…
• Personal characteristics are also important for doing
advocacy:
• Be nice, generous, and always helpful
• Be patient: successful advocacy takes time
• Have passion, determination, persistence, and
commitment to advance public health

47. From tobacco research to
tobacco control policies: the
role of advocacy
Xisca Sureda, BPharm, PhD.
Assistant Professor, Department of Surgery, Medical and
Social Science, Alcalá University
Contacto: francisca.sureda@uah.es
Twitter: @HHHproject & @XiscaSureda
Web: https://hhhproject.eu/

48. So, who is involved in advocacy?
• Media
• Civil Society, community groups
• Professional organization
• Practitioners
• NGOs
• Policymakers
• Other stakeholders
BUT ALSO RESEARCHERS

49. Generate evidence in tobacco control
A Participatory Action Research project to study
alcohol environment in Madrid: the use of Photovice
Funding: European Research Council Starting Grant 2013 HeartHealthyHoods
Agreement n. 336893 and Plan Nacional sobre Drogas (2016I047).
• To obtain a community diagnosis of the alcohol environment in the
city of Madrid using photovoice
• To translate photovoice findings into urban alcohol policy
recommendations
Objectives in our study:

50. Generate evidence in tobacco control
Research team: epidemiologist,
sociologist, photographer
Madrid Public Health Institute
Citizens
Policymakers
Who is involved?

51. Disseminate the evidence
Some tips to talk with the media….
1. Stay on message and keep it simple: Know what you
need to say and how to say it concisely. Have 3-4 ideas
in mind about what are the key messages of your
research. Be clear and simplify. Avoid being very
technical and using a lot of numbers and statistics
2. Have credibility: If you don’t know the answer to a
question, say so. You may point out that you are not an
expert on that particular issue.
3. Be yourself: smile and although you might be nervous,
think that probably no one knows the subject better
than you

52. Disseminate the evidence
The importance of media advocacy (and social media)