The Effect of Tobacco Control Mass Media Campaigns on Smoking-Related Behavior Among People With Mental Illness: A Systematic Literature Review.

INTRODUCTION: Tobacco control mass media campaigns (MMCs) can be effective generally, but little is known about their effects among people with mental illness. The objectives of this study were to systematically review: (1) Whether tobacco control MMCs affect smoking-related outcomes among people with mental illness. (2) Cost-effectiveness. AIMS AND METHODS: Data sources: MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, the Cochrane Library (searched March 2021), reference lists of included articles and relevant systematic reviews. Study eligibility criteria: Population: Adults with mental illness and experience of smoking tobacco and/or using other nicotine-containing products. Intervention/exposure: Tobacco control MMC messages. Comparator: No exposure, other tobacco control intervention(s), no comparator. Primary outcome: Changes in quitting behaviors. Study design: All primary research. Quantitative data were appraised using the EPHPP tool, qualitative data using CASP's Studies Checklist. Data were synthesized narratively. RESULTS: Eight studies were included, seven were at high risk of bias. There was inconclusive evidence of the effect of MMCs on quit attempts and intentions to quit among people with mental illness. Increasing advertisement exposure did not increase quit attempts or intentions to quit among those with mental illness, however, increased exposure to an advertisement that addressed smoking and mental health did. None of the studies assessed cost-effectiveness. CONCLUSIONS: Findings should be interpreted with caution as data are limited and of low or moderate quality. There is evidence to suggest that tobacco control MMCs have limited impact on those with mental illness, although campaigns that are specific to smoking and mental health may be effective. IMPLICATIONS: There is a paucity of good-quality evidence of the effect of tobacco control MMC messages among people with mental illness. Careful consideration should be given to the design of future studies that evaluate MMCs in order to minimize the risk of bias, establish causality, and ensure the findings reflect real-world implementation. Further research should examine the need for MMC messages that address mental health.

Impact of COVID-19 on corticosteroids and antibiotics prescribing in England: an interrupted time series analysis.

Inhaled corticosteroids (ICS), prednisolone and antibiotics all play a crucial role in the management of respiratory diseases. The aim of this study was to analyse whether the declaration of the COVID-19 pandemic affected prescribing rates, as public health measures were implemented to reduce transmission of SARS-CoV-2. Monthly practise-level prescribing data published by NHS Digital were analysed. At the point, the COVID-19 outbreak was declared a pandemic, ICS prescriptions rose significantly. This was followed by a decrease in ICS and prednisolone prescribing in the following months. There was no difference in the antibiotic prescribing trend.

The impact of televised tobacco control advertising content on campaign recall: evidence from the International Tobacco Control (ITC) United Kingdom Survey.

BACKGROUND: Although there is some evidence to support an association between exposure to televised tobacco control campaigns and recall among youth, little research has been conducted among adults. In addition, no previous work has directly compared the impact of different types of emotive campaign content. The present study examined the impact of increased exposure to tobacco control advertising with different types of emotive content on rates and durations of self-reported recall. METHODS: Data on recall of televised campaigns from 1,968 adult smokers residing in England through four waves of the International Tobacco Control (ITC) United Kingdom Survey from 2005 to 2009 were merged with estimates of per capita exposure to government-run televised tobacco control advertising (measured in GRPs, or Gross Rating Points), which were categorised as either "positive" or "negative" according to their emotional content. RESULTS: Increased overall campaign exposure was found to significantly increase probability of recall. For every additional 1,000 GRPs of per capita exposure to negative emotive campaigns in the six months prior to survey, there was a 41% increase in likelihood of recall (OR = 1.41, 95% CI: 1.24-1.61), while positive campaigns had no significant effect. Increased exposure to negative campaigns in both the 1-3 months and 4-6 month periods before survey was positively associated with recall. CONCLUSIONS: Increased per capita exposure to negative emotive campaigns had a greater effect on campaign recall than positive campaigns, and was positively associated with increased recall even when the exposure had occurred more than three months previously.

