An Age-Progression Intervention for Smoking Cessation: A Pilot Study Investigating the Influence of Two Sets of Instructions on Intervention Efficacy.

BACKGROUND: Research on age-progression facial morphing interventions for smoking cessation has not investigated the effect of different instructions for intervention delivery. The objective of this pilot study was to investigate the influence of two instruction types used to deliver the intervention on efficacy of the intervention. METHOD: Women were recruited and randomly allocated to an age-progression intervention session with (i) neutral instructions; (ii) instructions designed to reassure; or (iii) a condition that controlled for participant engagement ("control"). The conditions were delivered in a one-time procedure, after which primary (quitting intentions) and secondary (cigarettes/week, quit attempts) outcomes were measured immediately post-intervention, and at 1 and 3 months. RESULTS: Seventy-two women (M = 25.7; SD = 0.9) were recruited and randomly allocated to condition (Neutral n = 27, Reassuring n = 22, Control n = 23). Quitting intentions were higher in the Reassuring versus Control arm (3 months post-intervention, F = 4.37, p = 0.016, 95% CI [0.231, 2.539], eta2 = 0.11); quit attempts were greater in the two intervention arms (58%) versus Control (1-month post-intervention, 15%) (χ2 = 9.83, p < 0.05, OR 1.00 [0.28, 3.63]). CONCLUSIONS: Findings highlight the importance of optimising instructions to enhance intervention efficacy. TRIAL REGISTRATION: clinicaltrials.gov Record: NCT03749382.

"They are saying it's high, but I think it's quite low": exploring cardiovascular disease risk communication in NHS health checks through video-stimulated recall interviews with patients - a qualitative study.

BACKGROUND: NHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators. METHODS: Qualitative, semi-structured video-stimulated recall interviews were conducted with patients (n = 40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n = 19) or JBS3 lifetime CVD risk calculator (n = 21). Interviews were transcribed and analysed using reflexive thematic analysis. RESULTS: Analysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding. CONCLUSIONS: Effective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes. TRIAL REGISTRATION: ISRCTN10443908. Registered 7th February 2017.

Men's experiences of a personalised, appearance-based, facial-morphing, safer drinking intervention.

Risky alcohol consumption behaviours remain commonplace, representing a major threat to health and safety, and are especially evidenced by young university students. Consequently, new interventions targeting this high-risk group are required. The current study investigated young male university students' experiences of a personalised, appearance-based, facial morphing, safer drinking intervention. Twenty-five male student participants were recruited, aged 18-34 years. Inductive thematic analysis of data gathered whilst participants were immersed in the intervention, and thereby exposed to alcohol-aged images of their own faces, produced four primary themes: alcohol as a threat to appearance and health, motivations to protect appearance, motivational aspects of the intervention, and proposed improvements and applications. The results of the current study suggested that participants expressed intentions towards healthier consumption/maintenance of already non-risky intake, supporting the potential of the facial-morphing appearance-based approach to address risky alcohol consumption, even in high-risk groups.

Using social media for patient and public involvement and engagement in health research: The process and impact of a closed Facebook group.

