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Background and aims: Varenicline is one of the most effective smoking cessation treatments. Its supply in England was disrupted in July 2021 due to nitrosamine impurities found by its supplier, Pfizer. This study measured the impact of this disruption on smoking cessation in England. Design, setting and participants: The study used repeated cross‐sectional surveys conducted monthly, from June 2018 to December 2022. Set in England, it comprised a total of 3024 adults who reported smoking during the past year and had made at least one serious attempt to quit in the past 6 months. Measurements: Generalized additive models analyzed the association of the varenicline supply disruption with the trend in self‐reported varenicline use in the most recent quit attempt. We used these results to estimate the population‐level impact of the disruption on smoking cessation. Findings Before July 2021, the proportion of past 6‐month quit attempts using varenicline was stable at approximately 3.9% [risk ratio (RR)trend = 1.034, 95% confidence interval (CI) = 0.823–1.298]. The trend in varenicline use has changed sharply since the supply disruption (RRΔtrend = 0.297, 95% CI = 0.120–0.738), with prevalence falling by 69.3% per year since; from 4.1% in June 2021 to 0.8% in December 2022. Convergently, National Health Service general practitioner prescribing data reported that just 0.1% of prescriptions for smoking cessation treatments in December 2022 were for varenicline. Assuming that varenicline does not return to the market, we estimate that this could result in ~8400 fewer people stopping smoking for at least 6 months, ~4200 fewer long‐term ex‐smokers and ~1890 more avoidable deaths each year. Conclusions: In England, the disruption in supply of varenicline since 2021 has coincided with a substantial fall in the use of varenicline in attempts to quit smoking. [ABSTRACT FROM AUTHOR]

Sensitivity, specificity, and agreement between clinical and magnetic resonance imaging (MRI) gradings of the medial collateral ligament (MCL) after acute knee injury were evaluated in 362 patients. Ninety-seven per cent were injured during sports/recreation. Sensitivity and specificity of MRI for grade II or III MCL injury was 68% (95% CI 58–77%) and 90% (95% CI 86–93%), respectively. Weighted Kappa analysis showed moderate agreement between clinical and MRI grading (0.56 [95% CI 0.48–0.65]). Findings were similar for patients with and without concomitant cruciate ligament rupture (0.57 [95% CI 0.48–0.66] and 0.55 [95% CI 0.35–0.75], respectively) and for specialists in orthopaedics and knee sub-specialists (0.55 [95% CI 0.39–0.70] and 0.57 [95% CI 0.47–0.67], respectively). Agreement between clinical and MRI grading of MCL injuries by orthopaedic specialists in a general hospital is at least moderate regardless of the presence of cruciate ligament injury. [ABSTRACT FROM AUTHOR]

Background: Alcohol and smoking brief interventions (BIs) in general practice have been shown to be effective in lowering alcohol and smoking-related harm. Aim: To assess prevalence of self-reported BI receipt among increasing or higher-risk drinkers and past-year smokers in England, Scotland, and Wales, and associations between intervention receipt and socioeconomic position. Design & setting: Cross-sectional study using data from a monthly population-based survey in England, Scotland, and Wales. Method: The study comprised 47 799 participants (15 573 increasing or higher-risk drinkers [alcohol use disorders identification test consumption score ≥5] and 7791 past-year smokers) surveyed via telephone in 2020-2022 (during the COVID-19 pandemic). All data were self-reported. Prevalence of self-reported BI receipt was assessed descriptively; associations between receipt and socioeconomic position were analysed using logistic regression. Results: Among adults in England, Scotland, and Wales, 32.2% (95% confidence interval [CI] = 31.8 to 32.7) reported increasing or higher-risk drinking and 17.7% (95% CI = 17.3 to 18.1) past-year smoking. Among increasing or higher-risk drinkers, 58.0% (95% CI = 57.1 to 58.9) consulted with a GP in the past year, and of these, 4.1% (95% CI = 3.6 to 4.6) reported receiving BIs. Among past-year smokers, 55.8% (95% CI = 54.5 to 57.1) attended general practice in the past year; of these, 41.0% (95% CI = 39.4 to 42.7) stated receiving BIs. There was a tendency for patients from socioeconomically disadvantaged backgrounds to receive more alcohol (adjusted odds ratio [aOR] 1.38, 95% CI = 1.10 to 1.73) or smoking BIs (aOR 1.11, 95% CI = 0.98 to 1.26), but for the latter the results were statistically non-significant. Results did not differ notably by nation within Great Britain. Conclusion: BIs in general practice are more common for smoking than for alcohol. A greater proportion of BIs for alcohol were found to be delivered to people who were from socioeconomically disadvantaged backgrounds and who were increasing or higher-risk drinkers. [ABSTRACT FROM AUTHOR]

Aims, Design and Setting: The aim of this study was to determine which combination(s) of five e-cigarette-orientated intervention components, delivered on-line, affect smoking cessation. An on-line (UK) balanced five-factor (2 x 2 x 2 x 2 x 2 = 32 intervention combinations) randomized factorial design guided by the multi-phase optimization strategy (MOST) was used. Participants: A total of 1214 eligible participants (61% female; 97% white) were recruited via social media. Interventions: The five on-line intervention components designed to help smokers switch to exclusive e-cigarette use were: (1) tailored device selection advice; (2) tailored e-liquid nicotine strength advice; (3): tailored e-liquid flavour advice; (4) brief information on relative harms; and (5) text message (SMS) support. Measurements: The primary outcome was 4-week self-reported complete abstinence at 12 weeks post-randomization. Primary analyses were intention-to-treat (loss to follow-up recorded as smoking). Logistic regressions modelled the three- and two-way interactions and main effects, explored in that order. Findings: In the adjusted model the only significant interaction was a two-way interaction, advice on flavour combined with text message support, which increased the odds of abstinence (odds ratio = 1.55, 95% confidence interval = 1.13-2.14, P = 0.007, Bayes factor = 7.25). There were no main effects of the intervention components. Conclusions: Text-message support with tailored advice on flavour is a promising intervention combination for smokers using an e-cigarette in a quit attempt. [ABSTRACT FROM AUTHOR]

