The scandal of CSI, the little-known loophole used to deny EU citizens permanent residency

By now many EU citizens living in Britain feel disheartened and disappointed at Parliament’s failure to secure their rights post-Brexit. A particularly concerning issue that emerged is the years-long misinformation surrounding the Comprehensive Sickness Insurance (CSI). Aleksandra Herbeć writes that failure of the UK government to communicate information about the CSI, also through universities, could mean that thousands of EU citizens in the UK face losing their eligibility for Permanent Residency (PR), and even the possibility of deportation. The media, too, have failed to cover the issue of CSI properly or to address some of its dubious aspects

Use of smartphone-based interventions to support smoking cessation and pharmacotherapy use

This thesis reports findings from seven studies to develop and provide a preliminary evaluation of three smartphone apps tackling a different aspect of quitting. Study 1 was a pragmatic randomised controlled trial (RCT) of the NRT2Quit app that focused on improving adherence to nicotine replacement therapy (NRT) during quitting. Due to slow recruitment, the study was terminated early, but there was some evidence that the app could aid cessation. Study 2 was a theory-informed qualitative study of smokers’ and ex-smokers’ use of NRT, which identified barriers in capability, opportunity and motivation to NRT use and engagement with support on NRT use, which could also explain the poor recruitment into the NRT2Quit trial. Study 3 was a think-aloud study about NRT2Quit that showed that smokers were interested in the advice offered within the app, but preferred more comprehensive support, including craving management tools (CMTs). Study 4 was a pragmatic RCT of the BupaQuit app that offered CMTs versus an app version without them and found no detectable impact on cessation and several challenges to conducting pragmatic RCTs of apps. Study 5 identified barriers to verification of abstinence in such trials using personal carbon monoxide (CO) monitors. Study 6 involved follow-up interviews with the BupaQuit trial participants and found that while they were interested in CMTs, the app failed to meet their perceived needs, and many used unassigned cessation support. Study 7 used a mixed-methods approach to explore smokers’ views on personal, smartphone-enabled CO monitors and associated apps, which found that smokers were interested in such support but also highlighted challenges for the development and evaluation of such programmes. This PhD suggests that smokers can articulate a number of desired features in cessation apps, but making these appealing, engaging and effective remains a major challenge, and many barriers exist to appropriate evaluation

Social norms towards smoking and electronic cigarettes among adult smokers in seven European Countries: Findings from the EUREST-PLUS ITC Europe Surveys

Introduction: This study explores whether current smokers' social norms towards smoking and electronic cigarettes (e-cigarettes) vary across seven European countries alongside smoking and e-cigarette prevalence rates. At the time of surveying, England had the lowest current smoking prevalence and Greece the highest. Hungary, Romania and Spain had the lowest prevalence of any e-cigarette use and England the highest. Methods: Respondents were adult (≥18 years) current smokers from the 2016 EUREST-PLUS ITC (Romania, Spain, Hungary, Poland, Greece, Germany) and ITC 4CV England Surveys (N=7779). Using logistic regression, associations between country and (a) smoking norms and (b) e-cigarette norms were assessed, adjusting for age, sex, income, education, smoking status, heaviness of smoking, and e-cigarette status. Results: Compared with England, smoking norms were higher in all countries: reporting that at least three of five closest friends smoke (19% vs 65-84% [AOR=6.9-24.0; Hungary-Greece]), perceiving that people important to them approve of smoking (8% vs 14-57% [1.9-51.1; Spain-Hungary]), perceiving that the public approves of smoking (5% vs 6-37% [1.7-15.8; Spain-Hungary]), disagreeing that smokers are marginalised (9% vs 16-50% [2.3-12.3; Poland-Greece]) except in Hungary. Compared with England: reporting that at least one of five closest friends uses e-cigarettes was higher in Poland (28% vs 36% [2.7]) but lower in Spain and Romania (28% vs 6-14% [0.3-0.6]), perceiving that the public approves of e-cigarettes was higher in Poland, Hungary and Greece (32% vs 36-40% [1.5-1.6]) but lower in Spain and Romania in unadjusted analyses only (32% vs 24-26%), reporting seeing e-cigarette use in public at least some days was lower in all countries (81% vs 12-55% [0.1-0.4]; Spain-Greece). Conclusions: Smokers from England had the least pro-smoking norms. Smokers from Spain had the least pro-e-cigarette norms. Friend smoking and disagreeing that smokers are marginalised broadly aligned with country-level current smoking rates. Seeing e-cigarette use in public broadly aligned with country-level any e-cigarette use. Generally, no other norms aligned with product prevalence

Perceptions, Predictors of and Motivation for Quitting among Smokers from Six European Countries from 2016 to 2018: Findings from EUREST-PLUS ITC Europe Surveys

