NIHRDataInsights/HRCSData huggingface dataset:
Title: Using Game Theory to assess the effects of social norms and social networks on adolescent smoking in schools: a proof of concept study
Funder: Economic and Social Research Council

Abstract: This proof of concept study will harness novel transdisciplinary insights to contrast two school-based smoking prevention interventions among adolescents in the UK and Colombia, where smoking rates and norms are different, in order to better understand social norms-based mechanisms of action. We aim: to improve the measurement of social norms of smoking behaviours in adolescents and how they spread in schools; to better characterise the mechanisms of action of smoking prevention interventions in schools, learning lessons for future intervention research. One intervention is designed to harness peer influence, the other is based on classroom pedagogy. In a before and after design, we will obtain psychosocial, friendship and behavioural data (e.g. attitudes and intentions towards smoking and vaping) from 300 students from 3 schools for each intervention in the UK and the same number in Colombia. Pre-intervention, participants will take part in a Rule Following Game, and in Coordination and Double Dictator Games that allow us to assess their judgments about the social appropriateness of a range of smoking-related behaviours, and the estimation of individual sensitivity to social norms. After the interventions, these behavioural economic experiments will be repeated, so we can estimate how social norms (related to smoking) have changed, how sensitivity to classroom and year group norms have changed and how individual changes are related to changes among friends. We will use Game Theory approaches to extract norms and norms sensitivity parameters from the experiments, examining the influence of individual student attributes and their social networks within a Markov Chain Monte Carlo framework. Putative mechanisms will be inferred by triangulating our experiments with qualitative data from participants, by having data that contrasts the effects of two interventions with putatively different mechanisms, and by the contrast between two countries where norms are different.


Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;REPRODUCTIVE HEALTH AND CHILDBIRTH;STROKE
Title: Using the Theory of Planned Behaviour to determine attitudes and knowledge of e-cigarette use in a sample of Northern Irish young people (11-16yrs) and their parents.
Funder: Northern Ireland Chest, Heart and Stroke

Abstract: E-cigarette use is increasing rapidly among young people and adults in Great Britain yet no prevalence rates are available for Northern Ireland(NI). Research suggests an association with their use and intentions to try cigarettes in non-smokers, which could have detrimental effects on cancer rates as well respiratory and cardiovascular diseases. Research is urgently needed to ascertain patterns and predictors of e-cigarette use in NI. This study aims to use the Theory of Planned Behaviour (TPB)to provide a better understanding of the predictors of intentions to use e-cigarettes and how it relates to smoking behaviourin young people (aged 11-16 years) and their parents. It will involve a two stage mixed methods approach. Stage one will comprise of two independent elicitation studies, carried out in one school using focus groups, to ascertain attitudes and beliefs surrounding e-cigarette use inyoung people aged 11-16 and their parents. This data will be used to develop two questionnaires (one for young people and one for their parents), to inform a larger quantitative cross sectional study of all schools in NI (n=208). It is expected that 10-15% of schools will be recruited, giving a sample of 30 schools,with one class from years 8-12 being randomly selected. This will ascertain prevalence, knowledge and predictors of e-cigarette use in both young people and adults, and their link to smoking, using multi-level modelling. This will meet a gap in current research and provide evidence for policy and practice on the use of e-cigarettes in NI.


Research activity codes: 1.2 PSYCHOLOGICAL AND SOCIOECONOMIC PROCESSES;3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY
Title: Study of the effects of standardised packaging and the 2014 European Union Tobacco Products Directive on tobacco product pricing, consumption and smoking prevalence
Funder: Cancer Research UK

