Publications
175 results found
Filippidis FT, Laverty AA, Mons U, et al., 2018, Changes in smoking cessation assistance in the European Union between 2012 and 2017: pharmacotherapy versus counselling versus e-cigarettes, Tobacco Control, Vol: 28, Pages: 95-100, ISSN: 0964-4563
BACKGROUND: The landscape of smoking cessation may have changed in Europe recently. OBJECTIVES: To identify changes in use of smoking cessation assistance in the European Union (EU) and factors associated with use of cessation assistance. METHODS: Data from the 2012 (n=9921) and 2017 (n=9489) waves of the Eurobarometer survey were used. Self-reported use of smoking cessation assistance was assessed among smokers who had ever tried to quit and former smokers. Changes in use of each type of assistance were assessed using logistic regression. RESULTS: Among current and former smokers, those who had ever attempted to quit without assistance increased from 70.3% (2012) to 74.8% (2017). Current smokers were more likely to have used any assistance compared with former smokers (P<0.001). Use of e-cigarettes for smoking cessation assistance increased (3.7% to 9.7%)%), while use of pharmacotherapy (14.6% to 11.1%)%) and smoking cessation services (7.5% to 5.0%)%) declined. Younger people were more likely to have reported e-cigarette use for smoking cessation but less likely to have used a cessation service. Individuals living in countries with comprehensive smoking cessation policies were more likely to have used any cessation assistance (adjusted OR (aOR)=1.78; 95% CI 1.15 to 2.76), pharmacotherapy (aOR=3.44; 95% CI 1.78 to 6.66) and smoking cessation services (aOR=2.27; 95% CI 1.27 to 4.06) compared with those living in countries with weak smoking cessation policies. CONCLUSIONS: These findings highlight the need for approaches that ensure that smokers get support to quit smoking across the EU. The question of whether the availability of e-cigarettes will displace other methods, and the impact of such a displacement, should be closely evaluated.
Seferidi P, Laverty AA, Pearson-Stuttard J, et al., 2018, Implications of Brexit on the effectiveness of the UK soft drinks industry levy upon coronary heart disease in England: a modelling study, Public Health Nutrition, Vol: 21, Pages: 3431-3439, ISSN: 1368-9800
Objective:An industry levy on sugar-sweetened beverages (SSB) was implemented in the UK in 2018. One year later, Brexit is likely to change the UK trade regime with potential implications for sugar price. We modelled the effect of potential changes in sugar price due to Brexit on SSB levy impacts upon CHD mortality and inequalities.Design:We modelled a baseline SSB levy scenario; an SSB levy under ‘soft’ Brexit, where the UK establishes a free trading agreement with the EU; and an SSB levy under ‘hard’ Brexit, in which World Trade Organization tariffs are applied. We used the previously validated IMPACT Food Policy model and probabilistic sensitivity analysis to estimate the effect of each scenario on CHD deaths prevented or postponed and life-years gained, stratified by age, sex and socio-economic circumstance, in 2021.Setting:England.Subjects:Adults aged 25 years or older.Results:The SSB levy was associated with approximately 370 (95 % uncertainty interval 220, 560) fewer CHD deaths and 4490 (2690, 6710) life-years gained in 2021. Associated reductions in CHD mortality were 4 and 8 % greater under ‘soft’ and ‘hard’ Brexit scenarios, respectively. The SSB levy was associated with approximately 110 (50, 190) fewer CHD deaths in the most deprived quintile compared with 60 (20, 100) in the most affluent, under ‘hard’ Brexit.Conclusions:Our study found the SSB levy resilient to potential effects of Brexit upon sugar price. Even under ‘hard’ Brexit, the SSB levy would yield benefits for CHD mortality and inequalities. Brexit negotiations should deliver a fiscal and regulatory environment which promotes population health.
Patterson R, Webb E, Mindell JS, et al., 2018, Ethnic group differences in impacts of free bus passes in England: A national study, Journal of Transport and Health, Vol: 11, Pages: 1-14, ISSN: 2214-1405
BackgroundA pass permitting free bus travel for older people (aged ≥60 years) in England was introduced in 2006. There has been no examination of whether this scheme has differential effects across ethnic groups. We examined whether Black and South Asian participants were more likely to hold a bus pass and have higher associated levels of active travel than White participants.MethodsData come from the National Travel Survey, a nationally representative sample of the travel patterns of households in England. Using cross-sectional data from 33,344 participants eligible for a bus pass 2006–2014, we investigated ethnic differences in bus pass uptake and associations with bus use, active travel and walking ≥3 times per week.ResultsBlack participants were more likely to hold a bus pass (84%) than South Asian or White participants (74% and 75% respectively). Black participants accumulated 56% of their active travel as part of bus journeys, compared with 29% in White and 44% in South Asian participants. Bus pass possession was associated with increased odds of bus-related active travel in all ethnic groups.ConclusionsThese findings suggest that the free bus pass scheme in England is associated with higher levels of active travel and that these may be greater among minority ethnic groups. Removing financial barriers to active travel could produce important health benefits particularly among ethnic minority groups, who have low levels of leisure-based physical activity.
