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Jackson SE, Brown J, Beard E. Associations of Prevalence of E-cigarette Use With Quit Attempts, Quit Success, Use of Smoking Cessation Medication, and the Overall Quit Rate Among Smokers in England: A Time-Series Analysis of Population Trends 2007-2022. Nicotine Tob Res 2024; 26:826-834. [PMID: 38214664 PMCID: PMC11190046 DOI: 10.1093/ntr/ntae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/06/2023] [Accepted: 01/06/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION This study aimed to (1) provide up-to-date estimates of how changes in the prevalence of e-cigarette use have been associated with changes in smoking cessation activities and use of licensed treatments among smokers in England and (2) explore any changes in these associations over time. METHODS Data were aggregated quarterly on 67 548 past-year smokers between Q1-2007 and Q4-2022. Explanatory variables were the prevalence of (1) current e-cigarette use among smokers and (2) e-cigarette use during a quit attempt. Outcomes were rates of quit attempts and overall quits among past-year smokers, and the quit success rate and use of licensed treatments among those who made a quit attempt. RESULTS The success rate of quit attempts increased by 0.040% (95% CI 0.019; 0.062) for every 1% increase in the prevalence of e-cigarette use during a quit attempt. No clear evidence was found for an association between current e-cigarette use and the quit attempt rate (Badj = 0.008 [95% CI -0.045; 0.061]) or overall quit rate (Badj = 0.063 [-0.031; 0.158]); or between use of e-cigarettes during a quit attempt and the overall quit rate (Badj = 0.030 [-0.054; 0.114]), use of prescription medication (varenicline/bupropion/nicotine replacement therapy [NRT]: Badj = -0.036 [-0.175; 0.102]), or use of over-the-counter NRT (Badj = -0.052 [-0.120; 0.015]). There was no clear evidence this pattern of associations has changed substantially over time. CONCLUSIONS Changes in the prevalence of e-cigarette use in England through 2022 have been positively associated with the success rate of quit attempts but not clearly associated with the quit attempt rate, overall quit rate, or use of licensed smoking cessation treatments. IMPLICATIONS If the association between the increase in e-cigarette use and the quit success rate is causal, then the use of e-cigarettes in quit attempts has helped in the region of 30 000 to 50 000 additional smokers in England to successfully quit each year since they became popular in 2013, over and above the number who were quitting before the advent of e-cigarettes.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
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2
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Jackson SE, Tattan-Birch H, Shahab L, Beard E, Brown J. Have there been sustained impacts of the COVID-19 pandemic on trends in smoking prevalence, uptake, quitting, use of treatment, and relapse? A monthly population study in England, 2017-2022. BMC Med 2023; 21:474. [PMID: 38093317 PMCID: PMC10720231 DOI: 10.1186/s12916-023-03157-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Studies conducted during the early stages of the pandemic documented mixed changes in smoking behaviour: more smokers quitting successfully but little change in prevalence. This study aimed to examine whether there have been sustained impacts of the COVID-19 pandemic on smoking patterns in England. METHODS Data were from 101,960 adults (≥ 18 years) participating in the Smoking Toolkit Study, a monthly representative household survey, between June 2017 and August 2022. Interviews were conducted face-to-face until March 2020 and via telephone thereafter. Generalised additive models estimated associations of the pandemic onset (March 2020) with current smoking, uptake, cessation, quit attempts, and use of support. Models adjusted for seasonality, sociodemographic characteristics, and (where relevant) dependence and tobacco control mass-media expenditure. RESULTS Before the COVID-19 pandemic, smoking prevalence fell by 5.2% per year; this rate of decline slowed to 0.3% per year during the pandemic (RRΔtrend = 1.06, 95% CI = 1.02, 1.09). This slowing was evident in more but not less advantaged social grades (RRΔtrend = 1.15, 1.08, 1.21; RRΔtrend = 1.00, 0.96, 1.05). There were sustained step-level changes in different age groups: a 34.9% (95% CI = 17.7, 54.7%) increase in smoking prevalence among 18-24-year-olds, indicating a potential rise in uptake, in contrast to a 13.6% (95% CI = 4.4, 21.9%) decrease among 45-65-year-olds. In both age groups, these step-level changes were followed by the pre-pandemic declines stopping, and prevalence remaining flat. There were sustained increases in quitting among past-year smokers, with a 120.4% (95% CI = 79.4, 170.9%) step-level increase in cessation and a 41.7% (95% CI = 29.7, 54.7%) increase in quit attempts. The main limitation was the change in modality of data collection when the pandemic started; while this may have contributed to the step-level changes we observed, it is unlikely to explain changes in the slope of trends. CONCLUSIONS In England, the rate of decline in adult smoking prevalence stagnated during the COVID-19 pandemic through to 2022. At the start of the pandemic, a potential reduction in smoking prevalence among middle-aged adults and increases in quitting among smokers may have been offset by an increase in smoking among young adults. The slowing in the rate of decline was pronounced in more advantaged social grades.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- SPECTRUM Consortium, London, UK.
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Consortium, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Consortium, London, UK
| | - Emma Beard
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Consortium, London, UK
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Etoori D, Desai M, Mandal S, Rosenberg W, Sabin CA. A scoping review of media campaign strategies used to reach populations living with or at high risk for Hepatitis C in high income countries to inform future national campaigns in the United Kingdom. BMC Infect Dis 2023; 23:629. [PMID: 37752434 PMCID: PMC10523688 DOI: 10.1186/s12879-023-08603-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND With the advent of direct acting antivirals, the World Health Organisation proposed eliminating Hepatitis C as a public health threat by 2030. To achieve this, countries need to diagnose, engage in care and treat their undiagnosed populations. This will require sensitisation campaigns. However previous media campaigns have had mixed impact. We conducted a scoping review to identify and understand the impact of previous Hepatitis C media campaigns. These findings could inform the delivery of future campaigns. METHODS We searched five electronic databases for published literature on media campaigns conducted for Hepatitis C awareness, testing, and treatment in Organisation for Economic Co-operation and Development (OECD) countries since 2010. Two independent reviewers screened citations for inclusion. Additionally, we spoke to stakeholders in the Hepatitis C field in the UK and conducted a Google search to identify any unpublished literature. A quantitative synthesis was conducted to identify targeted populations, strategies and media used, aims and impact of the campaigns. RESULTS A title and year of publication screening of 3815 citations resulted in 113 papers that had a full abstract screen. This left 50 full-text papers, 18 were included of which 9 (50%) were from Europe. 5 (27.8%) of campaigns targeted minority ethnicities, and 9 (50%) aimed to increase testing. A Google search identified 6 grey literature sources. Most campaigns were not evaluated for impact. Discussions with stakeholders identified several barriers to successful campaigns including lack of targeted messaging, stigmatising or accusatory messaging, and short-lived or intermittent campaign strategies. CONCLUSION Future campaigns will likely need to be multifaceted and have multiple tailored interventions. Campaigns will need to be sizeable and robust, integrated into health systems and viewed as an ongoing service rather than one-offs.
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Affiliation(s)
- David Etoori
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - William Rosenberg
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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Kim K. Scanned information exposure and support for tobacco regulations among US youth and young adult tobacco product users and non-users. HEALTH EDUCATION RESEARCH 2023; 38:426-444. [PMID: 37565566 PMCID: PMC10516358 DOI: 10.1093/her/cyad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023]
Abstract
The influences of information exposure on youth and young adults' (YYA) support for smoking/vaping regulations have been understudied. This study examines (i) the relationships between routine exposure to (i.e. scanning) anti-smoking/pro-vaping information and YYA support for anti-smoking/vaping regulations and (ii) whether these relationships differ across YYA users and non-users of tobacco products. We analyzed the data from a nationally representative two-wave rolling cross-sectional survey of YYA in the United States, collected from 2014 to 2017 (baseline n = 10 642; follow-up n = 4001). Less than 5% of the participants ever scanned pro-smoking and anti-vaping information. Scanning anti-smoking information had significant positive relationships with support for all anti-smoking policies cross-sectionally, and this pattern was longitudinally significant in two anti-smoking policy contexts. Scanning pro-vaping information had significant negative associations with support for anti-vaping policies cross-sectionally, but not longitudinally. The lagged positive relationships between scanning anti-smoking information and support for anti-smoking regulations were stronger among YYA smokers than among YYA non-smokers, whereas evidence from adult data suggested the opposite pattern. The findings suggest that scanning information can affect YYA support for tobacco regulations. Future efforts are required to investigate mechanisms underlying the influences of scanned information on YYA support for tobacco regulations.