BACKGROUND: As part of a multifaceted approach to patient and public involvement and engagement (PPIE), alongside traditional methods, a closed Facebook group was established to facilitate PPIE feedback on various aspects of a project that used video-recording to examine risk communication in NHS Health Checks between June 2017 and July 2019. OBJECTIVE: To explore the process and impact of conducting PPIE through a closed Facebook group and to identify the associated benefits and challenges. METHODS: Supported by reflections and information from project meetings used to document how this engagement informed the project, we describe the creation and maintenance of the Facebook Group and how feedback from the group members was obtained. Facebook data were used to investigate levels and types of engagement in the closed Facebook group. We reflect on the challenges of using this method of engaging the public in health research. RESULTS: A total of 289 people joined the 'Risk Communication of Cardiovascular disease in NHS Health Checks' PPIE closed Facebook group. They provided feedback, which was used to inform aspects of the study, including participant-facing documents, recruitment, camera position and how the methodology being used (video-recorded Health Checks and follow-up interviews) would be received by the public. DISCUSSION: Using a closed Facebook group to facilitate PPIE offered a flexible approach for both researchers and participants, enabled a more inclusive method to PPIE (compared with traditional methods) and allowed rapid feedback. Challenges included maintaining the group, which was more labour intensive than anticipated and managing members' expectations. Suggestions for best practice include clear communication about the purpose of the group, assigning a group co-ordinator to be the main point of contact for the group, and a research team who can dedicate the time necessary to maintain the group. CONCLUSION: The use of a closed Facebook group can facilitate effective PPIE. Its flexibility can be beneficial for researchers, patients and public who wish to engage in the research process. Dedicated time for sustained group engagement is important. PATIENT OR PUBLIC CONTRIBUTION: Patient representatives were engaged with the development of the research described in this paper and a patient representative reviewed the manuscript.

Associations Between Covid-19-Related Threat, Stress, and Smoking in UK Adults Aged Under- and Over-30.

It has been suggested that smoking and age are associated with higher vulnerability to Covid-19. While threat of Covid-19 may reduce or stop smoking, increased stress due to lockdown could increase smoking behaviour. This study aimed to investigate changes in smoking behaviour in relation to age, Covid-19-related threat and subjective perceived stress during the UK lockdown. A cross-sectional study was performed. Online adverts were used to recruit UK residents who smoked combustible tobacco any time from January 2020. A questionnaire measured demographic information, smoking behaviour pre- and during-lockdown, perceived subjective stress (PSS), and Covid-19 related threat. Data were collected from a total of 145 participants (58% women, 39% men, 3% non-binary; mean age: 26 years, SD = 7.7), during UK lockdown between 22nd May and 22nd June 2020. Independent of stress and Covid-19-related threat, smoking was reduced in those aged less than 30 years. In participants aged 30 and above, increases in smoking behaviour were associated with higher PSS. The results highlight the relevance of the different stages of life on the relationship between stress, threat, and smoking behaviour. Greater emphasis should be placed on stress reduction for adult smokers aged 30 and above to enable smoking cessation.

UK women smokers' experiences of an age-progression smoking cessation intervention: Thematic analysis of accounts.

Objectives: Appearance-related interventions to promote healthy behaviour have been found effective to communicate health risks. The current study aimed to explore women smokers' experiences of age-progression software showing the effects of smoking on the face. Methods: A qualitative design was implemented, utilizing both individual interviews and focus groups within a critical realist framework. Fifteen, 19-52 year-old women smokers were administered an age-progression intervention. All participants responded to the intervention, engaged in semi-structured interviews, and were invited back to attend one of three focus groups. Data were analysed using inductive thematic analysis. Results: Four main themes were identified: Health versus Appearance, Shock Reaction, Perceived Susceptibility, and Intention to Quit. Participants found the intervention useful, voicing need for a comprehensive approach that includes both appearance and health. Despite increases in appearance-based apps which could diminish impact, women's accounts of shock induced by the aged smoking-morphed images were similar to previous work conducted more than ten years previously. Conclusions: The study provides novel insights in how women smokers currently perceive, and react to, an age-progression intervention for smoking cessation. Innovation: Findings emphasise the implementation of this intervention type accompanied by health information in a range of patient settings.

A thematic analysis of smokers' and non-smokers' accounts of E-cigarettes.

This study explored smokers' and non-smokers' accounts of E-cigarettes. A total of 51 UK-based participants, 20 men and 31 women, responded to open-ended questions online. Inductive thematic analysis identified that the factors that influence E-cigarette behaviour and opinion in adult smokers and non-smokers are related to social context, informative sources, practical aspects and health implications. Participants presented varying accounts of E-cigarettes, suggesting that individual narratives regarding E-cigarettes are multi-faceted. This is important information for health professionals and policy makers tasked with advising on E-cigarette use.

How has COVID-19 lockdown impacted smoking? A thematic analysis of written accounts from UK smokers.

Objective. This study was designed to investigate UK smokers' accounts of impacts of COVID-19 on their smoking, to develop implications for supporting smoking cessation.Design. One hundred and thirty-two smokers aged 19-52 years (mean age 25 years), recruited through an advert distributed through social media and a dedicated Twitter page, completed an anonymous online questionnaire.Main Outcome Measures. Smokers produced written accounts of how COVID-19 had impacted their smoking. Responses were of unlimited length and completed online 22nd May-22nd June 2020 during UK COVID-19 lockdown.Results. Inductive thematic analysis generated three themes: i) increased smoking as a coping mechanism to deal with anxiety, boredom, stress, and anger in COVID-19 lockdown; ii) lockdown as enabling quitting through lifting social barriers and enabling a focus on health benefits; and iii) no change, avoiding Government/media COVID-19 information due to disbelief, lack of trust, and perceptions of bias.Conclusions. Results demonstrate a need for credible public health messaging on COVID-19 risk aimed at smokers. Implications for supporting smoking cessation are discussed, including maintaining quitting in those "social smokers" who quit during lockdown, and support on stress-management and emotion regulation in those who use smoking as a way to cope with stress, anger, and boredom.

An investigation of factors encouraging and deterring EC use: a thematic analysis of accounts from UK adults.

OBJECTIVE: This study aimed to explore E-cigarette (EC) accounts from a small sample of UK adults with varied smoking/EC experiences. This was to contribute to existing knowledge of adult perceptions and understand the factors that encourage or deter use to inform health messaging aimed at professionals, policy makers and the general public. DESIGN: Twelve participants, five men and seven women aged 23-55 years (mean age 32.43) with mixed smoking/EC backgrounds took part in face-to-face interviews, analysed using semantic-level inductive thematic analysis. RESULTS: The analysis identified three key themes. Social influence (1) relates to the understanding of the social representations of ECs. Representation and knowledge (2) captures the impact of varied EC related communication on perception. Aspects of addiction (3) conveys aspects of nicotine addiction and how this influences EC use. CONCLUSION: ECs were generally perceived as more socially acceptable than cigarettes by non-smokers, although there were varying levels of acceptability depending on the type of EC device used. There was also unanimity concerning uncertainty surrounding the devices. Behavioural/sensory elements and personal enjoyment of ECs were consistent elements that encouraged or deterred use. Although non-smokers/vapers did not use the devices, they expressed similar apprehensions to those who did.

Cardiovascular disease risk communication in NHS Health Checks using QRISK®2 and JBS3 risk calculators: the RICO qualitative and quantitative study.

