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.

Clearing the air around e-cigarettes

Fears that “vaping” is a gateway to tobacco smoking are unfounded, shows a comprehensive review of available evidence on the harms and benefits of electronic or e-cigarettes and vapour devices, released today by University of Victoria’s Centre for Addictions Research of BC (CARBC) in a report called “Clearing the Air.”

Researchers surveyed the rapidly increasing academic literature on e-cigarettes and found evidence that vaping is replacing—rather than encouraging—the smoking of tobacco cigarettes among young people. The CARBC researchers identified 1,622 articles on the topic, of which 170 were relevant to their review. Evidence shows that tobacco use by youth has been declining while use of vapour devices has been increasing.

“Fears of a gateway effect are unjustified and overblown,” says principal investigator Marjorie MacDonald. “From a public health perspective, it’s positive to see youth moving towards a less harmful substitute to tobacco smoking.”

Among their other observations, CARBC researchers found strong evidence that the vapour from e-cigarettes is less toxic than tobacco cigarette smoke. Vapour devices do not release tar, and vapour emissions contain only eighteen of the 79 toxins found in cigarette smoke, including considerably lower levels of certain cancer causing agents and volatile organic compounds (VOCs). Almost all substances tested were substantially lower, or not detected, in vapour devices compared to cigarettes.

In addition, vapour from electronic devices is airborne for less than 30 seconds compared to 18 to 20 minutes for tobacco smoke, substantially reducing the time of second-hand exposure.

Researchers caution, however, that some vapour devices may contain potentially concerning levels of metals and particulate matter, noting that there has been insufficient research regarding some significant carcinogens that may still be present.

Finally, they found encouraging evidence that vapour devices could be at least as effective as other nicotine replacements as aids to help tobacco smokers quit.

“The public has been misled about the risks of e-cigarettes,” concludes Tim Stockwell, CARBC director and co-principal investigator. “Many people think they are as dangerous as smoking tobacco but the evidence shows this is completely false.”

A media kit containing author photos, full report (for media only, not for publication), and an infographic is available on Dropbox. An executive summary is available here.

Click here to read the original story on University of Victoria’s website.

Media contacts:
Tim Stockwell (Director, UVic’s Centre for Addictions Research) at 250-472-5445 or timstock@uvic.ca
Marjorie MacDonald (Scientist, UVic’s Centre for Addictions Research/Nursing) at 250-472-4399 or marjorie@uvic.ca
Suzanne Ahearne (University Communications + Marketing) at 250-721-6139 or sahearne@uvic.ca

MAJOR NEW REPORT  – UK HOSPITALS FAIL TO MEET NATIONAL STANDARDS IN EITHER HELPING PATIENTS QUIT SMOKING OR PROVIDING ‘SMOKE-FREE ENVIRONMENTS’

 

According to a major new report launched today (7/12/16) by the British Thoracic Society (BTS), NHS hospitals across UK are falling ‘woefully short’ of national standards on helping patients to quit smoking and enforcing smoke-free premises.

Experts f1-mediumpresenting the findings at the British Thoracic Society (BTS) Winter Meeting, will state that many NHS hospitals are missing out on a ‘golden opportunity’ to provide what is often the most effective front-line treatment for smoking patients who are sick  –  support and medication to help them quit tobacco.

The BTS Report ‘Smoking cessation: policy and practice in NHS hospitals’ is
unique in its scope and size; reviewing the smoking cessation & smoke-free policies and practices of 146 hospitals across UK between April and May 2016 – including the analysis of 14,750 patient records.

The main findings of the report are as follows:

  • Over 7 in 10 (72%) hospital patients who smoked were not asked if they’d like to stop
  • Only 1 in 13 (7.7%) hospital patients who smoked were referred for hospital-based or community treatment for their tobacco addiction
  • Over 1 in 4 (27%) hospital patients were not even asked if they smoke
  • Only 1 in 10 hospitals completely enforce their fully smoke-free premises. Rates of enforcement were even lower for hospitals which provided areas where smoking was allowed. The report highlights the importance of a smoke-free NHS – to trigger and support quit smoking attempts for patients and reduce second hand smoke exposure for children, staff and the public
  • Provision of nicotine replacement therapies and other smoking cessation treatments were ‘poor’ in hospital pharmacy formularies
  • Only 26% of hospitals had an identified consultant ‘lead’ overseeing their smoke-free and smoking cessation plans
  • 50% of frontline healthcare staff in hospitals were not offered training in smoking cessation

In the study, 25% of hospital patients were recorded as being ‘current smokers’ – which is higher than rates in the general adult population (19%)   Other studies have shown that approximately 1.1 million smokers are admitted to NHS hospitals a year.

The Society is using the report findings to call for all hospitals to deliver NICE Guidelines in this area (PH48) and that national regulators such as the Care Quality Commission (CQC) hold Hospital Boards accountable for the delivery of smoke-free and smoking cessation hospital policies.

The report also highlights a number of key activities that all NHS hospitals should deliver to help more of their patients quit smoking:

  1. Offer a prescription for Nicotine Replacement Therapy to all patients who smoke to help them cope with their tobacco dependence whilst in hospital
  1. Refer all patients who smoke in hospital to specialised stop smoking support services to explore the option of quitting smoking. Patients can opt out if they like – but the NHS should try to offer the most effective treatment and support whatever the illness – and with many smoking-related conditions such as chronic obstructive pulmonary disease (COPD), support and medication to help people quit smoking are the best front line treatments
  1. Employ an appropriately skilled senior clinician within the hospital to oversee, drive forward, and be accountable for the hospital’s smoking cessation service
  1. Employ smoking cessation practitioners in every hospital – this was recommended by NICE in 2013 but the report shows patchy delivery across the country
  1. Hospital Board involvement in delivering plans is key. Delivering smoke-free hospital grounds – as part of a wider smoking cessation policy – requires Hospital Boards to work together including the chief executive, director of human resources, director of facilities and the medical and nursing directors – in partnership with the ‘smoking cessation lead’ at the hospital

The Society is also encouraging more health professionals to become BTS ‘Stop Smoking Champions’ in their hospital. There are over 160 at present and they deliver a range of vital activities to champion stop smoking service provision.

For further information, contact stopsmokingchampions@brit-thoracic.org.uk or to see a video about the initiative go to: https://www.brit-thoracic.org.uk/standards-of-care/quality-improvement/smoking-cessation/bts-stop-smoking-champions/

Dr Sanjay Agrawal, Consultant Lung Specialist & Chair of the British Thoracic Society’s Tobacco Group, who led the audit said:

“Our report shows that many NHS hospitals are woefully failing to meet national guidance on delivering smoking cessation services and smoke-free premises. This is a dangerous situation that is costing the country dear in both health and economic terms. We must do better. Critically, hospitals are missing out on a golden opportunity to help supply often THE most effective treatment for illnesses that smokers are admitted with – support and treatment for their tobacco dependence.  If patients in other disease areas were not offered, by default, the most effective way to treat their condition – there would probably be an uproar. Nevertheless, this happens all too frequently with people with smoking-related illnesses. Many hospital boards need to sort out their leadership, plans and resources on this issue – so they can deliver some simple but life-changing steps: identify patients who smoke, ask them if they’d like to quit – and give effective treatment and support to help them stop.”

Dr Lisa Davies, Consultant Respiratory Physician at Aintree University Hospital and Chair of the British Thoracic Society Board, said:

“Being admitted to hospital should be a real window of opportunity for smokers to quit – given that smoking should be prohibited on the premises, tobacco use may be linked to their health condition, and expert stop smoking advice and therapies are potentially ‘on tap.’ This report shows, however, that we need to fund, plan and deliver smoking cessation work in hospitals far better – so we can fully deliver on this opportunity for our patients.

At a wider level, there is a real fight going on for the future of stop smoking support services in this country.  Many local authorities, facing overall budget reductions, have cut funding for community-based stop smoking services – meaning that people who need support may have nowhere to go.

The NHS must urgently work together, alongside local authorities, to plan and fund these vital services – to ensure no-one who needs treatment and support to stop smoking falls through the net.”

British Thoracic Society – UK hospitals fail to meet national standards in helping patients to quit smoking

British Thoracic Society, Smoking Cessation Audit Report:

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External news sources:

AOL – Hospitals ‘woefully failing’ to crack down on smoking

The Guardian – A third of children hospitalised with asthma ‘exposed to cigarette smoke’

Birmingham Mail – Number of patients forced to wait for hospital bed ‘rockets in five years’

NHE – All STPs urged to help patients quit smoking

The BMJ – NHS hospitals must help patients quit smoking, says British Thoracic Society

Experts say WHO needs better understanding of the evidence on e-cigs to inform its international tobacco control treaty.

A new WHO report fails to properly evaluate the evidence on e-cigarettes and could even undermine international efforts to reduce smoking, says a group of UK based academics.

UK academics are calling for better understanding of the potential benefits of e-cigarettes to reducing the smoking pandemic ahead of an international gathering of countries that have signed the World Health Organisation’s Framework Convention for Tobacco Control.

The 7th session of the Conference of the Parties (COP) of the Framework Convention on Tobacco Control (FCTC), a global public health treaty, will be held in Delhi, India from 7th-12th November 2016. At this meeting, Parties to the treaty (countries and other jurisdictions) will discuss whether similar policy measures recommended to reduce tobacco use should be applied to e-cigarettes.

In advance of the COP the World Health Organisation published a report about Electronic Nicotine Delivery Systems (ENDS) and Electronic Non-Nicotine Delivery Systems (ENDDS), also known as e-cigarettes. This aimed to summarise the evidence about these devices.

Academics from the UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research Centre of Excellence, have today published a robust critique of the WHO report setting out a series of concerns about the content of the document which, in their view, screen-shot-2016-10-26-at-12-37-14does not fairly represent existing evidence on e-cigarettes. Their critique examines each element of the WHO report and identifies flaws in the way the evidence is presented and problems with how the report could be interpreted, potentially encouraging countries to adopt excessive restrictions on e-cigarettes which could undermine efforts to reduce smoking.

The UKCTAS critique points to evidence set out in the recent Royal College of Physician’s’ report ‘Nicotine without Smoke’ and subsequent research which recognise that e-cigarettes are far less harmful than smoking and that smokers who find it difficult to stop should be encouraged to use them.

The WHO report fails to accurately present what is already known about e-cigarettes. In particular, it: positions e-cigarettes as a threat rather than an opportunity to reduce smoking; fails to accurately quantify any risks of e-cigarettes compared with smoking; misrepresents existing evidence about any harms to bystanders; discounts the fact that e-cigarettes are helping smokers to quit; does not recognise the place of some promotion of e-cigarettes to encourage smokers to switch to these less harmful products; fails to understand that the flavours in e-cigarettes are useful for people trying to stop smoking; mischaracterises the current e-cigarette market screen-shot-2016-10-26-at-12-39-18and appears to support very restrictive policies on e-cigarettes without including any good policy analysis. In addition, the WHO report does not acknowledge that significant restrictions on e-cigarettes could lead to unintended consequences, including increases in smoking.

Finally, the researchers point out that the WHO briefing is based on four unpublished papers which are still undergoing peer review, which does not allow for open, transparent scrutiny of the evidence. This does not, therefore, provide a good basis for policy making and risks undermining rather than promoting the aims of the FCTC, which is a treaty that was designed to help countries reduce smoking rates and save lives.

To read the full report click here.

Continue reading

Electronic cigarettes could have a huge effect on public health | Marcus Munafo, University of Bristol

June 20, 2016 2.17pm BST – Marcus Munafo – The Conversation

Tobacco still kills 6m people around the world every year. Despite huge public health efforts to help people quit and prevent young people starting, smoking remains the single greatest cause of ill health and premature death. And even with restrictions on tobacco advertising and smoking in public places, many young people continue to take up smoking. The situation is even worse in poorer countries, where support to stop smoking is limited, and tobacco control policies weaker.

So in light of this, how should we view the increasing popularity of electronic cigarettes?

image-20160620-8853-1qda1qwThe gadgets deliver a nicotine hit by heating a nicotine-containing propylene glycol (e-liquid) to create an aerosol (usually called “vapour”), which is inhaled. Put simply, they deliver nicotine almost as effectively as a conventional cigarette, but without the vast majority of other chemicals present in tobacco smoke (either from the tobacco itself, or as a result of the burning process).

A whole culture is emerging around “vaping”. Many devices offer a range of power settings, and a vast array of e-liquids is on offer, with varying nicotine contents and flavours. Enthusiasts often apply modifications to their devices, and engage in “cloud chasing” – competing to produce the largest and most interesting clouds of vapour. And yes, young people are experimenting with e-cigarettes (in the same way that they have always experimented with pretty much everything), although at the moment there is no strong evidence this is leading to subsequent cigarette use, or even long-term e-cigarette use.

The rapid growth in use of e-cigarettes, especially among smokers trying to cut down or quit, has taken the public health community and the tobacco industry by surprise. Both are struggling to catch up. Health professionals are hurrying to carry out research to develop evidence-based guidelines and policies. Meanwhile, the tobacco industry is buying up e-cigarette companies and introducing its own products onto the market.

So how concerned should we be about this emerging and disruptive technology?

Should we encourage existing smokers to use e-cigarettes to help them stop smoking, even if this means they continue using nicotine long-term? In the United Kingdom there is some consensus that smokers should be encouraged to use e-cigarettes if they feel they might help, and the National Centre for Smoking Cessation and Training is supportive of their use. Part of the reason many vapers feel so passionately about the subject (and react strongly when they feel that vaping is being unfairly attacked) is that for the first time, through the use of e-cigarettes, they have felt able to take control of their nicotine habit, stop smoking, and reassert some control over their health, without being medicalised in the process.

But a problem remains in the lack of information on the possible harm of e-cigarettes. This is unlikely to change any time soon, since the health effects of tobacco use can take several decades to emerge, and it’s probable the same will be true for e-cigarettes. Nothing is entirely risk-free, but the vastly reduced number of chemicals present in e-cigarette vapour compared to tobacco smoke means we can be confident that vaping will be much, much less harmful than smoking.

Heartening evidence

As part of the investigation into the effects of e-cigarettes, we investigated how the cells found in the arteries of the heart, known as human coronary artery endothelial cells, responded when they were exposed to both e-cigarette vapour and conventional cigarette smoke. We found the cells showed a clear stress response from the cigarette smoke, but not from the electronic cigarette. This suggests tobacco smokers may be able to reduce immediate tobacco-related harm by switching from conventional cigarettes to e-cigarettes.

Many people find it difficult to function without their first caffeine hit of the day. But no one is seriously calling for coffee shops to be dismantled or regulated. Nicotine is addictive, but much less so on its own than in tobacco, where other chemicals enhance its effect. At the doses consumed by vapers the harm is likely to be very low (although we need to continue to research this), and many vapers actually gradually move to zero nicotine content e-liquids, even while continuing to vape.

Of course, we may end up with a large population of long-term nicotine users who use e-cigarettes to deliver nicotine rather than cigarettes, but all of the evidence at the moment suggests that this population will almost entirely comprise ex-smokers. This would produce a vast public health gain.

We must be careful not to restrict smokers’ access to e-cigarettes, or over-state the potential harm of their use, if this will put people off making the transition from smoking to vaping. To do so would deny us one of the greatest public health improving opportunities of the last 50 years.

Original post – The Conversation | More on E-cigarettes from UKCTAS

New research from ASH Wales Cymru shows e-cigarettes are not a gateway to smoking for young people

New research released today shows no evidence that e-cigarettes are a ‘gateway’ for young people to start smoking. The annual survey, by tobacco control campaign group, ASH Wales Cymru, questioned more than 830, 11 to 18 year olds across Wales.

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For the third year running the survey shows there is no link between youths vaping and starting smoking tobacco.

It has been a concern among health professionals since the rapid emergence of e-cigarettes that they would ‘renormalise’ smoking and act as a ‘gateway’ towards tobacco for young people.

Of the young people who reported using both e-cigarettes and tobacco cigarettes at some point, 90% had used tobacco first, suggesting the absence of any ‘gateway’ theory. The report confirms e-cigarette use is confined to current smokers or ex-smokers and they are rarely used among ‘never’ smokers.

It also showed more than 30% of the e-cigarette users had quit smoking altogether. Reasons for using e-cigarettes varied from taste, to friends using them, to wanting to know what they were like.

Young people from the poorest parts of Wales were 25% more likely to have used an e-cigarette compared to their counterparts in the least deprived areas of the country.

These statistics around use by young people match recent results around adult usage from the Welsh Health Survey 2015.

This was the first time the Welsh Health Survey had looked at e-cigarette use. It revealed that 6% of over 16’s stated they currently use an e-cigarette – 140,000 of the Welsh population. Use among never smokers was negligible at 0.06%.

Suzanne Cass, Chief Executive of ASH Wales:

“For the third year in a row our research confirms young people are not using e-cigarettes if they’ve never smoked before.”

“E-cigarettes can contain highly addictive nicotine and there is no need for young non-smokers to use the devices. We are pleased to see these latest results confirm that e-cigarettes are being used as a smoking cessation device, similar to nicotine patches or gum and at the moment are not acting as a gateway towards tobacco.  E-cigarette users are now reducing the harm to their bodies caused by poisonous and cancer-causing tobacco smoke.”

Professor Linda Bauld from the University of Stirling and UK Centre for Tobacco and Alcohol Studies:

“There is a lot of confusion about the relationship between e-cigarettes and smoking in young people. Surveys from other countries do keep claiming there is a link despite youth smoking rates continuing to fall in the countries where these studies take place. This new data from Wales should reassure people that although young people are experimenting with e-cigarettes, we are not seeing regular use in never smokers. Meanwhile, youth smoking rates in Wales continue to decline, which is key to preventing cancer and other diseases that smoking causes.”

Ruth Coombs, Head of British Heart Foundation (BHF) Cymru:

“We are pleased that latest ASH Wales Cymru findings highlight encouraging trends to show that young people in Wales are not turning to e-cigarettes as a way to start smoking but rather as a way to reduce harm caused by intake of tobacco by cigarettes.”

 

Principal Findings:

  •  In terms of awareness of e-cigarettes, a large majority of respondents (90.7%) were aware of e-cigarettes. When stratified by age and gender the awareness of e-cigarettes remained extremely high. As many as 88.5% of respondents under the age of 13 were aware of what an e-cigarette is.
  • The most common sources of finding out about e-cigarettes were: seeing strangers using them in public (45.9%), reading or hearing about them on the internet or social media (42.6%), being told about them by friends (42.5%), and seeing them or hearing about them in the media (42.5%). By contrast only a very small proportion of respondents found out about e-cigarettes from a youth worker (3.3%) or health professional (3.0%).
  • The majority of respondents (68.6%) have never used an e-cigarette, with 13.7% only using an e-cigarette once and just 10% currently using an e-cigarette. A higher percentage of males reported currently using e-cigarettes every day (6.8%) relative to females (2.2%).
  • Respondents from the most deprived parts of Wales were far less likely to have never used an e-cigarette (48.6%) relative to respondents located in the least deprived areas of the country (75.4%).
  • The vast majority of never smokers have also never used an e-cigarette (88.9%), with a further 8.2% only ever having tried an e-cigarette once. Just 0.6% of never smokers currently use e-cigarettes regularly (i.e. more than once a week).
  • The main reasons for using e-cigarettes for the first time were to see what they tasted like (48.7%), because friends were using them (40.1%), and for a bit of fun (30.7%). 22.1% of respondents cited using e-cigarettes to reduce their intake of tobacco cigarettes.
  • The vast majority of respondents (90.3%) who had used e-cigarettes and smoked tobacco cigarettes reported starting to smoke tobacco cigarettes first.
  • Of the respondents who had used e-cigarettes and smoked tobacco cigarettes at some point (n = 172) 25.0% smoked fewer tobacco cigarettes since starting to use e-cigarettes, with 34.3% of respondents ceasing to smoke tobacco cigarettes altogether.

View the reportSee more on e-cigarettes | Other research from ASH Wales