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Affiliation(s)
- Kwanho Kim
- Department of Communication, Cornell University, 494 Mann Library Building, Ithaca, NY 14853, USA
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5
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Wallhed Finn S, Mejldal A, Baskaran R, Søgaard Nielsen A. The Danish RESPEKT Campaign: Impact of a National Mass Media Campaign Aiming to Increase Treatment Seeking for Alcohol Use Disorders. Subst Use Misuse 2022; 57:1082-1096. [PMID: 35422189 DOI: 10.1080/10826084.2022.2063897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: A minority of all with alcohol use disorders seek treatment. In Denmark, a media campaign, "RESPEKT," has been broadcast nationwide since 2015. The campaign is unique from an international perspective and aims to increase treatment-seeking. Similar interventions have, up until now, not been scientifically evaluated.Aim: To investigate campaign awareness, understanding, attitudes, and information-seeking pre- and post the campaign period. Also, associations to demographic factors and year of campaign will be investigated.Method: Study design: Repeated cross-sectional studyParticipants: Adults aged 30-70 years, in total n = 9169.Data: Pre- and post the campaign period between 2017 and 2020, an online questionnaire was administered by a market research company. The questionnaire covered demographic data, campaign awareness, understanding, attitudes, and information-seeking about treatment for alcohol use disorders. In addition, complete-case logistic regression was performed to model dichotomous outcomes, and odds ratios were calculated.Results: Campaign awareness varied between 8 and 40% over the different years. Understanding of the main message was high and received higher endorsements over the study period. A majority expressed positive attitudes toward the campaign and support for the main message regarding free treatment. However, very few self-reported seeking information about AUD treatment. Female sex was associated with higher awareness of the campaign, higher understanding and more positive attitudes toward the campaign.Conclusion: The campaign evoked positive attitudes and had an impact on increasing knowledge and changing attitudes. However, no effect on self-reported information seeking about treatment was found.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ruben Baskaran
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, The Faculty of Engineering, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Psychiatric Hospital, University Function, Odense, Denmark
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Marteau TM, Fletcher PC, Munafò MR, Hollands GJ. Beyond choice architecture: advancing the science of changing behaviour at scale. BMC Public Health 2021; 21:1531. [PMID: 34376159 PMCID: PMC8356415 DOI: 10.1186/s12889-021-11382-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
Addressing the global threats to population and planetary health requires changing many behaviours at scale. This demands consideration not only of the effect size of an intervention but also its reach - the proportion of the population exposed to the intervention.We propose that a relatively under-researched and generally poorly specified set of interventions involving changes to physical micro-environments - often referred to as Choice Architecture - has the potential to make a significant contribution to meeting this urgent challenge.Realising the potential of Choice Architecture interventions requires integration of basic - i.e. laboratory-based - and applied - i.e. field-based - research, generating interventions that can be delivered at scale alongside advancing theory. We illustrate this with examples to highlight the complementarity of laboratory and field studies informed by and in turn updating the results of evidence synthesis. The examples comprise two sets of interventions - changing the relative availability of products and changing their size - to reduce consumption of meat, energy from food and alcohol across populations.
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Affiliation(s)
- Theresa M Marteau
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marcus R Munafò
- University of Bristol, School of Psychological Science, Bristol, UK
| | - Gareth J Hollands
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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7
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Beard E, Brown J, Jackson SE, West R, Anderson W, Arnott D, Shahab L. Who would be targeted by increasing the legal age of sale of cigarettes from 18 to 21? A cross-sectional study exploring the number and characteristics of smokers in England. Addiction 2021; 116:2187-2197. [PMID: 33565612 PMCID: PMC8436755 DOI: 10.1111/add.15421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/07/2020] [Accepted: 01/13/2021] [Indexed: 01/01/2023]
Abstract
AIMS To establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and socio-demographic profile of those smokers. DESIGN AND SETTING Nationally representative cross-sectional survey of adults in England conducted between January 2009 and July 2019. PARTICIPANTS A total of 219 720 adults. MEASUREMENTS All participants reported their current smoking status and socio-demographic characteristics (i.e. age, gender, home ownership, social grade and ethnicity). Smokers reported motivation to quit, urges to smoke and the Heaviness of Smoking Index (HIS). Weighted prevalence statistics were calculated. Multinomial regression and logistic regression were used to assess differences in smoking characteristics among smokers and socio-demographic characteristics relative to non-smokers. FINDINGS The prevalence of smoking between January 2009 and July 2019 was highest among those aged 21-30. In 2019, 15.6% [95% confidence interval (CI) = 12.8-18.8%] of 18-20-year-olds reported smoking, which is estimated to represent 364 000 individuals in England. Relative to smokers aged 18-20, older smokers (aged 21+) had a higher motivation to quit smoking [odds ratios (ORs) = 1.40-1.45 range] and higher nicotine dependency as measured by urges to smoke (ORs = 1.06-1.24 range) and HSI (ORs = 1.05-2.85 range). Compared with non-smokers aged 18-20, smokers in this age group had lower odds of being female (OR = 0.89) and higher odds of being of white ethnicity (OR = 2.78) and from social grades C1-E (lower social grades) compared with AB (higher social grades) (OR = 1.19-1.83 range). CONCLUSION Increasing the age of sale of cigarettes to 21 years in England would currently target approximately 364 000 lower dependent smokers from more disadvantaged backgrounds aged 18-20, who have less motivation to quit.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | | | - Deborah Arnott
- Action on Smoking and Health (ASH)LondonUK
- Division of Epidemiology and Public Health, School of MedicineUniversity of Nottingham
| | - Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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8
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Levy DT, Sánchez-Romero LM, Li Y, Yuan Z, Travis N, Jarvis MJ, Brown J, McNeill A. England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking-attributable deaths in England. Addiction 2021; 116:1196-1211. [PMID: 32949419 PMCID: PMC9364758 DOI: 10.1111/add.15269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/14/2020] [Accepted: 09/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Whereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England. DESIGN Indirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP-related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012-2019 counterfactual No-NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking-attributable deaths. SETTING England, 2000-2019. PARTICIPANTS Nationally representative sample of population. MEASUREMENTS England's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies. FINDINGS Between 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012-2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model-predicted No-NVP reduction (males, 7.3%), the implied NVP-attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%-22.0%) for males and 20.4% (18.7%-22.2%) for females. The NVP-attributable reduction was 27.2% (22.8%-31.6%) for males and 31.7% (27.4%-36.5%) for females ages 18-24 and 18.6% (15.2%-21.8%) for males and 15.0% (11.1%-18.8%) for females ages 25-34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453-199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results. CONCLUSIONS An indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012-2019 coinciding with the growth in nicotine vaping product use.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Martin J Jarvis
- Department of Behavioural Science and Health, University College London, Gower Street, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, Gower Street, London, UK
| | - Ann McNeill
- National Addiction Centre, King's College London, UK
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Fulton EA, Newby K, Kwah K, Schumacher L, Gokal K, Jackson LJ, Naughton F, Coleman T, Owen A, Brown KE. A digital behaviour change intervention to increase booking and attendance at Stop Smoking Services: the MyWay feasibility RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Smoking remains a leading cause of illness and preventable death. NHS Stop Smoking Services increase quitting, but, as access is in decline, cost-effective interventions are needed that promote these services. StopApp™ (Coventry University, Coventry, UK) is designed to increase booking and attendance at Stop Smoking Services.
Design
A two-arm feasibility randomised controlled trial of StopApp (intervention) compared with standard promotion and referral to Stop Smoking Services (control) was conducted to assess recruitment, attrition and health equity of the design, alongside health economic and qualitative process evaluations.
Setting
Smokers recruited via general practitioners, community settings and social media.
Participants
Smokers aged ≥ 16 years were recruited in one local authority. Participants had to live or work within the local authority area, and there was a recruitment target of 120 participants.
Interventions
StopApp to increase booking and attendance at Stop Smoking Services.
Main outcome measures
Participants completed baseline measures and follow-up at 2 months post randomisation entirely online. Objective data on the use of Stop Smoking Services were collected from participating Stop Smoking Services, and age groups, sex, ethnicity and socioeconomic status in baseline recruits and follow-up completers/non-completers were assessed for equity.
Results
Eligible participants (n = 123) were recruited over 116 days, with good representation of lower socioeconomic status groups; black, Asian and minority ethnic groups; and all age groups. Demographic profiles of follow-up completers and non-completers were broadly similar. The attrition rate was 51.2%, with loss to follow-up lowest in the social media setting (n = 24/61; 39.3%) and highest in the general practitioner setting (n = 21/26; 80.8%). Most measures had < 5% missing data. Social media represented the most effective and cost-efficient recruitment method. In a future, definitive, multisite trial with recruitment driven by social media, our data suggest that recruiting ≥ 1500 smokers over 12 months is feasible. Service data showed that five bookings for the Stop Smoking Services were scheduled using StopApp, of which two did not attend. Challenges with data access were identified. A further five participants in the intervention arm self-reported booking and accessing Stop Smoking Services outside StopApp compared with two control arm participants. Event rate calculations for the intervention were 8% (Stop Smoking Services data), 17% (including self-reports) and 3.5% from control arm self-reports. A conservative effect size of 6% is estimated for a definitive full trial. A sample size of 840 participants would be required to detect an effect for the primary outcome measure of booking a Stop Smoking Services appointment in a full randomised controlled trial. The process evaluation found that participants were satisfied with the research team contact, study methods and provision of e-vouchers. Staff interviews revealed positive and negative experiences of the trial and suggestions for improvements, including encouraging smokers to take part.
Conclusion
This feasibility randomised controlled trial found that, with recruitment driven wholly or mainly by social media, it is possible to recruit and retain sufficient smokers to assess the effectiveness and cost-effectiveness of StopApp. The study methods and measures were found to be acceptable and equitable, but accessing Stop Smoking Services data about booking, attendance and quit dates was a challenge. A full trial may be feasible if service data are accessible. This will require careful planning with data controllers and a targeted social media campaign for recruitment. Changes to some study measures are needed to avoid missing data, including implementation of a more intensive follow-up data collection process.