Laverty AA, Filippidis FT, Vardavas C, 2018, Patterns, trends and determinants of e-cigarette use in 28 European Union Member States 2014-2017, Preventive Medicine, Vol: 116, Pages: 13-18, ISSN: 0091-7435
There is a lack of nationally representative data on regular e-cigarette use, as well as on the transition from experimentation to regular use. This study examines changes in these in Europe between 2014 and 2017. Data come from the 2014 (n = 27,801) and 2017 (n = 27,901) adult Special Eurobarometer for Tobacco Survey, providing nationally representative surveys of 28 EU member states. We defined regular use of e-cigarettes as daily or weekly use from a question on frequency of e-cigarette use. Among ever users of e-cigarettes we assessed socio-demographic correlates of becoming a regular user. 1.5% of the EU population were regular e-cigarette users in 2014, which had risen to 1.8% in 2017. In 2017 63 million Europeans aged 15 or older had ever used e-cigarettes (95% CI, 59.9 million–66.2 million), and 7.6 million (95% CI, 6.5million–8.9 million) were regular e-cigarette users. Among those who had ever used e-cigarettes, participants aged 15–24 years were less likely to be regular user than those aged ≥55 years (16.9% vs. 38.1%), as were never smokers compared with current and former smokers (12.8% vs. 27.0% vs. 41.3%). The proportion of adults who were regular e-cigarette users in 2017 ranged from 4.7% in the UK to 0.2% in Bulgaria. There have been slight rises in the proportion of people regularly using e-cigarettes in the EU, and this varies considerably between member states, indicating the role of the regional environment in supporting or deterring e-cigarette use.
Shather Z, Laverty A, Bottle RA, et al., 2018, Sustained socio-economic inequalities in hospital admissions for cardiovascular events among people with diabetes in England, The American Journal of Medicine, Vol: 131, Pages: 1340-1348, ISSN: 0002-9343
ObjectiveThis study aimed to determine changes in absolute and relative socio-economic inequalities in hospital admissions for major cardiovascular events and procedures among people with diabetes in England.MethodsWe identified all patients with diagnosed diabetes aged ≥45 years admitted to hospital in England between 2004-2005 and 2014-2015 for acute myocardial infarction, stroke, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Socio-economic status was measured using Index of Multiple Deprivation. Diabetes-specific admission rates were calculated for each year by deprivation quintile. We assessed temporal changes using negative binomial regression models.ResultsMost admissions for cardiovascular causes occurred among people aged ≥65 years (71%) and men (63.3%), and the number of admissions increased steadily from the least to the most deprived quintile. People with diabetes in the most deprived quintile had 1.94-fold increased risk of acute myocardial infarction (95% CI 1.79-2.10), 1.92-fold risk of stroke (95% CI 1.78-2.07), 1.66-fold risk of CABG (95% CI 1.50-1.74), and 1.76-fold risk of PCI (95% CI 1.64-1.89) compared with the least deprived group. Absolute differences in rates between the least and most deprived quintiles did not significantly change for acute myocardial infarction (P=0.29) and were reduced for stroke, CABG and PCI (by 17.5, 15 and 11.8 per 100,000 people with diabetes, respectively, P≤0.01 for all).ConclusionsSocio-economic inequalities persist in diabetes-related hospital admissions for major cardiovascular events in England. Besides improved risk stratification strategies considering socio-economically defined needs, wide-reaching population-based policy interventions are required to reduce inequalities in diabetes outcomes.
Panter J, Mytton O, Sharp S, et al., 2018, Using alternatives to the car and risk of all-cause, cardiovascular and cancer mortality, Heart, Vol: 104, Pages: 1749-1755, ISSN: 1355-6037
OBJECTIVE: To investigate the associations between using alternatives to the car which are more active for commuting and non-commuting purposes, and morbidity and mortality. METHODS: We conducted a prospective study using data from 3 58 799 participants, aged 37-73 years, from UK Biobank. Commute and non-commute travel were assessed at baseline in 2006-2010. We classified participants according to whether they relied exclusively on the car or used alternative modes of transport that were more active at least some of the time. The main outcome measures were incident cardiovascular disease (CVD) and cancer, and CVD, cancer and all-cause mortality. We excluded events in the first 2 years and conducted analyses separately for those who regularly commuted and those who did not. RESULTS: In maximally adjusted models, regular commuters with more active patterns of travel on the commute had a lower risk of incident (HR 0.89, 95% CI 0.79 to 1.00) and fatal (HR 0.70, 95% CI 0.51 to 0.95) CVD. Those regular commuters who also had more active patterns of non-commute travel had an even lower risk of fatal CVD (HR 0.57, 95% CI 0.39 to 0.85). Among those who were not regular commuters, more active patterns of travel were associated with a lower risk of all-cause mortality (HR 0.92, 95% CI 0.86 to 0.99). CONCLUSIONS: More active patterns of travel were associated with a reduced risk of incident and fatal CVD and all-cause mortality in adults. This is an important message for clinicians advising people about how to be physically active and reduce their risk of disease.
Filippidis F, Laverty A, 2018, “Euphoria” or “Only Teardrops”? Eurovision Song Contest performance, life satisfaction and suicide, BMC Public Health, Vol: 18, ISSN: 1471-2458
BackgroundThe popularity of the Eurovision Song Contest (ESC) in Europe has been high for decades. We aimed to assess whether a country’s performance in the ESC is associated with life satisfaction and suicide mortality in European countries.MethodsWe analysed nationally representative Eurobarometer survey data on life satisfaction from 33 European countries (N = 162,773) and country-level standardised suicide mortality data for years 2009 to 2015. The associations of winning the Contest, performing terribly, and higher final ranking with life satisfaction and suicide rates were all assessed.ResultsWinning the ESC was not statistically significantly associated with increased life satisfaction or suicide rates, although every ten-place increase in final ranking was associated with an increase in life satisfaction (adjusted odds ratios [aOR] 1.04; 95% confidence interval [CI]: 1.02 to 1.05) and a decrease in suicide mortality rates (β = − 0.30; 95% CI: -0.59 to − 0.01). Terrible performance was associated with greater life satisfaction compared to not competing at all (aOR 1.13; 95%CI: 1.07 to 1.20).ConclusionThe good news for participating countries is that just competing at the ESC is associated with higher life satisfaction among the population. As improved performance is linked to Ooh Aah Just a Little Bit of improved life satisfaction, further research into how such international competitions may impact public health is needed.
Chin S, Laverty A, Filippidis F, 2018, Trends and correlates of unhealthy dieting behaviours among adolescents in the United States, 1999-2013, BMC Public Health, Vol: 18, ISSN: 1471-2458
The increase in adiposity problems among United States adolescents has been accompanied by persistently high prevalence of unhealthy dieting behaviours (UDBs) such as fasting, taking diet pills/powders/liquids, and vomiting/taking laxatives.This study aimed to examine the associationsofself-perceptions of weightstatus, weight change intentions (WCIs)and UDBswith sex, age and race, as well astrends of UDBs in American adolescents across the weight spectrum.
Laverty AA, Vamos EP, Filippidis F, 2018, Uptake of e cigarettes among a nationally representative cohort of UK children, TOBACCO PREVENTION & CESSATION, Vol: 4, ISSN: 2459-3087
Introduction:Using nationally representative data this study examined experimentation with and regular use of e-cigarettes among children not using tobacco at age 11 years, followed up to age 14 years.Material and Methods:Data come from 10 982 children in the UK Millennium Cohort Study. Logistic regression assessed experimentation with and current use of e-cigarettes by age 14 years. We considered associations of sociodemographics at age 11 years with subsequent e-cigarette use, including data on family income, peer and caregiver smoking. Subsequent models were adjusted for current tobacco use to assess both the strength of the assocations between e-cigarette use and tobacco, and whether sociodemographics were associated with e-cigarettes independently of tobacco.Results:Among 10 982 children who reported never smoking at age 11 years, 13.9% (1525) had ever tried an e-cigarette by age 14 years, and of these 18.2% (278) reported being current users. Children in lower income households were more likely to have tried an e-cigarette than those in higher income households (Adjusted Odds Ratio, AOR 1.89, p=0.002). Children who reported friend (AOR 2.28, p<0.001) or caregiver smoking (AOR 1.77, p<0.001) at age 11 years were more likely to have tried an e-cigarette by age 14 years. After adjusting for current tobacco use, there was some attenuation of these associations, although associations of friend and caregiver smoking with e-cigarette use remained statistically significant.Conclusions:Children from lower income families were more likely to experiment with e-cigarettes by age 14 years, although this was heavily mediated by concurrent tobacco use. Caregiver and friend smoking are linked to trying e-cigarettes, although these relationships are less clear for regular e-cigarette use.
Laverty AA, Webb E, Vamos EP, et al., 2018, Associations of changes in public transport use with physical activity and adiposity in older adults, International Journal of Behavioral Nutrition and Physical Activity, Vol: 15, ISSN: 1479-5868
Background:We investigated predictors of two increases in older people’s public transport use: initiating public transport use among non-users; and increasing public transport use amongst users. We also investigated associations of these changes with physical activity, Body Mass Index (BMI) and waist circumference.Methods:Data come from the 2008 and 2012 English Longitudinal Study of Ageing (ELSA). Logistic regression assessed predictors of increases in public transport use among adults aged ≥50 years. Gender-stratified logistic and linear models assessed associations of increases in public transport use with changes in physical activity and adiposity.Results:Those becoming eligible for a free older person’s bus pass were more likely to both initiate and increase public transport use (e.g. for initiating public transport use Adjusted Odds Ratio (AORs) 1.77, 95% Confidence Interval 1.35; 2.33). Retiring from paid work was also associated with both initiating and increasing public transport use e.g. AOR 1.57 (1.29; 1.91) for initiating use.Women who increased public transport use had mean BMI 2.03 kg/m2 lower (− 2.84, − 1.21) at follow up than those who did not, although this was attenuated after adjusting for BMI at baseline (− 0.40 kg/m2, − 0.82, 0.01). After adjustment for baseline physical activity those initiating public transport use were more likely to undertake at least some physical activity in 2012 (e.g. AOR for women 1.67, 1.03; 2.72).Conclusions:Both initiating and increasing public transport use were associated with increased physical activity and may be associated with lower adiposity among women. These findings strengthen the case for considering public transport provision as an effective means of promoting healthier ageing.
Laverty AA, Thompson H, Cetateanu A, et al., 2018, Macro-environmental factors and physical activity in 28 European Union countries, European Journal of Public Health, Vol: 28, Pages: 300-302, ISSN: 1101-1262
Data from the representative 2013 Eurobarometer survey were combined with macro-environmental data to assess relationships with different domains of physical activity (PA) in 28 European Union countries. Higher mean annual temperatures were the only macro-environmental factor found to be associated with levels of physical activity; an increase in the mean annual temperature by 1°C was associated with−0.94 fewer minutes of vigorous-intensity activity per week (95% CI: −1.66 to −0.23). This highlights the importance of modifiable influences (e.g. opportunities for active travel) on PA and underscores the potential of public health interventions to raise levels of physical activity.
Ahmad A, Laverty AA, Cowling TE, et al., 2018, Changing nationwide trends in endoscopic, medical and surgical admissions for Inflammatory Bowel Disease: 2003-2013, BMJ Open Gastroenterology, Vol: 5, ISSN: 2054-4774
Background and study aims In the last decade, there have been major advances in inflammatory bowel disease (IBD) management but their impact on hospital admissions requires evaluation. We aim to investigate nationwide trends in IBD surgical/medical elective and emergency admissions, including endoscopy and cytokine inhibitor infusions, between 2003 and 2013.Patients and methods We used Hospital Episode Statistics and population data from the UK Office for National Statistics.Results Age-sex standardised admission rates increased from 76.5 to 202.9/100 000 (p<0.001) and from 69.5 to 149.5/100 000 (p<0.001) for Crohn’s disease (CD) and ulcerative colitis (UC) between 2003–2004 and 2012–2013, respectively. Mean length of stay (days) fell significantly for elective (from 2.6 to 0.7 and from 2.0 to 0.7 for CD and UC, respectively) and emergency admissions (from 9.2 to 6.8 and from 10.8 to 7.6 for CD and UC, respectively). Elective lower gastrointestinal (GI) endoscopy rates decreased from 6.3% to 3.7% (p<0.001) and from 18.4% to 17.6% (p=0.002) for CD and UC, respectively. Elective major abdominal surgery rates decreased from 2.8% to 1.0% (p<0.001) and from 4.9 to 2.4 (p=0.010) for CD and UC, respectively, with emergency rates also decreasing significantly for CD. Between 2006-2007 and 2012-2013, elective admission rates for cytokine-inhibitor infusions increased from 11.1 to 57.2/100 000 and from 1.4 to 12.1/100 000 for CD and UC, respectively.Conclusions Rising IBD hospital admission rates in the past decade have been driven by an increase in the incidence and prevalence of IBD. Lower GI endoscopy and surgery rates have fallen, while cytokine inhibitor infusion rates have risen. There has been a concurrent shift from emergency care to shorter elective hospital stays. These trends indicate a move towards more elective medical management and may reflect improvements in disease control.
Laverty AA, Filippidis FT, Fernandez E, et al., 2018, Associations of e-cigarette experimentation with support for tobacco control policies in the European Union, 2012-2014, Tobacco Induced Diseases, Vol: 16, ISSN: 1617-9625
Introduction:There are limited data on the potential effects of e-cigarette experimentation on support for tobacco control policies. To bridge this gap, we assessed associations between e-cigarette experimentation and support for tobacco control policies in the European Union 2012-2014. We also investigated variations across tobacco-use status, e-cigarette experimentation and sociodemographic characteristics.Methods:Datasets were used from the Special Eurobarometer for Tobacco surveys performed in 2012 (n=26 751) and 2014 (n=27 801). Tobacco control policies assessed were: banning advertising, policies to keep tobacco out of sight, banning online sales, banning flavors, standardized packaging, tax increases, and policies to reduce illicit trade in tobacco. We use multilevel logistic regression models to assess variations in socio-demographics and tobacco/e-cigarette use with support for these policies in 2014, and examined changes in support for these policies, between 2012 and 2014, separately by tobacco-use status (never, current, and former smokers).Results:Population support for tobacco control policies was high in 2014: policies to reduce illicit trade had the highest level of support at 70.1%, while tax increases were the least likely measure to be supported with 52.3% support. Among never and former smokers, experimentation with e-cigarettes was associated with reduced support for all tobacco control policies assessed. For example, never smokers who had experimented with e-cigarettes were less likely to support either tobacco advertising bans (adjusted odds ratio aOR=0.57, 95% confidence interval 0.46-0.71) or standardized packaging for tobacco (aOR=0.58, 95% CI: 0.47-0.71). Former smokers who had experimented with e-cigarettes were less likely to either support standardized packaging for tobacco (aOR=0.70, 95% CI: 0.60-0.82) or keeping tobacco out of sight (aOR=0.77, 95% CI: 0.65-0.90). Among current smokers, e-cigarette experimentation was not associated wi
Laverty AA, Millett C, Webb E, 2018, Take up and use of subsidised public transport: evidence from the English Longitudinal Study of Ageing, Journal of Transport and Health, Vol: 8, Pages: 179-182, ISSN: 2214-1405
BackgroundSince 2006 England has had a bus pass scheme which provides free bus travel for older people. The scheme is universal but there are questions over whether take up is equitable.MethodsData come from waves 6 and 7 of the English Longitudinal Study of Ageing collected in 2012 and 2014. Logistic regression assessed factors associated with take up of a free bus pass by 2014 among eligible people without a pass in 2012, and associations of this with public transport use in 2014.ResultsOf those eligible for a free bus pass in 2012, 16.1% did not have one. 18.8% of these people had taken up a bus pass by 2014. Take up was equitable according to wealth and other individual characteristics but was more common among people retiring from paid work (AOR 2.33, p = 0.025), and moving house (AOR 2.76, p = 0.014). People who took up a free bus pass were more likely to use public transport in 2014 (AOR 3.23, p < 0.001).DiscussionTake up of the free bus pass is equitable across groups, and is strongly linked to public transport use among older people.
