"The worst thing is lying in bed thinking 'I want a cigarette'" a qualitative exploration of smoker's and ex-smoker's perceptions of sleep during a quit attempt and the use of cognitive behavioural therapy for insomnia to aid cessation.

Smokers report poorer sleep quality than non-smokers and sleep quality deteriorates further during cessation, increasing risk of smoking relapse. Despite the use of cognitive behavioural therapy for insomnia (CBT-I) to aid quit attempts emerging in the area, little is known about smokers and ex smoker's experiences of sleep during a quit attempt or their perceptions of CBT-I. This study addresses this gap by exploring smoker's and ex-smoker's experiences of the link between smoking and sleep and how this may change as a function of smoking/smoking abstinence. It also explores views of traditional CBT-I components (i.e., perceived feasibility, effectiveness, barriers of use). We conducted semi-structured interviews with current and recently quit smokers (n = 17) between January and September 2022. The framework method was used for analysis. Four themes addressing research questions were described. These included: 1) A viscous cycle; poor sleep quality and negative psychological state during cessation; 2) Perceived engagement and effectiveness; the importance of feasibility, experience, value, identity and psychological state in assessing CBT-I as a cessation tool; 3) Striking a balance; tailoring CBT-I to reduce psychological overload in a time of lifestyle transition; and 4) Personalisation and digital delivery helping overcome psychological barriers during cessation. The analysis suggested during quit attempts smokers experienced a range of sleep problems that could increase risk of relapse due to a negative impact on psychological state. It also revealed participants thought that CBT-I is something they would use during a quit attempt but suggested changes and additions that would improve engagement and be better tailored to quitting smokers. Key additions included the integration of smoking-based cognitive restructuring, starting the intervention prior to a quit attempt, and the need for personalisation and tailoring.

The impact of introducing alcohol-free beer options in bars and public houses on alcohol sales and revenue: A randomised crossover field trial.

AIMS: The study aimed to estimate the impact of introducing a draught alcohol-free beer, thereby increasing the relative availability of these products, on alcohol sales and monetary takings in bars and pubs in England. DESIGN: Randomised crossover field trial. SETTING: England. PARTICIPANTS: Fourteen venues that did not previously sell draught alcohol-free beer. INTERVENTION AND COMPARATOR: Venues completed two intervention periods and two control periods in a randomised order over 8 weeks. Intervention periods involved replacing one draught alcoholic beer with an alcohol-free beer. Control periods operated business as usual. MEASUREMENTS: The primary outcome was mean weekly volume (in litres) of draught alcoholic beer sold. The secondary outcome was mean weekly revenue [in GBP (£)] from all drinks. Analyses adjusted for randomised order, special events, season and busyness. FINDINGS: The adjusted mean difference in weekly sales of draught alcoholic beer was -20 L [95% confidence interval (CI) = -41 to +0.4], equivalent to a 4% reduction (95% CI = 8% reduction to 0.1% increase) in the volume of alcoholic draught beer sold when draught alcohol-free beer was available. Excluding venues that failed at least one fidelity check resulted in an adjusted mean difference of -29 L per week (95% CI = -53 to -5), equivalent to a 5% reduction (95% CI = 8% reduction to 0.8% reduction). The adjusted mean difference in weekly revenue was +61 GBP per week (95% CI = -328 to +450), equivalent to a 1% increase (95% CI = 5% decrease to 7% increase) when draught alcohol-free beer was available. CONCLUSIONS: Introducing a draught alcohol-free beer in bars and pubs in England reduced the volume of draught alcoholic beer sold by 4% to 5%, with no evidence of the intervention impacting net revenue.

Associations between self-reported sleep quality, fatigue severity, factors associated with successful cessation, and cessation beliefs among regular smokers.

BACKGROUND: Smokers report poorer sleep than non-smokers and sleep quality deteriorates further during cessation, increasing risk of smoking relapse. Better understanding of the relationship between sleep and relapse-related outcomes could inform novel approaches to smoking cessation support. The aim of this study was to investigate same day associations of self-reported sleep quality and fatigue severity with factors associated with successful cessation and cessation beliefs, among regular smokers. METHODS: This cross-sectional observational study (n=412) collected self-reported sleep quality, fatigue severity, and factors associated with successful cessation and cessation beliefs among regular smokers via an online survey (60% male). RESULTS: There was evidence of an association between sleep quality (SQ) and reduced 24hr (ß = -0.12, p = 0.05) and lifetime (ß = -0.09, p = 0.04) abstinence self-efficacy. In addition, poorer SQ and higher fatigue severity (FS) were associated with increased smoking urges (SQ: ß = 0.27, p < .001; FS: ß = 0.32, p < .001), increased barriers to cessation (SQ: ß = 0.19, p < .001; FS: ß = 0.32, p < .001), and increased perceived risks to cessation (SQ: ß = 0.18, p < .001; FS: ß = 0.26, p < .001). Fatigue severity was weakly associated with increased perceived benefits to cessation (ß = 0.12, p = .017). CONCLUSIONS: Self-reported sleep quality and fatigue severity were associated with multiple factors associated with successful cessation and cessation beliefs. Further research is needed to extend these findings by using different methods to identify the temporal direction of associations and causality. IMPLICATIONS: This study is the first to examine associations between sleep quality, fatigue severity, and factors associated with successful cessation and cessation beliefs. Findings show that both sleep quality and fatigue severity are associated with multiple factors associated with successful cessation and could be modifiable targets for future smoking cessation interventions. Furthermore, our data suggest that fatigue severity has an independent effect on multiple factors associated with successful cessation when accounting for sleep quality. This indicates that fatigue, independent of sleep quality, could be an important factor in a quit attempt.