Aim To examine trends in public awareness and knowledge of drinking guidelines in the UK since their revision in 2016, which had moved from a daily to a weekly guideline, made the guideline the same for men and women, and reduced the guideline for men by around one-third. Method Data were from a representative, repeat cross-sectional survey. We analysed changes in awareness and knowledge of drinking guidelines among 8168 adult drinkers between 2016 and 2022 and associations with sociodemographic characteristics, smoking status and level of alcohol consumption. Results The proportion of drinkers aware of guidelines declined from 86.0% (95%CI 84.0–88.0%) in 2016 to 81.7% (79.5–84.0%) in 2019, then increased during the COVID-19 pandemic, peaking at 91.6% (90.1–93.1%) in 2020. The proportion who correctly identified the guideline as a maximum of exactly 14 units/week remained at around a quarter from 2016 (25.0%, 22.4–27.5%) to 2018 (25.8%, 23.2–28.3%), whereas the proportion who gave a figure of 14 units or fewer rose from 52.1 (49.2–55.0%) to 57.4% (54.6–60.3%). However, by 2022, guideline knowledge had worsened significantly, with these figures falling to 19.7 (17.4–21.9%) and 46.5% (43.6–49.4%), respectively. Changes over time were similar across subgroups. Odds of guideline awareness and knowledge were higher among drinkers who were aged ≥35, female, more educated and from more advantaged social grades. Conclusions The majority of adult drinkers in the UK are aware of low-risk drinking guidelines. However, 6 years since their announcement, knowledge of the revised drinking guidelines remains poor. Less than a quarter know the recommended weekly limit and only around half think it is 14 units or less. Inequalities have persisted over time, such that disadvantaged groups remain less likely to know the guidelines. [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: 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]

Aim: To measure whether the prevalence of use and real‐world effectiveness of different smoking cessation aids has changed in England since the coronavirus disease 2019 (COVID‐19) pandemic. Design: Representative monthly cross‐sectional surveys, January 2015–June 2021. Setting: England. Participants: A total of 7300 adults (≥18 y) who had smoked within the previous 12 months and had made ≥1 quit attempt during that period. Measurements The independent variable was the timing of the COVID‐19 pandemic (pre‐pandemic [January 2015–February 2020] vs pandemic [April 2020–June 2021]). We analysed (i) the association between the pandemic period and self‐reported use (vs non‐use) during the most recent quit attempt of: prescription medication (nicotine replacement therapy [NRT]/varenicline/bupropion), NRT bought over‐the‐counter, e‐cigarettes, traditional behavioural support and traditional remote support (telephone support/written self‐help materials/websites) and (ii) the interaction between the pandemic period and use of these cessation aids on self‐reported abstinence from quit date to survey. Covariates included age, sex, social grade, level of cigarette addiction and characteristics related to the quit attempt. Findings After adjustment for secular trends, there was a significant increase from the pre‐pandemic to pandemic period in the prevalence of use of traditional remote support by past‐year smokers in a quit attempt (OR = 2.18; 95% CI, 1.42–3.33); specifically telephone support (OR = 7.16; 95% CI, 2.19–23.45) and websites (OR = 2.39; 95% CI, 1.41–4.08). There was also an increase in the prevalence of use of prescription medication (OR = 1.47; 95% CI, 1.08–2.00); specifically varenicline (OR = 1.66; 95% CI, 1.09–2.52). There were no significant changes in prevalence of use of other cessation aids after adjustment for secular trends. People who reported using prescription medication (OR = 1.41; 95% CI, 1.09–1.84) and e‐cigarettes (OR = 1.87; 95% CI, 1.62–2.16) had greater odds of reporting abstinence than people who did not. There were no significant interactions between the pandemic period and use of any cessation aid on abstinence, after adjustment for covariates and use of the other aids, although data were insensitive to distinguish no change from meaningful modest (OR = 1.34) effects (Bayes factors 0.72–1.98). Conclusions: In England, the COVID‐19 pandemic was associated with an increase in use of remote support for smoking cessation and varenicline by smokers in a quit attempt up to June 2021. The data were inconclusive regarding an association between the pandemic and changes in the real‐world effectiveness of popular smoking cessation aids. [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]

Objective: Hemarthrosis after knee trauma often indicates serious joint injury. Few studies have evaluated agreement between clinical examination and findings from magnetic resonance imaging (MRI). We aimed to describe the agreement between acute clinical examination and subacute MRI findings after acute knee trauma with hemarthrosis and the importance of the subspecialty of the examiner. Design: Longitudinal cohort study. Agreement with MRI findings was evaluated by logistic regression. Setting: Helsingborg hospital. Patients: Thousand one hundred forty-five consecutive patients with hemarthrosis after knee trauma. Interventions: Clinical examination and MRI. Main outcome measures: agreement between clinical examination and findings from MRI. We considered the radiologist's report as the gold standard. Results: Median time (25th, 75th percentile) from injury to clinical examination was 2 (1, 7) days, and from injury to imaging was 8 (5, 15) days. The overall sensitivity and specificity of clinical examination versus MRI for major ligament injury or lateral patella dislocation (LPD) were 70% [95% confidence interval 67-73) and 66% (61-72), respectively. Orthopedic subspecialist knee had the highest agreement with anterior cruciate ligament rupture (adjusted odds ratios were 1.7 (95% confidence interval 1.2-2.3), 1.9 (1.2-3.0) and 5.9 (3.7-9.5) for orthopedic trainees, orthopedic subspecialists other, and orthopedic subspecialist knee, respectively]. For other ligament injuries and LPD, we did not find statistically significant differences. Conclusions: Clinical diagnosis after acute knee injury is relatively unreliable versus MRI findings even when performed by orthopedic specialists. However, the agreement is improved when the examination is performed by an orthopedic knee subspecialist. [ABSTRACT FROM AUTHOR]

