Children's exposure to second-hand smoke 10 years on from smoke-free legislation in England: Cotinine data from the Health Survey for England 1998-2018.

BACKGROUND: We aimed to investigate trends in children's exposure to second-hand tobacco smoke in England from 1998 to 2018. METHODS: We used twenty-one years of data from the Health Survey for England, a yearly repeated cross-sectional population study. A total of 49,460 children participated between 1998 and 2018, of whom 17,463 were biochemically confirmed non-smokers aged 4-15. We examined changes in (i) the proportion of children living in reported smoke-free homes and (ii) second-hand smoke uptake, measured quantitatively using saliva cotinine concentration. FINDINGS: The percentage of children living in a home reported to be smoke-free increased from 63.0% (95% CI 60.5%-65.2%) in 1998 to 93.3% (91.8%-94.6%) in 2018. This increase was most pronounced among children with a smoker parent, rising from 17.1% (14.7%-19.8%) to 75.9% (70.8%-80.4%). Segmented regression showed that the rate of adoption of smoke-free homes accelerated leading up to the 2007 ban on smoking in public places, growing most rapidly in the four years after its entry into law. Between 1998 and 2018, there was a ten-fold decline in geometric mean cotinine among non-smoking children, from 0.50 ng/ml (0.46-0.56) to 0.05 ng/ml (0.04-0.06). A total of 65.0% (61.2%-68.6%) of children had undetectable cotinine in 2018, up from 14.3% (12.7%-16.0%) in 1998. Children living in rented accommodation were more exposed than those from owner-occupied households, but they experienced similar relative declines across years. INTERPRETATION: Cotinine data show that children's exposure to second-hand smoke has fallen by some 90% since 1998, with an apparent acceleration in adoption of smoke-free homes since the 2007 ban on smoking in public places. A norm has emerged that sees smoking in the home as inappropriate, almost universally where parents are non-smokers, but also increasingly among smoking parents. FUNDING: Public Health England, now the Office for Health Improvement and Disparities, and Cancer Research UK.

Dependence on nicotine in US high school students in the context of changing patterns of tobacco product use.

BACKGROUND AND AIM: There have been substantial recent changes in youth tobacco product use in the United States-including, notably, a rapid increase in use of e-cigarettes. It is not known whether, and if so how far, these changes are reflected in levels of nicotine dependence. This study used data from a large, nationally representative sample of US adolescents to (i) estimate the annual prevalence of nicotine dependence in relation to current use of tobacco products, (ii) describe trends in dependence over time and (iii) evaluate whether the increase in youth use of tobacco products has been paralleled by a similar increase in the population burden of nicotine dependence. DESIGN: Secondary analysis of National Youth Tobacco Surveys conducted annually, 2012-19. SETTING: United States. PARTICIPANTS: A total of 86 902 high school students. MEASUREMENTS: Prevalence of (i) strong cravings to use tobacco in the past 30 days and (ii) wanting to use nicotine products within 30 minutes of waking, in relation to type of product used (cigarettes, other combustible tobacco, smokeless tobacco, e-cigarettes). FINDINGS: Between 2012 and 2019 there was a marked decline in past 30-day cigarette smoking and a surge in use of e-cigarettes. Different products were associated with differing levels of nicotine dependence, with cigarettes characterized by highest dependence (strong craving 42.3%; wanting to use within 30 minutes 16.8% among exclusive users in 2019) and e-cigarettes in otherwise tobacco-naive students by low dependence (16.1 and 8.8% respectively in 2019). The overall 33.8% increase in population use of nicotine products between 2012 and 2019 (from 23.2 to 31.2%) was not accompanied by an equivalent increase in overall population burden of dependence {percentage reporting craving 10.9% [95% confidence interval (CI) = 9.8-12.2%] in 2012 and 9.5% (95% CI = 7.5-12.0%) in 2019; wanting to use within 30 minutes 4.7% (95% CI = 4.0-5.5%) in 2012, 5.4% (95% CI = 4.0-7.2%) in 2019}. CONCLUSIONS: Among US high school students, increases in the prevalence of nicotine product use from 2012 to 2019 do not appear to have been accompanied by a similar increase in the population burden of nicotine dependence. This may be at least partly attributable to a shift in the most common product of choice from cigarettes (on which users are most dependent) to e-cigarettes (on which users are least dependent).

England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking-attributable deaths in England.

