Tobacco Control in England: Reducing Inequalities and Improving NHS Sustainability

tc phe.jpg

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!

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

Healthier central England or North–South divide? Analysis of national survey data on smoking and high-risk drinking

In England, around 20% of the population are smokers and 13% drink excessively. These behaviours are leading risk factors for several non-communicable diseases, including cancer, diabetes and chronic respiratory and cardiovascular conditions. It is estimated that around 8000 deaths/year are alcohol-related and 80 000 deaths of adults aged 35 and over are attributed to smoking annually. The prevalence and adverse effects of high-risk drinking and tobacco use are not equally distributed across the country, with large regional variations.

A North–South divide exists for smoking, with higher rates of tobacco use, smoking-related deaths and smoking-related harm in northern regions. 

In contrast, excessive alcohol consumption tends to be lowest in central and eastern regions, while an East versus West divide is seen in the prevalence of alcohol dependency and alcohol sales. These regional variations in consumption do not always map onto experienced harm, a phenomenon known as the Alcohol Harm Paradox. In 2014, alcohol-related death rates were significantly higher among regions in the north of England compared with those in the south.

Objectives: This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics.

Design: Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.

Measures: Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT.

Results: In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p<0.001; RR 0.91, p<0.05), East of England (RR 0.86, p<0.001), South East (RR 0.92, p<0.05) and London (RR 0.85, p<0.001). High-risk drinking was more common in the North but was less common in the Midlands, London and East of England. Adjustment for sociodemographics had little effect. There was a higher prevalence in the North East (RR 1.67, p<0.001), North West (RR 1.42, p<0.001) and Yorkshire and the Humber (RR 1.35, p<0.001); lower prevalence in the East Midlands (RR 0.69, p<0.001), West Midlands (RR 0.77, p<0.001), East of England (RR 0.72, p<0.001) and London (RR 0.71, p<0.001); and a similar prevalence in the South East (RR 1.10, p>0.05)

Figure 2Figure 2: Association between Government Office Region and high-risk drinking: (A) unadjusted;
(B) adjusted for gender, age, ethnicity and socioeconomic status (reference region: South West). Note: this shows the relative risk difference for each region relative to the South West (dotted reference region). Increasing red tones reflect increasingly higher significant risk and increasing blue tones reflect increasingly lower significant risk. Regions shaded white have a similar risk to the South West. Online supplementary figure S9 labels the Government Office Regions in England.
Expand Image – More diagrams in the main report

Conclusions: In adjusted analyses, smoking and high-risk drinking appear less common in ‘central England’ than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities.

Strengths and limitations of this study

  • Used a representative survey about smoking and drinking conducted on a large sample of the adult population in England.

  • Based on the most up-to-date information in England on regional differences in smoking and high-risk drinking accounting for disparities in gender, socioeconomic status (SES), ethnicity and age.

  • Respondents may have underestimated or failed to report their drinking and smoking.

  • Patterns of smoking and alcohol use were only available at the Government Office Region level, whereas important variation may occur at a more micro-geographical level.

bmj

Copyright information:
Published by the BMJ Publishing Group Limited.

 

Read the full report here!

Cigarette smoking increases coffee consumption: findings from a Mendelian randomisation analysis

Marcus Munafò and his colleagues at the University of Bristol, have looked into the smoking and drinking habits of about 250,000 people. They found that smoking makes you drink more caffeinated drinks, possibly by changing your metabolism so that you break down caffeine quicker, pushing you to drink more to get the same hit.

It’s impossible to do a randomised controlled trial (the most rigorous kind of scientific trial) when it comes to smoking, because it would be unethical to ask a randomly selected group of people to smoke. The next best thing is to study huge biobanks of health data. These biobanks contain information about people’s genes, diets and lifestyles.
coffee-cigarettes-smoking-400x400.jpgTo explore the relationship between smoking and caffeine, Munafo and his colleagues analysed data from biobanks in the UK, Norway and Denmark. They were particularly interested in people who had inherited a variant of a gene that has already been shown to increase cigarette smoking.

Chain drinking

The team found that people who had this gene variant also consumed more coffee – but only if they smoked. British people with the same variant also drank more tea, although their Danish and Norwegian counterparts didn’t. This is probably due to cultural differences, says Munafò. “People in Norway and Denmark don’t chain drink tea in the same way that people in the UK do,” he says.

The genetic variant seems to influence how much nicotine a person consumes. You can have zero, one or two copies – and each additional copy is linked to an increase in smoking of about one cigarette per day. Each copy also appears to increase coffee consumption by 0.15 cups per day.

“You could extrapolate from that and say that if you smoked 10 cigarettes per day more than the next person, you would be drinking the equivalent of about one and a half extra cups of coffee per day,” says Munafò. He is wary of doing so, though, because the amount of nicotine a person gets from a cigarette will depend on the type of cigarette and the way it is smoked.

The gene variant codes for a nicotine receptor, which is not known to directly interact with caffeine. This suggests that cigarette smoking increases caffeine consumption and not the other way around.

“The team have used a rather clever technique to establish causality, which normally you wouldn’t stand a cat in hell’s chance of doing with an epidemiological study,”

Robert West – University College London.

What’s the link?

There’s a chance that cigarette smoking and caffeine consumption are linked through habit – that smokers tend to pair the two. But Munafò thinks that the nicotine in cigarettes might also influence the way a person metabolises caffeine. “It’s possible that smokers metabolise caffeine more quickly,” he says. If that is the case, smokers might need to consume more caffeine to get the same effects that a non-smoker would experience.

