Publications
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Williams P, Bachir L, Cumella A, et al., 2024, Impact of omitting annual reviews for COPD on patient reported care quality – outcomes from the Asthma + Lung COPD patient passport, BMJ Open, ISSN: 2044-6055
Background: Regular clinical reviews of people with COPD provide an opportunity to optimise management and are recommended in national and international guidelines. However, there are limited data about the relationship between having an annual review and other aspects of care quality, which might influence decision making by healthcare professionals and commissioners.Method: Using data from 74,827 people with COPD completing the Asthma + Lung UK COPD Patient Passport, between 2014 and 2022, we conducted adjusted logistic regression (adjusting for year) and compared receipt of key items of care between those reporting that they had had an annual review (65.3%) and those who did not (34.%). To further capture patient experience, we also analyzed 4,228 free text responses to the 2021 Asthma + Lung UK annual COPD survey to the question “What’s the one thing that could improve your COPD care?”Results: We found that the absence of an annual review was associated with significantly worse COPD care across all domains studied, In particular inhaler training (Yes: 80.8% vs No: 38.4%, Adjusted Odds Ratio (AOR): 8.18 95% CI (7.89-8.47), having a written care plan (89.6% vs 56.9%, AOR 6.68 (6.35-7.05), and medication knowledge (72.6% vs 33.6%, AOR: 5.73 (5.51-5.96). Thematic analysis of the 2021 COPD survey responses identified three areas to improve care: 1) Access and support from healthcare services, 2) Improved treatment effectiveness, and 3) Interaction between COPD and the social environment.Discussion: Failure to deliver annual COPD reviews is associated with worse patient-reported experience of care quality. In parallel, people with COPD express a desire for greater support and access to healthcare services.
Williams P, Philip K, Buttery S, et al., 2024, Immediate smoking cessation support during lung cancer screening: long-term outcomes from two randomised controlled trials, Thorax, Vol: 79, Pages: 269-273, ISSN: 0040-6376
Background: Immediate smoking cessation interventions delivered alongside targeted lung health checks (TLHC) to screen for lung cancer increase self-reported abstinence at three months. The impact on longer-term, objectively confirmed quit rates remains to established. Methods: We followed up participants from two clinical trials in people aged 55-75 years who smoked and took part in a TLHC. These randomised participants in the TLHC by day of attendance to either usual care (signposting to smoking cessation services) or an offer of immediate smoking cessation support including pharmacotherapy. In the QuLIT1 trial this was delivered face to face, in QuLIT2 it was delivered remotely. Follow up was conducted 12 months after the TLHC by telephone interview with subsequent biochemical verification of smoking cessation using exhaled CO. Results: 430 people were enrolled initially (115 in QuLIT1 315 in QuLIT2), with 4 deaths before 12 months leaving 426 [62.1±5.27 years old and 48% female] participants for analysis. At 12 months, those randomised to attend on smoking cessation support intervention days had higher quit rates compared to usual care adjusted for age, gender, deprivation, and which trial they had been in; self-reported 7-day point prevalence (20.0% vs 12.8%; AOR=1.78 95% CI, 1.04-2.89) and CO verified quits (12.1% vs 4.7%; AOR=2.97 95% CI, 1.38-6.90). Those in the intervention arm were also more likely to report having made a quit attempt (30.2% vs UC 18.5%; AOR 1.90 95% CI 1.15-3.15). Conclusion: Providing immediate smoking cessation support alongside TLHC increases long term, biochemically confirmed smoking abstinence.
Radó MK, Kisfalusi D, Laverty AA, et al., 2024, Socio-economic inequalities in smoking and drinking in adolescence: Assessment of social network dynamics., Addiction, Vol: 119, Pages: 488-498
AIMS: We investigated whether (1) adolescents selected friends with a similar socio-economic status (SES), (2) smoking and alcohol consumption spread in networks and (3) the exclusion of non-smokers or non-drinkers differed between SES groups. DESIGN: This was a longitudinal study using stochastic actor-oriented models to analyze complete social network data over three waves. SETTING: Eight Hungarian secondary schools with socio-economically diverse classes took part. PARTICIPANTS: This study comprised 232 adolescents aged between 14 and 15 years in the first wave. MEASUREMENTS: Self-reported smoking behavior, alcohol consumption behavior and friendship ties were measured. SES was measured based upon entitlement to an income-tested regular child protection benefit. FINDINGS: Non-low-SES adolescents were most likely to form friendships with peers from their own SES group [odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.02-1.11]. Adolescents adjusted their smoking behavior (OR = 24.05, 95% CI = 1.27-454.86) but not their alcohol consumption (OR = 1.65, 95% CI = 0.62-4.39) to follow the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 0.98, 95% CI = 0.87-1.10), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.16, 95% CI = 1.01-1.33), but this association was not significantly different according to SES. CONCLUSIONS: Hungarian adolescents appear to prefer friendships within their own socio-economic status group, and smoking and alcohol consumption spread within those friendship networks. Socio-economic groups do not differ in the extent to which they encourage smoking or alcohol consumption.
