Publications
175 results found
Laverty AA, Millett C, Been JV, et al., 2022, A healthy future for children and adolescents, LANCET, Vol: 400, Pages: 1100-1100, ISSN: 0140-6736
Kyriakos C, Qi D, Chang CM, et al., 2022, Global market trends of flavour capsule and menthol cigarettes: An ecological analysis using commercial data across 78 countries, 2010-2020, Tobacco Induced Diseases, Vol: 20, Pages: 1-14, ISSN: 1617-9625
Introduction: This study describes market trends of flavour capsule cigarettes (FCCs) and menthol (non-capsule) cigarettes across 78 countries from 2010 to 2020 and examines country-level factors associated with market shares of these products.Methods: Market share and retail volume data came from the Euromonitor Passport database and country-level data came from the World Health Organization (WHO), World Bank, and International Monetary Fund. Multivariable linear fixed effects panel regression analyses were conducted to evaluate the relationship between predictor variables and market share of menthol and FCC, respectively.Results: The overall market share (i.e., the percentage retail volume out of total retail volume of all cigarette types) increased from 0.23% in 2010 to 4.5% in 2020 for FCCs and decreased from 5.0% to 3.8% for menthol cigarettes. Market shares of FCCs grew most rapidly in the Americas region and among upper-middle-income countries. Market shares of menthol cigarettes remained stable across most regions and were highest in the Western Pacific and Africa regions. The overall market share of FCCs was positively associated with unemployment rate (β=0.28, 95%CI: 0.12 to 0.44, p=0.001), and inversely associated with % of the population aged 15-29 (β=-0.57, 95%CI: -0.98 to -0.15, p=0.008), % of urban population (β=-0.88, 95%CI: -1.28 to -0.48, p<0.001), GDP PPP per capita (β=-0.13, 95%CI: -0.24 to -0.03, p=0.015), and age-standardised prevalence of cigarette smoking (β=-0.93, -1.38 to -0.49, p<0.001). In contrast, the overall market share of menthol was positively associated with urbanicity (β=0.24, 95%CI: 0.08 to 0.40, p=0.003), and negatively associated with unemployment rate (β=-0.09, 95%CI: -0.17 to -0.02, p=0.014).Conclusions: Global sales of FCCs grew substantially in the last decade, surpassing menthol (non-capsule) cigarettes, which also continued to be high in many regions. There is a need for increased
Vrinten C, Parnham J, Hopkinson N, et al., 2022, Risk factors for adolescent smoking uptake – analysis of prospective data from the UK Millennium Cohort Study, Tobacco Induced Diseases, Vol: 20, Pages: 1-6, ISSN: 1617-9625
Introduction:Most people who smoke initiate smoking in adolescence. Risk factors for smoking are changing over time as demographics shift, and technologies such as social media create new avenues for the tobacco industry to recruit smokers. We assessed risk factors associated with smoking uptake and regular smoking among a representative cohort of UK adolescents.Methods:Data come from 8944 children followed prospectively as part of the UK Millennium Cohort Study. Smoking uptake was assessed as adolescents who had never smoked tobacco at the age of 14 years, but reported smoking ≥1 cigarette per week by the age of 17 years (regular smoking). We used logistic regression to assess associations between smoking uptake and selected sociodemographic factors including household income, caregiver smoking, peer smoking, and social media use. Weighted percentages and Office for National Statistics Data were used to estimate numbers of regular smokers and new smokers in the UK.Results:Among the whole sample, 10.6% of adolescents were regular smokers at the age of 17 years. Of these, 52% initiated smoking between the ages of 14 and 17 years. Uptake was more common if caregivers smoked (13.6% vs 5.0%, p<0.001) or friends smoked (12.6% vs 4.3%, p<0.001), and among those reporting >5 hours/ day of social media use (9.8% vs 4.1%, p=0.006). Applying these percentages to population data, an estimated 160000 adolescents in the UK were regular smokers by the age of 17 years, of whom more than 100000 initiated smoking between the ages of 14 and 17 years.Conclusions:This analysis of smoking uptake and regular smoking highlight that smoking behavior remains highly transmissible within families and peer groups, reinforcing inequalities. Social media are highlighted as a potential vector.
