Background The Smoking and Alcohol Toolkit Study (STS/ATS) in England has delivered timely insights to inform and evaluate strategies aimed at reducing tobacco smoking- and alcohol-related harm. From the end of 2020 until at least 2024 the STS/ATS is expanding to Scotland and Wales to include all constituent nations in Great Britain. Expanding data collection to Scotland and Wales will permit the evaluation of how smoking and alcohol related behaviours respond to divergent policy scenarios across the devolved nations. Methods The STS/ATS consists of monthly cross-sectional household interviews (computer or telephone assisted) of representative samples of adults in Great Britain aged 16+ years. Commencing in October 2020 each month a new sample of approximately 1700 adults in England, 450 adults in Scotland and 300 adults in Wales complete the survey (~n = 29,400 per year). The expansion of the survey to Scotland and Wales has been funded for the collection of at least 48 waves of data across four years. The data collected cover a broad range of smoking and alcohol-related parameters (including but not limited to smoking status, cigarette/nicotine dependence, route to quit smoking, prevalence and frequency of hazardous drinking, attempts and motivation to reduce alcohol consumption, help sought and motives for attempts to reduce alcohol intake) and socio-demographic characteristics (including but not limited to age, gender, region, socio-economic position) and will be reviewed monthly and refined in response to evolving policy needs and public interests. All data analyses will be pre-specified and available on a free online platform. A dedicated website will publish descriptive data on important trends each month. Discussion The Smoking and Alcohol Toolkit Study will provide timely monitoring of smoking and alcohol related behaviours to inform and evaluate national policies across Great Britain.

Objective Contact tracing is one of the key public health response actions to control the outbreak of a novel virus. This paper describes the preparation process, activation and operational experience for contact tracing of individuals in response to confirmed COVID-19 cases in Wales. Study design A descriptive approach has been adopted and lessons learned from our initial public health response to COVID-19 will be used to develop a new operational model for contact tracing in Wales. Methods As part of preparations for the response in Wales, Public Health Wales formed a Contact Tracing Cell (CTC) ready to be mobilised in the event of a confirmed case. Results Trial activation of the CTC during the preparation period helped to resolve some issues before ‘real’ activation. A highly flexible approach was needed due to the constant changes to the guidance that required rapid understanding, updates to pathways and clear communication to contact tracers. Conclusions Our experience and recommendations may benefit future efforts to control the spread of the virus in Wales and elsewhere, particularly in supporting COVID-19 outbreaks in enclosed settings such as care homes or in geographically localised areas. Learning from the initial public health response to COVID-19 will guide the delivery and implementation of a new contact tracing model as we move to a later stage of the pandemic when containment measures become feasible in localised outbreaks. This may include scaling-up the CTC to mobilise contact tracers to local teams and the potential use of digital technologies to support the next operational model of the CTC in Wales.

There are concerns that the growing popularity of e-cigarettes promotes experimentation among children. Given the influence of the early years on attitude and habit formation, better understanding of how younger children perceive vaping before experimentation begins is needed, to prevent uptake and inform tobacco control strategies. We explored Welsh primary schoolchildren’s (aged 7–11) awareness of e-cigarettes relative to tobacco smoking, their understanding of the perceived risks and benefits and their intentions and beliefs about vaping. Data was collected using a mix of methods in June and July 2017 from 8 purposively selected primary schools across Wales. Four hundred and ninety-five children (52% female) aged 7 years (n = 165), 9 years (n = 185) and 11 years (n = 145) completed a class-administered booklet encompassing a draw and write exercise and survey. Ninety-six children participated in 24 peer discussion groups comprised of 2 boys and 2 girls from each year group. Data were analysed independently and findings triangulated. Survey analyses used frequencies, descriptive statistics and chi-squared tests. Content analysis was undertaken on the draw and write data and peer discussion groups were analysed thematically. Study findings highlight that primary schoolchildren have general awareness of e-cigarettes. Vaping was perceived to be healthier than smoking and there was some recognition that e-cigarettes were used for smoking cessation. Understanding of any health harms was limited. Few children intended to smoke or vape in the future but almost half thought it was okay for grownups. Children’s perceptions were influenced by exposure through family and friends. Findings suggest a need for e-cigarette education in primary schools, to highlight the associated risks of e-cigarette experimentation including the potential for tobacco initiation.