BACKGROUND AND AIMS: Whereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England. DESIGN: Indirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP-related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012-2019 counterfactual No-NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking-attributable deaths. SETTING: England, 2000-2019. PARTICIPANTS: Nationally representative sample of population. MEASUREMENTS: England's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies. FINDINGS: Between 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012-2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model-predicted No-NVP reduction (males, 7.3%), the implied NVP-attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%-22.0%) for males and 20.4% (18.7%-22.2%) for females. The NVP-attributable reduction was 27.2% (22.8%-31.6%) for males and 31.7% (27.4%-36.5%) for females ages 18-24 and 18.6% (15.2%-21.8%) for males and 15.0% (11.1%-18.8%) for females ages 25-34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453-199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results. CONCLUSIONS: An indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012-2019 coinciding with the growth in nicotine vaping product use.

Biochemical Verification of Tobacco Use and Abstinence: 2019 Update.

BACKGROUND: The changing prevalence and patterns of tobacco use, the advent of novel nicotine delivery devices, and the development of new biomarkers prompted an update of the 2002 Society for Research on Nicotine and Tobacco (SRNT) report on whether and how to apply biomarker verification for tobacco use and abstinence. METHODS: The SRNT Treatment Research Network convened a group of investigators with expertise in tobacco biomarkers to update the recommendations of the 2002 SNRT Biochemical Verification Report. RESULTS: Biochemical verification of tobacco use and abstinence increases scientific rigor and is recommended in clinical trials of smoking cessation, when feasible. Sources, appropriate biospecimens, cutpoints, time of detection windows and analytic methods for carbon monoxide, cotinine (including over the counter tests), total nicotine equivalents, minor tobacco alkaloids, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol are reviewed, as well as biochemical approaches to distinguishing cigarette smoking from use of electronic nicotine delivery devices (ENDS). CONCLUSIONS: Recommendations are provided for whether and how to use biochemical verification of tobacco use and abstinence. Guidelines are provided on which biomarkers to use, which biospecimens to use, optimal cutpoints, time windows to detection, and methodology for biochemical verifications. Use of combinations of biomarkers is recommended for assessment of ENDS use. IMPLICATIONS: Biochemical verification increases scientific rigor, but there are drawbacks that need to be assessed to determine whether the benefits of biochemical verification outweigh the costs, including the cost of the assays, the feasibility of sample collection, the ability to draw clear conclusions based on the duration of abstinence, and the variability of the assay within the study population. This paper provides updated recommendations from the 2002 SRNT report on whether and how to use biochemical markers in determining tobacco use and abstinence.

Recent trends in children's exposure to second-hand smoke in England: cotinine evidence from the Health Survey for England.

AIMS: To examine changes in children's exposure to second-hand tobacco smoke in England since 1998. DESIGN: Repeated cross-sectional surveys of the general population in England. SETTING: The Health Survey for England. PARTICIPANTS: A total of 37 038 children participating in surveys from 1998 to 2012, 13 327 of whom were aged 4-15 years, had available cotinine and were confirmed non-smokers. MEASUREMENTS: The proportion of children with smoking parents; the proportion of children living in homes reported to be smoke-free; the proportion of children with undetectable concentrations of cotinine; linear and quadratic trend estimates of geometric mean cotinine across years. FINDINGS: By 2012, 87.3% of children lived in a home that was smoke-free {97.2% [95% confidence interval (CI) = 95.9-98.1] when parents were non-smokers, 61.3% (95% CI = 55.5-66.8) when one or both parents smoked}. A total of 68.6% (95% CI = 64.3-72.6%) of children had undetectable cotinine in 2012, up from 14.3% (95% CI = 12.7-16.0%) in 1998. There was a highly significant linear trend across years (with a small but significant quadratic term) to declining geometric mean cotinine in all children from 0.52 ng/ml (95% CI = 0.48-0.57) in 1998 to 0.11 ng/ml (95% CI = 0.10-0.12) in 2012. Children from routine/manual backgrounds were more exposed, but experienced similar gains across years to those from non-manual backgrounds. CONCLUSIONS: In England, children's exposure to second-hand smoke has declined by 79% since 1998, with continuing progress since smoke-free legislation in 2007. An emerging social norm in England has led to the adoption of smoke-free homes not only when parents are non-smokers, but also when they smoke.

Variation in nicotine intake among U.S. cigarette smokers during the past 25 years: evidence from NHANES surveys.