Bijlani C, Vrinten C, Junghans C, et al., 2024, Changes in diet and physical activity following a community-wide pilot intervention to tackle childhood obesity in a deprived inner-London ward, BMC Public Health, Vol: 24, ISSN: 1471-2458
BackgroundLocal authorities in England have an important role in shaping healthy local environments contributing to childhood obesity. This study examined changes in diet and physical activity in primary school children following a three-year, complex, community-based intervention in Golborne ward, the second most deprived ward in London.MethodsThe Go-Golborne intervention aimed to shape the local environment across multiple settings with the engagement of a large number of local government and community stakeholders in a joint approach. Activities focused on six co-created themes to make changes to local environments and reduce sugary snacks and beverage consumption, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually between 2016 and 2019, from 1,650 children aged 6–11 years through six local schools, who all received the intervention. We used multilevel, linear and logistic random-slope regression models adjusted for time on study, baseline age, gender, ethnicity, deprivation quintile, school, and baseline weight status.ResultsAfter three years of follow-up, there were reductions in sugar-sweetened beverage consumption (adjusted beta -0·43 occasions/day, 95% CI -0·55 to -0·32), fruit and vegetable consumption (adjusted beta -0.22 portions, 95% CI -0.44 to 0.001) and car travel to and from school (adjusted OR 0·19, 95% CI 0·06 to 0·66), while screen time increased (high versus moderate/low: OR 2·30, 95% CI 1·36 to 3·90). For other behavioural outcomes, there was no statistically significant evidence of changes.ConclusionLocal authorities have substantial powers to make positive changes to the obesogenic environment but programmes remain under-evaluated. Results from the ambitious Go-Golborne intervention demonstrated mixed results in health behaviou
Williams P, Buttery SC, Hopkinson N, et al., 2024, Lung disease and social justice - COPD as a manifestation of structural violence., American Journal of Respiratory and Critical Care Medicine, ISSN: 1073-449X
Lung health, the development of lung disease, and how well a person with lung disease is able to live, all depend on a wide range of societal factors. These systemic factors that adversely affect people and cause injustice, can be thought of as “structural violence”. To make the causal processes relating to COPD more apparent, and the responsibility to interrupt or alleviate them clearer, we have developed a taxonomy to describe this. It contains five domains: 1)Avoidable lung harms: (i)processes impacting on lung development (ii)processes which disadvantage lung health in particular groups across the life course. 2)Diagnostic Delay: (i)healthcare factors (ii)norms and attitudes that mean that COPD is not diagnosed in a timely way, denying people with COPD effective treatment. 3)Inadequate COPD Care: ways in which the provision of care for people with COPD falls short of what is needed to ensure that they are able to enjoy the best possible health, considered as (i)healthcare resource allocation (ii)norms and attitudes influencing clinical practice. 4)Low status of COPD: ways both COPD as a condition and people with COPD are held in less regard and considered less of a priority than other comparable health problems. 5)Lack of Support: factors that make living with COPD more difficult than it should be (i)socioenvironmental factors (ii)factors that promote social isolation. This model has relevance for policymakers, healthcare professionals and the public as an educational resource, to change clinical practices and priorities and to stimulate advocacy and activism with the goal of the elimination of COPD.
Vincent H, Laverty AA, Brown J, et al., 2024, Association between the implementation of standardised tobacco packaging legislation and illicit tobacco and cross-border purchasing in England: a time-series analysis between 2012 and 2020., Tob Control
BACKGROUND: In May 2016, the UK announced standardising packaging legislation for tobacco products. There was a 12-month transition period with both branded and standardised packs on the market until May 2017. The aim of this study was to investigate whether the implementation of standardised packaging in England was associated with changes in illicit tobacco and cross-border purchasing. METHODS: We used Smoking Toolkit Study data covering the time period from 2012 to 2020. We ran time-series analysis using Autoregressive Integrated Moving Average with Exogenous Variable models to investigate the monthly changes in illicit tobacco and cross-border purchasing in England. The model was adjusted for other tobacco control policies implemented during the relevant time period and tobacco pricing. We used May 2017 as an implementation point and run sensitivity analysis using July 2016 and February 2017 as alternative implementation points given phased introduction of the policy. RESULTS: The average prevalence of illicit tobacco and cross-border purchasing in the past 6 months was 14.4%. The implementation of standardised tobacco packaging legislation was associated with a monthly decline in illicit tobacco and cross-border purchases after May 2017 by 0.16% per month (beta=-0.158, 95% CI -0.270 to -0.046). The results were robust to considering different implementation points for the policy (July 2016: beta=-0.109, 95% CI -0.213 to -0.005; February 2017: beta=-0.141, 95% CI -0.245 to -0.036). CONCLUSIONS: In contrast to the tobacco industry's argument that the legislation would lead to an increase in the illicit tobacco and cross-border market, this study demonstrates that the implementation of the policy is associated with a decline in illicit tobacco and cross-border purchases in England.
