UK Prevention Research Partnership (UKPRP) funding secured by UKCTAS academics

We are delighted to announce that UKCTAS has been successful in securing future funding through a multi-funder research initiative; the UK Prevention Research Partnership (UKPRP). UKTCAS academics joined forces with new collaborators and a range of public and private sector organisations to apply to the UKPRP.

The new consortium has now been awarded £5.9 million funding over five years and is called SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harM).

UKPRP research grants aim to develop, test and refine new, practical and cost-effective approaches to preventing non-communicable diseases at scale, which will in turn help to reduce health inequalities across the UK. The initiative is supported by twelve funders from UK Research and Innovation research councils, charities and government. In its first round of funding, four Consortia and four network grants have been awarded.

Prof. Linda Bauld, University of Edinburgh

“SPECTRUM intends to address some of the most controversial questions facing the health of our population. To reduce diseases like cancer, heart disease, diabetes and respiratory diseases we need to address their main preventable causes. To do so means introducing and enforcing public health policies that often clash with the business interests of very profitable companies.

SPECTRUM aims to produce research that can rise to this challenge. This research will be used by our partners outside of academia, who will be active members of SPECTRUM, to make the case for effective policy and practice to improve health and address inequalities in the UK and further afield.”

The SPECTRUM Consortium is led by Professor Linda Bauld (pictured above) from the University of Edinburgh and for the last 10 years has been the deputy director of UKCTAS. Co-investigators and collaborators from 10 Universities in the UK and one in Australia are included. In addition, the Consortium brings together leading alliances that aim to improve health and reduce inequalities in the UK and further afield, along with Public Health England, Health Scotland, Public Health Wales and two independent companies specialising in statistical modelling and retail data.

SPECTRUM will aim to conduct research to prevent and address harm to health from unhealthy commodities by using systems science to identify and evaluate solutions. The focus of the new Consortium will be the commercial determinants of health and health inequalities, continuing UKCTAS’s work at the population level on tobacco and alcohol, but also extending to unhealthy food and drink products where appropriate. The research will be organised around 8 inter-related Work Packages involving new research, along with knowledge exchange, impact and public engagement activities.

More information is available on UKCTAS.net/SPECTRUM

A content analysis of tobacco and alcohol content in Netflix and Amazon Prime original programmes accessed from the UK | Research Report

Quantifying tobacco and alcohol imagery in Netflix and Amazon Prime instant video original programming accessed from the UK: a content analysis.

Alexander B Barker, Jordan Smith, Abby Hunter, John Britton, Rachael L Murray

Exposure to tobacco and alcohol content in audio-visual media is a risk factor for smoking and alcohol use in young people. Previous UK research has quantified tobacco and alcohol content in films and broadcast television but not that of video-on-demand (VOD) services such as Netflix and Amazon Prime. Furthermore, it is not clear whether regulation by Dutch (Netflix) or UK (Amazon Prime) authorities results in differences in content. We report an analysis of tobacco and alcohol content in a sample of episodes from the most popular programmes from these two VOD providers, and compare findings with earlier studies of UK prime-time television content.

Content analysis of a sample of 50 episodes from the five highest rated series released on Netflix and Amazon Prime in 2016, using 1 min interval coding of any tobacco or alcohol content, actual or implied use, paraphernalia and branding.

Number of 1 min intervals containing tobacco and alcohol content by coding category.

Of 2704 intervals coded, any tobacco content appeared in 353 (13%) from 37 (74%) episodes. Any alcohol content appeared in 363 (13%) intervals in 47 (94%) episodes. There were no significant differences between the two services, however the proportion of episodes containing tobacco and alcohol was significantly higher in VOD original programmes than those recorded in an earlier study of prime-time UK television.

Alcohol branding seen in Netflix and Amazon prime instant video original programming.

Audio-visual tobacco and alcohol content is common in VOD original programmes and represents a further source of exposure to imagery causing smoking uptake and alcohol use in young people. This appears to be equally true of services regulated in the UK and The Netherlands. Given that VOD services are consumed by a global audience, it appears likely that VOD content is an important global driver of tobacco and alcohol consumption.

Strengths and Limitations of this study:

• This study is the first to explore alcohol and tobacco content in video-on-demand (VOD) programmes.
• Established methods were used to explore the content in VOD original content.
• This study provides a comparison of VOD alcohol and tobacco content to UK broadcast television content.
• This study is limited to a sample of programmes and episodes on each VOD service.
• As viewing figures are not available for VOD original content, we could not estimate exposure to tobacco and alcohol content.

