Tobacco Policy Influence on Denormalisation of Smoking

The social norms concept provides a fresh basis for thinking about how public health policies and campaigns impact health behaviour. Social norms offer much promise to the field of public health, nonetheless, the potential role of norms in changing health behaviour have not been fully embraced. This thesis demonstrates that one of the mechanisms by which national level policies (e.g. tobacco control) can promote health behaviour change, such as an increase in quit intentions, is by making smoking less normative and an undesirable behaviour. This study is vital as it provides a broad conceptualization of tobacco denormalisation and shows how its reasoning is able to influence normative beliefs and smoking behaviour. A review of literature was carried out to establish the generic origins of denormalisation as well as demonstrate that this approach (i.e. social norms) has been widely adopted in schools and college settings to influence health behaviour. As a broader perspective of this thinking was imperative to address public health issues at a societal level, tobacco control was employed to investigate how individual polices influence behaviour and normative beliefs. The research methodology used was pluralistic in nature, given that the majority of past tobacco control policy studies employed either quantitative or qualitative methods. Thus adopting both methods a richer amount of data would be obtained in order to generate an improved understanding of how public policy affects norms and smoking behaviour. To empirically examine the relationship between public policy, social norms and smoking behaviour a broad conceptualization was developed to investigate the normative pathways between national level tobacco policy effects on youth and adults’ smoking behaviour. Quantitative results from the longitudinal study, the International Tobacco Control (ITC) Scotland/UK survey, indicate that a comprehensive smoke-free law that covers, without exception, an entire nation (i.e. Scotland) has increased adult smokers’ perceived social unacceptability of smoking, to some extent higher in Scotland than rest of the UK which, in turn, is associated with quit intentions at follow-up, in both countries. The examination of data from the UK Youth Tobacco Policy Study (YTPS) also demonstrated that the influence of tobacco marketing awareness on adolescents’ smoking intentions is mediated by perceived norms. Prior to the enactment of the UK Tobacco Advertising and Promotion Act (TAPA), higher levels of awareness of tobacco advertising and promotion were independently associated with higher levels of perceived sibling approval which, in turn, were positively related to smoking intentions. Independent paths from perceived smoking prevalence and benefits fully mediated the effects of advertising and promotion awareness on intentions, during and after the enactment of the TAPA. Results from the qualitative study generally supported the quantitative findings and provided new insights into how adolescents’ normative beliefs and smoking behaviour are influenced by tobacco control policies. The qualitative group discussion suggests that smoke-free legislation and anti-smoking ads influence perceptions of prevalence, acceptability and smoking behaviour. A number of theoretical implications were presented, including the belief that social norms campaigns and interventions must be focal and salient in individuals’ consciousness so as to effect the desired behaviour change. A theoretical framework of the various normative mechanisms should consequently be integrated into tobacco control policies and norm-based interventions to work in a synergistic manner to influence health-related behaviour. Practical implications of this conceptualization include the view that, instead of public health interventions focusing on conventional approaches (for example, scare tactics), an appropriate strategy would be to incorporate specific information that corrects normative misperceptions and ambiguities among referent populations at individual and societal levels, with consequential normative and health behaviour change. It is recommended that future research employing tobacco industry perceptions and possibly a descriptive norm as additional normative mediators, aside from unacceptability, would be of value to examine whether smoke-free legislation influences quitting partly via changing favourable tobacco industry perceptions, social acceptability of smoking and perceived prevalence of smoking. To sum up, the findings demonstrate that societal level policy measures such as smoke-free legislation and the TAPA are critical elements of a comprehensive tobacco control program that can significantly influence adult smokers’ quit intentions and reduce adolescents’ smoking intentions respectively, by signifying smoking to be less normative and to be socially unacceptable