Mi J, Anindya K, Tran-Duy A, et al., 2023, Impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life of Australians: a population-based longitudinal data analysis, Frontiers in Public Health, Vol: 11, ISSN: 2296-2565
Background: Health risk factors, including smoking, excessive alcohol consumption, overweight, obesity, and insufficient physical activity, are major contributors to many poor health conditions. This study aimed to assess the impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life (HRQoL) in Australia.Methods: We used two waves of the nationally representative Household, Income, and Labor Dynamics in Australia (HILDA) Survey from 2013 and 2017 for the analysis. Healthcare resource utilization included outpatient visits, hospitalisations, and prescribed medication use. Work-related outcomes were assessed through employment status and sick leave. HRQoL was assessed using the SF-6D scores. Generalized estimating equation (GEE) with logit or log link function and random-effects regression models were used to analyse the longitudinal data on the relationship between health risk factors and the outcomes. The models were adjusted for age, sex, marital status, education background, employment status, equilibrium household income, residential area, country of birth, indigenous status, and socio-economic status.Results: After adjusting for all other health risk factors covariates, physical inactivity had the greatest impact on healthcare resource utilization, work-related outcomes, and HRQoL. Physical inactivity increased the likelihood of outpatient visits (AOR = 1.60, 95% CI = 1.45, 1.76 p < 0.001), hospitalization (AOR = 1.83, 95% CI = 1.66–2.01, p < 0.001), and the probability of taking sick leave (AOR = 1.31, 95% CI = 1.21–1.41, p < 0.001), and decreased the odds of having an above population median HRQoL (AOR = 0.48, 95% CI = 0.45–0.51, p < 0.001) after adjusting for all other health risk factors and covariates. Obesity had the greatest impact on medication use (AOR = 2.02, 95% CI = 1.97–2.29, p < 0.001) after adjusting for all other health risk factors and covariat
Vrinten C, Parnham JC, Radó MK, et al., 2023, Associations of social media use with smoking and e-cigarettes: a national longitudinal study., Lancet, Vol: 402 Suppl 1
BACKGROUND: Social media use is high among children and young people and might influence health behaviours. We examined social media use and use of tobacco and e-cigarettes in the UK. METHODS: We used data from participants aged 10-25 years from the UK Household Longitudinal Study (January 2015-January 2022). Participants were asked: "On a normal weekday, that is Monday to Friday, how many hours do you spend chatting or interacting with friends through a social website or app like that?". Specific social media platforms were not specified. Responses were none, less than 1 h, 1-3 h, 4-6 h, 7 h or more. Outcomes were current tobacco smoking and e-cigarette use. Generalised Estimating Equation (GEE) logistic regression models investigated associations of social media use with tobacco and e-cigarette use, and fixed effects analyses investigated changes in social media use with uptake of both products. Models included possible confounders such as age, sex, household income, ethnicity (White vs non-White) and use of tobacco or e-cigarettes by others within the home. All participants gave written informed consent. FINDINGS: The analytic sample included 10 808 participants with 27 962 observations (mean age 15·7 years [SD 3·8], 5080 [47%] male, 5728 [53%] female, and 7868 [73%] White). Current tobacco smoking was reported at one or more timepoints by 929 (8·6%) participants, and current e-cigarette use by 270 (2·5%) participants. In adjusted GEE models, all levels of social media use were associated with greater odds of current smoking than no use. This association was particularly apparent at higher levels of use adjusted odds ratio [aOR] 3·11, 95% CI 2·41-4·03 for ≥7 h use vs no use), with similar associations for e-cigarettes (aOR 3·04, 2·11-4·40 for ≥7 h use vs no use). Fixed effects analyses also found increased use of social media to be associated with increased uptake of both produc
Sukriti KC, Tewolde S, Laverty AA, et al., 2023, Uptake and adoption of the NHSApp in England: an observational study, BRITISH JOURNAL OF GENERAL PRACTICE, ISSN: 0960-1643
Vrinten C, Parnham J, Filippidis F, et al., 2023, Patterns of cigarette and e-cigarette use among UK adolescents: a latent class analysis of the Millennium Cohort Study, European Journal of Public Health, Vol: 33, Pages: 857-863, ISSN: 1101-1262
Background Patterning of cigarette and e-cigarette use among young people remains poorlycharacterised. We aimed to describe these patterns in the UK Millennium Cohort Study atage 14 and 17 years.Methods Data on cigarette and e-cigarette use come from 9,731 adolescents. Latent class analysisassigned participants to membership of classes of product use and multinomial logisticregression analyses assessed differences in the likelihood of belonging to classes bysociodemographic (age, gender, ethnicity, household income, maternal education, countryof residence) and smoking-related social factors (caregiver tobacco use, caregiver ecigarette use, and peer smoking).ResultsWe identified four classes of use: 45.8% of adolescents continued to abstain from cigarettesor e-cigarettes; 21.3% experimented (used once or in the past but not currently) withcigarettes and/or e-cigarettes by age 17 but were not current users; 19.0% were lateadopters, characterised by low levels of use at age 14 but high levels of experimentation andcurrent use at age 17; and 13.9% were early adopters, characterised by high levels ofexperimentation and current use at ages 14 and 17. At age 17, 70.4% of early adopterssmoked cigarettes regularly plus an additional 27.3% experimented with cigarettes.Corresponding percentages for e-cigarettes were 37.9% and 58.9%. Tobacco and ecigarette use by caregivers, and cigarette use by peers, were associated with being both lateadopters and early adopters. ConclusionApproximately one in seven adolescents in the UK are early adopters of nicotine products.This highlights the need to develop and implement effective policies to prevent nicotine useuptake.
