Reducing smoking in adolescents: cost-effectiveness results from the cluster randomized ASSIST (A Stop Smoking In Schools Trial)

Introduction: School-based smoking prevention programmes can be effective, but evidence on cost-effectiveness is lacking. We conducted a cost-effectiveness analysis of a school-based “peer-led” intervention.<p></p> Methods: We evaluated the ASSIST (A Stop Smoking In Schools Trial) programme in a cluster randomized controlled trial. The ASSIST programme trained students to act as peer supporters during informal interactions to encourage their peers not to smoke. Fifty-nine secondary schools in England and Wales were randomized to receive the ASSIST programme or usual smoking education. Ten thousand seven hundred and thirty students aged 12–13 years attended participating schools. Previous work has demonstrated that the ASSIST programme achieved a 2.1% (95% CI = 0%–4.2%) reduction in smoking prevalence. We evaluated the public sector cost, prevalence of weekly smoking, and cost per additional student not smoking at 24 months.<p></p> Results: The ASSIST programme cost of £32 (95% CI = £29.70–£33.80) per student. The incremental cost per student not smoking at 2 years was £1,500 (95% CI = £669–£9,947). Students in intervention schools were less likely to believe that they would be a smoker at age 16 years (odds ratio [OR] = 0.80; 95% CI = 0.66–0.96).<p></p> Conclusions: A peer-led intervention reduced smoking among adolescents at a modest cost. The intervention is cost-effective under realistic assumptions regarding the extent to which reductions in adolescent smoking lead to lower smoking prevalence and/or earlier smoking cessation in adulthood. The annual cost of extending the intervention to Year 8 students in all U.K. schools would be in the region of £38 million and could result in 20,400 fewer adolescent smokers.<p></p&gt

Anxious to see you: Neuroendocrine mechanisms of social vigilance and anxiety during adolescence.

Social vigilance is a behavioral strategy commonly used in adverse or changing social environments. In animals, a combination of avoidance and vigilance allows an individual to evade potentially dangerous confrontations while monitoring the social environment to identify favorable changes. However, prolonged use of this behavioral strategy in humans is associated with increased risk of anxiety disorders, a major burden for human health. Elucidating the mechanisms of social vigilance in animals could provide important clues for new treatment strategies for social anxiety. Importantly, during adolescence the prevalence of social anxiety increases significantly. We hypothesize that many of the actions typically characterized as anxiety behaviors begin to emerge during this time as strategies for navigating more complex social structures. Here, we consider how the social environment and the pubertal transition shape neural circuits that modulate social vigilance, focusing on the bed nucleus of the stria terminalis and prefrontal cortex. The emergence of gonadal hormone secretion during adolescence has important effects on the function and structure of these circuits, and may play a role in the emergence of a notable sex difference in anxiety rates across adolescence. However, the significance of these changes in the context of anxiety is still uncertain, as not enough studies are sufficiently powered to evaluate sex as a biological variable. We conclude that greater integration between human and animal models will aid the development of more effective strategies for treating social anxiety

The impact of Covid-19 on families, children aged 0-4 and pregnant women in Tower Hamlets: Wave One Survey Findings

Families in Tower Hamlets is an ongoing research project led by University College London into the impact of the Covid-19 pandemic on the lives of families with young children and pregnant women. This report is of initial findings from the ‘first 500’ respondents, who completed the survey between July and November 2020. We present findings in terms of seven main ethnic groups that broadly represent proportions in the local population: one third of the population identify as White British and White Irish; a further third identify as Bangladeshi; and a final third identify with a wide range of other ethnicities. There are marked differences within this group so we have used the categories: Other White; Asian Other; Somali; Black & Black Other; and Other ethnic group to illustrate the experiences of respondents. With this lens of ethnicity, combined with analysis by household income, we can see certain clear patterns arising. Here, we focus on five main areas: family livelihoods; housing and environment; supporting children at home; health and social support services; and participants’ own health and mental health. Subsequent outputs will present findings in more detail

Income, ethnic diversity and family life in East London during the first wave of the pandemic: An assets approach

Objective: This paper reports first results from a survey of 992 parents and parents to be living in an ethnically diverse and socio-economically unequal borough of East London during the coronavirus pandemic that reduced mobility, closed services and threatened public health. / Background: Little is known about the place based impacts of the pandemic on families with young children. We describe the living circumstances of families with children under five or expecting a baby living in Tower Hamlets during the Coronavirus pandemic in 2020, and then examine the relative importance of household characteristics such as ethnicity and household income for adverse impacts on survey respondents, as seen in mental health outcomes. / Method: a community survey sample recruited with support from the local council comprised 75% mothers/pregnant women, 25% fathers/partners of pregnant women. Reflecting the borough population, 35 percent were White British or Irish and 36 percent were Bangladeshi, and the remainder were from a wide range of ethnic backgrounds. Adopting an assets based approach, we describe material, familial and community assets using three household income bands and seven ethnic groups. We then use regressions to identify which assets were most important in mitigating adversity. / Results: We find that material assets (income, employment, food insecurity, housing quality) were often insecure and in decline but familial assets (home caring practices, couple relationships) were largely sustained. Community assets (informal support, service provision) were less available or means of access had changed. Our analyses find that while descriptively ethnicity structured adverse impacts of the pandemic related changes to family life, income and couple relationships were the most important assets for mitigating adversity as seen in mental health status. / Conclusion: Supporting family assets will require close attention to generating local and decent work as well as enhancing access to community assets

What Family Circumstances, During COVID-19, Impact on Parental Mental Health in an Inner City Community in London?

The introduction of lockdown due to a public health emergency in March 2020 marked the beginning of substantial changes to daily life for all families with young children. Here we report the experience of families from London Borough of Tower Hamlets with high rates of poverty and ethnic and linguistic diversity. This inner city community, like communities worldwide, has experienced a reduction or closure in access to education, support services, and in some cases, a change in or loss of income, job, and food security. Using quantitative survey items (N = 992), we examined what differences in family circumstances, for mothers and fathers of young children aged 0-5 living in Tower Hamlets, during March 2020 to November 2020, were associated with their mental health status. We measure parental mental health using symptoms of depression (self-report: Patient Health Questionnaire depression scale: PHQ-8), symptoms of anxiety levels (self-report: General Anxiety Disorder: GAD-7), and perceptions of direct loneliness. We find parental mental health difficulties are associated with low material assets (financial security, food security, and children having access to outside space), familial assets (parents time for themselves and parent status: lone vs. cohabiting), and community assets (receiving support from friends and family outside the household). South Asian parents and fathers across ethnicities were significantly more likely to experience mental health difficulties, once all other predictors were accounted for. These contributing factors should be considered for future pandemics, where restrictions on people's lives are put in place, and speak to the importance of reducing financial insecurity and food insecurity as a means of improving the mental health of parents

Interim Briefing Report. The First 500: The impact of Covid-19 on families, children aged 0-4 and pregnant women in Tower Hamlets

Families in Tower Hamlets is an ongoing research project led by University College London into the impact of the Covid-19 pandemic on the lives of families with young children and pregnant women. This report is of initial findings from the ‘first 500’ respondents, who completed the survey between July and September 2020. We present findings in terms of three main ethnic groups that broadly represent proportions in the local population: one third of the population identify as White British and White Irish; a further third identify as Bangladeshi; and a final third identify with a wide range of other ethnicities which we have had to present as ‘Other ethnicity’ in this report and we acknowledge this is unlikely to do justice to the range of experience within this group. With this lens of ethnicity, combined with analysis by household income, we can see certain clear patterns arising. Here, we focus on five main areas: family livelihoods; housing and environment; supporting children at home; health and social support services; and participants’ own health and mental health. Subsequent outputs will present findings in more detail

Variation in use of the 2-week referral pathway for suspected cancer: cross-sectional analysis

Background: A 2-Week Wait (2WW) referral pathway for earlier diagnosis of suspected cancer was introduced in England in 2000. Nevertheless, a significant proportion of patients with cancer are diagnosed by other routes (detection rate), only a small proportion of 2WW referrals have cancer (conversion rate) and there is considerable between-practice variation. Aim: This study examined use by practices of the 2WW referral in relation to all cancer diagnoses. Design and setting: A cross-sectional analysis of data extracted from the Cancer Waiting Times Database for all 2WW referrals in 2009 and for all patients receiving a first definitive treatment in the same year. Method: The age standardised referral ratio, conversion rate, and detection rate were calculated for all practices in England and the correlation coefficient for each pair of measures. The median detection rate was calculated for each decile of practices ranked by conversion rate and vice versa, performing nonparametric tests for trend in each case. Results: Data for 8049 practices, 865 494 referrals, and 224 984 cancers were analysed. There were significant correlations between referral ratio and conversion rate (inverse) and detection rate (direct). There was also a direct correlation between conversion and detection rates. There was a significant trend in conversion rate for deciles of detection rate, and vice versa, with a marked difference between the lowest and higher deciles. Conclusion: There is a consistent relationship between 2WW referral conversion rate and detection rate that can be interpreted as representing quality of clinical practice. The 2WW referral rate should not be a measure of quality of clinical care

Antifungal agents for invasive candidiasis in non-neutropenic critically ill adults: What do the guidelines recommend?

Objectives: Recommendations in clinical practice guidelines (CPG) may differ and cause confusion. Our objective was to appraise CPGs for antifungal treatment of invasive candidiasis (IC) in non-neutropenic critically-ill adult patients. Methods: We systematically searched the literature for CPGs published between 2008 and 2018. We assessed the quality of each guideline using six domains of the AGREE II instrument. We extracted and compared recommendations for different treatment strategies and assessed content quality.Results: Of 19 guidelines, the mean overall AGREE II score was 58%. The domain 'clarity of presentation' received the highest scores (88%) and 'applicability' the lowest (18%). CPGs provided detailed recommendations on antifungal prophylaxis (n = 10), with fluconazole recommended as initial prophylaxis in all seven CPGs citing a specific drug. Echinocandin was recommended as the initial drug in all 16 CPGs supporting empirical/pre-emptive treatment; and in 18 of 19 for targeted invasive candidiasis treatment. However, it remains unclear when to initiate prophylaxis, empirical or pre-emptive therapy or when to step down. Conclusions: The methodological quality of CPGs for antifungal treatment of IC in non-neutropenic critically-ill patients is suboptimal. Some treatment recommendations were inconsistent across indications and require local guidance to help clinicians make better informed decisions