Awareness of standardised tobacco packaging among adults and young people during the final phase of policy implementation in Great Britain

Background: In May 2016, along with the latest European Tobacco Products Directive (TPD), standardised packaging legislation was implemented in the UK. During the following 12-month transition period, both new and old types of packaging were allowed on the market. This study aimed to assess awareness of standardised packaging and other TPD changes in the UK population in March 2017, when both forms of packaging were in widespread use. Methods: We conducted two surveys—one in adults and one in young people—investigating awareness of plain packaging legislation. In young people, we also measured susceptibility to smoking using previously validated questions. We asked smokers whether they had recently changed the product they used and also whether they used any of the products that are banned by the new legislation. Results: In the adult survey, 73.5% (95% CI: 71.5–75.5%) of the participants were aware of the new legislation and 32.4% (95% CI: 30.3–34.5%) had noticed changes in tobacco packaging, this proportion being considerably higher among smokers (83.7%; 95% CI: 78.9–87.5%) than never smokers (20.7%; 95% CI: 18.2–23.4%). More than half (52.4%; 95% CI: 46.5–58.4%) were using pack sizes or shapes (typically less than 20 cigarettes or 30 g loose tobacco), that would become illegal after full TPD implementation, and 31.4% (95% CI: 26.2–37.1%) reported switching to a different product since October 2016, in most cases to a cheaper brand. Among young people, 20.2% (95% CI: 17.8–22.7%) reported that they had noticed standardised packaging, comprising 16.2% (95% CI: 13.7–19.0%) of non-susceptible never smokers, 25.6% (95% CI: 18.0–35%) of susceptible never smokers, and 49% (95% CI: 37.8–60.2%) of ever smokers. Conclusions: In the final stages of implementation, awareness of the introduction of standardised packs was highest among smokers. The TPD will cause nearly half of adult smokers to purchase larger packs, and may cause many smokers to switch to cheaper brands

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

Carlsberg alibi marketing in the UEFA Euro 2016 football finals: implications of Probably inappropriate alcohol advertising

Background: Alcohol advertising is a key driver of alcohol consumption, and is prohibited in France by the Loi Evin. In 2016 the Danish brewer Carlsberg sponsored the UEFA Euro 2016 finals, held in France, and used the alibis ‘Probably’ and ‘…the best in the world’ in place of Carlsberg in pitch-side advertising. We have quantified the advertising exposure achieved during the final seven games in the UEFA Euro 2016 championship. Methods: Appearances of the Carlsberg alibis ‘Probably’ and ‘the best in the world’ were counted and timed to the nearest second during all active play in live coverage of quarter final, semi-final and final matches broadcast in the UK. We used census data and viewing figures from Kantar Media to estimate gross and per capita impressions of these advertisements in the UK population. Results: In 796 minutes, 29 seconds of active play there were 746 alibi appearances, totalling 68 minutes 35 seconds duration and representing 8.6% of active playing time. Appearances were particularly frequent at the end of normal time, extra time and penalties. The seven matches delivered up to 7.43 billion Carlsberg alibi impressions to UK adults and 163.3 million to children. In the only match involving a second country with laws prohibiting alcohol advertising (France versus Iceland), exposure occurred for only 1.8% of playing time. Conclusions: Alibi marketing achieved significant advertising coverage during the final seven EURO 2016 championship games, particularly to children. Since ‘Probably’ is registered by Carlsberg as a wordmark this advertising appears to contravene the Loi Evin, though Carlsberg have defended their marketing actions

Corrigendum: A content analysis of tobacco and alcohol audio-visual content in a sample of UK reality TV programmes

Exposure to tobacco and alcohol content in audio-visual media is a risk factor for smoking and alcohol use in young people. We report an analysis of tobacco and alcohol content, and estimates of population exposure to this content, in a sample of reality television programmes broadcast in the UK. We used 1-minute interval coding to quantify tobacco and alcohol content in all episodes of five reality TV programmes aired between January and August 2018 (Celebrity Big Brother; Made in Chelsea; The Only Way is Essex; Geordie Shore and Love Island), and estimated population exposure using viewing data and UK population estimates. We coded 5219 intervals from 112 episodes. Tobacco content appeared in 110 (2%) intervals in 20 (18%) episodes, and alcohol in 2212 (42%) intervals and in all episodes. The programmes delivered approximately 214 million tobacco gross impressions to the UK population, including 47.37 million to children; and for alcohol, 4.9 billion and 580 million respectively. Tobacco, and especially alcohol, content is common in reality TV. The popularity of these programmes with young people, and consequent exposure to tobacco and alcohol imagery, represents a potentially major driver of smoking and alcohol consumption