Can primary care data be used to monitor regional smoking prevalence? An analysis of The Health Improvement Network primary care data.

BACKGROUND: Accurate and timely regional data on smoking trends allow tobacco control interventions to be targeted at the areas most in need and facilitate the evaluation of such interventions. Electronic primary care databases have the potential to provide a valuable source of such data due to their size, continuity and the availability of socio-demographic data. UK electronic primary care data on smoking prevalence from The Health Improvement Network (THIN) have previously been validated at the national level, but may be less representative at the regional level due to reduced sample sizes. We investigated whether this database provides valid regional data and whether it can be used to compare smoking prevalence in different UK regions. METHODS: Annual estimates of smoking prevalence by government office region (GOR) from THIN were compared with estimates of smoking prevalence from the General Lifestyle Survey (GLF) from 2000 to 2008. RESULTS: For all regions, THIN prevalence data were generally found to be highly comparable with GLF data from 2006 onwards. CONCLUSIONS: THIN primary care data could be used to monitor regional smoking prevalence and highlight regional differences in smoking in the UK.

Validation of The Health Improvement Network (THIN) primary care database for monitoring prescriptions for smoking cessation medications.

PURPOSE: Evaluation of tobacco policy requires high quality and timely data on smoking cessation behaviour in the general population and in relevant target groups. Electronic primary care databases have the potential to provide a valuable source of data due to their size and continuity, and the availability of demographic and socioeconomic data. We therefore sought to investigate whether The Health Improvement Network (THIN) prescribing data are complete and can therefore be used to monitor trends in the prescribing of smoking cessation medications. METHODS: The THIN smoking cessation medication prescriptions data for England were compared with smoking cessation medication dispensing data from NHS Prescription Services for January 2004 to December 2005. RESULTS: Throughout the period the rates of prescribing and dispensing were very similar, both for nicotine replacement therapy (NRT) and bupropion combined, and for each type of medication alone. For NRT, dispensing exceeded recorded GP prescribing by 5.5% during the study period. For bupropion, prescribing exceeded dispensing by 5%. CONCLUSIONS: THIN prescribing and national dispensing data are highly comparable. THIN prescribing data could potentially be used to monitor longitudinal trends in prescribing for smoking cessation medications.

The impact of media campaigns on smoking cessation activity: a structural vector autoregression analysis.

AIMS: To evaluate the effect of tobacco control media campaigns and pharmaceutical company-funded advertising for nicotine replacement therapy (NRT) on smoking cessation activity. DESIGN: Multiple time series analysis using structural vector autoregression, January 2002-May 2010. SETTING: England and Wales. DATA SOURCES: Tobacco control campaign data from the Central Office of Information; commercial NRT campaign data; data on calls to the National Health Service (NHS) stop smoking helpline from the Department of Health; point-of-sale data on over-the-counter (OTC) sales of NRT; and prescribing data from The Health Improvement Network (THIN), a database of UK primary care records. MEASUREMENTS: Monthly calls to the NHS stop smoking helpline and monthly rates of OTC sales and prescribing of NRT. FINDINGS: A 1% increase in tobacco control television ratings (TVRs), a standard measure of advertising exposure, was associated with a statistically significant 0.085% increase in calls in the same month (P = 0.007), and no statistically significant effect in subsequent months. Tobacco control TVRs were not associated with OTC NRT sales or prescribed NRT. NRT advertising TVRs had a significant effect on NRT sales which became non-significant in the seasonally adjusted model, and no significant effect on prescribing or calls. CONCLUSIONS: Tobacco control campaigns appear to be more effective at triggering quitting behaviour than pharmaceutical company NRT campaigns. Any effect of such campaigns on quitting behaviour seems to be restricted to the month of the campaign, suggesting that such campaigns need to be sustained over time.

Prescribing of nicotine replacement therapy to cardiovascular disease patients in England.

AIMS: In November 2005 the indications for nicotine replacement therapy (NRT) were broadened in the United Kingdom, making all forms available to patients with stable cardiovascular disease (CVD). This study aimed to estimate the effects of this change on prescribing of NRT to CVD patients in England. DESIGN: Segmented regression analysis of time series of monthly rates of prescribing of NRT. SETTING: A total of 350 general practices in England included in The Health Improvement Network (THIN), a database of UK electronic primary care records. PARTICIPANTS: All adult patients with coronary heart disease (CHD) or stroke registered with a THIN practice in England. MEASUREMENTS: The number of patients per 100,000 with CHD and stroke that received a prescription for NRT each month between January 2002 and June 2009. FINDINGS: Approximately 1500 per 100,000 smokers with CVD were prescribed NRT per month. Prescribing of NRT to CHD and stroke patients increased until the end of 2005 and subsequently decreased, with no immediate change following the Medicines and Healthcare Regulatory Authority (MHRA) licensing change. CONCLUSIONS: Broadening the marketing licence in the United Kingdom for nicotine replacement therapy to allow it to be prescribed to patients with CVD did not increase prescribing rates for this group of patients.

Prescribing of nicotine replacement therapy to adolescents in England.

AIMS: In November 2005, the indications for nicotine replacement therapy (NRT) were broadened in the United Kingdom, making all forms available to 12-17-year-olds. This study aimed to estimate the effects of this change on prescribing of NRT to adolescents in England. DESIGN: Segmented regression analysis of primary care data on prescribing of nicotine replacement therapy using general additive mixed models. SETTING: A total of 350 general practices in England included in The Health Improvement Network (THIN), a database of UK electronic primary care records. PARTICIPANTS: All 12-17-year-old patients registered with a THIN practice in England. Measurements Monthly rates of prescribing of NRT per 100 000 12-17-year-old patients registered with a THIN practice between January 2002 and June 2009. FINDINGS: Prescribing of NRT was highest in 16-17-year-olds and extremely low in 12-13-year-olds, generally fewer than 10 prescriptions per 100 000 adolescents per month. Girls tended to be prescribed NRT more frequently than boys. In 12-17-year-olds rates of prescribing were increasing prior to the broadening of indications, and there was no step change, but the rate of increase was lower, after the indications were broadened. CONCLUSIONS: Recent changes to the marketing licence for nicotine replacement therapy in England to include adolescents appear to have had little or no effect on prescribing practices.

Prescribing of smoking cessation medication in England since the introduction of varenicline.

AIMS: To estimate the effect of the introduction of a new smoking cessation medication, varenicline, and the publication of guidance related to its use, on trends in prescribing of smoking cessation medications in England. DESIGN: Interrupted time series analysis of primary care data on prescribing of smoking cessation medication using autoregressive integrated moving average (ARIMA) modelling. SETTING: A total of 446 general practices included in The Health Improvement Network (THIN), a database of UK electronic primary care records. PARTICIPANTS: All primary care patients registered with a THIN practice in England. MEASUREMENTS: Monthly rates of prescribing of varenicline, nicotine replacement therapy (NRT) and bupropion per 100 000 patients registered with a THIN practice between June 2000 and June 2009. FINDINGS: NRT was the most commonly prescribed stop smoking medication, and bupropion the least frequently prescribed. After its introduction in December 2006 varenicline rapidly became the second most commonly prescribed drug. There was no statistically significant change in overall prescribing for smoking cessation medications after its introduction (P = 0.760), or after the publication of the related guidance in July 2007 (P = 0.134). CONCLUSIONS: Soon after being introduced in England, varenicline was widely prescribed; after nicotine replacement therapy it was the most commonly prescribed cessation medication. However, this does not appear to have increased overall rates of prescribing for smoking cessation medication.