Correspondence to Dr Alex Barker; alexander.barker@nottingham.ac.uk

Stricter @Ofcom regulation of #AmazonPrimeVideo relative to european regulation of #Netflix does not translate into appreciably lower levels of #tobacco and #alcohol content. https://t.co/5cduJzp5sc

— Dr Alex Barker (@abbarkerpsych) February 15, 2019

Citation

Barker AB, Smith J, Hunter A, et al

Quantifying tobacco and alcohol imagery in Netflix and Amazon Prime instant video original programming accessed from the UK: a content analysis

BMJ Open 2019;9:e025807. doi: 10.1136/bmjopen-2018-025807

 

 

Electronic cigarettes: First time on a Priority Setting Partnership Group

Louise Ross – Clinical Consultant, National Centre for Smoking Cessation and Training.

When I first got the invitation to join the Priority Setting Partnership (PSP) on electronic cigarettes, I had no idea what a PSP was or did, nor had I ever heard of the James Lind Alliance (JLA), the organisation that runs the PSPs.

However, because of what I do, I’m intensely interested in e-cigarettes as a means of stopping smoking and staying stopped, so I read on…

What an opportunity it has been! It’s early days yet, but already we have formed an interactive and lively group – academics, people with lived experience, researchers and practitioners. Our task? To find out what the public want to know about e-cigarettes and vaping.

When I say ‘the public’, this includes anyone who is curious to know more through research – it could be GPs, hospital doctors, vapers, smokers, policy-makers, pregnant women, homeless people, prisoners, stop smoking practitioners – anyone who has thought ‘I really would like to see research done about xxx to do with vaping/e-cigarettes’ can respond to the survey we are sending out in January.

We haven’t got long to road-test the survey, but the team at JLA (who told us at the first meeting about some of the other PSPs they’ve been working on – who knew all this public participation was going on in research circles?) have skilfully guided us through the early steps.

So in early 2019, we will launch the survey and sit back and wait for lots of replies.

Long-term health effects? Useful for stopping smoking? Second-hand vapour? Improvements in asthma?

If you have a burning question that you’d like to see included in the list of research priorities, do fill in the survey.

Then the real work will begin, sifting through the suggestions, and deciding which are the most crucial to answer. I’m confident that we have a well-balanced, engaged and knowledgeable group to tackle this task, and I’m proud to have been included.

Original post on the James Lind Alliance website. 

Tobacco content still common on UK prime time TV, despite regulations | Research Report

Tobacco content still common on UK prime time TV, despite regulations

Likely to heavily influence young people’s take-up of smoking, say researchers

Tobacco content remains common on UK prime time TV,  cropping up in a third of all programmes, despite advertising and broadcasting regulations designed to protect children from this kind of exposure, reveals research published online in the journal Tobacco Control.

The amount of exposure has hardly changed in five years, and is likely to heavily influence young people’s take-up of smoking, say the researchers.

Big bother: Channel 5 broadcast most tobacco-related content.

The other channels also showed a number of cigarette-related scenes (EastEnders)

Tobacco content in film has been covered extensively, but relatively little attention has been paid to its inclusion on prime time TV, despite the fact that children are likely to spend more time watching TV than they are films, they point out.

The researchers therefore analysed the tobacco content of all programmes, adverts, and trailers broadcast on the five national free to air TV channels between 1800 and 2200 hours during the course of three separate weeks in September, October, and November 2015.

Their analysis included any actual or implied use, such as holding a cigarette without smoking it, or making a comment about smoking; smoking/tobacco paraphernalia; and presence of branding in 1 minute intervals. The results were then compared with those of a similar analysis carried out in 2010.

In all, 420 hours of broadcast footage, including 611 programmes, 909 adverts, and 211 trailers, were analysed.

Some 291 broadcasts (17% of all programmes) included tobacco content. The channel with the most tobacco content was Channel 5, and the one with the least was BBC2.

Tobacco content occurred in one in three TV programmes broadcast, and nearly one in 10 (8%) adverts or trailers.

Actual tobacco use occurred in one in eight (12%) programmes, while tobacco related content–primarily no smoking signs–occurred in just 2 percent of broadcasts. Implied use and branding were rare.

 

Reality bites: Coronation Street actress Helen Flanagan takes a drag on I’m A Celebrity

Lighting up: Shane Ritchie portrayed a chain-smoking Alfie Moon on EastEnders

Shameless: Channel 4’s own TV drama, Shameless, was not reticent about portraying tobacco

Although most tobacco content occurred after the 9 pm watershed, it still occurred on the most popular TV channels before then.  And comparison with the previous analysis in 2010 showed that the number of 1 minute intervals containing any tobacco content increased, rising from 731 to 751 in 2015.

Tobacco advertising, promotion and sponsorship, including paid product placement in TV adverts, is banned in the UK, but tobacco imagery in TV programmes and trailers is exempt, and covered instead by media regulator, OfCom’s, broadcasting code.

This code is designed to protect children by restricting depictions of tobacco use in children’s programmes, and preventing the glamorisation of smoking in programmes broadcast before 9 pm.

“Audiovisual tobacco content remains common in prime-time UK television programmes and is likely to be a significant driver of smoking uptake in young people,” emphasise the researchers.

“Guidelines on tobacco content need to be revised and more carefully enforced to protect children from exposure to tobacco imagery and the consequent risk of smoking initiation,” they added.

‘The number of smokers in the UK has fallen significantly since 2010 yet this research finds smoking is just as common on our screens. Given the proven link to childhood smoking Ofcom and the BBFC, which regulate TV and films, need to take the necessary steps to warn parents of the risks and protect our children from the harmful effects of tobacco imagery.’ 

Deborah Arnott, chief executive of Action on Smoking and Health.

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Notes for editors:

Research:  Content analysis of tobacco content in UK television doi 10.1136/tobaccocontrol-2018-054427

Journal: Tobacco Control

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Author contact: Dr Alex Barker, Division of Epidemiology & Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK. Email: alexander.barker@nottingham.ac.uk

Other links:
Tobacco on TV influences children, study finds | iNews

Smoking scenes are still common in a THIRD of prime time TV programmes despite strict regulations to protect children, finds study | Daily Mail

“The really interesting thing we found was that vaping may also encourage people who don’t even want to stop smoking, to eventually quit” Dr Caitlin Notley | University of East Anglia

Vaping helps people stop smoking – even when they don’t want to, according to new research from the University of East Anglia. A new study, funded by CRUK published today shows that smokers who switch to vaping may be better able to stay smoke-free in the long term. And that even people who didn’t want to stop smoking, have eventually quit because they found vaping more enjoyable.

Lead researcher Dr Caitlin Notley from UEA’s Norwich Medical School said:

“E-cigarettes are at least 95 per cent less harmful than tobacco smoking, and they are now the most popular aid to quitting smoking in the UK. However the idea of using e-cigarettes to stop smoking, and particularly long-term use, remains controversial. We wanted to find out about how people use e-cigarettes to quit smoking – and whether vaping supports long-term smoking abstinence.”

The research team carried out in-depth interviews with 40 vapers. They asked them about their tobacco smoking history and prior quit attempts, and about how they started vaping, their vape set up, preferred flavours and strength, and whether they had switched to vaping in attempt to quit smoking. They also asked them about situations and experiences that caused them to relapse into tobacco smoking.

“We found that vaping may support long-term smoking abstinence,” said Dr Notley. “Not only does it substitute many of the physical, psychological, social and cultural elements of cigarette smoking, but it is pleasurable in its own right, as well as convenient and cheaper than smoking. Our study group also felt better in themselves – they noticed better respiratory function, taste and smell. But the really interesting thing we found was that vaping may also encourage people who don’t even want to stop smoking, to eventually quit.”

While most of the sample group reported long histories of tobacco smoking and multiple previous quit attempts, a minority (17 per cent) said they enjoyed smoking and had never seriously attempted to quit.

“These were our accidental quitters,” said Dr Notley. “They hadn’t intended to quit smoking and had tried vaping on a whim, or because they had been offered it by friends. They went on to like it, and only then saw it as a potential substitute for smoking.”

“Many people talked about how they saw vaping was a no pressure approach to quitting,” she added. While most of the group switched quickly and completely from smoking to vaping, some found themselves using both cigarettes and vaping, and then sliding towards stopping smoking.

“We found that people did occasionally relapse with a cigarette, mainly due to social or emotional reasons, but it didn’t necessarily lead to a full relapse. This study suggests that vaping is a viable long-term substitute for smoking, with substantial implications for tobacco harm reduction.”