A randomised controlled trial of a complex intervention to reduce children’s exposure to secondhand smoke in the home

Objectives: Exposing children to secondhand tobacco smoke (SHS) causes significant harm and occurs predominantly through smoking by caregivers in the family home. We report a trial of a complex intervention designed to reduce secondhand smoke exposure of children whose primary caregiver feels unable or unwilling to quit smoking. Design: An open-label, parallel, randomised controlled trial. Setting: Deprived communities in Nottingham City and County, England Participants: Caregivers resident in Nottingham City and County in England who were at least 18 years old, the main caregiver of a child aged under 5 years living in their household, and reported that they were smoking tobacco inside their home. Interventions: We compared a complex intervention combining personalised feedback on home air quality, behavioural support and nicotine replacement therapy for temporary abstinence with usual care. Main outcomes: The primary outcome was change in air quality in the home, measured as average 16–24 hours levels of particulate matter of <2.5 µm diameter (PM2.5), between baseline and 12 weeks. Secondary outcomes included changes in maximum PM2.5, proportion of time PM2.5 exceeded WHO recommended levels of maximum exposure of 25 µg/mg3, child salivary cotinine, caregivers’ cigarette consumption, nicotine dependence, determination to stop smoking, quit attempts and quitting altogether during the intervention. Results: Geometric mean PM2.5 decreased significantly more (by 35.2%; 95% CI 12.7% to 51.9%) in intervention than in usual care households, as did the proportion of time PM2.5 exceeded 25 µg/mg3, child salivary cotinine concentrations, caregivers’ cigarette consumption in the home, nicotine dependence, determination to quit and likelihood of having made a quit attempt. Conclusions: By reducing exposure to SHS in the homes of children who live with smokers unable or unwilling to quit, this intervention offers huge potential to reduce children’s’ tobacco-related harm. Trial registration number ISRCTN81701383. This trial was funded by the UK National Institute for Health Research (NIHR): RP-PG-0608-10020 http://dx.doi.org/10.1136/tobaccocontrol-2016-05327

Population exposure to smoking and tobacco branding in the UK reality show Love Island'

Background: Reality television shows are popular with children and young adults; inclusion of tobacco imagery in these programmes is likely to cause smoking in these groups. Series 3 of the UK reality show Love Island, broadcast in 2017, attracted widespread media criticism for high levels of smoking depicted. We have quantified this tobacco content and estimated the UK population exposure to generic and branded tobacco imagery generated by the show. Methods: We used 1-minute interval coding to quantify actual or implied tobacco use, tobacco paraphernalia or branding, in alternate episodes of series 3 of Love Island; and Census data and viewing figures from Kantar Media to estimate gross and per capita tobacco impressions. Results: We coded 21 episodes comprising 1001 minutes of content. Tobacco imagery occurred in 204 (20%) intervals; the frequency of appearances fell significantly after media criticism. An identifiable cigarette brand, Lucky Strike Double Click, appeared in 16 intervals. The 21 episodes delivered an estimated 559 million gross tobacco impressions to the UK population, predominantly to women, including 47 million to children aged <16; and 44 million gross impressions of Lucky Strike branding, including 4 million to children <16. Conclusion: Despite advertising legislation and broadcasting regulations intended to protect children from smoking imagery in UK television, series 3 of Love Island delivered millions of general and branded tobacco impressions both to children and adults in the UK. More stringent controls on tobacco content in television programmes are urgently needed

Adult and adolescent exposure to tobacco and alcohol content in contemporary YouTube music videos in Great Britain: a population estimate

Background: We estimate exposure of British adults and adolescents to tobacco and alcohol content from a sample of popular YouTube music videos. Methods: British viewing figures were generated from 2 representative online national surveys of adult and adolescent viewing of the 32 most popular videos containing content. 2068 adolescents aged 11–18 years (1010 boys, 1058 girls), and 2232 adults aged 19+years (1052 male, 1180 female) completed the surveys. We used the number of 10 s intervals in the 32 most popular videos containing content to estimate the number of impressions. We extrapolated gross and per capita impressions for the British population from census data and estimated numbers of adults and adolescents who had ever watched the sampled videos. Results: From video release to the point of survey, the videos delivered an estimated 1006 million gross impressions of alcohol (95% CI 748 to 1264 million), and 203 million of tobacco (95% CI 151 to 255 million), to the British population. Per capita exposure was around 5 times higher for alcohol than for tobacco, and nearly 4 times higher in adolescents, who were exposed to an average of 52.1 (95% CI 43.4 to 60.9) and 10.5 (95% CI 8.8 to 12.3) alcohol and tobacco impressions, respectively, than in adults (14.1 (95% CI 10.2 to 18.1) and 2.9 (95% CI 2.1 to 3.6)). Exposure rates were higher in girls than in boys. Conclusions: YouTube music videos deliver millions of gross impressions of alcohol and tobacco content. Adolescents are exposed much more than adults. Music videos are a major global medium of exposure to such content

The effect of alcohol packaging size and strength on U.K. alcohol consumers’ classification of alcohol products as containing a single or multiple drinks

Objective: Reductions to the size and strength of alcohol products prompt reductions in alcohol consumption, although these effects may be limited to single drinks rather than packages that contain multiple drinks. This study investigated what product characteristics predict whether a product is seen as a single drink and seeks to identify the thresholds beyond which products are considered to contain multiple drinks. Methods: Ninety-four UK drinkers from the Prolific participant panel categorized 250 alcohol products with varying packaging sizes and strengths into single or multiple drinks. We used multilevel logistic regression to investigate whether packaging size, strength, total alcohol content and container type predicted the likelihood that products were classified as a single drink across five drink types (beer, cider, ready-to-drink, spirits, wine). We used receiver operating characteristics curve analysis to identify the point at which products become too large or too strong to be considered a single drink by most drinkers. Results: Larger products, bottled drinks, products with higher ABV and higher alcohol content were more likely to be classified as containing multiple drinks. We report thresholds for packaging size, ABV and total alcohol content where products switch from being seen as a single drink to containing multiple drinks. The thresholds did not significantly differ between low risk and increased risk drinkers. Conclusion: The reported thresholds can help researchers and policy makers encourage more accurate self-monitoring of alcohol consumption. Future research should test whether single drink classifications moderate the effect of packaging size and strength reductions on alcohol consumption

A content analysis of tobacco and alcohol audio-visual content in a sample of UK reality TV programmes.

Background: Exposure to tobacco and alcohol content in audio-visual media is a risk factor for smoking and alcohol use in young people. We report an analysis of tobacco and alcohol content, and estimates of population exposure to this content, in a sample of reality 6television programmes broadcast in the UK. Methods: We used one-minute interval coding to quantify tobacco and alcohol content in all episodes of five reality TV programmes aired between January and August 2018 (Celebrity Big Brother; Made in Chelsea ; The Only Way is Essex ; Geordie Shore and Love Island), and estimated population exposure using viewing data and UK population estimates. Results: We coded 5219 intervals from 112 episodes. Tobacco content appeared in 110 (2%) intervals in 20 (18%) episodes, and alcohol in 2212 (42%) intervals and in all episodes. The programmes delivered approximately 204 million tobacco gross impressions to the UK population, including 48.26 million to children; and for alcohol, 5.4 billion and 593 million respectively. Conclusion: Tobacco, and especially alcohol, content is common in reality TV. The popularity of these programmes with young people, and consequent exposure to tobacco and alcohol imagery, represents a potentially major driver of smoking and alcohol consumption

Systematic delivery of a smoking cessation intervention after discharge from a secondary care setting

Background Hospital admission provides an ideal opportunity to promote smoking cessation. Clinical guidelines recommend delivery of cessation interventions for all admissions but no research to date has focused on supporting smokers who successfully abstain from smoking whilst in hospital to maintain abstinence after discharge. We therefore designed a trial to test the effectiveness of an intensive home support intervention to maintain abstinence from smoking for newly abstinent smokers leaving hospital Methods Participants were recruited from 18 medical wards in one large teaching hospital in the UK and were individually randomised to either intervention or usual care using concealed allocation. During inpatient stay both treatment groups received smoking cessation support as recommended in NICE PH48 guidance. At discharge, patients randomised to usual care were offered a referral to a community Stop Smoking Service (SSS). Patients randomised to the intervention group were offered a home visit (or telephone call if a home visit is refused), as soon as practicable after discharge and typically within 48 hours, to deliver a multi-component intervention which included personalised behavioural support and nicotine replacement therapies (NRT). All smokers were asked to give consent to be contacted at four-weeks and three-months after discharge to assess smoking status and use of cessation support. Results 404 patients were randomised in total. 200 to intervention and 204 to usual care. Primary outcome data were available at four-weeks for 149 and 134 patients, respectively. Preliminary results demonstrate no statistically significant difference in quit rates between treatment groups at either 4 (21.00% intervention, 19.12% usual care) or 12 weeks (19.50% Intervention and 16.18% Usual Care) following discharge. Conclusions Adding a home visit to deliver additional smoking cessation support to patients who have remained abstinent during their hospital stay and treated according to NICE PH48 guidance does not increase quit rates