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

Exposing children to secondhand tobacco smoke (SHS) causes significant harm and occurs predominantly through smoking by caregivers in the family home. Researchers from UKCTAS at the University of Nottingham trialed a complex intervention designed to reduce secondhand smoke exposure of children whose primary caregiver feels unable or unwilling to quit smoking.

This was an open-label, parallel, randomised controlled trial carried out in deprived communities around Nottingham City and County.

The trial worked with caregivers who live 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.

The research compared a complex intervention that combined personalised feedback on home air quality, behavioural support and nicotine replacement therapy for temporary abstinence with usual care.

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.

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.

The team concluded that 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.

Read the full research report in the BMJ here.

This trial was funded by the UK National Institute for Health Research.

To find more information about this trial and the Smoke Free Homes project click here.

Over 200,000 children in England are living with Dependent Drinkers!

New figures released today reveal that over 200,000 children in England are living with dependent drinkers who could benefit from receiving specialist alcohol treatment.

The data from Public Health England estimates that there are 600,000 dependent drinkers who would benefit from treatment, yet only just over 100,000 are currently receiving the help they need.

These figures only cover adults who are most seriously dependent on alcohol. It is currently estimated that around 1.5 million adults in England and Wales have some form of alcohol dependence, and that there are 2.5 million children living with an adult drinking at risky levels.

The PHE data is released alongside a report from the Department for Work and Pensions (DWP) focused on improving the life chances and job prospects of the least well-off. The Department has said it will increase access to grant funding and introduce peer mentors for those in alcohol treatment to help them get back into work.

The report comes at a time when politicians are increasingly recognising the harm cheap alcohol is doing to the most vulnerable in society. The March budget included a consultation on the introduction of a new tax band designed to increase the price of strong white cider, a product which is predominantly consumed by children and heavy drinkers.

And earlier today a report published by the House of Lords Licensing Committee following an enquiry into the operation of the 2003 Licensing Act recognised the damage being done by cheap alcohol. The report calls for the introduction of a minimum unit price (MUP) for alcohol across the UK if it is introduced in Scotland and proves to be successful. Its introduction is being stalled by legal action being taken by sections of the alcohol industry. The report also calls for an end to multi-buy deals such as three for the price of two, a measure which has proved to be successful in Scotland.

Alcohol health experts welcomed the measures announced by the DWP today and the focus on the most vulnerable and lowest paid, pointing to studies which have shown that the least well off are around five times more likely to die from alcohol-related causes than those at the top of the income bracket.

Experts also called, however, for a wider, population-level approach to improving life and employment opportunities for dependent drinkers alongside greater support for individuals.

Liver physician Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

“We welcome the Government’s recognition that cheap alcohol is damaging some of the most vulnerable groups in society. The revelation that 200,000 children in England are living with adults in need of specialist help is deeply worrying. We need to make sure people get the support they need once they have a problem with alcohol, for their own sakes and for the sake of their children. But people don’t set out to become dependent drinkers and we need to stop more people from reaching that stage.

“For the greatest impact, the measures announced today should be combined with
measures like minimum unit pricing of alcohol. Studies have shown that setting a minimum price for alcohol would reduce unemployment and bring substantial numbers of unemployed drinkers back into the workforce.

“The government is already taking steps to tackle alcohol dependence in this broader way, with the recent announcement that it will be consulting on increasing the tax on high- strength ciders, drinks which are known to be drunk by the most vulnerable and do disproportionate harm.

“Studies also indicate that MUP would help address health inequalities, with over 80 per cent of lives saved coming from the lowest income groups. At the same time, the measure would not increase the price of alcohol sold in pubs and clubs.”

The Public Health England figures can be found here.
The DWP report, entitled Improving Lives: helping workless families, is available here.


