Abstract Objective: Exposure to marketing for foods high in fat, salt or sugar (HFSS) reportedly influences consumption, nutritional knowledge and diet-related health among adolescents. In 2018/2019, the UK government held two consultations about introducing new restrictions on marketing for HFSS foods. To reinforce why these restrictions are needed, we examined adolescents’ awareness of marketing for HFSS foods, and the association between past month awareness and weekly HFSS food consumption. Design: Cross-sectional survey that measured past month awareness of ten marketing activities for HFSS foods (1 = everyday; 6 = not in last month). Frequencies were converted into aggregate past month awareness across marketing activities and grouped into three categories (low/medium/high). Consumption was self-reported for fifteen foods (twelve HFSS) (1 = few times/d; 9 = never). For each food, frequency was divided into higher/lower weekly consumption. Setting: United Kingdom. Participants: 11–19-year-olds ( n 3348). Results: Most adolescents (90·8 %) reported awareness of a least one marketing activity for HFSS foods, and at least half reported seeing ≥70 instances in the past month. Television, social media and price offers were the marketing activities most frequently reported. Awareness was associated with higher weekly consumption for ten of the twelve HFSS foods. For example, those reporting medium marketing awareness were 1·5 times more likely to report higher weekly consumption of cakes/biscuits compared with those reporting low awareness (AOR = 1·51, P = 0·012). The likelihood of higher weekly HFSS food consumption increased relative to the level of marketing awareness. Conclusions: Assuming there is a causal relationship between marketing awareness and consumption, the restrictions proposed by the UK government are likely to help reduce HFSS consumption.
The illicit tobacco trade undermines the effectiveness of tobacco tax policies; increases the availability of cheap cigarettes, which, in turn, increases tobacco use and tobacco related deaths; and causes huge revenue losses to governments. There is limited evidence on the extent of illicit tobacco trade particularly cigarettes in Bangladesh. The paper presents the protocol for a mixed-methods study to estimate the extent of illicit cigarette trade in Bangladesh. The study will address three research questions: (a) What proportion of cigarettes sold as retail are illicit? (b) What are the common types of tax avoidance and tax evasion? (c) Can pack examination from the trash recycle market be considered as a new method to assess illicit trade in comparison to that from retailers and streets? Following an observational research method, data will be collected utilizing empty cigarette packs from three sources: (a) retailers; (b) streets; and (c) trash recycle market. In addition, a structured questionnaire will be used to collect information from retailers selling cigarettes. We will select post codes as Primary Sampling Unit (PSU) using a multi-stage random sampling technique. We will randomly select eight districts from eight divisions stratified by those with land border and non-land border; and within each district, we will randomly select ten postcodes, stratified by rural (five) and urban (five) PSU to ensure maximum geographical variation, leading to a total of eighty post codes from eight districts. The analysis will report the proportions of packs that do not comply with the study definition of illicit. Independent estimates of illicit tobacco are rare in low- and middle-income countries such as Bangladesh. Findings will inform efforts by revenue authorities and others to address the effects of illicit trade and counter tobacco industry claims.
