NIHRDataInsights/HRCSData huggingface dataset:
Title: Children Learning About Second-hand Smoke: Cluster randomised-controlled trial
Funder: Medical Research Council

Abstract: Second-hand smoke (SHS) exposure costs 800,000 lives a year. Children in developing countries are worst affected as smoke-free laws are only partially implemented. Private homes and cars remain a key source of SHS exposure. There is limited evidence on non-legislative interventions designed to protect children from SHS exposure. Following the success of two feasibility studies and a pilot trial, we plan to evaluate a school-based approach to protect children from SHS exposure in Bangladesh and Pakistan - countries with a strong commitment to smoke-free environments but with high levels of SHS exposure in children. We aim to assess the effectiveness and cost-effectiveness of a school-based Smoke-Free Intervention (SFI) in reducing children's exposure to SHS and the frequency and severity of respiratory symptoms. SFI, a behavioural intervention, consists of two 45-minute sessions delivered by schoolteachers over two consecutive days in classroom settings. Each session includes classroom presentations, a quiz, interactive games, storytelling and role-play. In our feasibility work, these activities helped children learn negotiation skills and develop confidence in persuading their parents/carers to implement smoking restrictions in their homes. We will conduct a two-arm cluster randomised controlled-trial in Dhaka and Karachi. We will recruit and randomise 66 schools (2,636 children); half will be allocated to receive SFI (arm 1) and the other half usual education (arm 2). A change in salivary cotinine -a highly sensitive and specific biomarker of SHS exposure- is the primary outcome. Secondary outcomes include frequency and severity of respiratory symptoms, healthcare contacts, school absenteeism, smoking uptake, lung functions and quality of life. An economic and process evaluation will also be conducted. The investigators' expertise and track record within the field is complemented by their extensive links with schools and with policy makers in the two countries.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Feasibility study of a peer-led, school-based, adolescent smoking prevention intervention (ASSIST) in culturally different middle income countries
Funder: Medical Research Council

Abstract: Our project focuses on China, Indonesia and the Philippines: 3 culturally diverse Asian middle-income countries with smoking rates that are high and predicted to increase or remain stable. We aim to assess: 1) if, and how, an informal school-based intervention ('ASSIST'), delivered by 12-13 year old 'peer supporters' to prevent smoking, which was developed and found to be effective in the UK, can be adapted for successful transfer in one or more of these countries; and 2) whether a future implementation effectiveness evaluation is feasible in one or more of the countries. In each country, we will build on completed small-scale scoping work, continuing stakeholder engagement (policymakers, school staff, students, parents) to ensure appropriate cultural adaptations while retaining ASSIST's key features. Train-the-trainers will be delivered by experienced UK personnel who will also support translation of materials. We will recruit 10 schools and randomise 6 to intervention and 4 to control. In intervention schools, ASSIST trainers will recruit students nominated as influential by the year group as peer supporters, run 2-day training sessions and support them to act as peer supporters in their school for 10 weeks. We will conduct baseline and 7-month follow-up surveys (which will include self-report smoking, social network data and exhaled carbon monoxide measures for verification of self-report smoking) of whole target year groups in all schools. Qualitative data collection will include: observations of training and selection procedures; focus groups/interviews with trainers and with students, staff and parents from intervention schools; and interviews with small numbers of control school staff. We will also gather data on intervention costs and determine policymaker interest in providing (financial) support for the intervention. We will determine whether pre-set progression criteria are met and a larger scale trial justified in one or more of these countries.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Development of a co-designed tobacco harm reduction toolkit for use within the homeless sector
Funder: Medical Research Council

Abstract: Smoking rates are high amongst people who are homeless yet those working with this population do not feel competent offering tobacco harm reduction (THR) support. This study aims to address this by co-designing, with people who use or work in homeless services, a THR toolkit (to include policy templates, conversation guides, treatment information resources) for the homeless sector. We will utilise elements of experience-based co-design (EBCD) methodology: Stage one: In keeping with an accelerated EBCD approach, we will produce a short film about smoking using existing footage from our previous projects. Stage two: We will facilitate 6 focus groups (each with 6-10 participants); 3 with service users with past or current lived experience of homelessness and 3 with homeless centre staff. Participants will be encouraged to discuss their responses to the film, paying attention to 'touchpoints' - emotionally charged or key moments in their smoking histories/provision of THR support. We will also elicit and thematically analyse views around several pre-defined themes: 1) understanding and experience of THR; 2) what good THR support would look and feel like; 3) what an effective and compassionate homeless service THR policy would look and feel like; 4) preferred person-centred terms and language. Stage 3: Four service users and four staff who participated in the focus groups will be recruited to join a co-design group with representatives from PHE, Action on Smoking and Health and the research team. The group will meet on 2-3 occasions and an artist scribe will visually capture each event. Materials will be developed via consensus and a design company will produce agreed resources. Stage 4: The THR toolkit will be implemented in one homeless centre. Interviews will be conducted with 5 service users and 5 staff one month after introduction. The THR toolkit and implementation feedback will shape a future main study to evaluate its efficacy.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Tobacco control policies and the health of Adolescents in Pakistan (TAP): a multi-method study
Funder: Medical Research Council

Abstract: Tobacco kills over 8 million people per year. Most tobacco users start during adolescence, and many continue into adulthood. Tobacco use among youth is declining in high-income countries, with most low and middle-income countries lagging behind, highlighting the need for robust policies. Pakistan has one of the world's highest tobacco-related disease burdens. Pakistan's government is committed to raising tobacco taxes and introducing plain packaging. We aim to inform these policies in Pakistan in order to reduce tobacco uptake and use among adolescents, thereby improving their health and preventing premature deaths and disabilities in later life. We propose a multi-method design, with five complementary studies: 1) A tobacco pack analysis will assess how tobacco companies promote their products, and compliance with warning regulations; 2) Stakeholders' interviews to ascertain support for, and views of, both policies; 3) Focus groups with adolescents to explore perceptions of tobacco packaging, including plain packaging, and prices; 4) A large cross-sectional survey with 10-16 year olds, including those attending secondary schools, and those in community settings who are not attending school, will explore their tobacco-related attitudes and behaviours, perceptions of tobacco packs and tobacco purchase behaviours; and 5) A price elasticity study to estimate the predicted fall in tobacco use in adolescents following a tobacco price increase. Our multidisciplinary team has expertise in tobacco control, policy evaluation and research translation. With our extensive policy links, we are confident that our work will directly contribute to improving adolescent health in Pakistan and beyond.


Research activity codes: 4.4 POPULATION SCREENING;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: COmmunities Facilitating incREasing Smoke-free Homes (CO-FRESH)
Funder: Medical Research Council

Abstract: Breathing the second-hand tobacco smoke (SHS) is estimated to cause over 880,000 premature deaths each year globally. SHS exposure is more common in disadvantaged households and poses particular long-term health burdens for children as they have smaller, and developing, respiratory systems. Deaths in childhood account for 28% of SHS-related deaths and 61% of the estimated 11 million disability-adjusted life-years lost per annum. Early life exposure to SHS is associated with impaired intra-uterine growth, smaller lungs, more respiratory infections, and exacerbations of asthma and illnesses such as glue ear. A child exposed to SHS in the home is also more likely to grow up to become a teenage and adult smoker. The 'COmmunities Facilitating incREasing Smoke-free Homes' (CO-FRESH) project will develop a co-created, community-level intervention to increase the proportion of smoke-free households within small towns and villages in low- and middle-income countries (LMICs). It will build on and combine previous work carried out by the University of Stirling and Universiti Putra Malaysia, aimed at encouraging individual behaviour change to prevent smoking in the home, with community-level intervention experience from the Universitas Gadjah Mada in Indonesia. The project will: (i) educate health and allied-health professionals about the benefits of a smoke-free home; (ii) inform the local population about the harms of second-hand tobacco smoke through targeted campaigns at smokers, non-smokers and children, and engagement with community influencers; (iii) provide personalised information to families about the impact of smoking on their household air quality; (iv) enable individual behaviour change through advice and support; and (v) establish mechanisms to measure and audit smoke-free homes (SFH) compliance. The work will also aim to lead to a full proposal to implement and evaluate a trial of the developed COFRESH intervention.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Supporting people in recovery from problematic alcohol and drug use to cut down or stop smoking: development and feasibility testing of a tobacco harm reduction intervention
Funder: Chief Scientist Office, Scotland

