scholarly journals The Impact of the Covid-19 Pandemic on Uptake of Influenza Vaccine: A UK-Wide Observational Study

2020 ◽  
Author(s):  
Patrik Bachtiger ◽  
Alex Adamson ◽  
Ji-Jian Chow ◽  
Rupa Sisodia ◽  
Jennifer K Quint ◽  
...  
Keyword(s):  
Public Health ◽  
Influenza Vaccination ◽  
Vaccination Rate ◽  
School Age Children ◽  
School Age ◽  
Flu Vaccination ◽  
Flu Vaccine ◽  
The Uk ◽  
The Impact ◽  
To Receive

ABSTRACTObjectivesThe objective of this study was to measure the impact of the Covid-19 pandemic on acceptance of flu vaccination in the 2020-21 season, including for those newly eligible for the UK National Health Service (NHS) free vaccination programme, extended this year to include an estimated 32.4 million (48.8%) of the UK population. Knowing intended uptake is essential to inform supply and steer public health messaging to maximise vaccination given the combined threats of both flu and Covid-19 — the unknown impact of which on both attitudes and the need for mass uptake yet again create the threat of ill-informed planning resulting in failure to meet necessary public health demand.MethodsAn online questionnaire posing question items on influenza vaccination was administered to registrants of the Care Information Exchange (CIE), the NHS’s largest patient electronic personal health record. This was part of a longitudinal study initiated during the Covid-19 pandemic lockdown. This analysis was limited to those who, in line with established NHS criteria, were previously or newly eligible but had not routinely received seasonal influenza vaccination in the past. Groups were stratified by response (yes/no) to intending to receive flu vaccination in 2020-21: Group 1.) Previously eligible now responding ‘yes’, 2.) Previously eligible still responding ‘no’, 3.) Newly eligible responding ‘yes’, and 4.) Newly eligible responding ‘no’. Within these groups, response by health worker status and each group’s inclination to vaccinate school age children was also measured. Summary statistics were reported alongside univariate and multivariable regression. Lastly, a network analysis visualised the frequency and co-occurrence of reasons qualifying response for or against influenza vaccination in 2020/21.FindingsAmong 6,641 respondents, 4,040 (61.1%) had previously routinely received the flu vaccination. 1,624 (24.5%) had been either previously eligible but not vaccinated (945, 58.2%) or newly eligible (679, 41.8%). Among the previously eligible participants who had not routinely received influenza vaccination 536 (56.7%) responded they would in 2020-21, increasing the vaccination rate in the entire previously eligible cohort from 79.6% to 91.2%, and 466 (68.6%) in the newly eligible.Multivariable logistic regression resulted in few substantial changes to effect estimates, with the exception of age, for which all estimates showed a stronger association with intention to receive the flu vaccine. In those who became newly eligible to receive the flu vaccine, there was an association between intention to receive the flu vaccine and increased age (OR = 1.07, 95% CI 1.03 to 1.12), IMD quintile, and considering oneself at high risk from Covid-19 (OR = 1.80, 95% CI 1.22 to 2.70).Network analysis showed the most frequent themes for previously eligible unvaccinated and newly eligible participants accepting vaccination in 2020/21 were: ‘precaution for myself’ (41.2% and 46.1%) and ‘Covid-19’ (27.4% and 27.1%), where the former was qualified by the latter in 36% and 29.1% of responses. Among the previously and newly eligible not intending to receive vaccination in 2020/21, misinformed themes of ‘makes me unwell’, ‘gives me flu’ and ‘vaccine doesn’t work’ were present across 37.4% and 21.9% of responses, respectively.Among participants with school age children, of those previously eligible who now intend to be vaccinated themselves, 82.5% also intend to vaccinate their children in 2020/21 compared to 25.8% of those who would not accept the influenza vaccine for themselves. Among the newly eligible respondents this was 82.1% and 43.5%, respectively. 49.9% of the previously unvaccinated healthcare workers would continue to decline the vaccine in 2020/21.InterpretationIn this UK-wide observational study, Covid-19 has increased acceptance of flu vaccination in 2020/21 from 79.6% to 91.2% in those previously eligible, and for the 69% of those newly eligible. This high anticipated vaccination rate (to 26 million (80%) of the UK population) requires appropriate planning, but can be further increased with effective messaging campaigns to address negative misconceptions about flu vaccination, which may also help in preparation for future Covid-19 vaccination. It remains of concern that 50% of healthcare professionals who refused it previously still do not intend to have the flu vaccine.

scholarly journals How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the UK? A cross-sectional online survey

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043397
Author(s):  
Austen El-Osta ◽  
Aos Alaa ◽  
Iman Webber ◽  
Eva Riboli Sasco ◽  
Emmanouil Bagkeris ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Social Isolation ◽  
Online Survey ◽  
Female Gender ◽  
School Age Children ◽  
School Age ◽  
Cross Sectional ◽  
The Uk ◽  
The Impact

ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age children.DesignCross-sectional online survey of parents of primary and secondary school-age children.SettingCommunity setting.Participants1214 parents of school-age children in the UK.MethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA Three-Item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression models.Main outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.ResultsHalf of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely during the first 100 days of lockdown. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. The sustained adoption of two modifiable health-seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) wmay help reduce feelings of social isolation and loneliness during lockdown.