Introduction. It has been estimated that smokers tend to fail to report unsuccessful quit attempts that lasted a short time and occurred a longer time ago. However, it is unclear whether the failure to report unsuccessful quit attempts varies by the type of cessation aid used. Methods. A total of 5,892 smokers aged 16+ years who had made 1+ quit attempts in the past year were surveyed between January 2014 and December 2020 as part of the Smoking Toolkit Study. Respondents indicated when their most recent quit attempt started, how long it lasted, and which cessation aid(s) were used (e.g., unaided, varenicline, and behavioural support). The percentage failure to report for each cessation aid and 95% bootstrap confidence intervals (CIs) were estimated with an established method. Test for equality of proportions was performed to examine whether quit attempts lasting between one day and one week and that started >6 months ago failed to be reported at a different rate depending on the cessation aid used. Results. We estimated that after three months, 97% (95% CI = 96 % -98%) of unaided quit attempts lasting less than one day, 80% (95% CI = 79 % -81%) of those lasting between one day and one week, and 60% (95% CI = 59 % -61%) of those lasting between one week and one month fail to be reported. Compared with unaided attempts, the estimated percentage failure to report quit attempts that lasted between one day and one week and that started >6 months ago was significantly lower for attempts involving behavioural support (92% of unaided attempts vs. 75% of attempts involving behavioural support, χ 2 1 = 9.29 , p = 0.002). No other significant differences were detected. Conclusions. Smokers in England appear to fail to report a substantial proportion of unsuccessful quit attempts. This failure appears particularly prominent for attempts that last a short time or occurred longer ago and appears lower for attempts involving behavioural support compared with unaided attempts. [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: The National Institute for Health and Care Excellence (NICE) has called for research into tobacco harm reduction across ethnicities, genders and socio‐economic status. Although there is increasing research focused on the latter two, relatively few studies have considered ethnic variations. Therefore this study aimed to assess (i) the association between ethnicity and use of e‐cigarettes and nicotine replacement therapy (NRT) for temporary abstinence and cutting down, and (ii) trends in prevalence of these over time. Design Repeated cross‐sectional household survey. Setting: England. Participants: Between April 2013 and September 2019, data were collected on 24 114 smokers, 16+ of age, taking part in the Smoking Toolkit Study (STS). Measurements Ethnicity coding included: White, mixed/multiple ethnic group, Asian, Black and Arab/other ethnic group. Smokers reported whether they were currently using e‐cigarettes and/or NRT for cutting down or during periods of temporary abstinence. Findings Odds of e‐cigarette use for cutting down and temporary abstinence were significantly lower among those of Asian ethnicity (OR = 0.79, 95% CI = 0.66–0.93) and Arab/other ethnicity (OR = 0.58, 95% CI = 0.40–0.83) compared with White ethnicity. Those of mixed/multiple ethnicity had higher odds for NRT us (OR = 1.42, 95% CI = 1.04–1.94) compared with those of White ethnicity. Trend analysis indicated that for White ethnicity, e‐cigarette use by smokers for cutting down and temporary abstinence followed an 'inverse S' shaped cubic curve indicating an overall rise, whereas NRT use followed an 'S' shaped cubic curve, indicating an overall decline. For mixed/multiple ethnicity a similar trend was found for NRT use only, with other ethnicities showing no statistically significant trends (suggesting relative stability over time). Conclusions: In England, e‐cigarette use by smokers for cutting down and temporary abstinence is less common among Asian and Arab/other ethnicity smokers compared with White smokers. Smokers of mixed/multiple ethnicity are the most likely to be using NRT compared with other ethnic groups for cutting down and temporary abstinence. E‐cigarette use by smokers for cutting down and temporary abstinence has increased over time among White smokers, whereas prevalence in other ethnic groups has remained stable. [ABSTRACT FROM AUTHOR]

Aims: To establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and socio‐demographic profile of those smokers. Design and setting: Nationally representative cross‐sectional survey of adults in England conducted between January 2009 and July 2019. Participants: A total of 219 720 adults. Measurements All participants reported their current smoking status and socio‐demographic characteristics (i.e. age, gender, home ownership, social grade and ethnicity). Smokers reported motivation to quit, urges to smoke and the Heaviness of Smoking Index (HIS). Weighted prevalence statistics were calculated. Multinomial regression and logistic regression were used to assess differences in smoking characteristics among smokers and socio‐demographic characteristics relative to non‐smokers. Findings The prevalence of smoking between January 2009 and July 2019 was highest among those aged 21–30. In 2019, 15.6% [95% confidence interval (CI) = 12.8–18.8%] of 18–20‐year‐olds reported smoking, which is estimated to represent 364 000 individuals in England. Relative to smokers aged 18–20, older smokers (aged 21+) had a higher motivation to quit smoking [odds ratios (ORs) = 1.40–1.45 range] and higher nicotine dependency as measured by urges to smoke (ORs = 1.06–1.24 range) and HSI (ORs = 1.05–2.85 range). Compared with non‐smokers aged 18–20, smokers in this age group had lower odds of being female (OR = 0.89) and higher odds of being of white ethnicity (OR = 2.78) and from social grades C1–E (lower social grades) compared with AB (higher social grades) (OR = 1.19–1.83 range). Conclusion: Increasing the age of sale of cigarettes to 21 years in England would currently target approximately 364 000 lower dependent smokers from more disadvantaged backgrounds aged 18–20, who have less motivation to quit. [ABSTRACT FROM AUTHOR]

