Smoking in social housing among adults in England, 2015–2020: a nationally representative survey

Objectives: To analyse associations between living in social housing and smoking in England and to evaluate progress towards reducing disparities in smoking prevalence among residents of social housing compared with other housing types. / Design: Cross-sectional analysis of nationally representative data collected between January 2015 and February 2020. / Setting: England. / Participants: 105 562 adults (≥16 years). / Primary and secondary outcome measures: Linear and logistic regression were used to analyse associations between living in social housing (vs other housing types) and smoking status, cigarettes per day, time to first cigarette, exposure to others’ smoking, motivation to stop smoking, quit attempts and use of cessation support. Analyses were adjusted for sex, age, social grade, region and year. / Results: Adults living in social housing had two times the odds of being a smoker (ORadj=2.17, 95% CI 2.08 to 2.27), and the decline in smoking prevalence between 2015 and 2020 was less pronounced in this high-risk group (−7%; ORadj=0.98, 95% CI 0.96 to 1.01) than among adults living in other housing types (−24%; ORadj=0.95, 95% CI 0.94 to 0.96; housing tenure–survey year interaction p=0.020). Smokers living in social housing were more addicted than those in other housing types (smoking within 30 min of waking: ORadj=1.50, 95% CI 1.39 to 1.61), but were no less motivated to stop smoking (ORadj=1.06, 95% CI 0.96 to 1.17) and had higher odds of having made a serious attempt to quit in the past year (ORadj=1.16, 95% CI 1.07 to 1.25). Among smokers who had tried to quit, those living in social housing had higher odds of using evidence-based cessation support (ORadj=1.22, 95% CI 1.07 to 1.39) but lower odds of remaining abstinent (ORadj=0.63, 95% CI 0.52 to 0.76). / Conclusions: There remain stark inequalities in smoking and quitting behaviour by housing tenure in England, with declines in prevalence stalling between 2015 and 2020 despite progress in the rest of the population. In the absence of targeted interventions to boost quitting among social housing residents, inequalities in health are likely to worsen

Increasing numbers of harbour seals and grey seals in the Solent

Harbour seals (Phoca vitulina) and grey seals (Halichoerus grypus) both occur within the UK, but display regional contrasting population trends. While grey seals are typically increasing in number, harbour seals have shown varying trends in recent decades following repeated pandemics. There is a need for monitoring of regional and local populations to understand overall trends. This study utilized a 20-year dataset of seal counts from two neighboring harbours in the Solent region of south England. Generalized additive models showed a significant increase in the numbers of harbour (mean 5.3–30.5) and grey (mean 0–12.0) seals utilizing Chichester Harbour. Conversely, in Langstone Harbour there has been a slight decrease in the number of harbour seals (mean 5.3–4.0). Accompanying photographic data from 2016 to 18 supports the increase in seal numbers within Chichester Harbour, with a total of 68 harbour and 8 grey seals identified. These data also show evidence of site fidelity of harbour seals in this area, with almost a quarter of animals resighted within the past three years. Overall, this long-term study indicates an increasing number of both harbour and grey seals within the Solent. However, more research is required to identify the drivers of this trend.</p

Nicotine strength of e-liquids used by adult vapers in Great Britain:a population survey 2016 to 2024

Background and aims: In March 2024, the UK government announced plans to introduce a Vaping Products Duty that will tax e-liquids based on their nicotine strength. This study examined trends in the nicotine strength of e-liquids used by adult vapers and differences in those currently used across relevant subgroups.Design: Nationally-representative, cross-sectional household survey, July 2016 to January 2024.Setting: Great Britain.Participants: 7,981 adult vapers.Measurements: Participants were asked whether the e-cigarette they mainly use contains nicotine (yes/no) and the e-liquid strength (no nicotine/&gt;0-≤6/7-11/12-19/≥20 mg/ml). We also collected information on the main device type used (disposable/refillable/pod), age, gender, occupational social grade, history of ≥1 mental health conditions, smoking status, and (among past-year smokers) level of cigarette addiction.Findings: The proportion of vapers in England using high-strength (≥20mg/ml) e-liquids increased from an average of 3.8% [95% confidence interval [CI] 2.9-5.0%] up to June 2021 to 32.5% [27.9-37.4%] in January 2024 (the vast majority of whom (93.3% in January 2024) reported using exactly 20mg/ml; the legal limit). This rise was most pronounced among those using disposable e-cigarettes, those aged 18-24y, and all smoking statuses (including never smokers) except long-term (≥1y) ex-smokers. Of those surveyed in 2022-24 in Great Britain, overall, 89.5% [88.1-90.8%] said they usually used e-cigarettes containing nicotine, 8.7% [7.5-10.0%] used nicotine-free e-cigarettes, and 1.8% [1.2-2.4%] were unsure. The proportion using ≥20mg/ml was higher among those mainly using disposable (47.9%) compared with pod (16.3%) or refillable (11.5%) devices; never smokers (36.0%), current smokers (28.8%), or recent (&lt;1y) ex-smokers (27.4%), compared with long-term ex-smokers (13.9%); and younger (16-24y; 44.2%) compared with older (≥25y; range 9.4-25.1%) age groups. There were no notable differences across other subgroups of interest.Conclusions: Use of high-strength nicotine e-liquids in England appears to have increased sharply in recent years. Most adult vapers in Great Britain appear to use e-cigarettes that contain nicotine but different subgroups use different strengths: nicotine strengths tend to be higher among those who mainly use disposable devices and those aged 16-24y, and lower among long-term ex-smokers.<br/

Presenting Symptoms in Newly Diagnosed Myeloma, Relation to Organ Damage, and Implications for Symptom-Directed Screening: A Secondary Analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) Trial

Multiple myeloma (MM) patients risk diagnostic delays and irreversible organ damage. In those with newly diagnosed myeloma, we explored the presenting symptoms to identify early signals of MM and their relationships to organ damage. The symptoms were recorded in patients’ own words at diagnosis and included diagnostic time intervals. Those seen by a haematologist >6 months prior to MM diagnosis were classified as precursor disease (PD). Most (962/977) patients provided data. Back pain (38%), other pain (31%) and systemic symptoms (28%) predominated. Patients rarely complain of ‘bone pain’, simply ‘pain’. Vertebral fractures are under-recognised as pathological and are the predominant irreversible organ damage (27% of patients), impacting the performance status (PS) and associated with back pain (odds ratio (OR) 6.14 [CI 4.47–8.44]), bone disease (OR 3.71 [CI 1.88–7.32]) and age >65 years (OR 1.58 [CI 1.15–2.17]). Renal failure is less frequent and associated with gastrointestinal symptoms (OR 2.23 [CI1.28–3.91]), age >65 years (OR 2.14 [CI1.28–3.91]) and absence of back pain (OR 0.44 [CI 0.29–0.67]). Patients with known PD (n = 149) had fewer vertebral fractures (p = 0.001), fewer adverse features (p = 0.001), less decline in PS (p = 0.001) and a lower stage (p = 0.04) than 813 with de novo MM. Our data suggest subgroups suitable for trials of ‘symptom-directed’ screening: those with back pain, unexplained pain, a general decline in health or low-impact vertebral compression fractures