In December 2014, Public Health Wales introduced a proof-of-concept incentive scheme, aiming to encourage National Health Service (NHS) dental practitioners in Wales to provide brief intervention for smoking cessation and increase referrals to Stop Smoking Wales (SSW). The scheme ran for 11 weeks. Practitioners were advised to only refer patients who agreed with the referral. Practices were reimbursed £7 for every referral sent to SSW. Eighty-three dental practices signed up to participate, equating to 18% of NHS sites across Wales. SSW received 308 referrals, of which 297 (96%) were considered new contacts. One hundred and fifty-eight individuals (51%) accepted an assessment. Of these, 48 actually attended (30%). Thirty-two individuals became treated smokers (attending both an assessment and treatment session). Of these, 22 became self-reported quitters; 19 of these were validated through carbon monoxide (CO) monitoring. The cost to receive individuals into SSW via the dental incentive scheme was approximately £98 per self-reported quitter. The scheme greatly increased the number of referrals to SSW from dentists, compared to previous records and so fulfilled its aims. Amendments to the process could improve cost-effectiveness of a similar scheme.

Issues addressed To establish the views of clinicians on the feasibility and effectiveness of using a novel lifestyle prescription form (LRx) which requires co‐signing by clinician and patient and is uniquely based on the design of the standard drug prescription form, in the primary and secondary health care settings. Methods Thirty‐six participants were issued with a “prescription” pad, of 20 LRx scripts, for 1 month and requested to issue an LRx prescription to patients they deemed suitable during their consultation, recording their reason for use of the LRx. Each clinician was then asked to complete a comprehensive feedback questionnaire. Results Feedback of the LRx was overwhelmingly positive. The script was viewed as a more effective way to convey and support cardiovascular lifestyle advice, than usual care. Forty per cent (196 of 480) of the LRx scripts that were provided to primary and secondary care clinicians during the study period were issued. In most consultations, the LRx script was issued to reaffirm dietary advice. Nurses and health care assistants were more likely than doctors to use the LRx in response to a request for lifestyle advice from a patient. Conclusions The LRx may be a useful addition to the clinician's communication toolkit to stimulate lifestyle behaviour changes in their patients. The main barrier to use in the study was lack of consultation time. So what? Issuing the LRx is a method of solidifying lifestyle advice that clinicians could utilise, providing them with another tool in their behaviour change arsenal, particularly with familiarity with the tool.

Within the context of reopening society in the summer of 2021, as the UK moved away from ’lockdown,’ the Government of Wales piloted the return on organised ‘mass gatherings’ of people at a number of test events. Behavioral observations were made at two of the test events to support this process. The research was particularly interested in four key factors: How (1) context within a venue, (2) environmental design, (3) staffing and social norms, and (4) time across an event, affected personal protective behaviors of social distancing, face covering use, and hand hygiene. Data collection was undertaken by trained observers across the above factors. Findings suggest that adherence of attendees was generally high, but with clear indications that levels were shaped in a systematic way by the environment, situational cues, and the passage of time during the events. Some instances of large-scale non-adherence to personal protective behaviors were documented. Overall, there were three main situations where behavioral adherence broke down, under conditions where: (1) staff were not present; (2) there was a lack of environmental signalling (including physical interventions or communications); and (3) later into the events when circumstances were less constrained and individuals appeared less cognitively vigilant. Behavioral observations at events can add precision and identify critical risk situations where/when extra effort is required. The findings suggest a liberal paternal approach whereby state authorities, health authorities and other key organisations can help nudge individuals towards COVID-safe behaviors. Finally, an individual’s intentions are not always matched by their actions, and so behavioral insights can help identify situations and contexts where people are most likely to require additional support to ensure COVID-19 personal protective behaviors are followed and hence protecting themselves and others.