OBJECTIVE: To estimate changes in nicotine intakes among U.S. cigarette smokers from 1988 to 2012 with the National Health and Nutrition Examination Survey (NHANES). METHODS: NHANES provides data on nationally representative samples of cigarette smokers from the civilian noninstitutionalized U.S. population. A total of 4,304 smokers aged 20 years and older were studied in NHANES III 1988-1994 and 7,095 were studied in the continuous NHANES 1999-2012. We examined serum cotinine concentrations, daily cigarette consumption, and estimated nicotine intake per cigarette, with adjustment for sex, age, racial/ethnic background, level of education, and body mass index. RESULTS: There was little overall change in nicotine intake from smoking cigarettes either in the U.S. population as a whole or in major racial/ethnic subgroups during the 25-year period from 1988. Serum cotinine averaged 223.7ng/mL (95% confidence interval [CI] = 216.1-231.3) in 1988-1994, which was not significantly different from the adjusted mean of 219.2ng/mL (95% CI = 214.1-224.4) in 1999-2012. During the same period, average daily cigarette consumption declined substantially, from 17.3 (95% CI = 16.5-18.0) in 1988-1994 to 12.3 (95% CI = 11.0-13.6) by 2012. Cotinine per cigarette smoked increased by some 42% between 1988-1994 and 2011-2012, from a geometric mean of 12.4 (95% CI = 11.7-13.1) to 17.6 (95% CI = 16.1-19.2). CONCLUSIONS: Reductions in cigarette smoking prevalence since the late 1980s, changes in cigarette product design, and the widespread introduction of smoke-free policies have not had a significant impact on nicotine intakes among U.S. smokers. Reductions in cigarette consumption have been offset by increased nicotine intake per cigarette smoked.

Dispelling myths about gender differences in smoking cessation: population data from the USA, Canada and Britain.

OBJECTIVES: Based mainly on findings from clinical settings, it has been claimed that women are less likely than men to quit smoking successfully. If true, this would have important implications for tobacco control interventions. The authors aimed to test this possibility using data from general population surveys. METHODS: The authors used data from major national surveys conducted in 2006-2007 in the USA (Tobacco Use Supplement to the Current Population Survey), Canada (Canadian Tobacco Use Monitoring Survey) and the UK (General Household Survey) to estimate rates of smoking cessation by age in men and women. RESULTS: The authors found a pattern of gender differences in smoking cessation which was consistent across countries. Below age 50, women were more likely to have given up smoking completely than men, while among older age groups, men were more likely to have quit than women. Across all age groups, there was relatively little difference in cessation between the sexes. CONCLUSIONS: Conclusions about gender differences in smoking cessation should be based on evidence from the general population rather than from atypical clinical samples. This study has found convincing evidence that men in general are not more likely to quit smoking successfully than women.

Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys.

BACKGROUND: Despite the high global burden of diseases caused by tobacco, valid and comparable prevalence data for patterns of adult tobacco use and factors influencing use are absent for many low-income and middle-income countries. We assess these patterns through analysis of data from the Global Adult Tobacco Survey (GATS). METHODS: Between Oct 1, 2008, and March 15, 2010, GATS used nationally representative household surveys with comparable methods to obtain relevant information from individuals aged 15 years or older in 14 low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam). We compared weighted point estimates and 95% CIs of tobacco use between these 14 countries and with data from the 2008 UK General Lifestyle Survey and the 2006-07 US Tobacco Use Supplement to the Current Population Survey. All these surveys had cross-sectional study designs. FINDINGS: In countries participating in GATS, 48·6% (95% CI 47·6-49·6) of men and 11·3% (10·7-12·0) of women were tobacco users. 40·7% of men (ranging from 21·6% in Brazil to 60·2% in Russia) and 5·0% of women (0·5% in Egypt to 24·4% in Poland) in GATS countries smoked a tobacco product. Manufactured cigarettes were favoured by most smokers (82%) overall, but smokeless tobacco and bidis were commonly used in India and Bangladesh. For individuals who had ever smoked daily, women aged 55-64 years at the time of the survey began smoking at an older age than did equivalently aged men in most GATS countries. However, those individuals who had ever smoked daily and were aged 25-34-years when surveyed started to do so at much the same age in both sexes. Quit ratios were very low (<20% overall) in China, India, Russia, Egypt, and Bangladesh. INTERPRETATION: The first wave of GATS showed high rates of smoking in men, early initiation of smoking in women, and low quit ratios, reinforcing the view that efforts to prevent initiation and promote cessation of tobacco use are needed to reduce associated morbidity and mortality. FUNDING: Bloomberg Philanthropies' Initiative to Reduce Tobacco Use, Bill and Melinda Gates Foundation, Brazilian and Indian Governments.

Impact of smoke-free legislation on children's exposure to secondhand smoke: cotinine data from the Health Survey for England.

OBJECTIVE: To examine the impact of the ban on smoking in enclosed public places implemented in England in July 2007 on children's exposure to secondhand tobacco smoke. DESIGN: Repeated cross-sectional surveys of the general population in England. SETTING: The Health Survey for England. PARTICIPANTS: Confirmed non-smoking children aged 4-15 with measured saliva cotinine participating in surveys from 1998 to 2008, a total of 10,825 children across years. MAIN OUTCOME MEASURES: The proportion of children living in homes reported to be smoke-free; the proportion of children with undetectable concentrations of cotinine; geometric mean cotinine as an objective indicator of overall exposure. RESULTS: Significantly more children with smoking parents lived in smoke-free homes in 2008 (48.1%, 95% CI 43.0% to 53.1%) than in either 2006 (35.5%, 95% CI 29.7% to 41.7%) or the first 6 months of 2007, immediately before the ban came into effect (30.5%, 95% CI 19.7% to 43.9%). A total of 41.1% (95% CI 38.9% to 43.4%) of children had undetectable cotinine in 2008, up from 34.0% (95% CI 30.8% to 37.3%) in 2006. Geometric mean cotinine in all children combined was 0.21 ng/ml (95% CI 0.20 to 0.23) in 2008, slightly lower than in 2006, 0.24 ng/ml (95% CI 0.21 to 0.26). CONCLUSIONS: Predictions that the 2007 legislative ban on smoking in enclosed public places would adversely affect children's exposure to tobacco smoke were not confirmed. While overall exposure in children has not been greatly affected by the ban, the trend towards the adoption of smoke-free homes by parents who themselves smoke has received fresh impetus.

Did smokefree legislation in England reduce exposure to secondhand smoke among nonsmoking adults? Cotinine analysis from the Health Survey for England.

BACKGROUND: On 1 July 2007, smokefree legislation was implemented in England, which made virtually all enclosed public places and workplaces smokefree. OBJECTIVES: We examined trends in and predictors of secondhand smoke exposure among nonsmoking adults to determine whether exposure changed after the introduction of smokefree legislation and whether these changes varied by socioeconomic status (SES) and by household smoking status. METHODS: We analyzed salivary cotinine data from the Health Survey for England that were collected in 7 of 11 annual surveys undertaken between 1998 and 2008. We conducted multivariate regression analyses to examine secondhand smoke exposure as measured by the proportion of nonsmokers with undetectable levels of cotinine and by geometric mean cotinine. RESULTS: Secondhand smoke exposure was higher among those exposed at home and among lower-SES groups. Exposure declined markedly from 1998 to 2008 (the proportion of participants with undetectable cotinine was 2.9 times higher in the last 6 months of 2008 compared with the first 6 months of 1998 and geometric mean cotinine declined by 80%). We observed a significant fall in exposure after legislation was introduced--the odds of having undetectable cotinine were 1.5 times higher [95% confidence interval (CI): 1.3, 1.8] and geometric mean cotinine fell by 27% (95% CI: 17%, 36%) after adjusting for the prelegislative trend and potential confounders. Significant reductions were not, however, seen in those living in lower-social class households or homes where smoking occurs inside on most days. CONCLUSIONS: We found that the impact of England's smokefree legislation on secondhand smoke exposure was above and beyond the underlying long-term decline in secondhand smoke exposure and demonstrates the positive effect of the legislation. Nevertheless, some population subgroups appear not to have benefitted significantly from the legislation. This finding suggests that these groups should receive more support to reduce their exposure.

The intergenerational transmission of thinness.

OBJECTIVES: To examine intergenerational associations for thinness and to compare maternal and paternal effects. DESIGN: Population-based, cross-sectional design using data from the Health Survey for England from January 1, 2001, through December 31, 2006. SETTING: The Health Survey for England, an annual, national survey representative of the population living in private households in England. PARTICIPANTS: Families with children and adolescents aged 2 to 15 years with anthropometric data available for children and adolescents and 2 parents (N = 4423 families, N = 7078 children and adolescents). MAIN EXPOSURE: Trained interviewers collected height and weight measurements. MAIN OUTCOME MEASURE: Child/adolescent thinness, categorized using International Obesity Task Force criteria. RESULTS: Of 7078 children and adolescents, 402 (5.7%) were categorized as being thin. Thinness was more common in 2- to 5-year-olds (odds ratio, 1.61; 95% confidence interval, 1.22-2.13) than in 11- to 15-year-olds and in children and adolescents from ethnic minority (black: 2.28; 1.22-4.26; and Asian: 3.65; 2.76-4.83) than white backgrounds, but no differences were observed by sex or socioeconomic status. The strongest predictor of child/adolescent thinness was parental weight status. The prevalence of thinness was highest (16.2%) when both parents were thinner and progressively lower when both parents were in the upper half of the healthy-weight range (7.8%) or were overweight (5.3%) or obese (2.5%), with no differences in the magnitude of maternal and paternal influences. CONCLUSIONS: These results are consistent with the idea that many cases of thinness are likely to represent the low end of the healthy distribution of weight and, as such, are likely to have a primarily genetic origin.

