DASHES Protocol: Development and Feasibility Testing of a Tailored Community Programme to Support People in Recovery from Problematic Alcohol and Drug Use to Cut Down or Stop Smoking Using Co-Creation.

BACKGROUND: Despite the continued global decline in adult tobacco prevalence, rates continue to be significantly higher in groups with problematic drug or alcohol use (PDA). It is estimated that people with alcohol, drug or mental health problems account for approximately half of all smoking deaths. In the UK, there are free stop smoking services for the general population. However, these services have been criticized as unsuitable for people in recovery from PDA due to their design, time-limited support, strict requirement for smoking abstinence and lack of consideration of harm reduction approaches. This has led to calls for alternative approaches to support this marginalized and underserved group. This research study seeks to respond to this call by co-creating and feasibility testing a tailored, trauma-informed service specifically for people seeking help for PDA, who are not in immediate crisis, and who may also want to reduce or stop their tobacco smoking. METHODS: The mixed-method study design has two parts. The development study (part one) will use participatory peer research methods to work with the target client group and key stakeholders involved in service delivery, commissioning, and policy to design the service (intervention). The feasibility study (part two) will test the delivery of the intervention protocol and capture data that will enable the assessment of whether progression to a future pilot randomized control trial is merited. CONCLUSIONS: The outcome of this study will be a theoretically informed, co-created intervention with the potential to improve population health by supporting people with problematic drug or alcohol use to cut down or stop tobacco smoking.

The Health-Related Quality of Life of Patients Waiting for Anterior Cruciate Ligament Reconstruction Is Worse Than an Age- and Sex-Matched Population: Increasing Time on Waiting List for Surgery Was Independently Associated with a Worse Quality of Life.

Background: The aims of this study were to assess the health-related quality of life (HRQoL) of patients awaiting anterior cruciate ligament (ACL) reconstruction compared to the population at risk: whether knee-specific function was predictive of HRQoL and to identify factors associated with a worse HRQoL. Methods: Sixty-seven patients (male, n = 50; female, n = 17; mean age, 29) identified from the surgical waiting list completed a questionnaire that included demographics, BMI, time of injury, EuroQol 5-dimension (EQ-5D), Short-Form (SF-36), and International Knee Documentation Committee (IKDC) scores. Age- and sex-matched HRQoL data were obtained from population level data. Results: The mean EQ-5D score for the study cohort was significantly worse than the matched score (difference, 0.367; p < 0.001), and the same trend was observed for all eight dimensions of the SF-36 score. Thirty-three (49%) patients felt their health, in general, was somewhat or much worse compared to one year ago. There was a correlation between IKDC and EQ-5D scores (r = 0.540, p < 0.001). Linear regression was used to formulate the EQ-5D score: EQ-5D = (IKDCx0.013)-0.015 (constant). The SF-36 physical component and length of time on the waiting list were independently associated with the HRQoL, with each 14-point drop or for every 200 days, a clinically significant deterioration in patients' HRQoL occurred, respectively. Conclusions: Patients had a significantly worse HRQoL when compared to the age- and sex-matched population, which deteriorates with worsening physical function and increasing length of time on the waiting list. The knee-specific IKDC correlated with HRQoL and could be used to estimate the EQ-5D score.