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.

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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

Participants needed: A pilot study into the determinants of behaviour change in alcohol use disorder.

Queen Mary University is looking for people with problematic drinking who are currently trying to stop drinking, but unable to do so.

A pilot study into the determinants of behaviour change in alcohol use disorder.

We would like to invite you to be part of this research project.  It is entirely up to you if you want to take part. If you choose not to take part there won’t be any disadvantages for you and you will hear no more about it.

Please read the following information; this will tell you why the research is being done and what you will be asked to do. Please ask if anything is not clear or you would like more information.

The Study.

Achieving and maintaining abstinence from alcohol can be difficult. Scientific study into the reasons behind these difficulties has identified a number of factors which may play a role in the inability to stop drinking. This project examines several of these to further clarify their role.

Why have I been invited to take part?

We are looking for two groups of people. Those who have successfully managed to stop drinking for 12 months or more, and those who cannot maintain abstinence for more than 30 days, despite a desire to stop.

What will happen if I take part?

If you wish to participate we will arrange an appointment that will take about 1-1.5 hours. This will consist of a series of questionnaires and behavioural tasks including holding your breath for as long as you can; a hand grip task; and a computer task where you will trace the outline of a shape. You will receive £10 to put towards any travel costs you may incur.

If you live outside of London you will be able to complete the study remotely and will receive payment by mail.

The session will be conducted by PhD student Daisy Thompson-Lake who is under the supervision of Professor Peter Hajek and Professor De La Garza.

If you agree to give contact details we will also contact you in the future to ask you for your breath holding time via email or telephone. This is not compulsory and you will receive the compensation should you decide to give no contact details.

What are the risks of taking part?

There are no risks associated with taking part in the study.

What are the benefits of taking part?

There are no direct benefits to you for taking part. However, the information you provide may contribute towards better understanding of factors contributing to stopping drinking, and future treatments.

Will my data be kept confidential?

Yes, if you agree to take part all information you give us will be kept confidential and only study staff will have access to this data. All data will be anonymised and there will be no information included in the study which could identify you.

What if I want to leave the study?

Your participation is entirely voluntary, and you are free to leave the study at any time for any reason. We will request your permission to keep the information you have given us until the time you decide to leave the study.

What happens if you are concerned or have any questions?

You will be able to contact Daisy Thompson-Lake (02078828244, d.g.y.thompson-lake@qmul.ac.uk ) if you are worried about anything or have any questions.

The Chief Investigator of this study is Professor Peter Hajek, Tobacco Dependence Research Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, 2 Stayner’s Road, Stepney Green, E1 4AH, Email: p.hajek@qmul.ac.uk Tel:  020 7882 8230.

A summary of the report from this study will be available upon request.

We would like to thank you for your interest in this study.

 

If interested please call or email Daisy on :

02078828244 or d.g.y.thompson-lake@qmul.ac.uk

Thinking about Drinking: A Year in the Life of an Alcohol Researcher at Stirling

Niamh was active in helping the media understand the implications of theniamhfitzgerald 2016 new alcohol guidelines. In this blog post she discusses what happened as a result of the publication of the new guidelines and how the media portray the facts in their own way.

By Niamh Fitzgerald, Research Profile, @NiamhCreate

Journalists love a good alcohol story, especially at this time of year, and January 2016 gave them the ideal ammunition with the publication of new advice from the UK’s Chief Medical Officers (CMOs) designed to provide people with ‘accurate information and clear advice about alcohol and its health risks’.  For the first time, the guidance advised that ‘no level of regular drinking can be considered completely safe’ and advised the same limit for both men and women – not to regularly drink above 14 units of alcohol (about 1 and a half bottles of wine) per week, at the same time moving away from the previous daily limits.  The guidance was based on a lengthy process involving experts from around the UK including Prof. Gerard Hastings (from Stirling) and followed emerging evidence on the links between alcohol and cancer – kicking off a furore of media coverage.

Media coverage following the publication of the new guidelines

The Daily Mail led with the news that the guidelines would ‘put a stop to the belief that red wine is good for you in moderation, while the Sun also focused on this ‘plonk lovers’ shock’ as the CMO’s ‘rubbished’ the supposed health benefits of wine.

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Others focused on the cancer risk, with the Scotsman leading with ‘drinkers at risk of cancer from single glass of wine’; whereas the Telegraph headline was ‘health chiefs attacked for nanny state alcohol guidelines’.  It was a frantic week for colleagues and I at the Institute for Social Marketing (ISM) as we sought to capture all of the newspaper, television and radio coverage for future analysis.  As Lecturer in Alcohol Studies at ISM, and lead for teaching and public engagement on alcohol for the UK Centre for Tobacco and Alcohol Studies (UKCTAS), I was interviewed about the new guidelines on BBC News for their ‘Ask This’ feature, which takes questions from viewers.  I also had a comment piece published in The Scotsman. Continue reading

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