Future work
We plan a full, definitive randomised controlled trial if the concerns around data access can be resolved, with adaptations to the recruitment and retention strategy.
Limitations
Our trial had high attrition and problems with collecting Stop Smoking Services data, which resulted in a reliance on self-reporting.
Trial registration
Research Registry: 3995. The trial was registered on 18 April 2018.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emily A Fulton
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Katie Newby
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kayleigh Kwah
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Lauren Schumacher
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kajal Gokal
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Louise J Jackson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Tim Coleman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Alun Owen
- Faculty of Engineering, Environment and Computing and Sigma Mathematics and Statistics Support Centre, Coventry University, Coventry, UK
| | - Katherine E Brown
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Holmes J, Beard E, Brown J, Brennan A, Kersbergen I, Meier PS, Michie S, Stevely AK, Buykx P. The impact of promoting revised UK low-risk drinking guidelines on alcohol consumption: interrupted time series analysis. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The UK’s Chief Medical Officers revised the UK alcohol drinking guidelines in 2016 to ≤ 14 units per week (1 unit = 10 ml/8 g ethanol) for men and women. Previously, the guideline stated that men should not regularly consume more than 3–4 units per day and women should not regularly consume more than 2–3 units per day.
Objective
To evaluate the impact of promoting revised UK drinking guidelines on alcohol consumption.
Design
Interrupted time series analysis of observational data.
Setting
England, March 2014 to October 2017.
Participants
A total of 74,388 adults aged ≥ 16 years living in private households in England.
Interventions
Promotion of revised UK low-risk drinking guidelines.
Main outcome measures
Primary outcome – alcohol consumption measured by the Alcohol Use Disorders Identification Test – Consumption score. Secondary outcomes – average weekly consumption measured using graduated frequency, monthly alcohol consumption per capita adult (aged ≥ 16 years) derived from taxation data, monthly number of hospitalisations for alcohol poisoning (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: T51.0, T51.1 and T51.9) and assault (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: X85–Y09), and further measures of influences on behaviour change.
Data sources
The Alcohol Toolkit Study, a monthly cross-sectional survey and NHS Digital’s Hospital Episode Statistics.
Results
The revised drinking guidelines were not subject to large-scale promotion after the initial January 2016 announcement. An analysis of news reports found that mentions of the guidelines were mostly factual, and spiked during January 2016. In December 2015, the modelled average Alcohol Use Disorders Identification Test – Consumption score was 2.719 out of 12.000 and was decreasing by 0.003 each month. After the January 2016 announcement, Alcohol Use Disorders Identification Test – Consumption scores did not decrease significantly (β = 0.001, 95% confidence interval –0.079 to 0.099). However, the trend did change significantly such that scores subsequently increased by 0.005 each month (β = 0.008, 95% confidence interval 0.001 to 0.015). This change is equivalent to 0.5% of the population moving each month from drinking two or three times per week to drinking four or more times per week. Secondary analyses indicated that the change in trend began 6 months before the guideline announcement. The secondary outcome measures showed conflicting results, with no significant changes in consumption measures and no substantial changes in influences on behaviour change, but immediate reductions in hospitalisations of 7.3% for assaults and 15.4% for alcohol poisonings.
Limitations
The pre-intervention data collection period was only 2 months for influences on behaviour change and the graduated frequency measure. Our conclusions may be generalisable only to scenarios in which guidelines are announced but not promoted.
Conclusions
The announcement of revised UK low-risk drinking guidelines was not associated with clearly detectable changes in drinking behaviour. Observed reductions in alcohol-related hospitalisations are unlikely to be attributable to the revised guidelines. Promotion of the guidelines may have been prevented by opposition to the revised guidelines from the government's alcohol industry partners or because reduction in alcohol consumption was not a government priority or because practical obstacles prevented independent public health organisations from promoting the guidelines. Additional barriers to the effectiveness of guidelines may include low public understanding and a need for guidelines to engage more with how drinkers respond to and use them in practice.
Trial registration
Current Controlled Trials ISRCTN15189062.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma Beard
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Inge Kersbergen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Abigail K Stevely
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- School of Humanities and Social Science, University of Newcastle, Newcastle, NSW, Australia
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11
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Beard E, Jackson SE, West R, Kuipers MAG, Brown J. Trends in Attempts to Quit Smoking in England Since 2007: A Time Series Analysis of a Range of Population-Level Influences. Nicotine Tob Res 2020; 22:1476-1483. [PMID: 31418449 PMCID: PMC7443610 DOI: 10.1093/ntr/ntz141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/12/2019] [Indexed: 02/02/2023]
Abstract
AIM To quantify population-level associations between quit attempts and factors that have varied across 2007-2017 in England. METHODS Data from 51 867 past-year smokers participating in the Smoking Toolkit Study (a monthly cross-sectional survey of individuals aged 16+) were aggregated over an 11-year period. Time series analysis was undertaken using ARIMAX modeling. The input series were: (1) prevalence of smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy; (2) prevalence of roll-your-own tobacco use; (3) prevalence of (a) smoking and (b) non-daily smoking; (4) mass media expenditure; (5) average expenditure on smoking; (6) characteristics in the form of (a) prevalence of high motivation to quit, (b) average age, (c) proportion from lower social grades, and (d) average number of cigarettes smoked; and (7) implementation of tobacco control policies. RESULTS There was a decline in the prevalence of quit attempts from 44.6% to 33.8% over the study period. The partial point-of-sale ban was associated with a temporary increase in quit attempt prevalence (Badjusted = 0.224%; 95% confidence interval [CI] 0.061 to 0.388). Quit attempts were positively associated with the prevalence of high motivation to quit (Badjusted = 0.165%;95% CI 0.048 to 0.282) and negatively associated with the mean age of smokers (Badjusted = -1.351%; 95% CI -2.168 to -0.534). All other associations were nonsignificant. CONCLUSION Increases in the prevalence of high motivation to quit was associated with higher prevalence of attempts to quit smoking, while an increase in the mean age of smokers was associated with lower prevalence. The introduction of the partial point-of-sale ban appeared to have a temporary positive impact. IMPLICATIONS This study provides insight into how monthly changes in a wide range of population-level factors are associated with changes in quit attempts over an extended time period in a country with a strong tobacco control climate. The findings suggest a need for intervention or policy to stimulate quit attempts in older smokers. Otherwise, increases in the mean age of a smokers appears likely to undermine wider efforts to promote quit attempts in a population.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Mirte A G Kuipers
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
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12
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Beard E, West R, Michie S, Brown J. Association of prevalence of electronic cigarette use with smoking cessation and cigarette consumption in England: a time-series analysis between 2006 and 2017. Addiction 2020; 115:961-974. [PMID: 31621131 PMCID: PMC7187187 DOI: 10.1111/add.14851] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/17/2019] [Accepted: 09/27/2019] [Indexed: 01/13/2023]
Abstract
AIMS To provide up-to-date estimates of how changes in the prevalence of electronic cigarette (e-cigarette) use in England have been associated with changes in smoking cessation activities and daily cigarette consumption among smokers in England. DESIGN Time-series analysis of population trends. SETTING England. PARTICIPANTS Participants came from the Smoking Toolkit Study, which involves repeated, cross-sectional household surveys of individuals aged 16 years and older in England. Data were aggregated on approximately 1200 past-year smokers each quarter (total n = 50 498) between 2007 and 2017. MEASUREMENTS Prevalence of e-cigarette use in current smokers was used to predict (a) prevalence of quit attempts among last-year smokers, (b) overall quit rates among last-year smokers and (c) mean cigarette consumption per day among current smokers. Prevalence of e-cigarette use during a quit attempt among last-year smokers was used to predict (a) quit success rate among last-year smokers and (b) overall quit rates among last-year smokers. FINDINGS Overall quit rates increased by 0.054% [95% confidence interval (CI) = 0.032-0.076, P < 0.001] and 0.050% (95% CI = 0.031-0.069, P < 0.001) respectively for every 1% increase in the prevalence of e-cigarette use by smokers and e-cigarette use during a quit attempt. Quit success rates increased by 0.060% (95% CI = 0.043-0.078, P < 0.001) for every 1% increase in the prevalence of e-cigarette use during a quit attempt. No clear evidence was found for an association between e-cigarette use and either prevalence of quit attempt (BAdj = 0.011, 95% CI = -0.046 to 0.069, P = 0.698) or cigarette consumption (BAdj = 0.019, 95% CI = -0.043 to 0.082, P = 0.542). CONCLUSION Changes in prevalence of e-cigarette use in England have been positively associated with the overall quit rates and quit success rates but not clearly associated with the prevalence of quit attempts and mean cigarette consumption.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Susan Michie
- Department of Educational, Clinical and Health PsychologyUniversity College LondonLondonUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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13
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Beard E, Brown J, Jackson S, West R, Anderson W, Arnott D, Shahab L. Long-term evaluation of the rise in legal age-of-sale of cigarettes from 16 to 18 in England: a trend analysis. BMC Med 2020; 18:85. [PMID: 32264873 PMCID: PMC7140583 DOI: 10.1186/s12916-020-01541-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess the long-term impact of the increase in age-of-sale of cigarettes from 16 to 18 in England in October 2007. METHODS Data were collected between November 2006 and September 2018 on 252,601 participants taking part in a nationally representative survey of adults aged 16+ in England, the Smoking Toolkit Study (STS). We assessed the impact of the introduction of the increase in age-of-sale on prevalence of ever smoking, current smoking, and quit attempts, among 16-17 year olds compared with 18-24 year olds. RESULTS Following the increase in age-of-sale, there was a declining trend in ever smoking that was greater among 16-17 year olds than 18-24 year olds (OR 0.990 versus OR 0.993; p = 0.019). Data on current smoking were insensitive to detect a difference between the age groups in a step-level change or change in trend following the increase in age-of-sale (Bayes factors (BFs) 0.75 and 2.10). Data on quit attempts were also insensitive to detect a change in trend (BF 0.71), and despite a greater step-level decline among those aged 16-17 (OR 0.311 versus OR 0.547, p = 0.025), quit attempts remained higher among those aged 16-17. Secondary analysis indicated that post-policy change, trends in current and ever smoking were linear for 16-17 year olds but quadratic for 18-24 year olds (slowing decline). CONCLUSION There is some evidence from an assessment of long-term trends in the Smoking Toolkit Study that the increase in legal age-of-sale of cigarettes in England was associated with a greater long-term decline in ever smoking among those aged 16-17 compared with those aged 18-24.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
| | - Sarah Jackson
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
| | | | | | - Lion Shahab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
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14
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Beard E, Jackson SE, West R, Kuipers MAG, Brown J. Population-level predictors of changes in success rates of smoking quit attempts in England: a time series analysis. Addiction 2020; 115:315-325. [PMID: 31626370 PMCID: PMC7004132 DOI: 10.1111/add.14837] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/25/2019] [Accepted: 09/23/2019] [Indexed: 01/10/2023]
Abstract
AIMS To quantify associations between the success of smoking quit attempts and factors that have varied throughout 2007-2018 at a population level. DESIGN time series analysis using Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling. SETTING AND PARTICIPANTS Data were aggregated from 54 847 past-year smokers taking part in the Smoking Toolkit Study which involves monthly repeated cross-sectional household surveys of individuals aged 16+ in England. MEASUREMENTS The input series were: (1) attempts at smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy (NRT); (2) use during a quit attempt of (a) e-cigarettes, (b) NRT over-the-counter, (c) medication on prescription and (d) face-to-face behavioural support; (3) use of roll-your-own tobacco; (4) prevalence of (a) smoking and (b) non-daily smoking; (5) tobacco control mass media expenditure; (6) expenditure on smoking; (7) smoker characteristics in the form of (a) high motivation to quit, (b) average age, (c) socio-economic status and (d) cigarette consumption; (8) implementation of tobacco control policies; and (9) quit attempt rate. FINDINGS The licensing of NRT for harm reduction was associated with a 0.641% [95% confidence interval (CI) = 0.073-1.209, P = 0.027] increase in the mean point prevalence of the success rate of quit attempts. For every 1% increase in the mean point prevalence of e-cigarette use and use of prescription medication during a quit attempt, the mean point prevalence of successful quit attempts increased by 0.106% (95% CI = 0.011-0.201, P = 0.029) and 0.143% (95% CI = 0.009-0.279, P = 0.038), respectively. For every 1% increase in the mean expenditure on tobacco control mass media, the mean point prevalence of successful quit attempts increased by 0.046% (95% CI = 0.001-0.092, P = 0.046). Other associations were not statistically significant. CONCLUSION In England between 2007 and 2018, licensing of nicotine replacement therapy for use in harm reduction, greater use of e-cigarettes and prescription medications during a quit attempt and higher expenditure on tobacco control mass media were all associated with higher success rates of quit attempts.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Mirte A. G. Kuipers
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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15
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Beard E, Marsden J, Brown J, Tombor I, Stapleton J, Michie S, West R. Understanding and using time series analyses in addiction research. Addiction 2019; 114:1866-1884. [PMID: 31058392 DOI: 10.1111/add.14643] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/17/2018] [Accepted: 04/29/2019] [Indexed: 11/29/2022]
Abstract
Time series analyses are statistical methods used to assess trends in repeated measurements taken at regular intervals and their associations with other trends or events, taking account of the temporal structure of such data. Addiction research often involves assessing associations between trends in target variables (e.g. population cigarette smoking prevalence) and predictor variables (e.g. average price of a cigarette), known as a multiple time series design, or interventions or events (e.g. introduction of an indoor smoking ban), known as an interrupted time series design. There are many analytical tools available, each with its own strengths and limitations. This paper provides addiction researchers with an overview of many of the methods available (GLM, GLMM, GLS, GAMM, ARIMA, ARIMAX, VAR, SVAR, VECM) and guidance on when and how they should be used, sample size det ermination, reporting and interpretation. The aim is to provide increased clarity for researchers proposing to undertake these analyses concerning what is likely to be acceptable for publication in journals such as Addiction. Given the large number of choices that need to be made when setting up time series models, the guidance emphasizes the importance of pre-registering hypotheses and analysis plans before the analyses are undertaken.
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Affiliation(s)
- Emma Beard
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - John Marsden
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jamie Brown
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Ildiko Tombor
- Department of Behavioural Science and Health, University College London, London, UK
| | - John Stapleton
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
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16
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Beard EV, West R, Jarvis M, Michie S, Brown J. 'S'-shaped curve: modelling trends in smoking prevalence, uptake and cessation in Great Britain from 1973 to 2016. Thorax 2019; 74:875-881. [PMID: 31391317 PMCID: PMC6824614 DOI: 10.1136/thoraxjnl-2018-212740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND It is believed that declines in smoking prevalence naturally slow over time as the smoking population 'hardens' and that progress has come primarily from reducing uptake rather than increasing cessation. To address these issues, we undertook the first formal attempt to model the trajectory of smoking prevalence and indices of uptake and cessation in Great Britain from 1973 to 2016. METHODS Using data from the General Lifestyle Survey between 1973 and 2008, the Integrated Household Survey between 2009 and 2014 and the Annual Population Survey between 2015 and 2016, this study modelled year-on-year changes in smoking prevalence, ever-smoking in 18-24-year-olds as an index of uptake, and quit ratios as an index of cessation. RESULTS For all three outcomes, changes over time were best fitted by what may be broadly characterised as 'S'-shaped curves: segmented functions characterised by initial rapid progress, a slowing or reversal, then renewed progress. Smoking prevalence in Great Britain showed a decelerating decline over time between 1973 and 2000, but then, after the introduction of the National 'Smoking Kills' tobacco control plan, the decline accelerated again and has remained nearly linear at -0.67 percentage points per year. Ever-smoking showed a decelerating decline which eventually ceased and began increasing around 1994 but then declined again after 2000. Quit ratios rose rapidly then slowed and then accelerated around 2000 and again more recently in 2013. CONCLUSION Long-term trends in smoking prevalence, uptake and cessation have followed a broadly 'S'-shaped trend suggesting that they are responsive to major tobacco control initiatives. The decline in prevalence has resulted both from reductions in uptake and increases in cessation.
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Affiliation(s)
- Emma Victoria Beard
- Department of Behavioural Science and Health, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Martin Jarvis
- Department of Behavioural Science and Health, University College London, London, UK
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, Sheffield, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
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17
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Marteau TM, White M, Rutter H, Petticrew M, Mytton OT, McGowan JG, Aldridge RW. Increasing healthy life expectancy equitably in England by 5 years by 2035: could it be achieved? Lancet 2019; 393:2571-2573. [PMID: 31258113 DOI: 10.1016/s0140-6736(19)31510-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/11/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Theresa M Marteau
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK.
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Mark Petticrew
- Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London UK
| | - Oliver T Mytton
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - James G McGowan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London, UK
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Bafunno D, Catino A, Lamorgese V, Pizzutilo P, Di Lauro A, Petrillo P, Lapadula V, Mastrandrea A, Ricci D, Galetta D. Tobacco control in Europe: A review of campaign strategies for teenagers and adults. Crit Rev Oncol Hematol 2019; 138:139-147. [PMID: 31092369 DOI: 10.1016/j.critrevonc.2019.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/27/2019] [Accepted: 01/27/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Europe the prevalence of tobacco use in adults and adolescents is among the highest within the WHO regions. Many resources have been allocated toward the prevention and support for smoking cessation. However, the implemented strategies in Europe have not been systematically evaluated. METHODS A systematic literature review was carried out to identify studies that analyzed the efficacy of the main smoking-prevention campaigns conducted in Europe. PRISMA guidelines were used to systematically review and extract data. RESULTS A total of 24 studies meeting inclusion criteria were identified. Each article was thoroughly reviewed and evaluated for quality, design, and methodology, with reference to the main areas of intervention: school (8); mass media (4) and technological tools (4); smoke-free environments (3); packaging (2) and taxes (3). The school programmes focusing on building skills to recognize and resist negative influences, the intensive use of media and technological equipments, health warnings and excise taxes have showed to be effective tools in reducing the tobacco use. CONCLUSIONS Intervention programmes to implement tobacco control policies and smoking cessation are active in many European countries. However, these programmes need to be constantly sustained to achieve a long term efficacy.
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Affiliation(s)
- Daniela Bafunno
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Annamaria Catino
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Vito Lamorgese
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Pamela Pizzutilo
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Alessandra Di Lauro
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Patrizia Petrillo
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Vittoria Lapadula
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Angelica Mastrandrea
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Donata Ricci
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Domenico Galetta
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy.
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Kwah KL, Fulton EA, Brown KE. Accessing National Health Service Stop Smoking Services in the UK: a COM-B analysis of barriers and facilitators perceived by smokers, ex-smokers and stop smoking advisors. Public Health 2019; 171:123-130. [PMID: 31128557 DOI: 10.1016/j.puhe.2019.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/15/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Smokers who access free National Health Service (NHS) Stop Smoking Services (SSS) in the UK are four times more likely to stop smoking, yet uptake of the services has been in decline in recent years. Evidence was collated to explore the beliefs of smokers, ex-smokers and Stop Smoking Advisors (SSAs) about SSS and the barriers and facilitators to access. STUDY DESIGN Mixed-methods design including i) a search of the literature; ii) a cross-sectional online questionnaire completed by 38 smokers and ex-smokers; and iii) semistructured interviews with 5 SSAs. METHODS PubMed, Web of Science, Scopus, Prospero and the NIHR Portfolio were searched in October 2017 to identify relevant studies. Smokers and ex-smokers were recruited to the online questionnaire via Public Health websites and social media in Warwickshire. SSAs identified via Public Health Warwickshire were invited to take part in an interview conducted over the telephone. Findings were collated and analysed using the COM-B ('Capability', 'Opportunity', 'Motivation' and 'Behaviour') model framework. RESULTS A range of practical and psychological or belief-based barriers and facilitators to accessing SSS were identified within all the components of the COM-B model, aside from physical capability, for example; 'Psychological capability', such as lack of understanding about what the service offers; 'Reflective motivation', such as lack of confidence in service efficacy; and 'Social opportunity', such as recommendations from healthcare professionals to attend. Suggestions and consideration on how future tobacco control intervention and public health messages can address these components are reported. CONCLUSIONS Public health interventions and campaigns may benefit from focussing on addressing the well-known perceived barriers and facilitators smokers experience, in particular focussing on the components of the COM-B that have been identified as being important to increase the uptake of SSS.
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Affiliation(s)
- K L Kwah
- Centre for Advances in Behavioural Science, Coventry University, Coventry, CV1 5FB, UK.
| | - E A Fulton
- Centre for Advances in Behavioural Science, Coventry University, Coventry, CV1 5FB, UK; Public Health Warwickshire, Warwickshire County Council, Warwick, CV34 4RL, UK
| | - K E Brown
- Centre for Advances in Behavioural Science, Coventry University, Coventry, CV1 5FB, UK; Public Health Warwickshire, Warwickshire County Council, Warwick, CV34 4RL, UK
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20
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Hefler M, Kerrigan V, Freeman B, Boot GR, Thomas DP. Using Facebook to reduce smoking among Australian Aboriginal and Torres Strait Islander people: a participatory grounded action study. BMC Public Health 2019; 19:615. [PMID: 31113480 PMCID: PMC6528248 DOI: 10.1186/s12889-019-6918-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is limited evidence for the effectiveness of social media to promote healthy behaviour among Indigenous Australians, including to reduce smoking. Social media has significant potential to stimulate interpersonal influence to quit, however an important knowledge gap is how and what content people choose to share with friends and family. This paper explores the decision making processes of community members for sharing tobacco control content with family and friends on Facebook. METHODS Community researchers were paid to choose and share at least one tobacco control post per week for a period of 6 months on their personal Facebook page. They documented reasons for their choices, which were coded and analysed to determine features of messages most likely to be shared, and salient considerations in the decision-making process. RESULTS Posts which are child-focused, feature Indigenous content, and are perceived as practical, relevant and credible, with a direct and unambiguous message, were most likely to be shared. Posts which included disgusting imagery about health impacts, were focused on the environment, or were ambiguous or sarcastic were less likely to be shared. Decisions were also based on whether content was perceived to contain new information, to be helpful for their friends, and to be consistent with the participant's online identity, as well as the perceived sensitivity of content. The potential impact on expensive mobile data for videos was also a factor. CONCLUSIONS When designing tobacco control messages to be shared on social media, health promoters should take into account how information will align with positive self-image and can contribute to social capital among the intended audience, and generate interpersonal engagement. Content should complement, rather than attempt to replicate, some message features that are effective on traditional broadcast media. This study shows the potential for health services to incorporate a strategy of using paid local social media 'champions' or 'ambassadors' to disseminate tobacco control messages on Facebook through community networks.
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Affiliation(s)
- Marita Hefler
- Tobacco Control Research Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811 Australia
| | - Vicki Kerrigan
- Tobacco Control Research Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811 Australia
| | - Becky Freeman
- Prevention Research Collaboration, School of Public Health, Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, NSW 2006 Australia
| | - Gordon Robert Boot
- Miwatj Health Aboriginal Corporation, PO Box 519, Nhulunbuy, NT 0881 Australia
| | - David P. Thomas
- Tobacco Control Research Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811 Australia
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Beard E, West R, Lorencatto F, Gardner B, Michie S, Owens L, Shahab L. What do cost-effective health behaviour-change interventions contain? A comparison of six domains. PLoS One 2019; 14:e0213983. [PMID: 30995224 PMCID: PMC6469762 DOI: 10.1371/journal.pone.0213983] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/05/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To help implement behaviour change interventions (BCIs) in practice it is important to be able to characterize their key components. This study compared broad features of cost-effective BCIs that addressed smoking, diet, physical activity, alcohol and sexual health. It also assessed the association of these with the magnitude of the cost-effectiveness estimates. METHODS A content analysis of 79 interventions based on 338 intervention descriptions was conducted, using the Behaviour Change Wheel (BCW) to classify intervention content in terms of intervention functions, and the BCT taxonomy to identify and categorise component Behaviour Change Techniques (BCT). Regression analysis identified the association of these with upper (pessimistic) and lower (optimistic) cost-effectiveness estimates. RESULTS The most and least common functions and BCT clusters were education (82.3%) and shaping knowledge (79.7%), and coercion (3.8%) and covert learning (2.5%). Smoking interventions contained the largest ([Formula: see text] = 12) number of BCTs and were most cost-effective. Several other factors were associated with worse (coercionfunction βupper = 36551.24; shaping knowledgeBCT βlower = 2427.78; comparison of outcomesBCT βupper = 9067.32; repetition and substitutionBCT βupper = 7172.47) and better (modellingfunction βlower = -2905.3; environmental restructuringfunction βupper = -8646.28; reward and threatBCT βupper = -5577.59) cost-effectiveness (p<0.05). DISCUSSION Cost-effective BCIs rely heavily on education with smoking interventions exhibiting the most comprehensive range of BCTs. Providing an example to aspire to, restructuring the environment and rewarding positive behaviour may be associated with greater cost-effectiveness.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Fabiana Lorencatto
- Department of Clinical, Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, United Kingdom
| | - Ben Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, United Kingdom
| | - Lesley Owens
- National Institute for Health and Care Excellence, NICE, London, United Kingdom
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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22
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Fulton E, Newby K, Gokal K, Kwah K, Schumacher L, Jackson LJ, Naughton F, Coleman T, Brown K. Tailored digital behaviour change intervention with e-referral system to increase attendance at NHS stop smoking services (the MyWay project): study protocol for a randomised controlled feasibility trial. BMJ Open 2019; 9:e028721. [PMID: 30962245 PMCID: PMC6500333 DOI: 10.1136/bmjopen-2018-028721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION In the UK, smokers who use stop smoking services (SSSs) are four times more likely to stop smoking than smokers who do not. Attendance has declined, warranting the development of interventions to address this. StopApp is a novel, brief online behaviour change intervention designed to address common barriers to SSS attendance. It links to widely commissioned service management software that enables instant appointment booking at a user's location and time of choice. METHODS AND ANALYSIS A two-arm parallel group, individual participant feasibility randomised controlled trial of StopApp (intervention) compared with the standard promotion of and referral to SSSs (control). The study includes a nested qualitative process evaluation to assess the acceptability of the research processes, with a subsample of participants. Smokers aged over 16 years will be recruited via three routes: General Practice (GP), community settings and online. After consenting and the collection of baseline data, participants will be randomised to control or intervention groups. Participants in the intervention group receive a link to StopApp and those in the control group receive standard web-based information about the SSSs. All participants are told they can book a SSS appointment but are under no obligation to do so. Online follow-up 2 months post randomisation includes data on SSS use and carbon monoxide verified 4-week quit rates. The study aims to recruit 162 smokers. ETHICS AND DISSEMINATION Ethics approval has been granted by the West Midlands-Edgbaston NHS Research Ethics Committee. The findings will be reported in conferences and peer-reviewed publications; and will be used to design the parameters necessary for a definitive trial to ascertain the effectiveness of StopApp at increasing booking and attendance at SSSs compared with existing methods for encouraging uptake.
