Exempting mental health units from smoke-free laws.
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Hospitals, Psychiatric↗
Biomedical subjects
Ann McNeill
Publications and source records attributed to Ann McNeill.
How did UK cigarette makers reduce tar to 10 mg or less?
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Carbon Monoxide↗
Designing smoking cessation services for school-age smokers: A survey and qualitative study.
To identify the preferred design characteristics of smoking cessation services for school-age smokers, we conducted focus groups with teenage smokers motivated to stop smoking. We surveyed all pupils in years 9-11 (aged 13-16) in a random sample of 10 schools in Nottinghamshire, United Kingdom, to elicit details of smoking behavior, and conducted 25 focus groups in 6 schools with current smokers who wanted to stop smoking. Of 4,065 pupils surveyed, 888 (22%) were current smokers, and 438 (50% of smokers) wanted to quit smoking. We sampled 226 of these individuals for focus group studies, and 135 (60%) participated. These participants were motivated to quit, and almost all had tried to do so but had found it too difficult. Many were aware of smoking cessation methods but had low perceptions of their effectiveness based on their own or others' poor experiences of these interventions, and few were aware of the possibility of professional cessation support. Given clear, nondirective information about interventions, participants reported a preference for confidential, nonjudgmental services delivered during school time by a trained counselor, allowed the option to attend with friends, and offered nicotine replacement therapy (NRT). School-age smokers in Nottinghamshire, United Kingdom, who are motivated to stop smoking have low knowledge and opinions of smoking cessation interventions. Our findings indicate that young smokers would favor school-based services offering confidential professional counseling and NRT.
Adolescent↗
Cigarette yields and human exposure: a comparison of alternative testing regimens.
OBJECTIVE: There is general agreement that the testing protocol for measuring cigarette smoke constituents-the International Organization for Standardization regimen-is an inappropriate mechanism for evaluating human exposure. Alternative smoking regimens have been introduced in Canada and Massachusetts; however, these regimens have not been evaluated against human smoking behavior and biomeasures of exposure. The objective of this study was to compare measures of smoke volume and nicotine uptake among human smokers against the puffing variables and nicotine yields generated by five different machine smoking regimens: (a) International Organization for Standardization, (b) Massachusetts, (c) Canadian, (d) a Compensatory regimen, and (e) a Human Mimic regimen. METHODS: Measures of smoke volume and puffing behavior were recorded for 51 smokers who used a portable smoking topography device for three 1-week trials. Measures of salivary cotinine were taken at the completion of each week. The cigarette brands smoked by participants were then machine-smoked under five testing regimens, including a human mimic condition where brands were machine smoked using the puffing behavior recorded from human smokers. The total volume of smoke collected from each cigarette and the nicotine, tar, and carbon monoxide yields were recorded. RESULTS: None of the four machine smoking regimens adequately reflected Human Mimic Yields of tar, nicotine, and carbon monoxide. In addition, none of the four smoking regimens generated nicotine yields that were associated with actual nicotine uptake in humans. CONCLUSIONS: None of the existing smoking regimens adequately represents human smoking behavior nor do they generate yields associated with human measures of nicotine uptake.
Adult↗
Ambivalence and uncertainty: experiences of and attitudes towards addiction and smoking cessation in the mid-to-late teens.
The late teens is an important transitional period as adolescents move into new social worlds which support or challenge their smoking. This paper draws on research with 99 Scottish 16- to 19-year olds which explored their understanding of their smoking and attitudes towards quitting and cessation support. The study involved qualitative interviews mostly with friendship pairs. Interviewees also completed a brief smoking questionnaire. Most regarded themselves as smokers but few thought they were addicted. Many were interested in quitting but this was not a priority. Perceived barriers to quitting related primarily to habitual and social aspects of dependence including friends' smoking, the smoking culture at work or college, stress and boredom. Few were interested in nicotine replacement therapy or cessation services, which they felt belonged to the world of older addicted smokers. The most effective quitting strategy was thought to be will-power. Traditional cessation services are therefore in their current form unlikely to appeal to older adolescents. Services aimed at this age group need to be grounded in their understandings of smoking and the social factors which support smoking. Young smokers should also be helped to understand how support may increase quitting success and how encourage quitting before smoking becomes entrenched in their daily routines.
Adolescent↗
Lung cancer mortality at ages 35-54 in the European Union: ecological study of evolving tobacco epidemics.
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Adult↗
Image, context and transition: smoking in mid-to-late adolescence.