Coupling picodroplet microfluidics with plate imaging for the rapid creation of biomanufacturing suitable cell lines with high probability and improved multi-step assurance of monoclonality.

BACKGROUND: There is an expectation from regulatory agencies that cell lines used in the commercial production of biopharmaceuticals are derived from a single cell progenitor. Traditional methods of single cell cloning include the use of the limiting dilution cloning method which often requires multiple rounds of low cell density cell plating and either microscopic evaluation that wells contain single cells and/or the calculation of a statistically derived probability of monoclonality. METHODS AND RESULTS: We have combined the single cell screening, deposition and picodroplet imaging ability of Sphere Fluidics' Cyto-Mine technology with the plate imaging capability of the Solentim Cell Metric to create a novel workflow for the generation of high producing clonal cell lines with both high probability and assurance of monoclonality. The efficiency of three key stages of the process (single cell picodroplet encapsulation, single picodroplet dispensation and single cell settling in the focal plane of the plate imager) was determined and a probability calculation was derived using the Wilson Score Interval method. The combined probability that a single cell is encapsulated into a picodroplet, is deposited into the correct well of a 96-well plate and that a cell settles into the focal plane of the plate imager yields a combined > 99% probability of monoclonality. Furthermore, visual verification of a single cell progenitor is obtained at multiple steps throughout the cloning workflow. CONCLUSION: This novel methodology for the rapid creation of high quality clonal cell lines for biomanufacturing purposes has many advantages over more traditional approaches including improved assurance of single cell derivation, integrated imaging capability, assay flexibility, equipment utilization time and in-process cell line segregation.

Striking a Balance: Physical Activity, Screen-Viewing and Homework during the Transition to Secondary School.

Physical activity levels decline, and screen-viewing behaviours increase during childhood and adolescence. The transition to secondary school appears to coincide with a sharp decline in physical activity. Parents have the potential to influence their child's behaviours, yet little is known about their expectations for their child's physical activity and screen-viewing during this transition. This paper explores parents' expectations for their children's physical activity and screen-viewing as they transition from primary to secondary school, and their proposed strategies for managing these behaviours during this time. Forty-two parents of children aged 10-11 years participated in a semi-structured telephone interviews in July 2017 or March 2018. The interview data were analysed via inductive and deductive content analysis to explore parents' perceptions of physical activity and screen-viewing during the transition, the reasons for their perceptions, and the strategies they intended to implement to help their child balance their behaviours. Most parents expected both physical activity and screen-viewing to increase during this transition. There were several individuals, social and school-level factors influencing these expectations. Overall, parents felt that helping their child balance their activity levels, screen-viewing and homework would be challenging.

A process evaluation of the PLAN-A intervention (Peer-Led physical Activity iNtervention for Adolescent girls).

BACKGROUND: Few adolescent girls engage in enough physical activity (PA) to meet recommendations and there is a need for new interventions to increase girls PA. We have previously published the results of the PLAN-A cluster randomised feasibility trial which was a peer-led school-based PA intervention, showing that the intervention was feasible and held promise to increase the PA of girls aged 12-13 years. In PLAN-A, pupils nominated by their peers as influential attend training to teach them how to influence, promote and normalise physical activity amongst their peer-group. This paper reports the results of the process evaluation of the PLAN-A feasibility study, specifically focussing on acceptability to key stakeholders, intervention fidelity, receipt/experiences and perceived effect and suggested intervention refinements before proceeding to a definitive RCT. METHODS: A mixed-methods process evaluation triangulated data from qualitative focus groups and interviews with peer-supporter and non peer-supporter pupils (N = 52), parents (N = 12), teachers (N = 6) and intervention training deliverers (N = 5), quantitative questionnaires, and observations of intervention delivery. Quantitative data were analysed descriptively, and qualitative data were analysed with the Framework Method. RESULTS: The duration, timings, content and delivery of the peer-supporter training were acceptable. There was good fidelity to the intervention manual and its underpinning theory including high fulfilment of session objectives and use of an autonomy-supportive motivational style. Peer-supporters engaged with and enjoyed the training and retained key peer-supporter messages (what counts as PA, encouragement, empathy and subtlety). Parents and teachers were supportive of the intervention and reported perceived effects including increased PA and awareness of it, improved peer relationships, and confidence. Suggested intervention refinements included increasing participatory learning, reducing technical jargon, and providing more support to overcome challenges to giving peer support. CONCLUSIONS: PLAN-A can be delivered as planned, is well-received, and appears to be effective in empowering adolescent girls to support their peer group to become more active. The refinements identified can be made within the original intervention structure, before proceeding to a definitive trial. TRIAL REGISTRATION: ISCTRN, ISRCTN12543546 , Registered on 28/7/2015.

Physical Activity during the School Holidays: Parent Perceptions and Practical Considerations.

Children's physical activity decreases during school holidays. Less structured days and reduced participation in organised activities may account for some of the decrease. Little is known about the factors that influence parents' decision to enrol their child in organised activity such as holiday clubs. This paper sought to explore parents' perceptions of their child's physical activity during school holidays and the factors that influence holiday activity-based decision making. Semi-structured telephone interviews were conducted with 42 parents of children aged 10-11 years in July 2017 or March 2018. Data were analysed using a combination of inductive and deductive content analysis to explore parents' perceptions of holiday-based physical activity and the factors associated with how they provide physical activity opportunities for their children. The data revealed that most parents consider their child's physical activity levels when planning for the school holidays. However, work commitments in the holidays meant many parents had to rely on both informal and formal childcare. Grandparents were the primary source of informal childcare, despite a perception that children were not as physically active when with them. Holiday clubs were also a viable option, but the cost, location and age-appropriateness of provision inhibit parents signing older children up to these regularly.

Results of a feasibility cluster randomised controlled trial of a peer-led school-based intervention to increase the physical activity of adolescent girls (PLAN-A).

BACKGROUND: Most adolescent girls in the UK do not meet government physical activity recommendations and effective interventions are needed. This study reports the results of a feasibility trial of PLAN-A, a novel school-based peer-led physical activity intervention for adolescent girls. METHODS: A two-arm cluster randomised controlled feasibility study was conducted in six English secondary schools (4 intervention & 2 control). Year 8 (age 12-13) girls were eligible and randomisation was at school-level. The intervention involved training Year 8 girls (out of school for two consecutive days, plus one top-up day 5 weeks later), who were identified by their peers as influential, to provide informal support to their friends to increase their physical activity. Feasibility of the intervention and the research was examined, including: recruitment, training attendance and data provision rates, evidence of promise of the intervention to affect weekday moderate-to-vigorous physical activity (MVPA), intervention cost and estimation of the sample size for a definitive trial. Accelerometer and questionnaire data were collected at the beginning of Year 8 (Time 0), the end of Year 8 (10-weeks after peer-supporter training) and the beginning of Year 9 (Time 2). RESULTS: Four hundred twenty-seven girls were recruited (95% recruitment rate). 55 girls consented to be a peer-supporter and 53 peer-supporters were trained (97% of those invited). Accelerometer return rates exceeded 85% at each time point and wear time criteria was met by 83%, 71% and 62% participants at Time 0, 1 and 2 respectively. Questionnaire data were provided by >91% of participants at each time point. Complete-case adjusted linear regression analysis showed evidence of a 6.09 minute (95% CI = 1.43, 10.76) between-arms difference in weekday MVPA at Time 2 in favour of the intervention arm. On average PLAN-A cost £2685 per school to deliver (£37 per Year 8 girl). There were no adverse events. A trial involving 20 schools would be adequately powered to detect a between-arms difference in weekday MVPA of at least six minutes. CONCLUSIONS: The PLAN-A intervention adopts a novel peer-led approach, is feasible, and shows evidence of promise to positively affect girls' physical activity levels. A definitive trial is warranted. TRIAL REGISTRATION: ISCTRN, ISRCTN12543546, Registered on 28/7/2015, URL of registry record: http://www.isrctn.com/ISRCTN12543546.

Examining the challenges posed to parents by the contemporary screen environments of children: a qualitative investigation.

BACKGROUND: The ubiquity of technology in modern society has led to the American Academy of Pediatrics adapting their screen-viewing (SV) recommendations for children. The revised guidelines encourage families to identify an appropriate balance between SV and other activities. The aims of this study were to explore parents' views of their child's SV time and how important it is for families to achieve a 'digital balance'. METHODS: Semi-structured telephone interviews were conducted with 51 parents of 8-9-year-old children, between July and October 2016. Inductive and deductive content analyses were used to explore parents' perceptions of their child's level of SV (low, medium, high), how parents feel about child SV, and the importance placed on achieving a digital balance. Parent report of child SV behaviours on weekdays and weekend days were assessed via questionnaire. RESULTS: Interview data revealed that because SV is considered the 'norm', parents struggle to limit it, partly because they want their children to be equipped for the modern technological world. While most parents believe SV to have negative effects on children, parents also report advantages to SV. Many parents feel that not all SV is equal, with tablets considered worse than television because of the isolated nature of activities, and educational SV considered more beneficial than non-educational SV. Most parents feel it is important for their family to achieve a digital balance, primarily to spend more quality family time together. Large variation was observed in parents' descriptions of child SV time on weekdays and weekend days. CONCLUSIONS: Parents recognise the importance of digital balance but want their children to fit into the ever-advancing digital world. Parents do not treat all SV equally. Watching television and engaging in educational SV may be encouraged, while 'playing' on tablets is discouraged. These findings highlight the challenge faced by researchers and policy makers to help families achieve a digital balance, and strategies are needed to support parents to plan child SV time.