Smoking in social housing among adults in England, 2015–2020: a nationally representative survey

Objectives: To analyse associations between living in social housing and smoking in England and to evaluate progress towards reducing disparities in smoking prevalence among residents of social housing compared with other housing types. / Design: Cross-sectional analysis of nationally representative data collected between January 2015 and February 2020. / Setting: England. / Participants: 105 562 adults (≥16 years). / Primary and secondary outcome measures: Linear and logistic regression were used to analyse associations between living in social housing (vs other housing types) and smoking status, cigarettes per day, time to first cigarette, exposure to others’ smoking, motivation to stop smoking, quit attempts and use of cessation support. Analyses were adjusted for sex, age, social grade, region and year. / Results: Adults living in social housing had two times the odds of being a smoker (ORadj=2.17, 95% CI 2.08 to 2.27), and the decline in smoking prevalence between 2015 and 2020 was less pronounced in this high-risk group (−7%; ORadj=0.98, 95% CI 0.96 to 1.01) than among adults living in other housing types (−24%; ORadj=0.95, 95% CI 0.94 to 0.96; housing tenure–survey year interaction p=0.020). Smokers living in social housing were more addicted than those in other housing types (smoking within 30 min of waking: ORadj=1.50, 95% CI 1.39 to 1.61), but were no less motivated to stop smoking (ORadj=1.06, 95% CI 0.96 to 1.17) and had higher odds of having made a serious attempt to quit in the past year (ORadj=1.16, 95% CI 1.07 to 1.25). Among smokers who had tried to quit, those living in social housing had higher odds of using evidence-based cessation support (ORadj=1.22, 95% CI 1.07 to 1.39) but lower odds of remaining abstinent (ORadj=0.63, 95% CI 0.52 to 0.76). / Conclusions: There remain stark inequalities in smoking and quitting behaviour by housing tenure in England, with declines in prevalence stalling between 2015 and 2020 despite progress in the rest of the population. In the absence of targeted interventions to boost quitting among social housing residents, inequalities in health are likely to worsen

'Stopping the start':support for proposed tobacco control policies - a population-based survey in Great Britain 2021-2023

OBJECTIVES: This study assessed public support for four proposed tobacco control policies in Great Britain: (1) Raising the sales age of tobacco by 1 year every year (Smokefree Generation); (2) Raising the sales age of tobacco from 18 years to 21 years; (3) Providing prescription e-cigarettes as smoking cessation aids to adults who smoke; (4) Restricting e-cigarette advertising to prevent youth uptake.DESIGN: Repeat cross-sectional population-based survey weighted to match the population of Great Britain.SETTING: The survey was conducted in England, Scotland and Wales in September 2021, October 2022 and October 2023.PARTICIPANTS: 6541 adults living in Great Britain.MAIN OUTCOME MEASURES: Support for each policy and year and prevalence ratios (PRs) comparing support between years and subgroups.RESULTS: The most popular policy each year was restricting e-cigarette advertising (74%/79%/85%), followed by raising the sales age to 21 years (50%/58%/64%), providing prescription e-cigarettes (45%/44%/47%) and Smokefree Generation (34%/44%/49%). The largest increases were for policies about the age of sale (Smokefree Generation: 2021/2022 PR=1.28, 95% CI 1.18 to 1.40, 2022/2023 PR=1.12, 95% CI 1.04 to 1.20; raising the age to 21 years: 2021/2022 PR=1.16, 95% CI 1.09 to 1.23, 2022/2023 PR=1.11, 95% CI 1.05 to 1.17). Only 30% opposed Smokefree Generation in 2023 down from 41% in 2021.CONCLUSIONS: Support for each policy increased each year, except for providing prescription e-cigarettes. Restricting e-cigarette advertising was the most popular policy, while support for age of sale policies, in particular for a Smokefree Generation, grew most.TRIAL REGISTRATION: The study protocol was published on the Open Science Framework (https://osf.io/46z2c/) prior to starting the analysis.</p

Reducing secondhand smoke exposure among nonsmoking pregnant women: a systematic review

Introduction: Exposure to second-hand smoke (SHS) in pregnancy leads to an increased risk of stillbirths, congenital malformations and low birth weight. There is a lack of evidence about how best to achieve reductions in SHS exposure among non-smoking pregnant women. This work systematically reviews individual or household interventions to reduce pregnant women’s exposure to SHS. Methods: MEDLINE, EMBASE and CINAHL databases were searched from their dates of inception to 17th April 2019. Studies were included if: participants were non-smoking pregnant women; involved an intervention to reduce SHS exposure or encourage partner quitting; and measured SHS exposure of pregnant women and/or recorded quit rates among partners. The UK National Institute for Health & Care Excellence (NICE) Quality Appraisal checklist was used to determine internal and external validity. Results: Nine studies met the inclusion criteria. Educational interventions were primarily targeted at the pregnant woman to change her or others’ behaviour, with only two studies involving the partner who smoked. Intervention delivery was mixed, spanning brief discussions through to more involving sessions with role play. The effective interventions involved multiple follow-ups. There was no standardised method of assessing exposure to SHS. Many of the included studies had moderate to high risk of bias. Conclusion: There is mixed evidence for interventions aimed at reducing pregnant women’s exposure to SHS, though multi-component interventions seem to be more effective. The effectiveness of family-centred approaches involving creating smoke-free homes alongside partner smoking cessation, perhaps involving pharmacological support and/or financial incentives, should be explored