This paper explores 16-19-year-old Scottish smokers' experiences and attitudes towards smoking and their understandings of the ways in which this transitional period impacts on their smoking behaviour. The study involved 49 qualitative interviews conducted mostly in friendship pairs. Interviewees also completed a brief smoking questionnaire. The paper highlights the salience of social context in smoking initiation and maintenance, and the role of smoking across a range of social spheres. Interviewees described how transitions from school to work, further education or un/employment, impacted on their smoking. Smoking was perceived to be an important 'lubricant' for social relations, and marker of an acceptable identity in familiar and new contexts which acted to reinforce and increase smoking. In contrast, smoking restrictions at home, work and/or educational settings were felt to moderate consumption. This has implications for cessation programmes for older adolescents who have been relatively ignored by tobacco control. The study also suggests that if smoke-free policies were extended to all workplaces, this would have a particular impact on smoking amongst older adolescents by hindering the transition from social to regular smoking.
Adolescent↗
The impact of CytoGam on cardiac transplant recipients with moderate hypogammaglobulinemia: a randomized single-center study.
BACKGROUND: We have previously shown that the preemptive use of cytomegalovirus (CMV) immunoglobulin (Ig) replacement (CytoGam) decreases the incidence of opportunistic infections in cardiac transplant recipients with severe hypogammaglobulinemia. However, the impact of Ig replacement in moderately hypogammaglobulinemic patients is unknown. METHODS: Periodic monitoring of the IgG levels was done in 300 heart transplant recipients. Moderate hypogammaglobulinemia (IgG, 350-500 mg/dl) developed in 56 patients (18.6%). Thirty-three patients declined randomization but agreed to have their IgG levels monitored. Twenty-three patients were randomized to placebo (n = 10) or CytoGam (n = 13) at 105 +/- 63 days after transplantation. RESULTS: The baseline characteristics were similar. A significant reduction in CMV infection was noted in the CytoGam Group compared with the Placebo Group (15.4% [2/13] vs 60% [6/10], p = .039). Among patients who declined randomization, CMV infection developed in 13 (39.4%) of 33, and 6 (46.1%) of the 13 progressed to severe hypogammaglobulinemia. A trend for reduction in the average episodes of > or =grade 2 rejection during the 6-month period after randomization was noted in the CytoGam group (0.4 +/- 0.6 vs 1.4 +/- 1.3, p = 0.065). CONCLUSIONS: The preemptive use of CytoGam decreases the incidence of CMV infection in patients with moderate hypogammaglobulinemia. A larger randomized study is needed to substantiate these results.
Adult↗
The impact of donor gender on cardiac peri-transplantation ischemia injury.
BACKGROUND: Cardiac allografts from female donors have been shown to be associated with increased risk of transplant vasculopathy. However, the influence of donor gender on peri-transplantation ischemic injury has not been evaluated. METHODS: A total of 361 patients (mean age, 52 +/- 10 years) underwent cardiac transplantation between January 1998 and December 2002. Patients were divided into 4 groups according to their donor-recipient gender status: Group A, male-male, 156; Group B, male-female, 37; Group C, female-male, 114; and Group D, female-female, 54. Serial right ventricular endomyocardial biopsy specimens were evaluated for ischemic injury during the first 4 weeks after transplantation. RESULTS: Patients were similar in baseline characteristics. An increased incidence of ischemic injury complicated by fibrosis (12.9%, p = 0.03) and subsequent development of transplant vasculopathy (Kaplan-Meier 6-year freedom from vasculopathy, 53.4%; p = 0.012) was noted in Group D. No survival difference was observed among the 4 groups, however. In Group D (F-F), 2 patients underwent retransplantation and 2 patients underwent revascularization. CONCLUSIONS: The transplantation of a female cardiac allograft into a female recipient is associated with increased risk of ischemic injury complicated by fibrosis and subsequent transplant vasculopathy.
Adult↗
A national strategy for smoking cessation treatment in England.
In 1998 the UK government published a White Paper on tobacco which set out the development of smoking cessation treatment services across England. This paper presents a detailed analysis of the events leading up to the inclusion of smoking cessation treatment services within the White Paper, and the background to the evaluation of those services, the results of which are the subject of the remaining papers in this supplement.
England↗
Lessons from the English smoking treatment services.
This paper summarizes and discusses the key findings of the evaluation of the English smoking treatment services, which were established in 1999 as part of the English National Health Service. Within 4 years these services existed throughout the country and were working at full capacity, a total of pound 76 million having been spent on them over this period, excluding medication costs. In the fourth year almost 235,000 people attended treatment and set a quit date, and the total budget, including medications, was approximately pound 50 million. At the end of the fourth year the government allocated pound 138 million for the services for the period April 2003-March 2006. The CO-validated 4-week abstinence rate was 53%, the validated 52-week abstinence rate was 15%, and the relapse rate from 4 to 52 weeks was 75%. There was no sex difference in cessation rates at long-term follow-up. The cessation results and relapse rate from weeks 4 to 52 are consistent with results from published studies, including clinical trials. The estimated cost per life-year saved was pound 684 and the figure is even lower if the potential future health care cost savings are taken into account at pound 438 per life-year saved. This compares with the benchmark of pound 20,000 per life-year saved, which the National Institute for Clinical Excellence (NICE) is using to recommend new health care interventions in the National Health Service. The services were also succeeding in reaching disadvantaged smokers. However, there have been problems, and other health care systems considering an initiative of this kind should: set national training standards and increase training capacity before launching the services; standardize the provision of pharmaceutical treatments and make them as accessible as possible before launching the services; and give the services at least 5 years of central funding to allow them to become well established. Monitoring is extremely important but should not be so much of a burden that it detracts from developing a quality service and although cessation targets can be helpful, care needs to be taken that they are reasonable and do not promote throughput at the expense of quality.
Cost-Benefit Analysis↗
Prospective study of the effect of exposure to other smokers in high school tutor groups on the risk of incident smoking in adolescence.
Adolescent smokers tend to have peers who smoke, but it is unclear whether this arises from self-selection of smoking peers or whether this is a causal effect on the uptake of smoking (incident smoking). The authors used school tutor group current smoking prevalence, an unbiased measure of peer smoking in high schools in the United Kingdom, to estimate the independent effect of peer smoking on incident smoking among high school students. In a prospective cohort study of children aged 13-15 years (grades 9 and 10) in 10 high schools in Nottinghamshire, United Kingdom, smoking behavior was surveyed in 2,881 students in 2000, and the survey was repeated in 2,109 students (73%) in 2001. There were 267 incident smokers (15%) among the 1,766 nonsmokers in 2000. The adjusted odds of incident smoking were significantly higher in girls, in students with parents or siblings who smoke, and in relation to school tutor group current smoking prevalence in 2000 (relative odds for highest relative to the lowest quartile of prevalence = 1.78, 95% confidence interval: 1.20, 2.64). This tutor group effect was independent of having a best friend who smoked in the 2001 study. Incident smoking is therefore increased among students exposed to other students who smoke, and preventing smoking at school may reduce adolescent smoking.
Adolescent↗
Use of and beliefs about light cigarettes in four countries: findings from the International Tobacco Control Policy Evaluation Survey.
This study examined reported use of, and beliefs about, so-called light cigarettes among adult smokers in four countries: Australia (Aus), Canada (Can), the United Kingdom (U.K.) and the United States (U.S.). The method used was parallel telephone surveys among 9,046 smokers across the four countries. The results indicated that more than half of all smokers in each country except the U.K. reported smoking light cigarette brands. A majority of smokers surveyed in each country except Canada continue to believe that light cigarettes offer some health benefit compared to regular cigarettes (Canada 43%, U.S. 51%, Australia 55%, U.K. 70%). A majority of smokers in all four countries believed that light cigarettes are smoother on the throat and chest than regular cigarettes. Predictors of use of light cigarettes and beliefs about possible benefits were very similar in the four countries. These results demonstrate an ongoing need for public education about why light cigarettes do not reduce harm and do not make quitting easier. The results provide further evidence for the need for regulatory measures in all four countries to prohibit the use of misleading light and mild descriptors including package imagery in product marketing (as prescribed in Article 11 of the Framework Convention on Tobacco Control), abandon the use of standard FTC/ISO tar and nicotine yields as consumer information, and adopt policies to regulate deceptive design features of cigarettes, such as ventilated filters.
Adult↗
'You can't go without a fag...you need it for your hash'--a qualitative exploration of smoking, cannabis and young people.
AIMS: To examine the relationship between smoking tobacco and cannabis use among smokers in their mid-to-late teens. DESIGN AND PARTICIPANTS: Two qualitative studies in Scotland. One study used semistructured paired interviews involving 99 16-19-year-old smokers, the other comprised eight focus groups involving 46 15-16-year-old smokers. MEASUREMENT: The interviews and focus groups explored the role and meaning of smoking in the participants' lives, smoking histories and future cessation intentions and how these related to other aspects of their lives, particularly cannabis use. FINDINGS: Cannabis use was regarded as an important and enjoyable aspect of many of the participants' lives. Importantly, cannabis use and cigarette smoking were linked inextricably. Several reported how smoking joints had been a 'gateway' to smoking cigarettes. While most wanted to quit smoking cigarettes, cannabis use reinforced their cigarette smoking and few wanted to stop using cannabis. CONCLUSION: National studies need to be conducted to examine how widespread the problem identified is and tobacco control initiatives and smoking cessation treatment services need to consider urgently how to overcome the barrier that a desire on the part of young people to continue cannabis smoking poses to achieving a reduction in tobacco use.
Adolescent↗