Laverty A, Jenkins R, Millett C, et al., 2022, Local area public sector spending and nutritional anaemia hospital admissions in England: a longitudinal ecological study, BMJ Open, Vol: 12, Pages: 1-14, ISSN: 2044-6055
Introduction: Reductions in local government spending may have impacts on diets and health which increase the risk of hospital admissions for nutritional anaemias. Mechanisms include potential impacts of changes to local authority (LA) services (e.g. housing services) on personal resources and food access, availability, and provision. We therefore investigated the association between changes in LA spending and nutritional anaemia related hospital admissions. Specifically we address whether greater cuts to LA spending were linked to increased hospital admissions for nutritional anaemia.Design: Longitudinal analysis of LA panel data using Poisson fixed effects regression models.Setting: 312 LAs in England (2005-2018). Main exposure: Total LA service expenditure per capita per year.Main outcome: Principal and total nutritional anaemia hospital admissions, for all ages and stratified by age (0-14, 15-64, 65+). Results: LA service expenditure increased by 9% between 2005 and 2009 then decreased by 20% between 2010 and 2018. Total nutritional anaemia hospital admissions increased between 2005 and 2018 from 173 to 633 admissions per 100,000 population. A £100 higher LA service spending was associated with a 1.9% decrease in total nutritional anaemia hospital admissions (adjusted Incidence Rate Ratio: 0.98, 95% CI 0.96 to 0.99). When stratified by age, this was seen only in adults. A £100 higher LA service spending was associated with a 2.6% decrease in total nutritional anaemia hospital admissions in the most deprived LAs (aIRR: 0.97, 95% CI: 0.95 to 1.0). Conclusion: Increased LA spending was associated with reduced hospital admissions for nutritional anaemia. Austerity related reductions had the opposite effect, increasing admissions, with greater impacts in more deprived areas. This adds further evidence to the potential negative impacts of austerity policies on health and health inequalities. Re-investing in LA services may prevent hospital admissions assoc
Chan JJL, Tran-Nhu L, Pitcairn CFM, et al., 2022, Inequalities in the prevalence of cardiovascular disease risk factors in Brazilian slum populations: A cross-sectional study, PLOS Global Public Health, Vol: 2, Pages: 1-19, ISSN: 2767-3375
BackgroundSocial and environmental risk factors in informal settlements and slums may contribute to increased risk of cardiovascular disease (CVD). This study assesses the socioeconomic inequalities in CVD risk factors in Brazil comparing slum and non-slum populations.MethodsResponses from 94,114 individuals from the 2019 Brazilian National Health Survey were analysed. The United Nations Human Settlements Programme definition of a slum was used to identify slum inhabitants. Six behavioural risk factors, four metabolic risk factors and doctor-diagnosed CVD were analysed using Poisson regression models adjusting for socioeconomic characteristics.ResultsCompared to urban non-slum inhabitants, slum inhabitants were more likely to: have low (less than five days per week) consumption of fruits (APR: 1.04, 95%CI 1.01–1.07) or vegetables (APR: 1.08, 95%CI 1.05–1.12); drink four or more alcoholic drinks per day (APR: 1.05, 95%CI 1.03–1.06); and be physically active less than 150 minutes per week (APR: 1.03, 95%CI 1.01–1.04). There were no differences in the likelihoods of doctor-diagnosed metabolic risk factors or CVD between the two groups in adjusted models. There was a higher likelihood of behavioural and metabolic risk factors among those with lower education, with lower incomes, and the non-White population.ConclusionsBrazilians living in slums are at higher risk of behavioural risk factors for CVD, suggesting local environments might impact access to and uptake of healthy behaviours.
Parnham J, Chang C-M, Rauber F, et al., 2022, The ultra-processed food content of school meals and packed lunches in the United Kingdom, Nutrients, Vol: 14, Pages: 1-14, ISSN: 2072-6643
British children have the highest levels of ultra-processed food (UPF) consumption in Europe. Schools are posited as a positive setting for impacting dietary intake but the level of UPFs consumed at schools is currently unknown. This study determined the UPF content of school food in the UK. We conducted a pooled cross-sectional analysis of primary (4-11 years, n=1,895) and secondary schoolchildren (11-18 years, n=1,408) from the UK’s National Diet and Nutrition Survey (2008-2017). Multivariable quantile regression models determined the association between meal-type (school meal or packed lunch) and lunchtime UPF intake (NOVA food classification system). We showed that on average UPF intake was high in both primary (72.6% total lunch Kcal) and secondary schoolchildren (77.8 % total lunch Kcal). Higher UPF intakes were observed in packed lunch consumers, secondary schoolchildren, and those in lower income households. This study highlights the need for a renewed focus on school food. Better guidance and policies which consider levels of industrial processing in food served in schools is needed to ensure the dual benefit of encouraging school meal uptake and equitably improving children’s diet.