Abstract: Rates of tobacco smoking are significantly higher in people with problematic drug or alcohol use than the general population. Smoking plays an important part in people becoming ill and dying young. In Scotland, there are no specialised stop smoking services (NHS SSS) for this group and uptake of existing NHS SSS is low. For most people, stopping smoking quickly is the best option so this means that standard NHS SSS focus on helping people stop over a few weeks with little support afterwards to reduce the chance that they start smoking again. This is different from effective substance misuse services, where reducing and managing use is seen as helpful. In standard NHS SSS, the pressure on staff and clients to achieve abstinence quickly is difficult, demotivating for recovering alcohol and substance users and can result in people withdrawing from services that were not designed to meet their needs. This study will develop and test a way of delivering a smoking cessation service (the intervention) that is tailored, trauma informed, and focused on harm reduction. It will support people recovering from problematic drug or alcohol use to cut down or stop smoking. The intervention will be co-developed and evaluated with service users as expert members of the team, practitioners working in substance misuse services and researchers with experience of designing harm reduction interventions


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Annual Tobacco Control Report: tracking local activity over the next two years
Funder: Cancer Research UK

Abstract: Every year since 2014 ASH, funded by CRUK, has undertaken a survey of local tobacco control leads to inform our understanding of what is happening in tobacco control at a local level. There have now been five surveys and reports, and a sixth is currently underway. To date, the surveys have given ASH and CRUK a clear understanding of local stop smoking service delivery as well as insights into local funding arrangements, the quality of local partnerships and the extent to which tobacco control is prioritised locally. In year one of the survey, we focused on the transition of public health responsibilities to local government following the reorganisation of the health service. Subsequently the surveys have provided a way of tracking the impact of national policy locally, including budget reductions, and monitoring changing models of service delivery. The next two years of surveys will have an important role to play in monitoring emerging NHS provided stop smoking support, and its interactions with local authority provision. They will also provide additional insight into local authority efforts to reduce smoking related health inequalities.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Current practices of smoking cessation practitioners when supporting tobacco cessation among cannabis users.
Funder: Cancer Research UK

Abstract: Background Tobacco and cannabis are two of the most commonly used psychoactive substances worldwide. In the UK co-use rates are high; it is estimated that 90% of cannabis smokers also smoke tobacco and 77% of cannabis users put tobacco in their joints. Despite this common co-use of tobacco and cannabis, they are rarely co-treated in clinical interventions. Continued cannabis smoking undermines tobacco smoking cessation attempts, yet little is known about current assessment and management of cannabis use by smoking cessation practitioners. Aim To identify practices of stop smoking practitioners when supporting tobacco cessation among cannabis users in order maximise smoking cessation rates among co-users attending services and inform policy and practice. Method An explanatory sequential mixed methods design will be used. An online quantitative survey will be sent to all smoking cessation practitioners registered with the National Centre for Smoking Cessation and Training (NCSCT) followed by a subsequent sub-sample of telephone qualitative interviews (n=20). The survey will be used to measure to the extent to which smoking cessation practitioners report Asking, Advising and/or Acting in response to client’s cannabis use. Knowledge, confidence, experience and attitudes towards simultaneous/sequential cessation and harm reduction approaches will be explored. The semi-structured interviews will explore more in depth how smoking cessation practitioners respond to clients’ cannabis use and the barriers and facilitators of engagement with co-use treatment. The survey will be analysed first followed by the interviews, and the two approaches will be mixed at the interpretation level. Descriptive statistical analyses will be conducted using SPSS to summarise questionnaire findings. Multivariable logistic regression will be used to estimate the odds ratios of Asking, Advising and/or Acting in response to client’s cannabis use. Transcribed interview data will be coded using NVivo and analysed using an approach known as Framework. A Patient and Public Involvement (PPI) group formed by smoking cessation practitioners and co-users has been established to inform this application. Quarterly meetings will take place to facilitate PPI involvement throughout the project. PPI members will contribute to the development of survey and interview guide, data analysis and interpretation and report writing. How the results of this research will be used. The results of this study will provide evidence on current practices, staff knowledge, behaviour and attitudes that affect the management of cannabis use in smoking cessation services to inform training and new policies on monitoring and treating co-use of tobacco and cannabis in the future.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Dual use of e-cigarettes and tobacco in those aged 45-64 in Scotland
Funder: Cancer Research UK