Patterson R, Ogilvie D, Laverty AA, et al., 2023, Equity impacts of cycling investment in England: a natural experimental study using longitudinally linked individual-level census data., SSM: Population Health, Vol: 23, ISSN: 2352-8273
BACKGROUND: Cycling is beneficial for health and the environment but the evidence on the overall and differential impacts of interventions to promote cycling is limited. Here we assess the equity impacts of funding awarded to support cycling in 18 urban areas between 2005 and 2011. METHODS: We used longitudinally linked 2001 and 2011 census data from 25,747 individuals in the Office for National Statistics Longitudinal Study of England and Wales. Logistic regression was used to assess the impacts of funding on commute mode as the interaction between time and area (intervention/comparison) in individual-level difference-in-difference analyses, adjusting for a range of potential confounding factors. Differential impacts were examined by age, gender, education and area-level deprivation, and uptake and maintenance of cycling were examined separately. RESULTS: Difference-in-difference analyses showed no intervention impact on cycle commuting prevalence in the whole sample (AOR = 1.08; 95% CI 0.92, 1.26) or among men (AOR = 0.91; 95% CI 0.76, 1.10) but found an intervention effect among women (AOR = 1.56; 95% CI 1.16, 2.10). The intervention promoted uptake of cycling commuting in women (AOR = 2.13; 95% CI 1.56, 2.91) but not men (AOR = 1.19; 95% CI 0.93, 1.51). Differences in intervention effects by age, education and area-level deprivation were less consistent and more modest in magnitude. CONCLUSIONS: Living in an intervention area was associated with greater uptake of cycle commuting among women but not men. Potential gender differences in the determinants of transport mode choice should be considered in the design and evaluation of future interventions to promote cycling.
McKevitt S, White M, Petticrew M, et al., 2023, Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England, JOURNAL OF PUBLIC HEALTH, ISSN: 1741-3842
Parnham JC, Vrinten C, Cheeseman H, et al., 2023, Changing awareness and sources of tobacco and e-cigarettes among children and adolescents in Great Britain, TOBACCO CONTROL, ISSN: 0964-4563
Tinner L, Holman D, Ejegi-Memeh S, et al., 2023, Use of intersectionality theory in interventional health research in high-income countries: a scoping review, International Journal of Environmental Research and Public Health, Vol: 20, Pages: 1-20, ISSN: 1660-4601
BACKGROUND: Intersectionality theory posits that considering a single axis of inequality is limited and that considering (dis)advantage on multiple axes simultaneously is needed. The extent to which intersectionality has been used within interventional health research has not been systematically examined. This scoping review aimed to map out the use of intersectionality. It explores the use of intersectionality when designing and implementing public health interventions, or when analysing the impact of these interventions. METHODS: We undertook systematic searches of Medline and Scopus from inception through June 2021, with key search terms including "intersectionality", "interventions" and "public health". References were screened and those using intersectionality and primary data from high-income countries were included and relevant data synthesised. RESULTS: After screening 2108 studies, we included 12 studies. Six studies were qualitative and focused on alcohol and substance abuse (two studies), mental health (two studies), general health promotion (one study) and housing interventions (one study). The three quantitative studies examined mental health (two studies) and smoking cessation (one study), while the three mixed-method studies examined mental health (two studies) and sexual exploitation (one study). Intersectionality was used primarily to analyse intervention effects (eight studies), but also for intervention design (three studies), and one study used it for both design and analysis. Ethnicity and gender were the most commonly included axes of inequality (11 studies), followed by socio-economic position (10 studies). Four studies included consideration of LGBTQ+ and only one considered physical disability. Intersectional frameworks were used by studies to formulate specific questions and assess differences in outcomes by intersectional markers of identity. Analytical studies also recommended intersectionality approaches to
Chamberlain RC, Fecht D, Davies B, et al., 2023, Health effects of Low Emission and Congestion Charging Zones: a systematic review, The Lancet Public Health, Vol: 8, Pages: e559-e574, ISSN: 2468-2667
Background: Low Emission Zones (LEZ) and Congestion Charging Zones (CCZ) have beenimplemented in several cities globally. We systematically reviewed the evidence on the impacts ofthese air pollution and congestion reduction schemes on a range of physical health outcomes.Methods: We searched MEDLINE, Embase, Web of Science, IDEAS, Greenfile, and TRID databasesthrough 4 January 2023. We included studies that evaluated the effect of the implementation of aLEZ or CCZ on air pollution-related health outcomes, including cardiovascular and respiratorydiseases, birth outcomes, dementia, lung cancer and diabetes, or road traffic injuries (RTI) usinglongitudinal study designs. We excluded studies without empirical health data. Two authorsindependently assessed papers for inclusion. Results were narratively synthesised and visualisedusing harvest plots. Risk of bias was assessed using the Graphic Appraisal Tool for Epidemiologicalstudies for correlation studies. The protocol was registered with PROSPERO (CRD42022311453).Findings: Of 2,279 studies screened, sixteen were included. Eight studies assessed LEZ in London,Milan, Tokyo, and several German cities, seven assessed the London CCZ and one the StockholmCCZ. Several LEZ studies identified positive effects on air pollution-related outcomes, with reductionsin at least some cardiovascular disease subcategories in five out of six studies investigating thisoutcome, although results for other health outcomes were less consistent. Six out of seven studieson the London CCZ reported reductions in total and/or car RTIs, although one reported an increasein cyclist/motorcyclist injuries and one reported an increase in serious/fatal injuries.Interpretation: Studies were limited in number and varied in design, intervention, and outcomes.Current evidence suggests LEZ schemes reduce air pollution related health outcomes, with thestrongest impact on cardiovascular disease. Evidence on CCZ is mainly limited to London butsuggests they reduce o