Williams P, Cumella A, Philip K, et al., 2022, Smoking and socio-economic factors linked to acute exacerbations of COPD: analysis from an Asthma + Lung UK survey, BMJ Open Respiratory Research, Vol: 9, ISSN: 2052-4439
Background: Understanding the factors driving acute exacerbations of COPD is key to reducing their impact on human health and wellbeing. Methods: 5997 patients, mean 66 years, 64% female, completed an online survey between December 2020 and May 2021 about living with COPD developed by the charity Asthma+Lung UK.Results: The 3731(62.2%) survey participants reporting frequent(>2/year) exacerbations were more likely to smoke (AOR 1.70, 95%CI 1.470-1.98), have lower annual household income (<£20,000, (AOR: 1.72, 1.36-2.17), live in a cold and damp home (AOR: 1.78, 1.50-2.11), and report previous occupational exposure to dust, fumes, and chemicals. Smokers were more likely to report attending hospital to manage their most recent AECOPD compared to ex-smokers (AOR: 1.25, 95% CI 0.99- 1.59).
Radó MK, van Lenthe FJ, Laverty AA, et al., 2022, Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries: a synthetic control study, The Lancet Public Health, Vol: 7, Pages: 1-10, ISSN: 2468-2667
BackgroundThere are few quantitative studies into the effect of comprehensive smoke-free legislation on neonatal and infant mortality in middle-income countries. We aimed to estimate the effects of implementing comprehensive smoke-free legislation on neonatal mortality and infant mortality across all middle-income countries.MethodsWe applied the synthetic control method using 1990–2018 country-level panel data for 106 middle-income countries from the WHO, World Bank, and Penn World datasets. Outcome variables were neonatal (age 0–28 days) mortality and infant (age 0–12 months) mortality rates per 1000 livebirths per year. For each middle-income country with comprehensive smoke-free legislation, a synthetic control country was constructed from middle-income countries without comprehensive smoke-free legislation, but with similar prelegislation trends in the outcome and predictor variables. Overall legislation effect was the mean average of country-specific effects weighted by the number of livebirths. We compared the distribution of the legislation effects with that of the placebo effects to assess the likelihood that the observed effect was related to the implementation of smoke-free legislation and not merely influenced by other processes.Findings31 (29%) of 106 middle-income countries introduced comprehensive smoke-free legislation and had outcome data for at least 3 years after the intervention. We were able to construct a synthetic control country for 18 countries for neonatal mortality and for 15 countries for infant mortality. Comprehensive smoke-free legislation was followed by a mean yearly decrease of 1·63% in neonatal mortality and a mean yearly decrease of 1·33% in infant mortality. An estimated 12 392 neonatal deaths in 18 countries and 8932 infant deaths in 15 countries were avoided over 3 years following the implementation of comprehensive smoke-free legislation. We estimated that an additional 104 063 infant deaths (inc
Jenkins RH, Vamos EP, Taylor-Robinson D, et al., 2022, Changes to local area public sector spending and food purchasing in England: a longitudinal ecological study, BMJ Nutrition, Prevention & Health, Vol: 5, Pages: 72-86, ISSN: 2516-5542
Objectives: Changes in public sector service spending may influence food consumption. We make use of changing local authority (LA) expenditure in England to assess impacts on food purchasing. We examine total LA service spending and explore two potential pathways: highways and transport spending which may affect access to food; and housing service expenditure which may affect household resources available to purchase foods. Design: Longitudinal panel survey at the LA level (2008-2015) using fixed effects linear regression. Setting: 324 LAs in England. Main exposure: Expenditure per capita on total LA services, highways and transport services, and housing services. Main outcome measures: LA area estimates of purchasing of fresh fruits and vegetables, high in fat, sugar and salt (HFSS) foods, and takeaways at home, expressed as a percentage of total food and drink expenditure. Results: Total LA service spending decreased by 17% on average between 2008 and 2015. A 10% decrease in total LA spending was associated with a 0.071 percentage point decrease in HFSS (95% CI -0.093 to -0.050) and a 0.015 percentage point increase in takeaways (95% CI 0.006 to 0.024). A 10% decrease in highways and transport expenditure was associated with a 0.006 percentage point decrease in fruit and vegetable purchasing (95% CI -0.009 to -0.002) and a 0.006 percentage point increase in takeaway purchasing (95% CI 0.001 to 0.010). These associations were seen in urban areas only when analyses were stratified by rural/urban area status. A 0.006 percentage point decrease in HFSS purchasing was also seen with a 10% decrease in housing expenditure (95% CI -0.010 to -0.002). Conclusion: Changes in LA spending may have impacts on food purchasing which are evident at the area level. This suggests that in addition to more prominent impacts such as foodbank use, austerity measures may have mixed impacts on food purchasing behaviours among the wider population.
