Examining differences in real-world effectiveness of e-cigarettes for smoking cessation by source of purchase in England: an observational study of different contexts before and after the COVID-19 pandemic.

INTRODUCTION: The effectiveness of e-cigarettes for smoking cessation may differ by source of purchase. The changing influence of self-selection on purchase location caused by COVID-19 pandemic-related vape shop closures means we can examine the association between smoking abstinence e-cigarette use by purchase source and test for moderation of this association by the timing of the pandemic. METHODS: Repeat-cross-sectional nationally representative surveys, conducted between January-2017 and August-2023. Participants (N=1,284; ≥18y, 46.9% women) who made a past-year quit attempt, used an e-cigarette in their most recent attempt, currently vaping and provided data on the purchase source were included. The association between e-cigarette purchase source and continuous abstinence following the most recent quit attempt was assessed with adjusted regression, including an interaction between the timing of pandemic restrictions (March-2020 through January-2022). RESULTS: Overall, 48.1% usually purchasing their e-cigarettes from vape shops, declining from 53.6% pre-pandemic to 40.6% during the pandemic. There was inconclusive evidence that those purchasing from vape shops had greater odds of quitting smoking (ORadj=1.25, 95%CI 0.92-1.76). The association between purchase source and successful quitting did not depend upon whether purchasing occurred before or during the pandemic (F=0.08, pinteraction=0.774; pre-pandemic: ORadj=1.23, 0.79-1.91; and pandemic: ORadj=1.29, 0.81-2.06). CONCLUSIONS: More data are needed to conclusively determine whether purchasing from a specialist vape shop increases smoking cessation. Given the changing influence of self-selection on purchase location caused by the pandemic, the similar associations between purchase source and quit success across both periods suggests it is unlikely an artefact of unmeasured confounding. IMPLICATIONS: It is important to know if where e-cigarettes are purchased can increase their effectiveness for smoking cessation. While we found a positive association between purchasing from a specialist vape shop and abstinence rates, the results were inconclusive. Further studies are required to establish whether purchasing from specialist vape shops improves smoking cessation outcomes compared with other purchase sources.

Secondhand Nicotine Absorption From E-Cigarette Vapor vs Tobacco Smoke in Children.

Importance: With the prevalence of e-cigarette use (vaping) increasing worldwide, there are concerns about children's exposure to secondhand vapor. Objective: To compare nicotine absorption among children who are (1) exposed to secondhand tobacco smoke only or (2) exposed to secondhand vapor only with (3) those exposed to neither. Design, Setting, and Participants: The US Continuous National Health and Nutrition Examination Survey (NHANES) is a repeat cross-sectional survey. Participants are interviewed in their homes and, several days after, visit a mobile examination center to provide biological specimens. This study uses data from a nationally representative sample of US households from 2017 to 2020. Participants were children aged 3 to 11 years with serum cotinine levels incompatible with current firsthand nicotine use (ie, <15 µg/L). The final analysis was conducted on January 9, 2024. Exposures: Reported exposure to secondhand smoke or vapor indoors in the past 7 days (only secondhand smoke, only secondhand vapor, or neither). Covariates included age, sex, ethnicity, family income, body weight, and height. Main Outcomes and Measures: The primary outcome was serum cotinine concentration, an objective biomarker of nicotine absorption. Geometric mean cotinine levels and 95% CIs were calculated using log-normal tobit regression, accounting for the complex survey design and weights. Results: The mean (SD) age of the 1777 children surveyed was 7.4 (2.6) years, 882 (49.6%) were female, and 531 (29.9%) had family incomes below the poverty level. Nicotine absorption, as indexed by serum cotinine level, was highest among children only exposed to secondhand smoke (0.494 µg/L µg/L; 95% CI, 0.386-0.633 µg/L), followed by those exposed only to secondhand vapor (0.081 µg/L; 95% CI, 0.048-0.137 µg/L), equating to 83.6% (95% CI, 71.5%-90.5%; P < .001) lower nicotine absorption. Among children with no reported secondhand exposure, the geometric mean cotinine level was 0.016 µg/L (95% CI, 0.013-0.021 µg/L), or 96.7% (95% CI, 95.6%-97.6%; P < .001) lower than for those with exposure to secondhand smoke. Results were similar after covariate adjustment. Conclusions and Relevance: In this cross-sectional study of US children, nicotine absorption was much lower in children who were exposed to secondhand vapor vs secondhand smoke, but higher than in those exposed to neither. These findings suggest that switching from smoking to vaping indoors may substantially reduce, but not eliminate, children's secondhand exposure to nicotine and other noxious substances.

Trends in long term vaping among adults in England, 2013-23: population based study.

OBJECTIVE: To examine trends in long term (>6 months) vaping among adults in England. DESIGN: Population based study. SETTING: England. PARTICIPANTS: 179 725 adults (≥18 years) surveyed between October 2013 and October 2023. MAIN OUTCOME MEASURES: Time trends in prevalence of long term vaping using logistic regression, overall and by vaping frequency (daily or non-daily), and main type of device used (disposable, refillable, or pod). RESULTS: The proportion of adults reporting long term vaping increased non-linearly, from 1.3% (95% confidence interval 1.1% to 1.5%) in October 2013 to 10.0% (9.2% to 10.9%) in October 2023, with a particularly pronounced rise from 2021. This rise included an increase in long term daily vaping, from 0.6% (0.5% to 0.8%) to 6.7% (6.0% to 7.4%). Absolute increases in long term vaping were larger among people with a history of regular smoking (current smokers: 4.8% (4.0% to 5.8%) to 23.1% (20.4% to 25.9%); recent former smokers: 5.7% (3.4% to 9.2%) to 36.1% (27.6% to 45.4%); long term former smokers: 1.4% (1.0% to 1.9%) to 16.2% (14.2% to 18.4%)), but an increase also occurred among people who had never regularly smoked (0.1% (0.0% to 0.2%) to 3.0% (2.3% to 3.8%)). Growth was also more pronounced in young adults (eg, reaching 22.7% (19.2% to 26.5%) of 18 year olds v 4.3% (3.6% to 5.2%) of 65 year olds), including among those who had never regularly smoked (reaching 16.1% (11.1% to 22.7%) of 18 year olds v 0.3% (0.1% to 0.6%) of 65 year olds). Between October 2013 and March 2021, most long term vapers mainly or exclusively used refillable electronic cigarettes (2.5% to 3.3% of adults) and few (0.1% of adults) used disposable devices. However, prevalence of long term vaping using disposable devices subsequently rose rapidly, and by October 2023 similar proportions of adults mainly or exclusively used disposable and refillable devices (4.9% (4.2% to 5.7%) and 4.6% (4.0% to 5.3%), respectively). CONCLUSIONS: The prevalence of long term vaping increased substantially among adults in England during 2013-23. Much of this increase occurred from 2021, coinciding with the rise in popularity of disposable e-cigarettes. Half of long term vapers now mainly or exclusively use disposable devices. The growth was concentrated among people with a history of regular smoking, but an increase also occurred among people who never regularly smoked, especially young adults.

Evaluation of a regional tobacco control programme (Greater Manchester's Making Smoking History) on quitting and smoking in England 2014 to 2022: a time-series analysis.

INTRODUCTION: This study aimed to assess the impact of Greater Manchester's Making Smoking History programme - a region-wide smoking cessation programme launched in January 2018 - on key smoking and quitting outcomes. METHODS: Data were from a nationally-representative monthly survey, 2014-2022 (n=171,281). We used interrupted time-series analyses (Autoregressive Integrated Moving Average [ARIMA] and generalised additive models [GAM]) to examine regional differences between Greater Manchester and the rest of England, before and during the programme's first five years. Outcomes were rates of quit attempts and overall quits among smokers, quit success rates among smokers who tried to quit (pre-registered outcomes), and current smoking prevalence among adults (unregistered outcome). RESULTS: Results showed mixed effects of the programme on quitting. Primary ARIMA models showed comparative reductions in quit success rates (change in quarterly difference between regions = -11.03%; 95%CI -18.96;-3.11) and overall quit rates in Greater Manchester compared with the rest of England (-2.56%; 95%CI -4.95;-0.18), and no significant change in the difference in the quit attempt rate (+2.95%; 95%CI -11.64;17.54). These results were not consistently observed across sensitivity analyses or GAM analyses. Exploratory ARIMA models consistently showed smoking prevalence in Greater Manchester declined more quickly than in the rest of England following initiation of the programme (-2.14%; 95%CI -4.02;-0.27). CONCLUSIONS: The first five years of Greater Manchester's Making Smoking History programme did not appear to be associated with substantial increases in quitting activity. However, exploratory analyses showed a significant reduction in the regional smoking rate, over and above changes in the rest of England over the same period. IMPLICATIONS: Taken together, these results show a relative decline in smoking prevalence in Greater Manchester but equivocal data on quitting, introducing some uncertainty. It is possible the programme has reduced smoking prevalence in the absence of any substantial change in quitting activity by changing norms around smoking and reducing uptake, or by reducing the rate of late relapse. It is also possible that an undetected effect on quitting outcomes has still contributed to the programme's impact on reducing prevalence to some degree. It will be important to evaluate the overall impact of the programme over a longer timeframe.

Differential effects of deep brain stimulation on reinstatement of cocaine seeking in male and female rats.

There are currently no FDA-approved treatments for cocaine use disorder. Recent preclinical and clinical studies showed that deep brain stimulation (DBS) in limbic regions reduced drug seeking behavior. Our previous work indicated that DBS of the nucleus accumbens shell attenuated reinstatement of cocaine seeking, a model of relapse, in male rats. The current experiments were designed to evaluate the effect of electrical DBS on cocaine reinstatement in female rats across the estrous cycle. Rats were allowed to self-administer cocaine and lever responding was subsequently extinguished. Cocaine seeking was reinstated by an acute injection of experimenter-delivered cocaine. The effect of nucleus accumbens shell DBS vs. sham stimulation on cocaine-primed reinstatement was evaluated in female and male rats using a within-subjects counterbalanced design. Consistent with previous work, accumbens shell DBS suppressed cocaine seeking in male rats. In sharp contrast, accumbens shell DBS had no effect on cocaine reinstatement in female rats evaluated in either the estrus or non-estrus phases. These results suggest that changes across the estrous cycle are not responsible for the differences in the effect of DBS on cocaine reinstatement between female and male rats.

Nicotine strength of e-liquids used by adult vapers in Great Britain: A population survey 2016 to 2024.

BACKGROUND AND AIMS: In March 2024, the UK government announced plans to introduce a Vaping Products Duty that will tax e-liquids based on their nicotine strength. This study examined trends in the nicotine strength of e-liquids used by adult vapers and differences in those currently used across relevant subgroups. DESIGN: Nationally-representative, cross-sectional household survey, July 2016 to January 2024. SETTING: Great Britain. PARTICIPANTS: 7981 adult vapers. MEASUREMENTS: Participants were asked whether the e-cigarette they mainly use contains nicotine (yes/no) and the e-liquid strength (no nicotine, >0-≤ 6, 7-11, 12-19 or ≥20 mg/ml). We also collected information on the main device type used (disposable/refillable/pod), age, gender, occupational social grade, history of ≥1 mental health conditions, smoking status and (among past-year smokers) level of cigarette addiction. FINDINGS: The proportion of vapers in England using high-strength (≥20 mg/ml) e-liquids increased from an average of 3.8% (95% confidence interval [CI] = 2.9-5.0) up to June 2021 to 32.5% (CI = 27.9-37.4) in January 2024 (the vast majority of whom [93.3% in January 2024] reported using exactly 20 mg/ml; the legal limit). This rise was most pronounced among those using disposable e-cigarettes, those aged 18-24 years and all smoking statuses (including never smokers) except long-term (≥1y) ex-smokers. Of those surveyed in 2022-2024 in Great Britain, overall, 89.5% (CI = 88.1-90.8) said they usually used e-cigarettes containing nicotine, 8.7% (CI = 7.5-10.0) used nicotine-free e-cigarettes, and 1.8% (CI = 1.2-2.4) were unsure. The proportion using ≥20 mg/ml was higher among those mainly using disposable (47.9%) compared with pod (16.3%) or refillable (11.5%) devices; never smokers (36.0%), current smokers (28.8%) or recent (<1y) ex-smokers (27.4%), compared with long-term ex-smokers (13.9%); and younger (16-24y; 44.2%) compared with older (≥25y; range 9.4-25.1%) age groups. There were no notable differences across other subgroups of interest. CONCLUSIONS: Use of high-strength nicotine e-liquids in England appears to have increased sharply in recent years. Most adult vapers in Great Britain appear to use e-cigarettes that contain nicotine but different subgroups use different strengths: nicotine strengths tend to be higher among those who mainly use disposable devices and those aged 16-24y, and lower among long-term ex-smokers.

Trends in Daily Cigarette Consumption Among Smokers: A Population Study in England, 2008-2023.

INTRODUCTION: This study aimed to estimate time trends in cigarette consumption among smokers in England between 2008 and 2023 and to explore differences by key potential moderators. AIMS AND METHODS: We used data from 57 778 adult cigarette smokers participating in a nationally representative monthly cross-sectional survey between January 2008 and September 2023. We estimated monthly time trends in mean daily consumption of (1) any, (2) manufactured, and (3) hand-rolled cigarettes among all smokers and by main type of cigarettes smoked, smoking frequency, age, gender, occupational social grade, region, nicotine replacement therapy use, and vaping status. RESULTS: Overall cigarette consumption fell from 13.6 [95% CI = 13.3 to 13.9] to 10.6 [10.5 to 10.8] per day between January 2008 and October 2019 (a 22% decrease), then remained stable up to September 2023. Over this period, the proportion mainly or exclusively smoking hand-rolled cigarettes increased (from 30.6% [29.1%-32.1%] in 2008 to 52.1% [49.7%-54.5%] in 2023). As a result, manufactured cigarette consumption fell by 47%, from 9.5 [9.2-9.8] per day in January 2008 to 5.0 [4.7-5.3] in September 2023, while hand-rolled cigarette consumption increased by 35%, from 4.2 [3.9-4.4] to 5.6 [5.3-5.9], respectively. The decline in overall cigarette consumption was observed across all subgroups, but was greater among non-daily smokers, younger smokers, and those who vaped. CONCLUSIONS: Over the last 15 years, the average number of cigarettes consumed each day by smokers in England has fallen by almost a quarter, but has plateaued since October 2019. There has been a sharp decline in the number of manufactured cigarettes consumed and an increase in the number of hand-rolled cigarettes consumed, as smokers have increasingly shifted towards using hand-rolled tobacco. IMPLICATIONS: While average cigarette consumption in England has fallen over the past 15 years, this declining trend has stalled (and reversed in some population groups) since 2019. The availability of cheap, hand-rolled tobacco appears to be undermining policies that aim to reduce smoking by raising the price of tobacco (eg, through taxation) and could be targeted to reignite the decline in cigarette consumption.

Impact of the disruption in supply of varenicline since 2021 on smoking cessation in England: A population study.