Abstract: Background: Preventing smoking is vital to cancer prevention. Tobacco companies promote smoking through a range of marketing strategies, using brand imagery, variation in design and size of packs, and a range of prices to build a range of brand equities that encourage young people to start smoking, and discourage established smokers from quitting. Premium brands are particularly important to the industry since the high profits they generate are used to cross-subsidise cheaper tobacco brands, thus ensuring affordability for young and other low-income smokers. We hypothesise that by removing branding and the facility to manipulate pack sizes, impending standardised packaging legislation and other measures included in the new European Union Tobacco Products Directive (TPD), will undermine these marketing strategies and reduce the facility for price cross-subsidisation, resulting in higher floor prices for tobacco. These measures are therefore likely to reduce smoking prevalence, but will also provoke industry responses to retain low-price customers, for example by promoting even lower cost options such as hand-rolling tobacco (HRT). Aims: To evaluate the effect of standardised packaging legislation and the TPD on tobacco price segmentation, floor prices, consumption, uptake and prevalence of use of cigarettes, HRT and electronic cigarettes, and smoking cessation by socio-economic status, age and gender in the UK and selected other countries. Methods: We will use a range of government, commercial and bespoke data sources to monitor smoking prevalence, retail prices and volumes, and brand choices of cigarettes, HRT and electronic cigarettes in relation to socioeconomic status, age and gender. We will use data for countries with or without TPD and standardised packaging legislation- Australia, Sweden, Ireland and the Netherlands- as controls to investigate the causal link between policy implementation and changes in outcome measures- prices, consumption patterns, switching between different products, brand categories and brands, and smoking prevalence. Comparisons will be made within and between countries using difference-in-difference or time series analysis as appropriate. We will also monitor tobacco industry marketing responses to these measures. How the results of this research will be used: The UK is the second country in the world to introduce standardised packaging. This project will evaluate the effect of this policy, and other imminent policy changes, on smoking prevalence; and thus provide data to refine UK policy as necessary, and guide other countries considering similar measures. It will also help to develop models to evaluate policies in other areas of public health.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;3.5 RESOURCES AND INFRASTRUCTURE (PREVENTION)
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY
Title: Partnership funding with Cancer Research UK for the cessation in pregnancy incentives trial (CPIT): a multi-centre phase III randomised controlled trial
Funder: Chief Scientist Office, Scotland

Abstract: Lifelong smokers die 10 years early but cessation by age 40 leads to a normal lifespan. Eighty percent of women have a baby, most before age 40. Pregnancy is an opportunity to quit while still healthy. Few of 130,000 UK pregnant smokers quit despite free counselling and Nicotine Replacement Therapy. Financial incentives have worked in small UK and US studies. A large trial is recommended by the National Institute for Health and Care Excellence (NICE). The aim of this study is to examine effectiveness and cost effectiveness of offering financial incentives to pregnant smokers to quit. Pregnant smokers will be invited to enrol at first smoking cessation service contact in four UK centres. Allocation will be to two groups by chance. The intervention group will be offered £400 of shopping vouchers. Women offered usual care will be compared with usual care plus incentives. Outcomes will include extra cost per quitter and the long term benefits. This trial builds on a successful single centre smaller study conducted in Scotland. The results will provide sufficient evidence for NICE and other relevant organisations to decide if financial incentives should be recommended for use with pregnant smokers.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Impacts of smoke-free public places legislation on youth smoking uptake
Funder: Economic and Social Research Council

Abstract: Although the ban on smoking in public places has improved health by reducing exposure to second-hand smoke, it is not yet clear whether this has had any impact on youth smoking uptake. Particularly, we do not know whether this has changed the long-standing trend for youths from more disadvantaged backgrounds to be more likely to take up smoking. We will use annual survey data on 11-15 year olds from 1994-2015 to understand the impacts of the smoking ban on inequalities in the chances of young people trying smoking, becoming occasional or daily smokers, or quitting after starting smoking. We will look to see if there is an immediate impact, or a more gradual impact that increases over time. In addition, it is well known that the smoking behaviour of parents can be an important influence on smoking uptake among their teenage children. It is unclear how a smoking ban will affect the smoking behaviour of parents. A ban on smoking in public places may mean that parents of young people smoke more at home to compensate for restrictions on their smoking elsewhere. Alternatively, it may lead to it being viewed as less acceptable to smoke around young people, and parents may smoke less at home around their children. Either effect would be an important influence on youth smoking uptake, and effects could vary depending on how disadvantaged the home is. We will therefore investigate what effects the smoking ban has had on the smoking behaviour of young people's parents, and how much of any impact on youth smoking uptake is explained by this. The smoking ban is not the only important change happening in the UK that might impact on youth smoking uptake. We will use differences in the timing of these events to differentiate between the impacts of the smoking ban and other changes such as the raising of the legal age for purchasing cigarettes from 16 to 18 years, and the increasing availability and use of e-cigarettes within the UK.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: HoptoStop: Development and feasibility of a novel intervention to promote active ageing and smoking cessation in inactive smokers
Funder: Medical Research Council