Young People’s Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015-2017

Concern has been expressed about the use of e-cigarettes among young people. Our study reported e-cigarette and tobacco cigarette ever and regular use among 11–16 year olds across the UK. Data came from five large scale surveys with different designs and sampling strategies conducted between 2015 and 2017: The Youth Tobacco Policy Survey; the Schools Health Research Network Wales survey; two Action on Smoking and Health (ASH) Smokefree Great Britain-Youth Surveys; and the Scottish Schools Adolescent Lifestyle and Substance Use Survey. Cumulatively these surveys collected data from over 60,000 young people. For 2015/16 data for 11–16 year olds: ever smoking ranged from 11% to 20%; regular (at least weekly) smoking between 1% and 4%; ever use of e-cigarettes 7% to 18%; regular (at least weekly) use 1% to 3%; among never smokers, ever e-cigarette use ranged from 4% to 10% with regular use between 0.1% and 0.5%; among regular smokers, ever e-cigarette use ranged from 67% to 92% and regular use 7% to 38%. ASH surveys showed a rise in the prevalence of ever use of e-cigarettes from 7% (2016) to 11% (2017) but prevalence of regular use did not change remaining at 1%. In summary, surveys across the UK show a consistent pattern: most e-cigarette experimentation does not turn into regular use, and levels of regular use in young people who have never smoked remain very lo

Protecting local Government Public Health Policy from vested interests

Background and challenges to implementation Article 5.3 of the Framework Convention on Tobacco Control states that &#8220;in setting and implementing public health policies with respect to tobacco control, parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law&#8221;. The guidelines are applicable to government officials, representatives and employees of any national, state, provincial, municipal, local or other public institution. The new Tobacco Control Plan for England states the government will continue to uphold its obligation under the FCTC. Local authorities are also responsible for meeting the treaty obligations. Intervention or response The Tobacco Control Collaborating Centre (TCCC) and Action on Smoking and Health (ASH) worked with local areas to map key departments that fall under the remit of Article 5.3, then review their activities and policies for compliance with Article 5.3 and its guidelines. They used this audit to develop a strategy that will protect their public health policy from the vested interests of the tobacco industry. Results and lessons learnt ASH and TCCC have built a toolkit to support local government to protect public health policy. The workshop will: Make the case for local government to implement/amend policies in line with Article 5.3 Discuss the approach needed to embed policies in line with Article 5.3 in local government setting and explore ways of addressing the challenges that emerge Present materials designed to support this process. Include a short case study from a local authority who piloted the materials. Conclusions and key recommendations Embedding policies which protect tobacco policy from the commercial and vested interests of the tobacco industry at every level of government is an important part of ensuring strong delivery of tobacco control across the whole of government. Local administration face particular pressures and challenges that need to be addressed through this process

Understanding the tobacco retail environment; next frontier for UK tobacco control

Background and challenges to implementation The UK is now a 'dark market' as such the supply chain and availability of tobacco has become a more important part of the marketing mix for tobacco companies. A key tactic of tobacco companies has been to seek to persuade small tobacco retailers that their interests align with those of tobacco manufacturers and to encourage them to oppose tobacco regulations and participate in the promotion of products. This project sought to better understand the extent to which tobacco retailers and tobacco manufacturers share interests and identify where they diverge. Intervention or response A report and infographic was produced using three sources: Analysis of retail trade publications to assess the claims being made by tobacco companies regarding the retail environment. Analysis of point of sale data from independent tobacco retailers testing the claims of tobacco companies regarding the importance of tobacco sales to small retailers. Survey of independent tobacco retailers in Britain. This sought to better understand the existing relationship between retailers and manufacturers, attitudes of retailers towards tobacco control policies and the extent to which they agreed with the positions taken by tobacco manufacturers regarding the retail environment. Results and lessons learnt While tobacco sales accounted for 25% of total income, margins were around 6% compared to an average 24% for the other products. As such average weekly profit was only 1.6% of income. Little evidence to support manufacturers claims that tobacco drives footfall or that retailers should stock full range of brand variants. Conclusions and key recommendations We demonstrated that the existing and future interests of small retailers and manufacturers are not aligned. We identified opportunities to encourage a more responsible approach to tobacco retailing aligning with public health interests