Alison Cox, director of cancer prevention at Cancer Research UK, who funded the project said: “The evidence so far shows that e-cigarettes are far safer than tobacco. E-cigarettes do still contain nicotine which is addictive, but it’s not responsible for the major harms of smoking. This is why they have great potential as an aid to help people quit smoking for good. It’s great to see this early indication that e-cigarettes could encourage smokers who weren’t originally thinking of quitting to give up. But more research is needed to understand exactly how e-cigarettes are being used by people who don’t want to stop smoking and how often this results in quitting. E-cigarettes are just one option for quitting – your local Stop Smoking Service can give you free advice on the best method for you, and with their support you’ll have the best chance of success.”

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‘The unique contribution of e-cigarettes for tobacco harm reduction in supporting smoking relapse prevention’ is published in Harm Reduction Journal on June 20, 2018.

Original article: How vaping helps even hardened smokers quit – Eurekalert

New study finds no clear evidence that nicotine “preloading” helps smokers to quit | University of Oxford

There is insufficient evidence to show that using nicotine patches for four weeks before a quit attempt (known as “preloading”) improves long-term smoking abstinence, finds a trial published by The BMJ this week.

The researchers found that nicotine preloading reduces craving intensity and seems to make quitting easier, but that this beneficial effect may have been masked by a concurrent reduction in the use of varenicline in the period after quit day. As varenicline is the most effective smoking cessation drug, this may have undermined the benefit of preloading.

If it were possible to overcome this unintended consequence, nicotine preloading “could lead to a worthwhile increase in long term smoking abstinence,” they say.

The research was funded by the National Institute for Health Research.

Although there have been several new drugs for tobacco cessation since the 1970s, treatment has remained largely the same, with behavioural support to motivate and strengthen a person’s resolve to remain abstinent and drugs to reduce the strength of urges to smoke after quit day.

Some studies have suggested that using nicotine replacement therapy before a quit attempt is more effective than when used in the conventional way to support abstinence, while other studies suggest preloading has no effect.

A research team from the UK Centre for Tobacco and Alcohol Studies, led by Professor Paul Aveyard at the University of Oxford, set out to examine the effectiveness of a nicotine patch worn for four weeks before a quit attempt.

Serving smaller alcoholic drinks could reduce the UK’s alcohol consumption | Research Report | University of Liverpool

New research published in Addiction, conducted by researchers from the Universities of Liverpool and Sheffield, highlights the potential benefits of reducing the standard serving size of alcoholic beverages.

It is well known that alcohol consumption contributes to premature death and ill health, and alcohol-related harm places a substantial burden on society. Many drinkers find it hard to cut down and attempts to cut down often do not lead to actual reductions in alcohol consumption. Therefore, changes to the environment that make it easier for people to drink less could have a substantial impact on public health.

One potential environmental influence on alcohol consumption is serving size. Nutrition research consistently shows that portion sizes affect how much a person eats. People eat more if they are given a relatively large portion of food compared to smaller portions, but they do not compensate for this by eating less later on. However, the effect that serving size has on alcohol consumption has not been examined until now. The present research aimed to investigate if reducing the serving size of alcoholic beverages would reduce alcohol consumption.

Standard vs Reduced serving sizes:

The researchers, led by Dr Inge Kersbergen from the University of Liverpool, tested the effects of reducing the serving size of alcohol on how much alcohol participants drank in two studies.

In the first study, participants were randomized to consume alcohol from standard or reduced serving sizes whilst watching a one-hour TV programme in a laboratory that looks like a living room. Standard serving sizes contained 2.07 units per serving (equivalent to a pint of weak lager) and reduced serving sizes contained 25% less than the standard serving.

In the second study, participants were invited to one of four pub quiz nights in a local bar which only sold standard vs. reduced serving sizes. Standard servings were pints and 175ml of wine (‘typically served as a medium glass in pubs’) and reduced servings were 2/3 pints and 125ml of wine (‘small glass’). Drink prices were adjusted to make sure that the standard and reduced serving sizes were the same value for money. Researchers observed how much alcohol each participant drank.

In both experiments, participants could order as many drinks as they wanted for the duration of the experiment. This means that participants drinking from reduced servings could compensate for the smaller serving size by ordering more drinks if they wanted to.