Haney E, Parnham JC, Chang K, et al., 2022, Dietary quality of school meals and packed lunches: a national study of primary and secondary schoolchildren in the UK, PUBLIC HEALTH NUTRITION, ISSN: 1368-9800
Foster PJI, Laverty AA, Filippidis FT, 2022, Perceptions of the safety of vaccines and vaccine associated knowledge levels in Europe: A 2019 cross-sectional study in 28 countries, Preventive Medicine, Vol: 159, ISSN: 0091-7435
Vaccination has saved millions of lives. Vaccine hesitancy was recently declared a major threat to health by the World Health Organisation. Sociodemographic variables and knowledge level about vaccines have been suggested previously to affect vaccine uptake. This study aimed to investigate how levels of vaccination knowledge and concerns around safety of vaccines varied across sociodemographic factors in the European Union and United Kingdom. Levels and sources of knowledge and vaccine attitude patterns were examined across different areas of Europe. Data from the March 2019 Eurobarometer survey was used in this study which had 27,524 participants across the European Union and the United Kingdom. Two-level logistic and linear regressions were used to look for associations between sociodemographic variables, vaccine attitudes and knowledge level. Those who trusted information from healthcare workers and healthcare authorities were most likely to have positive vaccine attitudes; those trusting internet sources the most were the least likely. Those with greater vaccine related knowledge were more likely to report positive vaccination attitudes. Healthcare workers are key to dissemination of vaccination advice however many are becoming hesitant themselves. An increasing number of people are seeking online sources for vaccination information, and this has implications with information accuracy and vaccine hesitancy. A considerable proportion of the adult population in the European Union and the United Kingdom was concerned about the safety or side effects of vaccines. Continued efforts to increase trust in vaccines both in whole populations and specific groups are needed.
Williams PJ, Cumella A, Philip KEJ, et al., 2022, Smoking and socio-economic factors linked to acute exacerbations of COPD: analysis from an Asthma + Lung UK survey
<jats:title>ABSTRACT</jats:title><jats:p>Understanding the factors driving acute exacerbations of COPD is key to reducing their impact on human health and wellbeing. 5997 patients, mean 66 years, 64% female, completed an online survey between December 2020 and May 2021 about living with COPD developed by the charity Asthma+Lung UK. The 3731(62.2%) reporting frequent(≥2/year) exacerbations were more likely to smoke (AOR 1.70, 95%CI 1.470-1.98), have lower annual household income (≤£20,000, (AOR: 1.72, 1.36-2.17), live in a cold and damp home (AOR: 1.78, 1.50-2.11), and report previous occupational exposure to dust, fumes, and chemicals. Strategies to improve COPD outcomes must address issues of social justice.</jats:p>
El Asmar M, Laverty A, Vardavas C, et al., 2022, How do Europeans quit using tobacco, e-cigarettes and heated tobacco products? A cross-sectional analysis in 28 European countries, BMJ Open, Vol: 12, ISSN: 2044-6055
Objectives: While smoking tobacco remains a substantial cause of harm in Europe, novel products such as electronic cigarettes or e-cigarettes (ECs) and heated tobacco products (HTPs) have entered the market recently. While debate still persists over the role of these novel products, they are now in widespread use. This study aimed to explore the prevalence and methods of attempts to quit EC and HTP.Setting: We analysed the 2020 Eurobarometer survey, which collected data in 28 European countries.Participants: A representative sample of individuals residing in these countries aged ≥15 years.Primary and secondary: outcome measures Multilevel regression analyses were performed to assess differences in quit attempts and cessation methods among tobacco smokers and exclusive EC/HTP users separately.Results: 51.1% of current tobacco smokers and 27.1% of exclusive EC or HTP users reported having ever made a quit attempt. The majority of former and current smokers (75.8%) who made a quit attempt did so unassisted, with 28.8% reporting at least one attempt using a cessation aid. The most popular cessation aids were nicotine replacement therapy or other medication (13.4%) and ECs (11.3%). 58.8% of exclusive EC or HTP users who had made a quit attempt did so unassisted, with 39.5% reporting the use of a cessation aid.Conclusion: Most EC and HTP users in Europe try to quit unassisted, although more of them report the use of a cessation aid compared with tobacco smokers. Cessation support services should take into consideration the increasing numbers of users of EC and HTP who may be trying to quit.