Albers PN, Rinaldi C, Brown H, et al., 2023, Natural experiments for the evaluation of place-based public health interventions: a methodology scoping review, Frontiers in Public Health, Vol: 11, Pages: 1-13, ISSN: 2296-2565
INTRODUCTION: Place-based public health evaluations are increasingly making use of natural experiments. This scoping review aimed to provide an overview of the design and use of natural experiment evaluations (NEEs), and an assessment of the plausibility of the as-if randomization assumption. METHODS: A systematic search of three bibliographic databases (Pubmed, Web of Science and Ovid-Medline) was conducted in January 2020 to capture publications that reported a natural experiment of a place-based public health intervention or outcome. For each, study design elements were extracted. An additional evaluation of as-if randomization was conducted by 12 of this paper's authors who evaluated the same set of 20 randomly selected studies and assessed 'as-if ' randomization for each. RESULTS: 366 NEE studies of place-based public health interventions were identified. The most commonly used NEE approach was a Difference-in-Differences study design (25%), followed by before-after studies (23%) and regression analysis studies. 42% of NEEs had likely or probable as-if randomization of exposure (the intervention), while for 25% this was implausible. An inter-rater agreement exercise indicated poor reliability of as-if randomization assignment. Only about half of NEEs reported some form of sensitivity or falsification analysis to support inferences. CONCLUSION: NEEs are conducted using many different designs and statistical methods and encompass various definitions of a natural experiment, while it is questionable whether all evaluations reported as natural experiments should be considered as such. The likelihood of as-if randomization should be specifically reported, and primary analyses should be supported by sensitivity analyses and/or falsification tests. Transparent reporting of NEE designs and evaluation methods will contribute to the optimum use of place-based NEEs.
Goodman A, Laverty AA, Furlong J, et al., 2023, The Impact of 2020 Low Traffic Neighbourhoods on Levels of Car/Van Driving among Residents: Findings from Lambeth, London, UK, Findings
<jats:p>We examined how residents’ driving changed after the implementation of low traffic neighbourhoods (LTNs) in Lambeth, London. We used postcode plus numberplate data from controlled parking zones, matched to annual MOT records. From 2018-2020 (‘pre’) to 2021-2023 (‘post’), mean past-year driving decreased by 0.7km/day among residents living inside the new LTNs and increased by 0.6km/day among residents in control areas elsewhere in Lambeth. This represents a difference-in-differences decrease of 1.3km/day (95% confidence interval 0.3 to 2.4) in LTN versus control areas, or a 6.4% relative decrease. Our findings suggest that residents started driving less once their area became an LTN.</jats:p>
Parnham JC, Vrinten C, Rado MK, et al., 2023, Multistate transition modelling of e-cigarette use and cigarette smoking among youth in the UK, LANCET CHILD & ADOLESCENT HEALTH, Vol: 7, Pages: 297-297, ISSN: 2352-4642
Laverty AA, Li CR, Chang KC-M, et al., 2023, Cigarette taxation and price differentials in 195 countries during 2014-2018, Tobacco Control, Vol: 32, Pages: 359-365, ISSN: 0964-4563
INTRODUCTION: Raising tobacco prices via increased taxation may be undermined by tobacco industry tactics to keep budget cigarettes on the market. Price differentials between budget and premium cigarettes allow smokers to trade down in the face of average price rises thus attenuating health benefits. This study examines global trends of price differentials and associations with taxation. METHODS: Ecological analysis of country-level panel data of 195 countries' price differentials was performed and compared against total, specific excise, ad valorem and other taxation. Price differentials were expressed as the difference between budget cigarette and premium pack prices (as % of premium pack prices). Two-level linear regression models with repeated measurements (2014, 2016 and 2018) nested within each country assessed the association between country-level taxation structures and price differentials, adjusted for year, geographical region and income group. RESULTS: Worldwide, median price differential between budget and premium 20-cigarette packs was 49.4% (IQR 25.9%-70.0%) in 2014 and 44.4% (IQR 22.5%-69.4%) in 2018 with significant regional variation. The largest price differentials in 2018 were in Africa, with the lowest in Europe. Total taxation was negatively associated with price differentials (-1.5%, 95% CI -2.5% to -0.4% per +10% total taxation) as was specific excise taxation (-2.5%, 95% CI -3.7% to -1.2% per +10% specific excise tax). We found no statistically significant association between ad valorem taxation and price differentials. CONCLUSION: Total levels of taxation and specific excise taxes were associated with smaller price differentials. Implementing high specific excise taxes may reduce price differentials and improve health outcomes.