Abstract: Smoking and physical inactivity are leading causes of preventable death both in the UK and worldwide. Stop-smoking services operating in local communities offer a prime opportunity to target these two very important health behaviours. Physical activity (PA) has been shown to regulate withdrawal symptoms and cigarette cravings, but when used as an adjunct to smoking-cessation treatment, few trials have identified an effect of PA on rates of smoking abstinence. A recent Cochrane review reported insufficient PA intensity and poor compliance to PA as limitations of the previous trials. Our innovative solution is to implement a brief and simple high impact PA intervention into smoking-cessation services and evaluate PA adherence by accelerometers specific to impact loading. No definitive trials have been conducted as of yet so it is important to carry out early phase research to guide continued intervention development. This project will therefore involve operations managers (Quit51), Public health Leads and a Smokers Panel in design workshops to address perceived logistical difficulties with initial intervention application. After refinement, the first early-phase study will then assess the acceptability and feasibility of accelerometer-guided high-impact PA among smokers (n=30) accessing smoking cessation support from their local service in Surrey (Quit51). We will use mixed-methods to assess recruitment and retention rates, demographic differences, adherence to PA, protocol efficacy and likely effect size. The second early-phase study will use interviews to explore thoughts to the PA intervention among three distinct users (1) those who declined to take part (n=15) (2) trial participants who did and did not adherence to the intervention (n=30) and (3) smoking-cessation advisors (n=15). The results of this research will inform the design of a future clustered, randomised trial of the intervention for clinical and cost effectiveness.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;5.6 PSYCHOLOGICAL AND BEHAVIOURAL;5.7 PHYSICAL
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Developing caffeine reduction interventions in quitting smokers
Funder: Medical Research Council

Abstract: Observational studies have identified an inverse relationship between caffeine consumption and smoking cessation. Furthermore work from our own group using Mendelian randomisation methods indicates that this relationship is causal. As caffeine consumption is a tractable target, investigation of caffeine reduction methods and outcomes is warranted. The importance of this work is further exemplified by the fact that caffeine consumption is common among smokers and tends to be higher in smokers compared to non-smokers. The mechanism underlying this effect seems to be, at least in part, metabolic. Cigarette smoke increases CYP1A2 activity, which is responsible for around 95% of caffeine metabolism. Thus, when an individual stops smoking, caffeine metabolism decreases, due to a loss of smoking-induced enhancement of the metabolising enzyme. This leads to a marked increase in circulating caffeine that builds up over time, despite no behavioural change in caffeine consumption. The research showing this effect dates back several decades, and it is therefore surprising that caffeine reduction is typically lacking from stop-smoking advice. In fact, the degree of the effect (i.e., caffeine levels increasing by 250% post-quit) indicates that the lack of caffeine advice is a serious omission. One explanation for this is that subsequent research failed to show benefits of caffeine abstinence on smoking cessation. We argue that this is due to a focus on caffeine abstinence rather than caffeine reduction. This project will develop caffeine reduction interventions that can be delivered both within Stop Smoking Services and directly to quitting smokers who do not present to services (e.g., through mobile platform applications). Throughout the project we will engage with SSS and smokers, and we will conduct an observational study testing the choice and effect of different caffeine reduction strategies.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: DOES MITOCHONDRIA-TARGETED HYDROGEN SULFIDE PREVENT AND/OR REVERSE CIGARETTE SMOKE-INDUCED LUNG INJURY? IMPLICATIONS FOR COPD.
Funder: Medical Research Council

