Identification and treatment of tobacco dependence among young people in residential homes during the statutory annual health assessment: a retrospective case-note review

Background Rates of tobacco smoking are substantially higher among young people accommodated in residential homes than in the general youth population. Public health guidance from the National Institute for Health and Care Excellence (NICE) recommends that all smokers should be identified, advised to quit, and offered treatment for tobacco dependence during health-care consultations. Opportunities to address tobacco dependence are available for young people in residential care through the annual statutory health review assessment (HRA). However, little is known about the extent to which HRA is used to address tobacco dependence among this population. We aimed to assess smoking-related recording and clinical practice during the HRA. Methods A retrospective review of the statutory health assessment forms of all young people accommodated in residential homes by an English local authority in the East Midlands between June 1, 2013, and May 31, 2014, was conducted. Practice was assessed with standards developed from statutory and NICE guidance relating the recording of smoking-related information during annual health assessments. Descriptive statistics were used to summarise the characteristics of the young people and the level of smoking-related recording. Associations between categorical variables were analysed with χ2 tests, and one-way ANOVA was used to assess continuous data. Ethics approval was provided by the Families, Young People & Children Clinical Audit, Standards, Effectiveness and Research Group of Leicestershire Partnership NHS Foundation Trust, and data were accessed under Section 251 of the NHS Act. Findings 31 young people were included in the review, of whom 30 (97%) had completed a statutory HRA. Inquiries about smoking were made in 23 (77%) instances. 12 (52%) of those who had participated in the HRA and who were asked about smoking were identified as smokers. Nine (75%) of these smokers engaged in discussions about their smoking and were offered treatment for tobacco dependence: two (22%) accepted a referral for treatment. The reasons for declining support for smoking cessation were documented in two (17%) cases. Interpretation Opportunities to address tobacco dependence among young people in residential homes are being missed during the HRA. Further research should explore clinician practice and attitudes to addressing tobacco dependence during the HRA and the perceptions of these young people in relation to receiving smoking cessation advice and the treatment offered. Funding This study was funded by a UK Centre for Tobacco and Alcohol Studies PhD studentship

Smoking and looked-after children: a mixed-methods study of policy, practice, and perceptions relating to tobacco use in residential units

Despite the implementation of smoke-free policies by local authorities and a statutory requirement to promote the health and well-being of looked-after children and young people in England, rates of tobacco use by this population are substantially higher than in the general youth population. A mixed-methods study, comprising a survey of residential care officers in 15 local authority-operated residential units and semi-structured, face-to-face interviews with residential carers in three local authority-operated residential units, was conducted in the East Midlands. Survey data were descriptively analysed; and interview data were transcribed and analysed using thematic framework analysis. Forty-two care officers (18% response rate) completed the survey, and 14 participated in the interviews. Despite reporting substantial awareness of smoke-free policies, a lack of adherence and enforcement became apparent, and levels of reported training in relation to smoking and smoking cessation were low (21%). Potential problems relating to wider tobacco-related harms, such as exploitative relationships; a reliance on tacit knowledge; and pessimistic attitudes towards LAC quitting smoking, were indicated. The findings highlight the need for the development of comprehensive strategies to promote adherence to and enforcement of local smoke-free policy within residential units for looked-after children and young people, and to ensure appropriate support pathways are in place for this population

Preparing for completely smoke-free mental health settings: findings on patient smoking, resources spent facilitating smoking breaks, and the role of smoking in reported incidents from a large mental health trust in England