Background: There are concerns that the growing popularity of e-cigarettes promotes experimentation among children. Current research has focused almost exclusively on children over 11 years. Given the possible lifelong health harms caused by behaviours established in early childhood, understanding younger children’s perceptions is essential; to inform tobacco control policies, prevention strategies and the wider debate on further regulation of vaping. In one of the first global studies to provide insights into younger children’s perceptions of e-cigarettes, we explored Welsh primary schoolchildren’s (aged 7-11) awareness of e-cigarettes relative to tobacco smoking, their understanding of the risks and benefits associated with e-cigarettes and their intentions and beliefs about vaping. Methods: Data was collected using a mix of methods in June and July 2017 from 8 purposively selected primary schools across Wales. Four hundred and ninety-five children (52% female), aged 7 years (n=165), 9 years (n=185) and 11 years (n=145) completed a class-administered booklet encompassing a draw and write exercise and questionnaire. Ninety-six children participated in 24 peer cohort-based discussion groups comprised of 2 boys and 2 girls. Data from the three tools were analysed independently and findings triangulated. Questionnaire analyses used frequencies, descriptive statistics and chi-squared tests. Content analysis was undertaken on the draw and write data and peer discussion groups were analysed thematically. Results: Primary schoolchildren have general awareness of e-cigarettes but understanding of any health harms or the role of nicotine in e-cigarettes is poor or misperceived, particularly in the youngest children. Vaping was viewed as healthier than smoking by most and there was some recognition that e-cigarettes were used for smoking cessation. Few children intended to smoke (1.8%) or vape (3.9%) in the future but almost half thought it was okay for grownups. Children’s perceptions were influenced by exposure through family and friends. Conclusions: There is a need for e-cigarette education in primary schools. Health promotion efforts should reinforce the message that vaping is ‘less harmful’ rather than ‘healthier’ and highlight associated risks of e-cigarette experimentation including the potential for tobacco initiation. Further research is needed to explore whether children’s perceptions influence their future use of tobacco or e-cigarettes.

ObjectivesTo design and test a method to assess whether test events were associated with an increase in risk of confirmed COVID-19, in order to inform policy on the safe re-introduction of spectator events following decreasing incidence of COVID-19 and relaxing of restrictions. ApproachWe designed a cohort study to measure relative risk of confirmed COVID-19 in those attending two large sporting events in South Wales during May-June 2021. First, we linked ticketing information to records on the Welsh Demographic Service (WDS) and identified NHS numbers for attendees. We then linked attendees to routine SARS-CoV-2 test data to calculate incidence rates in people attending each event for a fourteen days period following the event.  We selected a comparison cohort from WDS for each event, individually matched by age band, gender and locality of residence. Risk ratios were then computed for the two events. ResultsWe successfully assigned NHS numbers to 91% and 84% of people attending the two events, respectively. Other identifiers were available for the remainder. Only a small number of attendees (<10) had a record of confirmed COVID-19 following attendance at each event (14 day cumulative incidence: 36 and 26 per 100,000, respectively). Background incidences in Wales over the same periods were 22 and 61 per 100,000, respectively.  There was no evidence of significantly increased risk of COVID-19 at either event (event 1: 3.00 (0.18-47.9), p=0.50, event 2: 0.30 (0.04-2.34), p= 0.23). However, event 1, which didn’t include pre-event testing in their mitigations, had a higher risk ratio (>1) than event 2 (<1), which did include pre-event testing. ConclusionsWe demonstrate the potential for data linkage to inform COVID-19 policy regarding sporting events. At that point in the epidemic, there was no evidence that attending large sporting events increased risk of COVID-19. However, these events took place between epidemic waves when background incidence and testing rate was low.