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

BACKGROUND: Up-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. METHODS: The 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. RESULTS: Smoking 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. CONCLUSION: There is reason to believe that the STS findings (see http://www.smokinginengland.info) are generalisable to the adult population of England.

Impact of tobacco control policies on exhaled carbon monoxide in non-smokers.

BACKGROUND: Passive smoking is a serious health risk in non-smokers. The strength of tobacco control policies of the EU countries vary. This study aimed to investigate the relationship between secondhand smoke exposure, as assessed by exhaled carbon monoxide (eCO), and the strength of national tobacco control policies, in non-smokers in the EU. METHODS: Data were provided from the EU campaign 'HELP: for a life without tobacco' during national events settled in the 27 EU countries in 2006-2007. Individual information on age, gender, and eCO was obtained from 58,919 self-reported non-smokers. The strength of national tobacco control policies was scored by the Tobacco Control Scale (TCS). The relationship between eCO and TCS score was investigated using ecological and multilevel approaches. RESULTS: Both analyses reported a significant linear decrease in eCO per unit increase in TCS score, with a smaller estimation resulting from the multilevel analysis (beta=-0.03 ppm, 95% CI -0.04 to -0.02 vs -0.05, -0.02 to -0.08). CONCLUSION: The present study confirms, in a large European non-smoker population, the relevance of strong antismoking policies in reducing exposure to passive smoking. The findings give further reason to encourage European countries to strengthen their tobacco control policies to protect non-smokers from secondhand smoke.

Trends in and predictors of second-hand smoke exposure indexed by cotinine in children in England from 1996 to 2006.

AIMS: To explore trends in and predictors of second-hand smoke (SHS) exposure in children. To identify whether inequalities in SHS exposure are changing over time. DESIGN: Repeated cross-sectional study with data from eight annual surveys conducted over an 11-year period from 1996 to 2006. SETTING: England. PARTICIPANTS: Nationally representative samples of children aged 4-15 years living in private households. MEASUREMENTS: Saliva cotinine (4-15-year-olds), current smoking status (8-15-year-olds), smoking status of parents and carers, smoking in the home, socio-demographic variables. FINDINGS: The most important predictors of SHS exposure were modifiable factors-whether people smoke in the house on most days, whether the parents smoke and whether the children are looked after by carers who smoke. Children from more deprived households were more exposed and this remained the case even after parental smoking status has been controlled for. Exposure over time has fallen markedly among children (59% decline over 11 years in geometric mean cotinine), with the most marked decline observed in the period immediately preceding smoke-free legislation. Declines in exposure have generally been greater in children most exposed at the outset. For example, in children whose parents both smoke, median cotinine declined annually by 0.115 ng/ml compared with 0.019 ng/ml where neither parent smokes (P < 0.05). CONCLUSIONS: In the 11 years leading up to smoke-free legislation in England, the overall level of SHS exposure in children as well as absolute inequalities in exposure have been declining. Further efforts to encourage parents and carers to quit and to avoid smoking in the home would benefit child health.

Comparing maternal and paternal intergenerational transmission of obesity risk in a large population-based sample.

