Measuring the impact of the Capital Card®, a novel form of contingency management, on substance misuse treatment outcomes:A retrospective evaluation

Background The Capital Card, developed by WDP, is a digital innovation which acts as a form of contingency management, and aims to significantly improve service user outcomes. WDP is a substance misuse treatment provider commissioned by local authorities across the UK to support service users and their families affected by addiction. The Capital Card, much like commercial loyalty cards, uses a simple earn-spend points system which incentivises and rewards service users for engaging with services e.g. by attending key work sessions, Blood Borne Virus appointments or group-work sessions. The Spend activities available to service users are designed to improve overall wellbeing and build social and recovery capital, and include activities such as educational classes, fitness classes, driving lessons, and cinema tickets. Methods and findings We compared successful completion rates of 1,545 service users accessing one of WDP’s London based community services over a two-year period; before and after the Capital Card was introduced. Client demographics (age, sex and primary substance) were controlled for during the analysis. Once client demographics were controlled for, analysis showed that clients with a Capital Card were 1.5 times more likely to successfully complete treatment than those who had not had the Capital Card (OR = 1.507, 95% CI = 1.194 to 1.902). Conclusions The results of this initial evaluation are of particular interest to commissioners and policy makers as it indicates that the Capital Card can be used effectively as a form of contingency management to enhance recovery outcomes for service users engaging in community-based substance misuse services

Integrating visual and tactile information in the perirhinal cortex

By virtue of its widespread afferent projections, perirhinal cortex is thought to bind polymodal information into abstract object-level representations. Consistent with this proposal, deficits in cross-modal integration have been reported after perirhinal lesions in nonhuman primates. It is therefore surprising that imaging studies of humans have not observed perirhinal activation during visual–tactile object matching. Critically, however, these studies did not differentiate between congruent and incongruent trials. This is important because successful integration can only occur when polymodal information indicates a single object (congruent) rather than different objects (incongruent). We scanned neurologically intact individuals using functional magnetic resonance imaging (fMRI) while they matched shapes. We found higher perirhinal activation bilaterally for cross-modal (visual–tactile) than unimodal (visual–visual or tactile–tactile) matching, but only when visual and tactile attributes were congruent. Our results demonstrate that the human perirhinal cortex is involved in cross-modal, visual–tactile, integration and, thus, indicate a functional homology between human and monkey perirhinal cortices

Adolescent awareness and use of electronic cigarettes: A review of emerging trends and findings

Adult electronic cigarette (e-cigarette) use is increasing globally, and early studies have suggested that similar trends may be observed among the adolescent population, albeit at lower levels. The current literature review presents data collected since 2014 from 21 cross-sectional studies and one cohort study that were all published in English. In particular, it focuses on awareness, ever use, past 30-day use, and regular use of e-cigarettes. The article suggests that adolescents are nearing complete awareness of e-cigarettes. Furthermore, in relation to ever use and past 30-day use, higher prevalence rates continue to be reported across time, especially in the United States. Nonetheless, reported regular use of e-cigarettes remains much lower than past 30-day use, although conclusions are limited due to inconsistencies with measurement and consequent lack of cross-cultural applicability. The majority of studies do not report whether adolescents use non-nicotine e-cigarettes. There is a current absence of longitudinal studies that explore any association between e-cigarettes and tobacco use and little qualitative data that may illuminate how and why adolescents use e-cigarettes. Through addressing these methodological limitations, future research will be able to inform health care and policy more effectively

A Qualitative Exploration of the Role of Vape Shop Environments in Supporting Smoking Abstinence

E-cigarettes are the most popular method of quitting smoking in England and most are purchased in specialist vape shops. This qualitative study explores how the vape shop environment is experienced by quitters to support smoking abstinence. Semi-structured qualitative interviews were conducted to elicit experiences of e-cigarette use, including experiences of vape shops, in 40 people who had used e-cigarettes in a quit attempt. Observations of six shops in a range of locations were also undertaken. Interview and observation data were analysed using inductive thematic analysis and triangulated. At an individual level, smoking abstinence was supported through shop assistants’ attempts to understand customers’ smoking preferences in order to: (i) tailor advice about the most appropriate product; and (ii) offer an ongoing point of contact for practical help. At an interpersonal level, shops offered opportunity to socialise and reinforce a vaping identity, although the environment was perceived as intimidating for some (e.g., new and female users). At a structural level, shops ensured easy access to products perceived to be good value by customers and had adapted to legislative changes. Vape shops can provide effective behavioural support to quitters to maintain smoking abstinence. Health professionals could capitalise on this through partnership working with shops, to ensure best outcomes for clients wanting to use e-cigarettes to quit smoking