Teshima A, Filippidis F, Laverty A, 2022, Burden of current and past smoking across 28 European countries in 2017: A cross-sectional analysis, Tobacco Induced Diseases, Vol: 20, Pages: 1-11, ISSN: 1617-9625
IntroductionMost studies use the prevalence of current smoking as an indicator to quantify the burden of smoking.However, length and intensity of smoking, as well as time since cessation for former smokers are alsoknown to impact smoking-related health risks. The aim of this study was to quantify and compare theburden of smoking across the European Union (EU) using a range of smoking burden indicators.MethodsWe conducted a cross-sectional analysis using data from the March 2017 Eurobarometer 87.1(n=27,901 aged ≥15 years in 28 Member States [MS]) and the Tobacco Control Scale. We defined fiveindicators of smoking burden including the prevalence of current and ever smoking, length of smoking,pack-years, and discounted pack-years and ranked EU MS by each indicator. Two-level linear andlogistic regressions were performed to assess the association between these indicators and sociodemographic and tobacco policy factors.ResultsWide variations across the EU countries were observed in all smoking burden indicators. While someMS ranked consistently high (e.g. Greece, France) or consistently low (e.g. Ireland, United Kingdom)in all indicators, we found substantial discrepancies in ranking depending on the indicator used for MSsuch as Malta, Denmark, Finland and the Netherlands. All indicators of smoking burden were loweramong women and respondents without financial difficulties; however, the magnitude of thoseinequalities varied two-fold among the different indicators.ConclusionsUsing a range of smoking burden indicators can be more informative than relying on prevalence alone.Our analysis highlights the limitations of relying solely on prevalence of current smoking to estimatethe burden of smoking and the potential value of more nuanced indicators. We recommend thatmultiple and more nuanced indicators that consider former smokers, intensity and duration of smokingshould be utilised to monitor tobacco use and evaluate tobacco control policies.
Parnham JC, Chang K, Millett C, et al., 2022, The impact of the Universal Infant Free School Meal policy on dietary quality in English and Scottish primary school children: evaluation of a natural experiment, Nutrients, Vol: 14, ISSN: 2072-6643
The Universal Infant Free School Meal (UIFSM) policy was introduced in September 2014 in England and January 2015 in Scotland and offered all infant schoolchildren (ages 4-7 years) a free school lunch, regardless of income. Yet, impacts of UIFSM on dietary intakes and or social inequalities are not known. A difference-in-differences study using the National Diet and Nutrition Survey assessed pooled pre-UIFSM (2010-2014) and post-UIFSM (2014-2017) dietary data. English or Scottish infant schoolchildren (4-7 years; N=458) were the intervention group with junior schoolchildren (8-11 years; N=401) as controls. We found that implementation of UIFSM led to an increase in infant schoolchildren having a school meal. Impacts on key food groups such as fruit and vegetables or sweetened beverages were not seen. However, there was evidence that the UIFSM policy lowered consumption of foods associated with packed lunches, such as crisps, and some nutrients, such as total fat and sodium. Policy impacts differed by income group, with larger effect sizes in low-income children. In conclusion, evaluation of UIFSM demonstrated some improvements on dietary quality but the findings suggest school meal quality needs to be improved to fully realise the benefits of UIFSM.
Radó MK, Laverty AA, Hone T, et al., 2022, Cigarette taxation and neonatal and infant mortality: a longitudinal analysis of 159 countries, PLOS Global Public Health, Vol: 2, ISSN: 2767-3375
Previous studies on the associations between cigarette taxes and infant survival have all been in high-income countries and did not examine the relative benefits of different taxation levels and structures. We evaluated longitudinal associations of cigarette taxes with neonatal and infant mortality globally. We applied country-level panel regressions using 2008–2018 annual mortality and biennial WHO tobacco taxation data. Complete data was available for 159 countries. Outcomes were neonatal and infant mortality. We conducted analyses by type of taxes (i.e. specific cigarette taxes, ad valorem taxes, and other taxes, import duties and VAT) and the income group classification of countries. Covariates included scores for other WHO recommended tobacco control policies, socioeconomic, health-care, and air quality measures. Secondary analyses investigated the associations between cigarette tax and cigarette consumption. We found that a 10 percentage-point increase in total cigarette tax as a percentage of the retail price was associated with a 2.6% (95% Confidence Interval [CI]: 1.9% to 3.2%) decrease in neonatal mortality and a 1.9% (95% CI: 1.3% to 2.6%) decrease in infant mortality globally. Estimates were similar for both excise and ad valorem taxes. We estimated that 231,220 (95% CI: 152,658 to 307,655) infant deaths could have been averted in 2018 if all countries had total cigarette tax at least 75%. 99.2% of these averted deaths would have been in low- and middle-income countries (LMICs). The secondary analysis supported causal interpretation of results by finding that a 10 percentage-point increase in taxes was associated with a reduction of 94.6 (95% CI: 32.7 to 156.5) in annual cigarette consumption per capita. Although causal inference is precarious due to the quasi-experimental design, we used a robust analytical approach and focused on within-country changes. Limitations include an inability to include data on roll-your-own tobacco, other forms of toba
Chamberlain R, Fecht D, Davies B, et al., 2022, PROSPERO registration: Impacts of Low Emission and Congestion Charging Zones on physical health outcomes: a systematic review.
Williams P, Buttery S, Mweseli R, et al., 2022, Immediate smoking cessation support vs usual care in smokers attending a targeted lung health check; the QuLIT trial, BMJ Open Respiratory Research, Vol: 9, ISSN: 2052-4439
Objectives: Lung cancer screening programmes offer an opportunity to address tobacco dependence in current smokers. The effectiveness of different approaches to smoking cessation in this context has not yet been established. We investigated if immediate smoking cessation support, including pharmacotherapy, offered as part of a lung cancer screening programme, increases quit rates compared to usual care (Very Brief Advice to quit and signposting to smoking cessation services).Materials and Methods: We conducted a single-blind randomised controlled trial of current smokers aged 55-75 years attending a Targeted Lung Health Check (TLHC). On randomly allocated days smokers received either (1) immediate support from a trained smoking cessation counsellor with appropriate pharmacotherapy or (2) usual care. The primary outcome was self-reported quit rate at three months. We performed thematic analysis of participant interview responses.Results: Of 412 people attending between January and March 2020, 115(27.9%) were current smokers; 46% female, mean(SD) 62.4(5.3) years. Follow up data were available for 84 smokers. At 3 months quit rates in the intervention group were higher 14/48(29.2%) versus 4/36(11%) (2 3.98, p=0.04). Participant interviews revealed four smoking-cessation related themes; 1) Stress and anxiety, 2) Impact of the COVID-19 pandemic, 3) Computerised tomography scans influencing desire to quit, 4) Individual beliefs about stopping smoking. Conclusion: The provision of immediate smoking cessation support is associated with a substantial increase in quit rates at three months. Further research is needed to investigate longer term outcomes and to refine future service delivery.
KC S, Filippidis FT, Laverty AA, 2022, Legislative provisions for standardised tobacco packaging and changes in public support in 27 European countries, Tobacco Control, Vol: 32, Pages: 664-666, ISSN: 0964-4563
Background Global adoption of standardised packaging requirements for tobacco products is a victory for public health, but their proliferation and impacts rely partly on public support. How this is related to legislation remains underassessed. This study explored change over time in public support for standardised packaging in countries with varying degrees of legislative provisions.Methods We used data from 27 European countries, collected from 2017 (n=28, 300) and 2020 (n=27, 901) waves of the Eurobarometer survey, to assess self-reported support for standardised packaging regulations among both smokers and non-smokers. Countries were grouped into three categories of policy adoption (policy implemented; policy legislated; no legislation) and changes in support were assessed using multilevel Poisson regression models.Results In 2020, public support for standardised packaging was 71% (95% CI 68% to 74%) in countries that implemented standardised packaging legislation, 57% (55% to 60%) in countries that had legislated but not yet implemented legislation and 41% (40%to 42%) in countries with no legislation. Compared with 2017, this represented a relative change of +8% (1% to 15%), +12% (5% to 21%) and −5% (95% CI −2% to −8%), respectively, in the three country categories. Among smokers, there was no indication of change in support across the three groups. Among non-smokers, support increased in countries with existing legislation (adjusted prevalence ratio [aPR]=1.14, 95% CI 1.06 to 1.23) and decreased in countries with no legislation (aPR=0.93, 0.90 to 0.97).Conclusions Public support for standardised packaging regulations increased in countries implementing and legislating for these measures, particularly among non-smokers. An overall increase in support provides reassurance for policymakers defending policy action on tobacco packaging, as well as for those seeking to implement standardised packaging in their own countri
Parnham J, Millett C, Chang K, et al., 2021, Is the Healthy Start scheme associated with increased food expenditure in low-income families with young children in the United Kingdom?, BMC Public Health, Vol: 21, Pages: 1-11, ISSN: 1471-2458
Introduction: Healthy Start is a food assistance programme in the United Kingdom (UK) which aims to provide a nutritional safety-net and enable low-income families on welfare benefits to access a healthier diet through the provision of food vouchers. Healthy Start was launched in 2006 but remains under-evaluated. This study aims to determine whether participation in the Healthy Start scheme is associated with differences in food expenditure in a nationally representative sample of households in the UK. Methods: Cross-sectional analyses of the Living Costs and Food Survey dataset (2010-2017). All households with a child (0-3 years) or pregnant woman were included in the analysis (n=4,869). Multivariable quantile regression compared the expenditure and quantity of fruit and vegetables (FV), infant formula and total food purchases. Four exposure groups were defined based on eligibility, participation and income (Healthy Start Participating, Eligible Non-participating, Nearly Eligible low-income and Ineligible high-income households).Results: Of 876 eligible households, 54% participated in Healthy Start. No significant differences were found in FV or total food purchases between participating and eligible non-participating households, but infant formula purchases were lower in Healthy Start participating households. Ineligible higher-income households had higher purchases of FV. Conclusion: This study did not find evidence of an association between Healthy Start participation and FV expenditure. Moreover, inequalities in FV purchasing persist in the UK. Higher participation and increased voucher value may be needed to improve programme performance and counteract the harmful effects of poverty on diet.