BACKGROUND: The NHS Health Check is a national cardiovascular disease prevention programme. There is a lack of evidence on how health checks are conducted, how cardiovascular disease risk is communicated to foster risk-reducing intentions or behaviour, and the impact on communication of using different cardiovascular disease risk calculators. OBJECTIVES: RIsk COmmunication in Health Check (RICO) study aimed to explore practitioner and patient understanding of cardiovascular disease risk, the associated advice or treatment offered by the practitioner, and the response of the patients in health checks supported by either the QRISK®2 or the JBS3 lifetime risk calculator. DESIGN: This was a qualitative study with quantitative process evaluation. SETTING: Twelve general practices in the West Midlands of England, stratified on deprivation of the local area (bottom 50% vs. top 50%), and with matched pairs randomly allocated to use QRISK2 or JBS3 during health checks. PARTICIPANTS: A total of 173 patients eligible for NHS Health Check and 15 practitioners. INTERVENTIONS: The health check was delivered using either the QRISK2 10-year risk calculator (usual practice) or the JBS3 lifetime risk calculator, with heart age, event-free survival age and risk score manipulation (intervention). RESULTS: Video-recorded health checks were analysed quantitatively (n = 173; JBS3, n = 100; QRISK2, n = 73) and qualitatively (n = 128; n = 64 per group), and video-stimulated recall interviews were undertaken with 40 patients and 15 practitioners, with 10 in-depth case studies. The duration of the health check varied (6.8-38 minutes), but most health checks were short (60% lasting < 20 minutes), with little cardiovascular disease risk discussion (average < 2 minutes). The use of JBS3 was associated with more cardiovascular disease risk discussion and fewer practitioner-dominated consultations than the use of QRISK2. Heart age and visual representations of risk, as used in JBS3, appeared to be better understood by patients than 10-year risk (QRISK2) and, as a result, the use of JBS3 was more likely to lead to discussion of risk factors and their management. Event-free survival age was not well understood by practitioners or patients. However, a lack of effective cardiovascular disease risk discussion in both groups increased the likelihood of a maladaptive coping response (i.e. no risk-reducing behaviour change). In both groups, practitioners often missed opportunities to check patient understanding and to tailor information on cardiovascular disease risk and its management during health checks, confirming apparent practitioner verbal dominance. LIMITATIONS: The main limitations were under-recruitment in some general practices and the resulting imbalance between groups. CONCLUSIONS: Communication of cardiovascular disease risk during health checks was brief, particularly when using QRISK2. Patient understanding of and responses to cardiovascular disease risk information were limited. Practitioners need to better engage patients in discussion of and action-planning for their cardiovascular disease risk to reduce misunderstandings. The use of heart age, visual representation of risk and risk score manipulation was generally seen to be a useful way of doing this. Future work could focus on more fundamental issues of practitioner training and time allocation within health check consultations. TRIAL REGISTRATION: Current Controlled Trials ISRCTN10443908. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 50. See the NIHR Journals Library website for further project information.

In England, NHS Health Checks aim to prevent cardiovascular diseases, such as heart attack and stroke. Health checks are conducted in primary care by a health-care assistant or practice nurse, who should measure the patient's risk of cardiovascular disease before advising them on how to reduce their risk. Cardiovascular disease risk is measured using a cardiovascular disease risk calculator. These calculators use various patient characteristics (e.g. age, sex, blood pressure and cholesterol) to predict how likely patients are to have a heart attack or stroke in the future. The aim of this study was to compare how practitioners explain cardiovascular disease risk to patients during health checks when using two risk calculators: QRISK^®2, which measures the risk of heart attack or stroke over the next 10 years (current usual practice), and JBS3 (a newer risk calculator), which gives this risk across the lifetime, is more interactive and has various visual displays of risk. We were interested to see if using JBS3 in health checks would lead to better practitioner and patient understanding of cardiovascular disease risk and result in patients intending to change, or actually changing, their behaviour to reduce their cardiovascular disease risk (compared with QRISK2). Health checks were video-recorded: 73 using QRISK2 and 100 using JBS3. Patients and members of the public advised on the study design, methods and management. Most consultations lasted < 20 minutes, with most time spent discussing the causes of cardiovascular disease. There was evidence that, compared with health checks using JBS3, those using QRISK2 led to less discussion of risk and practitioners speaking far more than patients. Sixty-four health checks from each risk calculator group were examined in depth. Opportunities to check whether or not patients understood the cardiovascular disease risk information and to encourage ways to lower risk were missed, making it less likely that patients would change their behaviour. The way that risk is presented by JBS3 seems to be more easily understood by patients than that presented by QRISK2. Nineteen patients in the QRISK2 group and 21 patients in the JBS3 group were interviewed 4 weeks after the consultation, and the practitioners were interviewed after they had completed all of their health checks. Patients found it difficult to understand and remember what they had been told about their cardiovascular disease risk during their health check. Their understanding and motivation to change behaviour appeared to be higher when they were visually shown how behaviour changes could lower their risk. Practitioners sometimes misunderstood risk and used patients' reactions to judge whether or not they understood, rather than asking them. Our findings should help to improve how cardiovascular disease risk is communicated during health checks in future, through simple changes to the consultations (e.g. using aspects of JBS3) and by highlighting a gap in practitioners' training.

Cardiovascular disease risk communication in NHS Health Checks: a qualitative video-stimulated recall interview study with practitioners.

BACKGROUND: NHS Health Check (NHSHC) is a national programme to identify and manage cardiovascular disease (CVD) risk. Practitioners delivering the programme should be competent in discussing CVD risk, but there is evidence of limited understanding of the recommended 10-year percentage CVD risk scores. Lifetime CVD risk calculators might improve understanding and communication of risk. AIM: To explore practitioner understanding, perceptions, and experiences of CVD risk communication in NHSHCs when using two different CVD risk calculators. DESIGN & SETTING: Qualitative video-stimulated recall (VSR) study with NHSHC practitioners in the West Midlands. METHOD: VSR interviews were conducted with practitioners who delivered NHSHCs using either the QRISK2 10-year risk calculator (n = 7) or JBS3 lifetime CVD risk calculator (n = 8). Data were analysed using reflexive thematic analysis. RESULTS: In total, nine healthcare assistants (HCAs) and six general practice nurses (GPNs) were interviewed. There was limited understanding and confidence of 10-year risk, which was used to guide clinical decisions through determining low-, medium-, or high-risk thresholds, rather than as a risk communication tool. Potential benefits of some JBS3 functions were evident, particularly heart age, risk manipulation, and visual presentation of risk. CONCLUSION: There is a gap between the expectation and reality of practitioners' understanding, competencies, and training in CVD risk communication for NHSHCs. Practitioners would welcome heart age and risk manipulation functions of JBS3 to promote patient understanding of CVD risk, but there is a more fundamental need for practitioner training in CVD risk communication.

Association between age at first reported e-cigarette use and subsequent regular e-cigarette, ever cigarette and regular cigarette use.

BACKGROUND AND AIMS: Association of electronic cigarette use and subsequent smoking has received considerable attention, although age of first use has not. This study tested differences in regular (e-cigarettes, cigarettes) and ever (cigarettes) use between e-cigarette user groups: early versus never users, late versus never users, early versus late users and effects of controlling for covariates. DESIGN: Prospective study with 12- and 24-month follow-up of e-cigarette/cigarette ever/regular use with data from an intervention. SETTING: Forty-five schools in England (Staffordshire and Yorkshire). PARTICIPANTS: Never smokers (3289 13-14-year-olds) who were part of a cluster randomized controlled trial. MEASUREMENTS: The sample was divided into groups of e-cigarette users: early users (at 13-14 years), late users (at 14-15 years) and never users (at 13-14 and 14-15 years). Dependent variables were self-reported regular e-cigarette and cigarette use and ever cigarette use at 15-16 years. Covariates were assessed. FINDINGS: Early and late users compared with never users were significantly more likely to be regular e-cigarette users [early: odds ratio (OR) = 9.42, 95% confidence interval (CI) = 5.38, 16.49, P < 0.001; late: OR = 6.89, 95% CI = 4.11, 11.54, P < 0.001], ever cigarette users (early: OR = 7.96, 95% CI = 6.02, 10.53, P < 0.001; late: OR = 5.13, 95% CI = 3.85, 6.84, P < 0.001) and regular cigarette users (early: OR = 7.80, 95% CI = 3.99, 15.27, P < 0.001; late: OR = 4.34, 95% CI = 1.93, 9.77, P < 0.001) at age 15-16 years. Late users compared with early users had significantly lower rates of ever use of cigarettes at 15-16 years (OR = 0.48, 95% CI = 0.35, 0.66, P < 0.001), although this difference was non-significant at 12 months after first use of e-cigarettes (OR = 0.89, 95% CI = 0.64, 1.25, P = 0.498). Controlling for covariates did not change the findings. CONCLUSIONS: Adolescents in England who report using e-cigarettes at age 13-14 years have higher rates of subsequently initiating cigarette use than adolescents who report using e-cigarettes at age 14-15 years, a difference that may be attributable to a longer period of time to initiate cigarette use in former group.