About the Alcohol Health Alliance UK
The Alcohol Health Alliance UK (AHA) is a group of 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:
– Highlight the rising levels of alcohol-related health harm
– Propose evidence-based solutions to reduce this harm
– Influence decision makers to take positive action to address the damage caused by alcohol misuse

“Government has ‘no sense of direction’ in reducing devastating alcohol harm” | Lord Brooke

After Welfare, the cost of Health is the second biggest charge which Chancellors of the Exchequer have to deal with. Yet if one examines Budget speeches it rarely gets a mention, although in fairness to Phillip Hammond it did this year because of the crisis in Care which is directly linked to Health.

Health costs continue to grow at around 4% per annum but the economy is down around 2%. So with an aging population,the ‘health service car crash’ as one recent ex health service minister described it, every action must be taken or at least explored to avoid further injury or collapse.

That is what is at the heart of my debate – seeking changes that will reduce not only burgeoning public health costs but lead to healthier, happier and longer lives. As part of that, the Government must confront the stark challenge that alcohol abuse presents for the NHS in terms of financial costs, resources and impact on staff time and welfare.

Alcohol is estimated to cost the NHS around £3.5bn per year, which amounts to £120 for every taxpayer!

Even though drinking has declined marginally, there is a growing burden of alcohol related admissions and “activity” as our NHS tries to deal with the consequences of harmful drinking. This is not surprising when Public Health (England) recently reported:-

  • Alcohol is now the leading cause of death among 15 to 49 year olds.
  • There are now more than a million alcohol-related hospital admissions a year.
  • Alcohol caused more years of life lost to the workforce than from the 10 most cancers.
  • In England more than 10 million are drinking at levels that increase the risk of harming health.

There are 23,000 deaths related to alcohol in England each year, meaning that alcohol accounts for 10% of the UK burden of disease and death and is one of the three biggest avoidable risk factors of them.

Evidence indicates that the ease of access, availability and persistently cheap alcohol perpetuates these problems with deprivation and health inequalities particularly prevalent amongst men from lower socio-economic groups.

Alcohol is 60% more affordable today than it was in 1980. Affordability is one of the key drivers of consumption and harm: cheaper alcohol invariably leads to higher rates of death and disease.

David Cameron and the Coalition Government recognised this back in 2012 when they produced their progressive Alcohol Strategy. In its foreword he wrote”..and a real effort to get to grips with the root cause of the problem.That means coming down hard on cheap alcohol”

That hasn’t happened. Other aspects of the strategy have disappeared. There seems to be a vacuum with no discernible sense of direction. I will be pressing for one – the NHS certainly needs it.

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Lord Brooke of Alverthorpe is a Labour peer in the House of Lords.

Original post here: Politics Home

A Stop Smoking in Schools Trial: A process evaluation of the implementation of ASSIST in Scotland

…this study has demonstrated that it is feasible and acceptable to deliver the ASSIST programme in Scottish schools,

University of Stirling, Health Sciences

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In 2014 the Institute for Social Marketing and a team of collaborators were appointed to conduct a process evaluation of ASSIST (A Stop Smoking in Schools Trial). ASSIST is a peer-led, school-based smoking prevention programme that encourages the dissemination of non-smoking norms by training students aged 12-14 to work as peer supporters. ASSIST was previously evaluated via a large cluster randomised trial of 59 schools in South Wales and Avon, England. Results from this trial showed that ASSIST was effective and cost effective at reducing smoking prevalence in young people (Campbell et al 2008), (Hollingworth et al 2012). This led to the wider roll out of ASSIST in parts of England and Wales and more recently in Scotland.

The overall aim of the study was to evaluate the process of implementing ASSIST in Scotland.

Three different delivery models were piloted in three NHS boards. This did not impact on fidelity…

View original post 317 more words

Tobacco Control in England: Reducing Inequalities and Improving NHS Sustainability

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Public Health England and NHS England are hosting three one-day events with a practical focus on the current challenges and how they can be met, discussing implementation of tobacco control interventions and how the NHS can make its contribution, to the benefit not only of millions of smokers but its own sustainability.

London – Tuesday 4 April

Leeds – Wednesday 26 April

Birmingham – Thursday 4 May

Smoking rates in England have been declining steadily in the general adult population in recent years (17%), falling further and faster among young people (8%). However, hidden behind this success is slower progress among certain population groups, including individuals with mental health problems and those on lower incomes. Large geographical variations also remain, including amongst women who smoke during pregnancy.

Smokers from all groups are likely to be high users of healthcare services, with significant financial and capacity related implications. Addressing this will be key to ensuring NHS sustainability.

Reducing smoking is key to ensuring NHS sustainability and with the new national CQUIN for addressing risky behaviours (alcohol and tobacco) and local Sustainability and Transformation Plans, there is a fresh impetus for collective action to reduce the health inequalities caused by smoking.

Aim:

  • to explore opportunities for action across the local system to engage with smokers and support them to quit, tackling health inequalities and reducing the burden on the NHS and social care of smoking-related disease.

Objectives:

  • identify key areas for joint action to tackle smoking and reduce health inequalities
  • understand where smokers are accessing the healthcare system and how this impacts on primary and secondary care services
  • consider the ways in which healthcare professionals can integrate treatment for tobacco dependence into routine care and support smokers to quit

Who should attend?

  • local authority and NHS commissioners
  • CCG leads for acute care, mental health and maternity
  • healthcare and service providers
  • those with responsibility for managing: Commissioning for Quality and Innovation (CQUINS), delivery of Sustainability and Transformation Plans (STPs), implementation of the stillbirth reduction care bundle
  • regional strategic leads for health improvement and clinical networks

More information and registration!

Burwalls Annual Meeting for Teachers of Medical Statistics | University of Nottingham | 26-28th June 2017

Booking is now open for the Burwalls 2017 meeting which is being held at the University of Nottingham’s beautiful University Park campus towards the west of the city.

It is a great opportunity to share and network with other teachers of medical statistics who teach undergraduate medical students and health professionals.

The conference will open on Monday 26 June at 12.30pm, and close at 12.30pm on Wednesday 28 June.

A Programme will be available in the next few weeks and booking and will remain open until Monday 15th May at 5pm.

Getting there: Nottingham is easily accessible by train and coach. Frequent trains run direct from London St. Pancreas, Leicester, Derby, Sheffield and Birmingham, with connections to the north of England and Scotland and the South West. More information on train times and routes, see www.nationalrail.co.uk

Coaches arrive and depart from Broadmarsh bus station in the centre of the city and there are regular services to London, Derby and other destinations.

Full details of travel to/around Nottingham can be found here.

Car Parking: Parking is free of charge for registered delegates who will be issued with a permit for the duration of the conference. Car parking requirements will be requested at the time of booking.

More information: If you have any questions or would like more information about the event, please contact either:

Matthew Grainge, Conference organiser and Associate Professor of Medical Statistics (matthew.grainge@nottingham.ac.uk)
Graeme Docherty, Research Coordinator (graeme.docherty@nottingham.ac.uk)

More information and how to book your place!

University of Oxford PhD Studentship ~ Developing and testing peer-led interventions to promote switching from smoking to vaping.

Developing and testing peer-led interventions to promote switching from smoking to vaping.

PhD Studentship ~ Closing date: 26th May 2017

Applications are invited from individuals with a strong academic record who wish to develop a career in behavioural or primary care research. The student will join the thriving Health Behaviours team in the Nuffield Department of Primary Care Health Sciences who are working on range of interventions to support harm reduction and smoking cessation.

The project: The rise in popularity of electronic cigarettes (‘e-cigarettes’) in recent years has been accompanied by a growth in the number of virtual ‘vaper’ communities, with people sharing their advice and experiences of e-cigarettes with peers on internet support groups and discussion forums, many of which address ways of reducing or stopping smoking. The rise of peer to peer support is unique to e-cigarettes; no other means of stopping or reducing smoking attracts such passionate engagement from members of the public. This raises the possibility that we could better harness this peer support to enable more people to reduce or stop smoking using e-cigarettes and this project examines this. Continue reading