New evidence finds standardised cigarette packaging may reduce the number of people who smoke as UK legislation bans the use of branding on all cigarette packets from May 2017.

A Cochrane Review published today finds standardised tobacco packaging may lead to a reduction in smoking prevalence and reduces the appeal of tobacco.

According to the World Health Organisation, tobacco use kills more people worldwide than any other preventable cause of death. Global health experts believe the best way to reduce tobacco use is by stopping people starting to use tobacco and encouraging and helping existing users to stop.

plain-packs-620-x-348-heroThe introduction of standardised (or ‘plain’) packaging was recommended by the World Health Organisation, Framework Convention on Tobacco Control (WHO FCTC) guidelines. This recommendation was based on evidence around tobacco promotion in general and studies which examined the impact of changes in packaging on knowledge, attitudes, beliefs and behaviour. Standardised tobacco packaging places restrictions on the appearance of tobacco packs so that there is a uniform colour (and in some cases shape) with no logos or branding apart from health warnings and other government-mandated information, and the brand name appears in a prescribed uniform font, colour and size.

From next month, UK legislation on standardised packaging for all tobacco packs comes into full effect.

Australia was the first country in the world to implement standardised packaging of tobacco products.  The laws, which took full effect there in December 2012, also required enlarged pictorial health warnings.

A team of Cochrane researchers from the UK and Canada have summarised results from studies that examine the impact of standardised packaging on tobacco attitudes and behaviour. They have today published their findings in the Cochrane Library.

Continue reading

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.

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!

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

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

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