Men's reflections on their body image at different life stages: A thematic analysis of interview accounts from middle-aged men.

This study investigates how men's body image develops over time. A total of 14 men aged between 45 and 67 years completed in-depth interviews where they discussed their body image since childhood, prompted in some cases by photographs of themselves at different ages that they brought to the interviews. Transcripts were analysed using inductive thematic analysis. From the participants' accounts, it was evident that body concerns did not steadily improve or worsen, but waxed and waned over time. Results are discussed in relation to understanding changing body concerns in men's lives, and the implications of these for future research and practice.

A qualitative exploration of two risk calculators using video-recorded NHS health check consultations.

BACKGROUND: The aim of the study was to explore practitioner-patient interactions and patient responses when using QRISK®2 or JBS3 cardiovascular disease (CVD) risk calculators. Data were from video-recorded NHS Health Check (NHSHC) consultations captured as part of the UK RIsk COmmunication (RICO) study; a qualitative study of video-recorded NHSHC consultations from 12 general practices in the West Midlands, UK. Participants were those eligible for NHSHC based on national criteria (40-74 years old, no existing diagnoses for cardiovascular-related conditions, not on statins), and practitioners, who delivered the NHSHC. METHOD: NHSHCs were video-recorded. One hundred twenty-eight consultations were transcribed and analysed using deductive thematic analysis and coded using a template based around Protection Motivation Theory. RESULTS: Key themes used to frame the analysis were Cognitive Appraisal (Threat Appraisal, and Coping Appraisal), and Coping Modes (Adaptive, and Maladaptive). Analysis showed little evidence of CVD risk communication, particularly in consultations using QRISK®2. Practitioners often missed opportunities to check patient understanding and encourage risk- reducing behaviour, regardless of the risk calculator used resulting in practitioner verbal dominance. JBS3 appeared to better promote opportunities to initiate risk-factor discussion, and Heart Age and visual representation of risk were more easily understood and impactful than 10-year percentage risk. However, a lack of effective CVD risk discussion in both risk calculator groups increased the likelihood of a maladaptive coping response. CONCLUSIONS: The analysis demonstrates the importance of effective, shared practitioner-patient discussion to enable adaptive coping responses to CVD risk information, and highlights a need for effective and evidence-based practitioner training. TRIAL REGISTRATION: ISRCTN ISRCTN10443908 . Registered 7th February 2017.

Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators.

OBJECTIVES: Quantitatively examine the content of National Health Service Health Check (NHSHC), patient-practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators. DESIGN: RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation. SETTING AND PARTICIPANTS: Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40-74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients' age, gender and ethnicity. METHODS: Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management. RESULTS: 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8-38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01-12.48 vs QRISK2 M=7.44%, CI: 5.29-9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44-3.97 vs QRISK2=2.35%, CI: 1.89-2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92-42.17). CONCLUSIONS: There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences. TRIAL REGISTRATION NUMBER: ISRCTN10443908.

Perceived mechanisms of change in therapeutic yoga targeting psychological distress.

