Cost-effectiveness of a complex intervention to reduce children's exposure to second-hand smoke in the home.

BACKGROUND: Second-hand smoke (SHS) causes numerous health problems in children such as asthma, respiratory tract infections and sudden infant death syndrome. The home is the main source of exposure to SHS for children, particularly for young children. We estimated the cost-effectiveness of a complex intervention designed to reduce SHS exposure of children whose primary caregiver feels unable or unwilling to quit smoking. METHODS: A cost-effectiveness analysis was carried out alongside an open-label, parallel, randomised controlled trial in deprived communities in Nottingham, England. A complex intervention combining behavioural support, nicotine replacement therapy and personalised feedback on home air quality was compared with usual care. A total number of 205 households were recruited, where the main caregivers were aged 18 and over, with a child aged under five years living in their household reporting smoking inside their home. Analyses for this study were undertaken from the National Health Service/Personal Social Services perspective. All costs were estimated in UK pounds (£) at 2013/14 prices. The primary outcome was the incremental cost-effectiveness of change in air quality in the home, measured as average 16-24 h levels of particulate matter of < 2.5 µm diameter (PM2.5), between baseline and 12 weeks. Secondary outcomes included incremental cost per quitter, quit attempts and cigarette consumption in the home. A non-parametric bootstrap re-sampling technique was employed to explore uncertainty around the calculated incremental cost-effectiveness ratios. RESULTS: The complex intervention achieved reduced PM2.5 by 21.6 µg/m3 (95% CI: 5.4 to 37.9), with an incremental cost of £283 (95% CI: £254-£313), relative to usual care. The incremental cost-effectiveness ratio was £131 (bootstrapped 95% CI: £72-£467) per additional 10µg/m3 reduction in PM2.5, or £71 (bootstrapped 95% CI: -£57-£309) per additional quitter. CONCLUSIONS: This trial targeted a socio-economically disadvantaged population that has been neglected within the literature. The complex intervention was more costly but more effective in reducing PM2.5 compared with the usual care. It offers huge potential to reduce children's' tobacco-related harm by reducing exposure to SHS in the home. The intervention is considered cost-effective if the decision maker is willing to pay £131 per additional 10µg/m3 of PM2.5 reduction. TRIAL REGISTRATION: The Smoke Free Homes trial was registered with isrctn.com on 29 January 2013 with the identifier ISRCTN81701383 .

Cigarette brand diversity and price changes during the implementation of plain packaging in the United Kingdom.

BACKGROUND AND AIM: Plain packaging of cigarettes appeared in the United Kingdom in July 2016 and was ubiquitous by May 2017. The change coincided with another legislative change, raising the minimum pack size from 10 to 20 cigarettes. Laws imposing plain packaging on cigarette packs remove another promotional route from tobacco companies, but the effect of such laws on brand diversity, pricing and sales volume is unknown. This study aimed to (1) describe and quantify changes in brand diversity, price segmentation and sales volumes and (2) estimate the association between the introduction of plain cigarette packaging and cigarette pricing in the United Kingdom. DESIGN: We used a natural experiment design to assess the impact of plain packaging legislation on brand diversity and cigarette prices. The data comprised a sample of 76% of sales of cigarettes in the UK between March 2013 and June 2017. SETTING: United Kingdom. MEASUREMENTS: Cigarette prices, number of brands and products and volumes of sales. FINDINGS: During the period analysed, there was a slight decrease in the number of cigarette brands. There was also an initial increase observed in the number of cigarette products, due mainly to an increase in the number of products in packs of fewer than 20 cigarettes sold before July 2016, which was then followed by a rapid decrease in the number of products that coincided with the implementation of the new legislation. Cigarette sales volumes during this period did not deviate from the preceding secular trend, but prices rose substantially. Regression results showed that price per cigarette, regardless of pack size, was 5.0 [95% confidence interval (CI) = 4.8-5.3] pence higher in plain than in fully branded packs. For packs of 20 cigarettes, price increases were greater in the lower price quintiles, ranging from 2.6 (95% CI = 2.4-2.7) GBP in the lowest to 0.3 (95% CI = 0.3-0.4) GBP per pack in the highest quintile. CONCLUSIONS: The implementation of standardized packaging legislation in the United Kingdom, which included minimum pack sizes of 20, was associated with significant increases overall in the price of manufactured cigarettes, but no clear deviation in the ongoing downward trend in total volume of cigarette sales.

Carlsberg alibi marketing in the UEFA euro 2016 football finals: implications of Probably inappropriate alcohol advertising.

BACKGROUND: Alcohol advertising is a key driver of alcohol consumption, and is prohibited in France by the Loi Evin. In 2016 the Danish brewer Carlsberg sponsored the UEFA Euro 2016 finals, held in France, and used the alibis 'Probably' and '…the best in the world' in place of Carlsberg in pitch-side advertising. We have quantified the advertising exposure achieved during the final seven games in the UEFA Euro 2016 championship. METHODS: Appearances of the Carlsberg alibis 'Probably' and 'the best in the world' were counted and timed to the nearest second during all active play in live coverage of quarter final, semi-final and final matches broadcast in the UK. We used census data and viewing figures from Kantar Media to estimate gross and per capita impressions of these advertisements in the UK population. RESULTS: In 796 min, 29 s of active play there were 746 alibi appearances, totalling 68 min 35 s duration and representing 8.6% of active playing time. Appearances were particularly frequent at the end of normal time, extra time and penalties. The seven matches delivered up to 7.43 billion Carlsberg alibi impressions to UK adults and 163.3 million to children. In the only match involving a second country with laws prohibiting alcohol advertising (France versus Iceland), exposure occurred for only 1.8% of playing time. CONCLUSIONS: Alibi marketing achieved significant advertising coverage during the final seven EURO 2016 championship games, particularly to children. Since 'Probably' is registered by Carlsberg as a wordmark this advertising appears to contravene the Loi Evin, though Carlsberg have defended their marketing actions.