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Background and Aims: Long‐acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that is generating positive outcomes. Negative effects are typically mild and transient, but can occasionally be serious, resulting in treatment discontinuation/non‐adherence. This paper aims to analyse patients' accounts of how they felt during the first 72 h after initiating LAIB. Methods: Semi‐structured interviews were conducted (June 2021–March 2022) with 26 people (18 males and 8 females) who had started LAIB within the previous 72 h. Participants were recruited from treatment services in England and Wales and were interviewed by telephone using a topic guide. Interviews were audio‐recorded, transcribed and coded. The concepts of embodiment and embodied cognition framed the analyses. Data on participants' substance use, initiation onto LAIB and feelings were tabulated. Next, participants' accounts of how they felt were analysed following the stages of Iterative Categorization. Results: Participants reported complex combinations of changing negative and positive feelings. Bodily experiences included withdrawal symptoms, poor sleep, injection‐site pain/soreness, lethargy and heightened senses inducing nausea ('distressed bodies'), but also enhanced somatic wellbeing, improved sleep, better skin, increased appetite, reduced constipation and heightened senses inducing pleasure ('returning body functions'). Cognitive responses included anxiety, uncertainties and low mood/depression ('the mind in crisis') and improved mood, greater positivity and reduced craving ('feeling psychologically better'). Whereas most negative effects reported are widely recognized, the early benefits of treatment described are less well‐documented and may be an overlooked distinctive feature of LAIB. Conclusions: During the first 72 h after initiating long‐acting injectable buprenorphine, new patients report experiencing a range of interconnected positive and negative short‐term effects. Providing new patients with information about the range and nature of these effects can prepare them for what to expect and help them manage feelings and reduce anxiety. In turn, this may increase medication adherence. [ABSTRACT FROM AUTHOR]

Aims This paper estimates how far monthly changes in prevalence of cigarette smoking, motivation to quit and attempts to stop smoking have been associated with changes in prevalence of high-risk drinking, and motivation and attempts to reduce alcohol consumption in England. Design Data were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2016. These involve monthly household face-to-face surveys of representative samples of ~1700 adults in England. Measurements Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling was used to assess the association over time between monthly prevalence of (a) smoking and high-risk drinking; (b) high motivation to quit smoking and high motivation to reduce alcohol consumption; and (c) attempts to quit smoking and attempts to reduce alcohol consumption. Findings Mean smoking prevalence over the study period was 18.6% and high-risk drinking prevalence was 13.0%. A decrease of 1% of the series mean smoking prevalence was associated with a reduction of 0.185% of the mean prevalence of high-risk drinking 2 months later [95% confidence interval (CI) = 0.033 to 0.337, P = 0.017]. A statistically significant association was not found between prevalence of high motivation to quit smoking and high motivation to reduce alcohol consumption (β = 0.324, 95% CI = -0.371 to 1.019, P = 0.360) or prevalence of attempts to quit smoking and attempts to reduce alcohol consumption (β = −0.026, 95% CI = -1.348 to 1.296, P = 0.969). Conclusion Between 2014 and 2016, monthly changes in prevalence of smoking in England were associated positively with prevalence of high-risk drinking. There was no significant association between motivation to stop and motivation to reduce alcohol consumption, or attempts to quit smoking and attempts to reduce alcohol consumption. [ABSTRACT FROM AUTHOR]

Background and aims Regulation of electronic cigarettes has moved to the top of the addiction policy agenda, as demonstrated by the recent focus across the United Kingdom on introducing age-of-sale restrictions. However, the views of those affected by such regulation remain largely unexplored. This paper presents the first detailed qualitative exploration of adolescents' perceptions of existing, and opinions about potential e-cigarette regulation. Methods Sixteen focus groups, including a total of 83 teenagers between the ages of 14 and 17 years, were conducted in deprived, mixed and affluent urban areas in Scotland and England between November 2014 and February 2015. Transcripts were imported into Nivivo 10, coded thematically and analysed. Results Participants critically considered existing evidence and competing interests in regulatory debates and demonstrated sophisticated understanding of the advantages and disadvantages of regulation. They overwhelmingly supported strong e-cigarette regulation and endorsed restrictions on sales to minors, marketing and e-cigarette use in public places. Concern about potential health harms of e-cigarette use and marketing increasing the acceptability of vaping and smoking led these adolescents to support regulation. Conclusions In focus group discussions, a sample of UK adolescents exposed to particular communications about e-cigarettes supported strict regulation of e-cigarettes, including banning sales to minors and use in indoor public areas. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate-to-heavy (10+ CPD) smokers in England. Design Cross-sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 23 245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6-month follow-up. Measurements We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow-up. Findings Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9-32.8%). Compared with moderate-to-heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio-economic background. They were more motivated to quit and enjoyed smoking less. During the 6-month follow-up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate-to-heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate-to-heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over-the-counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Conclusions Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree. [ABSTRACT FROM AUTHOR]

Aims: To evaluate whether adding financial incentives to usual care is cost‐effective in encouraging pregnant women to quit tobacco smoking, compared with usual care alone. Design: Cost‐effectiveness analysis (CEA) and cost–utility analysis (CUA) from a health‐care provider's perspective, embedded in the Smoking Cessation in Pregnancy Incentives Trial (CPIT III). Long‐term analyses were conducted from the same perspective, using an existing Markov model over a life‐time horizon. Setting: Seven maternity smoking cessation sites in Scotland, England and Northern Ireland in the United Kingdom. Participants: In the short‐term analysis, CPIT III participants were assessed: women 16 years or older, self‐reporting as smokers, fewer than 24 weeks pregnant and English‐speaking (n = 944). The same population was used for the life‐time analysis, plus their infants. Measurements Costs included financial incentive vouchers and postage, cessation support and nicotine replacement therapy and neonatal stays. The outcome measure was a biochemically verified quit rate for the CEA and quality‐adjusted life‐years (QALYs) for CUA. Costs are presented in 2020 GBP sterling (£). Data for the life‐time analysis came from the trial and were combined with data from published literature embedded in the model, reporting incremental cost per quitter and QALY. A 3.5% discount rate was applied. Findings The short‐term incremental cost per quitter was £4400 and cost per QALY was £150 000. Results of sensitivity analyses confirmed these results. The long‐term analysis combined costs and outcomes for mother and infants; results showed a cost saving of £37 [95% confidence interval (CI]) = £35–106] and increase in QALYs of 0.171 (95% CI = 0.124–0.229). These findings indicate that, over a life‐time, financial incentives are cost‐saving and improve health outcomes. Conclusions: In the United Kingdom, offering up to £400 financial incentives, in addition to usual care, to support pregnant women to stop smoking appears to be highly cost‐effective over a life‐time for mother and infants. [ABSTRACT FROM AUTHOR]

Background and Aims: Most population studies that evaluate the relationship between nicotine vaping and cigarette cessation focus on limited segments of the smoker population. We evaluated vaping uptake and smoking cessation considering differences in smokers' plans to quit. Design: Longitudinal International Tobacco Control (ITC) Four Country Smoking and Vaping Surveys were conducted in 2016, 2018 and 2020. Setting: This study was conducted in the United States, Canada, England and Australia. Participants: Participants of this study were adult daily cigarette smokers who had not vaped in the past 6 months at baseline and had participated in two or more consecutive waves of the ITC Four Country Smoking and Vaping Surveys (n = 2815). Measurements Plans to quit cigarette smoking was assessed at baseline (within 6 months, beyond 6 months, not planning to quit) and at follow‐up (within 6 months vs not within 6 months), cigarette smoking cessation was assessed at follow‐up (smoking less than monthly [including complete cessation] vs daily/weekly/monthly smoking) and inter‐wave vaping uptake was assesed between baseline and follow‐up (none, only non‐daily vaping and any daily vaping). Generalized estimating equations were used to evaluate whether inter‐wave vaping uptake was associated with smoking cessation at follow‐up and with planning to quit at follow‐up, each stratified by plans to quit smoking at baseline. Findings Overall, 12.7% of smokers quit smoking. Smokers not initially planning to quit within 6 months experienced higher odds of smoking cessation when they took up daily vaping (32.4%) versus no vaping (6.8%; adjusted odds ratio [AOR], 8.58; 95% CI, 5.06–14.54). Among smokers planning to quit, smoking cessation rates were similar between those who did and did not take up daily vaping (25.1% vs 16.8%; AOR, 1.91; 95% CI, 0.91–4.00), although we could not account for potential use of cessation aids. Daily vaping uptake was associated with planning to quit smoking at follow‐up among those initially not planning to quit (AOR,6.32; 95% CI, 4.17–9.59). Conclusions: Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking. Excluding smokers not planning to quit from studies on vaping and smoking cessation may underestimate potential benefit of daily vaping for daily smokers. [ABSTRACT FROM AUTHOR]

Aim: To examine the association of self‐reported COVID‐19 disease status with cutting down, past‐month and past‐year quit attempts and motivation to stop smoking. Design and setting: Repeat cross‐sectional survey, representative of the adult population in England. Participants: Past‐year smokers, n = 3338 (aged ≥ 18 years) responding between May 2020 and April 2021. Measurements: Outcomes were (i) currently cutting down, (ii) having made a quit attempt in the past month, (iii) having made a quit attempt in the past year and (iv) motivation to stop smoking. The explanatory variable was self‐reported COVID‐19 disease status (belief in never versus ever had COVID‐19). Covariates included age, sex, occupational grade, region, children in the household, alcohol use and survey month. Findings Of past‐year smokers, 720 (21.6%) reported past‐COVID‐19 infection and 48 (1.4%) reported current COVID‐19 infection. In adjusted analyses, rates of currently cutting down [adjusted odds ratio (aOR) = 1.12, 95% confidence interval (CI) = 0.93–1.34], past‐year quit attempts (aOR = 0.99, 95% CI = 0.82–1.19) and motivation to stop smoking (aOR = 1.04, 95% CI = 0.89–1.23) were comparable in those who did and did not report ever having had COVID‐19. People who reported ever having had COVID‐19 had 39% higher odds than those without of attempting to quit in the past month, but the confidence interval contained the possibility of no difference (aOR = 1.39, 95% CI = 0.94–2.06) and for some the quit attempt may have occurred before they had COVID‐19. Conclusion: During the first year of the COVID‐19 pandemic in England, rates of reducing smoking and attempting to quit in the past year were similar in smokers who did or did not self‐report ever having had COVID‐19. There was also little difference in motivation to stop smoking between groups. However, causal interpretation is limited by the study design, and there is potential misclassification of the temporal sequence of infection and changes to smoking behaviour. [ABSTRACT FROM AUTHOR]

Aims: To examine whether polyuse of cigarettes and other smoked products (polysmoking) is predictive of quit attempts and quit success. Design: A prospective multi‐country cohort design. Setting: Australia, Canada, England and the United States. Participants: A total of 3983 adult daily cigarette smokers were surveyed in 2016 (wave 1 of data collection) and were re‐contacted in 2018 (wave 2) (i.e. waves 1–2 cohort) in the International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys; and 3736 smokers were surveyed in 2018 and re‐contacted in 2020 (wave 3) (i.e. waves 2–3 cohort). Measurements Participants were asked about their cigarette smoking and use of cigars, cigarillos, pipes and waterpipes. Outcomes were quit attempts between two survey waves and success, defined as having quit smoking all the combustible tobacco at the subsequent survey for 1 month or more. Findings Levels of polysmoking were 12.7% in the waves 1–2 cohort and 10.5% for the waves 2–3 cohort. Compared with cigarette‐only smokers, polysmokers were more likely to attempt to quit between waves 1 and 2 [54.9 versus 42.7%, adjusted odds ratio (aOR) = 1.37, 95% confidence interval (CI) = 1.08–1.74, P < 0.01], but not between waves 2 and 3 (43.8 versus 40.1%, aOR = 0.94, 95% CI = 0.72–1.22). Polysmoking predicted reduced likelihood of success in both cohorts among attempters and the overall samples. Between waves 2 and 3 there were significantly more transitions to non‐daily smoking among the polysmokers (12.4 versus 5.3%, χ2 = 40.4, P < 0.001). Conclusions: There is a consistent association between polysmoking (use of cigarettes together with other smoked products) and reduced quit success for combustible tobacco, but it is probably due to increased likelihood of transitioning to non‐daily use rather than complete cessation. [ABSTRACT FROM AUTHOR]

Background and aims: Mortality and drug treatment data suggest that the median age of people who inject drugs is increasing. We aimed to describe changes in the characteristics of people injecting drugs in the United Kingdom (UK). Design: Repeat cross‐sectional surveys and modelling. Setting: Low‐threshold services in the United Kingdom such as needle and syringe programmes. Participants: A total of 79 900 people who recently injected psychoactive drugs in the United Kingdom, recruited as part of the Unlinked Anonymous Monitoring Survey (England, Wales, Northern Ireland, 1990–2019) and Needle Exchange Surveillance Initiative (Scotland, 2008–2019). Measurements Age of people currently injecting, age at first injection, duration of injecting (each 1990–2019) and estimates of new people who started injecting (1980–2019). Findings In England, Wales and Northern Ireland between 1990 and 2019, the median age of people injecting increased from 27 (interquartile range [IQR], 24–31) to 40 (IQR, 34–46); median age at first injection increased from 22 (IQR, 19–25) to 33 (IQR, 28–39); and median years of injecting increased from 7 (IQR, 3–11) to 18 (IQR, 9–23). Values in Scotland and England were similar after 2008. The estimated number that started injecting annually in England increased from 5470 (95% prediction interval [PrI] 3120‐6940) in 1980 to a peak of 10 270 (95% PrI, 8980‐12 780) in 1998, and then decreased to 2420 (95% PrI, 1320‐5580) in 2019. The number in Scotland followed a similar pattern, increasing from 1220 (95% PrI, 740–2430) in 1980 to a peak of 3080 (95% PrI, 2160–3350) in 1998, then decreased to a 270 (95% PrI, 130–600) in 2018. The timing of the peak differed between regions, with earlier peaks in London and the North West of England. Conclusions: In the United Kingdom, large cohorts started injecting psychoactive drugs in the 1980s and 1990s and many still inject today. Relatively few people started in more recent years. This has led to changes in the population injecting drugs, including an older average age and longer injecting histories. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the impact of announcement of tax increases on factory‐made (FM) and roll‐your own (RYO) cigarettes in England. Design, Setting and Participants: Autoregressive integrated moving average with exogeneous input (ARIMAX) time–series modelling in England, UK. Data were aggregated monthly on 274 890 participants between 2007 and 2019 taking part in the Smoking Toolkit Study (STS). Measurements: The association of sustained step level changes for tax rises for FM cigarettes and temporary pulse effects for tax rises for RYO cigarettes with smoking, quit attempt and quit success prevalence as well as per‐capita self‐reported cigarette consumption and cost per cigarette was assessed. Findings A 10% rise in tax on RYO cigarettes was associated with a temporary 21.1% decline [95% confidence interval (CI) = –30.4 to −10.7] in smoking prevalence, and 20.7% decline (95% CI = –32.4 to −7.0) in per‐capita self‐reported cigarette consumption; while a 3% rise of tax on RYO cigarettes was associated with a temporary 20.7% decline (95% CI = –33.3 to −5.8) in the amount paid per RYO cigarette. For tax increases on FM cigarettes, a 5% above inflation tax rise was associated with a step‐level increase of 33.1% (95% CI = 18.4–49.5) in quit success rates. However, some of the findings were sensitive to model specification and temporally specific. Conclusion: The announcements of tax increases for cigarettes in England between 2010 and 2019 were inconsistently associated with temporary reductions in smoking prevalence, per‐capita self‐reported cigarette consumption and improved quit success. Paradoxically, reductions in the cost for roll‐your‐own cigarettes were also found. The results were not robust in all sensitivity analyses. [ABSTRACT FROM AUTHOR]

Aims: To assess how changes in the prevalence of e‐cigarette use among young adults have been associated with changes in the uptake of smoking in England between 2007 and 2018. Design Time–series analysis of population trends with autoregressive integrated moving average with exogeneous input (ARIMAX models). Setting: England. Participants: Data were aggregated quarterly on young adults aged 16–24 years (n = 37 105) taking part in the Smoking Toolkit Study. Measures: In the primary analysis, prevalence of e‐cigarette use was used to predict prevalence of ever regular smoking among those aged 16–24. Sensitivity analyses stratified the sample into those aged 16–17 and 18–24. Bayes' factors and robustness regions were calculated for non‐significant findings [effect size beta coefficient (B) = 3.1]. Findings There was evidence for no association between the prevalence of e‐cigarette use and ever regular smoking among those aged 16–24 [B = –0.015, 95% confidence interval (CI) = –0.046 to 0.016; P = 0.341; Bayes factor (BF) = 0.002]. Evidence for no association was also found in the stratified analysis among those aged 16–17 (B = 0.070, 95% CI –0.014 to 0.155, P = 0.102; BF = 0.015) and 18–24 (B = –0.021, 95% CI –0.053 to 0.011; P = 0.205; BF = 0.003). These findings were able to rule out percentage point increases or decreases in ever regular smoking prevalence greater than 0.31% or less than −0.03% for 16–17‐year‐olds and 0.01 or −0.08% for 18–24‐year‐olds for every 1%‐point increase in e‐cigarette prevalence. Conclusion: Prevalence of e‐cigarette use among the youth population in England does not appear to be associated with substantial increases or decreases in the prevalence of smoking uptake. Small associations cannot be ruled out. [ABSTRACT FROM AUTHOR]

Aim In France, following a long-term decline in smoking prevalence, an increase in smoking was observed between 2005 and 2010, an unusual occurrence in countries in the 'mature' stage of the smoking epidemic. By contrast, smoking prevalence in England, the neighbouring country, continued its long-term decline. Methods We identified and translated recent reports on smoking and tobacco control in France and using these assessed the main data sources on smoking and compared them with similar sources in England, in order to explore possible explanations. In France, national smoking prevalence data are collected 5-yearly, minimizing opportunities for fine-grained analysis; the comparable study in England is implemented annually. Results We identified several probable causes of the recent increased prevalence of smoking in France, the primary one being the absence of sufficient price rises between 2005 and 2010, due probably to the lack of a robust tobacco control strategy, which also appeared to have empowered tobacco industry influence. Funding to compensate tobacconists appears to incentivize tobacco sales and is significantly higher than tobacco control funding. Conclusions Mindful of the limitations of a case-study approach, the absence of sufficient price rises in the context of a weak tobacco control strategy seems the most likely explanation for the recent increase in smoking prevalence in France. A new cancer control plan and a national smoking reduction programme have been proposed by the French government in 2014 which, depending on implementation, may reverse the trend. In both countries, the higher levels of smoking among the more disadvantaged groups are of great concern and require greater political leadership for effective action. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Estimating ‘return on investment’ (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool ( http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. Methods: Estimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. Findings: Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single‐form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster‐acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face‐to‐face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self‐help materials (1%). There was insufficient evidence to obtain reliable, country‐specific estimates for interventions such as websites, smartphone applications and e‐cigarettes. Conclusions: Tax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions. [ABSTRACT FROM AUTHOR]

Background and Aims: In 2003, the UK government passed the Licensing Act for England and Wales. The Act provides a framework for regulating alcohol sale, including four licensing objectives with local governments having devolved responsibility for granting licences to sell alcohol. Members of the public can make representations of oppositions to licence applications. Applying the theories of the policy process, we explored the practices employed by licensing authorities when deciding on alcohol licences in situations of conflict between licence applicants and members of the public. Design Qualitative study comprising a framework analysis of in‐depth semi‐structured interviews and application of the theories of institutionalism, the advocacy coalition framework and role of ideas. Setting: Eleven local authorities in five regions in England in 2019. Participants: Purposive sample of 15 licensing officers, licensing subcommittee chairs, public health leads for licensing and police licensing officers. Measurements The interview schedule included mechanisms of public involvement in licensing, parties involved, the subject of conflicts and how licensing authorities made decisions. Findings When members of the public opposed licence applications, licensing authorities employed three key decision‐making practices: procedural fairness, partnership working and framing. The normativity of procedural fairness was an important institutional structure within which conflicts were resolved. Licensing authorities also worked in partnership with the involved parties, who often appeared as advocacy coalitions that shared beliefs and advanced specific issues to determine mutually acceptable solutions. At times, licensing authorities framed issues through ideational processes to solve problems. Conclusion: Licensing decision‐making under the United Kingdom's Licensing Act for England and Wales appear in many cases to focus on resolution of conflicts between licence applicants and members of the public rather than on promotion of licensing objectives. This raises uncertainty regarding the impact of public involvement on reducing alcohol availability, but ultimately represents a pragmatic process that seeks to restore balance in powers, improve transparency in decision‐making and empower communities. [ABSTRACT FROM AUTHOR]

Background and Aims: Having a negative cognitive style may lead someone to feel hopeless about his or her situation and be more likely to engage in coping-motivated drinking. We, therefore, aimed to investigate the association between cognitive style and drinking to cope. Design: Prospective cohort study. Setting: The former Avon Health Authority in South West England. Participants: A total of 1681 participants of the Avon Longitudinal Study of Parents and Children. Measurements: Participants completed cognitive style questions at age 17 and a subset of drinking to cope questions at age 24. We used linear regression to test the association between cognitive style and drinking to cope, controlling for confounders. Alcohol consumption and dependence scales were included in a secondary analysis. Findings: A 20-point increase (that was the standard deviation of the exposure variable) in cognitive style score at age 17 was associated with an increase of 0.24 in drinking to cope scores at age 24 after adjustment for confounding variables (95% CI) = 0.08-0.41, P = 0.003). We found no evidence of an association between cognitive style and alcohol consumption (coefficient = 0.03, 95% CI = -0.08-0.14, P = 0.591) before or after adjustment. There was evidence for an association with alcohol dependence, but this was not present after adjusting for confounders (coefficient = 0.01, 95% CI = -0.04-0.05, P = 0.769). Conclusions: In young adults in England, there appears to be a positive association between negative cognitive style and subsequent drinking to cope. [ABSTRACT FROM AUTHOR]

Background and Aims: The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. Design: Cross-sectional diagnostic study based on a nationally-representative survey. Settings: Community dwelling households in England. Participants: A total of 22 404 household residents aged =16 years reporting drinking alcohol at least occasionally. Measurements: Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. Findings: EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was 11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and 2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). Conclusions: A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions. [ABSTRACT FROM AUTHOR]

Aims: To estimate the associations between regular exposure to smoking by other people and motivation and attempts to quit among current smokers. To examine whether socio‐demographic and other factors moderate these associations. Design A repeat nationally representative cross‐sectional survey. Data were collected monthly between November 2014 and February 2019. Setting: England. Participants: Current smokers ≥16 years of age from the Smoking Toolkit Study (n = 15 136). Measurements Participants were asked whether other people regularly smoke in their presence, how motivated they were to quit and whether they had made a quit attempt in the past year. Moderators assessed were occupation‐based social grade, housing tenure, urges to smoke, high‐risk alcohol consumption, and disability. Adjusted analyses included moderators, socio‐demographic (age/sex/ethnicity/sexual orientation/marital status/children in household) and seasonal (quarter/year) confounders. Findings Current smokers who were regularly exposed to other people smoking in their presence were less likely to be highly motivated to quit (OR = 0.88 [95% CI 0.80–0.97]), but were no less likely to have made a quit attempt in the past year (OR 1.04 [0.97–1.13], Bayes Factor (BF) = 0.05). The inverse relationship between regular smoking exposure and motivation to quit was moderated by urges to smoke, such that exposure was only associated with a reduction in motivation among those without strong urges to smoke (OR 0.83 [0.75–0.93] versus OR 1.04 [0.86–1.26]; P = 0.048). None of the other factors significantly moderated the association with motivation to quit, and none moderated the relationship between regular smoking exposure and quit attempts. All non‐significant interactions, except social grade (BF = 1.44) with quit attempts, had Bayes Factors that supported the hypothesis of no moderation (BF range: 0.12–0.21). Conclusions: Among current smokers in England, regular exposure to other smokers appears to be associated with lower motivation to quit in people without strong urges to smoke, yet there appears to be no association with quit attempts in the previous year. Social grade, housing tenure, high‐risk alcohol consumption and disability do not moderate these associations. [ABSTRACT FROM AUTHOR]

Background and Aims: On 1 May 2018, Scotland became the first country in the world to introduce minimum unit pricing (MUP), a strength‐based floor price below which alcohol cannot be sold, across all alcoholic beverages. The legislation contains a sunset clause meaning a comprehensive mixed‐methods evaluation of its impact across a range of outcomes will inform whether it will continue beyond its sixth year. In this study, we assessed the impact of MUP on off‐trade alcohol sales (as a proxy for consumption) after its first year. Design, Setting and Participants: Controlled interrupted time–series regression was used to assess the impact of MUP on alcohol sales among off‐trade retailers in Scotland in the year after it was introduced, with England and Wales (EW) being the control group. In adjusted analyses, we included household disposable income, on‐trade alcohol sales and substitution between beverage categories as covariates. Measurements Weekly data on the volume of pure alcohol sold by off‐trade retailers in Scotland and EW between January 2013 and May 2019, expressed as litres of pure alcohol per adult. Findings The introduction of MUP in Scotland was associated with a 3.5% [95% confidence interval (CI) = 2.2–4.9%] reduction in off‐trade alcohol sales per adult after adjustment for the best available geographical control, disposable income and substitution. In unadjusted analysis, the introduction of MUP was associated with a 2.0% (95% CI = 0.4–3.6%) reduction in off‐trade alcohol sales per adult in Scotland. In EW, there was a 2.4% (95% CI = 0.8–4.0%) increase during the same time‐period. The reduction in off‐trade alcohol sales in Scotland was driven by reduced sales of spirits, cider and perry beverage categories. Conclusion: The implementation of minimum unit pricing for alcohol in Scotland in 2018 appears to have been associated with a reduction in off‐trade alcohol sales after its first year. [ABSTRACT FROM AUTHOR]

Background and Aims: The Licensing Act 2003 deregulated trading hours in England and Wales. Previous evaluations have focused upon consumption and harm outcomes, finding mixed results. Several evaluations speculated on the reasons for their results, noting the role of changes in the characteristics of drinking occasions. This study aimed to test proposed mechanisms of effect for the Licensing Act 2003 by evaluating changes in characteristics of drinking occasions. Design, Setting and Participants Interrupted monthly time–series analysis of effects in England and Wales versus a Scottish control series, using 2001–08 data collected via 7‐day drinking occasions diaries by the market research company Kantar (n = 89 192 adults aged 18+). Measurements Outcomes were start‐ and end‐time of each reported occasion; variation in finish time; prevalence of pre‐loading, post‐loading and late‐night drinking; and alcohol consumption (in units). Findings After the introduction of the Act, occasions shifted later at night in England and Wales [finish time +11.4 minutes; 95% confidence interval (CI) = 3.6–19.2]. More occasions involved pre‐loading in England and Wales relative to Scotland (0.02% increase; 95% CI = 0.01–0.03). There was no evidence of changes in variation in finish time, post‐loading, late‐night drinking or alcohol consumption. Conclusions: The Licensing Act 2003 in England and Wales appears to have had only limited effects on the characteristics of drinking occasions. This may help to explain its lack of substantial impacts on alcohol harms [ABSTRACT FROM AUTHOR]

Aims: To describe gender differences in alcohol consumption, purchasing preferences and alcohol‐attributable harm. To model the effects of alcohol pricing policies on male and female consumption and hospitalizations. Design Epidemiological simulation using the Sheffield Alcohol Policy Model version 4. Setting and Participants: Adults aged 18+ years, England. Interventions: Three alcohol pricing policies: 10% duty increase and minimum unit prices (MUP) of £0.50 and £0.70 per UK unit. Measures Gender‐specific baseline and key outcomes data: annual beverage‐specific units of alcohol consumed and beverage‐specific alcohol expenditure (household surveys). Alcohol‐attributable hospital admissions (administrative data). Key model parameters: literature‐based own‐ and cross‐price elasticities for 10 beverage‐by‐location categories (e.g. off‐trade beer). Sensitivity analysis with new gender‐specific elasticities. Literature‐based risk functions linking consumption and harm, gender‐disaggregated where evidence was available. Population subgroups: 120 subgroups defined by gender (primary focus), age, deprivation quintile and baseline weekly consumption. Findings Women consumed 59.7% of their alcohol as off‐trade wine while men consumed 49.7% as beer. Women drinkers consumed fewer units annually than men (494 versus 895) and a smaller proportion of women were high‐risk drinkers (4.8 versus 7.2%). Moderate drinking women had lower hospital admission rates than men (44 versus 547 per 100 000), but rates were similar for high‐risk drinking women and men (14 294 versus 13 167 per 100 000). All three policies led to larger estimated reductions in consumption and admission rates among men than women. For example, a £0.50 MUP led to a 5.3% reduction in consumption and a 4.1% reduction in admissions for men but a 0.7% reduction in consumption and a 1.6% reduction in hospitalizations for women. Conclusion: Alcohol consumption, purchasing preferences and harm show strong gender patterns among adult drinkers in England. Alcohol pricing policies are estimated to be more effective at reducing consumption and harm for men than women. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether the introduction of minimum unit pricing (MUP) in Scotland on 1 May 2018 was reflected in changes in the likelihood of alcohol‐related queries submitted to an internet search engine, and in particular whether there was any evidence of increased interest in purchasing of alcohol from outside Scotland. Design Observational study in which individual queries to the internet Bing search engine for 2018 in Scotland and England were captured and analysed. Fluctuations over time in the likelihood of specific topic searches were examined. The patterns seen in Scotland were contrasted with those in England. Setting: Scotland and England. Participants: People who used the Bing search engine during 2018. Measurements Numbers of daily queries submitted to Bing in 2018 on eight alcohol‐related topics expressed as a proportion of queries on that day on any topic. These daily likelihoods were smoothed using a 14‐day moving average for Scotland and England separately. Findings There were substantial peaks in queries about MUP itself, cheap sources of alcohol and online alcohol outlets at the time of introduction of MUP in May 2018 in Scotland, but not England. These were relatively short‐lived. Queries related to intoxication and alcohol problems did not show a MUP peak, but were appreciably higher in Scotland than in England throughout 2018. Conclusions: Analysis of internet search engine queries appears to show that a fraction of people in Scotland may have considered circumventing minimum unit pricing in 2018 by looking for on‐line alcohol retailers. The overall higher levels of queries related to alcohol problems in Scotland compared with England mirrors the corresponding differences in alcohol consumption and harms between the countries. [ABSTRACT FROM AUTHOR]

Background and aims: Association of electronic cigarette use and subsequent smoking has received considerable attention, although age of first use has not. This study tested differences in regular (e‐cigarettes, cigarettes) and ever (cigarettes) use between e‐cigarette user groups: early versus never users, late versus never users, early versus late users and effects of controlling for covariates. Design Prospective study with 12‐ and 24‐month follow‐up of e‐cigarette/cigarette ever/regular use with data from an intervention. Setting: Forty‐five schools in England (Staffordshire and Yorkshire). Participants: Never smokers (3289 13–14‐year‐olds) who were part of a cluster randomized controlled trial. Measurements The sample was divided into groups of e‐cigarette users: early users (at 13–14 years), late users (at 14–15 years) and never users (at 13–14 and 14–15 years). Dependent variables were self‐reported regular e‐cigarette and cigarette use and ever cigarette use at 15–16 years. Covariates were assessed. Findings Early and late users compared with never users were significantly more likely to be regular e‐cigarette users [early: odds ratio (OR) = 9.42, 95% confidence interval (CI) = 5.38, 16.49, P < 0.001; late: OR = 6.89, 95% CI = 4.11, 11.54, P < 0.001], ever cigarette users (early: OR = 7.96, 95% CI = 6.02, 10.53, P < 0.001; late: OR = 5.13, 95% CI = 3.85, 6.84, P < 0.001) and regular cigarette users (early: OR = 7.80, 95% CI = 3.99, 15.27, P < 0.001; late: OR = 4.34, 95% CI = 1.93, 9.77, P < 0.001) at age 15–16 years. Late users compared with early users had significantly lower rates of ever use of cigarettes at 15–16 years (OR = 0.48, 95% CI = 0.35, 0.66, P < 0.001), although this difference was non‐significant at 12 months after first use of e‐cigarettes (OR = 0.89, 95% CI = 0.64, 1.25, P = 0.498). Controlling for covariates did not change the findings. Conclusions: Adolescents in England who report using e‐cigarettes at age 13–14 years have higher rates of subsequently initiating cigarette use than adolescents who report using e‐cigarettes at age 14–15 years, a difference that may be attributable to a longer period of time to initiate cigarette use in former group. [ABSTRACT FROM AUTHOR]

Background and Aims: Advice from a general practitioner (GP) can encourage smokers to quit. This study aimed to estimate the prevalence and correlates of receipt of GP advice on smoking, what type of advice and support was offered and characteristics and quitting activity associated with different types of advice. Design/setting Data were collected between 2016 and 2019 in a series of monthly cross‐sectional surveys of representative samples of the adult population in England. Participants: A total of 11 588 past‐year smokers. Measurements Participants reported whether they had received advice or offer of support for smoking cessation from their GP in the last year. Socio‐demographic and behavioural characteristics and past‐year quit attempts and cessation were also recorded. Findings One in two [47.2%, 95% confidence interval (CI) = 46.1–48.3%] past‐year smokers who reported visiting their GP in the last year recalled receiving advice on smoking, and one in three (30.1%, 95% CI = 29.1–31.1%) reported being offered cessation support. The most common form of support offered was stop smoking services (16.5%, 95% CI = 15.7–17.3%) followed by prescription medication (8.1%, 95% CI = 7.5–8.7%); 3.7% (95% CI = 3.3–4.1%) reported having been recommended to use e‐cigarettes. Smokers who were older, non‐white, more addicted, and smoked five or more cigarettes/day had consistently higher odds of receiving advice or support. There were some differences by region, housing tenure, presence of children in the home and high‐risk drinking in the types of advice/support received. There were no significant differences by sex, occupational social grade, disability, type of cigarettes smoked, or survey year. Advice with any offer of support was associated with higher odds of attempting to quit than advice alone [adjusted odds ratio (ORadj) = 1.52, 95% CI = 1.30–1.76]. Advice alone was associated with higher odds of quit attempts than no advice in smokers with higher (ORadj = 1.34, 95% CI = 1.10–1.64) but not lower occupational social grade (ORadj = 0.90, 95% CI = 0.75–1.08). Conclusions: In England, a minority of smokers receive support from their GP to stop smoking. Those who do are more likely to be older, non‐white and more addicted to cigarettes. Advice plus offer of support appears to be associated with increased odds of making a quit attempt, while advice without offer of support appears only to be associated with increased odds of making a quit attempt in higher occupational social grade smokers. [ABSTRACT FROM AUTHOR]

Background and Aims: There have been few longitudinal studies of association between alcohol use and cognitive functioning in young people. We aimed to examine whether alcohol use is a causal risk factor for deficient cognitive functioning in young adults. Design Linear regression was used to examine the relationship between longitudinal latent class patterns of binge drinking and subsequent cognitive functioning. Two‐sample Mendelian randomization (MR) tested evidence for the causal relationship between alcohol use and cognitive functioning. Setting: South West England. Participants: The observational study included 3155 adolescents and their parents (fully adjusted models) from the Avon Longitudinal Study of Parents and Children (ALSPAC). Genetic instruments for alcohol use were based on almost 1 000 000 individuals from the genome‐wide association studies (GWAS) and Sequencing Consortium of Alcohol and Nicotine use (GSCAN). Genome‐wide association studies for cognitive outcomes were based on 2500 individuals from ALSPAC. Measurements Binge drinking was assessed at approximately 16, 17, 18, 21 and 23 years. Cognitive functioning comprised working memory, response inhibition and emotion recognition assessed at 24 years of age. Ninety‐nine independent genome‐wide significant single nucleotide polymorphisms (SNPs) associated with 'number of drinks per week' were used as the genetic instrument for alcohol consumption. Potential confounders were included in the observational analyses. Findings Four binge drinking classes were identified: 'low‐risk' (41.3%), 'early‐onset monthly' (19.1%), 'adult frequent' (22.5%) and 'early‐onset frequent' (17.0%). The association between early‐onset frequent binge drinking and cognitive functioning: working memory (b = −0.42, 95% confidence interval (CI) = −1.24 to 0.41), response inhibition (b = 31.9, 95% CI = −25.3 to 89.2), and emotion recognition (b = 0.02, 95% CI = −0.07 to 0.10) in comparison to low‐risk drinkers were inconclusive as to whether a difference was present. Two‐sample MR analyses similarly provided little evidence that alcohol use is associated with deficits in working memory using the inverse variance weight (b = 0.29, 95% CI = –0.42 to 0.99), response inhibition (b = −0.32, 95% CI = –1.04 to 0.39) and emotion recognition (b = 0.03, 95% CI = –0.55 to 0.61). Conclusions: Binge drinking in adolescence and early adulthood may not be causally related to deficiencies in working memory, response inhibition or emotion recognition in youths. [ABSTRACT FROM AUTHOR]

Background and Aims: Given the costs of alcohol to society, it is important to evaluate whether local alcohol licensing decisions can mitigate the effects of alcohol misuse. Robust natural experiment evaluations of the impact of individual licensing decisions could potentially inform and improve local decision‐making. We aimed to assess whether alcohol licensing decisions could be evaluated at small spatial scale by using a causal inference framework. Design Three natural experiments. Setting and participants: Three English local areas of 1000–15 000 people each. Intervention and comparator: The case study interventions were (i) the closure of a nightclub following reviews; (ii) closure of a restaurant/nightclub following reviews and (iii) implementation of new local licensing guidance (LLG). Trends in outcomes were compared with synthetic counterfactuals created using Bayesian structural time–series. Measurements Time–series data were obtained on emergency department admissions, ambulance call‐outs and alcohol‐related crime at the Lower or Middle Super Output geographical aggregation level. Findings Closure of the nightclub led to temporary 4‐month reductions in antisocial behaviour (−18%; 95% credible interval − 37%, −4%), with no change in other outcomes. Closure of the restaurant/nightclub did not lead to measurable changes in outcomes. The new licensing guidance led to small reductions in drunk and disorderly behaviour (nine of a predicted 21 events averted), and the unplanned end of the LLG coincided with an increase in domestic violence of two incidents per month. Conclusions: The impact of local alcohol policy, even at the level of individual premises, can be evaluated using a causal inference framework. Local government actions such as closure or restriction of alcohol venues and alcohol licensing may have a positive impact on health and crime in the immediate surrounding area. [ABSTRACT FROM AUTHOR]

Aims: At a time of declining smoking prevalence in England, it is useful to document any changes in the characteristics of smokers. This has implications for targeting tobacco control policies and interventions. This study compared the characteristics of smokers from 2008 to 2017 to assess changes in smoking and quitting patterns and socio‐demographic profile. Design and setting Analysis of annual trends in results from repeated cross‐sectional surveys of representative samples of the population in England from 2008 to 2017. Participants: The study included 208 813 adults aged 16+. Measurements Information was gathered on age, sex, social grade and region, cigarette consumption, cigarette dependence as measured by time to first cigarette of the day, daily smoking, smoking roll‐your‐own cigarettes, attempts to cut down, use of an e‐cigarette or nicotine replacement therapy, attempts to cut down or quit, use of support in quit attempts and whether the quit attempt was abrupt. Findings During the period, mean daily cigarette consumption [B = –0.30, 95% confidence interval (CI) = –0.33 to −0.27] and the time to first cigarette score decreased (B = –0.03, 95% CI = –0.03 to −0.02). The proportion of smokers attempting to cut down or quit decreased (odds ratio (OR) range = 0.96–0.97, 95% CI range = 0.95–0.97). Use of behavioural support [odds ratio (OR) = 0.89, 95% CI = 0.86–0.92] or no support decreased (OR = 0.98, 95% CI = 0.96–0.99), while use of pharmacological support, including e‐cigarettes, increased (OR = 1.04, 95% CI = 1.02–1.05). There was no significant change in the difference in social grade between smokers and non‐smokers comparing 2008 with 2017. Changes in smoking and quitting behaviour were independent of changes in socio‐demographic characteristics. Conclusions: Between 2008 and 2017 in England, smokers appear to have become less dependent on cigarettes but less likely to try to quit or cut down. Of those who tried to quit, fewer used behavioural support and more used pharmacological support. The proportion from more disadvantaged backgrounds did not change significantly. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Increasing the reach of smoking cessation services and/or including new but effective medications to the current provision may provide significant health and economic benefits; the scale of such benefits is currently unknown. The aim of this study was to estimate the cost‐effectiveness from a health‐care perspective of viable national level changes in smoking cessation provision in the Netherlands and England. Methods: A Markov‐based state transition model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)] was used to estimate costs and benefits [expressed in quality‐adjusted life years (QALY)] of changing the current provision of smoking cessation programmes in the Netherlands and England. The changes included: (a) increasing the reach of top‐level services to increase potential quitters (e.g. brief physician advice); (b) increasing the reach of behavioural support (group‐based therapy and SMS text‐messaging support) to increase the success rates; (c) including a new but effective medication (cytisine); and (d) all changes implemented together (combined change). The costs and QALYs generated by those changes over 2, 5, 10 years and a life‐time were compared with that of the current practice in each country. Results were expressed as incremental net benefit (INB) and incremental cost‐effectiveness ratio (ICER). A sequential analysis from a life‐time perspective was conducted to identify the optimal change. Results: The combined change was dominant (cost‐saving) over all alternative changes and over the current practice, in both countries. The combined change would generate an incremental net benefit of €11.47 (2 years) to €56.16 (life‐time) per smoker in the Netherlands and €9.96 (2 years) to €60.72 (life‐time) per smoker in England. The current practice was dominated by all alternative changes. Conclusion: Current provision of smoking cessation services in the Netherlands and England can benefit economically from the inclusion of cytisine and increasing the reach of brief physician advice, text‐messaging support and group‐based therapy. [ABSTRACT FROM AUTHOR]

Background and Aims In many countries, conflicting gradients in alcohol consumption and alcohol-associated mortality have been observed. To understand this 'alcohol harm paradox' we analysed the socio-economic gradient in alcohol-associated hospital admissions to test whether it was greater in conditions which were: (1) chronic (associated with long-term drinking) and partially alcohol-attributable, (2) chronic and wholly alcohol-attributable, (3) acute (associated with intoxication) and partially alcohol-attributable and (4) acute and wholly alcohol-attributable. Our aim was to clarify how (1) drinking patterns (e.g. intoxication linked to acute admissions or dependence linked to chronic conditions) and (2) non-alcohol causes (e.g. smoking and poor diet which are risks for partially alcohol-attributable conditions) contribute to the paradox. Design Regression analysis testing the modifying effects of condition-group (1-4 above) and sex on the relationship between area-based deprivation and admissions. Setting England, April 2010-March 2013. Participants A total of 9 239 629 English hospital admissions where a primary or secondary cause was one of 36 alcohol-associated conditions. Measurements Admissions by condition and deciles of Index of Multiple Deprivation (IMD). Socio-economic gradient measured as the relative index of inequality (RII, the slope of a linear regression of IMD on admissions adjusted for overall admission rate). Conditions were categorized by ICD-10 code. Findings A socio-economic gradient in hospitalizations was seen for all conditions, except partially attributable chronic conditions. The gradient was significantly steeper for conditions which were wholly attributable to alcohol and for acute conditions than for conditions partially alcohol-attributable and for chronic conditions. Gradients were steeper for men than for women in cases of wholly alcohol attributable conditions. Conclusions There is a socio-economic gradient in English hospital admission for most alcohol-associated conditions. The greatest inequalities are in conditions associated with alcohol dependence, such as liver disease and mental and behavioural conditions, and in acute conditions, such as alcohol poisoning and assault. Socio-economic differences in harmful drinking patterns (dependence and intoxication) may contribute to the 'alcohol harm paradox'. [ABSTRACT FROM AUTHOR]

Background and Aims Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin injection have a high risk of drug-related death soon after release from prison. The NALoxone InVEstigation (N-ALIVE) pilot trial (ISRCTN34044390) tested feasibility measures for randomized provision of naloxone-on-release (NOR) to eligible prisoners in England. Design. Parallel-group randomized controlled pilot trial. Setting English prisons. Participants A total of 1685 adult heroin injectors, incarcerated for at least 7 days pre-randomization, release due within 3 months and more than 6 months since previous N-ALIVE release. Intervention Using 1 : 1 minimization, prisoners were randomized to receive on release a pack containing either a single 'rescue' injection of naloxone or a control pack with no syringe. Measurements Key feasibility outcomes were tested against prior expectations: on participation (14 English prisons; 2800 prisoners), consent (75% for randomization), returned prisoner self-questionnaires (RPSQs: 207), NOR-carriage (75% in first 4 weeks) and overdose presence (80%). Findings Prisons (16) and prisoners (1685) were willing to participate [consent rate, 95% confidence interval (CI) = 70-74%]; 218 RPSQs were received; NOR-carriage (95% CI = 63-79%) and overdose presence (95% CI = 75-84%) were as expected. We randomized 842 to NOR and 843 to control during 30 months but stopped early, because only one-third of NOR administrations were to the ex-prisoner. Nine deaths within 12 weeks of release were registered for 1557 randomized participants released before 9 December 2014. Conclusions Large randomized trials are feasible with prison populations. Provision of take-home emergency naloxone prior to prison release may be a life-saving interim measure to prevent heroin overdose deaths among ex-prisoners and the wider population. [ABSTRACT FROM AUTHOR]

Aims Most people who quit smoking for a short term will return to smoking again in 12 months. We tested whether self-help booklets can reduce relapse in short-term quitters after receiving behavioural and pharmacological cessation treatment. Design A parallel-arm, pragmatic individually randomized controlled trial. Setting Smoking cessation clinics in England. Participants People who stopped smoking for 4 weeks after receiving cessation treatment in stop smoking clinics. Intervention Participants in the experimental group (n = 703) were mailed eight booklets, each of which taught readers how to resist urges to smoke. Participants in the control group (n = 704) received a leaflet currently used in practice. Measurements The primary outcome was prolonged, carbon monoxide-verified abstinence from months 4 to 12. The secondary outcomes included 7-day self#x02010;reported abstinence at 3 and 12 months. Mixed-effects logistic regression was used to estimate treatment effects and to investigate possible effect modifying variables. Findings There were no statistically significant differences between the groups in prolonged abstinence from months 4 to 12 (36.9% versus 38.6%; odds ratio 0.93, 95% confidence interval 0.75-1.16; P = 0.524). In addition, there were no significant differences between the groups in any secondary outcomes. However, people who reported knowing risky situations for relapse and using strategies to handle urges to smoke were less likely to relapse. Conclusions In people who stop smoking successfully with behavioural support, a comprehensive self-help educational programme to teach people skills to identify and respond to high-risk situations for return to smoking did not reduce relapse. [ABSTRACT FROM AUTHOR]

Aims To estimate the effect on drug misuse treatment completion of a pilot scheme to pay service providers according to rates of recovery. Design A controlled, quasi-experimental (difference-in-differences) observational study using multi-level random effects logistic regression. Setting Drug misuse treatment providers in all 149 commissioning areas in England in the financial years 2011-12 and 2012-13. Participants Service users treated in England in 2011-12 and 2012-13. Intervention and comparators Linkage of provider payments to performance indicators in eight pilot commissioning areas in England compared with all 141 non-pilot commissioning areas in England. Measurements Recovery was measured by successful completion of treatment (free from drugs of dependence) and engagement with services was measured by rates of declining to continue with treatment. Findings Following the introduction of the pilot scheme, service users treated in pilot areas were 1.3 percentage points [odds ratio (OR) = 0.859; 95% confidence interval (CI) = 0.788, 0.937] less likely to complete treatment compared with those treated in comparison areas. Service users treated in pilot areas were 0.9 percentage points (OR = 2.934; 95% CI = 2.094, 4.113) more likely to decline to continue with treatment compared with those treated in comparison areas. Conclusions In the first year of the pilot 'Payment by Results for Drugs Recovery' scheme in England, linking payments to outcomes reduced the probability of completing drug misuse treatment and increased the proportion service users declining to continue with treatment. [ABSTRACT FROM AUTHOR]

Aims Financial incentives were the single most effective intervention for smoking cessation in pregnancy in a recent Cochrane Review, but based on a few small trials in the United States using only 7-day point prevalence measures of cessation. This study estimates (a) prolonged cessation in an unselected population of English pregnant smokers who are offered financial incentives for quitting and (b) 'gaming', i.e. false reporting of smoking status to enter the scheme or gain an incentive. Design Single-arm intervention study Setting Antenatal clinic and community Participants A total of 239 pregnant smokers enrolled into the financial incentive scheme, attending for maternity care at one hospital in an area of high deprivation in England over a 42-week period. Measurements Smoking cessation at delivery and 6 months postpartum, assessed using salivary cotinine; gaming assessed using urinary and salivary cotinine at enrolment, 28 and 36 weeks gestation, and 2 days and 6 months postpartum. Findings Thirty-nine per cent (239 of 615) of smokers were enrolled into the scheme, 60% (143 of 239) of whom made a quit attempt. Of those enrolled, 20% [48 of 239; 95% confidence interval (CI) = 14.9%, 25.1%] were quit at delivery and 10% (25 of 239; 95% CI = 6.2%, 13.8%) at 6 months postpartum. There was no evidence that women gamed to enter the scheme, but evidence that 4% (10 of 239) of those enrolled gamed on one or more occasions to gain vouchers. Conclusions Enrolment on an incentive scheme in an unselected English cohort of pregnant smokers was associated with prolonged cessation rates comparable to those reported in US trials. Rates of gaming were arguably insufficiently high to invalidate the use of such schemes. [ABSTRACT FROM AUTHOR]

Aims To investigate the relationship between cannabis and tobacco use by age 15 and subsequent educational outcomes. Design Birth cohort study. Setting England. Participants The sample was drawn from the Avon Longitudinal Study of Parents and Children; a core sample of 1155 individuals had complete information on all the variables. Measurements The main exposures were cannabis and tobacco use at age 15 assessed in clinic by computer-assisted questionnaire and serum cotinine. The main outcomes were performance in standardized assessments at 16 [Key Stage 4, General Certificate of Secondary Education (GCSE)] in English and mathematics (mean scores), completion of five or more assessments at grade C level or higher and leaving school having achieved no qualifications. Analyses were sequentially adjusted for multiple covariates using a hierarchical approach. Covariates considered were: maternal substance use (ever tobacco or cannabis use, alcohol use above recommended limits); life course socio-economic position (family occupational class, maternal education, family income); child sex; month and year of birth; child educational attainment prior to age 11 (Key Stage 2); child substance use (tobacco, alcohol and cannabis) prior to age 15 and child conduct disorder. Findings In fully adjusted models both cannabis and tobacco use at age 15 were associated with subsequent adverse educational outcomes. In general, the dose-response effect seen was consistent across all educational outcomes assessed. Weekly cannabis use was associated negatively with English GCSE results [grade point difference (GPD), -5.93, 95% confidence interval (CI) = -8.34, -3.53] and with mathematics GCSE results (GPD, -6.91, 95% CI = -9.92, -3.89). Daily tobacco smoking was associated negatively with English GCSE (GPD, -11.90, 95% CI = -13.47, -10.33) and with mathematics GCSE (GPD, -16.72, 95% CI = -18.57, -14.86). The greatest attenuation of these effects was seen on adjustment for other substance use and conduct disorder. Following adjustment, tobacco appeared to have a consistently stronger effect than cannabis. Conclusions Both cannabis and tobacco use in adolescence are associated strongly with subsequent adverse educational outcomes. Given the non-specific patterns of association seen and the attenuation of estimates on adjustment, it is possible that these effects arise through non-causal mechanisms, although a causal explanation cannot be discounted. © 2015 Society for the Study of Addiction [ABSTRACT FROM AUTHOR]

Aims The Randomized Injectable Opioid Treatment Trial ( RIOTT) compared supervised injectable heroin ( SIH) and supervised injectable methadone ( SIM) with optimized oral methadone ( OOM) ( ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design Multi-site randomized controlled trial ( RCT) comparing SIH versus OOM and SIM versus OOM. Setting Three supervised injectable opiate clinics in England. Participants Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment ( n = 127), randomized to either SIH( n = 43), SIM( n = 42) or OOM( n = 42). All received high levels of medical and psychosocial support. Measurements Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health ( SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [ SIH = odds ratio ( OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs ( SIH = mean change £-289.43; P < 0.001; SIM = mean change £-183.41; P < 0.001; OOM = mean change £-162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £-92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM ( SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes. [ABSTRACT FROM AUTHOR]

Aim To identify shared patterns of views in young people relating to the influence of industry-driven alcohol marketing (price, promotion, product and place of purchase/consumption) on their reported drinking behaviour. Design Q methodology harnessed qualitative and quantitative data to generate distinct clusters of opinions as follows: 39 opinion statements were derived from earlier in-depth qualitative interviews with 31 young people; by-person factor analysis was carried out on 28 participants' (six previous interviewees and 22 new recruits) rank orderings of these statements (most-to-least agreement); interpretation of the factor arrays was aided by 10-15-minute debriefing interviews held immediately following each Q-sort. Setting Northeast England Participants Young people aged 14-17 years purposively recruited from high schools, higher education colleges, youth centres and youth offending teams. Findings Centroid factor extraction and varimax rotation of factors generated three distinct accounts: factor one ('autonomous, sophisticated consumers') illustrated a self-defined sense of individuality and autonomy in alcohol choices; factor two ('price-driven consumers') appeared price-led, choosing to drink what was most accessible or cheapest; and factor three ('context-focused consumers') described drinking practices where products were chosen to serve specific functions such as being easy to carry while dancing. Conclusions Considering young people's views on alcohol marketing, different perspectives can be identified. These include perceived imperviousness to maketing, responsiveness to price and affordability and responsiveness to marketing focusing on youth lifestyles. [ABSTRACT FROM AUTHOR]

Aims To evaluate a heroin overdose management training programme for family members based on emergency recovery procedures and take-home naloxone ( THN) administration. Design A two-group, parallel-arm, non-blinded, randomized controlled trial of group-based training versus an information-only control. Setting Training events delivered in community addiction treatment services in three locations in England. Participants A total of 187 family members and carers allocated to receive either THN training or basic information on opioid overdose management ( n = 95 and n = 92, respectively), with 123 participants completing the study. Measurements The primary outcome measure was a self-completion Opioid Overdose Knowledge Scale ( OOKS; range 0-45) and an Opioid Overdose Attitudes Scale ( OOAS; range 28-140) was the secondary outcome measure. Each group was assessed before receiving their assigned condition and followed-up 3 months after. Events of witnessing and managing an overdose during follow-up were also recorded. Findings At follow-up, study participants who had received THN training reported greater overdose-related knowledge relative to those receiving basic information only [ OOKS mean difference, 4.08 (95% confidence interval, 2.10-6.06; P < 0.001); Cohen's d = 0.74 (0.37-1.10)]. There were also more positive opioid overdose-related attitudes among the trained group at follow-up [ OOAS mean difference, 7.47 (3.13-11.82); P = 0.001; d = 0.61 (0.25-0.97)]. At the individual level 35 and 54%, respectively, of the experimental group increased their knowledge and attitudes compared with 11 and 30% of the control group. During follow-up, 13 participants witnessed an overdose with naloxone administered on eight occasions: five among the THN-trained group and three among the controls. Conclusions Take-home naloxone training for family members of heroin users increases opioid overdose-related knowledge and competence and these benefits are well retained after 3 months. [ABSTRACT FROM AUTHOR]

Aims To investigate the prevalence of cannabis use and problem use in boys and girls at age 16 years, and to investigate the role of adversity in early life and of conduct disorder between the ages of 4 and 13 years as risk factors for these outcomes. Design Birth cohort study. Setting England. Participants A total of 4159 (2393 girls) participants in the Avon Longitudinal Study of Parents and Children ( ALSPAC) birth cohort providing information on cannabis use at age 16. Measurements Cannabis use and problem cannabis use at age 16 were assessed by postal questionnaire. Material adversity, maternal substance use, maternal mental health and child conduct disorder were all assessed by maternal report. Findings Cannabis use was more common among girls than boys (21.4% versus 18.3%, P = 0.005). Problem cannabis use was more common in boys than girls (3.6% versus 2.8%, P = 0.007). Early-onset persistent conduct problems were associated strongly with problem cannabis use [odds ratio ( OR) = 6.46, 95% confidence interval ( CI) = 4.06-10.28]. Residence in subsidized housing ( OR = 3.10, 95% CI = 1.95, 4.92); maternal cannabis use ( OR 8.84, 95% CI 5.64-13.9) and any maternal smoking in the postnatal period ( OR = 2.69, 95% CI = 1.90-3.81) all predicted problem cannabis use. Attributable risks for adolescent problem cannabis use associated with the above factors were 25, 13, 17 and 24%, respectively. Conclusions Maternal smoking and cannabis use, early material disadvantage and early-onset persistent conduct problems are important risk factors for adolescent problem cannabis use. This may have implications for prevention. [ABSTRACT FROM AUTHOR]

Aims To characterize publically funded tobacco control campaigns in England between 2004 and 2010 and to explore if they were in line with recommendations from the literature in terms of their content and intensity. International evidence suggests that campaigns which warn of the negative consequences of smoking and feature testimonials from real-life smokers are most effective, and that four exposures per head per month are required to reduce smoking prevalence. Design Characterization of tobacco control advertisements using a theoretically based framework designed to describe advertisement themes, informational and emotional content and style. Study of the intensity of advertising and exposure to different types of advertisement using data on population-level exposure to advertisements shown during the study period. Setting England. Measurements Television Ratings ( TVRs), a standard measure of advertising exposure, were used to calculate exposure to each different campaign type. Findings A total of 89% of advertising was for smoking cessation; half of this advertising warned of the negative consequences of smoking, while half contained how-to-quit messages. Acted scenes featured in 72% of advertising, while only 17% featured real-life testimonials. Only 39% of months had at least four exposures to tobacco control campaigns per head. Conclusions A theory-driven approach enabled a systematic characterization of tobacco control advertisements in England. Between 2004 and 2010 only a small proportion of tobacco control advertisements utilized the most effective strategies-negative health effects messages and testimonials from real-life smokers. The intensity of campaigns was lower than international recommendations. [ABSTRACT FROM AUTHOR]

Aims To assess the incidence of long-term smoking cessation as a function of age, gender, social grade and their interactions. Design and setting Cross-sectional surveys of population representative samples of smokers in England. Participants A total of 24 094 ever smokers (≥21 and ≤60 years of age) participating in household surveys between November 2006 and February 2011. Measurements The ratio of long-term (>1 year) ex-smokers to ever-smokers was calculated for each age. Regression analyses were used to model the association between age and quit ratio, with the change in quit ratio by year of age n years versus all years up to n-1 years, yielding an estimate of the quitting incidence at that age. Analyses were conducted for the entire sample and then for the sample stratified by gender and social grade, and interactions assessed between these variables. Findings A cubic trend was needed to fit the data. The estimated quitting incidence between ages 21 and 30 was 1.5% (95% CI: 1.0%-2.0%), between 31 and 50 it was 0.3% (95% CI: 0.2%-0.5%) and between 51 and 60 it was 1.2% (95% CI: 0.7%-1.7%). Age interacted with gender and social grade: women and smokers from higher social grades had a higher incidence of quitting than men and those from lower social grades specifically in young adulthood. Conclusions The incidence of smoking cessation in England appears to be greater in young and old adults compared with those in middle age. Women and higher social grade smokers show a greater incidence of quitting than men and those from lower social grades specifically in young adulthood. [ABSTRACT FROM AUTHOR]

Aims To characterize e-cigarette use, users and effects in a sample of Electronic Cigarette Company (TECC) and Totally Wicked E-Liquid (TWEL) users. Design and setting Online survey hosted at the University of East London with links from TECC/TWEL websites from September 2011 to May 2012. Measurements Online questionnaire. Participants One thousand three hundred and forty-seven respondents from 33 countries (72% European), mean age 43 years, 70% male, 96% Causacian, 44% educated to degree level or above. Findings Seventy-four percent of participants reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke. Seventy-two percent of participants used a 'tank' system, most commonly, the eGo-C (23%). Mean duration of use was 10 months. Only 1% reported exclusive use of non-nicotine (0 mg) containing liquid. E-cigarettes were generally considered to be satisfying to use; elicit few side effects; be healthier than smoking; improve cough/breathing; and be associated with low levels of craving. Among ex-smokers, 'time to first vape' was significantly longer than 'time to first cigarette' ( t1104 = 11.16, P < 0.001) suggesting a lower level of dependence to e-cigarettes. Ex-smokers reported significantly greater reduction in craving than current smokers (χ21 = 133.66, P < 0.0007) although few other differences emerged between these groups. Compared with males, females opted more for chocolate/sweet flavours (χ21 = 16.16, P < 0.001) and liked the e-cigarette because it resembles a cigarette (χ23 = 42.65, P < 0.001). Conclusions E-cigarettes are used primarily for smoking cessation, but for a longer duration than nicotine replacement therapy, and users believe them to be safer than smoking. [ABSTRACT FROM AUTHOR]

Aims Nicotine is known to enhance aspects of cognitive functioning in abstinent smokers, but the effects on specific areas of executive functions and in non-smokers are inconclusive. This may be due in part to the poor sensitivity of tests used to assess executive functions. This study used a new virtual reality assessment of executive functions known as JEF (the Jansari assessment of Executive Functions) to address this issue. Design A 2 × 2 design manipulating group (smokers and never-smokers) and drug [nicotine (4 mg for smokers; 2 mg for never smokers) versus placebo gum]. Setting School of Psychology; University of East London Participants Seventy-two participants (aged 18-54 years): 36 minimally deprived (2 hours) smokers and 36 never-smokers. Measurements Components of executive function were measured using the virtual reality paradigm JEF, which assesses eight cognitive constructs simultaneously as well as providing an overall performance measure. Findings Univariate analyses of variance revealed that nicotine improved overall JEF performance, time-based prospective memory and event-based prospective memory in smokers ( P < 0.01), but not in never-smokers. Action-based prospective memory was enhanced in both groups ( P < 0.01) and never-smokers out-performed smokers on selective thinking and adaptive thinking ( P < 0.01). Conclusions Executive functioning and prospective memory as aspects of cognitive performance can be enhanced by nicotine gum in smokers who have abstained for as little as 2 hours. [ABSTRACT FROM AUTHOR]

Aims To investigate associations between socio-economic position in early life and later alcohol use and problem use among male and female adolescents. Design Birth cohort study. Setting South West England. Participants A total of 2711 girls and 2379 boys with one or more measures of alcohol use or problem use at age 15 years. Measurements Exposure measures were highest parental social class, maternal education and household disposable income (all maternal self-report before school-age); outcome measures were heavy typical drinking, frequent drinking, regular binge drinking, alcohol-related psychosocial problems and alcohol-related behavioural problems. Findings Alcohol use and related problems were relatively common amongst adolescent girls and boys. Boys were slightly more likely to report frequent drinking and girls were slightly more likely to drink heavily and to experience alcohol-related psychosocial problems. Higher maternal education appeared protective in relation to alcohol-related problems, particularly among boys. Higher household income was associated with greater risk of alcohol use and problem use, most apparently among girls. Conclusions Children from higher-income households in England appear to be at greater risk of some types of adolescent alcohol problems, and these risks appear different in girls compared to boys. Childhood social advantage may not generally be associated with healthier behaviour in adolescence. [ABSTRACT FROM AUTHOR]

Aims The NHS Stop Smoking Service ( NHS-SSS) helps approximately half its clients to quit for 4 weeks. However, most initially successful quitters relapse within 6 months. Short message service ( SMS) texting has been shown to facilitate stopping smoking. We describe the development, implementation and subsequent evaluation, in terms of practicability and client response, of an SMS text-based relapse prevention intervention ( RPI) delivered within routine community and specialist National Health Service ( NHS) Stop Smoking Service (SSS) provision in four Primary Care Trusts. Design Text messages aimed at motivation to remain abstinent, preventing careless lapses and continuing the full course of medicine for smoking cessation were developed and sent weekly to clients' mobile phones for 12 weeks and fortnightly for 6 months. They were asked to respond to some of the texts and contact the NHS SSS if they lapsed. They were also offered free nicotine mini lozenges to be sent via the mail on three occasions. Setting NHS SSS. Participants 202 clients who had been abstinent for 4 weeks. Measurements Feasibility of introducing RPI into routine care; response to interactive messages and requests for the medication; rating of the helpfulness of RPI; self-reported and carbon monoxide ( CO)-validated smoking status for up to 26 weeks. Findings A text-based RPI was easy to implement within the NHS SSS provided by specialist advisers, but enrolment of clients from services provided by a network of pharmacists was difficult because client contact details were often lacking. Where records of the number of people invited to RPI were available, 94% of eligible participants enrolled. The RPI was well received by both SSS clients and staff, with 70% ( n = 63) of clients who completed follow-up considering the intervention helpful. Eighty-five per cent ( n = 172) of clients responded to at least one of the nine interactive text messages. Sixty-four clients (32% of the total, 47% of those we managed to contact) reported continuous abstinence at 6 months. Eighteen (9%) clients who relapsed to smoking used the RPI to re-engage with the NHS SSS and 10 (5%) successfully re-established abstinence. Conclusions In smokers attending National Health Service Stop Smoking Services who are abstinent 4 weeks after their quit date, a relapse prevention intervention based on SMS text messaging was well received, and can be implemented economically and rapidly. A controlled trial is needed to establish whether it has a significant impact on relapse. [ABSTRACT FROM AUTHOR]

Aims To introduce an 'opt out' referral pathway for smoking cessation in pregnancy and to compare different methods for identifying pregnant smokers in maternity care. Design Pilot study that analysed routine data from maternity and smoking cessation services with biochemical validation of smoking status. Setting Dudley and South Birmingham, England. Participants A total of 3712 women who entered the referral pathway-1498 in Dudley and 2214 in South Birmingham. Measurements Routine monitoring data on smoking at maternity booking, referral to smoking cessation services, number of women who set quit dates set and short-term (4-week) self-report smoking status. Comparison of self-report, carbon monoxide ( CO)-validated and urinary cotinine-validated smoking status for a subsample ( n = 1492) of women at maternity booking. Findings In Dudley 27% of women who entered the opt out referral pathway were identified as smokers following CO testing. Of those referred to the smoking cessation services, 19% reported stopping smoking at 4-week follow-up. In South Birmingham 17% were smokers at booking, with 5% of those referred recorded as non-smokers at 4 weeks. The number of women quitting did not increase during the study when compared with the previous year, despite higher referral rates in both areas. An optimum cut-off CO measurement of 4 parts per million (p.p.m.) was identified for sensitivity and specificity. Conclusion The introduction of an opt out referral pathway between maternity and stop smoking services resulted in more women being referred for support to quit but not higher numbers of quitters, suggesting that automatic referral may include women who are not motivated to stop and who may not engage with services. Routine carbon monoxide monitoring introduced as part of a referral pathway should involve a cut-off of 4 p.p.m. to identify smoking in pregnancy. [ABSTRACT FROM AUTHOR]

Aims To assess the feasibility and effectiveness of a new service using referral liaison advisers to increase the number of referrals of parents/carers at selected Children's Centres to National Health Service ( NHS) Stop Smoking Services ( SSS) and/or smoke-free families schemes ( SFS). Design This mixed-methods pilot study collected numerical data on indicators of smoking behaviours and carried out face-to-face and telephone interviews. Settings Thirteen Children's Centres in Liverpool and Nottingham using local providers of smoking cessation services, from September 2010 to April 2011. Participants Parents and carers registered with, and staff working for, Children's Centres. Measures Number of smokers referred to smoking cessation services and/or smoke-free family schemes and the views of service providers and users on the new service. Findings In Liverpool, 181 referrals to NHS SSS were made from 331 identified smokers (54.7%); extrapolated to 12 months, this represents a 182% increase in referrals from baseline and a similar extrapolation indicates a 643% increase from baseline of referrals to smoke-free families schemes. There were no reliable baseline data for Nottingham; 31 referrals were made (30.7% of smokers) to SSS and 44 referrals to SFS from 52 contacts (84.6%). The interviews highlighted the need for sustained personal contact with parents/carers to discuss smoking behaviours and concerns and their willingness to be referred to SFS as part of caring for their child. Conclusions Routine recording of smoking status and appropriate follow-up by trained staff in Children's Centres can lead to significant numbers of clients attending stop-smoking services, although relatively few stop smoking. [ABSTRACT FROM AUTHOR]

Aim To evaluate smokeless tobacco cessation in communities of South Asian origin. Design Multi-centre prospective cohort study. Setting Three tobacco cessation services offering specialist smokeless tobacco cessation outreach clinic support to South Asians ( Bangladeshi, Indian and Pakistani) resident in England. Participants A total of 239 South Asian participants seeking to stop smokeless tobacco use between November 2010 and December 2011. Measurements Socio-demographics, tobacco use and dependence, self-reported abstinence at 4 weeks and satisfaction measures. Findings Participants' mean age was 45 [standard deviation ( SD) = 13] years, were predominantly female (76%), of Bangladeshi origin (74%), either home carers (53%) or not working (29%). Sixty-three per cent were recruited from community locations, 21% through a clinical contact and 16% through friends and family. Mean daily number of smokeless tobacco intakes was 10 ( SD = 7) and the mean dependence score was 4.5 ( SD = 1.9). Sixty-three per cent of participants achieved continuous abstinence 4 weeks after quitting. Using nicotine replacement therapy ( NRT) versus not using it [ OR = 3.47, 95% confidence interval ( CI): 1.25, 9.62] and below median (≤8) daily smokeless tobacco intakes ( OR = 1.91, 95% CI: 1.07, 3.40) predicted successful abstinence. Conclusion South Asian smokeless tobacco users resident in England accessing services to help them stop appear to have short-term success rates comparable with smokers attending stop-smoking services, with higher success rates being reported by those using nicotine replacement therapy. [ABSTRACT FROM AUTHOR]

Aims Variability in effectiveness of treatment for substance abuse disorder ( SUD) is an important and understudied issue. This study aimed to quantify the extent of outcome variability in the English SUD treatment system after adjusting for potential confounding variables. Design Prospective cohort study using data from the English national drug treatment outcome monitoring database. Setting All 149 administrative areas delivering publicly funded SUD services in the National Health Service and non-governmental sector. Participants New adult admissions between January 2008 and October 2010 with illicit heroin-related problems in all administrative areas, with an in-treatment review conducted between 5 and 26 weeks (mean = 129.5 days; SD = 40.0) up to 30 April 2011 ( n = 65 223; 75.6% of eligible clients). Individuals were divided randomly to form model developmental and internal validation samples. These were contrasted with an independent (external) sample of the same population admitted to treatment between November 2010 and April 2011 and followed to 31 October 2011 ( n = 13 797; 81.4% of those eligible). Measurements and analysis The outcome measure was self-reported illicit heroin use, categorized as abstinent or deteriorated (the latter by Reliable Change Index), each risk-adjusted by person-level (demographics, clinical severity and treatment complexity) and area-level ( SUD prevalence, social deprivation and severity averages) covariates by multivariable logistic regression using multiply imputed outcome and covariate data. Risk-adjusted models were assessed by information criteria and discrimination (c-index). Standardized outcome rates were compared by funnel plot with 95% and 99% control limits. Findings Models of heroin abstinence (48.4%) and deterioration (3.2%) were comparable across the developmental and validation samples (c-index = 0.70-0.71 and 0.82-0.87), with 79.2 and 94.0%, respectively, of the 149 treatment areas falling within 95% control limits. At the 99% limit, seven areas (4.7%) achieved abstinence rates above the national average, and eight had relatively poor abstinence rates (5.4%). At the 99% control limit, one area achieved very low deterioration outcomes and two (1.3%) were worse that the average. Risk adjustment served to increase abstinence rates in good performing areas by 0.63% and reduce abstinence rates by 0.37% in poor performing areas, and by 0.12% and 0.18%, respectively, for deterioration. Conclusion There is some exceptional variability in the apparent effectiveness of the English treatment system for substance use disorders. It is important to determine the source of this variability in order to inform drug treatment delivery and its evaluation both in England and overseas. [ABSTRACT FROM AUTHOR]

Aims Previous research has shown that a substantial proportion of smokers believe that nicotine causes serious diseases such as cancer, possibly deterring the use of nicotine replacement therapy ( NRT) for smoking cessation or smoking reduction. This study examined beliefs about the harms specifically from long-term use of NRT and associations between these and its use for smoking cessation and smoking reduction. Design and setting Data were collected from 1657 smokers and recent ex-smokers involved in the Smoking Toolkit Study, a series of monthly household surveys of English adults aged 16 and over. Measurements Participants were asked if they thought the use of NRT for a year or more was harmful, and if so, to volunteer what they believed the harms to be. They were also asked if they were using NRT for smoking reduction and/or if they had used NRT in the past year during a quit attempt. Findings Six percent and 25% of smokers respectively, believed that the long term use of NRT was very or quit harmful to health; and a further 29% reported that they 'didn't know'. The most commonly reported harms were addiction and lung cancer. There was no association between these beliefs and use of NRT for smoking reduction or smoking cessation. Conclusion A significant minority of smokers in England believe that the use of nicotine replacement therapy for a year or more is harmful. However, belief that long-term nicotine replacement therapy use can cause health harm does not appear to act as a deterrent to using it in a quit attempt or for smoking reduction. [ABSTRACT FROM AUTHOR]

Aims A network of Stop Smoking Services has been set up within the National Health Service ( NHS) in England. The services deliver a combination of behavioural support and medication. It is important to establish the degree of variability in quit rates attributable to differences between individual practitioners, to gauge the scope for improvement by training and professional support. The aim of the present analysis was to examine how far short-term quit rates depend on the practitioner delivering the intervention after adjusting for potential confounding variables. Design Observational study using routinely collected data. Setting Thirty-one NHS Stop Smoking Services in England. Participants Data from 46 237 one-to-one treatment episodes (supported quit attempts) delivered by specialist practitioners. Measurements Three-level logistic regression models were fitted for carbon monoxide ( CO)-validated short-term (4-week) quit rates. Models adjusted for age, gender, exemption from prescription charges, medication and intervention setting for each treatment episode, number of clients for each practitioner and economic deprivation at the level of the Stop Smoking Service. Secondary analyses included (i) the Heaviness-of-Smoking Index ( HSI) as predictor and (ii) 4-week quit rates whether or not confirmed by CO. Findings Differences between individual specialist practitioners explained 7.6% of the variance in CO-verified quit rates after adjusting for client demographics, intervention characteristics and practitioner and service variables ( P < 0.001). HSI had little impact on this figure; in quits not necessarily validated by CO, practitioners explained less variance. Conclusions Individual stop smoking practitioners appear to differ to a significant degree in effectiveness. It is important to examine what underlies these differences in order to improve selection, training and professional development. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This study investigated associations between self-reported illness, social factors and health behaviours and non-drinking among young people aged 18-34 years. Design Logistic regression analysis of cross-sectional national survey data, collected from the Health Survey for England 2006 and 2008. Data were collected through face-to-face interviews and are self-reported. Participants and settings A total of 2826 male and 3618 females aged 18-34 years drawn from a nationally representative multi-stage stratified probability sampling design across England. Measurements Non-drinkers were based on those who reported 'no' to drinking alcohol currently. Exposure measures included self-reports of having a limiting long-standing illness, long-standing illness or self-reported poor health. We adjusted for ethnicity, income, education, general physical activity and other factors. Findings Having a limiting long-standing illness during early adulthood increased the odds of being a non-drinker 1.74 times for men ( P < 0.01) and 1.45 times for women ( P < 0.01). In both men and women belonging to the lowest income quintile or having no qualifications was associated with increased odds of being a non-drinker ( P < 0.001), indicating that the social gradient in non-drinking begins at an early age. Men and women aged 18-34 years with the lowest activity levels were also more likely to be non-drinkers ( P < 0.01). Conclusion Young adults who have a limiting long-standing illness are more likely not to drink alcohol even after adjusting for a range of social and demographic measures. Studies on the putative health benefits of moderate alcohol consumption later in life need to take account of early life history. [ABSTRACT FROM AUTHOR]