Economic impact of smoking and of reducing smoking prevalence

Background: Tobacco smoking is the cause of many preventable diseases and premature deaths in the UK and around the world. It poses enormous health- and non-health-related costs to the affected individuals, employers, and the society at large. The World Health Organization (WHO) estimates that, globally, smoking causes over US$500 billion in economic damage each year. Objectives: This paper examines global and UK evidence on the economic impact of smoking prevalence and evaluates the effectiveness and cost effectiveness of smoking cessation measures. Study selection Search methods: We used two major health care/economic research databases, namely PubMed and the National Institute for Health Research (NIHR) database that contains the British National Health Service (NHS) Economic Evaluation Database; Cochrane Library of systematic reviews in health care and health policy; and other health-care-related bibliographic sources. We also performed hand searching of relevant articles, health reports, and white papers issued by government bodies, international health organizations, and health intervention campaign agencies. Selection criteria: The paper includes cost-effectiveness studies from medical journals, health reports, and white papers published between 1992 and July 2014, but included only eight relevant studies before 1992. Most of the papers reviewed reported outcomes on smoking prevalence, as well as the direct and indirect costs of smoking and the costs and benefits of smoking cessation interventions. We excluded papers that merely described the effectiveness of an intervention without including economic or cost considerations. We also excluded papers that combine smoking cessation with the reduction in the risk of other diseases. Data collection and analysis: The included studies were assessed against criteria indicated in the Cochrane Reviewers Handbook version 5.0.0. Outcomes assessed in the review: Primary outcomes of the selected studies are smoking prevalence, direct and indirect costs of smoking, and the costs and benefits of smoking cessation interventions (eg, “cost per quitter”, “cost per life year saved”, “cost per quality-adjusted life year gained,” “present value” or “net benefits” from smoking cessation, and “cost savings” from personal health care expenditure). Main results: The main findings of this study are as follows: 1. The costs of smoking can be classified into direct, indirect, and intangible costs. About 15$151 billion. 2.The costs of smoking notwithstanding, it produces some potential economic benefits. The economic activities generated from the production and consumption of tobacco provides economic stimulus. It also produces huge tax revenues for most governments, especially in high-income countries, as well as employment in the tobacco industry. Income from the tobacco industry accounts for up to 7.4% of centrally collected government revenue in China. Smoking also yields cost savings in pension payments from the premature death of smokers. 3. Smoking cessation measures could range from pharmacological treatment interventions to policy-based measures, community-based interventions, telecoms, media, and technology (TMT)-based interventions, school-based interventions, and workplace interventions. 4. The cost per life year saved from the use of pharmacological treatment interventions ranged between US$128 and US$1,450 and up to US$4,400 per quality-adjusted life years (QALYs) saved. The use of pharmacotherapies such as varenicline, NRT, and Bupropion, when combined with GP counseling or other behavioral treatment interventions (such as proactive telephone counseling and Web-based delivery), is both clinically effective and cost effective to primary health care providers. 5. Price-based policy measures such as increase in tobacco taxes are unarguably the most effective means of reducing the consumption of tobacco. A 10$2 to US$112 per life year gained (LYG) while reducing smoking prevalence by up to 30 6. Smoking cessation classes are known to be most effective among community-based measures, as they could lead to a quit rate of up to 35$500 and US$614 per LYG. 7. Advertising media, telecommunications, and other technology-based interventions (such as TV, radio, print, telephone, the Internet, PC, and other electronic media) usually have positive synergistic effects in reducing smoking prevalence especially when combined to deliver smoking cessation messages and counseling support. However, the outcomes on the cost effectiveness of TMT-based measures have been inconsistent, and this made it difficult to attribute results to specific media. The differences in reported cost effectiveness may be partly attributed to varying methodological approaches including varying parametric inputs, differences in national contexts, differences in advertising campaigns tested on different media, and disparate levels of resourcing between campaigns. Due to its universal reach and low implementation costs, online campaign appears to be substantially more cost effective than other media, though it may not be as effective in reducing smoking prevalence. 8. School-based smoking prevalence programs tend to reduce short-term smoking prevalence by between 30$16,400 to US$580,000 depending on the scale and scope of intervention. The cost effectiveness of school-based programs show that one could expect a saving of approximately between US$2,000 and US$20,000 per QALY saved due to averted smoking after 2–4 years of follow-up. 9. Workplace-based interventions could represent a sound economic investment to both employers and the society at large, achieving a benefit–cost ratio of up to 8.75 and generating 12-month employer cost savings of between$150 and $540 per nonsmoking employee. Implementing smoke-free workplaces would also produce myriads of new quitters and reduce the amount of cigarette consumption, leading to cost savings in direct medical costs to primary health care providers. Workplace interventions are, however, likely to yield far greater economic benefits over the long term, as reduced prevalence will lead to a healthier and more productive workforce. Conclusions: We conclude that the direct costs and externalities to society of smoking far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes (ie, in terms of a healthy population and a productive workforce). There are enormous differences in the application and economic measurement of smoking cessation measures across various types of interventions, methodologies, countries, economic settings, and health care systems, and these may have affected the comparability of the results of the studies reviewed. However, on the balance of probabilities, most of the cessation measures reviewed have not only proved effective but also cost effective in delivering the much desired cost savings and net gains to individuals and primary health care providers

