Smokers from lower socioeconomic groups are less likely to be successful in stopping smoking than more affluent smokers, even after accessing cessation programmes. Data were analysed from 3057 clients of nine services. Routine monitoring data were expanded with CO validated smoking status at 52-week follow-up. Backwards logistic regression modelling was used to consider which factors were most important in explaining the relationship between SES and quitting. The odds ratio of stopping smoking among more affluent clients, compared with more disadvantaged clients, after taking into account design variables only, was 1.85 (95% CI 1.44 to 2.37) which declined to 1.44 (1.11 to 1.87) when all controls were included. The factors that explained more than 10% of the decline in the odds ratio were age, proportion of friends and family who smoked, nicotine dependence, and taking varenicline. A range of factors contribute to lower cessation rates for disadvantaged smokers. Some of these can be modified by improved smoking cessation service provision, but others require contributions from wider efforts to improve material, human, and social capital.

This article reports findings from the first phase of a longitudinal, qualitative study based on a cohort of 50 gamblers. The overall study is designed to explore the development of ‘gambling careers’. Within it, this first phase of analysis examines the ways that individuals begin gambling, focusing on the role of social relationships and environmental context in this process. Drawing on theories of social learning and cultural capital, we argue that gambling is a fundamentally social behaviour that is embedded in specific environmental and cultural settings. Our findings reveal the importance of social networks, such as family, friends and colleagues, as well as geographical-cultural environment, social class, age and gender, in the initiation of gambling behaviour. They also suggest that those who begin gambling at an early age within family networks are more likely to develop problems than those who begin later, amongst friends and colleagues. However, we caution against simplistic interpretations, as a variety of inter-dependent social factors interact in complex ways here.

Survival from out-of-hospital cardiac arrest (OHCA) varies across the developed world. Although not all OHCA are recoverable, the survival rate in Scotland is lower than in comparable countries, with higher average survival rates of 7.9% in England and 9% across Europe. The purpose of this paper is to explore the barriers, facilitators and public attitudes to administering bystander cardiopulmonary resuscitation (CPR) which could inform future policy and initiatives to improve the rate of bystander CPR. Data was collected via a cross-sectional general population survey of 1027 adults in Scotland. 52% of respondents had been trained in CPR. Of those who were not trained, two fifths (42%) expressed a willingness to receive CPR training. Fewer than half (49%) felt confident administering CPR, rising to 82% if they were talked through it by a call handler. Multivariate analyses identified that people in social grade C2DE were less likely than those in social grade ABC1 to be CPR trained and less confident to administer CPR if talked through by a call handler. The older a person was, the less likely they were to be CPR trained, show willingness to be CPR trained or be confident to administer bystander CPR with or without instruction from an emergency call handler. These findings are particularly relevant considering that most OHCA happen in the homes of older people. In a developed country such as Scotland with widely available CPR training, only half of the adult population reported feeling confident about administering bystander CPR. Further efforts tailored specifically for people who are older, unemployed and have a lower social grade are required to increase knowledge, confidence and uptake of training in bystander CPR.

This article explores the ways that individuals experience recovery from gambling problems. Arguing against reductive, bio-medical models of addiction, we adopt a broadly interpretive epistemology to analyse gamblers’ narratives of recovery. Using data from a longitudinal qualitative study of ‘gambling careers’ we suggest that processes of behaviour change are embedded in wider social relations and revolve around shifting concepts of self-identity. This involves processes of biographical and temporal reconstruction which are grounded in material circumstances, particularly those relating to money and social relationships. Various configurations of recovery exist, but common to all is a dynamic temporal reorientation and an increased sense of agency and authenticity as individuals move into a future that they feel they have some control over. These narratives suggest that experiences of gambling addiction and recovery, and the self-concepts that accompany them, are fluid and contextual and that ‘managing’ gambling is about re-shaping the self in culturally appropriate ways. It is hoped that aspects of this analysis may be of relevance for understanding the narrative dimensions of addiction and recovery more generally.

This article presents findings from a five year study of ‘gambling careers’ designed to explore the ways that individuals move in and out of problematic behaviour over time. A longitudinal qualitative methodology was used to investigate patterns of stability and change in a cohort of 50 problem and recreational gamblers. The study found that change, rather than stability, was the norm in gambling behaviour and identified four different trajectories of behaviour: progression, reduction, consistency and non-linearity. Drawing on rich narrative accounts of respondents’ gambling behaviour, the study begins to suggest reasons for these different types of movement, highlighting the role of material factors such as employment, environment and social context in each. It concludes that gambling behaviour is highly variable over time, and recommends that future research focus on patterns of behaviour rather than on ‘types’ of gamblers.

Disadvantaged smokers are less likely to be successful when trying to stop smoking than more affluent smokers. In the UK, NHS Stop Smoking Services (SSS) provide a range of pharmacotherapy and behavioural support, delivered by advisors with a range of backgrounds. Whether the types of support provided and who provides it influence differences in quit rates amongst low SES smokers compared with high SES smokers has not previously been examined. 202,084 records of smokers in England who attended a NHS Stop Smoking Service between July 2010 and June 2011 were acquired. Smokers were followed-up by services at four weeks post quit date. Multilevel logistic regression models of CO validated quits were employed. Disadvantage was explored through the National Statistics Socio-Economic Classification (NS-SEC) and by eligibility for free prescriptions, an indicator of low income amongst adults aged between 19 and 59 in England. Affluent smokers were more likely to quit than disadvantaged smokers (OR 1.38 (1.35 to 1.42) for clients who paid for prescriptions compared to those eligible for free prescriptions). 80% of service clients received one-to-one counselling but open group forms of behavioural therapy were more successful (main effect OR 1.26 (1.12 to 1.41)) except amongst some of the most disadvantaged clients (long-term unemployed and prisoners). Closed groups were little deployed and they were not significantly more successful than one-to-one behavioural therapy after controls. Who delivered treatment did make a difference for some clients, with all but the most affluent less likely to be successful if they had been treated by a nurse compared with other types of advisers, including smoking cessation specialists (main effect OR 0.73 (0.65 to 0.83)). This study provides further evidence that disadvantaged smokers find quitting more difficult even when they have attended a smoking cessation programme. The findings suggest that open groups should be promoted, although they may not be as effective as other forms of behavioural therapy for the long-term unemployed or prisoners. Further research is required to explore why most groups of smokers who attended services staffed by nurses were less likely to quit than those who received treatment from other types of advisors.