Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial

Objective To evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking.Design Randomised controlled trial.Setting Five general practices in Hertfordshire, England.Participants 561 current smokers aged over 35.Intervention All participants were offered spirometric assessment of lung function. Participants in intervention group received their results in terms of "lung age" (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services.Main outcome measures The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease.Results Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at 280 pound ((euro) 365, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants.Conclusion Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.Trial registration National Research Register N0096173751

Health and Economic Mobility

Surveys the literature on how health affects earnings and wealth, and vice versa. Examines factors such as parents' socioeconomic status, health at birth and in childhood, chronic conditions, and disability, and their effects on education and income

Smoking in Germany: Stylized Facts, Behavioral Models, and Health Policy

It is well known that smoking causes severe adverse health effects, and it seems evident that governments are justified or even obliged to implement measures of tobacco control to mitigate these effects.Yet, as this paper argues with a distinct focus on Germany, the three most important and still largely open questions in the design and implementation of economic and health policy are, whether government action is justified at all, what behavioral patterns this policy should try to alter, and whether the policy measures chosen indeed exert any substantial effects on the targeted outcomes.We conclude that the case for control measures aiming at the prevention of smoking initiation among adolescents is indeed strong, but also that their proper design would benefit from a better understanding of behavioral issues and that their empirical evaluation requires (non-experimental) study designs that facilitate the identification of causal effects.Tobacco, tobacco control, rational addiction

Typology and Dynamics of Heavier Drinking Styles in Great Britain: 1978-2010.

AIMS: To identify a typology of heavier drinking styles in Great Britain and to identify socio-demographic trends in the typology over the period 1978-2010. METHODS: We applied multiple correspondence analysis and agglomerative hierarchical clustering to beverage-specific quantity-frequency measures of alcohol consumption in the repeated cross-sectional General Lifestyle Survey of Great Britain, 1978-2010. The cluster analysis focuses on the 60,043 adult respondents over this period reporting average drinking levels above the UK Government guidelines. We projected sex, age, income, education, socio-economic status and tobacco consumption variables onto the clusters to inspect socio-demographic trends in heavier drinking. RESULTS: We identified four stable clusters of heavier drinking: (a) high volume beer; (b) beer and spirit combination; (c) all beverage and (d) wine and spirit only. The socio-demographic characteristics of the clusters were distinct from both each other and the general population. However, all clusters had higher median incomes and higher smoking rates than the population. Increases in the prevalence of heavier drinking were driven by a 5-fold increase in the contribution of the female-dominated, wine and spirit only cluster. CONCLUSIONS: Recent changes in per capita alcohol consumption in Great Britain occurred within the context of a stable typology of heavier drinking styles and shifting socio-demographics. Identifying these trends is essential to better understand how drinking cultures develop over time and where potentially problematic drinking styles may emerge. Our findings suggest that careful attention to patterns and cultures of consumption is more important than relying on headline consumption data, for both understanding drinking behaviours and targeting interventions. SHORT SUMMARY: This analysis of alcohol consumption survey data identifies four styles of heavier drinking in Great Britain, which remain unchanged over the period 1978-2010. The socio-demographic characteristics of the drinking styles are distinct from both each other and the general population, with increased participation of female and older drinkers over time

The adolescent drinker : correlates and predictors of alcohol consumption among Swedish youth

Background: Drinking among adolescents has declined in most high-income countries during the past two decades. In Sweden, the reduction in youth drinking has been more pronounced than in many other parts of the world. The lower alcohol consumption has been reflected in several indicators. However, many adolescents still drink, and there is an urgency to understand the current situation in light of the non-drinking trend. The studies in this thesis examine concurrent and longitudinal factors not previously examined in a Swedish context. Overall aim: The overarching objective of this thesis is to improve our understanding of alcohol use during mid and late adolescence among contemporary youth. The four studies included in this thesis address this aim by answering the following research questions: (I) What are the motivations for drinking, and how are motives associated with drinking? (II) How are general and institutional trust associated with drinking? (III) How are psychosocial factors related to two-year drinking status? and (IV) Does the age of onset have an independent effect on subsequent drinking? Data and method: All studies of this thesis exploited data from the Futura01 project. Since 2017, this project has followed a cohort of Swedish adolescents born in 2001. A self-reporting school survey was carried out at baseline (T1), and at a follow-up (T2) in 2019, when the respondents were 15/16 and 17/18 years, respectively. At T1, 5,537 individuals (81.7%) participated; at T2, 4,018 individuals (72.4%) participated. Multivariable linear and logistic regression models examined associations with alcohol use. Results: (I) Social and enhancement motives were most strongly associated with drinking frequency, whereas enhancement motives had the strongest association with heavy drinking frequency. Coping-depression motives also had a positive but weaker link with drinking and heavy drinking frequency. Conformity motives were negatively related to how often adolescents drank. (II) General and institutional trust was found to be negatively associated with drinking status, and institutional trust had the stronger link. Cross-combinations with low scores on both trust dimensions were related to the highest probability of drinking. Parental control and support, along with school satisfaction, modified the associations. (III) Abstainers reported better mental health and parental relationships, and worse friendships, whereas the opposite was true for early-onset drinkers. Later-onset drinkers were linked to a more favorable psychosocial situation than early drinkers. (IV) An early drinking onset predicted higher alcohol consumption two years later. Those with the earlier onset scored higher on AUDIT-C and had a higher probability of risky and binge drinking in late adolescence. Early binge drinking was found to be more predictive of later binge drinking than the age of onset of any drinking. Those with early drinking onset were more exposed to risk factors. Conclusions: Adolescents’ motivations for drinking are closely related to their consumption of alcohol. The social aspects of drinking are supported by the links between different forms of trust and alcohol use, in addition to patterns of parent/friend relationships and drinking status in adolescents. Early drinkers are a psychosocially vulnerable group burdened with numerous problems and risk factors for alcohol use. An early drinking onset is also related to more alcohol use in late adolescence. To prevent youth drinking, it is important to improve parent-child relationships, build trust, and support mental health. Preventing early drinking likely reduces alcohol consumption in late adolescence