Introduction The National Health Service (NHS) Trusts in England have provided the setting in which applied health investigators conduct their research. Funding for the NHS to support this work has been provided by the government in the form of block allocations to research-active NHS organisations. Historically, grant awards have been held in associated university accounts rather than managed through the NHS. This is now changing. In professional terms, the area of interest is the partnership working created among UK Universities and NHS Trusts by the new arrangements for funding applied health research in Best Research for Best Health (BRfBH) (UK Department of Health, 2006). This funding, which will largely be sought by clinical academics (i.e., clinically qualified professionals employed by the higher education sector), will be managed through the partner NHS Trusts. This will necessitate greater coordination and collaboration between higher education institutions (HEIs) and the NHS Trusts. In practice-related terms, these new awards will require NHS and university research management teams to develop new processes and policies to manage funding, contracts, and projects. From an academic perspective, there is an increasing focus on theoretical and methodological issues of researching concepts and implementing partnerships. This interest has grown, particularly in the social science disciplines, as a result of the government focus on, and, in some cases the mandate for, partnership working. Thus, the aim of this review is to examine what the academic literature on partnership working suggests may be the opportunities and challenges that health researchers face in light of the BRfBH policy. Best Research for Best Health The UK Department of Health launched BRfBH in January 2006 following widespread consultation with stakeholders. This government strategy proposes radical changes in the funding and organisation of clinical research in the NHS and associated university-based medical schools in the UK. The purpose of the policy change is to make the NHS an internationally recognised centre of excellence for research, develop the clinical research workforce, and make patient-focused, applied research a priority. The strategy has 16 accompanying implementation plans that detail, amongst other things, the centralisation of funding, the creation of a National Institute for Health Research (NIHR), and the development of a new clinical research network for England. Prior to the launch of the new policy, Government consultants identified many barriers to clinical research in the UK, including historical allocation models for NHS research and development (R&D) funding, bureaucratic NHS Trust management practices at the local level, few effective incentives to conduct research in the NHS, a dramatic decline in the number of clinical academics, and the perception by academic researchers that NHS funding and applied research are of lesser value compared to other funding sources. Funding will now be centralised by incrementally removing R&D funds currently housed within 253 Trusts across the UK. This funding will be made available through various competitive funding streams. NIHR provides the mechanism to meet the expectations of BRfBH, and will direct and oversee ali NHS-funded research in England. Another aim of the new strategy is to reduce the burden of complicated regulatory systems for researchers through limiting bureaucracy and streamlining the systems for managing and regulating research. However, there is little detail about how NHS Trusts will manage their legal obligation to safeguard patients within this new system, and a commonly expressed concern among R&D support staff is that the new processes will merely add another layer of bureaucracy rather than reduce the burden to researchers. One crucial requirement of the new funding model is that the NHS and academia will need to work in close partnership to access funding streams, as the funds and contracts are awarded to the NHS partner. …
Scotland's smoke‐free legislation, introduced in March 2006, included an exemption for psychiatric hospitals. However, following the successful implementation of smoke‐free laws in almost all other workplaces in Scotland, important questions have been raised about why mental health facilities should be excluded. This study aimed to explore a move towards mental health settings becoming smoke‐free in Scotland by reviewing relevant literature, seeking the views of stakeholders and examining a number of case study hospitals who had recently or were in the process of going smoke‐free. The study found that stakeholders were overwhelmingly in favour of moving towards smoke‐free environments. Allowing smoking to continue in these settings when almost all other workplaces are smoke‐free was perceived as reinforcing the stigma attached to mental health, exacerbating inequalities in health, damaging the health of mental health professionals and potentially contributing to staff recruitment problems. Evidence from the international literature and from the case studies suggested that smoke‐free policies can be successfully implemented in mental health settings. This article discusses these findings and examines the factors that need to be considered if implementation is to be successful.
Nicotine replacement therapy, in the form of nicotine patches, is commonly offered to pregnant women who smoke to help them to stop smoking, but this approach has limited efficacy in this population. Electronic cigarettes (e-cigarettes) are also used by pregnant women who smoke but their safety and efficacy in pregnancy are unknown. Here, we report the results of a randomized controlled trial in 1,140 participants comparing refillable e-cigarettes with nicotine patches. Pregnant women who smoked were randomized to e-cigarettes (n = 569) or nicotine patches (n = 571). In the unadjusted analysis of the primary outcome, validated prolonged quit rates at the end of pregnancy in the two study arms were not significantly different (6.8% versus 4.4% in the e-cigarette and patch arms, respectively; relative risk (RR) = 1.55, 95%CI: 0.95-2.53, P = 0.08). However, some participants in the nicotine patch group also used e-cigarettes during the study. In a pre-specified sensitivity analysis excluding abstinent participants who used non-allocated products, e-cigarettes were more effective than patches (6.8% versus 3.6%; RR = 1.93, 95%CI: 1.14-3.26, P = 0.02). Safety outcomes included adverse events and maternal and birth outcomes. The safety profile was found to be similar for both study products, however, low birthweight (<2,500 g) was less frequent in the e-cigarette arm (14.8% versus 9.6%; RR = 0.65, 95%CI: 0.47-0.90, P = 0.01). Other adverse events and birth outcomes were similar in the two study arms. E-cigarettes might help women who are pregnant to stop smoking, and their safety for use in pregnancy is similar to that of nicotine patches. ISRCTN62025374.
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