Evaluation of ‘Eyelander’: a video game designed to engage children and young people with homonymous visual field loss in compensatory training

Introduction: Rehabilitation can improve visual outcomes for adults with acquired homonymous visual field loss. However, it is unclear whether (re)habilitation improves visual outcomes for children because previous training schedules have been tiresome, uninteresting, and failed to keep them engaged. In this study we assessed whether children and young people with homonymous visual field loss would adhere to six weeks of unsupervised compensatory training using a specialised video game. Methods: Participants aged between 7 and 25 with homonymous visual field loss completed table-top assessments of visual search across four site visits. Two baseline assessments separated by four weeks evaluated spontaneous improvements before training began. Participants were then given a copy of the video game to use unsupervised at home for six weeks. Two follow-up assessments separated by four weeks were then conducted to evaluate immediate and acutely maintained effects of training. Results. 15 candidates met the inclusion-exclusion criteria, 9 participated, and 8 completed the study. Participants completed an average of 5.6 hours training unsupervised over the six weeks. Improvements on in-game metrics plateaued during week 3 of training. The time taken to find objects during table-top activities improved by an average of 24% (95% CI [2%, 46%]) after training. Discussion: The findings demonstrate that children and young people with homonymous visual field loss will engage with gamified compensatory training, and can improve visual outcomes with less time commitment than adults have required with non-gamified training in previous studies. Appropriately powered, randomised controlled trials are required to evaluate the validity and generalisability of observed training effects. Implications for practitioners: We conclude that (re)habilitation specialists can use specialist video games and gamification to engage children and young people with homonymous visual field loss in long-term unsupervised training schedules

Cessation support for smokers with mental health problems: a survey of resources and training needs

Aims: Around thirty percent of smokers have a mental health problem. Smoking cessation has been associated with mental health benefits, but smoking prevalence remains high in populations with mental health problems. This study aimed to assess mental health related knowledge, practice, and training needs of practitioners supporting smoking cessation. Methods: UK stop smoking practitioners (n = 717) recruited via a database of a national provider of smoking cessation training in June 2016 sufficiently completed an online survey about available resources, knowledge, confidence, and training needs related to smoking cessation and mental health. Responses were described and compared between practitioners with a mental health lead and those without such a lead in their service using chi-square statistics and t-tests. Results: A considerable proportion agreed (37%) or were undecided (28.9%) that smoking helped people with mental health problems feel better and agreed (17.2%) or were undecided (30.2%) that cessation would exacerbate mental health symptoms. Only 11.6% said their service had designated funding for smokers with mental health problems and 26.5% were or had a staff member who was a dedicated lead practitioner for mental health work. Practitioners from services that had a dedicated mental health lead were more confident in supporting smokers with different mental health problems and using different pharmacotherapies (all p < 0.001) and were more likely to disagree that cessation was detrimental (p = 0.001). A majority of practitioners were interested in training, particularly about smoking cessation effects on psychiatric medication (84.3% of n = 632) and how to tailor stop smoking support to clients with mental health problems (82.4%). Conclusion: Practitioners who support smoking cessation have limited knowledge about mental health and smoking but are willing to learn and improve. However, they are hindered by a lack of resources

Pattern and prevalence of vaping nicotine and non-nicotine drugs in the United Kingdom: a cross-sectional study

Objectives: Electronic vaping devices are being used to consume nicotine and non-nicotine psychoactive drugs. We aimed to determine the pattern and prevalence of using vaping devices for nicotine and/or non-nicotine drug administration in the United Kingdom and how these differ by drug type and individual sociodemographic characteristics. We explored reasons for vaping onset and continuation. Design: An online cross-sectional survey Participants: A convenience sample of adults (aged ≥18 years) in the UK. Primary and secondary outcome measures: The primary outcome was prevalence of current use (within the last 30 days) of a vaping device to administer either nicotine or 18 types of non-nicotine drugs. We additionally evaluated reasons for onset and continuation of vaping. Sociodemographic characteristics were compared between the UK general population using census data and those vaping non-nicotine drugs. Results: We recruited 4027 participants of whom 1637 (40.7%) had ever used an electronic vaping device; 1495 (37.1%) had ever vaped nicotine and 593 (14.7%) had ever vaped a non-nicotine drug. Overall, 574 (14.3%) currently vaped nicotine and 74 (1.8%) currently vaped a non-nicotine drug. The most common currently vaped non-nicotine drug was cannabis (n=58, 1.4%). For nicotine, people’s modal reasons to start and continue vaping was to quit smoking tobacco. For almost all other drugs, people’s modal reason to start vaping was curiosity and to continue was enjoyment. Compared with the general population, the population who had ever vaped a non-nicotine drug were significantly younger, had more disabilities and fewer identified as white, female, heterosexual or religious. Conclusions: A non-trivial number of people report current use and ever use of an electronic vaping device for non-nicotine drug administration. As vaping technology advances and drug consumption changes, understanding patterns of use and associated behaviours are likely to be increasingly important to both users and healthcare professionals

Pattern and prevalence of vaping nicotine and non-nicotine drugs in the United Kingdom:a cross-sectional study

OBJECTIVES: Electronic vaping devices are being used to consume nicotine and non-nicotine psychoactive drugs. We aimed to determine the pattern and prevalence of using vaping devices for nicotine and/or non-nicotine drug administration in the United Kingdom and how these differ by drug type and individual sociodemographic characteristics. We explored reasons for vaping onset and continuation.DESIGN: An online cross-sectional survey PARTICIPANTS: A convenience sample of adults (aged ≥18 years) in the UK.PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was prevalence of current use (within the last 30 days) of a vaping device to administer either nicotine or 18 types of non-nicotine drugs. We additionally evaluated reasons for onset and continuation of vaping. Sociodemographic characteristics were compared between the UK general population using census data and those vaping non-nicotine drugs.RESULTS: We recruited 4027 participants of whom 1637 (40.7%) had ever used an electronic vaping device; 1495 (37.1%) had ever vaped nicotine and 593 (14.7%) had ever vaped a non-nicotine drug. Overall, 574 (14.3%) currently vaped nicotine and 74 (1.8%) currently vaped a non-nicotine drug. The most common currently vaped non-nicotine drug was cannabis (n=58, 1.4%). For nicotine, people's modal reasons to start and continue vaping was to quit smoking tobacco. For almost all other drugs, people's modal reason to start vaping was curiosity and to continue was enjoyment. Compared with the general population, the population who had ever vaped a non-nicotine drug were significantly younger, had more disabilities and fewer identified as white, female, heterosexual or religious.CONCLUSIONS: A non-trivial number of people report current use and ever use of an electronic vaping device for non-nicotine drug administration. As vaping technology advances and drug consumption changes, understanding patterns of use and associated behaviours are likely to be increasingly important to both users and healthcare professionals.</p

Interventions to change vaping harm perceptions and associations between harm perceptions and vaping and smoking behaviours: A systematic review

Aims: To synthesize and describe the evidence from among young people and adults to assess: (i) what interventions have been effective in changing vaping harm perceptions; and (ii) to what extent vaping harm perceptions predict any changes in vaping and smoking behaviours. // Methods: Systematic review searching five databases (Embase, PsycINFO, Medline, CINAHL, Scopus) from January 2007 to January 2023. Eligible studies reported quantitative data with >1 time point among young people (sample majority aged <18 years) or adults (sample majority aged ≥18 years). Interventions were considered if they communicated vaping harms, categorized as relative (vaping vs smoking) or absolute (vaping vs not vaping). Outcomes were changes in: (i) vaping (absolute, relative) or nicotine harm perceptions; (ii) vaping or smoking behaviours. Evidence was synthesized narratively. // Results: Eighty-five articles were included, of which 46 assessed interventions to change vaping harm perceptions and 39 assessed associations between harm perceptions and subsequent vaping/smoking behaviours. All studies among young people and most among adults were from the USA. Interventions aimed at young people typically communicated that vaping and nicotine are harmful/addictive (absolute harms), often in the form of educational programmes and media campaigns. Interventions aimed at adults typically communicated that vaping is harmful but less harmful than smoking (relative harms), often via written materials and educational workshops. In addition to methodological and analytical heterogeneity, risk of bias was high; hence findings should be interpreted with caution. Generally, interventions appeared to be effective in changing perceptions that reflected the intervention content among young people (12/14 studies) and adults (24/32 studies), at least in the short-term (38/46 studies only assessed the outcome pre- and immediately post-intervention). Interventions communicating that vaping is harmful and addictive (absolute harms) increased perceptions that vaping is harmful and addictive among young people (12/14) and adults (16/23 studies) and also increased the misperception that vaping is as harmful as smoking (relative harm) among young people (2/2 studies) and adults (5/8 studies). There was also some evidence that both absolute and relative harm perceptions predicted vaping and smoking behaviours, such that perceiving vaping as harmful deterred vaping among both young people (8/9 studies) and adults (4/7 studies), while misperceiving vaping as equally/more harmful than smoking prevented adults from quitting smoking (5/6 studies). // Conclusions: Interventions to change vaping harm perceptions appear to be effective. Vaping harm perceptions appear to predict vaping and smoking behaviours

Paying the price:Financial hardship and its association with psychological distress among different population groups in the midst of Great Britain's cost-of-living crisis

BackgroundGreat Britain has been experiencing a cost-of-living crisis since late 2021, with the cost of everyday essentials rising more quickly than the average household income. This study provides up-to-date information on levels of subjective and objective financial hardship during this crisis, differences across population subgroups, and associations with psychological distress.MethodsWe used data from a representative cross-sectional survey of adults (≥16 y) in Great Britain (n = 7,027) conducted January–March 2023. Subjective financial hardship was defined as reporting finding it quite/very difficult to manage financially these days and objective financial hardship as reporting having been in rent/mortgage arrears in the past 12 months. Past-30-day psychological distress was assessed with the K6 and categorised as no/low (scores ≤4), moderate (5–12), and severe distress (≥13). Covariates included sociodemographic characteristics, mental health history, smoking status, and alcohol consumption.ResultsOverall, 12.9% [95%CI = 12.0–13.8%] reported subjective financial hardship and 6.5% [5.8–7.2%] objective financial hardship. Groups experiencing more hardship included non-binary people, ethnic minority groups, less advantaged social grades, those living in private rented or social housing, those unemployed and seeking work or not in paid work for other reasons, those with more children in the household, those with a history of ≥1 mental health conditions, those who currently smoked and those who drank not at all or at very high levels. Subjective/objective financial hardship was associated with greater odds of experiencing moderate (ORadj = 1.96 [1.59–2.42]/ORadj = 1.86 [1.40–2.47]) or severe psychological distress (ORadj = 4.11 [3.07–5.50]/ORadj = 2.23 [1.52–3.29]). These associations between financial hardship and psychological distress were similar across all sociodemographic, mental health, smoking, and alcohol characteristics.ConclusionsIn the first quarter of 2023, around one in eight adults in Great Britain reported finding it difficult to manage financially and one in fifteen reported having been in rent or mortgage arrears in the past 12 months, with higher rates of financial hardship among disadvantaged groups. However, disadvantage did not appear to compound the psychological impact of financial hardship: people experiencing financial hardship were substantially more likely to report moderate or severe psychological distress regardless of their sociodemographic characteristics.<p/

Psychological distress, tobacco smoking and alcohol use:A population survey in Great Britain

Aims: Psychological distress, smoking and alcohol use are interconnected. This study explores how distress and smoking independently, and in combination, are associated with alcohol consumption, past attempts and motivation to restrict alcohol use among people in Great Britain. Methods: Pooled cross-sectional data of people (aged ≥ 16) in Great Britain (N = 87326) collected monthly from April 2020 to June 2023 in the nationally representative Smoking and Alcohol Toolkit Study. Multinomial and binary logistic regressions assessed how past 30-day distress (Kessler Psychological Distress Scale) and smoking were associated with alcohol use risk level (AUDIT-C), past-year attempts to restrict alcohol use, and motivation to restrict alcohol use in three months, adjusting for sex, age, socioeconomic and geographic characteristics. Findings. The interaction between distress and smoking on alcohol use risk level was significant. At all distress levels, odds of using alcohol at increasing or high risk were higher among participants who smoked in the past or currently. Moderate or serious distress was associated with lower odds of using alcohol at increasing risk among participants who did not smoke. Higher distress was positively associated with past-year attempts to restrict alcohol use, while smoking in those reporting low–to–moderate distress was negatively associated with past-year attempts. Higher distress was positively associated with motivation to restrict alcohol use in three months. Conclusions: Smoking currently or in the past was independently associated with increased odds of using alcohol at increasing- or high-risk levels. Among those not smoking, higher distress was associated with reduced odds of using alcohol at increasing risk.</p

Association of psychological distress with smoking cessation, duration of abstinence from smoking, and use of non-combustible nicotine-containing products: A cross-sectional population survey in Great Britain

BACKGROUND: Tobacco smoking cessation is associated with improvements in mental health. This study assessed psychological distress, using the K6 non-specific screening tool ((items cover feelings of nervousness, hopelessness, restlessness, depression, ‘everything an effort’ and worthlessness), by smoking status, time since quit, and use of a non-combustible nicotine product. METHODS: Monthly repeat cross-sectional household survey of adults (18 + ) from October 2020–February 2022 in Great Britain (N = 32,727). Using unadjusted and adjusted logistic regression (adjusted models included socio-demographic characteristics and ever diagnosis with a mental health condition), we assessed: associations between any/serious past-month psychological distress and smoking status and time since quit, whether these relationships were moderated by ever diagnosis with a mental health condition, and associations between distress and use of a nicotine product by people who formerly smoked. RESULTS: In the unadjusted model, those who had not smoked for > 1y and who had never smoked had lower odds of any distress (OR = 0·42, 95 % CI 0·39-0·45; OR = 0·44, 0·41-0·47) compared with those who currently smoked. Moreover, the association of lower distress in those who had not smoked for > 1y and never smoked compared with those who currently smoked was more pronounced among those who had ever been diagnosed with a mental health condition (AOR = 0·58, 0·51-0·66; AOR = 0·60, 0·53-0·67) than among those who had not (AOR = 0·86, 0·76-0·98; AOR = 0·72, 0·65-0·81). In adjusted models of people who formerly smoked, current use of any nicotine product was associated with higher odds of distress compared with not using any nicotine product (AOR 1·23, 1·06-1·42)