INTRODUCTION: This study was designed to investigate yoga teachers' and yoga therapists' perceptions of the ways yoga is applied to treat symptoms of psychological distress, and identify the defining features, main components, and mechanisms of change in therapeutic practice. METHODS: A qualitative design was employed. Six yoga teachers who had specific training and experience in teaching therapeutic yoga or practicing 'yoga therapy' took part in one-to-one interviews during which they gave accounts of their experiences of helping people cope with psychological distress through yoga. Participants' interviews were transcribed verbatim and were analysed using an integrative inductive-deductive thematic analysis. RESULTS: Four key themes were identified in relation to the benefits of therapeutic yoga: Awareness, Choice, Relationships, and Tailoring. CONCLUSIONS: The findings support previous research which suggests that individualised yoga therapy is a promising intervention, and may help to form a theoretical rationale for the future treatment of psychological distress with yoga.

Evidence that an intervention weakens the relationship between adolescent electronic cigarette use and tobacco smoking: a 24-month prospective study.

BACKGROUND: The electronic cigarette (e-cigarette) use to subsequent smoking relationship in adolescents has received much attention. Whether an intervention to reduce smoking initiation attenuated this relationship was assessed. METHOD: Data were from 3994 adolescent never smokers (aged 13-14 years at baseline) as part of a cluster randomised controlled trial. Self-report measures of smoking, e-cigarette use and covariates were assessed and used to predict ever smoked cigarettes, any recent tobacco smoking and regularly smoked cigarettes at 24-month follow-up. RESULTS: Baseline ever use of e-cigarettes was associated with ever smoked cigarettes (OR=4.03, 95% CI 3.33 to 4.88; controlling for covariates, OR=2.78, 95% CI 2.20 to 3.51), any recent tobacco smoking (OR=3.38, 95% CI 2.72 to 4.21; controlling for covariates, OR=2.17, 95% CI 1.76 to 2.69) and regularly smoked cigarettes (OR=3.60, 95% CI 2.35 to 5.51; controlling for covariates, OR=1.27, 95% CI 1.17 to 1.39) at follow-up. For ever smoked cigarettes only, the impact of e-cigarette use was attenuated in the intervention (OR=1.83) compared with control (OR=4.53) condition. For ever smoked cigarettes and any recent tobacco smoking, the impact of e-cigarette use was attenuated among those with friends who smoked (OR=2.05 (ever smoked); 1·53 (any tobacco use)) compared with those without friends who smoked (OR=3.32 (ever smoked); 2·17 (any tobacco use)). CONCLUSIONS: This is one of the first studies to show that e-cigarette use was robustly associated with measures of smoking over 24 months and the first to show an intervention to attenuate the relationship. Further research with a broader age range of adolescents is required.

Development and testing of a model for risk and protective factors for eating disorders and higher weight among emerging adults: A study protocol.

Research has demonstrated that eating disorders (ED) and higher weight have lifetime co-occurrence suggesting that they may be best considered within a common etiological model. Although we know that body dissatisfaction is likely to be a risk factor for both outcomes, other proposed risk and protective factors for each condition have not been adequately explored. The current paper tests a conceptual model that is based on a review of the existing literature from both areas of scholarship. It considers biological, sociocultural, psychological, and behavioral factors that may contribute to both outcomes. The model will be tested in a longitudinal design with an initial sample of 600 emerging adults (aged 18-30) per country in nine different countries (total sample = 5400 participants). Questionnaires will be completed online on two occasions, 12 months apart. The first full phase of the study commenced in July 2018, the same time Body Image was approached to publish this protocol paper (the final revised paper was submitted in September 2019), and data collection will be finalized in December 2019. Multi-group path analysis will identify the biopsychosocial predictors - both cross-sectionally and longitudinally - of both ED and higher weight, and how these vary across countries and gender.

Qualitative Analysis of Factors Influencing Patient Persistence and Adherence to Prescribed Overactive Bladder Medication in UK Primary Care.