Abstract: Background The role of ecigarettes in smoking cessation is still contentious, with many who adopt them to aid quit attempts using both tobacco and e-cigarettes (dual use). A recent Cancer Research UK funded study (A24782) found that of adult dual users in Scotland and England, use of e-cigarettes was reported as resulting in stopping smoking completely in only 26% of individuals. There is currently a dearth of qualitative research of dual users. Data from the Scottish Health Survey (SHeS)2016-17 demonstrated that dual use was significantly higher in those aged 45-64 (20%) compared with other age groups. Aims: to explore dual use of e-cigarettes and tobacco in those aged 45-64 in Scotland, in order to explore the high levels of dual use in this age group. In addition, to assess, for example: • patterns of dual use in this age group • factors which contribute to or mitigate against dual use • views of different types of e-cigarettes used • perceptions of any impacts of dual use in the short and longer term • intentions to quit tobacco and/or e-cigarettes in the future. Methods: We propose accessing SHeS datasets 2016-18 to: a) conduct secondary analysis and b) conduct qualitative in-depth interviews. The 2016-2018 SHeS dataset will include around 4300 adults aged 45-64, of whom c200 will be dual users. Of these, about 160 will have agreed to be recontacted for potential follow-up research. a) Potential secondary analysis of SHeS would cover a range of health behaviours and outcomes for: (i) all dual users compared with non smokers/ecigarette users (ii) dual users aged 45-64 compared with other dual users and (iii) dual users aged 45-64 compared with 45-64 year olds who only smoke. b) The purposive sampling for the qualitative follow-up research will be guided by the results of the secondary analysis. However, in-depth individual interviews with c25-30 dual users will be conducted covering: • Gender: men and women • SIMD quintiles (low to high) • Quit attempts (zero to several) • Associated risk factors identified by secondary analysis • ex-dual users. We would use a thematic approach to analysing the data, facilitated by NVivo 10. Use of results: This study will increase understanding of dual use in those aged 45-64, and will help inform recommendations for policy and practice. The findings will be presented at major conferences, and papers will be submitted for publication. The secondary analysis dataset will be archived.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE
Title: Annual Local Tobacco Control Report
Funder: Cancer Research UK

Abstract: ASH has been undertaking surveys of local government activity on tobacco control since 2013 with funding from Cancer Research UK. This project will maintain this survey and extend project to cover new Integrated Care Boards (ICB) and their approach to tobacco control. This survey has been valuable to track local delivery, attitudes, level of priority in relation to tobacco control. The next two years it will be important to track the impact of ongoing funding pressures and the implications of additional delivery through NHS. At the same time a new Tobacco Control Plan is anticipated which could impact local delivery. Expanding survey to encompass ICBs is important and timely in light of the new investments being made by NHSE to support smokers to stop. Surveys will be developed with expert input and conducted online. Lead staff member working on tobacco control within local authorities that have public health budget are the respondents to this survey. Response rates have never fallen below 70%. Surveying ICBs is a novel part of this project and the organisations have only formally existed since July 2022. It is unclear what response rate can be expected from these organisations. Analysis and recommendations will be presented in annual reports. The outputs of this work have had national, regional and local influence in the past and will continue to in the future.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE