What are the main sources of smoking cessation support used by adolescent smokers in England?: a cross-sectional study

Background Adolescent smoking is a worldwide public health concern. Whilst various support measures are available to help young smokers quit, their utilization of cessation support remains unknown. Methods A cross-sectional study was conducted using data from the 2012 Smoking, Drinking and Drug Use among Young People survey to quantify the use of seven different types of cessation support by adolescents aged 11-16 in England who reported current smoking and having tried to quit, or ex-smoking. Logistic regression was used to calculate odds ratios and 95 % confidence intervals for the associations between participant characteristics and reported use of cessation support. Results Amongst 617 current and ex-smokers, 67.3 % (95 % CI 63.0-71.2) reported use of at least one cessation support measure. Not spending time with friends who smoke was the most commonly-used measure, reported by 45.4 % of participants (95 % CI 41.1-49.8), followed by seeking smoking cessation advice from family or friends (27.4 %, 95 % CI 23.7-31.5) and using nicotine products (15.4 %, 95 % CI 12.6-18.7). Support services provided by the National Health Service (NHS) were infrequently utilized. Having received lessons on smoking was significantly associated with reported use of cessation support (adjusted OR 1.55, 95 % CI 1.02-2.34) and not spending time with friends who smoked (adjusted OR 1.98, 95 % CI 1.33-2.95). Students with family members who smoked were more likely to report asking family or friends for help to quit (adjusted OR 1.74, 95 % CI 1.07-2.81). Respondents who smoked fewer cigarettes per week were generally less likely to report use of cessation support measures. Conclusion The majority of young smokers reported supported attempts to quit, though the support they used tended to be informal rather than formal. Evidence is needed to quantify the effectiveness of cessation support mechanisms which are acceptable to and used by young smokers

Did hardening occur among smokers in England from 2000 to 2010?

Aims To assess trends in the prevalence of ‘hardcore’ smoking in England between 2000 and 2010, and to examine associations between hardcore smoking and socio-demographic variables. Design Secondary analysis of data from the United Kingdom's General Lifestyle Survey (GLF) and the Health Survey for England (HSE). Setting Households in England. Participants Self-reported adult current smokers resident in England aged 26 years and over. Measurements Hardcore smokers were defined in three ways: smokers who do not want to quit (D1), those who ‘usually’ smoke their first cigarette of the day within 30 minutes of waking (D2) and a combination of D1 and D2, termed D3. Multivariable logistic regression was used to explore associations between these variables and calendar year, age, sex and socio-economic status, and P-values for trends in odds were calculated. Findings The odds of smokers being defined as hardcore according to D3 increased over time in both the GLF (P < 0.001) and HSE (P = 0.04), even after adjusting for risk factors. Higher dependence (D2) was noted in men [odds ratio (OR): 1.19, 95% confidence interval (CI): 1.13–1.24], those of 50–59 years (OR: 1.94, 95% CI: 1.80–2.09) and smokers in lower occupational groups (OR: 2.11, 95% CI: (1.97–2.26). Lack of motivation to quit (D1) increased with age and was more likely in men. Conclusions The proportion of smokers in England with both low motivation to quit and high dependence appears to have increased between 2000 and 2010, independently of risk factors, suggesting that ‘hardening’ may be occurring in this smoker populatio

Economic cost of smoking in people with mental disorders in the UK

Background Smoking is the largest preventable cause of death in the UK and imposes a huge economic burden on society. Both the prevalence and extent of smoking are significantly higher among people with mental disorders than among the general population. Aims To estimate the economic costs of the health effects of cigarette smoking among people with mental disorders in the UK from a societal perspective. Methods This study uses the WHO's economics of tobacco toolkit to assess the costs of the health effects of cigarette smoking among people with mental disorders in 2009/10 in the UK. Based on the cost of illness approach, direct healthcare costs, indirect morbidity costs and indirect mortality costs due to smoking-related diseases were calculated to estimate the avoidable economic burden of smoking in people with mental disorders. Results The estimated economic cost of smoking in people with mental disorders was £2.34 billion in 2009/10 in the UK, of which, about £719 million (31% of the total cost) was spent on treating diseases caused by smoking. Productivity losses due to smoking-related diseases were about £823 million (35%) for work-related absenteeism and £797 million (34%) was associated with premature mortality. Conclusions Smoking in people with mental disorders in the UK imposes significant economic costs. The development and implementation of smoking cessation interventions in this group should therefore be a high economic and clinical priority

Can primary care data be used to evaluate the effectiveness of tobacco control policies?: data quality, method development and assessment of the impact of smokefree legislation using data from the Health Improvement Network

Background: Smokefree legislation is just one of a number of tobacco control policies introduced in the UK in the last decade in an attempt to curb the harm caused by smoking. Whilst such legislation is known to have reduced non-smokers’ exposure to environmental tobacco smoke, less is known about whether the introduction of a smoking ban encourages existing smokers to attempt to quit and to seek support to do so from appropriate sources such as their general practitioner. High quality data are needed to evaluate the effectiveness of legislation in prompting smokers to change their smoking behaviour, and data collected routinely in primary care may provide such an opportunity. However, there is little contemporary evidence about the quality of the smoking data recorded in primary care, nor how best to analyse these data, which must be addressed before the resource can be used to evaluate the effectiveness of tobacco control policies. Methods: Initially, a systematic review was undertaken to assess the impact of national comprehensive smokefree legislation on population smoking prevalence, cigarette consumption and quitting behaviour. Then, the quality of smoking status and cessation intervention recording in The Health Improvement Network (THIN) database, a large database of UK primary care records, was investigated using indirect standardisation to compare rates of recording with external data sources. Having identified Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis as an appropriate method to assess the impact of smokefree legislation on measures of smoking-related clinical activity recorded in THIN data, several sensitivity analyses were untaken to assess the impact of decisions that must be taken during the data analysis process. In the light of this knowledge, ARIMA models were used to investigate changes in the rate of recording of patients’ smoking status, delivery of cessation advice, referral of smokers to specialist cessation services and prescribing of smoking cessation medications in the months leading up to, and after, the introduction of smokefree legislation. Results: The findings of the systematic review provide some evidence that in populations where well-enforced, comprehensive smokefree policies have been implemented quitting activity increased in the run up to, and/or following, the introduction of the legislation. Assessment of the quality of the smoking information recorded in THIN showed that the data have improved in recent years, such that the recorded prevalence of smoking is now similar to that reported in national surveys. Some uncertainty does, however, remain about the quality of recording of the delivery of cessation advice or referral of smokers to cessation services. ARIMA modelling highlighted a 6.2% increase in Nicotine Replacement Therapy (NRT) prescribing in the six months before smokefree legislation was introduced in England, and a 13.2% increase in bupropion prescribing in the three months pre-ban. A 5.5% decline in NRT prescribing and a 13.7% decline in bupropion prescribing were seen in the nine months post-legislation, declines which were offset to an extent, but not completely, by prescribing of varenicline which was first available on prescription in December 2006. Similar, though non-statistically significant, patterns were seen in Scotland, Wales and Northern Ireland, where the smaller number of practices in THIN in these countries reduced the power to detect small changes in prescribing. In England, the patterns of change in prescribing did not differ with patient sex, age group, medical history or social class. Conclusions: The improved quality of the smoking data recorded in the THIN dataset suggests that primary care data may be a valuable resource with which to evaluate the effectiveness of tobacco control policies such as smokefree legislation. The significant increases in prescribing of NRT and bupropion in the run-up to the introduction of smokefree legislation in the UK suggest that smokers looking to quit may seek support to do so from primary care, though the decline in rates of prescribing post-legislation suggests that this positive change may not be sustained. This may represent a missed opportunity to maximise the impact of smoking bans by ensuring that smokers are aware of, and indeed access, cessation support available through primary care both before and after legislation is enacted, and should be noted by policy makers planning the introduction of smokefree legislation elsewhere. Ensuring that smokers are aware of, and indeed access, the effective support that is available through primary care to help them quit may be one way to maximise the positive impacts of smokefree legislation and reduce the health and economic burdens of continued tobacco use

Restricted visiting reduces nosocomial viral respiratory tract infections in high-risk neonates

Restricting visitors on the neonatal intensive care unit to parents only during a worldwide pandemic resulted in a 39% reduction in nosocomial viral respiratory tract infections in neonatal patients. These findings need validating in a prospective trial

Association between women’s experience of domestic violence and childhood vaccination in West Africa: Cross-sectional analysis of Demographic and Health Survey data

Background: In 2021, 25 million children worldwide did not receive full basic childhood vaccinations, the highest figure in over a decade. There are large variations between countries in vaccination coverage. Globally, the lifetime prevalence of domestic violence among ever-partnered women is 30%. Exposure to domestic violence affects both maternal and child health. However, there is limited contemporary evidence on whether children born to women who are exposed to domestic violence are any more or less likely to be vaccinated. Methods: We conducted a cross-sectional study using data from the most recent Demographic and Health Surveys (DHS) from 7 West African countries (Benin, Gambia, Liberia, Mali, Nigeria, Senegal, Sierra Leone). We used multivariable logistic regression to examine the association between women’s lifetime experience of any emotional, physical and/or sexual domestic violence and whether her most-recent born child aged 12–35 months old had received a full complement of basic childhood vaccinations (covering tuberculosis, diphtheria, tetanus, pertussis, polio and measles). Results: Data from 9,104 mother-child pairs was analysed (range 480 from Senegal to 3,230 from Nigeria). Overall, 47% of children were fully vaccinated (range 31% in Nigeria to 81% in The Gambia). 41% of women reported any experience of domestic violence (range 20% in Senegal to 54% in Sierra Leone). After adjustment for a range of child, maternal, household and partner-level variables, children born to women who reported experience of domestic violence were no more or less likely to be fully vaccinated (adjusted odds ratio = 1.02, 95% confidence interval 0.90–1.17). There was some evidence that the association may vary by country; in Sierra Leone, children born to women who reported experience of domestic violence were significantly less likely to be fully vaccinated (adjusted odds ratio = 0.62, 95%CI 0.44–0.88). Conclusions: There was no significant association between a woman’s exposure to domestic violence and whether her child was fully vaccinated. Further work is needed to understand the contextual factors which may explain potential variations between countries

Rapidly increasing trend of recorded alcohol consumption since the end of the armed conflict in Sri Lanka

Aim: To evaluate temporal changes in recorded alcohol consumption in Sri Lanka during and after the armed conflict 1998 – 2013. Methods: District level alcohol sales, and mid-year population data for the whole study period (1998-2013) were consistently available from the Department of Excise and the Department of Census and Statistics for 18 of 25 districts. These data were used to estimate the recorded per capita consumption for the areas that were not directly exposed to the armed conflict. An interrupted time series design was employed to estimate the impact of the end of the armed conflict on recorded adult per capita alcohol consumption of population lived in the 18 districts. Results: Adult per capita recorded alcohol consumption among Sri Lankans living in the 18 districts was 1.59 litres of pure alcohol in 1998. This increased up to 2.07 litres in 2009 and 2.55 litres in 2013. Prior to the end of the conflict in 2009 adult per capita recorded consumption increased by 0.051 litres of pure alcohol per year (95% CI 0.029-0.074, p<0.001); after 2009 this was 0.166 litres per year (95% CI 0.095-0.236, p<0.001). Beer consumption showed the highest per capita growth compared with other beverages. Conclusions: Adult per capita recorded alcohol consumption among Sri Lankans living in areas that were not directly exposed to the conflict increased markedly after the end of the conflict. Rapid socio-economic development, alcohol industry penetration and lack of alcohol control strategies during the post-conflict period may have driven this increase

Measuring alcohol consumption in population surveys: a review of international guidelines and comparison with surveys in England

Aims: To review the international guidelines and recommendations on survey instruments for measurement of alcohol consumption in population surveys, and to examine how national surveys in England meet the core recommendations. Methods: A systematic search for international guidelines for measuring alcohol consumption in population surveys was undertaken. The common core recommendations for alcohol consumption measures and survey instruments were identified. Alcohol consumption questions in national surveys in England were compared with these recommendations for specific years and over time since 2000. Results: Four sets of international guidelines and three core alcohol consumption measures (alcohol consumption status, average volume of consumption, frequency and volume of binge drinking) with another optional measure (drinking context) were identified. English national surveys have been inconsistent over time in including questions that provide information on average volume of consumption but have not included questions on another essential alcohol consumption measure, frequency of heavy episodic drinking. Instead they have used questions that focus only on maximum volume of alcohol consumed on any day in the previous week. Conclusions: International guidelines provide consistent recommendations for measuring alcohol consumption in population surveys. These recommendations have not been consistently applied in English national surveys and this has contributed to the inadequacy of survey measurements for monitoring vital aspects of alcohol consumption in England over recent years

Exposure to point-of-sale displays and changes in susceptibility to smoking: findings from a cohort study of school students

Aims To investigate the association between frequency of visiting shops and noticing of tobacco point-of-sale (PoS) displays and the development of susceptibility to smoking, or smoking uptake, in secondary school students. Design Two surveys of a school based cohort study carried out in 2011 and 2012. Settings Nottinghamshire, UK. Participants A total of 2270 children aged 11–16 years from eight schools in Nottinghamshire. Measurements We investigated changes in susceptibility to smoking and smoking status in relation to frequency of visiting shops and noticing PoS displays and number of tobacco brands recognized, controlling for a range of potential confounders. Susceptibility to smoking was defined using a set of three questions covering intentions to try smoking, to smoke within the next year and likelihood of smoking if a best friend offered a cigarette. For the analysis we used multinomial logistic regression. Findings Among non-susceptible never smokers, noticing PoS displays more frequently was associated independently with an increased risk of becoming susceptible to smoking [adjusted relative risk ratio (RRR) = 1.74; 99% confidence interval (CI) = 1.13–2.69], but was not associated with smoking uptake. Recognizing a higher number of brands among non-susceptible never smokers doubled the risk of becoming susceptible to smoking and of becoming a smoker, but this did not have a significant effect on transition to smoking among susceptible never smokers. Frequency of noticing tobacco PoS displays was not associated significantly with smoking uptake among those who were susceptible never smokers at baseline. Conclusions Noticing tobacco point-of-sale displays more often and recognizing a higher number of tobacco brands is associated with an increased risk of becoming susceptible to smoking among adolescents in the United Kingdom, and recognizing a higher number of brands is associated positively with an increased risk of smoking uptake

A comparison of United Kingdom primary care data with other national data sources for monitoring the prevalence of smoking during pregnancy

Background: We aimed to assess the potential usefulness of primary care data for estimating smoking prevalence in pregnancy by comparing the primary care data estimates with those obtained from other data sources. Methods: In The Health Improvement Network (THIN) primary care database we identified pregnant smokers using smoking information recorded during pregnancy. Where this information was missing, we used smoking information recorded prior to pregnancy. We compared annual smoking prevalence from 2000 to 2012 in THIN with measures from the Infant Feeding Survey (IFS), Smoking At Time of Delivery (SATOD), Child Health Systems Programme (CHSP) and Scottish Morbidity Record (SMR). Results: Smoking estimates from THIN data converged with estimates from other sources after 2004, though still do not agree completely. For example, in 2012 smoking prevalence at booking was 11.6% in THIN using data recorded only during pregnancy, compared to 19.6% in SMR data. However, the use of smoking data recorded up to 27 months before conception increased the THIN prevalence to 20.3%, improving the agreement. Conclusion: Under-recording of smoking status during pregnancy results in unreliable prevalence estimates from primary care data and needs improvement. However, the inclusion of pre-conception smoking records may increase the utility of primary care data