It’s also possible that the apparent link between smoking and coffee drinking could be down to some unknown function of the genetic variant, says West. “It evolved for a purpose, and it wasn’t to smoke,” he says.

A relationship between smoking and coffee might make it harder for smokers to quit, says Munafò. If a smoker stops smoking, but continues to drink plenty of coffee, they might start to experience unpleasant side effects, such as jitteriness. This might be misinterpreted as a symptom of smoking withdrawal, says Munafò. His team plans to investigate this.

newscience
By Jessica Hamzelou

Journal reference: bioRxiv, DOI: 10.1101/107037

John Britton speaks to RegWatchCanada on #COP7FCTC and the World Health Organization’s view of E-cigarettes

Just as vapers in several countries began to feel like events may finally be turning in favor of e-cigarettes as a harm reduction tool, the harsh realities of the global public health movement shattered any optimism.

The World Health Organization is just wrapping its Conference of the Parties to the Framework Convention on Tobacco Control, known as COP7, in India and according to professor John Britton, Chair of the Tobacco Advisory Group at the Royal College of Physicians in Britain (RCP), the future for vaping looks bleak.

The RCP, Public Health England and the UK Centre for Tobacco and Alcohol Studies have all endorsed e-cigarettes as a vital tool in the battle to end the tobacco epidemic.

Tune in to this special edition of RegWatch and learn why officials from England’s top public health organizations fear that pending WHO regulatory action on e-cigarettes could kill millions of people.

RegulatorWatch.com

screen-shot-2016-11-14-at-10-59-59screen-shot-2016-11-14-at-11-00-27

Click here to read the UKCTAS commentary on the WHO report on e-cigarettes. –  Released 26/10/2016

FRANCE-SMOKING-TOBACCO-CIGARETTE

Research associate position available at the University of Bath | Tobacco Control Research Group | Fixed Term

bathThe University of Bath is seeking to appoint a Research Associate in Public Health/Applied Policy Research based at the University of Bath’s Tobacco Control Research Group within the Department for Health, which is part of the UK Centre for Tobacco and Alcohol Studies (UKCTCS).

The successful applicant will be working on an exciting project, funded by Cancer Research UK, on researching the activities of the tobacco industry, predominantly in the UK but also internationally, as and where necessary. The new post-holder will work as part of a small research team for the University’s widely acclaimed knowledge exchange platform, TobaccoTactics.org, helping the research leader ensure the website’s quality, relevance and timeliness. The Research Associate will also be expected to contribute to and publish their research in high-impact journals in collaboration with other members of the Tobacco Control Research Group and present their work at conferences and events where relevant.

The successful candidate will hold a PhD in a relevant subject (e.g. public health, international relations, political and social sciences, business studies, law, and business), or an equivalent professional qualification and significant relevant experience where applicable. The candidate will ideally have a track record in undertaking mixed methods research and must be highly motivated and committed. Experience in effective knowledge exchange and writing for diverse audiences to secure research impact would be advantageous. Ideally you will have experience of undertaking policy related research in tobacco control or a very similar area.

This is a full time position, fixed-term for up to 9 months.

For more information and to apply click here.

Novel ways of using tobacco packaging to deter smoking – University of Stirling – PhD opportunity

About This Project

Packaging is an important marketing tool for tobacco companies, helping to capture attention, create brand awareness, foster positive brand attitudes and communicate product attributes. For smokers, the pack is their personal choice, a statement of their identity, something that stays with them wherever they go and something that it is typically seen countless times a day. The pack turns a generic product into a bespoke marque. Even for non-smokers, tobacco packaging is a familiar feature of life, whether within shops, as litter or in the hands of smoking friends and relatives. It is unsurprising, then, that tobacco companies have been very creative in their use of all elements of the pack – colour, shape and design, the cellophane wrapper, inserts, and the cigarette itself – to communicate the positive qualities of the product and the brand.

SP-TPDMock_upLoresGovernments have also recognised the importance of packaging as a communications tool. Health warnings, for instance, first appeared on cigarette packs almost half a century ago in the UK, and over time have increased in size and now include pictures. These warnings are a cost-effective and credible means of informing of the health risks of smoking. From May 2017 standardised packaging will be implemented, which will essentially leave all packs looking the same and make the health warnings stand out even more.

Much more could still be done with the packaging however. For instance, pack inserts are an inexpensive means of communication, and have been widely used by tobacco companies. Could the use of inserts, with positively framed messages encouraging smokers to quit and promoting self-efficacy to do so, be of value within the UK? There is also the cigarette itself, which tobacco industry journals refer to as an increasingly important promotional tool. While at a very early stage, academics have begun to explore the possibility of using the appearance of the cigarette to deter smoking, for instance unattractively coloured cigarettes or cigarettes displaying health warnings. Further research exploring these ideas, or the many other potential ways to reduce the appeal of cigarettes, would be of significant value.

There are likely many other possibilities of using the pack to discourage non-smokers from starting and encourage smokers to stop. Supposing, for example, the pack had an audio warning when it was opened? Or it featured a Quick Response barcode on the pack that could direct smartphone users to a stop-smoking service, or similar innovations using barcodes, like augmented reality, which could direct the user to social networking campaigns. The options are many and varied. As the Scottish Government has set a target date for reducing smoking prevalence to less than 5% of the population, and packaging is seen as a crucial platform for health promotion, this PhD could help generate ideas that could help reach this target.

This PhD would have two key objectives:
• To explore the range of possible health promoting packaging innovations, and
• To explore how consumers respond to some of these measures.

For More information and to apply for this PhD click here.