Cowling TE, Laverty AA, Harris MJ, et al., 2017, Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey, Journal of the Royal Society of Medicine, Vol: 110, Pages: 440-451, ISSN: 1758-1095
Objective: To examine associations between the contractand ownership type of general practices and patient experiencein England.Design: Multilevel linear regression analysis of a nationalcross-sectional patient survey (General Practice PatientSurvey).Setting: All general practices in England in 2013–2014(n ¼ 8017).Participants: 903,357 survey respondents aged 18 years orover and registered with a general practice for six monthsor more (34.3% of 2,631,209 questionnaires sent).Main outcome measures: Patient reports of experienceacross five measures: frequency of consulting a preferreddoctor; ability to get a convenient appointment; rating ofdoctor communication skills; ease of contacting the practiceby telephone; and overall experience (measured onfour- or five-level interval scales from 0 to 100). Modelsadjusted for demographic and socioeconomic characteristicsof respondents and general practice populations and arandom intercept for each general practice.Results: Most practices had a centrally negotiated contractwith the UK government (‘General Medical Services’54.6%; 4337/7949). Few practices were limited companieswith locally negotiated ‘Alternative Provider MedicalServices’ contracts (1.2%; 98/7949); these practices providedworse overall experiences than General MedicalServices practices (adjusted mean difference 3.04, 95%CI 4.15 to 1.94). Associations were consistent in directionacross outcomes and largest in magnitude for frequencyof consulting a preferred doctor (12.78, 95% CI15.17 to 10.39). Results were similar for practicesowned by large organisations (defined as having 20 practices)which were uncommon (2.2%; 176/7949).Conclusions: Patients registered to general practicesowned by limited companies, including large organisations,reported worse experiences of their care than otherpatients in 2013–2014.
Rann O, Sharland M, Long P, et al., 2017, Did the accuracy of oral amoxicillin dosing of children improve after British National Formulary dose revisions in 2014?: national cross sectional survey in England, BMJ Open, Vol: 7, ISSN: 2044-6055
Objectives Inaccurate antibiotic dosing can lead to treatment failure, fuel antimicrobial resistance and increase side effects. The British National Formulary for Children (BNFC) guidance recommends oral antibiotic dosing according to age bands as a proxy for weight. Recommended doses of amoxicillin for children were increased in 2014 ‘after widespread concerns of under dosing’. However, the impact of dose changes on British children of different weights is unknown, particularly given the rising prevalence of childhood obesity in the UK. We aimed to estimate the accuracy of oral amoxicillin dosing in British children before and after the revised BNFC guidance in 2014.Setting and participants We used data on age and weights for 1556 British children (aged 2–18 years) from a nationally representative cross-sectional survey, the Health Survey for England 2013.Interventions We calculated the doses each child would receive using the BNFC age band guidance, before and after the 2014 changes, against the ‘gold standard’ weight-based dose of amoxicillin, as per its summary of product characteristics.Primary outcome measure Assuming children of different weights were equally likely to receive antibiotics, we calculated the percentage of the children who would be at risk of misdosing by the BNFC age bands.Results Before 2014, 54.6% of children receiving oral amoxicillin would have been underdosed and no child would have received more than the recommended dose. After the BNFC guidance changed in 2014, the number of children estimated as underdosed dropped to 5.8%, but 0.5% of the children would have received too high a dose.Conclusions Changes to the BNFC age-banded amoxicillin doses in 2014 have significantly reduced the proportion of children who are likely to be underdosed, with only a minimal rise in the number of those above the recommended range.
Filippidis FT, Laverty AA, Hone T, et al., 2017, Association of cigarette price differentials and infant mortality in 23 European Union countries, JAMA Pediatrics, ISSN: 2168-6203
Importance: Raising the price of cigarettes by increasing taxation has been associated with improved perinatal and child health outcomes. Transnational tobacco companies have sought to undermine tobacco tax policy by adopting pricing strategies which maintain the availability of budget cigarettes.Objective: To assess associations betweenmedian cigarette prices, cigarette price differentials andinfant mortalityacross Europe.Design: Longitudinal ecological study of regions within the European Union. Setting: 23 European countries; 2004 –2014 (data from 276 sub-national regions).Participants: Infant populations in relevant countries.Interventions: Median cigarette prices and the differential between these and minimum cigarette prices were obtained from Euromonitor International.Pricing differentialswere calculated as the proportions(%) obtained by dividing minimum by median cigarette price. Priceswere adjusted for inflation.Main outcome measure: Annual infant mortality rates. Associations were assessed using linear fixed-effect panel regression modelsadjusted for smoke-free policies; Gross Domestic Product; unemployment rate; education; maternal age; and underlining temporal trends.Results: A €1 per pack increase in the median cigarette price was associated with a decline of -0.23 deaths per 1,000 live births in the same year (95% Confidence Interval [CI]: -0.37 to -0.09) and -0.16 per 1,000 live births the following year (95% CI: -0.30 to -0.03). An increase of 10% in the price differential between median and minimum priced cigarettes was associated with an increase of 0.07 deaths per 1,000 live births (95% CI: 0.01 to 0.13) the following year.Cigarette price increasesacross 23 European countries between 2004 and 2014 were associated with 9,208(95% CI: 8,601to 9,814) fewer infant deaths; 3,195(95% CI: 3,017to 3,372)infant deaths could have been avoided had there beenno differential between median and the minimum priced cigarettes during this period. Conclus
Laverty AA, Filippidis FT, Fernandez E, et al., 2017, E-cigarette use and support for banning e-cigarette use in public places in the European Union., Prev Med, Vol: 105, Pages: 10-14
We investigated the factors associated with support for banning e-cigarette use in public places in the European Union (EU) and how this varies by socio-demographic determinants, use of tobacco, ever use of e-cigarettes and their perceived harm. Data are from the representative Special Eurobarometer for Tobacco survey performed in 2014 (n=27,801) in 28 EU member states. Analyses were conducted separately by tobacco use status (never, current, and former smokers) and e-cigarette experimentation status. 70.9% of never smokers, 63.1% of former smokers and 45.7% of current smokers in the EU supported a ban on the use of e-cigarettes in public places. In all groups, support for banning e-cigarettes in public places was lower among those who had experimented with e-cigarettes (adjusted odds ratios (aOR) 0.43 vs. 0.50 vs. 0.61, among never, current and former smokers respectively) and higher among those who perceived e-cigarettes as harmful (aORs 2.49 vs 2.35 vs. 2.40, among never, current and former smokers respectively). 40.5% of those who had experimented with e-cigarettes supported a ban on use in public places, although levels of support were lower among those who started using e-cigarettes in order to circumvent existing smoking bans (aOR 0.54, 95% Confidence Interval 0.45-0.64). Bans of e-cigarette use in public places in Europe have high levels of public support even among former and current tobacco smokers, although this does vary across population groups. As legislators consider approaches to e-cigarette use, public opinion is likely to become more important to the passing and enforcement of any legislation.
Laverty AA, Bottle R, Kim SH, et al., 2017, Gender differences in hospital admissions for major cardiovascular events and procedures in people with and without diabetes in England: a nationwide study 2004 – 2014, Cardiovascular Diabetology, Vol: 16, ISSN: 1475-2840
BackgroundSecondary prevention of cardiovascular disease (CVD) has improved immensely during the past decade but controversies persist on cardiovascular benefits among women with diabetes. We investigated 11-year trends in hospital admission rates for acute myocardial infarction (AMI), stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) in people with and without diabetes by gender in England.MethodsWe identified all hospital admissions for cardiovascular disease causes among people aged 17 years and above between 2004 and 2014 in England. We calculated diabetes-specific and non-diabetes-specific rates for study outcomes by gender. To assess temporal changes, we fitted negative binomial regression models.ResultsDiabetes-related admission rates remained unchanged for AMI (incidence rate ratio (IRR) 0.99 [95% CI 0.98–1.01]), increased for stroke by 2% (1.02 [1.01–1.03]) and PCI by 3% (1.03 [1.01–1.04]) and declined for CABG by 3% (0.97 [0.96–0.98]) annually. Trends did not differ significantly by diabetes status. Women with diabetes had significantly lower rates of AMI (IRR 0.46 [95% CI 0.40–0.53]) and stroke (0.73 [0.63–0.84]) compared with men with diabetes. However, gender differences in admission rates for AMI attenuated in diabetes compared with the non-diabetic group. While diabetes tripled admission rates for AMI in men (IRR 3.15 [95% CI 2.72–3.64]), it increased it by over fourfold among women (4.27 [3.78–4.93]). Furthermore, while the presence of diabetes was associated with a threefold increased rates for PCI and fivefold increased rates for CABG (IRR 3.14 [2.83–3.48] and 5.01 [4.59–5.05], respectively) in men, among women diabetes was associated with a 4.4-fold increased admission rates for PCI and 6.2-fold increased rates for CABG (4.37 [3.93–4.85] and 6.24 [5.66–6.88], respectively). Proportional changes in rates were similar in men and women for
Carruthers J, Bottle R, Laverty AA, et al., 2017, Nation-wide trends in non-alcoholic steatohepatitis (NASH) in patients with and without diabetes between 2004-05 and 2014-15 in England, Diabetes Research and Clinical Practice, Vol: 132, Pages: 102-107, ISSN: 1872-8227
AimsThere are no national studies evaluating the epidemiology of non-alcoholic steatohepatitis (NASH) in England. NASH is becoming an increasingly important health issue given the inexorable rise in obesity and diabetes. We evaluated the rates of NASH in people with and without diabetes from 2004–2005 to 2014–2015.MethodsWe identified cases of biopsy-proven NASH in people with and without diabetes in England over an eleven-year period using Hospital Episode Statistics. We estimated incidence rates for each year. Negative binomial regression models were fitted to test trends.ResultsOver the study period, people without diabetes recorded a 3% reduction in admission rates per year (incidence rate ratio (IRR) (95% CI) 0.97 (0.96–0.98), p < 0.001), whilst there was an increase in admission rates in people with diabetes (IRR (95% CI) 1.01 (1.00–1.02), p = 0.04). In people with diabetes, this upward trend was driven by people over 65 years (IRR (95% CI) 1.03 (1.02–1.04), p < 0.001) and men (IRR (95% CI) 1.01 (1.0–1.02), p = 0.03). Inpatient mortality declined for people with diabetes by 2% per year after adjusting for age, sex and year (IRR (95% CI) 0.98 (0.95–0.99), p = 0.03). The 2% decline per year in inpatient mortality for people without diabetes did not achieve statistical significance after adjustment (IRR (95% CI) 0.98 (0.95–1.01), p = 0.175).ConclusionsThere was a decline in NASH-related hospital admissions amongst people without diabetes over eleven years, whilst rates increased in people with diabetes. These observations highlight the increasing burden of NASH.
Ahmad A, Laverty A, Alexakis C, et al., 2017, Changing nationwide patterns in UK admissions for medical therapy, surgery, lower gi endoscopy and anti-tnf infusions for inflammatory bowel disease between 2003-2013, Annual General Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ Publishing Group, Pages: A158-A158, ISSN: 0017-5749
Barker R, Laverty A, Hopkinson NS, 2017, Adjuncts for sputum clearance in COPD – clinical consensus vs actual use, BMJ Open Respiratory Research, Vol: 4, ISSN: 2052-4439
Introduction Oscillatory positive pressure devices can be used as adjuncts to improve sputum clearance in COPD, though the evidence base is incomplete. The attitudes of physiotherapists towards the place of these devices in the care of COPD patients is not known. In addition, their actual use in practice compared to the prescription of medications has not been studied. Methods We analysed English prescribing data, obtained from OpenPrescribing.net, for a three year period from 2013. In addition we conducted an online survey of members of the Association of Chartered Physiotherapists in Respiratory Care (ACPRC) asking about awareness of devices, thresholds for treatment and device preference.Results Out of a potential 3.2 million COPD patient years of treatment between 2013-2015, 422,744 patient years of treatment with carbocisteine, at a cost of £73 million were prescribed, as well as 1.1 million years treatment with tiotropium. In the same period only 4,989 OPEP devices were prescribed. Given overlapping indications for OPEP devices and carbocisteine this disparity requires explanation. There were 116 responses to the survey (12% response rate), 72% in hospital practice, 28% based in the community. There were variations in respondents’ threshold for treatment with sputum adjuncts in COPD. Asked to choose between the Acapella®, Flutter® and Positive Expiratory Pressure mask (PEP), if only one were available, preferences were 69%, 24% and 6% respectively.Conclusions There is a one-hundred fold difference between use of carbocisteine and OPEP devices in COPD, with far fewer devices being prescribed than are included in the phenotypes that clinicians believe they are effective in. Variation in physiotherapist attitudes to treatment thresholds highlights the need for research into the effectiveness of OPEP devise in specific patient phenotypes.
McKay AJ, Laverty AA, Majeed A, 2017, The divergence of minimum unit pricing policy across the UK: opportunities for public health policy development., Journal of the Royal Society of Medicine, Vol: 110, Pages: 358-364, ISSN: 1758-1095
Filippidis FT, Laverty AA, Fernandez E, et al., 2017, Correlates of self-reported exposure to advertising of tobacco products and electronic cigarettes across 28 European Union member states., Tobacco Control, Vol: 26, Pages: e130-e133, ISSN: 0964-4563
BACKGROUND: Despite advertising bans in most European Union (EU) member states, outlets for promotion of tobacco products and especially e-cigarettes still exist. This study aimed to assess the correlates of self-reported exposure to tobacco products and e-cigarettee advertising in the EU. METHODS: We analysed data from wave 82.4 of the Eurobarometer survey (November-December 2014), collected through interviews in 28 EU member states (n=27 801 aged ≥15 years) and data on bans of tobacco advertising extracted from the Tobacco Control Scale (TCS, 2013). We used multilevel logistic regression to assess sociodemographic correlates of self-reported exposure to any tobacco and e-cigarette advertisements. RESULTS: 40% and 41.5% of the respondents reported having seen any e-cigarette and tobacco product advertisement respectively within the past year. Current smokers, males, younger respondents, those with financial difficulties, people who had tried e-cigarettes and daily internet users were more likely to report having seen an e-cigarette and a tobacco product advertisement. Respondents in countries with more comprehensive advertising bans were less likely to self-report exposure to any tobacco advertisements (OR 0.87; 95% CI 0.79 to 0.96 for one-unit increase in TCS advertising score), but not e-cigarette advertisements (OR 1.08; 95% CI 0.95 to 1.22). CONCLUSION: Ten years after ratification of the Framework Convention for Tobacco Control, self-reported exposure to tobacco and e-cigarette advertising in the EU is higher in e-cigarette and tobacco users, as well as those with internet access. The implementation of the Tobacco Products Directive may result in significant changes in e-cigarette advertising, therefore improved monitoring of advertising exposure is required in the coming years.