The researchers found that participants who were served relatively smaller servings drank less alcohol in a single drinking session than participants who were served standard servings. In the first study, reduced serving sizes led to a 20.7% – 22.3% decrease in alcohol consumption over a one-hour drinking period in the ‘living room’ lab. In the second study, reduced serving sizes led to a 32.4% – 39.6% decrease alcohol consumption over a longer drinking period (up to three hours) during the real-life pub quiz.

Based on the results the researchers used the Sheffield Alcohol Policy Model to estimate that reducing the standard serving size of beer, wine and cider in bars and restaurants by a quarter would lead to 1,400 fewer deaths and 73,000 fewer hospital admissions every year.

Public health intervention:

Dr Kersbergen, said: “These studies are the first to demonstrate that reducing the serving size of alcoholic beverages prompts reductions in alcohol consumption.

The typical serving size of beer in the UK of a pint is larger than many other countries and the size of wine servings in UK bars and restaurants has increased in recent decades, so there is room for serving sizes to be reduced without making them unrealistically small. Reducing the standard serving size of alcohol in bars and restaurants may be an effective way to reduce alcohol consumption at the population level and improve public health.”

Professor Matt Field, who leads the Addiction research group within the Department of Psychological Sciences at the University of Liverpool, added: “Reducing the standard serving size of alcoholic drinks could automatically prompt people to drink less, even if they are not motivated to cut down. But at the same time, the total amount that people consume would remain completely their own choice”.

Dr Eric Robinson, a University of Liverpool researcher who was also involved in the study, said: “Our research showed that people do not seem to compensate for the smaller servings by ordering more drinks on a single night and it seems unlikely that any further compensation would happen, but future research is needed to find out if people may compensate in other ways, such as drinking more often or getting stronger drinks.”

The full study, entitled ‘Reducing the standard serving size of alcoholic beverages prompts reductions in alcohol consumption’, can be found here and was funded in part by an MRC research grant awarded to Dr Eric Robinson.

Original post 14/05/2018: University of Liverpool News

The Drink Less smartphone app: the project so far | Claire Garnett

‘Drink Less’ is a smartphone app for iOS devices that aims to help people reduce their alcohol consumption (drinklessalcohol.com) – you can download it here.

It was developed and evaluated by a team of researchers at University College London using evidence and theory from the field of behavioural science.

Smartphone apps have a wide reach and can be provided to many users at a low cost though few have been evaluated. This means there’s little information on whether and how they work. When the Drink Less app was launched in 2016, many of its users agreed to participate in a study and have their anonymous data used for scientific research to test it.

The study tested the five separate app modules (you can read more about the app’s different features in a previous UKCTAS blog post) which each focused on a different behaviour change strategy. Nearly 700 users were recruited to the trial and different groups were randomly given either intensive or minimal versions of each of the app modules. The effectiveness of each was then measured by comparing levels of drinking before using the app and after one-month.

On average, over the month following download, people logged-in 12 times and drank four fewer units of alcohol. People who received a more intensive version of a module did not reduce their alcohol consumption significantly more than people who got a less intensive version of the same module. However, combinations of specific modules led to a greater reduction in alcohol consumption where users had the intensive versions of both modules. This evaluation has recently been published and you can read about it in more detail here.

User testimonials

Drink Less seems to be a popular app amongst users. It has been downloaded over 21,000 times and the app consistently appears amongst the top results for the ‘alcohol’ search term on the Apple App Store and has an average 4-star rating (based on 26 ratings as of 23/3/2018).

In addition to that, the researchers at UCL have received a lot of positive feedback about the app, some of which is shared below (with their permission):

“Well researched and brilliantly designed. It’s both easy and thorough to track drinking and how it affects all areas your life. It’s designed so it’s not preaching because mostly you capture and listen to your own advice – very individualised and very powerful. A great tool to help consider past consequence and create better future behaviours around use of alcohol.”

“Excellent app that is so useful. Would definitely recommend it.”

“Lots of these apps around but this one is easy to use, non-judgemental and backed up by theory. Really like it. I was surprised by my results. Tracker, goal setting and ideas about how my drinking compares with others. I was surprised!”

“I would like to thank the developers who have worked on the app – it’s been a real help for me as I had become a seriously habitual drinker – I have now settled into a good routine, limiting my intake to under 14 units/week and only imbibing on Friday and Saturday evenings. I couldn’t have done it without your help, thank you. I have told many friends about my success with the app…it really has proved to be a game changer.”