Parnham JC, McKevitt S, Vamos EP, et al., 2023, Evidence use in the UK's COVID-19 free school meals policy: a thematic content analysis, Policy Design and Practice, Vol: 6, Pages: 328-343, ISSN: 2574-1292
Free school meals (FSM) are a well-recognized intervention for tackling food insecurity among school children. National school closures during the COVID-19 pandemic meant that there was a need to rapidly adapt the delivery of FSM. A range of food-assistance policies were implemented, but it is not clear if they were evidence-based. This study aimed to determine the transparency of evidence use and identify other competing influences in the UK’s FSM policy decisions. Thematic content analysis was used to review 50 publicly available policy documents and debate transcripts on FSM policy published between March 2020 and 2021. This period covered the first national school closures (March 2020–July 2020), school holidays, and the second national school closures (January 2021–March 2021). The Evidence Transparency Framework (ETF) was used to assess the transparency of evidence use in policy documents. We found that overall transparency of evidence use was poor but was better for the Holiday Activities and Food (HAF) program. The Government showed preference for replacing FSM with food parcels, rather than more agentic modes of food assistance, such as cash-vouchers. This preference appeared to be closely aligned with ideological views on the welfare state. With an absence of evidence, value-based reasoning took precedent and was polarized by social media. This article highlights the need for a formal review into FSM, one which includes a comparison of low and high agentic food assistance policies. Such a review would address the evidence gap, improve food assistance policy, and aid policymakers in future periods of uncertainty.
Williams PJ, Philip KEJ, Gill NK, et al., 2023, Immediate, remote smoking cessation intervention in participants undergoing a targeted lung health check: quit smoking lung health intervention trial, a randomized controlled trial, Chest, Vol: 163, Pages: 455-463, ISSN: 0012-3692
BACKGROUND: Lung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective. RESEARCH QUESTION: Does an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)? STUDY DESIGN AND METHODS: In a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3 months. Differences between groups were assessed using logistic regression. RESULTS: Three hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48% of whom were women, were randomized to TSI (n = 152) or UC (n = 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.61; P = .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention. INTERPRETATION: Immediate provision of an intensive telephone-based smoking cessation intervention, delivered within a targeted lung screening context, is associated with incr
McKevitt S, White M, Petticrew M, et al., 2023, Typology of how ‘harmful commodity industries’ interact with local governments in England: a critical interpretive synthesis, BMJ Global Health, Vol: 8, Pages: 1-13, ISSN: 2059-7908
Introduction Industries that produce and market potentially harmful commodities or services (eg, tobacco, alcohol, gambling, less healthy foods and beverages) are a major influence on the drivers of behavioural risk factors for non-communicable diseases. The nature and impact of interactions between public bodies and ‘harmful commodity industries’ (HCIs) has been widely recognised and discussed at national and international levels, but to date little is known about such interactions at local or regional government levels. This study aimed to identify and characterise actual and potential interactions and proposes a typology of interactions between HCIs and English local authorities (LAs).Methods Five electronic databases covering international literature (PubMed, EBSCO, OVID, Scopus and Web of Science) were searched up to June 2021. We also performed online searches for publicly available, web-based grey literature and documented examples of interactions in an English LA context. We conducted a critical interpretive synthesis of the published and grey literature to integrate and conceptualise the data in the context of English LAs.Results We included 47 published papers to provide the frame for the typology, which was refined and contextualised for English LAs through the available grey literature. Three categories were developed, describing the medium through which interactions occur: (1) direct involvement with LAs, (2) involvement through intermediaries and (3) involvement through the local knowledge space. Within these, we grouped interactions into 10 themes defining their nature and identified illustrative examples.Conclusion Our typology identifies complex inter-relationships and characterises interactions between HCIs and LAs, with illustrative examples from English LAs. Drawn from well-established theories and frameworks in combination with contextual information on English LAs, this typology explores the LA perspective and could help local decis
Williams P, Cheeseman H, Arnott D, et al., 2023, Use of tobacco and e-cigarettes among youth in Great Britain in 2022: analysis of a cross sectional survey, Tobacco Induced Diseases, Vol: 21, ISSN: 1617-9625
Introduction:Although e-cigarettes can be an effective form of nicotine substitution for adults attempting to quit smoking, their use among children and young people is a concern. Accurate data about this are needed to inform debates over policy and regulation in the UK and elsewhere.Methods:Using data from an online survey of 2613 youth aged 11–18 years, conducted by the market research company YouGov in March 2022, we present prevalence estimates of e-cigarette and tobacco use. We use logistic regression models to assess differences in e-cigarette use, tobacco use and use of disposable e-cigarettes across a range of covariates including age, sex, tobacco smoking status, social class, and country.Results:Among the 18.0% of those surveyed who reported ever having smoked a cigarette, 83.9% were not regular (at least once per week) smokers and 16.1% were (15.1% and 2.9% of the total sample, respectively). Among the 19.2% of those surveyed who had ever used an e-cigarette, 79.2% were not regular users, while 20.8% were (15.2% and 4.0% of the total sample, respectively). Regular e-cigarette use was more common than regular tobacco smoking (4.0% vs 2.9%). E-cigarette use was more common among those who also smoked tobacco, with 9.0% of never e-cigarette users ever smoking tobacco, compared with 89.4% of regular e-cigarette users. Both smoking and e-cigarette use were associated with increasing age and use by others within the home, but not with social class. Use of disposable e-cigarettes was reported by 53.8% of those who have ever used an e-cigarette, and more common among females than males.Conclusions:Regular e-cigarette use is now more common than smoking in children and youth, though the majority of this is among those who have also smoked tobacco. Measures to reduce the appeal of both e-cigarettes and tobacco to children and young people are warranted.
Filippidis FT, Laverty AA, 2023, Tobacco, novel tobacco and nicotine products, and respiratory health, ERS Monograph, Vol: 2023, Pages: 80-88, ISSN: 2312-508X
Tobacco smoking and exposure to second-hand smoke have been shown to negatively impact human health, including, but not limited to, increased risk of lung cancer, COPD, asthma and lower respiratory tract infections. Novel tobacco and nicotine products, such as e-cigarettes and heated tobacco products, are promoted as less harmful, but whether they actually pose significantly lower health risks is contested. Use of all tobacco and nicotine products is higher among disadvantaged groups and contributes to health inequalities among people in different socioeconomic levels. Tobacco control policies have been shown to substantially lower the prevalence of tobacco use and reduce inequalities within and among countries, while different policies may be needed to address concerns regarding novel products.
Rajani N, Hoelscher J, Laverty A, et al., 2023, A multi-country analysis of transnational tobacco companies’ market share, Tobacco Induced Diseases, Vol: 21, ISSN: 1617-9625
Introduction:The international tobacco market is dominated by five transnational tobacco companies (TTCs) which continue to interfere with measures to reduce tobacco consumption. The aim of this study is to better understand the current international tobacco industry market structure by providing an overview of the market share of these five companies globally.Methods:A longitudinal multi-country study design was used to understand market share trends across 90 different countries from 2011 to 2020. Descriptive analyses were conducted based on market share and market size data obtained from Euromonitor Passport. Market share (%), maximal market share (%) and cumulative market share (%) were calculated. Maps and boxplots are used to present the descriptive analyses. Median cumulative TTC market share and interquartile ranges for each year were calculated and stratified by country income level.Results:The average maximal market share of one company in a country was 50% (IQR: 40.0–63.5) in 2020 compared to 51.5% in 2011 (IQR: 41.3–69.0). One of the five TTCs had the highest market share in 77 out of the 90 countries. Philip Morris International was the main market player in 38 countries, followed by British American Tobacco (24), Japan Tobacco International (8), Imperial Brands (6), and lastly China National Tobacco Corporation was only dominant in China. The percentage of cigarettes manufactured by one of the five TTCs remained relatively stable between 2011 (86.4%) and 2020 (85.2%). Average cumulative TTC market shares increased between 2011 and 2020 in both low- and middle-, and high-income countries.Conclusions:The international tobacco market is concentrated with a small number of large players, and this has not changed substantially between 2011 and 2020. The impact of this on the ability of the tobacco industry to resist policy changes is unknown but presents a cause for concern.
