Smoking Toolkit Study Research Articles

Association between smoking and alcohol-related behaviours: a time-series analysis of population trends in England.

AimsThis paper estimates how far monthly changes in prevalence of cigarette smoking, motivation to quit and attempts to stop smoking have been associated with changes in prevalence of high‐risk drinking, and motivation and attempts to reduce alcohol consumption in England.DesignData were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2016. These involve monthly household face‐to‐face surveys of representative samples of ~1700 adults in England.MeasurementsAutoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling was used to assess the association over time between monthly prevalence of (a) smoking and high‐risk drinking; (b) high motivation to quit smoking and high motivation to reduce alcohol consumption; and (c) attempts to quit smoking and attempts to reduce alcohol consumption.FindingsMean smoking prevalence over the study period was 18.6% and high‐risk drinking prevalence was 13.0%. A decrease of 1% of the series mean smoking prevalence was associated with a reduction of 0.185% of the mean prevalence of high‐risk drinking 2 months later [95% confidence interval (CI) = 0.033 to 0.337, P = 0.017]. A statistically significant association was not found between prevalence of high motivation to quit smoking and high motivation to reduce alcohol consumption (β = 0.324, 95% CI = –0.371 to 1.019, P = 0.360) or prevalence of attempts to quit smoking and attempts to reduce alcohol consumption (β = −0.026, 95% CI = –1.348 to 1.296, P = 0.969).ConclusionBetween 2014 and 2016, monthly changes in prevalence of smoking in England were associated positively with prevalence of high‐risk drinking. There was no significant association between motivation to stop and motivation to reduce alcohol consumption, or attempts to quit smoking and attempts to reduce alcohol consumption.

Study protocol of the German Study on Tobacco Use (DEBRA): a national household survey of smoking behaviour and cessation

BackgroundThe prevalence of tobacco smoking in Germany is high (~27%). Monitoring of national patterns of smoking behaviour and data on the “real-world” effectiveness of cessation methods are needed to inform policies and develop campaigns aimed at reducing tobacco-related harm. In England, the Smoking Toolkit Study (STS) has been tracking such indicators since 2006, resulting in the adaptation of tobacco control policies. However, findings cannot be directly transferred into the German health policy context. The German Study on Tobacco Use (DEBRA: “Deutsche Befragung zum Rauchverhalten”) aims to provide such nationally representative data.Methods/DesignIn June 2016, the study started collecting data from computer-assisted, face-to-face household interviews in people aged 14 years and older. Over a period of 3 years, a total of ~36,000 respondents will complete the survey with a new sample of ~2000 respondents every 2 months (=18 waves). This sample will report data on demographics and the use of tobacco and electronic (e-)cigarettes. Per wave, about 500–600 people are expected to be current or recent ex-smokers (<12 months since quitting). This sample will answer detailed questions about smoking behaviour, quit attempts, exposure to health professionals’ advice on quitting, and use of cessation aids. Six-month follow-up data will be collected by telephone.DiscussionThe DEBRA study will be an important source of data for tobacco control policies, health strategies, and future research. The methodology is closely aligned to the STS, which will allow comparisons with data from England, a country with one of the lowest smoking prevalence rates in Europe (18%).Trial registrationThis study has been registered at the German Clinical Trials Register (DRKS00011322) on 25th November 2016.

Use of aids for smoking cessation and alcohol reduction: A population survey of adults in England.

BackgroundIt is important for policy planning to chart the methods smokers and high-risk drinkers use to help them change their behaviour. This study assessed prevalence of use, and characteristics of users, of support for smoking cessation and alcohol reduction in England.MethodsData were used from the Smoking and Alcohol Toolkit Studies, which involve monthly face-to-face computer-assisted interviews of adults aged 16+ in England. We included data collected between June 2014 and July 2015 on 1600 smokers who had made at least one quit attempt and 911 high-risk drinkers (defined as scores >8+ on the full AUDIT or 5+ on questions 1–3 of the AUDIT-C) who had made an attempt to cut down in the past 12 months. Participants provided information on their socio-demographic characteristics and use of aids during their most recent quit attempt including pharmacotherapy, face-to-face counselling, telephone support, self-help materials (digital and printed), and complementary medicine.ResultsA total of 60.3% of smokers used aids in the past year, compared with just 14.9% of high-risk drinkers. Use of pharmacotherapy was high among smokers and very low among drinkers (56.0%versus1.2%). Use of other aids was low for both behaviours: face-to-face counselling (2.6%versus4.8%), self-help materials (1.4%versus4.1%) and complementary medicine (1.0%versus0.5%). Use of aids was more common among smokers aged 25–54 compared with 16–24 year olds (25–34,ORadj1.49,p = 0.012; 35–44,ORadj1.93,p < 0.001; 35–44,ORadj1.93,p < 0.001; 45–54,ORadj1.66,p = 0.008), with cigarette consumption >10 relative to <1 (10–20,ORadj2.47,p = 0.011; >20,ORadj4.23,p = 0.001), and less common among ethnic minorities (ORadj0.69,p = 0.026). For alcohol reduction, use of aids was higher among ethnic minority groups (ORadj2.41;p = 0.015), and those of social-grade D/E relative to AB (ORadj2.29,p = 0.012&ORadj3.13,p < 0.001).ConclusionIn England, the use of pharmacotherapy is prevalent for smoking cessation but not alcohol reduction. Other aids are used at a low rate, with face-to-face counselling being more common for alcohol reduction than smoking cessation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3862-7) contains supplementary material, which is available to authorized users.

Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends

Objectives To estimate how far changes in the prevalence of electronic cigarette (e-cigarette) use in England have been associated with changes in quit success, quit attempts, and use of licensed...

Has growth in electronic cigarette use by smokers been responsible for the decline in use of licensed nicotine products? Findings from repeated cross-sectional surveys

BackgroundThe rise in electronic cigarette use by smokers may be responsible for the decreased use of licensed nicotine products and/or increased overall use of non-tobacco nicotine-containing products. This paper reports...

Protocol for a national monthly survey of alcohol use in England with 6-month follow-up: ‘The Alcohol Toolkit Study’

BackgroundTimely tracking of national patterns of alcohol consumption is needed to inform and evaluate strategies and policies aimed at reducing alcohol-related harm. Between 2014 until at least 2017, the Alcohol Toolkit Study (ATS) will provide such tracking data and link these with policy changes and campaigns. By virtue of its connection with the ‘Smoking Toolkit Study’ (STS), links will also be examined between alcohol and smoking-related behaviour.Methods/DesignThe ATS consists of cross-sectional household, computer-assisted interviews of representative samples of adults in England aged 16+. Each month a new sample of approximately 1800 adults complete the survey (~n = 21,600 per year). All respondents who consent to be followed-up are asked to complete a telephone survey 6 months later. The ATS has been funded to collect at least 36 waves of baseline and 6-month follow-up data across a period of 3 years. Questions cover alcohol consumption and related harm (AUDIT), socio-demographic characteristics, attempts to reduce or cease consumption and factors associated with this, and exposure to health professional advice on alcohol. The ATS complements the STS, which has been tracking key performance indicators relating to smoking since 2006. As both the ATS and STS involve the same respondents, it is possible to assess interactions between changes in alcohol and tobacco use. Data analysis will involve: 1) Descriptive and exploratory analyses undertaken according to a pre-defined set of principles while allowing scope for pursuing lines of enquiry that arise from prior analyses; 2) Hypothesis testing according to pre-specified, published analysis plans. Descriptive data on important trends will be published monthly on a dedicated website: www.alcoholinengland.info.DiscussionThe Alcohol Toolkit Study will improve understanding of population level factors influencing alcohol consumption and be an important resource for policy evaluation and planning.

Associations between use of pharmacological aids in a smoking cessation attempt and subsequent quitting activity: a population study.

Modelling the population impact and cost-effectiveness of smoking cessation aids is limited by lack of knowledge about how the use of aids changes across quit attempts. Here we test whether the quit method used in a previous attempt influences (i) future decisions to quit and/or (ii) treatment/s used during subsequent attempts. Data came from the Smoking Toolkit Study, a United Kingdom national household survey. Smokers (n = 5489) who completed a baseline and 6-month follow-up questionnaire. Respondents were asked what treatment/s, grouped as: prescription medication/s [bupropion, varenicline or nicotine replacement therapy (NRT)], over-the-counter NRT or unaided that they had used in their most recent quit attempt (at baseline), and any use of treatment/s for a quit attempt in the last 3 months at follow-up. Smokers who had tried to quit at baseline were more likely to report having tried to quit again prior to follow-up [all odds ratios ≥ 2.19 relative to no attempt at baseline, P < 0.001]. Smokers who tried to quit using pharmacological aids were more likely to try to quit again at follow-up (all ORs ≥ 2.19 relative to no attempt at baseline, P < 0.001). Smokers tended to re-try aids used in baseline attempts in future attempts (all ORs ≥ 1.48 relative to no attempt at baseline, P < 0.01). Smokers who have tried to quit in the past year are more likely to try to quit again within 6 months regardless of whether they used a pharmacological aid, and they are more likely to re-try aids they had used previously.

Prevalence of NRT use and associated nicotine intake in smokers, recent ex-smokers and longer-term ex-smokers.

BackgroundNicotine replacement therapy (NRT) is used by smokers wanting to reduce their smoking and to quit. However, there are very little data on nicotine intake associated with NRT use in representative population samples. This study aimed to provide estimates for NRT use and associated nicotine exposure among smokers, recent and longer-term ex-smokers in England, a country with a permissive regulatory regime for nicotine substitution.MethodsIn the Smoking Toolkit Study, a monthly series of representative household surveys of adults aged 16+ in England, current and recent ex-smokers who agreed to be re-contacted were followed up 6 months later and standard socio-demographic and smoking characteristics assessed (N = 5,467, response rate 25.1%). A random sub-sample (N = 1,614; 29.5%) also provided saliva, analysed for cotinine.ResultsThe sample followed up was broadly representative of the original sample. At follow-up, 11.8% (95%CI 10.9–12.8, N = 565) of current smokers, 34.8% (95%CI 28.9–41.3, N = 77) of recent (≤3 months) ex-smokers, and 7.8% (95%CI 5.6–10.6, N = 36) of longer-term (>3 months) ex-smokers reported using NRT. Smokers who used NRT had similar saliva cotinine concentrations to smokers who did not use NRT (mean ± sd = 356.0±198.6 ng/ml vs. 313.1±178.4 ng/ml). Recent ex-smokers who used NRT had levels that were somewhat lower, but not significantly so, than current smokers (216.7±179.3 ng/ml). Longer-term ex-smokers using NRT had still lower levels (157.3±227.1 ng/ml), which differed significantly from smokers using NRT (p = 0.024).ConclusionsConcurrent use of nicotine replacement therapy while smoking is relatively uncommon and is not associated with higher levels of nicotine intake. Among ex-smokers, NRT use is common in the short but not longer-term and among longer-term users is associated with lower nicotine intake than in smokers.

Association of amount and duration of NRT use in smokers with cigarette consumption and motivation to stop smoking: A national survey of smokers in England

IntroductionClinical trials have found that the use of nicotine replacement therapy (NRT) to reduce cigarette consumption results in significant declines in cigarette consumption and increases smokers' propensity to quit. However, observational “real-world” studies have found much smaller effects. This may be because of low levels of NRT use. This study examined the association between amount and duration of NRT use amongst those attempting to reduce their cigarette consumption with motivation to quit and cigarette consumption. MethodsData came from 2,158 smokers who took part in the Smoking Toolkit Study. A representative survey of smokers in England aged 16+. ResultsOnly 54.4% of patch users and 32.2% of non-transdermal NRT users reported using NRT with a frequency that would be expected to substantially influence cigarette consumption (4+ units per day for acute NRT forms and at least daily for transdermal patches). Those using the patch at or above this threshold smoked 1.3 cigarettes per day fewer than those using it below the threshold (p=0.059), whilst those using non-transdermal NRT at or above this threshold smoked 0.9 cigarettes less per day (p=0.022). In both cases, those using NRT more frequently had greater motivation to quit. Less than 1/5th of participants reported using a combination of NRT products. Use of NRT long-term was associated with lower motivation to quit and higher cigarette consumption. ConclusionSmokers attempting to reduce their cigarette intake are underusing NRT and this is associated with cigarette consumption and motivation to quit. These findings may explain why population-based studies have failed to report similar findings to clinical trials.

