Objectives: Exposing children to secondhand tobacco smoke (SHS) causes significant harm and occurs predominantly through smoking by caregivers in the family home. We report a trial of a complex intervention designed to reduce secondhand smoke exposure of children whose primary caregiver feels unable or unwilling to quit smoking.Design: An open-label, parallel, randomised controlled trial.Setting: Deprived communities in Nottingham City and County, EnglandParticipants: Caregivers resident in Nottingham City and County in England who were at least 18 years old, the main caregiver of a child aged under 5 years living in their household, and reported that they were smoking tobacco inside their home.Interventions: We compared a complex intervention combining personalised feedback on home air quality, behavioural support and nicotine replacement therapy for temporary abstinence with usual care.Main outcomes: The primary outcome was change in air quality in the home, measured as average 16–24 hours levels of particulate matter of < 2.5 µm diameter (PM_2.5), between baseline and 12 weeks. Secondary outcomes included changes in maximum PM_2.5, proportion of time PM_2.5 exceeded WHO recommended levels of maximum exposure of 25 µg/mg³, child salivary cotinine, caregivers’ cigarette consumption, nicotine dependence, determination to stop smoking, quit attempts and quitting altogether during the intervention.Results: Arithmetic mean PM_2.5 decreased significantly more (by 35.2 %; 95% CI 12.7% to 51.9 %) in intervention than in usual care households, as did the proportion of time PM_2.5 exceeded 25 µg/mg³, child salivary cotinine concentrations, caregivers’ cigarette consumption in the home, nicotine dependence, determination to quit and likelihood of having made a quit attempt.Conclusions: By reducing exposure to SHS in the homes of children who live with smokers unable or unwilling to quit, this intervention offers huge potential to reduce children’s’ tobacco-related harm.Trial registration number: ISRCTN81701383.This trial was funded by the UK National Institute for Health Research (NIHR): RP-PG-0608-10020

Background and aims: Smoking prevalence has been falling in England for more than 50 years, but remains a prevalent and major public health problem. This study used an age–period–cohort (APC) approach to measure lifecycle, historical and generational patterns of individual smoking behaviour.Design: APC analysis of repeated cross‐sectional smoking prevalence data obtained from three nationally representative surveys.Setting: England (1972–2019).Participants: Individuals aged 18–90 years.Measurements: We studied relative odds of current smoking in relation to age in single years from 18 to 90, 24 groups of 2‐year survey periods (1972–73 to 2018–19) and 20 groups of 5‐year birth cohorts (1907–11 to 1997–2001). Age and period rates were studied for two groups of birth cohorts: those aged 18–25 years and those aged over 25 years.Findings: Relative to age 18, the odds of current smoking increased with age until approximately age 25 [odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.41–1.56] and then decreased progressively to age 90 (OR = 0.06, 95% CI = 0.04–0.08). They also decreased almost linearly with period relative to 1972–73 (for 2018–19: OR = 0.30, 95% CI = 0.26–0.34) and with birth cohort relative to 1902–06, with the largest decreased observed for birth cohort 1992–96 (OR = 0.44, 95% CI = 0.35–0.46) and 1997–2001 (OR = 0.35, 95% CI = 0.74–0.88). Smoking declined in the 18–25 age group by an average of 7% over successive 2‐year periods and by an average of 5% in those aged over 25.Conclusions: Smoking in England appears to have declined over recent decades mainly as a result of reduced smoking uptake before age 25, and to a lesser extent to smoking cessation after age 25.

Background: We estimate exposure of British adults and adolescents to tobacco and alcohol content from a sample of popular YouTube music videos. Methods: British viewing figures were generated from 2 representative online national surveys of adult and adolescent viewing of the 32 most popular videos containing content. 2068 adolescents aged 11–18 years (1010 boys, 1058 girls), and 2232 adults aged 19+years (1052 male, 1180 female) completed the surveys. We used the number of 10 s intervals in the 32 most popular videos containing content to estimate the number of impressions. We extrapolated gross and per capita impressions for the British population from census data and estimated numbers of adults and adolescents who had ever watched the sampled videos. Results: From video release to the point of survey, the videos delivered an estimated 1006 million gross impressions of alcohol (95% CI 748 to 1264 million), and 203 million of tobacco (95% CI 151 to 255 million), to the British population. Per capita exposure was around 5 times higher for alcohol than for tobacco, and nearly 4 times higher in adolescents, who were exposed to an average of 52.1 (95% CI 43.4 to 60.9) and 10.5 (95% CI 8.8 to 12.3) alcohol and tobacco impressions, respectively, than in adults (14.1 (95% CI 10.2 to 18.1) and 2.9 (95% CI 2.1 to 3.6)). Exposure rates were higher in girls than in boys. Conclusions: YouTube music videos deliver millions of gross impressions of alcohol and tobacco content. Adolescents are exposed much more than adults. Music videos are a major global medium of exposure to such content.

Objective: This study aims to understand long‐term trends in obesity and overweight in England by estimating life‐course transitions as well as historical and birth cohort trends for both children and adults.Methods: Data on individuals aged 5 to 85 years old from the Health Survey for England were used, covering the period 1992 to 2019 and birth cohorts born between 1909 and 2013. Individual BMI values were classified as healthy weight, overweight, or obesity. Trends were compared, and an age‐period‐cohort model was estimated using logistic regression and categorical age, period, and cohort groups.Results: There was significant variation in age trajectories by birth cohorts for healthy weight and obesity prevalence. The odds of having obesity compared with a healthy weight increased consistently with age, increased throughout the study period (but faster between 1992 and 2001), and were higher for birth cohorts born between 1989 and 2008. The odds of having overweight showed an inverted U‐shape among children, increased through adulthood, have been stable since 2012, and were considerably higher for the youngest birth cohort (2009–2013).Conclusions: Younger generations with higher overweight prevalence coupled with increasing obesity prevalence with age suggest that obesity should remain a high priority for public health policy makers in England.

Background Reality television shows are popular with children and young adults; inclusion of tobacco imagery in these programmes is likely to cause smoking in these groups. Series 3 of the UK reality show Love Island, broadcast in 2017, attracted widespread media criticism for high levels of smoking depicted. We have quantified this tobacco content and estimated the UK population exposure to generic and branded tobacco imagery generated by the show. Methods We used 1-min interval coding to quantify actual or implied tobacco use, tobacco paraphernalia or branding, in alternate episodes of series 3 of Love Island, and Census data and viewing figures from Kantar Media to estimate gross and per capita tobacco impressions. Results We coded 21 episodes comprising 1001 min of content. Tobacco imagery occurred in 204 (20%) intervals; the frequency of appearances fell significantly after media criticism. An identifiable cigarette brand, Lucky Strike Double Click, appeared in 16 intervals. The 21 episodes delivered an estimated 559 million gross tobacco impressions to the UK population, predominantly to women, including 47 million to children aged <16 and 44 million gross impressions of Lucky Strike branding, including 4 million to children <16. Conclusion Despite advertising legislation and broadcasting regulations intended to protect children from smoking imagery in UK television, series 3 of Love Island delivered millions of general and branded tobacco impressions both to children and adults in the UK. More stringent controls on tobacco content in television programmes are urgently needed.

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.