Showing papers by "Sarah E Jackson published in 2021"

Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019-20 data.

Abstract: AIM: To examine changes in smoking, drinking and quitting/reduction behaviour following the COVID-19 lockdown in England. DESIGN/SETTING: Monthly cross-sectional surveys representative of the adult population in England, aggregated before (April 2019-February 2020) versus after (April 2020) lockdown. PARTICIPANTS: A total of 20 558 adults (≥ 16 years). MEASUREMENTS: The independent variable was the timing of the COVID-19 lockdown (before versus after March 2020). Dependent variables were: prevalence of smoking and high-risk drinking, past-year cessation and quit attempts (among past-year smokers), past-year attempts to reduce alcohol consumption (among high-risk drinkers) and use of evidence-based (e.g. prescription medication/face-to-face behavioural support) and remote support [telephone support/websites/applications (apps)] for smoking cessation and alcohol reduction (among smokers/high-risk drinkers who made a quit/reduction attempt). Covariates included age, sex, social grade, region and level of nicotine and alcohol dependence (as relevant). FINDINGS: The COVID-19 lockdown was not associated with a significant change in smoking prevalence [17.0% (after) versus 15.9% (before), odds ratio (OR) = 1.09, 95% CI = 0.95-1.24], but was associated with increases in quit attempts [39.6 versus 29.1%, adjusted odds ratio (ORadj ) = 1.56, 95% CI = 1.23-1.98], quit success (21.3 versus 13.9%, ORadj = 2.01, 95% CI = 1.22-3.33) and cessation (8.8 versus 4.1%, ORadj = 2.63, 95% CI = 1.69-4.09) among past-year smokers. Among smokers who tried to quit, there was no significant change in use of evidence-based support (50.0 versus 51.5%, ORadj = 1.10, 95% CI = 0.72-1.68) but use of remote support increased (10.9 versus 2.7%, ORadj = 3.59, 95% CI = 1.56-8.23). Lockdown was associated with increases in high-risk drinking (38.3 versus 25.1%, OR = 1.85, CI = 1.67-2.06), but also alcohol reduction attempts by high-risk drinkers (28.5 versus 15.3%, ORadj = 2.16, 95% CI = 1.77-2.64). Among high-risk drinkers who made a reduction attempt, use of evidence-based support decreased (1.2 versus 4.0%, ORadj = 0.23, 95% CI = 0.05-0.97) and there was no significant change in use of remote support (6.9 versus 6.1%, ORadj = 1.32, 95% CI = 0.64-2.75). CONCLUSIONS: Following the March 2020 COVID-19 lockdown, smokers and high-risk drinkers in England were more likely than before lockdown to report trying to quit smoking or reduce alcohol consumption and rates of smoking cessation and use of remote cessation support were higher. However, high-risk drinking prevalence increased post-lockdown and use of evidence-based support for alcohol reduction by high-risk drinkers decreased with no compensatory increase in use of remote support.

A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders.

Abstract: Exercise addiction is associated with multiple adverse outcomes and can be classified as co-occurring with an eating disorder, or a primary condition with no indication of eating disorders. We conducted a meta-analysis exploring the prevalence of exercise addiction in adults with and without indicated eating disorders. A systematic review of major databases and grey literature was undertaken from inception to 30/04/2019. Studies reporting prevalence of exercise addiction with and without indicated eating disorders in adults were identified. A random effect meta-analysis was undertaken, calculating odds ratios for exercise addiction with versus without indicated eating disorders. Nine studies with a total sample of 2140 participants (mean age = 25.06; 70.6% female) were included. Within these, 1732 participants did not show indicated eating disorders (mean age = 26.4; 63.0% female) and 408 had indicated eating disorders (mean age = 23.46; 79.2% female). The odds ratio for exercise addiction in populations with versus without indicated eating disorders was 3.71 (95% CI 2.00–6.89; I2 = 81; p ≤ 0.001). Exercise addiction prevalence in both populations differed according to the measurement instrument used. Exercise addiction occurs more than three and a half times as often as a comorbidity to an eating disorder than in people without an indicated eating disorder. The creation of a measurement tool able to identify exercise addiction risk in both populations would benefit researchers and practitioners by easily classifying samples.

COVID-19, smoking, vaping and quitting: a representative population survey in England.

Abstract: 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 ( 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.

Moderators of changes in smoking, drinking, and quitting behaviour associated with the first Covid-19 lockdown in England

Abstract: Aim To estimate changes in smoking, drinking, and quitting behaviour from before to during the first Covid-19 lockdown in England, and whether changes differed by age, sex, or social grade. Design Representative cross-sectional surveys of adults, collected monthly between August 2018 and July 2020. Setting England. Participants 36,980 adults (≥18y). Measurements Independent variables were survey month (pre-lockdown: August-February vs. lockdown months: April-July) and year (pandemic: 2019/20 vs. comparator: 2018/19). Smoking outcomes were smoking prevalence, cessation, quit attempts, quit success, and use of evidence-based or remote cessation support. Drinking outcomes were high-risk drinking prevalence, alcohol reduction attempts, and use of evidence-based or remote support. Moderators were age, sex, and occupational social grade (ABC1=more advantaged/C2DE=less advantaged). Findings Relative to changes over the same time period in 2018/19, lockdown was associated with significant increases in smoking prevalence (+24.7% in 2019/20 vs. 0.0% in 2018/19, ORadj=1.35[95%CI=1.12-1.63]) and quit attempts (+39.9% vs. −22.2%, ORadj=2.48[1.76-3.50]) among 18-34 year-olds, but not older groups. Increases in cessation (+156.4% vs. −12.5%, ORadj=3.08[1.86-5.09]) and the success rate of quit attempts (+99.2% vs. +0.8%, ORadj=2.29[1.31-3.98]) were also observed, and did not differ significantly by age, sex, or social grade. Lockdown was associated with a significant increase in high-risk drinking prevalence across all sociodemographic groups (+39.5% vs. −7.8%, ORadj=1.80[1.64-1.98]), with particularly high increases among women (ORadj=2.17[1.87-2.53]) and social grades C2DE (ORadj=2.34[2.00-2.74]). Alcohol reduction attempts increased significantly among high-risk drinkers from social grades ABC1 (ORadj=2.31[1.78-3.00]) but not C2DE (ORadj=1.25[0.83-1.88]), with larger increases among those aged 18-34 (ORadj=2.56[1.72-3.81]) and ≥60 (ORadj=1.43[1.05-1.95]) than 35-59 (ORadj=2.51[1.51-4.18]). There were few significant changes in use of support for smoking cessation or alcohol reduction, although samples were small. Conclusions In England, the first Covid-19 lockdown was associated with increased smoking prevalence among younger adults, and increased high-risk drinking prevalence among all adults. Smoking cessation activity also increased: more younger smokers made quit attempts during lockdown and more smokers quit successfully. Socioeconomic disparities in drinking behaviour were evident: high-risk drinking increased by more among women and those from less advantaged social grades (C2DE) but the rate of reduction attempts increased only among the more advantaged social grades (ABC1).

Moderators of changes in smoking, drinking and quitting behaviour associated with the first COVID-19 lockdown in England.

Abstract: Aim To estimate changes in smoking, drinking and quitting behaviour from before to during the first COVID-19 lockdown in England, and whether changes differed by age, sex or social grade. Design Representative cross-sectional surveys of adults, collected monthly between August 2018 and July 2020. Setting England. Participants A total of 36 980 adults (≥ 18 years). Measurements Independent variables were survey month (pre-lockdown: August-February versus lockdown months: April-July) and year (pandemic: 2019/20 versus comparator: 2018/19). Smoking outcomes were smoking prevalence, cessation, quit attempts, quit success and use of evidence-based or remote cessation support. Drinking outcomes were high-risk drinking prevalence, alcohol reduction attempts and use of evidence-based or remote support. Moderators were age, sex and occupational social grade (ABC1 = more advantaged/C2DE = less advantaged). Findings Relative to changes during the same time period in 2018/19, lockdown was associated with significant increases in smoking prevalence [+24.7% in 2019/20 versus 0.0% in 2018/19, adjusted odds ratio (aOR) = 1.35, 95% confidence interval (CI) = 1.12-1.63] and quit attempts (+39.9 versus -22.2%, aOR = 2.48, 95% CI = 1.76-3.50) among 18-34-year-olds, but not older groups. Increases in cessation (+156.4 versus -12.5%, aOR = 3.08, 95% CI = 1.86-5.09) and the success rate of quit attempts (+99.2 versus +0.8%, aOR = 2.29, 95% CI = 1.31-3.98) were also observed, and did not differ significantly by age, sex or social grade. Lockdown was associated with a significant increase in high-risk drinking prevalence among all socio-demographic groups (+39.5 versus -7.8%, aOR = 1.80, 95% CI = 1.64-1.98), with particularly high increases among women (aOR = 2.17, 95% CI = 1.87-2.53) and social grades C2DE (aOR = 2.34, 95% CI = 2.00-2.74). Alcohol reduction attempts increased significantly among high-risk drinkers from social grades ABC1 (aOR = 2.31, 95% CI = 1.78-3.00) but not C2DE (aOR = 1.25, 95% CI = 0.83-1.88). There were few significant changes in use of support for smoking cessation or alcohol reduction, although samples were small. Conclusions In England, the first COVID-19 lockdown was associated with increased smoking prevalence among younger adults and increased high-risk drinking prevalence among all adults. Smoking cessation activity also increased: more younger smokers made quit attempts during lockdown and more smokers quit successfully. Socio-economic disparities in drinking behaviour were evident: high-risk drinking increased by more among women and those from less advantaged social grades (C2DE), but the rate of reduction attempts increased only among the more advantaged social grades (ABC1).

Internet use, social isolation and loneliness in older adults

Abstract: The aim of this study was to explore associations between internet/email use in a large sample of older English adults with their social isolation and loneliness. Data from the English Longitudinal Study of Ageing Wave 8 were used, with complete data available for 4,492 men and women aged ⩾ 50 years (mean age = 64.3, standard deviation = 13.3; 51.7% males). Binomial logistic regression was used to analyse cross-sectional associations between internet/email use and social isolation and loneliness. The majority of older adults reported using the internet/email every day (69.3%), fewer participants reported once a week (8.5%), once a month (2.6%), once every three months (0.7%), less than every three months (1.5%) and never (17.4%). No significant associations were found between internet/email use and loneliness, however, non-linear associations were found for social isolation. Older adults using the internet/email either once a week (odds ratio (OR) = 0.60, 95% confidence interval (CI) = 0.49–0.72) or once a month (OR = 0.60, 95% CI = 0.45–0.80) were significantly less likely to be socially isolated than every day users; those using internet/email less than once every three months were significantly more likely to be socially isolated than every day users (OR = 2.87, 95% CI = 1.28–6.40). Once every three months and never users showed no difference in social isolation compared with every day users. Weak associations were found between different online activities and loneliness, and strong associations were found with social isolation. The study updated knowledge of older adults’ internet/email habits, devices used and activities engaged in online. Findings may be important for the design of digital behaviour change interventions in older adults, particularly in groups at risk of or interventions targeting loneliness and/or social isolation.

Negative vaccine attitudes and intentions to vaccinate against Covid-19 in relation to smoking status: a population survey of UK adults.

Abstract: INTRODUCTION: We examined differences in negative attitudes towards vaccines in general, and intentions to vaccinate against Covid-19 specifically, by smoking status in a large sample of adults in the UK. METHOD: Data were from 29,148 adults participating in the Covid-19 Social Study in September-October 2020. Linear regression analyses examined associations between smoking status (current/former/never) and four types of general negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial logistic regression examined associations between smoking status and uncertainty and unwillingness to be vaccinated for Covid-19. Covariates included sociodemographic characteristics and diagnosed health conditions. RESULTS: Relative to never and former smokers, current smokers reported significantly greater mistrust of vaccine benefit, were more worried about unforeseen future effects, had greater concerns about commercial profiteering, and had a stronger preference for natural immunity (Badjs 0.16-0.36, p<0.001). Current smokers were more likely to be uncertain (27.6% vs. 22.7% of never smokers: RRadj 1.43 [95%CI 1.31-1.56]; vs. 19.3% of former smokers: RRadj 1.55 [1.41-1.73]) or unwilling (21.5% vs. 11.6% of never smokers: RRadj 2.12 [1.91-2.34]; vs. 14.7% of former smokers: RRadj 1.53 [1.37-1.71]) to receive a Covid-19 vaccine. CONCLUSIONS: Current smokers hold more negative attitudes towards vaccines in general, and are more likely to be undecided or unwilling to vaccinate against Covid-19, compared with never and former smokers. With a disproportionately high number of smokers belonging to socially clustered and disadvantaged socioeconomic groups, lower vaccine uptake in this group could also exacerbate health inequalities. IMPLICATIONS: These results suggest that without intervention, smokers will be less likely than non-smokers to take up the offer of a Covid-19 vaccine when offered. Targeted policy action may be required to ensure low uptake of Covid-19 vaccination programmes does not compound health inequalities between smokers and non-smokers.

Vitamin D and the hepatitis B vaccine response: a prospective cohort study and a randomized, placebo-controlled oral vitamin D3 and simulated sunlight supplementation trial in healthy adults

Abstract: To determine serum 25(OH)D and 1,25(OH)2D relationship with hepatitis B vaccination (study 1). Then, to investigate the effects on hepatitis B vaccination of achieving vitamin D sufficiency (serum 25(OH)D ≥ 50 nmol/L) by a unique comparison of simulated sunlight and oral vitamin D3 supplementation in wintertime (study 2). Study 1 involved 447 adults. In study 2, 3 days after the initial hepatitis B vaccination, 119 men received either placebo, simulated sunlight (1.3 × standard-erythema dose, 3 × /week for 4 weeks and then 1 × /week for 8 weeks) or oral vitamin D3 (1000 IU/day for 4 weeks and 400 IU/day for 8 weeks). We measured hepatitis B vaccination efficacy as percentage of responders with anti-hepatitis B surface antigen immunoglobulin G ≥ 10 mIU/mL. In study 1, vaccine response was poorer in persons with low vitamin D status (25(OH)D ≤ 40 vs 41–71 nmol/L mean difference [95% confidence interval] − 15% [− 26, − 3%]; 1,25(OH)2D ≤ 120 vs ≥ 157 pmol/L − 12% [− 24%, − 1%]). Vaccine response was also poorer in winter than summer (− 18% [− 31%, − 3%]), when serum 25(OH)D and 1,25(OH)2D were at seasonal nadirs, and 81% of persons had serum 25(OH)D < 50 nmol/L. In study 2, vitamin D supplementation strategies were similarly effective in achieving vitamin D sufficiency from the winter vitamin D nadir in almost all (~ 95%); however, the supplementation beginning 3 days after the initial vaccination did not effect the vaccine response (vitamin D vs placebo 4% [− 21%, 14%]). Low vitamin D status at initial vaccination was associated with poorer hepatitis B vaccine response (study 1); however, vitamin D supplementation commencing 3 days after vaccination (study 2) did not influence the vaccination response. Study 1 NCT02416895; https://clinicaltrials.gov/ct2/show/study/NCT02416895 ; Study 2 NCT03132103; https://clinicaltrials.gov/ct2/show/NCT03132103 .

Trends in use of e-cigarette device types and heated tobacco products from 2016 to 2020 in England.

Abstract: This study examined use trends of e-cigarette devices types, heated tobacco products (HTPs) and e-liquid nicotine concentrations in England from 2016 to 2020. Data were from a representative repeat cross-sectional survey of adults aged 16 or older. Bayesian logistic regression was used to estimate proportions and 95% credible intervals (CrIs). Of 75,355 participants, 5.3% (weighted = 5.5%) were currently using e-cigarettes or HTPs, with the majority (98.7%) using e-cigarettes. Among e-cigarette users, 53.7% (CrI 52.0-55.1%) used tank devices, 23.7% (22.4-25.1%) mods, 17.3% (16.1-18.4%) pods, and 5.4% (4.7-6.2%) disposables. Tanks were the most widely used device type throughout 2016-2020. Mods were second until 2020, when pods overtook them. Among all e-cigarette/HTP users, prevalence of HTP use remains rare (3.4% in 2016 versus 4.2% in 2020), whereas JUUL use has risen from 3.4% in 2018 to 11.8% in 2020. Across all years, nicotine concentrations of ≤ 6 mg/ml were most widely (41.0%; 39.4-42.4%) and ≥ 20 mg/ml least widely used (4.1%; 3.4-4.9%). Among e-cigarette/HTP users, ex-smokers were more likely than current smokers to use mod and tank e-cigarettes, but less likely to use pods, disposables, JUUL and HTPs. In conclusion, despite growing popularity of pods and HTPs worldwide, refillable tank e-cigarettes remain the most widely used device type in England.

Independent Associations Between Different Measures of Socioeconomic Position and Smoking Status: A Cross-Sectional Study of Adults in England.

Abstract: Introduction To gain a better understanding of the complex and independent associations between different measures of socioeconomic position (SEP) and smoking in England. Aims and methods Between March 2013 and January 2019 data were collected from 120 496 adults aged 16+ in England taking part in the Smoking Toolkit Study. Of these, 18.04% (n = 21 720) were current smokers. Six indicators of SEP were measured: social grade, employment status, educational qualifications, home and car ownership and income. Models were constructed using ridge regression to assess the contribution of each measure of SEP, taking account of high collinearity. Results The strongest predictor of smoking status was housing tenure. Those who did not own their own home had twice the odds of smoking compared with homeowners (odds ratio [OR] = 2.01). Social grade, educational qualification, and income were also good predictors. Those in social grades C1 (OR = 1.04), C2 (OR = 1.29), D (OR = 1.39), and E (OR = 1.78) had higher odds of smoking than those in social grade AB. Similarly, those with A-level/equivalent (OR = 1.15), GCSE/vocational (OR = 1.48), other/still studying (OR = 1.12), and no post-16 qualifications (OR = 1.48) had higher odds of smoking than those with university qualifications, as did those who earned in the lowest (OR = 1.23), third (OR = 1.18), and second quartiles (OR = 1.06) compared with those earning in the highest. Associations between smoking and employment (OR = 1.03) and car ownership (OR = 1.05) were much smaller. Conclusions Of a variety of socioeconomic measures, housing tenure appears to be the strongest independent predictor of smoking in England, followed by social grade, educational qualifications, and income. Employment status and car ownership have the lowest predictive power. Implications This study used ridge regression, a technique which takes into account high collinearity between variables, to gain a better understanding of the independent associations between different measures of SEP and smoking in England. The findings provide guidance as to which SEP measures one could use when trying to identifying individuals most at risk from smoking, with housing tenure identified as the strongest independent predictor.

Dependence on nicotine in US high school students in the context of changing patterns of tobacco product use.

Abstract: 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).

Harm Perceptions of E-cigarettes Among Smokers With and Without Mental Health Conditions in England: A Cross-Sectional Population Survey.

Abstract: INTRODUCTION E-cigarettes (ECs) may benefit smokers with mental health conditions who are more likely to smoke, and smoke more heavily, than those without mental health conditions. This could be undermined if harm misperceptions in this group are high as is the case in the general population. This study aimed to assess EC harm perceptions relative to cigarettes as a function of mental health status and a variety of characteristics. METHODS Data were collected from 6531 current smokers in 2016/2017 in household surveys of representative samples of adults. The associations of mental health status (self-reported mental health condition and past year treatment), smoking and EC use characteristics, and characteristics relating to use of potential information sources with harm perceptions of ECs relative to cigarettes (measured by correct response "less harmful" vs. wrong responses "more harmful," "equally harmful," "don't know") were analyzed with logistic regression. RESULTS A similar proportion of smokers without mental health conditions (61.5%, 95% CI 60.1-62.9) and with mental health conditions (both with [61.3%, 95% confidence interval [CI] 58.7-63.8] and without past year treatment [61.5%, 95% CI 58.1-64.7]) held inaccurate EC harm perceptions (all P > 0.05). Being female, nonwhite, aged 25-34 compared with 16-24, from lower social grades (C2, D, and E), not having post-16 qualifications, no EC experience, a daily smoker, unmotivated to quit <1 month, non-internet user and non-broadsheet reader were all associated with more inaccurate harm perceptions (all p < .05). CONCLUSIONS The majority of smokers in England have inaccurate harm perceptions of ECs regardless of mental health status. IMPLICATIONS This study is the first to use a nationally representative sample in order to investigate whether smokers with and without mental health conditions differ with regard to harm perceptions of ECs. Findings show that the majority of smokers in England hold inaccurate harm perceptions of ECs, and this does not differ as a function of mental health status. A number of characteristics associated with disadvantaged groups were significantly associated with inaccurate harm perceptions. These findings highlight the need to improve awareness and understanding among disadvantaged groups regarding the relative harms of ECs compared with tobacco.

Smoking and Quitting Behavior by Sexual Orientation: A Cross-Sectional Survey of Adults in England.

Abstract: Objective To assess associations between sexual orientation and smoking and quitting behavior among adults in England. Methods Data were collected from 112 537 adults (≥16 years) participating in a nationally representative monthly cross-sectional survey between July 2013 and February 2019. Sexual orientation was self-reported as heterosexual, bisexual, lesbian/gay, or prefer-not-to-say. Main outcomes were smoking status, e-cigarette use, cigarettes per day, time to first cigarette, motivation to stop smoking, motives for quitting, use of cessation support, and past-year quit attempts. Associations were analyzed separately for men and women using multivariable regression models adjusted for relevant covariates. Results Smoking prevalence is now similar between gay (21.6%), prefer-not-to-say (20.5%) and heterosexual men (20.0%), and lesbian (18.3%) and heterosexual women (16.9%), but remains higher among bisexual men (28.2%, adjusted odds ratio [ORadj] = 1.41, 95% confidence interval [CI] = 1.11 to 1.79) and bisexual women (29.8%, ORadj = 1.64, 95% CI = 1.33 to 2.03) and lower among prefer-not-to-say women (14.5%, ORadj = 0.85, 95% CI = 0.72 to 0.99). Among smokers, bisexuals were less addicted than heterosexuals, with bisexual men smoking fewer cigarettes per day (Badj = -2.41, 95% CI = -4.06 to -0.75) and bisexual women less likely to start smoking within 30 min of waking (ORadj = 0.66, 95% CI = 0.45 to 0.95) than heterosexuals. However, motivation to stop smoking and quit attempts did not differ significantly. Conclusions In England, differences in smoking prevalence among people with different sexual orientations have narrowed, primarily driven by a larger decline in smoking rates among sexual minority groups than heterosexuals. Bisexual men and women remain more likely to smoke but have lower levels of addiction while being no less likely to try to quit. Implications This population-based study provides an up-to-date picture of smoking and quitting behavior in relation to sexual orientation among adults in England. Findings suggest that widely documented disparities in smoking prevalence have narrowed over recent years, with gay men and lesbian women no longer significantly more likely to smoke than heterosexuals, although smoking remains more common among bisexual men and women. Insights into differences in level of addiction, use of cessation support, and motives for quitting may help inform the development of targeted interventions to further reduce smoking among sexual minority groups.

Influence of Vitamin D Supplementation by Simulated Sunlight or Oral D3 on Respiratory Infection during Military Training

Abstract: PURPOSE: To determine the relationship between vitamin D status and upper respiratory tract infection (URTI) of physically active men and women across seasons (study 1). Then, to investigate the effects on URTI and mucosal immunity of achieving vitamin D sufficiency (25(OH)D ≥50 nmol·L-1) by a unique comparison of safe, simulated-sunlight or oral D3 supplementation in winter (study 2). METHODS: In study 1, 1,644 military recruits were observed across basic military training. In study 2, a randomized controlled trial, 250 men undertaking military training received either placebo, simulated-sunlight (1.3x standard erythemal dose, three-times-per-week for 4-weeks and then once-per-week for 8-weeks) or oral vitamin D3 (1,000 IU·day-1 for 4-weeks and then 400 IU·day-1 for 8-weeks). URTI was diagnosed by physician (study 1) and Jackson common cold questionnaire (study 2). Serum 25(OH)D, salivary secretory immunoglobulin A (SIgA) and cathelicidin were assessed by LC-MS/MS and ELISA. RESULTS: In study 1, only 21% of recruits were vitamin D sufficient during winter. Vitamin D sufficient recruits were 40% less likely to suffer URTI than recruits with 25(OH)D 0.05). Supplementation did not affect salivary SIgA or cathelicidin. CONCLUSION: Vitamin D sufficiency reduced the URTI burden during military training.

Estimation of risk of neuropsychiatric adverse events from varenicline, bupropion and nicotine patch versus placebo: secondary analysis of results from the EAGLES trial using Bayes factors.

Abstract: Author(s): Beard, Emma; Jackson, Sarah E; Anthenelli, Robert M; Benowitz, Neal L; Aubin, Lisa St; McRae, Thomas; Lawrence, David; Russ, Cristina; Krishen, Alok; Evins, A Eden; West, Robert | Abstract: Background and aimsAnalysed using classical frequentist hypothesis testing with alpha set to 0.05, the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) did not find enough evidence to reject the hypothesis of no difference in neuropsychiatric adverse events (NPSAEs) attributable to varenicline, bupropion, or nicotine patch compared with placebo. This might be because the null hypothesis was true or because the data were insensitive. The present study aimed to test the hypothesis more directly using Bayes factors.DesignEAGLES was a randomised, double-blind, triple-dummy, controlled trial.SettingGlobal (16 countries across five continents), between November 2011 and January 2015.ParticipantsParticipants were smokers with (nn=n4116) and without (nn=n4028) psychiatric disorders.InterventionsVarenicline (1nmg twice daily), bupropion (150nmg twice daily), nicotine patch (21nmg once daily with taper) and matched placebos.MeasurementsThe outcomes included: (i) a composite measure of moderate/severe NPSAEs; and (ii) a composite measure of severe NPSAEs. The relative evidence for there being no difference in NPSAEs versus data insensitivity for the medications was calculated in the full and sub-samples using Bayes factors and corresponding robustness regions.FindingsFor all but two comparisons, Bayes factors were l1/3, indicating moderate to strong evidence for no difference in risk of NPSAEs between active medications and placebo (Bayes factor = 0.02-0.23). In the psychiatric cohort versus placebo, the data were suggestive, but not conclusive of no increase in NPSAEs with varenicline (Bayes factorn=n0.52) and bupropion (Bayes factorn=n0.71). Here, the robustness regions ruled out an≥7% and ≥8% risk increase with varenicline and bupropion, respectively.ConclusionsSecondary analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study trial using Bayes factors provides moderate to strong evidence that use of varenicline, bupropion or nicotine patches for smoking cessation does not increase the risk of neuropsychiatric adverse events relative to use of placebo in smokers without a history of psychiatric disorder. For smokers with a history of psychiatric disorder the evidence also points to no increased risk but with less confidence.

Prevalence and correlates of receipt by smokers of general practitioner advice on smoking cessation in England: a cross-sectional survey of adults.

Abstract: 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.

'Give 'em the vape, sell 'em the pods': razor-and-blades methods of pod e-cigarette pricing.

Abstract: The razor-and-blades model is a pricing strategy of selling base products, like razor handles, at a loss but making profits on repeated sales of complementary goods, like blades (reflected by the proverb ‘Give ‘em the razor, sell ‘em the blades’, widely misattributed to King C. Gillette).1 This strategy has been used across a myriad of industries, from games consoles to inkjet printers.1 More recently, it has been adopted by pod electronic cigarette (‘e-cigarette’) manufacturers. Pod e-cigarettes like JUUL, Vuse, blu, and Logic use disposable cartridges (‘pods‘) that are pre-filled with e-liquid. On average, these cartridges cost four times the price of the same amount of bottled e-liquid, making them more expensive in North America than the equivalent number of combustible cigarettes.2 So how do pod e-cigarette manufacturers overcome this price differential? Across North America and Europe, some have begun using razor-and-blades pricing models — providing a base e-cigarette device (‘vape’) cheaply or for free (figure 1) but making large profits on disposable device-specific pods.1 3 Figure 1 (Top) New customer deal on the blu US online store, offering an e-cigarette and six pods for only US$9.99. (Middle-left) Alto pod e-cigarette priced at US$0.99 on the Vuse US online store. (Middle-centre) Point-of-sale advertisement for the Logic Compact, available for £4 (US$5.5) …

Smokers' use of e-cigarettes in situations where smoking is not permitted in England: quarterly trends 2011-2020 and associations with sociodemographic and smoking characteristics.

Abstract: INTRODUCTION This study aimed to examine how the proportion of dual users of cigarettes and e-cigarettes who use e-cigarettes in situations where smoking is not permitted has changed since e-cigarettes became popular in England, and to characterize those who do so. METHODS Data were from 5081 adults in England who reported current smoking and current use of e-cigarettes ('dual users') participating in a nationally-representative monthly survey between April 2011 and February 2020. We modeled quarterly changes in prevalence of e-cigarette use in situations where smoking is not permitted and assessed multivariable associations with sociodemographic and smoking characteristics. RESULTS Between 2011 and 2020, prevalence of e-cigarette use in situations where smoking is not permitted followed a positive cubic trend, with a decelerating increase from an estimated 52.5% of dual users in Q2-2011 to 72.7% in Q3-2014, followed by a small decline to 67.5% in 2018, and subsequent increase to 74.0% in 2020. Odds were higher among those who were from more disadvantaged social grades, reported stronger smoking urges, or had made a past-year quit attempt, and lower among those who were aged at least 65 years (vs. 16-24 years), from the south (vs. north) of England, reported currently cutting down on their cigarette consumption or currently using nicotine replacement therapy. CONCLUSIONS In England, use of e-cigarettes in situations where smoking is not permitted is common among dual cigarette and e-cigarette users, has increased nonlinearly since 2011, and is particularly prevalent among those who are younger, disadvantaged, more addicted, have recently failed to quit, and are not attempting to cut down. IMPLICATIONS The ability to use nicotine in smoke-free settings appears to be an important part of the appeal of e-cigarettes. It is possible that if e-cigarette use was prohibited in public places, smokers may be deterred from using e-cigarettes alongside combustible tobacco, which could undermine quitting. Our results suggest disadvantaged and more addicted smokers would be disproportionately affected, suggesting such restrictions may contribute to inequalities in smoking and associated health outcomes.

Evaluation of the London Smoking Cessation Transformation Programme: a time-series analysis.

Abstract: 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.

Effectiveness of training stop-smoking advisers to deliver cessation support to the UK national proposed standard versus usual care in Malaysia: a two-arm cluster-randomized controlled trial.

Abstract: To assess the effectiveness of training stop smoking services providers in Malaysia to deliver support for smoking cessation based on the UK National Centre for Smoking Cessation and Training (NCSCT) standard treatment programme compared with usual care. Design Two‐arm cluster‐randomized controlled effectiveness trial across 19 sites with follow‐up at 4‐week, 3‐month, and 6‐month. Setting Stop smoking services operating in public hospitals in Malaysia. Participants Five hundred and two smokers [mean ± standard deviation (SD), age 45.6 (13.4) years; 97.4% male] attending stop smoking services in hospital settings in Malaysia: 330 in 10 hospitals in the intervention condition and 172 in nine hospitals in the control condition. Intervention and comparator The intervention consisted of training stop‐smoking practitioners to deliver support and follow‐up according to the NCSCT Standard Treatment Programme. The comparator was usual care (brief support and follow‐up). Measurements The primary outcome was continuous tobacco smoking abstinence up to 6 months in smokers who received smoking cessation treatment, verified by expired‐air carbon monoxide (CO) concentration. Secondary outcomes were continuous CO‐verified tobacco smoking abstinence up to 4 weeks and 3 months. Results Follow‐up rates at 4 weeks, 3 months and 6 months were 80.0, 70.6 and 53.3%, respectively, in the intervention group and 48.8, 30.8 and 23.3%, respectively, in the control group. At 6‐month follow‐up, 93 participants in the intervention group and 19 participants in the control group were abstinent from smoking, representing 28.2 versus 11.0% in an intention‐to‐treat (ITT) analysis assuming that participants with missing data had resumed smoking, and 52.8 versus 47.5% in a follow‐up‐only (FUO) analysis. Unadjusted odds ratios (accounting for clustering) were 5.04, (95% confidence interval (CI) = 1.22–20.77, P = 0.025) and 1.70, (95% CI = 0.25–11.53, P = 0.589) in the ITT and FUO analyses, respectively. Abstinence rates at 4 week and 3 month follow‐ups were significantly higher in the intervention versus control group in the ITT but not the FUO analysis. Conclusions On an intention‐to‐treat analysis with missing‐equals‐smoking imputation, training Malaysian stop smoking service providers in the UK National Centre for Smoking Cessation and Training standard treatment programme appeared to increase 6 month continuous abstinence rates in smokers seeking help with stopping compared with usual care. However, the effect may have been due to increasing follow‐up rates.

Who would be targeted by increasing the legal age of sale of cigarettes from 18 to 21? A cross-sectional study exploring the number and characteristics of smokers in England

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

Differences between ethnic groups in self-reported use of e-cigarettes and nicotine replacement therapy for cutting down and temporary abstinence: A cross-sectional population-level survey in England

Abstract: 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.