Background and Aims: There are concerns that national population‐based estimates of illicit drug use are underestimated. We investigated this by comparing estimates of illicit substance use at age 24 from the Crime Survey for England and Wales (CSEW) with a birth cohort (Avon Longitudinal Study of Parents and Children, ALSPAC) and by comparing the Smoking and Alcohol Toolkit Studies (STS/ATS) to ALSPAC. Design Cross‐sectional household survey and cross‐sectional data from one wave of a longitudinal birth cohort. Setting: England and Wales. Participants: Young adults aged 23–25 reporting on substance use in 2017 to CSEW (n = 1165), ALSPAC (n = 3389) and STS/ATS (n = 950). Measurements Lifetime and past‐year illicit drug use, smoking status and hazardous drinking at age 24. Findings The 2017 CSEW estimate of lifetime illicit drug use was 40.6%, compared with 62.8% in ALSPAC (risk difference % [RD%] = 22.2%; 95% CI = 18.9–25.5%; P ≤ 0.001). The RD in lifetime use between ALSPAC and the CSEW was 23.2% (95% CI = 20.0–26.4%) for cannabis, 16.9% (95% CI = 14.4–19.4%) for powder cocaine and 24.8% (95% CI = 22.6–27.0%) for amphetamine. Past‐year drug use was 16.4% in CSEW, compared with 36.7% in ALSPAC (RD% = 20.3%; 95% CI = 17.6–23.0%; P ≤ 0.001). For past‐year substance use, the RD between ALSPAC and the CSEW was 15.4% (95% CI = 12.9–17.9%) for cannabis, 14.8% (95% CI = 13.0%–16.6%) for powder cocaine and 15.9% (95% CI = 14.5–17.4%) for amphetamine. Levels of current smoking were similar between STS (27.4%) and ALSPAC (29.4%). Hazardous drinking was substantially higher in ALSPAC (60.3%) than the ATS (32.1%; RD% = 28.2%; 95% CI = 24.8–31.6%; P ≤ 0.001). Conclusions: The Avon Longitudinal Study of Parents and Children provides one source of validation for measurements of drug use in government household surveys and indicates that illicit drug use may be underestimated in the Crime Survey for England and Wales. [ABSTRACT FROM AUTHOR]

Background and Aim: There have been substantial recent changes in youth tobacco product use in the United States—including, notably, a rapid increase in use of e‐cigarettes. It is not known whether, and if so how far, these changes are reflected in levels of nicotine dependence. This study used data from a large, nationally representative sample of US adolescents to (i) estimate the annual prevalence of nicotine dependence in relation to current use of tobacco products, (ii) describe trends in dependence over time and (iii) evaluate whether the increase in youth use of tobacco products has been paralleled by a similar increase in the population burden of nicotine dependence. Design Secondary analysis of National Youth Tobacco Surveys conducted annually, 2012–19. Setting: United States. Participants: A total of 86 902 high school students. Measurements Prevalence of (i) strong cravings to use tobacco in the past 30 days and (ii) wanting to use nicotine products within 30 minutes of waking, in relation to type of product used (cigarettes, other combustible tobacco, smokeless tobacco, e‐cigarettes). Findings Between 2012 and 2019 there was a marked decline in past 30‐day cigarette smoking and a surge in use of e‐cigarettes. Different products were associated with differing levels of nicotine dependence, with cigarettes characterized by highest dependence (strong craving 42.3%; wanting to use within 30 minutes 16.8% among exclusive users in 2019) and e‐cigarettes in otherwise tobacco‐naive students by low dependence (16.1 and 8.8% respectively in 2019). The overall 33.8% increase in population use of nicotine products between 2012 and 2019 (from 23.2 to 31.2%) was not accompanied by an equivalent increase in overall population burden of dependence {percentage reporting craving 10.9% [95% confidence interval (CI) = 9.8–12.2%] in 2012 and 9.5% (95% CI = 7.5–12.0%) in 2019; wanting to use within 30 minutes 4.7% (95% CI = 4.0–5.5%) in 2012, 5.4% (95% CI = 4.0–7.2%) in 2019}. Conclusions: Among US high school students, increases in the prevalence of nicotine product use from 2012 to 2019 do not appear to have been accompanied by a similar increase in the population burden of nicotine dependence. This may be at least partly attributable to a shift in the most common product of choice from cigarettes (on which users are most dependent) to e‐cigarettes (on which users are least dependent). [ABSTRACT FROM AUTHOR]

Background and aims: E‐cigarettes may potentially help young adult smokers to quit smoking, yet little is known about differences among socio‐economic groups. We examined associations between key socio‐economic characteristics and e‐cigarette use among recent former smokers and current smokers in a sample of young adults in England. Design, setting, participants and measurements: We used data on 346 recent former regular (daily for 12+ months) smokers and 1913 current smokers from the ages 25–26 wave of the Next Steps cohort study (2015–2016). In multinomial logistic regression, we estimated relative risk ratios (RRR) of e‐cigarette use (never, former, non‐daily, daily) by educational attainment, social class [using the National Statistics Socio‐economic classification (NS‐SEC)] and employment status [full‐time, part‐time, unemployed and other 'inactivity' (e.g. stay‐at‐home parents and permanantly disabled)], adjusting for sex. Findings Among recent former regular smokers, there were no patterns of association between socio‐economic characteristics and e‐cigarette use. Among current smokers: (1) compared with higher occupation (NS‐SEC I/II), intermediate occupation (NS‐SEC III/IV) was positively associated with non‐daily e‐cigarette use [RRR = 1.77, 95% confidence interval (CI) = 1.03–3.03]; (2) compared with full‐time employment, unemployment was negatively associated with non‐daily and daily e‐cigarette use (RRR = 0.38, 95% CI = 0.18–0.81; RRR = 0.12, 95% CI = 0.02–0.56) and other economic inactivity was negatively associated with daily e‐cigarette use (RRR = 0.39, 95% CI = 0.16–0.93). Conclusions: Among young adult smokers in England, lower‐status occupational groups were more likely to use e‐cigarettes on a non‐daily basis than to have never used compared with higher status occupational groups. Compared with people in full‐time employment, those without employment were less likely to use e‐cigarettes daily than to have never used. [ABSTRACT FROM AUTHOR]

Background and aim: National social marketing campaigns have been shown to promote smoking cessation in England. There is reason to believe that regional and city‐wide campaigns can play a valuable role in reducing smoking prevalence over and above any national tobacco control activity. This study aimed to assess the impact of the London Smoking Cessation Transformation Programme, a multi‐component citywide smoking cessation programme, on quit attempts and quit success rates. Design and Setting: Interrupted time–series analyses, using Autoregressive Integrated Moving Average (ARIMA) and generalized additive models (GAM) of population trends in the difference between monthly quit attempts and quit success rates among smokers who made a quit attempt in London versus the rest of England before and during the first year of the programme. Participants: A total of 55 528 past‐year adult smokers who participated in a monthly series of nationally representative cross‐sectional surveys in England between November 2006 and August 2018. Twelve and a half per cent of smokers lived in London (intervention region) and 87.5% lived in the rest of England (control region). Measurements Monthly prevalence of quit attempts and quit success rates among smokers who made a quit attempt. Findings The monthly difference in prevalence of quit attempts in London compared with the rest of England increased by 9.59% [95% confidence interval (CI) = 4.35–14.83, P < 0.001] from a mean of 0.04% pre‐intervention to 9.63% post‐intervention. The observed increase in success rates among those who tried was not statistically significant (B = 4.72; 95% CI = –2.68 to 12.11, P = 0.21); Bayes factors indicated that these data were insensitive. GAM analyses confirmed these results. Conclusion: The promotion of the London Smoking Cessation Transformation Programme during September 2017 was associated with a significant increase in quit attempts compared with the rest of England. The results were inconclusive regarding an effect on quit success among those who tried. [ABSTRACT FROM AUTHOR]

Aims: To estimate (1) associations between self‐reported COVID‐19, hand‐washing, smoking status, e‐cigarette use and nicotine replacement therapy (NRT) use and (2) the extent to which COVID‐19 has prompted smoking and vaping quit attempts and more smoking inside the home. Design Cross‐sectional household surveys. Setting and participants: A representative sample of the population in England from April to May 2020. The sample included 3179 adults aged ≥ 18 years. Measurements Participants who reported that they definitely or thought they had coronavirus were classified as having self‐reported COVID‐19. Participants were asked how often they wash their hands after returning home, before preparing foods, before eating or before touching their face. They were also asked whether, due to COVID‐19, they had (i) attempted to quit smoking, (ii) attempted to quit vaping and (iii) changed the amount they smoke inside the home. Findings Odds of self‐reported COVID‐19 were significantly greater among current smokers [20.9%, adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI) = 1.04–1.73] and long‐term (> 1‐year) ex‐smokers (16.1%, aOR = 1.33, 95% CI = 1.05–1.68) compared with never smokers (14.5%). Recent (< 1‐year) ex‐smokers had non‐significantly greater odds of self‐reported COVID‐19 (22.2%, aOR = 1.50, 95% CI = 0.85–2.53). Bayes factors indicated there was sufficient evidence to rule out large differences in self‐reported COVID‐19 by NRT use and medium differences by e‐cigarette use. With the exception of hand‐washing before face‐touching, engagement in hand‐washing behaviours was high (> 85%), regardless of nicotine use. A minority (12.2%) of quit attempts in the past 3 months were reportedly triggered by COVID‐19, and approximately one in 10 current e‐cigarette users reported attempting to quit vaping because of COVID‐19. Conclusions: In England, current smokers and long‐term ex‐smokers appear to have higher odds of self‐reported COVID‐19 compared with never smokers in adjusted analyses, but there were no large differences between people who used nicotine replacement therapy or e‐cigarettes. Engagement in hand‐washing appears to be high, regardless of nicotine or tobacco use. A minority of past‐year smokers and current e‐cigarette users, respectively, report attempting to quit smoking/vaping due to COVID‐19. [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]

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]

Background and Aims: The expense associated with using non‐combustible nicotine products as an alternative to smoking may deter smoking reduction or cessation. This study aimed to estimate (i) how much adults in England spend each week on smoking and alternative nicotine products and (ii) the potential cost saving that could be achieved by switching from smoking to using an alternative nicotine delivery product. Design and Setting: Data came from September to November 2018 waves of the Smoking Toolkit Study, a series of national household surveys of the adult population in England. Participants: A total of 859 adults (aged ≥ 16 years) who reported current smoking or current use of an alternative nicotine product. Measurements Participants reported their average weekly expenditure on smoking and alternative nicotine products [nicotine replacement therapy (NRT) or e‐cigarettes]. Findings Current smokers who did not use any alternative nicotine delivery products (n = 602) reported spending on average £23.09 [95% confidence interval (CI) = £21.64–24.54] on smoking each week. Ex‐smokers who used alternative nicotine products (n = 91) reported spending on average £8.59 (95% CI = £6.80–10.39) on these products each week; £8.03 (95% CI = £6.03–10.03) on e‐cigarettes and £10.05 (95% CI = £5.62–14.47) on NRT. People who both smoked and used alternative nicotine products (dual users, n = 166) spent on average £24.54 (95% CI = £21.78–27.29) on smoking and £7.49 (95% CI = £6.00–8.99) on alternative nicotine products each week. Expenditure on smoking was higher among heavier, more addicted smokers and lower among those with routine/manual occupations, non‐daily smokers and roll‐your‐own tobacco users. Expenditure on e‐cigarettes was higher among men, users from central and southern versus northern England and smokers who had tried to quit in the past year, and lower among current smokers. Expenditure on NRT was lower among roll‐your‐own tobacco users. Conclusions: In England, expenditure among e‐cigarette and nicotine replacement therapy users is approximately one‐third of the expenditure of smokers. The average smoker may save an estimated £15.06 per week by switching completely to e‐cigarettes or £13.04 per week by switching to nicotine replacement therapy, although this is likely to differ according to individual usage patterns. [ABSTRACT FROM AUTHOR]

Background and Aims: Understanding whether and how far smokers' characteristics influence the effectiveness of treatment may be important for tailoring recommendations on cessation aids to those most likely to help the user achieve abstinence. This study aimed to estimate the effectiveness of commonly used smoking cessation aids and test whether their effectiveness differs according to cigarette addiction, socio‐economic status, age or sex. Design Correlational design using cross‐sectional survey data collected monthly between 2006 and 2018. Setting: England. Participants: A total of 18 929 adults (aged ≥ 16 years, 52.0% female) who had smoked within the previous 12 months and had made at least one quit attempt during that period. Measurements The outcome was self‐reported abstinence from quit date to survey. Independent variables were self‐reported use during the most recent quit attempt of: prescription nicotine replacement therapy (NRT), NRT over‐the‐counter, varenicline, bupropion, e‐cigarettes, face‐to‐face behavioural support, telephone support, written self‐help materials, websites and hypnotherapy. Moderators were cigarette addiction, social grade, age and sex. Findings After adjustment for covariates and use of other cessation aids, users of e‐cigarettes [odds ratio (OR) = 1.95, 95% confidence interval (CI) = 1.69–2.24] and varenicline (OR = 1.82, 95% CI = 1.51–2.21) had significantly higher odds of reporting abstinence than those who did not report use of these cessation aids. Use of prescription NRT was associated with increased abstinence in older (≥ 45 years) (OR = 1.58, 95% CI = 1.25–2.00) but not younger (< 45 years) smokers (OR = 1.09, 95% CI = 0.85–1.42). Use of websites was associated with increased abstinence in smokers from lower (OR = 2.20, 95% CI = 1.22–3.98) but not higher social grades (OR = 0.74, 95% CI = 0.40–1.38). There was little evidence of benefits of using other cessation aids. Conclusions: Use of e‐cigarettes and varenicline are associated with higher abstinence rates following a quit attempt in England. Use of prescription of nicotine replacement therapy is also associated with higher abstinence rates, but only in older smokers, and use of websites only in smokers from lower socio‐economic status. [ABSTRACT FROM AUTHOR]

Aims: To examine smoking prevalence, motivation and attempts to stop smoking, markers of cigarette addiction and success in quit attempts of people living in social housing in England compared with other housing tenures. Design and setting: A large cross‐sectional survey of a representative sample of the English population conducted between January 2015 and October 2017. Participants: A total of 57 522 adults (aged ≥ 16 years). Measurements Main outcomes were smoking status, number of cigarettes per day, time to first cigarette, exposure to smoking by others, motivation to stop smoking, past‐year quit attempts and use of cessation support. Covariates were age, sex, social grade, region and survey year. Findings Adults in social housing had twice the odds of being smokers than those living in other housing types [odds ratio (OR) = 2.09, 95% confidence interval (CI) = 1.98–2.22, P < 0.001]. Smokers in social housing consumed more cigarettes daily (adjusted mean difference = 1.09 cigarettes, 95% CI = 0.72–1.46, P < 0.001) and were more likely to smoke within 30 minutes of waking (OR = 1.63, 95% CI = 1.48–1.79, P < 0.001) than smokers living in other housing types. Prevalence of high motivation to stop smoking was similar across housing types (OR = 1.04, 95% CI = 0.91–1.19, P = 0.553). The prevalence of quit attempts and use of cessation support within the past year were greater in social compared with other housing (OR = 1.14, 95% CI = 1.03–1.26, P = 0.011; OR = 1.30, 95% CI = 1.09–1.54, P = 0.003), but success in quitting was much lower (OR = 0.57, 95% CI = 0.45–0.72, P < 0.001). Conclusions: In England, living in social housing is a major independent risk factor for smoking. These easily identifiable hot‐spots consist of smokers who are at least as motivated to stop as other smokers, but find it more difficult. [ABSTRACT FROM AUTHOR]

Introduction: Higher levels of anxiety and depression have been found to be associated with greater difficulty in stopping smoking. This raises the question as to whether mood disturbance may be associated with exposure to, and use of, quitting support. Aims: This study examined whether General Practitioner (GP) advice and/or offer of support, or stop-smoking service use differed between smokers reporting or not reporting depression/anxiety. Methods: Data came from the Smoking Toolkit Study. Participants were 1,162 English adults who reported currently smoking or having stopped within the past 12 months, aged 40+ years, surveyed between April and September 2012. Anxiety/depression was assessed by the mood disturbance item of the EuroQol five dimensions questionnaire (EQ-5D). This was compared to recall of GP quit advice and/or support, and stop-smoking aid use adjusting for age, gender, and social grade. Results/Findings: Smokers reporting depression/anxiety were more likely to recall being offered advice and support to stop smoking by their GP (OR = 1.50, 95% C.I. = 1.05–2.13). However, there were no significant differences in use of stop-smoking aids during the past year. Conclusions: Smokers reporting depression/anxiety are more likely to be offered stop-smoking support by their GPs, but this does not appear to translate into stop-smoking aid use, despite high motivation to quit. Given higher nicotine dependence in this group, mental health specific support may need to be offered, and more needs to be done to make this offer of aid attractive. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To compare the proportion of people in England with probable alcohol dependence [Alcohol Use Disorders Identification Test (AUDIT) score ≥ 20] with those with other drinking patterns (categorized by AUDIT scores) in terms of motivation to reduce drinking and use of alcohol support resources. Design: A combination of random probability and simple quota sampling to conduct monthly cross‐sectional household computer‐assisted interviews between March 2014 and August 2017. Setting: The general population in all nine regions of England. Participants: Participants in the Alcohol Toolkit Study (ATS), a monthly household survey of alcohol consumption among people aged 16 years and over in England (n = 69 826). The mean age was 47 years [standard deviation (SD) = 18.78; 95% confidence interval (CI) = 46.8–47] and 51% (n = 35 560) were female. Measurements: χ2 tests were used to investigate associations with demographic variables, motivation to quit drinking, attempts to quit drinking, general practitioner (GP) engagement and types of support accessed in the last 12 months across AUDIT risk zones. Findings: A total of 0.6% were classified as people with probable alcohol dependence (95% CI = 0.5–0.7). Motivation to quit (χ2 = 1692.27, P < 0.001), current attempts (χ2 = 473.94, P < 0.001) and past‐year attempts (χ2 = 593.67, P < 0.001) differed by AUDIT risk zone. People with probable dependence were more likely than other ATS participants to have a past‐year attempt to cut down or quit (51.8%) and have received a specialist referral from their GP about drinking (13.7%), and less likely to report no motivation to reduce their drinking (26.2%). Those with probable dependence had higher use of self‐help books and mobile applications (apps) than other ATS participants; however, 27.7% did not access any resources during their most recent attempt to cut down. Conclusions: Adults in England with probable alcohol dependence, measured through the Alcohol Use Disorders Identification Test, demonstrate higher motivation to quit drinking and greater use of both specialist treatment and self‐driven support compared with those in other Alcohol Use Disorders Identification Test zones, but most do not access treatment resources to support their attempts. [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: The Motivation To Stop Scale (MTSS) is a single-item instrument which has been shown to predict quit attempts in the next 6 months in a previous validation study conducted in England. The aim of the current study was to determine the external validity of the MTSS among Dutch smokers in predicting quit attempts in the next 12 months. A secondary aim was to compare the discriminative accuracy of the MTSS with that of a Stages of Change assessment. Methods: We analysed data from three consecutive waves of the International Tobacco Control (ITC) Netherlands Survey (n = 1272). We conducted logistic regression analyses with the baseline score of the MTSS (measured in 2012 or 2013) predicting a quit attempt in the next 12 months (measured in 2013 or 2014). We furthermore compared the area under the Receiver Operating Characteristics (ROCAUC) curves of the MTSS and a Stages of Change measure. Results: A total of 450 smokers (35.4%) made a quit attempt between baseline and 12-month follow-up. The regression analysis showed a positive relationship between scoring on the MTSS and quit attempts (odds ratio = 18.15, 95% confidence interval =8.12-40.58 for the most vs. least motivated group). The discriminative accuracy of the MTSS (ROCAUC = 0.68) was marginally higher than that of a Stages of Change assessment (ROCAUC = 0.65), but not statistically significant (P=0.21). Conclusion: The MTSS is an externally valid instrument to predict quit attempts in the next 12 months. [ABSTRACT FROM AUTHOR]