Jawad M, Laverty AA, Millett C, 2017, Pokémon GO: are limited physical activity benefits undermined by McFlurries consumed?, BMJ, Vol: 356, ISSN: 0959-8138
Seferidi P, Millett C, Laverty AA, 2017, Sweetened beverage intake in association to energy and sugar consumption and cardiometabolic markers in children, Pediatric Obesity, Vol: 13, Pages: 1-9, ISSN: 2047-6310
BackgroundArtificially sweetened beverages (ASBs) are promoted as healthy alternatives to sugar‐sweetened beverages (SSBs) in order to reduce sugar intake, but their effects on weight control and glycaemia have been debated. This study examines associations of SSBs and ASBs with energy and sugar intake and cardiometabolic measures.MethodsOne thousand six hundred eighty‐seven children aged 4–18 participated in the National Diet and Nutrition Survey Rolling Programme (2008/9–2011/12) in the UK. Linear regression was used to examine associations between SSBs and ASBs and energy and sugar, overall and from solid foods and beverages, and body mass index, waist‐to‐hip ratio and blood analytes. Fixed effects linear regression examined within‐person associations with energy and sugar.ResultsCompared with non‐consumption, SSB consumption was associated with higher sugar intake overall (6.1%; 4.2, 8.1) and ASB consumption with higher sugar intake from solid foods (1.7%; 0.5, 2.9) but not overall, mainly among boys. On SSB consumption days, energy and sugar intakes were higher (216 kcal; 163, 269 and 7.0%; 6.2, 7.8), and on ASB consumption days, sugar intake was lower (−1.0%; −1.8, −0.1) compared with those on non‐consumption days. SSB and ASB intakes were associated with higher levels of blood glucose (SSB: 0.30 mmol L−1; 0.11, 0.49 and ASB: 0.24 mmol L−1; 0.06, 0.43) and SSB intake with higher triglycerides (0.29 mmol L−1; 0.13, 0.46). No associations were found with other outcomes.ConclusionSugar‐sweetened beverage intake was associated with higher sugar intake and both SSBs and ASBs with a less healthy cardiometabolic profile. These findings add to evidence that health policy should discourage all sweetened beverage consumption.
Borges MC, Louzada ML, de Sá TH, et al., 2017, Artificially sweetened beverages and the response to the global obesity crisis, Plos Medicine, Vol: 14, ISSN: 1549-1676
In March 2015, the World Health Organization (WHO) published revised guidelines onsugar intake that call on national governments to institute policies to reduce sugarintake and increase the scope for regulation of sugar-sweetened beverages (SSBs).• In face of the growing threat of regulatory action on SSBs, transnational beverage companiesare responding in multiple ways, including investing in the formulation and salesof artificially sweetened beverages (ASBs), promoted as healthier alternatives to SSBs.• The absence of consistent evidence to support the role of ASBs in preventing weightgain and the lack of studies on other long-term effects on health strengthen the positionthat ASBs should not be promoted as part of a healthy diet.• The promotion of ASBs must be discussed in a broader context of the additional potentialimpacts on health and the environment. In addition, a more robust evidence base,free of conflicts of interest, is needed.
Pérez-Pevida B, Romero S, Silva C, et al., 2017, Non-alcoholic fatty liver disease and pancreatic beta cell function in non-diabetic patients, EASD, Pages: 1-608
Filippidis FT, Laverty AA, Vardavas CI, 2016, Experimentation with e-cigarettes as a smoking cessation aid: a cross-sectional study in 28 European Union member states, BMJ Open, Vol: 6, ISSN: 2044-6055
Objectives: To describe patterns of experimentation with electronic cigarettes as a smoking cessation aid, their self-reported impact on smoking cessation and to identify factors associated with self-reported successful quit attempts within the European Union (EU). Design: A cross-sectional study. Setting: 28 European Union member states. Methods: We analysed data from wave 82.4 of the Special Eurobarometer survey, collected in December 2014 from all 28 EU member states. The total sample size was n=27 801 individuals aged .15 years; however, our analyses were conducted in different subgroups with sample sizes ranging from n=470 to n=9363. Data on e-cigarette experimentation and its self-reported impact on smoking cessation were collected. Logistic regression models were used to assess factors associated with experimentation of e-cigarettes as cessation aids and with successful quitting. Logistic regression was also used to assess changes in the use of e-cigarettes as cessation aids between 2012 (using data from wave 77.1 of the Eurobarometer) and 2014 in each member state. Results: E-cigarettes were often experimented with as a cessation aid, especially among younger smokers (OR=5.29) and those who reported financial difficulties (OR=1.33). In total, 10.6% of those who had ever attempted to quit smoking and 27.4% of those who did so using a cessation aid had experimented with e-cigarettes as a cessation aid. Among those who had used e-cigarettes as a cessation aid, those with higher education were more likely to have been successful in quitting (OR=2.23). There was great variation in trends of use of e-cigarette as a cessation aid between member states. Conclusions: Experimentation with e-cigarettes as a potential cessation aid at a population level has increased throughout the EU in recent years, and certain population groups are more likely to experiment with them as cessation aids. Research on the potential population impact of these trends is imperatively needed
Filippidis FT, Gerovasili V, Laverty AA, 2016, Commentary on Farsalinos et al. (2016): Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries., Addiction, Vol: 112, Pages: 544-545, ISSN: 1360-0443
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.