Tobacco policy influence on denormalisation of smoking

The social norms concept provides a fresh basis for thinking about how public health policies and campaigns impact health behaviour. Social norms offer much promise to the field of public health, nonetheless, the potential role of norms in changing health behaviour have not been fully embraced. This thesis demonstrates that one of the mechanisms by which national level policies (e.g. tobacco control) can promote health behaviour change, such as an increase in quit intentions, is by making smoking less normative and an undesirable behaviour. This study is vital as it provides a broad conceptualization of tobacco denormalisation and shows how its reasoning is able to influence normative beliefs and smoking behaviour. A review of literature was carried out to establish the generic origins of denormalisation as well as demonstrate that this approach (i.e. social norms) has been widely adopted in schools and college settings to influence health behaviour. As a broader perspective of this thinking was imperative to address public health issues at a societal level, tobacco control was employed to investigate how individual polices influence behaviour and normative beliefs. The research methodology used was pluralistic in nature, given that the majority of past tobacco control policy studies employed either quantitative or qualitative methods. Thus adopting both methods a richer amount of data would be obtained in order to generate an improved understanding of how public policy affects norms and smoking behaviour. To empirically examine the relationship between public policy, social norms and smoking behaviour a broad conceptualization was developed to investigate the normative pathways between national level tobacco policy effects on youth and adults’ smoking behaviour. Quantitative results from the longitudinal study, the International Tobacco Control (ITC) Scotland/UK survey, indicate that a comprehensive smoke-free law that covers, without exception, an entire nation (i.e. Scotland) has increased adult smokers’ perceived social unacceptability of smoking, to some extent higher in Scotland than rest of the UK which, in turn, is associated with quit intentions at follow-up, in both countries. The examination of data from the UK Youth Tobacco Policy Study (YTPS) also demonstrated that the influence of tobacco marketing awareness on adolescents’ smoking intentions is mediated by perceived norms. Prior to the enactment of the UK Tobacco Advertising and Promotion Act (TAPA), higher levels of awareness of tobacco advertising and promotion were independently associated with higher levels of perceived sibling approval which, in turn, were positively related to smoking intentions. Independent paths from perceived smoking prevalence and benefits fully mediated the effects of advertising and promotion awareness on intentions, during and after the enactment of the TAPA. Results from the qualitative study generally supported the quantitative findings and provided new insights into how adolescents’ normative beliefs and smoking behaviour are influenced by tobacco control policies. The qualitative group discussion suggests that smoke-free legislation and anti-smoking ads influence perceptions of prevalence, acceptability and smoking behaviour. A number of theoretical implications were presented, including the belief that social norms campaigns and interventions must be focal and salient in individuals’ consciousness so as to effect the desired behaviour change. A theoretical framework of the various normative mechanisms should consequently be integrated into tobacco control policies and norm-based interventions to work in a synergistic manner to influence health-related behaviour. Practical implications of this conceptualization include the view that, instead of public health interventions focusing on conventional approaches (for example, scare tactics), an appropriate strategy would be to incorporate specific information that corrects normative misperceptions and ambiguities among referent populations at individual and societal levels, with consequential normative and health behaviour change. It is recommended that future research employing tobacco industry perceptions and possibly a descriptive norm as additional normative mediators, aside from unacceptability, would be of value to examine whether smoke-free legislation influences quitting partly via changing favourable tobacco industry perceptions, social acceptability of smoking and perceived prevalence of smoking. To sum up, the findings demonstrate that societal level policy measures such as smoke-free legislation and the TAPA are critical elements of a comprehensive tobacco control program that can significantly influence adult smokers’ quit intentions and reduce adolescents’ smoking intentions respectively, by signifying smoking to be less normative and to be socially unacceptable.EThOS - Electronic Theses Online ServiceCancer Research UKGBUnited Kingdo

The peripheral blood transcriptome in septic cardiomyopathy: an observational, pilot study.