Characterization of Long-Term Users of Nicotine Replacement Therapy: Evidence From a National Survey

Harm reduction involving partial or complete substitution of cigarettes with nicotine replacement therapy (NRT) is likely to benefit smokers by reducing exposure to carcinogens and by increasing the likelihood of permanent cessation. This article aimed to assess the determinants of short- and long-term NRT use for harm reduction in order to inform interventions aimed at helping smokers struggling to quit to switch to complete NRT substitution. Data were used from the Smoking Toolkit Study, a population-based survey of adults in England aged 16 years and older (n = 9,224). Participants were asked about their sociodemographic characteristics and tobacco use. Attitudes toward smoking were also assessed using questions covering 4 factors: motives, identity, evaluations, and plans. Concurrent short-term (<3 months) and long-term (≥ 3 months) NRT use was uncommon among smokers at 10.8% (95% confidence interval [CI] = 10.1-11.4) and 5.0% (95% CI = 4.6-5.4), respectively. Long-term NRT users had higher odds of being older, in nonmanual occupations, and more addicted than smokers with short-term or no NRT use (all p < .01). They reported lower odds of attempting to stop and higher odds of exhibiting a positive smoker identity than short-term users (p < .001). Conversely, long-term NRT users had higher odds of having made a recent quit attempt, to have plans to stop, and lower odds of a positive smoker identity than smokers not using NRT (all p < .001). While users of NRT for harm-reduction purposes are a heterogeneous group, it appears they are more critical of smoking than never users and tend to positively modulate their behavior, setting them on a path toward cessation.

‘Real-world’ effectiveness of smoking cessation treatments: a population study

There is a need for more evidence on the 'real-world' effectiveness of commonly used aids to smoking cessation from population-level studies. This study assessed the association between abstinence and use of different smoking cessation treatments after adjusting for key potential confounding factors. Cross-sectional data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. England. A total of 10 335 adults who smoked within the previous 12 months and had made at least one quit attempt during that time. Participants were classified according to their use of cessation aids in their most recent quit attempt: (i) medication (nicotine replacement therapy, bupropion or varenicline) in combination with specialist behavioural support delivered by a National Health Service Stop Smoking Service; (ii) medication provided by the prescribing health-care professional without specialist behavioural support; (iii) nicotine replacement therapy (NRT) bought over the counter; and (iv) none of these. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including tobacco dependence. Compared with smokers using none of the cessation aids, the adjusted odds of remaining abstinent up to the time of the survey were 3.25 [95% confidence interval (CI) = 2.05-5.15] greater in users of prescription medication in combination with specialist behavioural support, 1.61 (95% CI = 1.33-1.94) greater in users of prescription medication combined with brief advice and 0.96 (95% CI = 0.81-1.13) in users of NRT bought over the counter. After adjusting for major confounding variables such as tobacco dependence, smokers in England who use a combination of behavioural support and pharmacotherapy in their quit attempts have almost three times the odds of success than those who use neither pharmacotherapy nor behavioural support. Smokers who buy nicotine replacement therapy over the counter with no behavioural support have similar odds of success in stopping as those who stop without any aid.

Was the Expansion of the Marketing License for Nicotine Replacement Therapy in the United Kingdom to Include Smoking Reduction Associated With Changes in Use and Incidence of Quit Attempts?

In December 2009 and January 2010, the UK Medicines and Healthcare Products Regulatory Agency expanded the marketing license for a number of nicotine replacement therapies (NRTs) to include smoking reduction without an intention to stop completely. This study examined whether this was associated with a change in incidence of use of NRT for harm reduction (i.e., smoking reduction and/or temporary abstinence) and in smoking cessation activity. Data were taken from 10,497 smokers who took part in the Smoking Toolkit Study, which involves monthly representative household surveys of adults aged 16+ in England. Incidence of use of NRT for smoking reduction and/or temporary abstinence and attempts to stop smoking in 2009 was compared with the 2 years following the expansion of the marketing license. Expansion of the license was not associated with an increase in incidence of NRT use for harm reduction, which was already substantial prior to the change. The odds of a quit attempt were lower in the second year following the license change relative to the year before, but there was no change in the success of quit attempts. Expansion of the UK marketing license for NRT to include smoking reduction without the intention of quitting was not associated with an increase in use of NRT for this purpose. It was followed by a reduction in the incidence of quit attempts (but not their success) although this may have been a continuation of a pre-existing decline.

