Attitudes of parents towards the ‘Fit Together’ childhood obesity prevention programme: a qualitative study

Background: The latest available data for England show that childhood obesity continues to be a major public health concern with 9.3% of 4–5 years old and 18.9% of 10–11 years old children found to be obese (1). The aim of the study was to explore attitudes towards a community based childhood obesity prevention project among parents participating in the programme. Methods: The ‘Fit Together’ programme was provided in socio-economically deprived areas of Leeds which, at the time of the research study, was in its final year of running. The programme was delivered for 2 hours each week over a six week period by community health educators, and involved health education and cooking sessions. A convenience sample of parents who had attended at least one session of the Fit Together programme, delivered between November-December 2014, were recruited from a children’s centre (where families access health advice and related activities with their children aged 0– 5yr) and a primary school. Semi-structured interviews were conducted using a topic schedule with prompts, and were digitally recorded. A short screening questionnaire was completed to obtain demographic information. Three parents were present in each of the two Fit Together sessions allocated for recruitment. These six parents were recruited to the study and were interviewed. Interviews were transcribed verbatim, transcripts manually coded and thematic analysis conducted using a framework approach. Ethical approval for the study was obtained from the Faculty of Health & Social Sciences Local Research Ethics Coordinator, Leeds Beckett University. Results: Participants were all mothers with 1–3 children, and mean age was 27 years. Four participants self-defined their ethnicity as White British and the remaining two as Pakistani. Themes emerging from the interview data suggested that participants’ appraisal of the programme was positive and they reported benefits in behaviour change relevant to addressing childhood obesity. Parents felt the programme was logistically suitable, and had appropriate content and leaders. All participants would recommend the programme and highlighted the development of their cooking skills, which related to an increase in home cooking and in fruit and vegetable consumption. The opportunity to involve their children and spend time with them learning skills was a strongly held view among respondents. Parents felt the programme had also increased their awareness of nutrition content and children’s dietary habits. However, the view that an extended programme and subsequent follow-up were needed was commonly held. Additional benefits beyond behaviour change were also expressed. For example, the importance of social interaction was clear, with respondents reporting the alleviation of boredom and isolation while attending the programme, as this participant states: “Something to do ain’t it? Gets you out. There’s nothing else to go to” (White British, 23yr, 2 children). Participants also reported exchanging cultural beliefs and learning new styles of cooking from people from different backgrounds. Discussion: The findings of this first exploration of parents’ attitudes to Fit Together supports existing literature on the value of community educators in delivering health interventions (2). Beneficial behaviour change such as increased homecooking was consistent with previous programmes (3). Conclusion: Attitudes towards Fit Together were positive, with mothers viewing the programme as acceptable and bene- ficial. References 1. Stevens. L., & Nelson, M. The contribution of school meals and packed lunch to food consumption and nutrient intakes in UK primary school children from a low income population. Journal of Human Nutrition and Dietetics, 24; 223–232. 2011. 2. Evans, C., & Harper, C. A History and Review of school meals standards in the UK. Journal of Human Nutrition and Dietetics, 89–99. 2009. 3. Lop ez Nomdedeu, C. Agencia Espanola de Seguridad Alimentaria y Nutricion. Ministerio de Sanidad y Consum. La alimentacion de tus ni nos. Nutrici ~ on Saludable de la Infan- cia a la Adolescencia. Madrid: Fiselgraf, S.L. 2002

Multimodal Smoking Cessation in a Real-Life Setting: Combining Motivational Interviewing With Official Therapy and Reduced Risk Products

Background: Tobacco use is a global pandemic, affecting an estimated 1.2 billion people and resulting in substantial health burdens and associated costs. Objectives: The aim of this study was to estimate the efficacy of several treatments for smoking cessation in a real-life setting and to evaluate predictors of smoking abstinence. Methods: This research was designed with a sample of 593 cases recorded over the period between 2015 and 2016. Six treatment groups were included: (1) bupropion and motivational interviewing (MI); (2) bupropion, nicotine replacement therapy (NRT), and MI; (3) NRT and MI; (4) varenicline and MI; (5) personal vaporizer electronic cigarette and MI; and (6) electronic cigarette, cigarette like “cigalike,” and MI. Results: Results support the efficacy of all treatment groups when used in a real-life setting. The predictors of smoking abstinence were sex, partner smoking status, previous quit attempts, daily consumption, self-efficacy, and level of nicotine dependence. Conclusions: The use of different therapeutic strategies in clinical practice, including pharmacotherapy and nonstandard electronic nicotine delivery systems, such as an electronic cigarette, ensures a greater chance of cessation success and the possibility of tailoring interventions according to patients’ resources

Nicotine patch preloading for smoking cessation (the preloading trial): study protocol for a randomized controlled trial

Background: The use of nicotine replacement therapy before quitting smoking is called nicotine preloading. Standard smoking cessation protocols suggest commencing nicotine replacement therapy only on the first day of quitting smoking (quit day) aiming to reduce withdrawal symptoms and craving. However, other, more successful smoking cessation pharmacotherapies are used prior to the quit day as well as after. Nicotine preloading could improve quit rates by reducing satisfaction from smoking prior to quitting and breaking the association between smoking and reward. A systematic literature review suggests that evidence for the effectiveness of preloading is inconclusive and further trials are needed. Methods/Design: This is a study protocol for a multicenter, non-blinded, randomized controlled trial based in the United Kingdom, enrolling 1786 smokers who want to quit, funded by the National Institute for Health Research, Health Technology Assessment program, and sponsored by the University of Oxford. Participants will primarily be recruited through general practices and smoking cessation clinics, and randomized (1:1) either to use 21 mg nicotine patches, or not, for four weeks before quitting, whilst smoking as normal. All participants will be referred to receive standard smoking cessation service support. Follow-ups will take place at one week, four weeks, six months and 12 months after quit day. The primary outcome will be prolonged, biochemically verified six-month abstinence. Additional outcomes will include point prevalence abstinence and abstinence of four-week and 12-month duration, side effects, costs of treatment, and markers of potential mediators and moderators of the preloading effect. Discussion: This large trial will add substantially to evidence on the effectiveness of nicotine preloading, but also on its cost effectiveness and potential mediators, which have not been investigated in detail previously. A range of recruitment strategies have been considered to try and compensate for any challenges encountered in recruiting the large sample, and the multicentre design means that knowledge can be shared between recruitment teams. The pragmatic study design means that results will give a realistic estimate of the success of the intervention if it were to be rolled out as part of standard smoking cessation service practice. Trial registration: Current Controlled Trials ISRCTN33031001. Registered 27 April 2012

Variability and effectiveness of comparator group interventions in smoking cessation trials : A systematic review and meta-analysis

Funding: This work was funded by Cancer Research UK (application number C50862/A18446). The systematic review protocol was previously peer-reviewed by Cancer Research UK as part of the funding process. The funder had no role in protocol design, decision to publish, or preparation of the manuscriptPeer reviewedPublisher PD

Should cigarette pack sizes be capped?

BACKGROUND: Very few countries regulate maximum cigarette pack size. Larger, non-standard sizes are increasingly being introduced by the tobacco industry. Larger portion sizes increase food consumption; larger cigarette packs may similarly increase tobacco consumption. Here we consider the evidence for legislation to cap cigarette pack size to reduce tobacco-related harm. AIMS AND ANALYSIS: We first describe the regulations regarding minimum and maximum pack sizes in the 12 countries that have adopted plain packaging legislation and describe the range of sizes available. We then discuss evidence for two key assumptions that would support capping pack size. First, regarding the causal nature of the relationship between pack size and tobacco consumption, observational evidence suggests that people smoke fewer cigarettes when using smaller packs. Secondly, regarding the causal nature of the relationship between reducing consumption and successful cessation, reductions in number of cigarettes smoked per day are associated with increased cessation attempts and subsequent abstinence. However, more experimental evidence is needed to infer the causal nature of these associations among general populations of smokers. CONCLUSION: Cigarette pack size is positively associated with consumption and consumption is negatively associated with cessation. Based on limited evidence of the causal nature of these associations, we hypothesize that government regulations to cap cigarette pack sizes would positively contribute to reducing smoking prevalence

Reduction versus abrupt cessation in smokers who want to quit.

BACKGROUND: The standard way to stop smoking is to quit abruptly on a designated quit day. A number of smokers have tried unsuccessfully to quit this way. Reducing smoking before quitting could be an alternative approach to cessation. Before this method is adopted it is important to determine whether it is at least as successful as abrupt quitting. OBJECTIVES: 1. To compare the success of reducing smoking to quit and abrupt quitting interventions. 2. To compare adverse events between arms in studies that used pharmacotherapy to aid reduction. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Review Group specialised register using topic specific terms. The register contains reports of trials of tobacco addiction interventions identified from searches of MEDLINE, EMBASE and PsycInfo. We also searched reference lists of relevant papers and contacted authors of ongoing trials. Date of most recent search: July 2012. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that recruited adults who wanted to quit smoking. Studies included at least one condition which instructed participants to reduce their smoking and then quit and one condition which instructed participants to quit abruptly. DATA COLLECTION AND ANALYSIS: The outcome measure was abstinence from smoking after at least six months follow-up. We pooled the included trials using a Mantel-Haenszel fixed-effect model. Trials were split for two sub-group analyses: pharmacotherapy vs no pharmacotherapy, self help therapy vs behavioural support. Adverse events were summarised as a narrative. It was not possible to compare them quantitatively as there was variation in the nature and depth of reporting across studies. MAIN RESULTS: Ten studies were relevant for inclusion, with a total of 3760 participants included in the meta-analysis. Three of these studies used pharmacotherapy as part of the interventions. Five studies included behavioural support in the intervention, four included self-help therapy, and the remaining study had arms which included behavioural support and arms which included self-help therapy. Neither reduction or abrupt quitting had superior abstinence rates when all the studies were combined in the main analysis (RR= 0.94, 95% CI= 0.79 to 1.13), whether pharmacotherapy was used (RR= 0.87, 95% CI= 0.65 to 1.22), or not (RR= 0.97, 95% CI= 0.78 to 1.21), whether studies included behavioural support (RR= 0.87, 95% CI= 0.64 to 1.17) or self-help therapy (RR= 0.98, 95% CI= 0.78 to1.23). We were unable to draw conclusions about the difference in adverse events between interventions, however recent studies suggest that pre-quit NRT does not increase adverse events. AUTHORS' CONCLUSIONS: Reducing cigarettes smoked before quit day and quitting abruptly, with no prior reduction, produced comparable quit rates, therefore patients can be given the choice to quit in either of these ways. Reduction interventions can be carried out using self-help materials or aided by behavioural support, and can be carried out with the aid of pre-quit NRT. Further research needs to investigate which method of reduction before quitting is the most effective, and which categories of smokers benefit the most from each method, to inform future policy and intervention development

Gradual reduction vs abrupt cessation as a smoking cessation strategy in smokers who want to quit.

CLINICAL QUESTION: Is gradual smoking cessation associated with poorer success rates than abrupt cessation in smokers who want to quit? BOTTOM LINE: Gradual reduction may not be associated with a clinically significant difference in smoking cessation rates compared with abrupt cessation