BACKGROUND: Previous research showed childhood obesity to be more strongly associated with maternal weight than with paternal weight. However, confidence in this finding is limited by the lack of objectively measured data from both parents. OBJECTIVE: We quantified the individual and combined effects of maternal and paternal overweight/obesity on obesity risk in children. DESIGN: Data were pooled from the annual Health Surveys for England carried out between 2001 and 2006. Families with < or =2 children aged 2-15 y with anthropometric data available for both parents and children were included (n = 4432 families, n = 7078 children). Weights and heights were measured by a trained nurse. RESULTS: Having 2 overweight parents was associated with an increased risk of child obesity [odds ratio (OR): 2.2; 95% CI: 1.3, 3.7; P < 0.001] compared with having 2 normal-weight parents. Having 2 obese (including severely obese) parents was associated with a higher risk of child obesity (OR: 12.0; 95% CI: 7.2, 20.1; P < 0.01), and having 2 severely obese parents was associated with an even higher risk of child obesity (OR: 22.3; 95% CI: 10.3, 48.4; P < 0.01) independent of age, sex, socioeconomic status, and ethnicity. Mother-child associations (r = 0.27) for body mass index were significantly stronger than father-child associations (r = 0.23), even after adjustment for plausible levels (< or =4%) of undisclosed nonpaternity. Associations were the same for sons and daughters but increased with age. CONCLUSIONS: There is a strong and graded association between parental weight status and risk of childhood obesity, which is significantly stronger for maternal weight. Parental obesity could be used to target preventive interventions in the preschool years to avoid serious adverse effects on the future health of children.

The place for harm reduction and product regulation in UK tobacco control policy.

Tobacco use remains the leading cause of preventable death in this country and more needs to be done to reduce smoking rates. Harm reduction is one policy option. Smokers smoke for the nicotine, but die from the other toxins in cigarette smoke. Harm reduction in tobacco control aims to reduce the harm arising from nicotine use by shifting smokers, who are unable to quit, to using far less hazardous sources of nicotine, notably medicinal nicotine, in place of cigarettes. This article argues that for harm reduction to work in the UK, a nicotine product regulation authority is first needed. This would regulate nicotine products in proportion to harm to ensure that, contrary to the current paradoxical arrangements, the most harmful source of nicotine, the cigarette, becomes the most highly regulated (and thus the least easily accessible, available and attractive). It goes onto explore how a harm reduction strategy might be further developed, exploring controversies and potential pitfalls. It argues that the public health community needs to own and drive this debate because failure to do so would let the tobacco industry gain the upper hand and see thousands of more unnecessary deaths from tobacco use.

Awareness of lifestyle risk factors for cancer and heart disease among adults in the UK.

OBJECTIVE: To examine and compare awareness of lifestyle risk factors for cancer and heart disease in a single UK representative sample. METHODS: Two open-ended questions about cancer and heart disease risk factors were included in a population-based survey of 1747 adults. Responses were coded for four lifestyles with established links to both diseases: smoking, eating an unhealthy diet, drinking excessive alcohol and physical inactivity. RESULTS: Awareness of lifestyle risk factors was low for both diseases, although higher for heart disease than cancer. The average number identified by respondents was 2.1 (heart disease) and 1.4 (cancer). The strongest predictor was education (both p<0.001). Awareness that physical inactivity is a cancer risk factor was particularly low at 7%. CONCLUSION: These findings suggest that public awareness of the impact of lifestyle on commonly feared diseases, especially cancer, is low. PRACTICE IMPLICATIONS: Unhealthy lifestyles make a significant contribution to ill health and mortality. Increased public awareness of the links between lifestyles and commonly feared diseases might help people understand the potential health consequences of their actions and encourage them to make much-needed lifestyle changes. Efforts are needed to improve public health messages about how lifestyle risk factors impact on the chances of developing these important diseases.

Nicotine intake in cigarette smokers in England: distribution and demographic correlates.

Documenting smoke intake by objective biochemical markers is important for quantification of exposure to toxins. The aim of this report is to show the most definitive distribution of the nicotine metabolite, cotinine, yet available from English smokers in the period before implementation of the legislation banning smoking in indoor public areas. A total of 6,423 cigarette smokers, ages 16 years and above, taking part in the Health Survey for England between 1998 and 2003 provided a saliva cotinine value. Data on cigarette consumption, age, gender, social class, deprivation (as indicated by manual or nonmanual occupation, car ownership, and housing tenure), marital status, and region were collected. Cotinine concentrations showed no overall trend over the study period. The mean value was 289.15 ng/mL (SD 174.43); excluding those who had not smoked in the past 24 hours, the mean value was 302.08 ng/mL (SD 168.78). A higher cotinine concentration was associated with being middle-aged (peaking at 40 years), being male, being single, greater economic deprivation, and not living in London. After adjusting for cigarette consumption, higher values were associated with middle age, being male, and greater deprivation. This study provides the most complete picture yet of the smoke intake of cigarette smokers in England. The fact that cotinine peaks at around the age of 40 years raises the possibility that nicotine intake continues to increase decades after a person starts to smoke. Greater nicotine intake in more deprived smokers could explain why they find it harder to stop smoking.