Stevenson S, Collins A, Jennings N, et al., 2021, A hybrid approach to identifying and assessing interactions between climate action (SDG13) policies and a range of SDGs in a UK context (vol 2, 43, 2021), DISCOVER SUSTAINABILITY, Vol: 2
Pitcairn C, Laverty A, Chan J, et al., 2021, Inequalities in the prevalence of major depressive disorder in Brazilian slum populations: a cross-sectional analysis, Epidemiology and Psychiatric Sciences, Vol: 30, ISSN: 2045-7979
Aims:The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations.Methods:Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression.Results:Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5–10.3), 10.8% (95% CI: 10.4–11.2) and 6.9% (95% CI: 6.6–7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9–9.3 v. 10.7%; 95% CI: 10.2–11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4–12.1 v. 11.3%; 95% CI: 10.8–11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77–0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78–0.97). Slum residents showed a greater likelihood of report
Chang C-M, Mayne E, Laverty A, et al., 2021, Cigarette prices in eight sub-Saharan African countries in 2018: a cross-sectional analysis, BMJ Open, Vol: 11, ISSN: 2044-6055
Objective: While the trend in smoking prevalence is decreasing worldwide, the number of male tobacco smokers is growing in Africa. This study compares the cigarette market in eight sub-Saharan African countries. This includes examining cigarette prices, pricing differentials, pack sizes and affordability at national and subnational levels.Design and setting: A cross-sectional data analysis using data from the Data on Alcohol and Tobacco in Africa (DATA) Project. The DATA Project was centrally coordinated by project supervisors following a standardised protocol. University students were recruited to conduct data collection and a total of 22 347 retail cigarette price data points collected between June and August 2018 were analysed (including Botswana, Ethiopia, Lesotho, Namibia, Nigeria, South Africa, Zambia and Zimbabwe). Prices were converted to US$ and standardised to the price of a 20-cigarette pack.Results: This research found large price differentials within provinces/states, with the gap between medium and minimum prices per 20-cigarette pack exceeding 50% of the medium price in 18 out of 24 provinces/states. Single cigarettes were widely available, especially in Lesotho and Ethiopia. Results of multivariable regression suggest prices (per 20-cigarette pack) were lower for cigarettes sold in packs than single sticks (−US$0.27, 95% CI: −US$0.39 to −US$0.23) and lower in less populated areas (−US$0.28 in rural compared with urban settings, 95% CI: −US$0.41 to −US$0.15). Availability of cheaper single cigarettes (lower per unit price than packed cigarettes) were identified for Lesotho and South Africa.Conclusions: These findings identify a varied picture in cigarette pricing in studied countries and suggest measures to tackle pricing differentials and availability of single sticks are warranted. These measures should counteract the potential health consequences of the increasing penetration of tobacco indus
Stevenson S, Collins A, Jennings N, et al., 2021, A hybrid approach to identifying and assessing interactions between climate action (SDG13) policies and a range of SDGs in a UK context, Discover Sustainability, Vol: 2, ISSN: 2662-9984
In 2015 the United Nations drafted the Paris Agreement and established the Sustainable Development Goals (SDGs) for all nations. A question of increasing relevance is the extent to which the pursuit of climate action (SDG 13) interacts both positively and negatively with other SDGs. We tackle this question through a two-pronged approach: a novel, automated keyword search to identify linkages between SDGs and UK climate-relevant policies; and a detailed expert survey to evaluate these linkages through specific examples. We consider a particular subset of SDGs relating to health, economic growth, affordable and clean energy and sustainable cities and communities. Overall, we find that of the 89 UK climate-relevant policies assessed, most are particularly interlinked with the delivery of SDG 7 (Affordable and Clean Energy) and SDG 11 (Sustainable Cities and Communities) and that certain UK policies, like the Industrial Strategy and 25-Year Environment Plan, interlink with a wide range of SDGs. Focusing on these climate-relevant policies is therefore likely to deliver a wide range of synergies across SDGs 3 (Good Health and Well-being), 7, 8 (Decent Work and Economic Growth), 9 (Industry, Innovation and Infrastructure), 11, 14 (Life Below Water) and 15 (Life on Land). The expert survey demonstrates that in addition to the range of mostly synergistic interlinkages identified in the keyword search, there are also important potential trade-offs to consider. Our analysis provides an important new toolkit for the research and policy communities to consider interactions between SDGs, which can be employed across a range of national and international contexts.