BACKGROUND:Septic cardiomyopathy (SCM) is common in sepsis and associated with increased morbidity and mortality. Left ventricular global longitudinal strain (LV GLS), measured by speckle tracking echocardiography, allows improved identification of impaired cardiac contractility. The peripheral blood transcriptome may be an important window into SCM pathophysiology. We therefore studied the peripheral blood transcriptome and LV GLS in a prospective cohort of patients with sepsis. RESULTS:In this single-center observational pilot study, we enrolled adult patients (age > 18) with sepsis within 48 h of admission to the ICU. SCM was defined as LV GLS > - 17% based on echocardiograms performed within 72 h of admission. We enrolled 27 patients, 24 of whom had high-quality RNA results; 18 (75%) of 24 had SCM. The group was 50% female and had a median (IQR) age of 59.5 (48.5-67.0) years and admission APACHE II score of 21.0 (16.0-32.3). Forty-six percent had septic shock. After filtering for low-expression and non-coding genes, 15,418 protein coding genes were expressed and 73 had significantly different expression between patients with vs. without SCM. In patients with SCM, 43 genes were upregulated and 30 were downregulated. Pathway analysis identified enrichment in type 1 interferon signaling (adjusted p < 10-5). CONCLUSIONS:In this hypothesis-generating study, SCM was associated with upregulation of genes in the type 1 interferon signaling pathway. Interferons are cytokines that stimulate the innate and adaptive immune response and are implicated in the early proinflammatory and delayed immunosuppression phases of sepsis. While type 1 interferons have not been implicated previously in SCM, interferon therapy (for viral hepatitis and Kaposi sarcoma) has been associated with reversible cardiomyopathy, perhaps suggesting a role for interferon signaling in SCM

Application of the Kerman-Klein method to the solution of a spherical shell model for a deformed rare-earth nucleus

Core-particle coupling models are made viable by assuming that core properties such as matrix elements of multipole and pairing operators and excitation spectra are known independently. From the completeness relation, it is seen, however, that these quantities are themselves algebraic functions of the calculated core-particle amplitudes. For the deformed rare-earth nucleus 158Gd, we find that these sum rules are well-satisfied for the ground state band, implying that we have found a self-consistent solution of the non-linear Kerman-Klein equations.Comment: revtex and postscript, including 1 figure(postscript), submitted to Phys.Rev.Let

The Galaxy Population of Low-Redshift Abell Clusters

We present a study of the luminosity and color properties of galaxies selected from a sample of 57 low-redshift Abell clusters. We utilize the non-parametric dwarf-to-giant ratio (DGR) and the blue galaxy fraction (fb) to investigate the clustercentric radial-dependent changes in the cluster galaxy population. Composite cluster samples are combined by scaling the counting radius by r200 to minimize radius selection bias. The separation of galaxies into a red and blue population was achieved by selecting galaxies relative to the cluster color-magnitude relation. The DGR of the red and blue galaxies is found to be independent of cluster richness (Bgc), although the DGR is larger for the blue population at all measured radii. A decrease in the DGR for the red and red+blue galaxies is detected in the cluster core region, while the blue galaxy DGR is nearly independent of radius. The fb is found not to correlate with Bgc; however, a steady decline toward the inner-cluster region is observed for the giant galaxies. The dwarf galaxy fb is approximately constant with clustercentric radius except for the inner cluster core region where fb decreases. The clustercentric radial dependence of the DGR and the galaxy blue fraction, indicates that it is unlikely that a simple scenario based on either pure disruption or pure fading/reddening can describe the evolution of infalling dwarf galaxies; both outcomes are produced by the cluster environment.Comment: 28 pages, 6 figures, accepted for publication in Ap

Degenerate Domain Wall Solutions in Supersymmetric Theories

A family of degenerate domain wall configurations, partially preserving supersymmetry, is discussed in a generalized Wess-Zumino model with two scalar superfields. We establish some general features inherent to the models with continuously degenerate domain walls. For instance, for purely real trajectories additional "integrals of motion" exist. The solution for the profile of the scalar fields for any wall belonging to the family is found in quadratures for arbitrary ratio of the coupling constants. For a special value of this ratio the solution family is obtained explicitly in terms of elementary functions. We also discuss the threshold amplitudes for multiparticle production generated by these solutions. New unexpected nullifications of the threshold amplitudes are found.Comment: 21 pages, LaTeX, 3 figures using epsf.st