Her Life Depends On It: Sport, Physical Activity and the Health and Well-Being of American Girls

This report is a comprehensive compendium of research that points to physical activity and sport as fundamental solutions for many of the serious health and social problems faced by American girls. An appreciable mass of evidence-based knowledge about girls' involvement with sport and physical activity has been generated during the last decade. The amount and quality of this research are uneven and varied. For example, a good deal of research examines the associations between physical activity and risk for coronary heart disease, but studies that focus on risk for Alzheimer's disease are just beginning to issue. Researchers have verified links between high school athletic participation and teen pregnancy prevention, although more longitudinal research is needed to thoroughly confirm the connections. Overall, however, this report shows that the current state of knowledge on the relationship of physical activity to the health and social needs of American girls warrants the serious attention of public health officials, educators and sport leaders

Understanding the social determinants of non-communicable diseases in Nepal : a systems perspective : a thesis presented in the partial fulfilment of the requirements for the degree of Doctor of Philosophy (PhD) in Health Sciences at Massey University, Wellington Campus, New Zealand

Figures are re-used with permission.Non-communicable diseases (NCDs) constitute more than half of the total disease burden in Nepal. Global evidence indicates the problem of NCDs is influenced by the complex interaction of social determinants including behavioural, socio-economic and environmental. These determinants are the focus of global prevention strategies for tackling NCDs. The health system of Nepal, however, is yet to adopt this comprehensive prevention strategies. The main objective of this research was to understand the social determinants of NCDs in Nepal and identify leverage points for systemic actions in Nepal. The study utilized a systems thinking methodology which enabled a creative combination of case study methods and qualitative causal loop diagramming. In each of the two selected case districts (Bhaktapur and Morang), semi-structured interviews (n=39) and focus group discussions (n=12) were conducted with key stakeholders and community members. These case studies were informed by policy level interviews (n=24). Thematic analysis, guided by the adapted social determinants of health framework, helped to identify key themes and develop causal loop diagrams (CLDs). The findings of the thematic analysis, and CLDs, were then validated through local and policy sense-making workshops. The analysis showed four key interlinked thematic areas, each of which is being published as separate papers. The first paper describes the community and stakeholders’ perception and experience of the rising burden of NCDs. The social experience of NCDs metabolic risks such as hypertension and diabetes were shown to be normalised. Moreover, differences in social experience were observed based on gender and socio-economic circumstances. The second paper described the critical role played by tobacco and alcohol in the interaction of social determinants of NCDs. The analysis indicates that socio-economic circumstances was root cause of changing, and damaging alcohol and tobacco practices, and increased the vulnerability to exploitation by industries. The third paper revealed that poor dietary practices and physical inactivity were resulting due to changes in social practices shaped by worsening dietary and physical environment. Socio-economic circumstances, urbanisation and migration all contributed to the population being exposed to an obesogenic environment. While all three papers discussed specific health system challenges, the fourth paper elaborated on health sector challenges, including the curative focus and limited capacity of the health system both at district and policy or national level to prevent NCDs in Nepal. Three key leverage points for health system action on the social determinant of NCDs were identified by viewing the final CLD through the lens of Donella Meadows’ framework for identifying key health system action on the social determinants of health. These leverage points indicated that the health sector should focus on the development of a robust prevention system for effective NCDs action. Overall, the study highlighted the interactions of socio-economic, gender, commercial and health system determinants driving the NCDs problem in Nepal. The leverage analysis indicated that the health sector should focus on the development of a robust prevention system for effective action on complex problem like NCDs. The Ministry of Health could play a proactive role in creating the prevention system that could effectively guide all sectors towards collective action to impacting social and commercial determinants of health

Tobacco sales prohibition and teen smoking

We evaluate one of the most prevalent prohibitory policies: banning the sales of tobacco to teens. We exploit the staggered introduction of sales bans across Switzerland and analyze rich data from 2001 to 2016. The estimates do not indicate an immediate or long-run systematic reduction in the overall prevalence of smoking because of sales bans. We also examine a range of behavioral mechanisms that are key to understand the consequences of prohibitory policies such as habit formation, social appeal of smoking, circumvention behavior, or risk perceptions. Among others, we find that teens circumvent the bans by getting cigarettes from peers. Moreover, teens consider smokers less cool when a sales ban is in place, but they do not consider smoking more dangerous

Drugs research: an overview of evidence and questions for policy

In 2001 the Joseph Rowntree Foundation embarked upon a programme of research that explored the problem of illicit drugs in the UK. The research addressed many questions that were often too sensitive for the government to tackle. In many cases, these studies represented the first research on these issues. This study gives an overview of the projects in the programme. The topics covered include: * The policing of drug possession. * The domestic cultivation, purchasing and heavy use of cannabis. * Non-problematic heroin use, heroin prescription and Drug Consumption Rooms. * The impact of drugs on the family. * Drug testing in schools and in the workplac