BACKGROUND AND AIMS: Varenicline is one of the most effective smoking cessation treatments. Its supply in England was disrupted in July 2021 due to nitrosamine impurities found by its supplier, Pfizer. This study measured the impact of this disruption on smoking cessation in England. DESIGN, SETTING AND PARTICIPANTS: The study used repeated cross-sectional surveys conducted monthly, from June 2018 to December 2022. Set in England, it comprised a total of 3024 adults who reported smoking during the past year and had made at least one serious attempt to quit in the past 6 months. MEASUREMENTS: Generalized additive models analyzed the association of the varenicline supply disruption with the trend in self-reported varenicline use in the most recent quit attempt. We used these results to estimate the population-level impact of the disruption on smoking cessation. FINDINGS: Before July 2021, the proportion of past 6-month quit attempts using varenicline was stable at approximately 3.9% [risk ratio (RR)trend = 1.034, 95% confidence interval (CI) = 0.823-1.298]. The trend in varenicline use has changed sharply since the supply disruption (RRΔtrend = 0.297, 95% CI = 0.120-0.738), with prevalence falling by 69.3% per year since; from 4.1% in June 2021 to 0.8% in December 2022. Convergently, National Health Service general practitioner prescribing data reported that just 0.1% of prescriptions for smoking cessation treatments in December 2022 were for varenicline. Assuming that varenicline does not return to the market, we estimate that this could result in ~8400 fewer people stopping smoking for at least 6 months, ~4200 fewer long-term ex-smokers and ~1890 more avoidable deaths each year. CONCLUSIONS: In England, the disruption in supply of varenicline since 2021 has coincided with a substantial fall in the use of varenicline in attempts to quit smoking.

Characterising smoking and nicotine use behaviours among women of reproductive age: a 10-year population study in England.

BACKGROUND: Tobacco smoking affects women's fertility and is associated with substantial risks of adverse pregnancy outcomes. This study explored trends by socioeconomic position in patterns of smoking, use of non-combustible nicotine products, and quitting activity among women of reproductive age in England. METHODS: Data come from a nationally representative monthly cross-sectional survey. Between October 2013 and October 2023, 197,266 adults (≥ 18 years) were surveyed, of whom 44,052 were women of reproductive age (18-45 years). Main outcome measures were current smoking, vaping, and use of nicotine replacement therapy (NRT), heated tobacco products (HTPs), and nicotine pouches; mainly/exclusively smoking hand-rolled cigarettes and level of dependence among current smokers; past-year quit attempts among past-year smokers; and success of quit attempts among those who tried to quit. We modelled time trends in these outcomes, overall and by occupational social grade (ABC1 = more advantaged/C2DE = less advantaged). RESULTS: Smoking prevalence among women of reproductive age fell from 28.7% [95%CI = 26.3-31.2%] to 22.4% [19.6-25.5%] in social grades C2DE but there was an uncertain increase from 11.7% [10.2-13.5%] to 14.9% [13.4-16.6%] in ABC1. By contrast, among all adults and among men of the same age, smoking prevalence remained relatively stable in ABC1. Vaping prevalence among women of reproductive age more than tripled, from 5.1% [4.3-6.0%] to 19.7% [18.0-21.5%], with the absolute increase more pronounced among those in social grades C2DE (reaching 26.7%; 23.3-30.3%); these changes were larger than those observed among all adults but similar to those among men of the same age. The proportion of smokers mainly/exclusively smoking hand-rolled cigarettes increased from 40.5% [36.3-44.9%] to 61.4% [56.5-66.1%] among women of reproductive age; smaller increases were observed among all adults and among men of the same age. Patterns on other outcomes were largely similar between groups. CONCLUSIONS: Among women of reproductive age, there appears to have been a rise in smoking prevalence in the more advantaged social grades over the past decade. Across social grades, there have been substantial increases in the proportion of women of reproductive age who vape and shifts from use of manufactured to hand-rolled cigarettes among those who smoke. These changes have been more pronounced than those observed in the general adult population over the same period.

Are people more likely to vape or smoke indoors? A population survey of adults in England.

BACKGROUND: Increasingly, people smoke cigarettes outdoors and avoid exposing bystanders to harm. People may not have the same motivation to vape outdoors since e-cigarettes, unlike cigarettes, do not create side stream emissions and exhaled aerosol contains fewer toxicants than secondhand smoke. This study aims to estimate the prevalence and correlates of vaping and smoking indoors among adults in England. METHODS: Data came from the Health Survey for England 2019, a cross-sectional household survey. Adults who vape or smoke (N=1,530) were asked whether they had vaped or smoked indoors inside the home, car, or other places within the past seven days. Logistic regression was used to estimate prevalence and key correlates of indoor use, including age, sex, presence of adults/children in home, housing tenure and nicotine dependence. RESULTS: People who exclusively vaped were much more likely to use their product indoors than those who exclusively smoked (87.0% versus 52.0%; odds ratio [OR]=6.16, 95% confidence interval [CI]=4.09-9.28). Similarly, people who dual used had higher odds of vaping than smoking indoors (62.1% versus 44.3%; within-person OR=3.76, 95%CI=2.06-6.84). The preference for vaping over smoking indoors was found across different locations, including at home and in cars. Those who were older, highly dependent on nicotine, and lived alone were most prone to use any product indoors. While housing tenure was not strongly associated with vaping indoors, those living in social housing were much more likely to smoke indoors than homeowners. CONCLUSIONS: Adults in England are much more likely to vape than smoke indoors. Age, nicotine dependence, and living alone are strongly associated with both behaviours. IMPLICATIONS: Our results show that people have a strong preference for vaping over smoking indoors, including in the home. Given the high prevalence of vaping indoors, policymakers, landlords and businesses must weigh up the ethics, benefits, and harms of extending smoke-free laws to include e-cigarettes.