“I love your app. In 2 weeks it’s helped me understand my consumption and learn to plan which has helped me cut down. I like the fact it’s contributing to wider research too. I’d tried a number of apps that help you monitor your alcohol consumption, most of them I stopped using after a week or two… but that did change when I started to use the Drink Less app. What I learned was that I needed to think ahead and plan when I was going to drink…

I’m never going to stop drinking, I love a glass of wine, but it has stopped me casually drinking without thinking. I now understand that I must have been passively consuming way way too much. You hear that all the time, but nothing made it as tangible as this app… I work in an industry where alcohol plays a large part of the culture, so gaining this understanding helped me manage those work situations where alcohol was central much better.”

“I’ve been participating with your Drink Less App for the last 14 weeks. During which I’ve made significant changes to my drinking consumption and life style. I feel I’m getting back some control over my drinking which was controlling me…my GP has me down as having average consumption at 27 alcohol units per week. It’s been like that for many years. That’s before I found and started working with your Drink Less app. So getting it down to 13 units / wk is something my wife and I are proud of. Thanks again for your help and please keep up the good work.”

Plans for the future

Drink Less is in a good position to be built upon as an already successful app. Initial findings suggest that it has the potential to help excessive drinkers in the UK reduce their alcohol consumption at a low incremental cost per user.

Next up for the Drink Less app is to create an optimised version based on user feedback and the findings from the screening trial. This research is part of an 18-month project funded by the NIHR SPHR. And as part of this project, a funding application will be submitted for a confirmatory trial to determine whether the Drink Less app can provide an effective alternative to the help people usually receive for alcohol reduction.

All of the related scientific papers on the Drink Less app are available here.

Our paper on the development of the Drink Less app is out now – systematic development based on evidence and theory using a person-based approach, in line with Open Science principles @jamiebrown10 @SusanMichie @robertjwest @dhc23 @BehavioralMed #TBM https://t.co/lVVhzthYqp

— Claire Garnett (@ClaireVGarnett) May 8, 2018

Acknowledgements

This research was funded by the UK Centre for Tobacco and Alcohol Studies (UKCTAS), the Society for Study of Addiction (SSA), the NIHR School for Public Health Research (NIHR SPHR) and Cancer Research UK (CRUK). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

The Drink Less app was built by Greg Plumby, Edward Warrender and Chris Pritchard (from Portable Pixels) and Hari Karam Singh.

Stubbing out the public health problem of an era | Blog piece by Tim Coleman | #myresearchlegend

Sir Richard Doll had an illustrious career. Through his efforts, the world learned much about the causes of cancer and the dangers of asbestos, radiation and, of course, smoking. Following his research into smoking and lung cancer during the 1950s, the realisation dawned that tobacco use was the public health problem of the era and not a harmless pastime. We all know what’s happened since. How many other 20th century epidemiologists have had such a transformative impact on peoples’ understanding of the determinants of disease?

To what extent do I consider Sir Richard Doll to be a research ‘legend’? I’m not sure I’ve earned the right to bestow that honour, so I’ve taken advice. The Cambridge English Dictionary says a ‘legend’ is “someone very famous and admired, usually because of their ability in a particular area”. Just considering the one area of Doll’s work emphasised above, this is a no-brainer; ‘legend’ threshold is clearly surpassed. Don’t take my word for this, though, Google ‘Richard Doll’ and see if you can find reason to disagree.

Am I hasty in allocating ‘legend’ status? Doll certainly changed the world’s knowledge of many illnesses; shouldn’t an NIHR research legend demonstrate clear NHS impact too? Fortunately Doll’s influence here doesn’t disappoint, even if one again only considers smoking. I am a GP. How would this be different if Sir Richard had never lived? Firstly, I’d probably smoke. A pipe would give me more gravitas than cigarettes and I’d have to either smoke in my consulting room, like some doctors did, or schedule regular ‘pipe breaks’ into my day. I would be blissfully ignorant about harms from smoking and more likely to offer patients cigarettes than help with stopping, even if they developed lung cancer or heart disease.

Smoking Kills

Thankfully, Sir Richard did exist. Although I tried smoking as a teenager, a friend’s mum made me think again and I didn’t ever fully adopt the habit. Immature, teenage me was saved from smoking because Doll had shown how harmful smoking is. Fast forward to my GP work in 2018; again due to Doll, I fully realise that smoking kills my patients and wrecks their lives.

Also, due to research which was only possible because of his early work, I can offer smokers numerous types of cessation support. It’s even possible to refer on to Stop Smoking Services (SSS) for specialist help, though a major cloud on the horizon is that these vital services are no longer universal; they are endangered.

Through their work at the Statistical research Unit of the MRC, Doll and Hill demonstrated that smoking causes lung cancer; before this smoking was ubiquitous across social classes and many doctors smoked. By 1954, the government accepted the link and the middle classes started quitting in droves. When he died in 2005, Doll would very likely have been delighted that UK smoking rates were falling fast. However, improvements were chiefly amongst the better off, so smoking had become disproportionately concentrated amongst society’s poorest. Given his well-documented non-conformist views, my bet is that he would have been saddened that those with most to gain benefited least from such massive social change. Nevertheless, he might have been heartened by the government’s national and vigorous action against smoking. Back then, although SSS were a very new NHS entity, it was mandatory for Primary Care Trusts to deliver them and SSS were closely performance-managed by the then Department of Health. Any smoker could access services’ evidenced-based support to increase their chances of permanent cessation.

Smoking Prevention

Worldwide, legions of researchers, including me, have followed Doll by trying to find ways of treating or preventing smoking. Few epidemiologists have caused such a seismic shift in the international research agenda. Take a look at the thousands of randomised controlled trials (RCTs) reviewed in the tobacco section of the Cochrane Library. All of these studies test interventions against smoking. This necessary work continues today and NIHR is a leading supporter funding, for example, the largest ever RCTs of Nicotine Replacement Therapy used in pregnancy* or for ‘preloading’.

The NHS is 70. Celebrating research legends is a great idea but it’s important we remember what they did and why they are lauded. It took almost half a century after Doll and Hill’s landmark paper for the NHS to implement national treatment services for smokers, and sadly less than 20 years later these have become an optional extra with patchy coverage across the country. Smoking is less prevalent than in the past but there are still millions of UK citizens who want to stop and can’t manage this alone. Smoking is still a national problem and requires a national NHS response. A crucial component of this response should be to help quitters by giving them the very best support.

Sir Richard’s work has had a great impact, as all research should. The demise of SSS suggests we risk forgetting this when instead we should continue to build on his significant achievements.

*More information on the trial: Double-blind, randomised, placebo-controlled trial of nicotine replacement therapy (NRT) in pregnancy – SNAP is available on the NIHR Journals Library website.

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Tim Coleman, Professor of Primary Care, Faculty of Medicine & Health Sciences
University of Nottingham and NIHR Senior Investigator

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The NIHR is highlighting seven research legends whose work has shaped the NHS, as part of its celebrations for the NHS’s 70th birthday and the NIHR’s I Am Research campaign.

Original post on NIHR website. – Posted: 04 May 2018

Alcohol Policy in Practice | Continuing Professional Development Course | 11th-13th September 2018

Following the successful Alcohol CPD courses held in 2014-2017; we are delighted to announce the line-up for our 2018 course, featuring some exciting new inputs!

This year’s course will feature inputs from Prof. Anna Gilmore and colleagues from the University of Bath, Dr Carol Emslie from Glasgow Caledonian University, Dr James Nicholls from Alcohol Research UK, and Professor Karine Gallopel-Morvan from the EHESP School of Public Health, France. We also welcome the return of highly-rated inputs from leading experts such as Katherine Brown from the Institute of Alcohol Studies and Colin Shevills of Balance North East.

What previous participants said:

“Great range of content and world-class speakers. Organisers did an amazing job including looking after us all while we were here. The mix of lectures / Q & As / panel discussions was great. Really worth taking time away from work/home to attend this.”
“Extremely informative course and relevant to current alcohol policy challenges. Good venue, convenient location and lovely setting. Module well organised and brilliant range of speakers.”
“Thank you very much. It was a great privilege to listen and attend this course. Lectures and lecturers were outstanding.”
“Very informative useful training, well worth my time and travel.”
“Wonderful networking opportunity.”
“Thank you for such a brilliant training event – the content was spot on, all the presentations and sessions were really, really good and I came away feeling that I had learned masses: a rich diet of fact and opinion. I can honestly say that I have rarely – if ever – enjoyed such an event quite as much as this one.”

Anyone wishing to gain an in-depth understanding and up to date insight into evidence and innovative practice in alcohol policy in the UK and internationally.

Previous participants have included people working in public health, local and national alcohol policy, or alcohol research; from Iceland to New Zealand.

Places are filling up fast and the early-bird rate applies until Friday 15th June 2018! 

Apply Here!