Abstract: Chronic obstructive pulmonary disease (COPD) is a non-curable progressive chronic respiratory disease characterised by pulmonary inflammation in the peripheral airways and lung parenchyma that results in continual irreversible lung tissue damage and airflow limitation. The major risk factor in the development in COPD in Western countries is cigarette smoke (CS) with ~ 80% of all COPD deaths linked to this cause. Thus, interventions to prevent/reverse the damage to the lung caused by CS could offer a novel treatment option in COPD and related lung diseases. CS has very recently been shown to deplete lung levels of the newly identified endogenous anti-inflammatory and antioxidant molecule, hydrogen sulfide (H2S). We therefore propose that COPD is a condition of "H2S deficiency" and COPD progression can be prevented/suppressed or treated with mitochondria-targeted H2S. Our preliminary data show CS exposure to macrophages depleted cellular and mitochondrial H2S levels, and removal of endogenous H2S exacerbated CS-induced mitochondrial oxidant production and inflammasome activation/activity. These effects were attenuated by novel mitochondria-targeted H2S donors (mtH2SD) we have developed. We further determined the effect of mtH2SD in experimentally induced COPD (using CS exposure over 8 weeks) and show mtH2SD suppressed CS-induced inflammation and loss of lung function, and prevented alveolar destruction. Thus, we will synthesise novel mtH2SD which target mitochondria and generate H2S by different processes. We will examine their effects on CS-induced mitochondrial dysfunction and inflammasome activation/activity in human macrophages and elucidate the molecular mechanisms for these observations. We will then establish the efficacy of mtH2SD in unique in vivo CS-induced lung inflammation and CS-induced experimental COPD models. These studies will determine whether targeting H2S to mitochondria using mtH2SD prevent, suppress and/or reverse CS-induced lung injury in COPD.


Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Embracing multi-ethnicity in studying the genetics of smoking behaviour
Funder: Medical Research Council

Abstract: This project will provide novel insights into the aetiology of smoking behaviour in diverse populations, which will help to underpin advances in precision prevention of tobacco-related disease, and contribute to define best practice for the analysis of health data in populations with a different demographic history, and genetic structure, from Europeans. Traits to be analysed include smoking initiation, cessation, quantity (cigarettes per day) and dependence (combining smoking quantity and time to the first cigarette). The variables to be used in association testing will be derived and harmonised from the answers to the questionnaires used in each cohort. Individuals of European, Asian and African ancestry will be included in ancestry-specific and trans-ethnic genome-wide association studies. Methods from population genetics will be combined with association testing for the analysis of individuals of admixed ancestry. Discovery analyses will be carried out using the data made available by UK Biobank, a large longitudinal study which includes samples from 500,000 volunteers aged 40-69 years, where the three ancestries of interest are all represented. Replication analyses will be carried out in ancestry-specific cohorts. Linear mixed model association testing will be used under an additive genetic model for all phenotypes, including sex and age as covariates. On the associated variants, in silico functional follow-up analyses interrogating public databases will include eQTL analyses and variant annotation with the aim of identifying regions and genes of interest. On the genes identified, pathway and druggability analyses will be performed to understand the impact of the findings.


Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Behavioural interventions for smoking cessation: a suite of Cochrane reviews including an overview of reviews and network meta-analyses with covariates informed by updates of existing Cochrane reviews
Funder: Department of Health and Social Care

Abstract: This overview of Cochrane reviews will assess the effect of behavioural interventions designed to support smoking cessation attempts. We aim to address three questions. (1) How do modes of delivery, person delivering the intervention, and the theoretical basis of these interventions compare with each other in relation to the achievement of abstinence? (2) Do the effects vary by other characteristics, including population, setting, and intervention length? (3) What is the evidence on the costs and cost-effectiveness of the interventions compared? Key Cochrane reviews will be updated to feed into the overview. We will follow standard Cochrane methods for review updates. For the overview, we will use direct and indirect comparisons where appropriate, including network meta-analyses with covariates. Evidence on cost-effectiveness will be generated through a review of relevant, existing cost-effectiveness studies (trial and model based), presented in the form of a brief economic commentary.

Lay abstract: This project consists of a large review which will compare different types of behavioural support to help people stop smoking. This includes things like counselling, websites, and telephone services which are designed to support people who want to quit smoking, and are often provided through the NHS or local governments. Our project aims to address three questions. First, does the way the support is delivered affect how many people successfully stop smoking? Second, does the number of people who successfully stop smoking with behavioural support vary based on other characteristics, like where the support is delivered and who it is delivered to? Third, how do different types of behavioural support compare in terms of cost? To answer these questions, we will update existing reviews on specific types of behavioural support. We will then conduct an overview of these reviews in order to compare the interventions to each other. We will also review studies on costs.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Understanding social norms and social network effects in school based smoking prevention
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: This project aims to build on the findings of the previously commissioned research, developing the 'Dead Cool' smoking prevention intervention into new social contexts. It is anticipated that the findings of this study will bring durther opportunities for knowledge transfer and diffusion of research based interventions developed inot practice in broader global settings.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE