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Background: Heroin is a substance with a unique social profile in that it is commonly used by individuals alone but there is a paucity of qualitative research exploring how social influences impact the continuation of heroin use, particularly when people are trying to stop using heroin. This study explored social determinants which influence the continuation of heroin use in males in UK community treatment who use illicit heroin alongside opioid replacement therapy. Design: Participants were self-selecting from an initial purposively recruited sample. Using Janis (1972) 8 symptoms of Groupthink as an a priori framework for analysis, the study method utilised qualitative interviews with fourteen males. The discussions were digitally-recorded, transcribed verbatim, and analysed thematically. Findings: Contrasting with the evidence base, the sample included people who transitioned from recreational drug use to dependent heroin use without experiencing trauma of any kind. Far from becoming socially isolated when actively using heroin, interviews identified a shift in social networks from networks built on shared moments to networks underpinned by transactional exchange. Components of Groupthink were identified when participants described belonging to heroin using networks and continued to use heroin whilst trying to abstain though individual accountability was central to the decision to continue to use heroin. Conclusions: The conflict between the individual goal of abstinence and the group goal of continuation suggests that social network interventions could be more successful if delivered to cohorts of people who buy heroin together. [ABSTRACT FROM AUTHOR]

Introduction: This article reports on a Department of Health UK funded project to implement consensus substance misuse teaching in undergraduate curricula in medical schools in England. The aim was to better equip practising doctors of the future to deal with substance misuse issues. Method: A project coordinator worked with local curriculum coordinators and academic champions in 19 participating medical schools. Substance misuse teaching was mapped using a toolkit outlining national learning outcomes as specified in Tomorrow's Doctors. This enabled a detailed overview of current substance misuse teaching, and identified gaps. Results: Common areas for all schools requiring further development included iatrogenic addiction, professionalism, fitness to practice, attitudes and issues relating to stigma, child-related issues, and social consequences of substance misuse. Students reported lacking confidence in performing key skills, including substance use history taking, discussing options for patients wishing to reduce or stop use, and recommending appropriate help organisations. This led to medical schools developing new or enhanced learning outcomes and teaching materials. Discussion: The project has, through national guidance and changes, enhanced the training and education of student doctors, and established a basis for substance misuse teaching that has already influenced the learning of our future doctors.

Introduction Pod Vaping Devices (PVD) such as JUUL have become extremely popular in the United States although their uptake and use in the United Kingdom remain lower. A key difference between the United States and the United Kingdom is the nicotine strength legally permitted, typically 59 mg/mL in the United States but capped at 20 mg/mL in the United Kingdom and European Union. This may limit the ability of EU vaping devices to deliver satisfactory nicotine levels. The primary aim was to compare the EU- (18 mg/mL nicotine strength) with the U.S.-JUUL (59 mg/mL) on daily smokers' subjective experiences, craving relief, and blood nicotine levels. Aims and Methods Double-blind, counterbalanced within-participants design with two conditions: 18 mg/mL versus 59 mg/mL. On two separate occasions, UK smokers (N =19, 10 males, 9 females) vaped ad libitum for 60 mins and provided blood samples at baseline 5, 15, 30, and 60 min. Subjective effects (incl. satisfaction) were measured at 10 and 60 min and, craving and withdrawal symptoms (WS) at baseline, 10 and 60 min. Results Satisfaction did not differ between conditions. There was a significant interaction between Time and Nicotine concentration for Nicotine Hit (p =.045). Mean self-report of Nicotine Hit increased under the use of the 59 mg/mL from 10 to 60 min and decreased under the 18 mg/mL. Participants reported higher Throat Hits following use of the 59 mg/mL (p =.017). There were no differences in other subjective effects including craving, WS relief (p s >.05). Liquid consumption was doubled under the 18 versus the 59 mg/mL (p =.001) and nicotine boost was significantly higher in the 59 mg/mL at all time-points (p ≤.001). Conclusions The results did not support our hypotheses that satisfaction, craving, and withdrawal reduction would be higher with the 59 mg/mL JUUL. This could be because of the doubling of liquid consumption in the 18 mg/mL. Whether satisfaction and craving relief persist over the longer-term outside of the lab remains to be determined. Implications In a 60-min ad-lib vaping session, the EU-JUUL was found to produce comparable satisfaction, craving- and withdrawal relief as the U.S.-JUUL in this sample of UK smokers. These findings could suggest that the higher nicotine concentrations available in PVDs in the United States are not necessary for providing satisfaction and improving craving and WS. However, this was at the expense of a considerable increase in liquid consumption indicative of compensatory puffing. [ABSTRACT FROM AUTHOR]

Introduction E-Cigarette voucher schemes have been piloted across the UK to support populations to quit smoking. This short report evaluates a scheme that targets vulnerable and disadvantaged smokers who had failed to quit smoking by other means. Methods Descriptive summary evaluation of service data on smoking outcomes and qualitative data from selected participants, as "key-informants" (n = 4) and key stakeholders (stop smoking staff, vape shop staff, and general practitioners [GPs]). Results In total, 668 participants were referred to the scheme, and 340 participants redeemed a voucher. By intention to treat analysis (ITT) 143/668 (21%) were recorded as quit smoking at 4 weeks. At 12 weeks, 7.5% of participants had quit, by ITT. Overall, the pilot project was well received by clients as it offered an affordable route into vaping for smoking cessation. GPs supported the scheme and appreciated being able to offer an alternative to entrenched smokers. Conclusions The scheme shows promise in supporting entrenched smokers to quit smoking. The offer of similar voucher schemes across the UK suggests the potential to reduce overall smoking prevalence and associated morbidity and mortality. Implications Working with GPs in a deprived area, it was possible to set-up a vape shop voucher scheme for smoking cessation. Patients with comorbidities who had tried and failed to quit smoking previously were referred to receive a vape shop voucher to be redeemed for an initial starter kit, alongside support from the stop smoking service. This innovative scheme enabled 42% of entrenched smokers who redeemed a voucher to successfully quit smoking within 4 weeks. [ABSTRACT FROM AUTHOR]

Background and aims: Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. Methods: Terms related to tobacco, nicotine and vaping products were identified in the research literature and their usage characterised. Basic Formal Ontology was used as a unifying upper‐level ontology to describe the domain, and classes with definitions and labels were developed linking them to this ontology. Labels, definitions and properties were reviewed and revised in an iterative manner until a coherent set of classes was agreed by the authors. Results: Overlapping, but distinct classes were developed: 'tobacco‐containing product', 'nicotine‐containing product' and 'vaping device'. Subclasses of tobacco‐containing products are 'combustible tobacco‐containing product', 'heated tobacco product' and 'smokeless tobacco‐containing product'. Subclasses of combustible tobacco‐containing product include 'cigar', 'cigarillo', 'bidi' and 'cigarette' with further subclasses including 'manufactured cigarette'. Manufactured cigarettes have properties that include 'machine‐smoked nicotine yield' and 'machine‐smoked tar yield'. Subclasses of smokeless tobacco product include 'nasal snuff', 'chewing tobacco product', and 'oral snuff' with its subclass 'snus'. Subclasses of nicotine‐containing product include 'nicotine lozenge' and 'nicotine transdermal patch'. Subclasses of vaping device included 'electronic vaping device' with a further subclass, 'e‐cigarette'. E‐cigarettes have evolved with a complex range of properties including atomiser resistance, battery power, properties of consumables including e‐liquid nicotine concentration and flavourings, and the ontology characterises classes of product accordingly. Conclusions: Use of an ontology of tobacco, nicotine and vaping products should help reduce ambiguity and confusion in tobacco control research and practice. [ABSTRACT FROM AUTHOR]

Background: Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention.Aims: We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone.Method: A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation.Results: We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm.Conclusions: We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To provide baseline cohort descriptives and assess change in health behaviours since the UK COVID‐19 lockdown. Design: A prospective cohort (N = 1,044) of people recruited online, purposively targeting vulnerable populations. Methods: After a baseline survey (April 2020), participants completed 3 months of daily ecological momentary assessments (EMA). Dietary, physical activity, alcohol, smoking, vaping and substance use behaviours collected retrospectively for the pre‐COVID‐19 period were compared with daily EMA surveys over the first 30 days during early lockdown. Predictors of behaviour change were assessed using multivariable regression models. Results: 30% of the cohort had a COVID‐19 at risk health condition, 37% were classed as deprived and 6% self‐reported a mental health condition. Relative to pre‐pandemic levels, participants ate almost one portion of fruit and vegetables less per day (vegetables mean difference −0.33, 95% CI −0.40, −0.25; fruit −0.57, 95% CI −0.64, −0.50), but showed no change in high sugar portions per day (−0.03, 95% CI −0.12, 0.06). Participants spent half a day less per week doing ≥30 min of moderate to vigorous physical activity (−0.57, 95% CI −0.73, −0.40) but slightly increased days of strength training (0.21, 95% CI 0.09, 0.34), increased alcohol intake (AUDIT‐C score change 0.25, 95% CI 0.13, 0.37), though did not change smoking, vaping or substance use behaviour. Worsening health behaviour change was associated with being younger, female and higher body mass index. Conclusions: The cohort reported worsening health behaviours during early lockdown. Longer term changes will be investigated using further waves of data collection. [ABSTRACT FROM AUTHOR]

Background and aims: E‐cigarettes are the most popular consumer choice for support with smoking cessation in the United Kingdom. However, there are concerns that long‐term e‐cigarette use may sustain concurrent tobacco smoking or lead to relapse to smoking in ex‐smokers. We aimed to explore vaping trajectories, establishing e‐cigarette users' perspectives on continued e‐cigarette use in relation to smoking relapse or abstinence. Design Qualitative longitudinal study collecting detailed subjective data at baseline and ~12 months later. Setting: United Kingdom. Participants: E‐cigarette users (n = 37) who self‐reported that they had used e‐cigarettes to stop smoking at baseline. Measurements Semi‐structured qualitative interviews (face‐to‐face or telephone) collected self‐reported patterns of e‐cigarette use. Thematic analysis of transcripts and a mapping approach of individual pathways enabled exploration of self‐reported experiences, motives, resources, and environmental and social influences on vaping and any concurrent tobacco smoking. Findings Three broad participant pathways were identified: 'maintainer' (e‐cigarette use and not smoking), 'abstainer' (neither smoking nor using e‐cigarettes), and 'relapser' (dual‐using, or relapsed back to tobacco smoking only). In each pathway, individual experiences with vaping nicotine appeared to play an important role and appeared to be related to psychological and social factors. A social context supportive of vaping was important for the maintainers, as was a belief in the need to overcome nicotine addiction for the abstainers, and dislike of the 'vaping culture' expressed by some in the relapser group. Dual‐users held beliefs such as a need for cigarettes at time of acute stress that affirmed dependence on tobacco. Conclusions: In a sample of UK e‐cigarette users who report having used e‐cigarettes to quit smoking, a social context that supports continued vaping was perceived to be helpful in preventing relapse to smoking. [ABSTRACT FROM AUTHOR]

Introduction: Finding effective ways to help pregnant women quit smoking and maintain long-term abstinence is a public health priority. Electronic cigarettes (ie, vaping) could be a suitable cessation tool in pregnancy for those who struggle to quit; however, healthcare professionals (HCP) must be informed about these devices to offer appropriate advice. This study used the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Theoretical Domains Framework (TDF) to explore HCP attitudes towards vaping in pregnancy and postpartum; beliefs about the health risks of vaping; perceived barriers and facilitators of vaping in pregnancy; knowledge of current guidelines and policies; and training needs.Methods: Interviews (n = 60) were conducted with midwives (n = 17), health visitors (n = 10), general practitioners (n = 15) and stop smoking specialists (n = 18) across the United Kingdom. Interview transcriptions were analyzed thematically using the framework approach and the COM-B.Results: Discussing vaping as a tool for quitting smoking in pregnancy was prevented by a lack of capability (limited knowledge of vaping, lack of training in smoking cessation); lack of opportunity (restricted by organizational policies and guidelines, lack of time and financial issues impacting on training), and negative social influences (sensationalist media and stigma associated with vaping in pregnancy); and lack of motivation (fear of future litigation and comebacks should adverse effects from vaping arise).Conclusions: Factors related to capability, opportunity, and motivation were identified that influence HCPs attitudes and behaviors towards vaping in pregnancy. Gaps in knowledge and training needs were identified, which could inform the development of targeted vaping training.Implications: Vaping could be suitable in pregnancy for those struggling to quit smoking. However, HCPs must be informed about these devices to offer appropriate advice. These data extend our knowledge of factors influencing HCP attitudes and behaviors towards vaping in pregnancy. Generally, vaping was perceived as safer than cigarettes, but a perceived lack of evidence, health and safety risks, dependency, and regulation issues were concerning. Considering our findings, greater efforts are needed to ensure HCPs are sufficiently informed about vaping and guidelines available. More importance should be placed on training for all HCPs who have contact with pregnant women. [ABSTRACT FROM AUTHOR]

Background: The Capital Card, developed by WDP, is a digital innovation which acts as a form of contingency management, and aims to significantly improve service user outcomes. WDP is a substance misuse treatment provider commissioned by local authorities across the UK to support service users and their families affected by addiction. The Capital Card, much like commercial loyalty cards, uses a simple earn-spend points system which incentivises and rewards service users for engaging with services e.g. by attending key work sessions, Blood Borne Virus appointments or group-work sessions. The Spend activities available to service users are designed to improve overall wellbeing and build social and recovery capital, and include activities such as educational classes, fitness classes, driving lessons, and cinema tickets. Methods and findings: We compared successful completion rates of 1,545 service users accessing one of WDP's London based community services over a two-year period; before and after the Capital Card was introduced. Client demographics (age, sex and primary substance) were controlled for during the analysis. Once client demographics were controlled for, analysis showed that clients with a Capital Card were 1.5 times more likely to successfully complete treatment than those who had not had the Capital Card (OR = 1.507, 95% CI = 1.194 to 1.902). Conclusions: The results of this initial evaluation are of particular interest to commissioners and policy makers as it indicates that the Capital Card can be used effectively as a form of contingency management to enhance recovery outcomes for service users engaging in community-based substance misuse services. [ABSTRACT FROM AUTHOR]

Purpose Whilst there are pockets of excellence in the provision of Child and Adolescent Mental Health Services (CAMHS), many services fail to meet young people’s needs. Considering this, the purpose of this paper is to ascertain perceptions of CAMHS provision in a rural county of the UK to inform re-design of youth mental health services.Design/methodology/approach The study comprised of two phases: phase one involved analysis of questionnaire data of youth views of CAMHS. Phase two involved analysis of the “Have Your Say” event data which explored perceptions of CAMHS and future service re-design. Data were thematically analysed.Findings Knowledge of the existence and purpose of CAMHS was variable. Participants wanted accessible information about services, rights, confidentiality and for this to be provided in multiple media. Young people wanted staff who were easy to talk to, genuine, understanding and who valued their insights. Participants wanted to be offered choice about appointments, location and timing. An ideal mental health service was described as a “one-stop-shop” of co-locality and multi-agency collaboration. Young people clearly expressed a desire to influence the design and delivery of the radical service re-design and to be embedded in its development.Practical implications The results highlighted multiple problems with CAMHS provision and provided a clear justification for the re-design of services.Originality/value This was a novel approach demonstrating the importance, utility and power of effective participatory practices for informing the re-design of services. [ABSTRACT FROM AUTHOR]

This article presents exploratory qualitative data from a pragmatic sample ( n== 11) of vulnerable young people (aged 13-18 years) in contact with youth services. Data were gathered during a substance-use services needs assessment project undertaken in a rural county in the United Kingdom. Semi-structured qualitative interviews explored engagement with services and narratives of episodes of substance-use information-seeking. A range of different information sources were reported, but consensus was expressed regarding source credibility. Parents, particularly mothers, and older siblings were perceived as the most credible. The range of information sources utilized by young people is discussed in terms of furthering research understanding of credibility of sources of information. Implications for services and for future research are discussed. [ABSTRACT FROM AUTHOR]

Aims: To assess the cost-effectiveness of the Cessation of Smoking Trial in Emergency Department (COSTED) intervention compared with signposting to local stop smoking service (SSS) from the National Health Service (NHS) and personal social services (PSS) perspective., Design, Setting and Participants: This was a two-group, multi-centre, pragmatic, individually randomized controlled trial set in six Emergency Departments (EDs) in urban and rural areas in the United Kingdom. Adult (≥ 18 years) daily smokers (at least one cigarette or equivalent per day) but not daily e-cigarette users, with carbon monoxide reading ≥ 8 parts per million, attending the ED (n = 972) were included. The intervention consisted of provision of an e-cigarette starter kit plus brief smoking cessation advice and referral to a local SSS. Control was an information card on how to access local SSS., Measurements: Intervention costs included costs of training and delivery. Control costs included costs of printing information cards. Costs of smoking cessation and health-care services were estimated based on quantities reported by participants and unit costs extracted from secondary sources. The effects were measured by quality-adjusted life years (QALYs) derived from EQ-5D-5L. Other outcomes were smoking cessation measures. The primary outcome was incremental cost-effectiveness ratio (ICER), which was calculated by dividing the difference in costs by the difference in QALYs between groups., Findings: The mean intervention costs were £48 [standard error (SE) = £0] per participant and the mean control costs were £0.2 (SE = £0) per participant. Using regression estimates, total costs were £31 [95% confidence interval (CI) = -£341 to £283] higher and 6-month QALYs were 0.004 (95% CI = -0.004 to 0.014) higher in the intervention group than in the control group. The ICER was calculated at £7750 (probability of cost-effective at range £20 000-30 000: 72.2-76.5%)., Conclusions: The UK Cessation of Smoking Trial in Emergency Department (COSTED) intervention (provision of an e-cigarette starter kit plus brief smoking cessation advice) was cost-effective compared with signposting to local stop smoking services under the current recommendations of the maximum acceptable thresholds., (© 2024 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background and Aims: Smoking is extremely common among adults experiencing homelessness, but there is lack of evidence for treatment efficacy. E-cigarettes are an effective quitting aid, but they have not been widely tested in smokers with complex health and social needs. Here we build upon our cluster feasibility trial and evaluate the offer of an e-cigarette or usual care to smokers accessing a homeless centre., Design, Setting and Participants: Multi-centre two-arm cluster-randomized controlled trial with mixed-method embedded process and economic evaluation in homeless centres in England, Scotland and Wales. Adult smokers (18+ years; n = 480) accessing homeless centres and who are known to centre staff and willing to consent., Intervention and Comparator: Clusters (n = 32) will be randomized to either an e-cigarette starter pack with weekly allocations of nicotine containing e-liquid for 4 weeks [choice of flavours (menthol, fruit and tobacco) and strengths 12 mg/ml and 18 mg/ml] or the usual care intervention, which comprises very brief advice and a leaflet signposting to the local stop smoking service., Measurements: The primary outcome is 24-week sustained carbon monoxide-validated smoking cessation (Russell Standard defined, intention-to-treat analysis)., Secondary Outcomes: (i) 50% smoking reduction (cigarettes per day) from baseline to 24 weeks; (ii) 7-day point prevalence quit rates at 4-, 12- and 24-week follow-up; (iii) changes in risky smoking practices (e.g. sharing cigarettes, smoking discarded cigarettes) from baseline to 4, 12 and 24 weeks; (iv) cost-effectiveness of the intervention; and (v) fidelity of intervention implementation; mechanisms of change; contextual influences and sustainability., Conclusions: This is the first study, to our knowledge, to randomly assign smokers experiencing homelessness to an e-cigarette and usual care intervention to measure smoking abstinence with embedded process and economic evaluations. If effective, its results will be used to inform the larger-scale implementation of offering e-cigarettes throughout homeless centres to aid smoking cessation., (© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Objectives: To determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time., Design: Mixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study., Setting: UK online survey and interviews with community-dwelling individuals in the East of England., Participants: People in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study., Primary and Secondary Outcome Measures: The online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant's perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks., Results: 703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18-60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home., Conclusions: People with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Purpose: Across the UK and USA, postpartum smoking relapse rates are high, and rates of breastfeeding and physical activity are low. This project aimed to explore these interrelated health behaviours and technology use, for intervention development to support postpartum cancer prevention., Methods: Focus groups and interviews with 26 purposively selected women (15 in Vermont, USA and 11 in Norfolk, UK). Recruitment was from deprived areas experiencing multiple disadvantage. Qualitative data were thematically analysed from dual cultural perspectives, underpinned by the social ecological model., Results: Women negotiate interrelated lifestyle behaviours as part of managing an identity in transition, moving through stages of disturbance, adaptation, acceptance and integration towards "becoming" a new Mother. Technology was integral to women's process of engagement with mothering identities. Intersectionality underpins complex patterns of interrelated behaviour., Conclusions: There is scope to improve electronic/digital support for postpartum women cross-nationally to promote interrelated cancer-preventative lifestyle behaviours. Abbreviations CDC: Center for Disease Control, US; PA: Physical activity; SES: Socioeconomic status; SVI: Social Vulnerability Index; UK: UK; US: USA; WIC: Women infants and children office.

Developed in collaboration with WHO Department of Mental Health and Substance Abuse, this study (conducted in India, the UK, and the USA) integrated feedback from mental health service users into the development of the chapter on mental, behavioural, and neurodevelopmental disorders for ICD-11. The ICD-11 will be used for health reporting from January, 2022. As a reporting standard and diagnostic classification system, ICD-11 will be highly influential by informing policy, clinical practice, and research that affect mental health service users. We report here the first study to systematically seek and collate service user perspectives on a major classification and diagnostic guideline. Focus groups were used to collect feedback on five diagnoses: depressive episode, generalised anxiety disorder, schizophrenia, bipolar type 1 disorder, and personality disorder. Participants were given the official draft diagnostic guidelines and a parallel lay translation. Data were then thematically analysed, forming the basis of co-produced recommendations for WHO, which included features that could be added or revised to better reflect lived experience and changes to language that was confusing or objectionable to service users. The findings indicated that an accessible lay language version of the ICD-11 could be beneficial for service users and their supporters., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Relapse to tobacco smoking for pregnant women who quit is a major public health problem. Evidence-based approaches to intervention are urgently required. This study aimed to develop an intervention to be integrated into existing healthcare. A mixed methods approach included a theory-driven systematic review identifying promising behaviour change techniques for targeting smoking relapse prevention, and qualitative focus groups and interviews with women (ex-smokers who had remained quit and those who had relapsed), their partners and healthcare professionals ( N = 74). A final stage recruited ten women to refine and initially test a prototype intervention. Our qualitative analysis suggests a lack, but need for, relapse prevention support. This should be initiated by a trusted 'credible source'. For many women this would be a midwife or a health visitor. Support needs to be tailored to individual needs, including positive praise/reward, novel digital and electronic support and partner or social support. Advice and support to use e cigarettes or nicotine replacement therapy for relapse prevention was important for some women, but others remained cautious. The resulting prototype complex intervention includes face-to-face support reiterated throughout the postpartum period, tailored digital and self-help support and novel elements such as gifts and nicotine replacement therapy (NRT).

Background and Aims: E-cigarettes are the most popular aid to quitting smoking in the UK. Although many smokers quit, relapse is common. Historically, the literature has reported strong associations between tobacco smoking lapse and relapse following a quit attempt. This article aims to explore how smoking lapse is experienced by those who vape to quit smoking., Design and Methods: A purposive sample of 40 UK vapers were matched to a sampling frame from a representative sample of UK quitters. Semi-structured qualitative interviews were conducted. Data were thematically analysed iteratively situating reported experiences of smoking lapse within narrative descriptions of vaping. Iterative categorization was used as a technique to further explore a subset of data specifically focused on smoking lapse., Results: Analysis revealed that smoking lapse is perceived qualitatively differently when using e-cigarettes as compared to past quit attempts. Having the pleasurable alternative of vaping meant that full relapse to smoking was not inevitable. Instead, lapses were perceived as 'permissive' or 'purposive', intentional and contextualised, or for some as unintentional, with the resulting emotional response negatively reinforcing ongoing tobacco smoking abstinence., Discussion and Conclusions: Our novel findings suggest that the role of tobacco smoking lapse in relation to relapse status may be theoretically redefined, drawing on data from vapers. These findings question the utility of previous theories of the role of smoking lapse in the relapse process. For ex-smokers, vaping offers a pleasurable, viable pharmacological, but also social and psychological, substitution option for smoking and potentially powerfully alters the experience and threat of any lapse., (© 2018 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)