Epigenetic inheritance of phenotypes associated with parental exposure to cocaine.

Parental exposure to drugs of abuse induces changes in the germline that can be transmitted across subsequent generations, resulting in enduring effects on gene expression and behavior. This transgenerational inheritance involves a dynamic interplay of environmental, genetic, and epigenetic factors that impact an individual's vulnerability to neuropsychiatric disorders. This chapter aims to summarize recent research into the mechanisms underlying the inheritance of gene expression and phenotypic patterns associated with exposure to drugs of abuse, with an emphasis on cocaine. We will first define the epigenetic modifications such as DNA methylation, histone post-translational modifications, and expression of non-coding RNAs that are impacted by parental cocaine use. We will then explore how parental cocaine use induces heritable epigenetic changes that are linked to alterations in neural circuitry and synaptic plasticity within reward-related circuits, ultimately giving rise to potential behavioral vulnerabilities. This discussion will consider phenotypic differences associated with gestational as well as both maternal and paternal preconception drug exposure and will emphasize differences based on offspring sex. In this context, we explore the complex interactions between genetics, epigenetics, environment, and biological sex. Overall, this chapter consolidates the latest developments in the multigenerational effects and long-term consequences of parental substance abuse.

Trends in purchasing cross-border, illicit and home-brewed alcohol: A population study in Great Britain, 2020-2023.

INTRODUCTION: The last 3 years have seen substantial changes in Great Britain (GB) including the COVID-19 pandemic, cost-of-living crisis and policy changes such as minimum unit pricing. We examined changes in purchasing cross-border, illicit and home-brewed alcohol among risky drinkers over this period. METHODS: Data were used from 22,086 adult (≥18 years) increasing/higher-risk drinkers (AUDIT-C ≥5) participating in a monthly cross-sectional survey between October 2020 and August 2023. We estimated time trends in the proportion reporting obtaining alcohol from: (i) cross-border (any/within-GB/international); (ii) illicit; and (iii) home-brewed sources in the past 6 months. RESULTS: Between October 2020 and August 2023, the proportion reporting cross-border alcohol purchases increased (from 8.5% to 12.5% overall; prevalence ratio [PR] = 1.47 [95% CI 1.17-1.86]). This was largely driven by an increase in cross-border purchases abroad (PR = 1.52 [1.13-2.05]), with a smaller, uncertain increase in cross-border purchases within GB (PR = 1.37 [0.96-1.95]). The prevalence of cross-border alcohol purchasing was higher in Wales (13.8% [12.3-15.4%]) and Scotland (6.1% [5.4-6.8%]) than England (3.6% [3.3-3.9%]). There was little change in illicit alcohol purchasing in England or Wales (4.1% [3.7-4.4%]; 4.2% [3.2-5.1%]), but in Scotland it fell from 5.7% to 2.4% (PR = 0.42 [0.19-0.81]). Home-brewed alcohol was rare (GB: 3.1% [2.9-3.4]) and stable. DISCUSSION AND CONCLUSIONS: The proportion of increasing/higher-risk drinkers in GB purchasing cross-border alcohol increased between October 2020 and August 2023, due to an increase in people buying alcohol abroad. Cross-border alcohol purchases within GB were more commonly reported in Wales and Scotland. The small proportion purchasing illicit alcohol did not change substantially in England or Wales, but fell by half in Scotland.

The relationship between gender discrimination and wellbeing in middle-aged and older women.

BACKGROUND: Emerging evidence suggests that perceived gender discrimination negatively impacts mental wellbeing in young women. PURPOSE: This study explored whether a similar relationship exists in middle-aged and older women. METHODS: A total of 3081 women (aged ≥52 years) from the English Longitudinal Study of Ageing provided data on perceived gender discrimination in 2010/11. Depressive symptoms, loneliness, quality of life and life satisfaction were assessed in 2010/11 and in 2016/17. RESULTS: Perceived gender discrimination was reported by 282 (9.2%) participants. Cross-sectionally, women who perceived gender discrimination reported more depressive symptoms (ß = 0.34, 95% CI 0.11 to 0.57) and had higher loneliness scores (ß = 0.14, 95% CI 0.08 to 0.20) than women who did not perceive gender discrimination. They also reported significantly lower quality of life (ß = -2.50, 95% CI -3.49 to -1.51) and life satisfaction (ß = -1.07, 95% CI -1.81 to -0.33). Prospectively, perceived gender discrimination was associated with greater loneliness scores (ß = 0.08, 95% CI 0.02 to 0.14), as well as lower ratings of quality of life (ß = -0.98, 95% CI -0.09 to -1.86), and life satisfaction (ß = -1.04, 95% CI -0.34 to -1.74), independent of baseline values. CONCLUSIONS: Middle-aged and older women who perceive gender discrimination report poorer mental wellbeing than those who do not perceive discrimination. Further, this type of discrimination may be predictive of declining mental wellbeing over time. These findings highlight the need for interventions to target gender-based discrimination to improve the wellbeing of women at mid- and older age.

Trends in Exclusive Non-Cigarette Tobacco Smoking in England: A Population Survey 2013-2023.

INTRODUCTION: The UK Government intends to implement a "smokefree generation" policy prohibiting the sale of all tobacco products to people born after 2008. National surveys provide comprehensive data on cigarette smoking, but little is known about patterns of non-cigarette tobacco smoking across key population groups. AIMS AND METHODS: Using data from a nationally representative cross-sectional survey of adults in England, collected monthly between September 2013 and September 2023 (n = 196 721), we estimated time trends in exclusive non-cigarette tobacco (eg, cigar/pipe/shisha) smoking prevalence, overall and by age, gender, occupational social grade, region, ethnicity, and vaping status. Interviews were conducted face-to-face until March 2020 and via telephone thereafter. RESULTS: From September 2013 to September 2023, there was a non-linear increase in exclusive non-cigarette tobacco smoking prevalence (from 0.36% to 1.68%; prevalence ratio = 4.72 [95% CI = 3.43-6.48]). Prevalence was relatively stable up to February 2020 (at an average of 0.46%), then increased sharply at the start of the COVID-19 pandemic (at the same time as survey methods changed), to 0.90% (0.82%-0.99%) in March 2020. This was followed by a steadier rise, peaking at 1.97% in May 2022, before falling slightly to 1.68% by September 2023. In 2022/2023, 1 in 10 smokers (10.8% [9.64%-12.0%]) exclusively used non-cigarette tobacco. The rise in prevalence was observed across all subgroups but was most pronounced among younger adults (eg, reaching 3.21% of 18-year-olds vs. 1.09% of 65-year-olds). Prevalence was consistently higher among men and current vapers. CONCLUSIONS: Although exclusive use of non-cigarette combustible tobacco remains rare among adults in England, it has increased in recent years, particularly among younger ages. As of September 2023, there were approximately 772 800 adult exclusive non-cigarette tobacco smokers in England; around five times more than a decade earlier. IMPLICATIONS: The proportion of adults in England who do not use cigarettes at all but smoke other combustible tobacco products has increased substantially in recent years, with a particularly pronounced rise among young people. The inclusion of non-cigarette combustible tobacco products under the proposed "smokefree generation" policy is therefore likely to be important for achieving the greatest reduction in youth uptake of tobacco smoking, as it would ensure young people who are unable to legally buy cigarettes do not buy other combustible tobacco products that are similarly harmful to health.

Trends in Harm Perceptions of E-Cigarettes vs Cigarettes Among Adults Who Smoke in England, 2014-2023.

Importance: Electronic cigarettes (e-cigarettes) are less harmful to users than combustible cigarettes. However, public health and media reporting have often overstated the potential risks of e-cigarettes, and inaccurate perceptions of the harms of vaping relative to smoking are pervasive. Objective: To examine time trends in harm perceptions of e-cigarettes compared with combustible cigarettes among adults who smoke. Design, Setting, and Participants: This nationally representative monthly cross-sectional survey study was conducted from November 2014 to June 2023 in England. Participants were adults who currently smoke. Main Outcomes and Measures: Participants were asked whether they thought e-cigarettes were less harmful, equally harmful, or more harmful than cigarettes, or did not know, with the proportion responding less harmful (vs all other responses) as the primary outcome. Logistic regression was used to test associations between survey wave and participants' perceptions of the harms of e-cigarettes. Results: Data were collected from 28 393 adults who smoke (mean [SD] age, 43.5 [17.3] years; 13 253 [46.7%] women). In November 2014, 44.4% (95% CI, 42.0%-46.8%) thought e-cigarettes were less harmful than cigarettes, 30.3% (95% CI, 28.2%-32.6%) thought e-cigarettes were equally harmful, 10.8% (95% CI, 9.4%-12.3%) thought they were more harmful, and 14.5% (95% CI, 12.9%-16.4%) did not know. However, by June 2023, the proportion who thought e-cigarettes were less harmful had decreased by 40% (prevalence ratio, 0.60; 95% CI, 0.55-0.66), and the proportion who thought e-cigarettes were more harmful had more than doubled (prevalence ratio, 2.16; 95% CI, 1.84-2.54). Changes over time were nonlinear: late 2019 saw a sharp decline in the proportion who thought e-cigarettes were less harmful and increases in the proportions who thought they were equally or more harmful. These changes were short-lived, returning to pre-2019 levels by the end of 2020. However, perceptions worsened again from 2021 up to the end of the study period: the proportion who thought e-cigarettes were more harmful increased to a new high, and the proportion who thought e-cigarettes were less harmful decreased to levels comparable to those in late 2019. As a result, in June 2023, the perception that e-cigarettes were equally as harmful as cigarettes was the most commonly held view among adults who smoke (33.7%; 95% CI, 31.4%-36.1%), with roughly similar proportions perceiving e-cigarettes to be less (26.7%; 95% CI, 24.6%-28.9%) and more (23.3%; 95% CI, 21.1%-25.7%) harmful. Conclusions and Relevance: This survey study of adults who smoke in England found that harm perceptions of e-cigarettes have worsened substantially over the last decade, such that most adults who smoked in 2023 believed e-cigarettes to be at least as harmful as cigarettes. The timing of the 2 most notable changes in harm perceptions coincided with the e-cigarette, or vaping product, use-associated lung injury outbreak in 2019 and the recent increase in youth vaping in England since 2021.

Associations of Prevalence of E-cigarette Use With Quit Attempts, Quit Success, Use of Smoking Cessation Medication, and the Overall Quit Rate Among Smokers in England: A Time-Series Analysis of Population Trends 2007-2022.

INTRODUCTION: This study aimed to (1) provide up-to-date estimates of how changes in the prevalence of e-cigarette use have been associated with changes in smoking cessation activities and use of licensed treatments among smokers in England and (2) explore any changes in these associations over time. METHODS: Data were aggregated quarterly on 67 548 past-year smokers between Q1-2007 and Q4-2022. Explanatory variables were the prevalence of (1) current e-cigarette use among smokers and (2) e-cigarette use during a quit attempt. Outcomes were rates of quit attempts and overall quits among past-year smokers, and the quit success rate and use of licensed treatments among those who made a quit attempt. RESULTS: The success rate of quit attempts increased by 0.040% (95% CI 0.019; 0.062) for every 1% increase in the prevalence of e-cigarette use during a quit attempt. No clear evidence was found for an association between current e-cigarette use and the quit attempt rate (Badj = 0.008 [95% CI -0.045; 0.061]) or overall quit rate (Badj = 0.063 [-0.031; 0.158]); or between use of e-cigarettes during a quit attempt and the overall quit rate (Badj = 0.030 [-0.054; 0.114]), use of prescription medication (varenicline/bupropion/nicotine replacement therapy [NRT]: Badj = -0.036 [-0.175; 0.102]), or use of over-the-counter NRT (Badj = -0.052 [-0.120; 0.015]). There was no clear evidence this pattern of associations has changed substantially over time. CONCLUSIONS: Changes in the prevalence of e-cigarette use in England through 2022 have been positively associated with the success rate of quit attempts but not clearly associated with the quit attempt rate, overall quit rate, or use of licensed smoking cessation treatments. IMPLICATIONS: If the association between the increase in e-cigarette use and the quit success rate is causal, then the use of e-cigarettes in quit attempts has helped in the region of 30 000 to 50 000 additional smokers in England to successfully quit each year since they became popular in 2013, over and above the number who were quitting before the advent of e-cigarettes.

Who would be affected by a ban on disposable vapes? A population study in Great Britain.

OBJECTIVES: The UK government is consulting on banning disposable e-cigarettes. This study aimed to describe trends in disposable e-cigarette use among adults in Great Britain since 2021 and establish who would currently be affected by a ban on disposables. STUDY DESIGN: Nationally-representative monthly cross-sectional survey. METHODS: We analysed data from 69,973 adults surveyed between January 2021 and August 2023. We estimated monthly time trends in the weighted prevalence of current disposable e-cigarette use among adults and by sociodemographic characteristics and smoking status. RESULTS: From January 2021 to August 2023, the prevalence of disposable e-cigarette use grew from 0.1 % to 4.9 %. This rise was observed across all population subgroups but was most pronounced among younger adults (e.g. reaching 15.9 % of 18-year-olds compared with 1.3 % of 65-year-olds), those who currently smoke (16.3 %), and those who stopped smoking in the past year (18.2 %). Use among never smokers remained relatively rare (1.5 %), except among 18- to 24-year-olds (7.1 %). Use was significantly higher in England than Wales or Scotland (5.3 % vs. 2.0 % and 2.8 %) and among less (vs. more) advantaged social grades (6.1 % vs. 4.0 %), those with (vs. without) children (6.4 % vs. 4.4 %), and those with (vs. without) a history of mental health conditions (9.3 % vs. 3.1 %). CONCLUSIONS: A ban on disposable e-cigarettes would currently affect one in 20 adults in Great Britain (approximately 2.6 million people). The proportion who would be affected would be greatest among young people, including the 316,000 18-24 year-olds who currently use disposables but who have never regularly smoked tobacco, which may discourage uptake of vaping in this group. However, a ban would also affect 1.2 million people who currently smoke and a further 744,000 who previously smoked. It would also have a disproportionate impact on disadvantaged groups that have higher rates of smoking and typically find it harder to quit.

The impact of a diabetes diagnosis on health and well-being: Findings from the English Longitudinal Study of Ageing.

BACKGROUND: Poorer health and well-being are associated with diabetes risk. However, little is known about the trajectory of health and well-being from before to after diabetes diagnosis. We compared depressive symptoms, quality of life, self-rated health, and loneliness at three time points (prediagnosis, diagnosis, 2-4 years post diagnosis) in individuals who developed diabetes and a comparison group. METHODS: Health and well-being measures were self-reported by 3474 participants from the English Longitudinal Study of Ageing. Repeated measures analysis of variance and generalized estimating equations were used to investigate differences by group, time, and group-by-time interactions. RESULTS: A total of 473 (13.6%) participants developed diabetes. The diabetes group reported greater depressive symptoms (W2(1) = 20.67, p < .001) and lower quality of life (F = 1, 2535 = 10.30, p = .001) and were more likely to rate their health as fair/poor (W2(1) = 67.11, p < .001) across time points, adjusting for age, sex, and wealth. They also reported greater loneliness (F = 1, 2693 = 9.70, p = .002) in unadjusted analyses. However, this was attenuated to the null in adjusted analyses. The group-by-time interaction was significant for quality of life (F = 1.97, 5003.58 = 5.60, p = .004) and self-rated health (W2(2) = 11.69, p = .003), with a greater decline in these measures over time in the diabetes group in adjusted analyses. CONCLUSION: People who received a diabetes diagnosis had greater depressive symptoms, lower quality of life, and poorer self-rated health than those who did not develop diabetes. Quality of life and self-rated health deteriorated more rapidly following a diagnosis. Screening for these factors around the time of diagnosis could allow for interventions to improve the health and well-being of those with diabetes.

Have there been sustained impacts of the COVID-19 pandemic on trends in smoking prevalence, uptake, quitting, use of treatment, and relapse? A monthly population study in England, 2017-2022.

BACKGROUND: Studies conducted during the early stages of the pandemic documented mixed changes in smoking behaviour: more smokers quitting successfully but little change in prevalence. This study aimed to examine whether there have been sustained impacts of the COVID-19 pandemic on smoking patterns in England. METHODS: Data were from 101,960 adults (≥ 18 years) participating in the Smoking Toolkit Study, a monthly representative household survey, between June 2017 and August 2022. Interviews were conducted face-to-face until March 2020 and via telephone thereafter. Generalised additive models estimated associations of the pandemic onset (March 2020) with current smoking, uptake, cessation, quit attempts, and use of support. Models adjusted for seasonality, sociodemographic characteristics, and (where relevant) dependence and tobacco control mass-media expenditure. RESULTS: Before the COVID-19 pandemic, smoking prevalence fell by 5.2% per year; this rate of decline slowed to 0.3% per year during the pandemic (RRΔtrend = 1.06, 95% CI = 1.02, 1.09). This slowing was evident in more but not less advantaged social grades (RRΔtrend = 1.15, 1.08, 1.21; RRΔtrend = 1.00, 0.96, 1.05). There were sustained step-level changes in different age groups: a 34.9% (95% CI = 17.7, 54.7%) increase in smoking prevalence among 18-24-year-olds, indicating a potential rise in uptake, in contrast to a 13.6% (95% CI = 4.4, 21.9%) decrease among 45-65-year-olds. In both age groups, these step-level changes were followed by the pre-pandemic declines stopping, and prevalence remaining flat. There were sustained increases in quitting among past-year smokers, with a 120.4% (95% CI = 79.4, 170.9%) step-level increase in cessation and a 41.7% (95% CI = 29.7, 54.7%) increase in quit attempts. The main limitation was the change in modality of data collection when the pandemic started; while this may have contributed to the step-level changes we observed, it is unlikely to explain changes in the slope of trends. CONCLUSIONS: In England, the rate of decline in adult smoking prevalence stagnated during the COVID-19 pandemic through to 2022. At the start of the pandemic, a potential reduction in smoking prevalence among middle-aged adults and increases in quitting among smokers may have been offset by an increase in smoking among young adults. The slowing in the rate of decline was pronounced in more advantaged social grades.

Trends in where people buy their vaping products and differences by user and device characteristics: A population study in England, 2016-23.

AIMS: To explore where people in England typically buy e-cigarettes/vaping products, how their characteristics and the types of products purchased differ according to the source of purchase and whether this is changing over time. DESIGN: This was a nationally representative monthly cross-sectional survey. SETTING: The study was conducted in England, 2016-23. PARTICIPANTS: A total of 6507 adults (≥ 18 years) who reported current vaping. MEASUREMENTS: Participants were asked where they usually buy their vaping products: vape shops, supermarkets/convenience stores, on-line or other sources ('other' or cheap from friends). FINDINGS: Up to 2020, vape shops were the most common source of purchase (mean monthly proportion = 43.3%), followed by supermarkets/convenience stores (29.7%) and on-line retailers (20.5%). In 2020, these purchasing patterns shifted: on-line purchasing increased and vape-shop purchasing fell. The rise in on-line purchasing was short-lived, peaking at 33.6% [95% confidence interval (CI) = 31.0-36.5%] in July 2021, and soon returned to baseline levels. However, the fall in vape-shop purchasing persisted, remaining below 31% from July 2021 onwards, displaced by a rapid rise in purchasing from supermarkets and convenience stores from 31.6% (95% CI = 29.6-33.7%) in January 2021 to 48.5% (95% CI = 42.9-54.8%) by April 2023. This rise was most pronounced among younger adults (aged 18-35 years; Pinteraction < 0.001) and those mainly using disposable devices (Pinteraction = 0.013). Purchasing from other sources was relatively rare, and declined from 9.1% (95% CI = 6.6-12.7%) in July 2016 to 4.3% (95% CI = 2.6-7.1%) in April 2023. CONCLUSIONS: Supermarkets and convenience stores have recently overtaken vape shops to become the most popular places to buy vaping products in England. This change appears to have been driven by the rising popularity of new disposable e-cigarettes among younger adults, who tend to buy these products from supermarkets/convenience stores.