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Affiliation(s)
- Emily Fulton
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Katie Newby
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Kajal Gokal
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Kayleigh Kwah
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Lauren Schumacher
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Tim Coleman
- Division of General Practice, University of Nottingham, Nottingham, UK
| | - Katherine Brown
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
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23
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Kuipers MAG, Beard E, West R, Brown J. Associations between tobacco control mass media campaign expenditure and smoking prevalence and quitting in England: a time series analysis. Tob Control 2018; 27:455-462. [PMID: 28667091 PMCID: PMC6047146 DOI: 10.1136/tobaccocontrol-2017-053662] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/06/2017] [Accepted: 05/30/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND It has been established that mass media campaigns can increase smoking cessation rates, but there is little direct evidence estimating associations between government expenditure on tobacco control mass media campaigns and smoking cessation. This study assessed the association over 8 years between mass media expenditure in England and quit attempts, smoking cessation and smoking prevalence. METHODS Autoregressive integrated moving average modelling with exogenous variables (ARIMAX) was applied to monthly estimates from the Smoking Toolkit Study between June 2008 and February 2016. We assessed the association between the trends in mass media expenditure and (1) quit attempts in the last two months, (2) quit success among those who attempted to quit and (3) smoking prevalence. Analyses were adjusted for trends in weekly spending on tobacco by smokers, tobacco control policies and the use of established aids to cessation. RESULTS Monthly spending on mass media campaigns ranged from nothing to £2.4 million, with a mean of £465 054. An increase in mass media expenditure of 10% of the monthly average was associated with a 0.51% increase (of the average) in success rates of quit attempts (95% CI 0.10% to 0.91%, p=0.014). No clear association was detected between changes in mass media expenditure and changes in quit attempt prevalence (β=-0.03, 95% CI -2.05% to 2.00%, p=0.979) or smoking prevalence (β=-0.03, 95% CI -0.09% to 0.03%, p=0.299). CONCLUSION Between 2008 and 2016, higher monthly expenditure on tobacco control mass media campaigns in England was associated with higher quit success rates.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Epidemiology and Public Health, University College London, London, UK
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Emma Beard
- Department of Epidemiology and Public Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Robert West
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jamie Brown
- Department of Epidemiology and Public Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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24
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Beard E, Brown J, Michie S, West R. Is prevalence of e-cigarette and nicotine replacement therapy use among smokers associated with average cigarette consumption in England? A time-series analysis. BMJ Open 2018; 8:e016046. [PMID: 29921676 PMCID: PMC6020958 DOI: 10.1136/bmjopen-2017-016046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/21/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Many smokers use e-cigarettes and licensed nicotine replacement therapy (NRT), often in an attempt to reduce their cigarette consumption. We estimated how far changes in prevalence of e-cigarette and NRT use while smoking were accompanied by changes in cigarette consumption at the population level. DESIGN Repeated representative cross-sectional population surveys of adults aged 16+ years in England. METHODS We used Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling of monthly data between 2006 and 2016 from the Smoking Toolkit Study. Prevalence of e-cigarette use and NRT use in current smokers, and specifically for smoking reduction and temporary abstinence, were input variables. Mean daily cigarette consumption was the dependent variable. Analyses involved adjustment for mass media expenditure and tobacco-control policies. RESULTS No statistically significant associations were found between changes in use of e-cigarettes (β -0.012, 95% CI -0.026 to 0.002) or NRT (β 0.015, 95% CI -0.026 to 0.055) while smoking and daily cigarette consumption. Neither did we find clear evidence for an association between e-cigarette use (β -0.010, 95% CI -0.025 to 0.005 and β 0.011, 95%-0.027 to 0.004) or NRT use (β 0.006, 95%-0.030 to 0.043 and β 0.022, 95%-0.020 to 0.063) specifically for smoking reduction and temporary abstinence, respectively, and changes in daily cigarette consumption. CONCLUSION If use of e-cigarettes and licensed NRT while smoking acted to reduce cigarette consumption in England between 2006 and 2016, the effect was likely very small at a population level.
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Affiliation(s)
- Emma Beard
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
- Research Department of Educational, Clinical and Health Psychology, University College London, London, UK
| | - Jamie Brown
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
- Research Department of Educational, Clinical and Health Psychology, University College London, London, UK
| | - Susan Michie
- Research Department of Educational, Clinical and Health Psychology, University College London, London, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
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25
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Dono J, Bowden J, Kim S, Miller C. Taking the pressure off the spring: the case of rebounding smoking rates when antitobacco campaigns ceased. Tob Control 2018; 28:233-236. [PMID: 29627797 PMCID: PMC6580791 DOI: 10.1136/tobaccocontrol-2017-054194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Smoking rates have been compared with a spring, requiring continuous downward pressure against protobacco forces, rather than a screw, which once driven down stays down. Quality antitobacco mass media campaigns put downward pressure on smoking rates. The suspension of a major Australian state campaign provided a natural experiment to assess effects on smoking. Furthermore, we document the positive influence of robust monitoring and mature advocacy on the political decision to reinstate funding. We also document the misuse by industry of South Australian smoking data from the period between Australia's implementation and subsequent evaluation of plain packaging. METHODS A time series analysis was used to examine monthly smoking prevalence trends at each of four intervention points: (A) commencement of high-intensity mass media campaign (August 2010); (B) introduction of plain packaging (December 2012), (C) defunding of campaign (July 2013); and (D) reinstatement of moderate-intensity campaign (July 2014). FINDINGS The suspension of the antitobacco campaign was disruptive to achieving smoking prevalence targets. There was an absence of a downward monthly smoking prevalence trajectory during the non-campaign period. Moreover, there was a significant decline in smoking prevalence during the period of high-intensity advertising, which continued after the introduction of plain packaging laws, and at the recommencement of campaign activity. CONCLUSIONS While the observed declines in smoking prevalence are likely due to a combination of interventions and cannot be attributed exclusively to antitobacco advertising, the results reinforce the political decision to reinstate the campaign and demonstrate the need for maintained investment to keep downward pressure on smoking rates.
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Affiliation(s)
- Joanne Dono
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Jacqueline Bowden
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Susan Kim
- Heart Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Caroline Miller
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Population Health and Clinical Practice, University of Adelaide, Adelaide, South Australia, Australia
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26
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Haghpanahan H, Mackay DF, Pell JP, Bell D, Langley T, Haw S. The impact of TV mass media campaigns on calls to a National Quitline and the use of prescribed nicotine replacement therapy: a structural vector autoregression analysis. Addiction 2017; 112:1229-1237. [PMID: 28192615 PMCID: PMC5485022 DOI: 10.1111/add.13793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/04/2016] [Accepted: 02/08/2017] [Indexed: 11/28/2022]
Abstract
AIMS To estimate (1) the immediate impact; (2) the cumulative impact; and (3) the duration of impact of Scottish tobacco control TV mass media campaigns (MMCs) on smoking cessation activity, as measured by calls to Smokeline and the volume of prescribed nicotine replacement therapy (NRT). DESIGN Multivariate time-series analysis using secondary data on population level measures of exposure to TV MMCs broadcast and smoking cessation activity between 2003 and 2012. SETTING AND PARTICIPANTS Population of Scotland. MEASUREMENTS Adult television viewer ratings (TVRs) as a measure of exposure to Scottish mass media campaigns in the adult population; monthly calls to NHS Smokeline; and the monthly volume of prescribed NRT as measured by gross ingredient costs (GIC). FINDINGS Tobacco control TVRs were associated with an increase in calls to Smokeline but not an increase in the volume of prescribed NRT. A 1 standard deviation (SD) increase of 194 tobacco control TVRs led to an immediate and significant increase of 385.9 [95% confidence interval (CI) = 171.0, 600.7] calls to Smokeline (unadjusted model) within 1 month. When adjusted for seasonality the impact was reduced, but the increase in calls remained significant (226.3 calls, 95% CI = 37.3, 415.3). The cumulative impact on Smokeline calls remained significant for 6 months after broadcast in the unadjusted model and 18 months in the adjusted model. However, an increase in tobacco control TVRs of 194 failed to have a significant impact on the GIC of prescribed NRT in either the unadjusted (£1361.4, 95% CI = -£9138.0, £11860.9) or adjusted (£6297.1, 95% CI = -£2587.8, £15182.1) models. CONCLUSIONS Tobacco control television mass media campaigns broadcast in Scotland between 2003 and 2012 were effective in triggering calls to Smokeline, but did not increase significantly the use of prescribed nicotine replacement therapy by adult smokers. The impact on calls to Smokeline occurred immediately within 1 month of broadcast and was sustained for at least 6 months.
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Affiliation(s)
- Houra Haghpanahan
- Faculty of Health Sciences and SportUniversity of StirlingStirlingUK
| | | | - Jill P. Pell
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - David Bell
- School of Business and EconomyUniversity of StirlingStirlingUK
| | - Tessa Langley
- UK Centre for Tobacco and Alcohol StudiesDivision of Epidemiology and Public Health University of NottinghamNottinghamUK
| | - Sally Haw
- Faculty of Health Sciences and SportUniversity of StirlingStirlingUK
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27
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Wells M, Aitchison P, Harris F, Ozakinci G, Radley A, Bauld L, Entwistle V, Munro A, Haw S, Culbard B, Williams B. Barriers and facilitators to smoking cessation in a cancer context: A qualitative study of patient, family and professional views. BMC Cancer 2017; 17:348. [PMID: 28526000 PMCID: PMC5438552 DOI: 10.1186/s12885-017-3344-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 05/11/2017] [Indexed: 01/23/2023] Open
Abstract
Background Continued smoking after cancer adversely affects quality of life and survival, but one fifth of cancer survivors still smoke. Despite its demands, cancer presents an opportunity for positive behaviour change. Smoking often occurs in social groups, therefore interventions which target families and individuals may be more successful. This qualitative study explored patients, family members and health professionals’ views and experiences of smoking and smoking cessation after cancer, in order to inform future interventions. Methods In-depth qualitative interviews (n = 67) with 29 patients, 14 family members and 24 health professionals. Data were analysed using the ‘Framework’ method. Results Few patients and family members had used National Health Service (NHS) smoking cessation services and more than half still smoked. Most recalled little ‘smoking-related’ discussion with clinicians but were receptive to talking openly. Clinicians revealed several barriers to discussion. Participants’ continued smoking was explained by the stress of diagnosis; desire to maintain personal control; and lack of connection between smoking, cancer and health. Conclusions A range of barriers to smoking cessation exist for patients and family members. These are insufficiently assessed and considered by clinicians. Interventions must be more effectively integrated into routine practice.
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Affiliation(s)
- Mary Wells
- NMAHP Research Unit, University of Stirling, Scion House, Stirling, FK9 4HN, UK.
| | - Patricia Aitchison
- NMAHP Research Unit, University of Stirling, Scion House, Stirling, FK9 4HN, UK
| | - Fiona Harris
- NMAHP Research Unit, University of Stirling, Scion House, Stirling, FK9 4HN, UK
| | - Gozde Ozakinci
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK
| | - Andrew Radley
- NHS Tayside, Public Health Directorate, Kings Cross Hospital, Dundee, DD3 8EA, UK
| | - Linda Bauld
- Insitute of Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Vikki Entwistle
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Alastair Munro
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK
| | - Sally Haw
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Bill Culbard
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, EH11 4BN, UK
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28
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Kuipers MAG, Beard E, Hitchman SC, Brown J, Stronks K, Kunst AE, McNeill A, West R. Impact on smoking of England's 2012 partial tobacco point of sale display ban: a repeated cross-sectional national study. Tob Control 2017; 26:141-148. [PMID: 26903596 PMCID: PMC6166602 DOI: 10.1136/tobaccocontrol-2015-052724] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/29/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND A partial tobacco point of sale (PoS) display ban was introduced in large shops (>280 m2 floor area) in England on 6 April 2012. The aim of this study was to assess the medium-term effects of the partial tobacco PoS display ban on smoking in England. METHODS Data were used from 129 957 respondents participating in monthly, cross-sectional household surveys of representative samples of the English adult population aged 18+ years from January 2009 to February 2015. Interrupted-time series regression models assessed step changes in the level of current smoking and cigarette consumption in smokers and changes in the trends postban compared with preban. Models were adjusted for sociodemographic variables and e-cigarette use, seasonality and autocorrelation. Potential confounding by cigarette price was accounted for by time, as price was almost perfectly correlated with time. RESULTS Following the display ban, there was no immediate step level change in smoking (-3.69% change, 95% CI -7.94 to 0.75, p=0.102) or in cigarette consumption (β -0.183, 95% CI -0.602 to 0.236). There was a significantly steeper decline in smoking post display ban (-0.46% change, 95% CI -0.72 to -0.20, p=0.001). This effect was demonstrated by respondents in manual occupations (-0.62% change, 95% CI -0.72 to -0.20, p=0.001), but not for those in non-manual occupations (-0.42, 95% CI -0.90 to 0.06, p=0.084). Cigarette consumption declined preban period (β -0.486, 95% CI -0.633 to -0.339, p<0.001), but no significant change in cigarette consumption trend was observed (β 0.019, 95% CI -0.006 to 0.042, p=0.131). CONCLUSIONS The partial tobacco PoS display ban introduced in England in April 2012 did not lead to an immediate decline in smoking, but was followed by a decline in the trend of smoking prevalence that could not be accounted for by seasonal factors, e-cigarette use or price changes.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Beard
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sara C Hitchman
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert West
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
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Brown J. A gateway to more productive research on e-cigarettes? Commentary on a comprehensive framework for evaluating public health impact. Addiction 2017; 112:21-22. [PMID: 27444564 PMCID: PMC5215645 DOI: 10.1111/add.13449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/28/2022]
Abstract
Commentary to: A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products
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Affiliation(s)
- Jamie Brown
- Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
- Cancer Research UK Health Behaviour Research CentreUniversity College LondonWC1E 6BTUK
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30
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Mader EM, Lapin B, Cameron BJ, Carr TA, Morley CP. Update on Performance in Tobacco Control: A Longitudinal Analysis of the Impact of Tobacco Control Policy and the US Adult Smoking Rate, 2011-2013. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22:E29-35. [PMID: 26618847 PMCID: PMC5035147 DOI: 10.1097/phh.0000000000000358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CONTEXT Tobacco use remains the leading cause of preventable death in the United States. States and municipalities have instituted a variety of tobacco control measures (TCMs) to address the significant impact tobacco use has on population health. The American Lung Association annually grades state performance of tobacco control using the State of Tobacco Control grading framework. OBJECTIVE To gain an updated understanding of how recent efforts in tobacco control have impacted tobacco use across the United States, using yearly State of Tobacco Control TCM assessments. DESIGN The independent TCM variables of smoke-free air score, cessation score, excise tax, and percentage of recommended funding were selected from the American Lung Association State of Tobacco Control reports. Predictors of adult smoking rates were determined by a mixed-effects model. SETTING/PARTICIPANTS The 50 US states and District of Columbia. MAIN OUTCOME MEASURE Adult smoking rate in each state from 2011 to 2013. RESULTS The average adult smoking rate decreased significantly from 2011 to 2013 (21.3% [SD: 3.5] to 19.3% [SD: 3.5], P = .016). All forms of TCMs varied widely in implementation levels across states. Excise taxes (β = -.812, P = .006) and smoke-free air regulations (β = -.057, P = .008) were significant, negative predictors of adult smoking. Cessation services (β = .015, P = .46) did not have a measurable effect on adult smoking. CONCLUSION Tobacco control measures with the strongest influence on adult smoking include the state excise tax and state smoke-free air regulations. The lack of robust funding for tobacco cessation services across the majority of US states highlights an important shortfall in current tobacco control policy.
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Affiliation(s)
- Emily M. Mader
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
| | - Brittany Lapin
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
| | - Brianna J. Cameron
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
| | - Thomas A. Carr
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
| | - Christopher P. Morley
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
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StopApp: Using the Behaviour Change Wheel to Develop an App to Increase Uptake and Attendance at NHS Stop Smoking Services. Healthcare (Basel) 2016; 4:healthcare4020031. [PMID: 27417619 PMCID: PMC4934584 DOI: 10.3390/healthcare4020031] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 11/17/2022] Open
Abstract
Smokers who attend NHS Stop Smoking Services (SSS) are four times more likely to stop smoking; however, uptake has been in decline. We report the development of an intervention designed to increase uptake of SSS, from a more motivated self-selected sample of smokers. In Phase 1 we collected data to explore the barriers and facilitators to people using SSS. In Phase 2, data from extant literature and Phase 1 were subject to behavioural analysis, as outlined by the Behaviour Change Wheel (BCW) framework. Relevant Behaviour Change Techniques (BCTs) were identified in order to address these, informing the content of the StopApp intervention. In Phase 3 we assessed the acceptability of the StopApp. Smokers and ex-smokers identified a number of barriers to attending SSS, including a lack of knowledge about what happens at SSS (Capability); the belief that SSS is not easy to access (Opportunity); that there would be ’scare tactics’ or ‘nagging’; and not knowing anyone who had been and successfully quit (Motivation). The ‘StopApp’ is in development and will link in with the commissioned SSS booking system. Examples of the content and functionality of the app are outlined. The next phase will involve a full trial to test effectiveness.
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Brown J, Michie S, Walmsley M, West R. An Online Documentary Film to Motivate Quit Attempts Among Smokers in the General Population (4Weeks2Freedom): A Randomized Controlled Trial. Nicotine Tob Res 2016; 18:1093-100. [PMID: 26220547 PMCID: PMC4826487 DOI: 10.1093/ntr/ntv161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/17/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Online motivational films to promote quit attempts could encourage large numbers of smokers to stop at low unit cost. We evaluated an online film documenting the experiences of smokers who recorded the first month of their successful attempts to quit (4Weeks2Freedom). The film was designed to boost motivation and self-efficacy and provide role-models to promote ex-smoker identities. METHODS This was a randomized trial with individual assignment to a no-intervention control (n = 1016), an informational film (n = 1004), or 4Weeks2Freedom (n = 999). The development of 4Weeks2Freedom was informed by PRIME theory and focus-group testing with smokers. The 90-minute film was available online to view in one sitting or as chapters over 4 weeks to coincide with the progress of an attempt. The primary outcome was a quit attempt in the 4 weeks between assignment and study endpoint by intent-to-treat. RESULTS Participants smoked a mean of 13 cigarettes per day and 31% reported not wanting to stop. At follow-up, 55% reported viewing the informational control film and 56% viewing 4Weeks2Freedom. There was no detectable effect compared with the no-intervention control (OR = 0.99, 95% CI = 0.81 to 1.21, 24.3% vs. 24.5%) or informational control film (OR = 0.99, 95% CI = 0.80 to 1.21, 24.3% vs. 24.6%). Calculation of Bayes factors ruled out insensitive data and indicated the intervention was no more effective than either the no-intervention control (Bayes factor = 0.20) or informational control film (Bayes factor = 0.27). The pattern of results was unchanged in sensitivity analyses that examined the effect among only those who viewed the films. CONCLUSION The online documentary film (4Weeks2Freedom) designed to boost motivation and self-efficacy and to promote ex-smoker identity does not appear to prompt quit attempts among smokers. IMPLICATIONS This trial found that an online documentary film (4Weeks2Freedom) designed to boost motivation and self-efficacy and to promote ex-smoker identity was ineffective in prompting quit attempts among an unselected panel of smokers from the UK. This approach appears unpromising as a means of raising the rate at which smokers attempt to quit and is a low priority for future research.