The European Tobacco Products Directive (TPD) was introduced in 2016 in an effort to decrease prevalence of smoking and increase cessation in the European Union (EU). This study aimed to explore quitting behaviours, motivation, reasons and perceptions about quitting, as well as predictors (reported before the TPD implementation) associated with post-TPD quit status. A cohort study was conducted involving adult smokers from six EU countries (n= 3195). Data collection occurred pre-(Wave 1; 2016) and post-(Wave 2; 2018) TPD implementation. Bivariate and logistic regression analyses of weighted data were conducted. Within this cohort sample, 415 (13.0%) respondents reported quitting at Wave 2. Predictors of quitting were moderate or high education, fewer cigarettes smoked per day at baseline, a past quit attempt, lower level of perceived addiction, plans for quitting and the presence of a smoking-related comorbidity. Health concerns, price of cigarettes and being a good example for children were among the most important reasons that predicted being a quitter at Wave 2. Our findings show that the factors influencing decisions about quitting may be shared among European countries. European policy and the revised version of TPD could emphasise these factors through health warnings and/or campaigns and other policies

Smokers’ Views on Personal Carbon Monoxide Monitors, Associated Apps, and Their Use: An Interview and Think-Aloud Study

Smartphone-based personal carbon monoxide (CO) monitors and associated apps, or “CO Smartphone Systems” (CSSs) for short, could enable smokers to independently monitor their smoking and quitting. This study explored views and preferences regarding CSSs and their use among 16 adult, UK-based smokers. First, semi-structured interviews explored participants’ expectations of CSSs. Secondly, a think-aloud study identified participants’ reactions to a personal CO monitor and to existing or prototype apps. Framework Analysis identified five themes: (1) General views, needs, and motivation to use CSSs; (2) Views on the personal CO monitor; (3) Practicalities of CSS use; (4) Desired features in associated apps; and (5) Factors affecting preferences for CSSs and their use. Participants had high expectations of CSSs and their potential to increase motivation. Priority app features included: easy CO testing journeys, relevant and motivating feedback, and recording of contextual data. Appearance and usability of the personal CO monitor, and accuracy and relevance of CO testing were considered important for engagement. Participants differed in their motivation to use and preferences for CSSs features and use, which might have non-trivial impact on evaluation efforts. Personal CO monitors and associated apps may be attractive tools for smokers, but making CSSs easy to use and evaluating these among different groups of smokers may be challenging

Smokers’ Views on Personal Carbon Monoxide Monitors, Associated Apps, and Their Use: An Interview and Think-Aloud Study

Smartphone-based personal carbon monoxide (CO) monitors and associated apps, or “CO Smartphone Systems” (CSSs) for short, could enable smokers to independently monitor their smoking and quitting. This study explored views and preferences regarding CSSs and their use among 16 adult, UK-based smokers. First, semi-structured interviews explored participants’ expectations of CSSs. Secondly, a think-aloud study identified participants’ reactions to a personal CO monitor and to existing or prototype apps. Framework Analysis identified five themes: (1) General views, needs, and motivation to use CSSs; (2) Views on the personal CO monitor; (3) Practicalities of CSS use; (4) Desired features in associated apps; and (5) Factors affecting preferences for CSSs and their use. Participants had high expectations of CSSs and their potential to increase motivation. Priority app features included: easy CO testing journeys, relevant and motivating feedback, and recording of contextual data. Appearance and usability of the personal CO monitor, and accuracy and relevance of CO testing were considered important for engagement. Participants differed in their motivation to use and preferences for CSSs features and use, which might have non-trivial impact on evaluation efforts. Personal CO monitors and associated apps may be attractive tools for smokers, but making CSSs easy to use and evaluating these among different groups of smokers may be challenging

Quitting activity and use of cessation assistance reported by smokers in eight European countries: Findings from the EUREST-PLUS ITC Europe Surveys

There is clear evidence that the use of cessation aids significantly increases the likelihood of successful smoking cessation. The aim of this study was to examine quitting activity and use of cessation aids among smokers from various European countries. Subgroup differences were also examined for sex, income, education, and age in each country.Cross-sectional data were collected in 2016 from 10,683 smokers in eight European countries participating in the ITC Project: England (n=3,536), Germany (n=1,003), Greece (n=1,000), Hungary (n=1,000), the Netherlands (n=1,136), Poland (n=1,006), Romania (n=1,001), and Spain (n=1,001). We measured quitting activity, including quit attempts in the previous 12 months and intention to quit, use of cessation aids (i.e., medication, quitlines, internet, local services, and e-cigarettes), and whether respondents had received advice about quitting and e-cigarettes from health professionals.Quit attempts were most common in England (46.3%) and least common in Hungary (10.4%). Quit intention was highest in England and lowest in Greece. Use of e-cigarettes to quit was highest in England (51.6%) and lowest in Spain (5.0%). Use of cessation aids was generally low across all countries; in particular this was true for quitlines, internet-based support, and local services. Receiving health professional advice to quit was highest in Romania (56.5%), and lowest in Poland (20.8%); few smokers received advice about e-cigarettes from health professionals. No clear differences were found for sex and income groups. Across countries, smokers with lower education reported less quitting activity.Quitting activity and use of cessation methods were low in most countries. Greater quit attempts and use of cessation aids were found in England, where large investments in tobacco control and smoking cessation have been made. Health professionals are important for motivating smokers to quit and promoting the effectiveness of various methods, but overall, few smokers get advice to quit