BPS-Saturated Walls in Supersymmetric Theories

Domain-wall solutions in four-dimensional supersymmetric field theories with distinct discrete vacuum states lead to the spontaneous breaking of supersymmetry, either completely or partially. We consider in detail the case when the domain walls are the BPS-saturated states, and 1/2 of supersymmetry is preserved. Several useful criteria that relate the preservation of 1/2 of supersymmetry on the domain walls to the central extension appearing in the N=1 superalgebras are established. We explain how the central extension can appear in N=1 supersymmetry and explicitly obtain the central charge in various models: the generalized Wess-Zumino models, and supersymmetric Yang-Mills theories with or without matter. The BPS-saturated domain walls satisfy the first-order differential equations which we call the creek equations, since they formally coincide with the (complexified) equations of motion of an analog high-viscosity fluid on a profile which is given by the superpotential of the original problem. Some possible applications are considered.Comment: Several equations are corrected, the discussion of the two-dimensional soliton in Section 6 is modified, references are updated and expande

Supersymmetric effects in top quark decay into polarized W-boson

We investigate the one-loop supersymmetric QCD (SUSY-QCD) and electroweak (SUSY-EW) corrections to the top quark decay into a b-quark and a longitudinal or transverse W-boson. The corrections are presented in terms of the longitudinal ratio \Gamma(t-->W_L b)/\Gamma(t--> W b) and the transverse ratio \Gamma(t-->W_- b)/\Gamma(t--> W b). In most of the parameter space, both SUSY-QCD and SUSY-EW corrections to these ratios are found to be less than 1% in magnitude and they tend to have opposite signs. The corrections to the total width \Gamma(t-->W b) are also presented for comparison with the existing results in the literature. We find that our SUSY-EW corrections to the total width differ significantly from previous studies: the previous studies give a large correction of more than 10% in magnitude for a large part of the parameter space while our results reach only few percent at most.Comment: Version in PRD (explanation and refs added

The derivation of the formyl-group oxygen of chlorophyll b in higher plants from molecular oxygen.

The mechanism of formation of the formyl group of chlorophyll b has long been obscure but, in this paper, the origin of the 7-formyl-group oxygen of chlorophyll b in higher plants was determined by greening etiolated maize leaves, excised from dark-grown plants, by illumination under white light in the presence of either H218O or 18O2 and examining the newly synthesized chlorophylls by mass spectroscopy. To minimize the possible loss of 18O label from the 7-formyl substituent by reversible formation of chlorophyll b-71-gem-diol (hydrate) with unlabelled water in the cell, the formyl group was reduced to a hydroxymethyl group during extraction with methanol containing NaBH4: chlorophyll a remained unchanged during this rapid reductive extraction process. Mass spectra of chlorophyll a and [7-hydroxymethyl]-chlorophyll b extracted from leaves greened in the presence of either H218O or 18O2 revealed that 18O was incorporated only from molecular oxygen but into both chlorophylls: the mass spectra were consistent with molecular oxygen providing an oxygen atom not only for incorporation into the 7-formyl group of chlorophyll b but also for the well-documented incorporation into the 131-oxo group of both chlorophylls a and b [see Walker, C. J., Mansfield, K. E., Smith, K. M. & Castelfranco, P. A. (1989) Biochem. J. 257, 599–602]. The incorporation of isotope led to as much as 77% enrichment of the 131-oxo group of chlorophyll a: assuming identical incorporation into the 131 oxygen of chlorophyll b, then enrichment of the 7-formyl oxygen was as much as 93%. Isotope dilution by re-incorporation of photosynthetically produced oxygen from unlabelled water was negligible as shown by a greening experiment in the presence of 3-(3,4-dichlorophenyl)-1,1-dimethylurea. The high enrichment using 18O2, and the absence of labelling by H218O, unequivocally demonstrates that molecular oxygen is the sole precursor of the 7-formyl oxygen of chlorophyll b in higher plants and strongly suggests a single pathway for the formation of the chlorophyll b formyl group involving the participation of an oxygenase-type enzyme