Profile of menthol cigarette smokers in the months following the removal of these products from the market: a cross-sectional population survey in England

Introduction: In May 2020, the EU Tobacco Products Directive ban on the sale of menthol cigarettes was implemented in England. This study examined the prevalence of menthol cigarette smoking after the ban, according to sociodemographic and smoking characteristics. / Methods: Cross-sectional data came from a representative survey of current smokers (18+) in England (unweighted n=2681) between July 2020 and June 2021. The weighted prevalence of menthol cigarette smoking as a proportion of total cigarette smoking was calculated, log-binomial regression explored trends over time, and χ2 statistics assessed the relationship between menthol smoking, sociodemographic and smoking characteristics. Sources of purchase of menthol cigarettes were explored. / Results: Between July 2020 and June 2021, 15.7% (95% CI 14.5 to 17.1) of smokers reported smoking menthol cigarettes. The fitted non-linear trend supported no initial change followed by a possible reduction across April–June 2021 and fit the data better than linear and null (no change) models (χ2(2)=2519.7, p=0.06; χ2(3)=2519.7, p=0.006). Menthol cigarette smoking was more common among younger groups (16–24=25.2%; 25–34=19.9%) and women (19.4%). Menthol cigarette smokers showed lower cigarette dependence compared with other smokers. Past-6-month purchases of menthol cigarettes from any illicit or cross-border source declined from 30.1% in the last 6 months of 2020 to 17.5% in the first 6 months of 2021. / Conclusions: A substantial minority of current smokers in England reported menthol cigarette smoking between July 2020 and June 2021, despite the ban, possibly reflecting mitigation of restrictions by a variety of licit means, such as legal menthol accessories. The reduction in menthol smoking across April–June 2021 warrants further monitoring

Changes in roll-your-own tobacco and cigarette sales volume and prices before, during and after plain packaging legislation in the UK

Background Plain packaging and minimum pack size legislation for tobacco products was introduced in the UK in May 2016, with a 1-year sell-off period until May 2017, during which both fully branded and plain packs of various sizes were legally available. This study investigates trends in prices of roll-your-own tobacco (RYO) before, during and after implementation of this legislation, and compares trends with those observed in the cigarette market. Methods We used Nielsen Scantrack data for the period from March 2013 to June 2018 to describe trends in UK inflation-adjusted prices and volumes of both RYO and cigarettes, and linear regression to estimate changes in prices associated with the introduction of plain packaging and the minimum pack sizes of 30 g RYO and 20 cigarettes. Results In contrast to a downward trend in cigarette sales volumes, RYO volumes rose throughout the study period. By the time plain packs accounted for 75% or more of sales, the average price of products sold in equivalent pack sizes had increased, relative to average prices in the year before implementation and with adjustment for tax changes, from 34.9 to 38.8 pence per gram for RYO (mean difference 4.26, 95% CI 3.99 to 4.53 pence, 12% increase), and from 38.6 to 41.13 pence for cigarettes (mean difference 2.53, 95% CI 2.24 to 2.83 pence, 7% increase) per cigarette. Conclusions New legislation resulted in higher prices for RYO and manufactured cigarettes. However, sales volumes of RYO continued to increase throughout the study period, perhaps because RYO remains a less expensive means of smoking tobacco

Comparison between online and offline price of tobacco products using novel datasets

Price of tobacco products has traditionally been relevant both for the industry, to respond to policy changes, and for governments, as an effective tobacco control measure. However, monitoring prices across a wide range of brands and brand variants requires access to expensive commercial sales databases. This study aims to investigate the comparability of average tobacco prices from two commercial sources and an in-house monitoring database which provides daily data in real time at minimal cost. We used descriptive and regression analysis to compare the monthly average numbers of brands, brand variants, products and prices of cigarettes and hand-rolling tobacco using commercial data from Nielsen Scantrack and Kantar Worldpanel, and an online price database (OPD) created in Nottingham, for the period from May 2013 to February 2017. There were marked differences in the number of products tracked in the three data sources. Nielsen was the most comprehensive and Kantar Worldpanel the least. Though average prices were very similar between the three datasets, Nottingham OPD prices were the highest and Kantar Worldpanel the lowest. However, regression analysis demonstrated that after adjustment for differences in product range, price differences between the datasets were very small. After allowing for differences in product range these data sources offer representative prices for application in price research. Online price tracking offers an inexpensive and near real-time alternative to the commercial datasets

Effect of UK plain tobacco packaging and minimum pack size legislation on tobacco and nicotine product switching behaviour

Background and aims: The introduction of plain tobacco packaging and minimum pack size legislation in the United Kingdom between May 2016 and May 2017 was accompanied by substantial changes in tobacco product diversity and pricing. This study investigates the extent to which these changes were associated with consumer switching between tobacco product types and price segments, and from tobacco to non-tobacco nicotine products. Design: Longitudinal study (changing trends in product and price choices) and survey (reasons for consumer choices). Setting: Great Britain Participants: We used 11 695 British households from Kantar Worldpanel who purchased tobacco and non-tobacco nicotine products from March 2011 to December 2017. Measurements: Product choice was defined using household's monthly purchases of tobacco (cigarettes, roll-your-own (RYO) tobacco, cigar/cigarillo and pipe tobacco) and non-tobacco nicotine products (e-cigarettes and nicotine replacement therapy), while price was defined using price paid by pack size and by price quartiles. Our switching analysis considered three switching alternatives: switching to a different tobacco product or to a combination of tobacco products, switching to any non-nicotine tobacco product, and switching out of our dataset. We explored changes in price quartile purchasing behaviour using binary variables for whether a household purchased or not from each price quartile monthly. Finally, self-declared consumer's choice was assessed through survey responses. Findings: The introduction of plain packaging and minimum pack sizes coincided with major switching to purchasing of pack sizes of 20 cigarettes or 30 g or larger RYO tobacco (>99% of purchases in December 2017) and a migration towards lower-price cigarettes, as for cigarettes, around 80% of purchases were in the lowest price quartiles at the end of the study period compared to about 50% at the start of the study period. During the first 6 months of implementation there was also a marked increase in the likelihood that cigarette smokers would switch to non-tobacco nicotine (OR 1.74, 95% CI: 1.18 to 2.57), predominantly e-cigarettes, compared with the period before May 2016. Survey results suggest that price was the main driver of changes in purchasing behaviour. Conclusions: Implementation of plain packaging and minimum pack size legislation in the UK appears to have been associated with tobacco users switching to lower price tobacco products and to e-cigarettes

Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019

Background and aim: In 2016, England initiated the implementation of standardised tobacco packaging, introduced in conjunction with minimum pack sizes and other measures included in the 2014 European Tobacco Products Directive, over the course of a 1-year sell-off period ending in May 2017. These measures have been shown to have been associated with increases in tobacco prices and product diversity. We now investigate the association between implementation of the new legislation and smoking status in England. Design: Segmented regression analysis of repeated cross-sectional surveys using a generalised linear model with individual-level data to test for a change in trend and immediate step change. Setting: England. Participants: Participants in the Smoking Toolkit Study, which involves repeated, cross‐sectional household surveys of individuals aged 16 years and older in England. The sample included 278 219 individual observations collected between November 2006 and December 2019. Intervention: Implementation of standardised packaging legislation (May 2016 and May 2017). Measurements: Individual-level current smoking status adjusted for implementation of tobacco control policies, cigarette price, seasonality and autocorrelation. Findings: The implementation of standardised packaging was associated with a significant step reduction in the odds of being a smoker after May 2017 (OR: 0.93; 95% CI 0.87 to 0.99). The magnitude of the association was similar when modelling the step change in May 2016 at the start of the 1-year policy implementation period (OR: 0.90; 95% CI: 0.83 to 0.97). Conclusions: This is the first independent study demonstrating that implementation of standardised packaging was associated with a reduction in smoking in England which occurred in anticipation of, rather than after, full policy implementation. It appears that the odds of being a smoker were affected by the prospect of the move to standardised packs and accompanying legislation

Smoke-free policies and non-smokers’ reactions to SHS exposure in small and medium enterprises

Introduction: Non-smoker employees can significantly improve the existing smoke-free policies in the workplace by asserting their right for smoke-free air and confronting smoker colleagues. The aim of the study was to assess the psychological and social drivers of non-smokers' readiness to assert their right for smoke-free air in the workplace. Materials and Methods: Twenty-six small-and-medium enterprises (SME) with diverse background were randomly selected, and 284 employees agreed to participate in the study. Our study focused on the responses of 85 non-smokers (M age = 34 years, SD = 7.98, 84.2% worked in indoor offices). A cross-sectional design was used and participants completed a structured anonymous questionnaire assessing background and demographic characteristics, and psychosocial predictors of assertiveness intentions. Results: Although more than half of non-smokers reported they were often/almost always bothered by exposure to SHS, roughly one third of them reported having asked their colleagues not to smoke at work. Regression analysis showed that the effects of distal predictors (i.e. annoyance due to SHS exposure) were mediated by past behaviour, attitudes (protection motivation beliefs), social norms, and self-efficacy. Conclusions: Health beliefs related to SHS exposure, and concerns about workplace health and job performance, social norms and self-efficacy can increase the assertiveness of non-smokers in workplace settings. Related campaigns should focus on communicating normative messages and self-efficacy training to empower non-smoker employees to act assertively towards protecting their smoke-free rights

Socio-demographic and lifestyle factors associated with overweight in a representative sample of 11-15 year olds in France: Results from the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The prevalence of overweight in children and adolescents is high and overweight is associated with poor health outcomes over short- and long-term. Lifestyle factors can interact to influence overweight. Comprehensive studies linking overweight concomitantly with several demographic and potentially-modifiable lifestyle factors and health-risk behaviours are limited in adolescents - an age-group characterized by changes in lifestyle behaviours and high prevalence of overweight. Thus, the objective of the current study was to examine the association of overweight with several socio-demographic and lifestyle variables simultaneously in a representative sample of adolescents.</p> <p>Methods</p> <p>A nationally representative sample of 11-15 year-olds (n = 7154) in France participated as part of the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) study. Students reported data on their age, height, weight, socio-demographic variables, lifestyle factors including nutrition practices, physical activity at two levels of intensity (moderate and vigorous), sedentary behaviours, as well as smoking and alcohol consumption patterns using standardized HBSC protocols. Overweight (including obesity) was defined using the IOTF reference. The multivariate association of overweight with several socio-demographic and lifestyle factors was examined with logistic regression models.</p> <p>Results</p> <p>The adjusted odds ratios for the association with overweight were: 1.80 (95% CI: 1.37-2.36) for low family affluence; 0.73 (0.60-0.88) for eating breakfast daily; 0.69 (0.56-0.84) for moderate to vigorous physical activity (MVPA); and 0.71 (0.59-0.86) for vigorous physical activity (VPA). Significant interactions between age and gender as well as television (TV) viewing and gender were noted: for boys, overweight was not associated with age or TV viewing; in contrast, for girls overweight correlated negatively with age and positively with TV viewing. Fruit and vegetable intake, computer and video-games use, smoking and alcohol consumption were not associated with overweight.</p> <p>Conclusions</p> <p>In multivariate model, family affluence, breakfast consumption and moderate to vigorous as well as vigorous physical activity were negatively associated with overweight. These findings extend previous research to a setting where multiple risk and protective factors were simultaneously examined and highlight the importance of multi-faceted approaches promoting physical activity and healthy food choices such as breakfast consumption for overweight prevention in adolescents.</p

The SPECTRUM Consortium: a new UK Prevention Research Partnership consortium focussed on the commercial determinants of health, the prevention of non-communicable diseases, and the reduction of health inequalities

The main causes of non-communicable diseases (NCDs), health inequalities and health inequity include consumption of unhealthy commodities such as tobacco, alcohol and/or foods high in fat, salt and/or sugar. These exposures are preventable, but the commodities involved are highly profitable. The economic interests of ‘Unhealthy Commodity Producers’ (UCPs) often conflict with health goals but their role in determining health has received insufficient attention. In order to address this gap, a new research consortium has been established. This open letter introduces the SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harM) Consortium: a multi-disciplinary group comprising researchers from 10 United Kingdom (UK) universities and overseas, and partner organisations including three national public health agencies in Great Britain (GB), five multi-agency alliances and two companies providing data and analytic support. Through eight integrated work packages, the Consortium seeks to provide an understanding of the nature of the complex systems underlying the consumption of unhealthy commodities, the role of UCPs in shaping these systems and influencing health and policy, the role of systems-level interventions, and the effectiveness of existing and emerging policies. Co-production is central to the Consortium’s approach to advance research and achieve meaningful impact and we will involve the public in the design and delivery of our research. We will also establish and sustain mutually beneficial relationships with policy makers, alongside our partners, to increase the visibility, credibility and impact of our evidence. The Consortium’s ultimate aim is to achieve meaningful health benefits for the UK population by reducing harm and inequalities from the consumption of unhealthy commodities over the next five years and beyond

Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study

Background There has been a rapid increase in the retail availability of e-cigarettes in the UK and elsewhere. It is known that exposure to cigarette point-of-sale (POS) displays influences smoking behaviour and intentions in young people. However, there is as yet no evidence regarding the relationship between e-cigarette POS display exposure and e-cigarette use in young people. Methods This cross sectional study survey was conducted in four high schools in Scotland. A response rate of 87% and a total sample of 3808 was achieved. Analysis was by logistic regression on e-cigarette outcomes with standard errors adjusted for clustering within schools. The logistic regression models were adjusted for recall of other e-cigarette adverts, smoking status, and demographic variables. Multiple chained imputation was employed to assess the consistency of the findings across different methods of handling missing data. Results Adolescents who recalled seeing e-cigarettes in small shops were more likely to have tried an e-cigarette (OR 1.92 99% CI 1.61 to 2.29). Adolescents who recalled seeing e-cigarettes for sale in small shops (OR 1.80 99% CI 1.08 to 2.99) or supermarkets (OR 1.70 99% CI 1.22 to 2.36) were more likely to intend to try them in the next 6 months. Conclusions This study has found a cross-sectional association between self-reported recall of e-cigarette POS displays and use of, and intention to use, e-cigarettes. The magnitude of this association is comparable to that between tobacco point of sale recall and intention to use traditional cigarettes in the same sample. Further longitudinal data is required to confirm a causal relationship between e-cigarette point of sale exposure and future use in young people.Publisher PDFPeer reviewe

Instructor and client views of a community falls prevention service and the impact of the COVID-19 pandemic: a qualitative exploration of a service in England

Objectives: Falls are the most common cause of injury related deaths in people over 75. The aim of this study was to explore the experience of providers (instructors) and service users (clients) of a falls prevention exercise programme and the impact of the COVID-19 pandemic in Derbyshire, UK. Methods: Ten one-to-one interviews with class instructors and five focus groups with clients (n=41). Transcripts were analysed using inductive thematic analysis. Results: Most clients were initially motivated to attend the programme to improve their physical health All clients reported improvements in their physical health as a result of attending the classes; additional benefits to social cohesion were also widely discussed. Clients referred to the support provided by instructors during the pandemic (online classes and telephone calls) as a ‘life-line’. Clients and instructors thought more could be done to advertise the programme, especially linking in with community and healthcare services. Conclusions: The benefits of attending exercise classes went beyond the intended purpose of improving fitness and reducing the risk of falls, extending into improved mental and social wellbeing. During the pandemic the programme also prevented feelings of isolation. Participants felt more could be done to advertise the service and increase referrals from healthcare settings