Background: It is assumed that smokers rarely quit without ‘attempting’ to do so but the assumption does not appear to have been adequately tested. This study assessed the prevalence of reporting having stopped without reporting a quit attempt and the reasons given for this discrepancy.Methods: Data were collected from ex-smokers who said they had quit within the last 12 months during nationally representative household surveys conducted monthly between 2006–12.Results: Of the 1,892 ex-smokers who said that they had quit within the last 12 months, 13.9% (95%CI = 12.4%–15.5%) reported having made no serious quit attempts in that period. In a sub-group of 24 smokers who were asked why they had reported stopping without also reporting an attempt, nine cited inconsistency over timing; three reported stopping without attempting to do so; four did not consider it an ‘attempt’ because they had succeeded; and six had not ruled out the occasional cigarette in the future.Conclusions: A substantial minority of people who report having stopped in the past year may fail to report a corresponding quit attempt. However, quitting smoking without considering that one has tried appears to be rare. Instead, the most common reason for the discrepancy is inconsistent reporting of the timing of quit attempts. [ABSTRACT FROM PUBLISHER]

Aims To use a unique longitudinal data set to assess the association between e-cigarette use while smoking with smoking cessation attempts, cessation and substantial reduction, taking into account frequency of use and key potential confounders. Design Web-based survey, baseline November/December 2012, 1-year follow-up in December 2013. Setting Great Britain. Participants National general population sample of 4064 adult smokers, with 1759 (43%) followed-up. Measurements Main outcome measures were cessation attempt, cessation and substantial reduction (≥50% from baseline to follow-up) of cigarettes per day (CPD). In logistic regression models, cessation attempt in the last year (analysis n = 1473) and smoking status ( n = 1656) at follow-up were regressed on to baseline e-cigarette use (none, non-daily, daily) while adjusting for baseline socio-demographics, dependence and nicotine replacement (NRT) use. Substantial reduction ( n = 1042) was regressed on to follow-up e-cigarette use while adjusting for baseline socio-demographics and dependence and follow-up NRT use. Findings Compared with non-use, daily e-cigarette use at baseline was associated with increased cessation attempts [odds ratio (OR) = 2.11, 95% confidence interval (CI) = 1.24-3.58, P = 0.006], but not with cessation at follow-up (OR = 0.62, 95% CI = 0.28-1.37, P = 0.24). Non-daily use was not associated with cessation attempts or cessation. Daily e-cigarette use at follow-up was associated with increased odds of substantial reduction (OR = 2.49, 95% CI = 1.14-5.45, P = 0.02), non-daily use was not. Conclusions Daily use of e-cigarettes while smoking appears to be associated with subsequent increases in rates of attempting to stop smoking and reducing smoking, but not with smoking cessation. Non-daily use of e-cigarettes while smoking does not appear to be associated with cessation attempts, cessation or reduced smoking. [ABSTRACT FROM AUTHOR]

Background and Aims Modelling the population impact and cost-effectiveness of smoking cessation aids is limited by lack of knowledge about how the use of aids changes across quit attempts. Here we test whether the quit method used in a previous attempt influences (i) future decisions to quit and/or (ii) treatment/s used during subsequent attempts. Design and Setting Data came from the Smoking Toolkit Study, a United Kingdom national household survey. Participants and Measures Smokers ( n = 5489) who completed a baseline and 6-month follow-up questionnaire. Respondents were asked what treatment/s, grouped as: prescription medication/s [bupropion, varenicline or nicotine replacement therapy (NRT)], over-the-counter NRT or unaided that they had used in their most recent quit attempt (at baseline), and any use of treatment/s for a quit attempt in the last 3 months at follow-up. Results Smokers who had tried to quit at baseline were more likely to report having tried to quit again prior to follow-up [all odds ratios ≥ 2.19 relative to no attempt at baseline, P < 0.001]. Smokers who tried to quit using pharmacological aids were more likely to try to quit again at follow-up (all ORs ≥ 2.19 relative to no attempt at baseline, P < 0.001). Smokers tended to re-try aids used in baseline attempts in future attempts (all ORs ≥ 1.48 relative to no attempt at baseline, P < 0.01). Conclusions Smokers who have tried to quit in the past year are more likely to try to quit again within 6 months regardless of whether they used a pharmacological aid, and they are more likely to re-try aids they had used previously. [ABSTRACT FROM AUTHOR]

Background and Aims Electronic cigarettes (e-cigarettes) are rapidly increasing in popularity. Two randomized controlled trials have suggested that e-cigarettes can aid smoking cessation, but there are many factors that could influence their real-world effectiveness. This study aimed to assess, using an established methodology, the effectiveness of e-cigarettes when used to aid smoking cessation compared with nicotine replacement therapy (NRT) bought over-the- counter and with unaided quitting in the general population. Design and Setting A large cross-sectional survey of a representative sample of the English population. Participants The study included 5863 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either an e-cigarette only (n = 464), NRT bought over-the-counter only (n = 1922) or no aid in their most recent quit attempt (n = 3477). Measurements The primary outcome was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including nicotine dependence. Findings E-cigarette users were more likely to report abstinence than either those who used NRT bought over-the-counter [odds ratio (OR) = 2.23, 95% confidence interval (CI) = 1.70–2.93, 20.0 versus 10.1%] or no aid (OR = 1.38, 95% CI = 1.08–1.76, 20.0 versus 15.4%). The adjusted odds of non-smoking in users of e-cigarettes were 1.63 (95% CI = 1.17–2.27) times higher compared with users of NRT bought over-the-counter and 1.61 (95% CI = 1.19–2.18) times higher compared with those using no aid. Conclusions Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence. [ABSTRACT FROM AUTHOR]

Objectives: Stopping smoking leads to greater happiness and life satisfaction. This raises the question as to whether harm reduction, i.e. smoking reduction (SR) and the use of Nicotine Replacement Therapy (NRT) for SR, might lead to a similar benefit. This is of importance, given that the National Institute of Clinical Excellence in the UK is due to release guidance on harm reduction in 2013.Design: Data were collected from 1,532 smokers involved in the Smoking Toolkit Study.Method: Participants were asked if they were cutting down and if they were using Nicotine Replacement Therapy (NRT). Smokers also rated happiness and life satisfaction.Results: There was no evidence of an association between SR or use of NRT for SR and either reported ‘happiness’ or ‘life satisfaction’. Nor was there an association between measures of ‘happiness’ or ‘life satisfaction’ and cigarette consumption.Conclusion: It appears that SR is not associated with mental health benefits. This suggests that complete cessation may be necessary for benefits to be incurred. Prospective studies are necessary to confirm these findings. [ABSTRACT FROM PUBLISHER]

Background and aims There is a need for more evidence on the 'real-world' effectiveness of commonly used aids to smoking cessation from population-level studies. This study assessed the association between abstinence and use of different smoking cessation treatments after adjusting for key potential confounding factors. Design Cross-sectional data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 10 335 adults who smoked within the previous 12 months and had made at least one quit attempt during that time. Measurements Participants were classified according to their use of cessation aids in their most recent quit attempt: (i) medication (nicotine replacement therapy, bupropion or varenicline) in combination with specialist behavioural support delivered by a National Health Service Stop Smoking Service; (ii) medication provided by the prescribing health-care professional without specialist behavioural support; (iii) nicotine replacement therapy ( NRT) bought over the counter; and (iv) none of these. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including tobacco dependence. Findings Compared with smokers using none of the cessation aids, the adjusted odds of remaining abstinent up to the time of the survey were 3.25 [95% confidence interval ( CI) = 2.05-5.15] greater in users of prescription medication in combination with specialist behavioural support, 1.61 (95% CI = 1.33-1.94) greater in users of prescription medication combined with brief advice and 0.96 (95% CI = 0.81-1.13) in users of NRT bought over the counter. Conclusions After adjusting for major confounding variables such as tobacco dependence, smokers in England who use a combination of behavioural support and pharmacotherapy in their quit attempts have almost three times the odds of success than those who use neither pharmacotherapy nor behavioural support. Smokers who buy nicotine replacement therapy over the counter with no behavioural support have similar odds of success in stopping as those who stop without any aid. [ABSTRACT FROM AUTHOR]

Slipped capital femoral epiphysis (SCFE) is a rare adolescent hip disease that leads to a hip shape abnormality. Typical treatment involves in-situ fixation. It is not known if the degree of initial hip shape abnormality associated with SCFE has a significant effect on long-term hip function. A cohort of patients aged 18-50 who had undergone in-situ fixation for SCFE from 1970 onwards in our institution provided IHOT-33 (hip function) outcome data. Frog lateral radiographs from the time of surgery were used to measure radiological hip shape using both Southwick angle and alpha angle. There were 38 patients (46 hips) SCFE patients who met the eligibility criteria. We obtained follow-up data for 32 patients (38 hips), 83% follow-up. Ten patients (20 hips) had bilateral SCFE. The mean follow-up was 12.7 years (95% CI 10.7-14.7). 32 patients matched for age and sex who had no history of SCFE provided control IHOT-33 outcome data. There was a significant difference (p<0.05) in long-term hip function between patients undergoing in-situ fixation for SCFE and the control population (mean IHOT-33 scores of 71.8 and 95.8 respectively). There was no significant (p>0.05) correlation between long-term hip function and Southwick angle or lateral alpha angle. The initial severity of hip shape abnormality due to SCFE was not a strong predictor of long-term hip function. Other extraneous factors not related to hip shape may have an equally if not more important role to play in the subsequent long-term outcome of SCFE. [ABSTRACT FROM AUTHOR]

Background: Financial incentives are effective in moderating physician and patient behaviour, but they have not been studied in the context of medical education. Aim: This study assessed whether financial incentives can motivate students to acquire electrocardiogram (ECG) interpretation skills. Methods: Students enrolled for a cardio-respiratory teaching module ( n = 121) were randomised to an intervention (financial incentive) or a control (book voucher raffle) condition. All students took three validated exams of ECG interpretation skills (at module entry, module exit and seven weeks later). Only the exit exam was financially incentivised in the intervention group. The primary outcome was the proportion of students who correctly identified ≥60% of clinically important diagnoses in the exit exam. Results: Financial incentives more than doubled the odds of correctly identifying ≥60% of diagnoses in the exit exam (adjusted odds ratio 2.44, 95% confidence interval 1.05-5.67) and significantly increased student learning time. However, there was no significant effect on performance levels in the retention exam. Conclusions: Financial incentives increase reported learning time and examination results in the short-term. The lack of a sustained effect on performance suggests that financial incentives may foster a superficial or strategic rather than a deep approach to learning. [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 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]