Laverty AA, Millett C, 2021, A respiratory pandemic should focus the mind on tobacco control, Thorax, Vol: 77, Pages: 7-8, ISSN: 0040-6376
Laverty AA, Filippidis FT, Been JV, et al., 2021, Smoke-free vehicles – impact of legislation on child smoke exposure across three countries, European Respiratory Journal, Vol: 58, Pages: 1-3, ISSN: 0903-1936
Laverty AA, Vardavas CI, Filippidis FT, 2021, Prevalence and reasons for use of Heated Tobacco Products (HTP) in Europe: an analysis of Eurobarometer data in 28 countries, The Lancet Regional Health - Europe, Vol: 8, Pages: 1-7, ISSN: 2666-7762
BackgroundHeated Tobacco Products (HTP) are a relatively new class of tobacco products, with limited data on usage patterns. We assessed the prevalence and reasons for use among persons aged ≥15 years in 27 European Union member states and the United Kingdom·MethodsThe 2020 Eurobarometer (93·2) survey was analysed (n=28,300, aged ≥15). Multi-level regression analyses assessed socio-demographic differences in use while separate analyses investigated reasons for starting to use HTP. Results are presented as adjusted Odds Ratios (aOR) and weighted percentages with 95% Confidence Intervals (95%CI).FindingsOverall, 6·5% (95% CI 6·1;7·0) of participants had ever used a HTP. 1·3% (1·1%;1·5%) of participants were current users of HTP, and 0·7% (0·6% to 0·9%) daily users. Current and former tobacco smokers were more likely than never tobacco smokers to use HTP (aOR 36·3 (22·9;57·5), and 7·3 (4·3;12·3) respectively. Youth aged 15-24 years of age were substantially more likely to report use, e.g. aOR for ever use=7·77 (6·56;9·21) compared to those aged ≥55 years. 51·3% of ever HTP users reported at least weekly concurrent use of combustible tobacco. Among those who reported ever use of HTP, but not e-cigarettes, the most popular reason for use was the perception that HTP are less harmful than smoking tobacco (39·5%), followed by use by friends (28·4%) and stopping or reducing smoking (28·2%).InterpretationConsiderable numbers of people in the EU have ever used HTP, although current and daily use remains low. Current use is more common among younger people, and current and former smokers.FundingNone
Laverty AA, Been JV, 2021, Protecting children from tobacco-related harm in private vehicles, The Lancet Public Health, Vol: 6, Pages: e539-e540, ISSN: 2468-2667
Goodman A, Furlong J, Laverty AA, et al., 2021, Impacts of 2020 low traffic neighbourhoods in London on road traffic injuries, Findings, Pages: 1-8
We assessed the impacts of Low Traffic Neighbourhoods (LTNs) implemented in 2020 on road traffic injuries. We used police data from October-December 2018/2019 (pre) compared with the same period in 2020 (post). We found absolute numbers of injuries inside LTNs halved relative to the rest of London (ratio 0.51, p<0.001). Considering changes in background travel patterns, our results indicate substantial reductions in pedestrian injury risk. Risks to other road users may also have fallen, but by a more modest amount. We found no evidence of changes in injury numbers or risk on LTN boundary roads.
Been J, Laverty AA, Tsampi A, et al., 2021, European progress in working towards a tobacco-free generation, European Journal of Pediatrics, Vol: 180, Pages: 3423-3431, ISSN: 0340-6199
Children have the right to grow up free from the hazards associated with tobacco smoking. Tobacco smoke exposure can have detrimental effects on children’s health and development, from before birth and beyond. As a result of effective tobacco control policies, European smoking rates are steadily decreasing among adults, as is the proportion of adolescents taking up smoking. Substantial variation however exists between countries, both in terms of smoking rates and regarding implementation, comprehensiveness and enforcement of policies to address smoking and second-hand smoke exposure. This is important because comprehensive tobacco control policies such as smoke-free legislation and tobacco taxation have extensively been shown to carry clear health benefits for both adults and children. Additional policies such as increasing the legal age to buy tobacco, reducing the number of outlets selling tobacco, banning tobacco display and advertising at the point-of-sale, and introducing plain packaging for tobacco products can help reduce smoking initiation by youth. At societal level, health professionals can play an important role in advocating for stronger policy measures, whereas they also clearly have a duty to address smoking and tobacco smoke exposure at the patient level. This includes providing cessation advise and referring to effective cessation services.Conclusion: Framing of tobacco exposure as a child right’s issue and of comprehensive tobacco control as a tool to work towards the ultimate goal of reaching a tobacco-free generation can help accelerate European progress to curb the tobacco epidemic.
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