Response to Campbell et al., (2018) - Health risk perceptions and reasons for use of tobacco products among clients in addictions treatment

Campbell et al. (2018) paper focuses on an important issue, smoking amongst those seeking treatment for substance use disorder (SUD). The paper examines rates of use, health perceptions and reasons for use of tobacco and nicotine containing products in order to examine variables associated with product use

Medicalisation of vaping in the UK? E-cigarette users' perspectives on the merging of commercial and medical routes to vaping

Background: In the UK, most smokers choosing e-cigarettes to quit smoking will access vaping via commercial routes. In recent years, however, a shift towards medicalisation of vaping has become apparent, with public health guidance supporting e-cigarettes for smoking cessation and increased partnership working between healthcare professionals and the vaping industry. To achieve the UK’s Smokefree 2030 target, the UK Government has set out measures to utilise e-cigarettes in NHS settings and to move towards streamlining processes to make e-cigarettes available to a million smokers. This paper aims to understand acceptability of different approaches by seeking perspectives of people with lived experience of e-cigarette use for smoking cessation. Methods: Mixed methods data, collected between March 2018 and March 2019 as part of a broader study of e-cigarette use trajectories (ECtra study). Data here relate to views of partnership working and medicalisation of vaping extracted from 136 interviews/extended surveys of people who had used e-cigarettes to try to stop smoking. Qualitative data were thematically analysed. Participant ratings of interventions were presented descriptively and differences in participant characteristics and ratings were reported. Results: Three qualitative themes were identified: pro-partnership, anti-partnership and medicalisation dissonance. Medicalisation was discussed for its potential to reassure smokers about e-cigarette harms and its potential to reach smokers from disadvantaged backgrounds. Concerns were raised about cost-effectiveness, quality of support, conflicts of interest, and limiting product choice. Most participants rated interventions involving partnership working as potentially helpful in switching from smoking to vaping. There were no statistically significant associations between age, gender and socio-economic status and helpfulness ratings. Conclusions: Both commercial and medical routes to vaping offer perceived benefits to vapers and may complement and reinforce each other to support smoking cessation

Development of a Complex Intervention for the Maintenance of Postpartum Smoking Abstinence: Process for Defining Evidence-Based Intervention.

Relapse to tobacco smoking for pregnant women who quit is a major public health problem. Evidence-based approaches to intervention are urgently required. This study aimed to develop an intervention to be integrated into existing healthcare. A mixed methods approach included a theory-driven systematic review identifying promising behaviour change techniques for targeting smoking relapse prevention, and qualitative focus groups and interviews with women (ex-smokers who had remained quit and those who had relapsed), their partners and healthcare professionals (N = 74). A final stage recruited ten women to refine and initially test a prototype intervention. Our qualitative analysis suggests a lack, but need for, relapse prevention support. This should be initiated by a trusted 'credible source'. For many women this would be a midwife or a health visitor. Support needs to be tailored to individual needs, including positive praise/reward, novel digital and electronic support and partner or social support. Advice and support to use e cigarettes or nicotine replacement therapy for relapse prevention was important for some women, but others remained cautious. The resulting prototype complex intervention includes face-to-face support reiterated throughout the postpartum period, tailored digital and self-help support and novel elements such as gifts and nicotine replacement therapy (NRT)

Detector for imaging and dosimetry of laser-driven epithermal neutrons by alpha conversion

An epithermal neutron imager based on detecting alpha particles created by boron neutron capture mechanism is discussed. The diagnostic mainly consists of a mm thick Boron Nitride (BN) sheet (as an alpha converter) in contact with a non-borated cellulose nitride film (LR115 type-II) detector. While the BN absorbs the neutrons below 0.1 eV, the fast neutrons register insignificantly in the detector due to their low neutron capture and recoil cross-sections. The use of solid-state nuclear track detectors (SSNTD), unlike image plates, micro-channel plates and scintillators, provide safeguard from the x-rays, gamma-rays and electrons. The diagnostic was tested on a proof-of-principle basis, in front of a laser driven source of moderated neutrons, which suggests the potential of using this diagnostic (BN+SSNTD) for dosimetry and imaging applications