Light smokers are less likely to receive advice to quit from their GP than moderate-to-heavy smokers: A comparison of national survey data from the Netherlands and England

Background: A substantial proportion of smokers nowadays smoke fewer than 10 cigarettes per day (cpd). These ‘light’ smokers are still exposed to significant health risks but may not receive as much attention from health professionals as heavier smokers. The Netherlands and England are two countries with very different smoking cessation treatment climates and may vary in the extent to which GPs advise on smoking cessation.Objectives: To assess whether Dutch and English light smokers (< 10 cpd) are less likely to receive advice to stop smoking during a consultation with their GP than moderate-to-heavy smokers (≥ 10 cpd).Methods: We compared data from two series of national surveys: the Dutch ‘Continuous Survey of Smoking Habits’ and the English ‘Smoking Toolkit Study’. We included respondents to both surveys from February 2010 to December 2011, aged 16+ years, who consulted their GP in the previous 12 months.Results: A total of 7734 smokers responded to the surveys in the Netherlands and 10 383 in England. The percentage of Dutch smokers who received advice to quit from their GP was 22.6% (95% CI = 21.5–23.7) compared with 58.9% (95% CI = 57.6–60.2) of English smokers. Light smokers were less likely to receive advice to quit than moderate-to-heavy smokers, both in the Netherlands (OR = 0.57, 95% CI = 0.50–0.65) and in England (OR = 0.64, 95% CI = 0.57–0.72).Conclusion: Smokers in the Netherlands are less than half as likely to receive advice to quit from their GP as smokers in England. In both countries, light smokers are less likely to receive advice to quit from their GP than moderate-to-heavy smokers.

Predictive validity of the Motivation To Stop Scale (MTSS): A single-item measure of motivation to stop smoking

BackgroundMany different measures of motivation to stop smoking exist but it would be desirable to have a brief version that is standard for use in population surveys and for evaluations of interventions to promote cessation. The aim of this study was to assess the predictive validity and accuracy of the single-item Motivation To Stop Scale (MTSS). MethodsThis study is part of the “Smoking Toolkit Study;” a monthly survey of representative samples of the English population. We used data from 2483 respondents to the surveys from November 2008 to January 2011, who were smokers, used the MTSS, and were followed up 6 months later to provide information on quit attempts since baseline. The MTSS consists of one item with seven response categories ranging from 1 (lowest) to level 7 (highest level of motivation to stop smoking). ResultsA total of 692 smokers (27.9% (95% CI=26.1–29.6)) made an attempt to quit smoking between baseline and 6-month follow-up. The odds of quit attempts increased linearly with increasing level of motivation at baseline (p<0.001) and were 6.8 (95% CI=4.7–9.9) times higher for the highest level of motivation compared with the lowest. The accuracy of the MTSS for discriminating between smokers who did and did not attempt to quit was ROCAUC=0.67 (95% CI=0.65–0.70). ConclusionsThe MTSS provides strong and accurate prediction of quit attempts and is a candidate for a standard single-item measure of motivation to stop smoking. Further research should assess the external validity of this measure in different smoking populations.

Beliefs about the harms of long‐term use of nicotine replacement therapy: perceptions of smokers inEngland

Previous research has shown that a substantial proportion of smokers believe that nicotine causes serious diseases such as cancer, possibly deterring the use of nicotine replacement therapy (NRT) for smoking cessation or smoking reduction. This study examined beliefs about the harms specifically from long-term use of NRT and associations between these and its use for smoking cessation and smoking reduction. Data were collected from 1657 smokers and recent ex-smokers involved in the Smoking Toolkit Study, a series of monthly household surveys of English adults aged 16 and over. Participants were asked if they thought the use of NRT for a year or more was harmful, and if so, to volunteer what they believed the harms to be. They were also asked if they were using NRT for smoking reduction and/or if they had used NRT in the past year during a quit attempt. Six percent and 25% of smokers respectively, believed that the long term use of NRT was very or quit harmful to health; and a further 29% reported that they 'didn't know'. The most commonly reported harms were addiction and lung cancer. There was no association between these beliefs and use of NRT for smoking reduction or smoking cessation. A significant minority of smokers in England believe that the use of nicotine replacement therapy for a year or more is harmful. However, belief that long-term nicotine replacement therapy use can cause health harm does not appear to act as a deterrent to using it in a quit attempt or for smoking reduction.

Very low rate and light smokers: smoking patterns and cessation‐related behaviour in England, 2006–11

There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate-to-heavy (10+ CPD) smokers in England. Cross-sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. England. A total of 23,245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6-month follow-up. We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow-up. Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9-32.8%). Compared with moderate-to-heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio-economic background. They were more motivated to quit and enjoyed smoking less. During the 6-month follow-up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate-to-heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate-to-heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over-the-counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree.

Association between use of nicotine replacement therapy for harm reduction and smoking cessation: a prospective study of English smokers

AimsIt is important to know how far smokers' attempts at using nicotine replacement therapy (NRT) for smoking ‘harm reduction’ (reducing harm from continued smoking) promote or undermine cessation. To contribute...

'The smoking toolkit study': a national study of smoking and smoking cessation in England

BackgroundUp-to-date data tracking of national smoking patterns and cessation-related behaviour is required to evaluate and inform tobacco control strategies. The Smoking Toolkit Study (STS) was designed for this role. This paper describes the methodology of the STS and examines as far as possible the representativeness of the samples.MethodsThe STS consists of monthly, cross sectional household interviews of adults aged 16 and over in England with smokers and recent ex-smokers in each monthly wave followed up by postal questionnaires three and six months later. Between November 2006 and December 2010 the baseline survey was completed by 90,568 participants. STS demographic, prevalence and cigarette consumption estimates are compared with those from the Health Survey for England (HSE) and the General Lifestyle Survey (GLF) for 2007-2009.ResultsSmoking prevalence estimates of all the surveys were similar from 2008 onwards (e.g 2008 STS = 22.0%, 95% C.I. = 21.4% to 22.6%, HSE = 21.7%, 95% C.I. = 20.9% to 22.6%, GLF = 20.8%, 95% C.I. = 19.7% to 21.9%), although there was heterogeneity in 2007 (chi-square = 50.30, p < 0.001). Some differences were observed across surveys within sociodemographic sub-groups, although largely in 2007. Cigarette consumption was virtually identical in all surveys and years.ConclusionThere is reason to believe that the STS findings (see http://www.smokinginengland.info) are generalisable to the adult population of England.

Changes in smoking prevalence in 16–17‐year‐old versus older adults following a rise in legal age of sale: findings from an English population study

To assess smoking prevalence before and after the rise in legal age of sale of cigarettes in England and Wales from age 16 to age 18 in October 2007. A series of monthly cross-sectional household surveys: the 'Smoking Toolkit Study'. England. A total of 53, 322 adults aged 16 and over interviewed between October 2006 and May 2009, 1136 of whom were aged 16 or 17 years. Change in smoking prevalence from pre- to post-legislation, assessed by self-reported smoking status, among the 16-17-year-old group and older adults. The prevalence change following the legislation among those aged 16 and 17 was 7.1 percentage points (denominator=1136) compared with 2.4 percentage points (denominator=52,186) for older adults (odds ratio 1.36, P=0.024, 95% confidence interval=1.04-1.77 for the interaction). There was no difference within older age categories. There was a greater fall in prevalence in 16-17-year-olds following an increase in age of sale than in older age groups. This provides some support to the view that raising the age of sale can, at least in some circumstances, reduce smoking prevalence in younger age groups.

Failure to report attempts to quit smoking

Introduction Accurately assessing quit attempt history is important to develop population estimates of cessation and to increase our understanding of smoking trajectories. Thus, the current study investigated failure to report quit attempts as a function of length of quit attempt by time since quit attempt over the past year. Methods The present study used data from the Smoking Toolkit Study, a series of population-based surveys of smokers and recent ex-smokers in England aged 16 years and older. Among the 11,772 smokers identified at baseline (24.4% of the total sample), this study focused on the 4234 participants (36.0% of current smokers) who reported between one and three quit attempts in the past year. Results There was a strong trend for quit attempts that lasted for shorter periods of time to fail to be reported. After three months, 90.1% of those lasting less than one day, 63.7% of those lasting between a day a one week, and 38.9% of those lasting between one week and one month failed to be reported. Conclusion A large proportion of unsuccessful quit attempts fail to be reported, particularly if they only last a short time or occurred longer ago. Therefore, population estimates of quit attempts based on retrospective data may be considerable underestimates and estimates of the success of quit attempts may be overestimates. Future research is needed to establish whether there is differential reporting of quit attempts as a function of features of attempts such as use of cessation aids.