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Aims To explore trends in and predictors of second-hand smoke (SHS) exposure in children. To identify whether inequalities in SHS exposure are changing over time. Design Repeated cross-sectional study with data from eight annual surveys conducted over an 11-year period from 1996 to 2006. Setting England. Participants Nationally representative samples of children aged 4–15 years living in private households. Measurements Saliva cotinine (4–15-year-olds), current smoking status (8–15-year-olds), smoking status of parents and carers, smoking in the home, socio-demographic variables. Findings The most important predictors of SHS exposure were modifiable factors—whether people smoke in the house on most days, whether the parents smoke and whether the children are looked after by carers who smoke. Children from more deprived households were more exposed and this remained the case even after parental smoking status has been controlled for. Exposure over time has fallen markedly among children (59% decline over 11 years in geometric mean cotinine), with the most marked decline observed in the period immediately preceding smoke-free legislation. Declines in exposure have generally been greater in children most exposed at the outset. For example, in children whose parents both smoke, median cotinine declined annually by 0.115 ng/ml compared with 0.019 ng/ml where neither parent smokes ( P < 0.05). Conclusions In the 11 years leading up to smoke-free legislation in England, the overall level of SHS exposure in children as well as absolute inequalities in exposure have been declining. Further efforts to encourage parents and carers to quit and to avoid smoking in the home would benefit child health. [ABSTRACT FROM AUTHOR]

Aim To compare the characteristics and outcomes of users accessing pharmacy and group-based smoking treatment. Design Observational study of administrative information linked with survey data. Setting Glasgow, Scotland. Participants A total of 1785 service users who set a quit date between March and May 2007. Intervention Smoking treatment services based in pharmacies providing one-to-one support, and in the community offering group support. Measurements Routine monitoring data included information about basic demographic characteristics, deprivation category of residence, nature of intervention and smoking status at 4-week follow-up determined by carbon monoxide (CO) readings ≤10. These data were supplemented by information about socio-economic status and smoking-related behaviours obtained from consenting service recipients by treatment advisers. Findings In the pharmacy-based service 18.6 % of users ( n = 1374) were CO-validated as a quitter at 4 weeks, compared with 35.5 % ( n = 411) in the group-based service. In a multivariate model, restricted to participants ( n = 1366) with data allowing adjustment for socio-demographic and behavioural characteristics and including interaction terms, users who accessed the group-based services were almost twice as likely (odds ratio 1.980; confidence interval 1.50–2.62) as those who used pharmacy-based support to have quit smoking at 4-week follow-up. Conclusions Specialist-led group-based services appear to have higher quit rates than one-to-one services provided by pharmacies but the pharmacy services treat many more smokers. More research is needed to determine what can be done to bring the success rates of pharmacy services up to those of specialist-led groups and how to expand access to group-based services. [ABSTRACT FROM AUTHOR]

To determine the effectiveness of smoking cessation services in enabling smokers living in disadvantaged areas to access treatment services, and to assess the extent of variations between areas.Observational study of administrative information linked with survey data.A representative sample of 19 of the 95 English health areas in 2001.All England smoking data by deprivation category obtained from the Health Survey of England were used to estimate neighbourhood smoking prevalence rates. Area of residence data from smokers setting a quit date were used to calculate the proportion of smokers in receipt of treatment services in different economic deprivation categories.In general, treatment services were seeing smokers from the most disadvantaged areas where smoking prevalence rates were highest; 32.3% of all smokers in receipt of treatment services lived in the most disadvantaged quintile of areas compared with 9.6% resident in the most advantaged quintile. An indicator of‘positive discrimination’ was calculated for each health authority area to quantify the extent to which the proportion of disadvantaged smokers being treated was greater than the proportion in the local population. This figure ranged from just under 0% to 18%.National Health Service (NHS) smoking cessation services have been successful in reaching smokers from disadvantaged communities. If improved access to support for smokers living in the poorest communities can be extended, sustained and translated into long-term quitting then smoking cessation services have the potential to make a useful contribution to addressing inequalities in health. [ABSTRACT FROM AUTHOR]

To examine the impact of socio-demographic factors, smoking-related behaviour and service characteristics on CO-validated quit rates at 4-week follow-up in English smoking treatment services, and to compare the results with those for self-reported quitters.Observational study of administrative information linked with survey data for 6959 recipients of smoking treatment services who set a quit date between October 2001 and March 2003.Two contrasting areas of England, Nottingham and North Cumbria, consisting of nine primary care trust (PCT) localities.Routine monitoring data specified by the Department of Health included information about basic demographic characteristics, postcode of residence from which a deprivation category was identified, nature of intervention and smoking status at 4-week follow-up. These data were supplemented with additional information about referral pathways, socio-economic status and smoking-related behaviours obtained from consenting service recipients by NHS advisers.More than one-half of clients (53%) were CO-validated as quitters at 4 weeks, rising to 60.7% when self-reported cases were included. Age (OR 1.026; CI 1.022–1.029) and being extremely determined to quit (OR 1.46; CI 1.26–1.71) were associated positively with CO-validated cessation, whereas women (OR 0.85; CI 0.77–0.94), users with lower socio-economic status (OR 0.92; CI 0.88–0.95), those smoking 31 or more cigarettes daily (OR 0.75; CI 0.64–0.88) and those with relatively poor health status (OR 0.72; CI 0.63–0.82) were less likely to quit. Although the vast majority of users received one-to-one support, those who had group counselling were more likely to be successful in their quit attempt (OR 1.38; CI 1.09–1.76). Self-report and CO-validated quitters were similar in terms of their characteristics.These results obtained from routine services support those obtained from clinical trials and confirm the effectiveness of counselling combined with pharmacotherapies to assist smokers to quit in the short term. However, the relative effectiveness of group interventions raises questions about why one-to-one counselling is used much more commonly. The importance of socio-demographic and nicotine-related dependency factors also suggests that local service targets for smoking cessation need to take account of the social distribution of these characteristics. [ABSTRACT FROM AUTHOR]

To assess the impact of English treatment services on CO-validated quit rates at 52-week follow-up, to explore the relationship between service-related characteristics and socio-demographic and behavioural factors with cessation outcomes, and to compare the characteristics of service users lost to follow-up with CO-validated quitters.Observational study of administrative information linked with survey data for 2069 recipients of smoking treatment services who set a quit date between May and November 2002.Two contrasting areas of England, Nottingham and North Cumbria, consisting of nine primary care trust (PCT) localities.Routine monitoring data specified by the Department of Health included information about basic demographic characteristics, postcode of residence from which a deprivation category was identified, nature of intervention, and smoking status at 4-week follow-up. These data were supplemented with information about smoking status at 52 weeks, referral pathways, relapse experiences, number of follow-up contact attempts, socio-economic status and smoking-related behaviours obtained from consenting service recipients by treatment advisers.One user in seven (14.6%) reported prolonged abstinence and was CO-validated as a successful quitter at 52 weeks. This rose to 17.7% when self-report cases were included. Relapse rates between 4 and 52 weeks were almost identical between the two study areas—75%. Relapse was most likely to occur in the first 6 months following treatment. Users who self-reported quitting at 4 weeks were less likely (13.7%) than those with biochemical verification of smoking status at 4 weeks (25.2%) to be CO-validated quitters at 52 weeks (P = 0.004). Older users (OR 1.023; CI 1.014–1.032), people who smoke mainly for pleasure rather than to cope (OR 1.38; CI 1.02–1.87), and those who were extremely determined (OR 1.58; CI 1.21–2.05) were more likely to be quitters at 52-week follow-up, whereas those with lower socio-economic status (OR 0.86; CI 0.78–0.96), who smoked their first cigarette of the day within 5 minutes of waking (OR 0.73; CI 0.55–0.96) or had another smoker in their household (OR 0.65; CI 0.49–0.86) were less likely. In contrast, users lost to follow-up tended to be younger and experienced different referral pathways than CO-validated quitters. Gender was not statistically significantly associated with cessation at 52 weeks and nor were any of the key characteristics of intervention, such as group or one-to-one counselling.These results obtained from routine services are consistent with those obtained from clinical trials in relation to abstinence at one year. Given that a high proportion of smokers relapsed between 4 weeks and 1 year it is important that future assessments of longer-term outcomes are conducted. However, following-up service users many months after an intervention is expensive, and reasonable estimates of quit rates can be estimated from short-term outcomes, provided that they have been CO-validated. Future studies should monitor outcomes from a selection of services treating different groups of smokers, particularly if more is to be learned about the role of smoking treatment services in reducing inequalities in health. [ABSTRACT FROM AUTHOR]

The aim of this paper is to develop a better understanding of the relationship between income and health using a cross-sectional survey of the general British population. It is divided into two parts. First, it examines a number of methodological inconsistencies in the existing literature and assesses their consequences for the inferences that can be drawn about the income-health association. These issues include: the measurement of income and its functional form; health selection; and the role of confounders. Second, it explores the relative strength of the income-health association in contrast to that of other socioeconomic measures. The relationship between income and health is complex. However, having taken into account a range of methodological problems, income is still significantly associated with health. The association appears to be non-linear and is attenuated but not removed by controlling for health selection effects. The inclusion of a wide range of confounders into models of income and health reduces the association between them, but does not make it insignificant. In comparison to other socioeconomic measures, income appears to be a better discriminator of health status than education or occupation. However, tenure and car ownership seem to be at least as good if not better than current income. [ABSTRACT FROM AUTHOR]

Examines key aspects of private financing in social policy in Great Britain. Operations of a welfare state; Reliance on private insurance; Social division of welfare; Implications for social welfare.