Introduction: Despite high smoking prevalence and excessive smoking-related morbidity and mortality among people with mental disorder compared to the general population, smoking treatment is often neglected in mental health settings. The UK National Institute of Health and Clinical Excellence (NICE) recently issued public health guidance stipulating completely smoke-free mental health settings. This project evaluated existing smoking-related practices in preparation for guidance implementation. The objectives were to: audit the recording of smoking-related information and treatment provision; explore current arrangements relating to the facilitation of patient smoking; measure staff time spent and identify costs of facilitating smoking; and explore the role of smoking in smoking-related incidents. Methods: A mixed-methods study was conducted across four acute adult mental health wards, accommodating 16 patients each, over six months. It included a case-note audit, on-site observations, and a qualitative content analysis of incident reports. Results: Smoking status was recorded for less than half of the 290 patients admitted (138, 48%). Of those, 98 (71%) were recorded as current smokers, of whom 72 (74%) had received brief smoking cessation advice. Staff spent 6028 h facilitating smoking, representing an annual cost of £131,040 across four wards. Incident reports demonstrated that smoking facilitation was often central to the cause of incidences, triggered frustration in patients, and strained staff resources. Conclusion: The findings highlight the importance and potential of implementing completely smoke-free policies using comprehensive pathways

The prevalence of mental health problems among users of NHS stop smoking services: effects of implementing a routine screening procedure

<p>Abstract</p> <p>Background</p> <p>Tobacco dependence among people with mental health problems is an issue that deserves attention both from a clinical and from a public health perspective. Research suggests that Stop Smoking Services often fail to ask clients about underlying mental health problems and thus fail to put in place the treatment adaptations and liaison procedures often required to meet the needs of clients with a mental health condition who want to stop smoking. This study assesses the recording of mental health problems in a large NHS stop smoking service in England and examines the effect of implementing a short screening procedure on recording mental health conditions.</p> <p>Methods</p> <p>Treatment records from the Stop Smoking Service covering a period of 13 months were audited. The prevalence of reported mental health problems in the six month period before the implementation of the mental health screening procedure was compared with that of the six month period following implementation. The screening procedure was only implemented in the support services directly provided by the Stop Smoking Service. Comparisons were also made with third-party sections of the service where no such screening procedure was introduced.</p> <p>Results</p> <p>The prevalence of reported mental health problems among a total of n = 4999 clients rose from less than 1% before implementation of the screening procedure to nearly 12% in the period following implementation, with the change being statistically significant. No significant rise was observed over the same period in the sections of the service where no screening procedure was implemented.</p> <p>Conclusions</p> <p>The absence of standard procedures to record mental health problems among service users in many stop smoking services is currently likely to prevent the detection of co morbidity. Implementing a simple screening procedure appears suitable to increase the routine recording of mental health problems in a stop smoking service, which is an essential step to ensure services can be tailored and delivered appropriately to the client group.</p

Alcohol consumption and risk of common cancers: evidence from a cohort of adults from the United Kingdom

Background: Recent guidelines from the United Kingdom recommend that men and women should drink no more than 14 units of alcohol per week. This recommendation takes into account the link between alcohol and several cancers; however, there is a dearth of high quality evidence from the UK to support this. Methods: Alcohol consumption using a detailed diary was obtained from 8,670 adults representative of the UK population in 1984/5, with follow-up data from cancer registries until 2009. Hazard ratios (HR) adjusted for several variables including cigarette smoking were calculated for cancers of the breast, lung, colorectum and prostate separately using Cox regression. Results: Units per week on a typical basis, fitted as a linear term, was associated with breast cancer in women (HR=1.27 per 10 units/week; 95% CI 1.03-1.58) and lung cancer in men (HR=1.16; 1.06-1.27). Increased risks of lung (HR=2.23; 1.18-4.24) and colorectal (HR = 2.28; 1.13-4.57) cancer were seen in men at 15-28 units/week along with higher levels of consumption. Some findings differed by alcohol type. Conclusions: Overall, alcohol consumption of 15-28 units/week may be harmful in men with respect to common cancers. A linear association between alcohol consumption and risk of breast cancer was observed in women

The role of regular engagement with non-companion animals and proximity to green and blue space for mental health, wellbeing, and loneliness during Covid-19 social distancing measures: findings from a UK survey study