INTRODUCTION: Pharmacotherapy for overactive bladder (OAB) is generally associated with low rates of persistence and adherence. This study was conducted to explore the patient journey in a UK primary care setting (experiences, perceptions, attitudes, and levels of engagement and expectations) and identify self-reported reasons for patient non-adherence and/or non-persistence to medications for OAB. METHODS: This was a qualitative, non-interventional study involving one-to-one semi-structured, face-to-face or phone interviews with individuals aged 40-80 years, diagnosed with OAB, and currently taking, or having taken, either antimuscarinic or ß3-adrenoceptor agonist medications within the last 12 months. Thematic analyses of interview transcripts identified themes surrounding the participants' experiences with OAB. RESULTS: A total of 20 interviews were conducted (face-to-face, n = 13; telephone, n = 7). Interviews from five men and 13 women (mean age 70 years) were included in the final analysis. The most common OAB symptoms reported included urgency, frequency, incontinence and nocturia. Several key themes of factors influencing persistence and/or adherence to prescribed OAB medication were identified: patients' attitude and condition adaptation behaviour; support with treatment; unmet efficacy/tolerability expectations; drug/condition hierarchy. Non-adherence and/or non-persistence to OAB medication was largely intentional, with patients balancing side effects against perceived clinical benefits. Perceived lack of efficacy was the primary reason for discontinuing treatment. Other factors cited included side effects of medication (either experienced or a fear of future effects), a general aversion to long-term medication taking, drug/condition hierarchy relative to other comorbidities, and limited healthcare professional (HCP) support/engagement. Patients expressed condition adaptation behaviours to help self-manage their condition. CONCLUSION: Persistence and adherence to OAB medication may be suboptimal. HCPs might be able to improve persistence and adherence by fostering realistic treatment expectations and scheduling regular medication reviews. These measures may help optimise patient care and support more adherent behaviours, thus minimising the impact of undertreated OAB on patient quality of life. FUNDING: Innovate UK and Astellas Pharma Europe Ltd (APEL).

Patterns and predictors of e-cigarette, cigarette and dual use uptake in UK adolescents: evidence from a 24-month prospective study.

BACKGROUND AND AIMS: To assess prevalence and predictors of e-cigarettes/cigarettes patterns of use in adolescents in England. DESIGN: Prospective study with 24-month follow-up of e-cigarette/cigarette ever/regular use with data from an intervention evaluation. SETTING: Forty-five schools in England (Staffordshire and Yorkshire). PARTICIPANTS: A total of 3210 adolescents who, at baseline, were aged 13-14 years and had never used e-cigarettes/cigarettes. MEASUREMENTS: Based on e-cigarette/cigarette ever use at follow-up, six groups were created: (a) never user, (b) e-cigarette only, (c) cigarette only, (d) dual use-order of use unclear, (e) dual use-e-cigarettes used first and (f) dual use-cigarettes used first. Baseline measures were: gender, ethnicity, socio-economic status, impulsivity, family plus friend smoking and smoking-related beliefs (attitude and perceived behavioural control). FINDINGS: In groups (a) to (f), there were 71.5, 13.3, 3.3, 5.7, 2.9 and 3.4% adolescents, respectively. Among groups using cigarettes, regular smoking was more prevalent in group (f) (dual use-cigarettes used first) [17.6%, 95% confidence interval (CI) = 10.4, 24.8] than in groups (c), (d) and (e) combined (7.3%, 95% CI = 4.7, 9.9). Among groups using e-cigarettes, regular use was less prevalent in group (b) (e-cigarette only) (1.9%, 95% CI = 0.6, 3.2) than in groups (d), (e) and (f) combined (12.2%, 95% CI = 8.9, 15.5). Higher impulsivity plus friends and family smoking were predictive of being in groups (b) to (f) compared with group (a) (never users). Males were more likely to be in group (b) compared to group (a); females were more likely to be in groups (c) to (f) compared to group (a). CONCLUSIONS: Regular use of e-cigarettes/cigarettes varies across groups defined by ever use of e-cigarettes/cigarettes. Interventions targeted at tackling impulsivity or adolescents whose friends and family members smoke may represent fruitful avenues for future research.