Williams P, Philip K, Alghamdi S, et al., 2023, Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis, Chronic Respiratory Disease, Vol: 20, Pages: 1-14, ISSN: 1479-9723
IntroductionLung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established.MethodsWe undertook a systematic review and meta-analysis of smoking cessation interventions delivered during lung health screening, published prior to 20/07/2022 MEDLINE, PsychINFO, CENTRAL, EMBASE, CINAHL and Scopus databases. Two reviewers screened titles, and abstracts, four reviewed each full text using prespecified criteria, extracted relevant data, assessed risk of bias and confidence in findings using the GRADE criteria. The review was registered prospectively on PROSPERO (CRD42021242431).Results10 randomised controlled trials and three observational studies with a control group were identified. Meta-analysis of nine RCTs demonstrated that smoking cessation interventions delivered during lung screening programmes increased quit rates compared to usual care (odds ratios: 2.01, 95%: 1.49–2.72 p < 0.001). Six RCTs using intensive (≥3 behavioural counselling sessions) interventions demonstrated greater quit rates compared to usual care (OR: 2.11, 95% CI 1.53–2.90, p < 0.001). A meta-analysis of two RCTs found intensive interventions were more effective than non-intensive (OR: 2.07, 95%CI 1.26–3.40 p = 0.004), Meta-analysis of two RCTs of non-intensive interventions (≤2 behavioural counselling sessions or limited to online information audio take home materials such as pamphlets) did not show a higher quit rate than usual care (OR: 0.90, 95% CI 0.39–2.08 p = 0.80).DiscussionModerate quality evidence supports smoking cessation interventions delivered within a lung screening setting compared to usual care, with high-quality evidence that more intensive interventions are likely to be most effective.
Clara S, Laverty A, Oyinlola O, 2022, The prevalence and socio-demographic associations of household food insecurity in seven slum sites across Nigeria, Kenya, Pakistan, and Bangladesh. A cross-sectional study, PLoS One, Vol: 17, ISSN: 1932-6203
Although the proportion of people living in slums is increasing in low- and middle-income countries and food insecurity is considered a severe hazard for health, there is little research on this topic. This study investigated and compared the prevalence and socio-demographic associations of household food insecurity in seven slum settings across Nigeria, Kenya, Pakistan, and Bangladesh. Data were taken from a cross-sectional, household-based, spatially referenced survey conducted between December 2018 and June 2020. Household characteristics and the extent and distribution of food insecurity across sites was established using descriptive statistics. Multivariable logistic regression of data in a pooled model including all slums (adjusting for slum site) and site-specific analyses were conducted. In total, a sample of 6,111 households were included. Forty-one per cent (2,671) of all households reported food insecurity, with varying levels between the different slums (9–69%). Household head working status and national wealth quintiles were consistently found to be associated with household food security in the pooled analysis (OR: 0·82; CI: 0·69–0·98 & OR: 0·65; CI: 0·57–0·75) and in the individual sites. Households which owned agricultural land (OR: 0·80; CI: 0·69–0·94) were less likely to report food insecurity. The association of the household head’s migration status with food insecurity varied considerably between sites. We found a high prevalence of household food insecurity which varied across slum sites and household characteristics. Food security in slum settings needs context-specific interventions and further causal clarification.
Lee TY, Anindya K, Marthias T, et al., 2022, Low physical activity is associated with adverse health outcome and higher costs in Indonesia: a national panel study, Frontiers in Cardiovascular Medicine, Vol: 9, Pages: 1-11, ISSN: 2297-055X
Aims: To assess the association between low physical activity, cardiovascular disease (CVD) and risk factors, health service utilization, risk of catastrophic health expenditure, and work productivity in Indonesia.Methods: In this population-based, panel data analysis, we used data from two waves of the Indonesian Family Life Survey (IFLS) for 2007/2008 and 2014/2015. Respondents aged 40–80 years who participated in both waves were included in this study (n = 5,936). Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ-SF). Multinomial logistic regression model was used to examine factors associated with physical activity levels (low, moderate, and high). We applied a series of multilevel mixed-effect panel regression to examine the associations between physical activity and outcome variables.Results: The prevalence of low physical activity increased from 18.2% in 2007 to 39.6% in 2014. Compared with those with high physical activity, respondents with low physical activity were more likely to have a 10-year high CVD risk (AOR: 2.11, 95% CI: 1.51–2.95), use outpatient care (AOR: 1.26, 95% CI: 1.07–1.96) and inpatient care (AOR 1.45, 95% CI: 1.07–1.96), experience catastrophic health expenditure of 10% of total household expenditure (AOR: 1.66, 95% CI: 1.21–2.28), and have lower labor participation (AOR: 0.24, 95% 0.20–0.28).Conclusions: Low physical activity is associated with adverse health outcomes and considerable costs to the health system and wider society. Accelerated implementation of public health policies to reduce physical inactivity is likely to result in substantial population health and economic benefits.
Rojas-Garcia A, Holman D, Tinner L, et al., 2022, Use of intersectionality theories in interventional health research in high-income countries: a systematic scoping review, LANCET, Vol: 400, Pages: 58-58, ISSN: 0140-6736
Vrinten C, Parnham JC, Filippidis FT, et al., 2022, Risk factors for adolescent smoking uptake: an analysis of prospective data from the Millennium Cohort Study, Publisher: ELSEVIER SCIENCE INC
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