Context: The Covid-19 pandemic led to increased use of green/blue space as indoor spaces became frequently inaccessible. These changes impacted the direct interactions between humans and nature. Aims: To investigate the links between mental health, loneliness, wellbeing, and interaction with non-companion animals, proximity to and use of green/blue space. Methods: A cross-sectional online survey of adult UK residents was conducted between April and June 2020. The questionnaire included validated and bespoke items measuring demographics and exposures and outcomes related to mental health, wellbeing, loneliness, human-animal interactions with non-companion animals (wildlife/farm animals), and proximity to and use of green/blue space before and since the first UK Covid-19 lockdown. Key results: Of 5,926 participants, 4,408 (74.4%) reported interacting with non-companion animals at least every other day. Frequent engagement with non-companion animals was significantly associated with smaller decreases in mental health scores (b = .131, 95% CI [.007 – .256], p =.038) and smaller increases in loneliness scores (b = -.135, 95% CI [-.241 – .030], p = .012). Just under half (48.4%, n=2,867) reported living directly next to a green/blue space, and over half (52.3%; n=3,097) reported using such space at least every day since lockdown. Regular use of green/blue space since lockdown was significantly associated with higher mental health (b = .154, 95% CI [.037 – .272], p = .010), lower loneliness (b = -.334, 95% CI [-.430 – -.238], p =.001), and higher wellbeing (b = .810, 95% CI [.572 – 1.047], p = .001). Closer proximity to such space was significantly associated with lower loneliness scores (b = -.224, 95% CI [-.319 - -.130], p = .001), and higher wellbeing scores (b = .632, 95% CI [.319 - .873], p =.001). Conclusion: The multi-faceted human-nature relationship may promote key human health benefits in the context of the lockdown. Implications: These findings highlight the importance of green/blue space and the human-animal relationship, and how they might play a critical role in maintaining people’s mental health within a pandemic context. Further targeted investigations relating to these areas and links with human health, are important within both pandemic and non-pandemic contexts

Implementing complete smokefree policies in mental health inpatient settings Results from a before and after mixed-methods evaluation : results from a before and after mixed-methods evaluation

Abstract Background Tobacco smoking is extremely prevalent in people with severe mental illness (SMI) and has been recognised as the main contributor to widening health inequalities in this population. Historically, smoking has been deeply entrenched in the culture of mental health settings in the UK, and until recently, smokefree policies tended to be only partially implemented. However, recent national guidance and the government’s tobacco control plan now call for the implementation of complete smokefree policies. Many mental health Trusts across the UK are currently in the process of implementing the new guidance, but little is known about the impact of and experience with policy implementation. Methods This paper reports findings from a mixed-methods evaluation of policy implementation across 12 wards in a large mental health Trust in England. Quantitative data were collected and compared before and after implementation of NICE guidance PH48 and referred to 1) identification and treatment of tobacco dependence, 2) smoking-related incident reporting, and 3) prescribing of psychotropic medication. A qualitative exploration of the experience of inpatients was also carried out. Descriptive statistical analyses were performed, and the feasibility of collecting relevant and complete data for each quantitative component was assessed. Qualitative data were analysed using thematic framework analysis. Results Following implementation of the complete smokefree policy, increases in the numbers of patients offered smoking cessation advice (72% compared to 38%) were identified. While incident reports demonstrated a decrease in challenging behaviour during the post-PH48 period (6% compared to 23%), incidents relating to the concealment of smoking materials increased (10% compared to 2%). Patients reported encouraging changes in smoking behaviour and motivation to maintain change after discharge. However, implementation issues challenging full policy implementation, including covert facilitation of smoking by staff, were reported, and difficulties in collecting relevant and complete data for comprehensive evaluation purposes identified. Conclusions Overall, the implementation of complete smokefree policies in mental health settings may currently be undermined by partial support. Strategies to enhance support and the establishment of suitable data collection pathways to monitor progress are required