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Affiliation(s)
- Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom;
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; National Centre for Smoking Cessation and Training, London, United Kingdom
| | | | - Robert West
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom; National Centre for Smoking Cessation and Training, London, United Kingdom
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Dixon H, Murphy M, Scully M, Rose M, Cotter T. Identifying effective healthy weight and lifestyle advertisements: Focus groups with Australian adults. Appetite 2016; 103:184-191. [PMID: 27079189 DOI: 10.1016/j.appet.2016.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 03/29/2016] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
Abstract
This study explored adult's attitudes and reactions to a range of television advertisements (ads) promoting healthy weight, physical activity and healthy eating. Twenty-four focus groups (N = 179) were conducted in metropolitan and regional areas of the Australian states of Victoria, New South Wales (NSW) and Queensland, with participants segmented by sex, education (no tertiary, at least some tertiary) and life stage (young adults, parents). Each group was assigned to one of the three advertising streams - Weight, Activity, or Nutrition - where responses to five different ads were explored using semi-structured, moderator-led discussions. Discussion transcripts were qualitatively content analysed using a conventional approach. Four main themes were identified in participants' discussions about the ads' main messages - (i) Why is it a problem? (ii) Who is it a problem for? (iii) What should I do about it? (iv) How do I make the changes? Reactions varied by demographic factors and current weight and lifestyle status. Participants furthest from achieving public health recommendations for weight, diet and activity were motivated by 'what' and 'how' ads involving gentle persuasion and helpful hints. Participants who were closer to meeting these recommendations were motivated by 'why' ads featuring more graphic and emotive content and new information. Findings suggest a strategic approach is important for the development of public health ads promoting healthy weight and lifestyle, with consideration given to the specific communication goals and who the target audience is. This should help ensure an appropriate message is delivered to priority population subgroups in the most informative and motivating manner.
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Affiliation(s)
- Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, Australia.
| | - Michael Murphy
- Michael Murphy Research, 5/8A Dickens Street, Elwood, 3184, Australia
| | - Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, Australia
| | - Mischa Rose
- Michael Murphy Research, 5/8A Dickens Street, Elwood, 3184, Australia
| | - Trish Cotter
- Vital Strategies, 61 Broadway, Suite 2800, New York, 10006, USA
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Allen K, Kypridemos C, Hyseni L, Gilmore AB, Diggle P, Whitehead M, Capewell S, O'Flaherty M. The effects of maximising the UK's tobacco control score on inequalities in smoking prevalence and premature coronary heart disease mortality: a modelling study. BMC Public Health 2016; 16:292. [PMID: 27036296 PMCID: PMC4818400 DOI: 10.1186/s12889-016-2962-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 03/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background Smoking is more than twice as common among the most disadvantaged socioeconomic groups in England compared to the most affluent and is a major contributor to health-related inequalities. The United Kingdom (UK) has comprehensive smoking policies in place: regular tax increases; public information campaigns; on-pack pictorial health warnings; advertising bans; cessation; and smoke-free areas. This is confirmed from its high Tobacco Control Scale (TCS) score, an expert-developed instrument for assessing the strength of tobacco control policies. However, room remains for improvement in tobacco control policies. Our aim was to evaluate the cumulative effect on smoking prevalence of improving all TCS components in England, stratified by socioeconomic circumstance. Methods Effect sizes and socioeconomic gradients for all six types of smoking policy in the UK setting were adapted from systematic reviews, or if not available, from primary studies. We used the IMPACT Policy Model to link predicted changes in smoking prevalence to changes in premature coronary heart disease (CHD) mortality for ages 35–74. Health outcomes with a time horizon of 2025 were stratified by quintiles of socioeconomic circumstance. Results The model estimated that improving all smoking policies to achieve a maximum score on the TCS might reduce smoking prevalence in England by 3 % (95 % Confidence Interval (CI): 1–4 %), from 20 to 17 % in absolute terms, or by 15 % in relative terms (95 % CI: 7–21 %). The most deprived quintile would benefit more, with absolute reductions from 31 to 25 %, or a 6 % reduction (95 % CI: 2–7 %). There would be some 3300 (95 % CI: 2200–4700) fewer premature CHD deaths between 2015–2025, a 2 % (95 % CI: 1.4–2.9 %) reduction. The most disadvantaged quintile would benefit more, reducing absolute inequality of CHD mortality by about 4 % (95 % CI: 3–9 %). Conclusions Further, feasible improvements in tobacco control policy could substantially improve population health, and reduce health-related inequalities in England. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2962-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirk Allen
- Lancaster Medical School, Lancaster University, Lancaster, UK.,Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK.
| | - Lirije Hyseni
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Anna B Gilmore
- Department for Health, University of Bath, UK Centre for Tobacco and Alcohol Studies (UKCTAS), Bath, UK
| | - Peter Diggle
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
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Leas EC, Myers MG, Strong DR, Hofstetter CR, Al-Delaimy WK. Recall of anti-tobacco advertisements and effects on quitting behavior: results from the California smokers cohort. Am J Public Health 2015; 105:e90-7. [PMID: 25521871 DOI: 10.2105/ajph.2014.302249] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether an anti-tobacco television advertisement called "Stages," which depicted a woman giving a brief emotional narrative of her experiences with tobacco use, would be recalled more often and have a greater effect on smoking cessation than 3 other advertisements with different intended themes. METHODS Our data were derived from a sample of 2596 California adult smokers. We used multivariable log-binomial and modified Poisson regression models to calculate respondents' probability of quitting as a result of advertisement recall. RESULTS More respondents recalled the "Stages" ad (58.5%) than the 3 other ads (23.1%, 23.4%, and 25.6%; P<.001). Respondents who recalled "Stages" at baseline had a higher probability than those who did not recall the ad of making a quit attempt between baseline and follow-up (adjusted risk ratio [RR]=1.18; 95% confidence interval [CI]=1.03, 1.34) and a higher probability of being in a period of smoking abstinence for at least a month at follow-up (adjusted RR=1.55; 95% CI=1.02, 2.37). CONCLUSIONS Anti-tobacco television advertisements that depict visceral and personal messages may be recalled by a larger percentage of smokers and may have a greater impact on smoking cessation than other types of advertisements.
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Affiliation(s)
- Eric C Leas
- Eric C. Leas, David R. Strong, and Wael K. Al-Delaimy are with the Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA. Mark G. Myers is with the Psychology Service, Veterans Affairs San Diego Healthcare System, and the Department of Psychiatry, University of California, San Diego. C. Richard Hofstetter is with the Graduate School of Public Health and the Department of Political Science, San Diego State University, San Diego, CA
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Duke JC, Mann N, Davis KC, MacMonegle A, Allen J, Porter L. The impact of a state-sponsored mass media campaign on use of telephone quitline and web-based cessation services. Prev Chronic Dis 2014; 11:E225. [PMID: 25539129 PMCID: PMC4279867 DOI: 10.5888/pcd11.140354] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Most US smokers do not use evidence-based interventions as part of their quit attempts. Quitlines and Web-based treatments may contribute to reductions in population-level tobacco use if successfully promoted. Currently, few states implement sustained media campaigns to promote services and increase adult smoking cessation. This study examines the effects of Florida's tobacco cessation media campaign and a nationally funded media campaign on telephone quitline and Web-based registrations for cessation services from November 2010 through September 2013. METHODS We conducted multivariable analyses of weekly media-market-level target rating points (TRPs) and weekly registrations for cessation services through the Florida Quitline (1-877-U-CAN-NOW) or its Web-based cessation service, Web Coach (www.quitnow.net/florida). RESULTS During 35 months, 141,221 tobacco users registered for cessation services through the Florida Quitline, and 53,513 registered through Web Coach. An increase in 100 weekly TRPs was associated with an increase of 7 weekly Florida Quitline registrants (β = 6.8, P < .001) and 2 Web Coach registrants (β = 1.7, P = .003) in an average media market. An increase in TRPs affected registrants from multiple demographic subgroups similarly. When state and national media campaigns aired simultaneously, approximately one-fifth of Florida's Quitline registrants came from the nationally advertised portal (1-800-QUIT-NOW). CONCLUSION Sustained, state-sponsored media can increase the number of registrants to telephone quitlines and Web-based cessation services. Federally funded media campaigns can further increase the reach of state-sponsored cessation services.
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Affiliation(s)
- Jennifer C Duke
- RTI International, 3040 East Cornwallis Rd, Research Triangle Park, NC 27709. E-mail:
| | - Nathan Mann
- RTI International, Research Triangle Park, North Carolina
| | - Kevin C Davis
- RTI International, Research Triangle Park, North Carolina
| | | | - Jane Allen
- RTI International, Research Triangle Park, North Carolina
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Durkin S, Wakefield M. Commentary on Sims et al. (2014) and Langley et al. (2014): mass media campaigns require adequate and sustained funding to change population health behaviours. Addiction 2014; 109:1003-4. [PMID: 24796401 DOI: 10.1111/add.12564] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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