scholarly journals Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015

2019 ◽  
Vol 24 (49) ◽  
Author(s):  
Sam Abbott ◽  
Hannah Christensen ◽  
Nicky J. Welton ◽  
Ellen Brooks-Pollock
Keyword(s):  
High Risk ◽  
Labour Force ◽  
Demographic Data ◽  
Credible Interval ◽  
Incidence Rates ◽  
School Age Children ◽  
School Age ◽  
Bcg Vaccination ◽  
The Uk ◽  
The Impact

Background In 2005 in England, universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates. Aim Estimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England. Methods We conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both the universal and targeted vaccination between 1 January 2000 and 31 December 2010. We then estimated incidence rates over a 5-year follow-up period and used regression modelling to estimate the impact of the change in policy on TB. Results In the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR): 0.74; 95% credible interval (CrI): 0.61 to 0.88 and neonatal IRR: 0.62; 95%CrI: 0.44 to 0.88). We found some evidence that the change in policy was associated with an increase in incidence rates in the UK born school-age population (IRR: 1.08; 95%CrI: 0.97 to 1.19) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96; 95%CrI: 0.82 to 1.14). Overall, we found that the change in policy was associated with directly preventing 385 (95%CrI: −105 to 881) cases. Conclusions Withdrawing universal vaccination at school age and targeting vaccination towards high-risk neonates was associated with reduced incidence of TB. This was largely driven by reductions in the non-UK born with cases increasing in the UK born.

scholarly journals The Impact of the Covid-19 Pandemic on Uptake of Influenza Vaccine: A UK-Wide Observational Study (Preprint)

2020 ◽  
Author(s):  
Patrik Bachtiger ◽  
Alexander Adamson ◽  
Ji-Jian Chow ◽  
Rupa Sisodia ◽  
Jennifer K Quint ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
National Health ◽  
Personal Health Record ◽  
Resource Planning ◽  
Flu Vaccination ◽  
The Face ◽  
Uk National Health Service ◽  
The Uk ◽  
The Impact ◽  
To Receive

BACKGROUND In the face of the Covid-19 pandemic, the UK National Health Service (NHS) flu vaccination eligibility is extended this year to ~32.4 million (48.8%) of the population. Knowing intended uptake will inform supply and public health messaging to maximise vaccination. OBJECTIVE The objective of this study was to measure how the Covid-19 pandemic will impact uptake of the UK National Health Service's (NHS) expanded flu vaccination programme, and to inform reasons for or against vaccination. METHODS Intention to receive influenza vaccine in 2020-21 was asked of all registrants of the NHS’s largest electronic personal health record. Of those who were either newly or previously eligible but had not previously received influenza vaccination, multivariable logistic regression, and network analysis were used to examine reasons to have or decline vaccination. RESULTS Among 6,641 respondents, 945 (14.2%) were previously eligible but not vaccinated of whom 536 (56.7%) intend to receive flu vaccination in 2020/21, as do 466 (68.6%) of the newly eligible, increasing nationwide vaccination demand by ~50%. Intention to receive the flu vaccine was associated with increased age, index of multiple deprivation (IMD) quintile, and considering oneself at high risk from Covid-19. Among those eligible but intending not to be vaccinated in 2020/21, 164 (30.2%) gave misinformed reasons. 47 (49.9%) of previously unvaccinated healthcare workers will decline vaccination in 2020/21. CONCLUSIONS In this sample, Covid-19 has increased acceptance of flu vaccination from 79.6% to 91.2% in those previously eligible, and 69% in the newly eligible. Meeting this demand for flu vaccination of ~26 million of the UK population is 50% higher than last year. This study is essential for informing resource planning and the need for effective messaging campaigns to address negative misconceptions, a strategy also necessary for Covid-19 vaccination programmes.

scholarly journals Impact of COVID-19 Pandemic on Flu and COVID-19 Vaccination Intentions among University Students

Vaccines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 70 ◽  
Author(s):  
Roberta Pastorino ◽  
Leonardo Villani ◽  
Marco Mariani ◽  
Walter Ricciardi ◽  
Guendalina Graffigna ◽  
...  
Keyword(s):  
Public Health ◽  
University Students ◽  
Web Based ◽  
Vaccination Programs ◽  
Perceived Vulnerability ◽  
Flu Vaccination ◽  
Flu Vaccine ◽  
Level Of Concern ◽  
High Level ◽  
The Impact

Flu vaccination for the general population, and specifically for vulnerable subgroups, brings the potential to reduce the impact of the COVID-19 pandemic in terms of mobility, mortality, and hospitalizations. In Italy, flu vaccination is recommended to all ≥6 months of age, even if it is only free of charge for specific categories. We investigated the intentions towards flu and COVID-19 vaccinations from a sample of 436 Italian university students. Results of a web-based survey show that 77.52% of them were willing to get the flu vaccine and 94.73% were willing to be vaccinated against COVID-19 when available. We identified positive predictive factors to undertake flu vaccination as being a medical student, having undertaken a previous vaccination against flu, and having a high level of concern and perceived vulnerability to the COVID-19 pandemic. Reinforced public health activities might consider engaging university students a as possible “positive influencer” towards flu and COVID-19 vaccination programs.

scholarly journals Estimating the effect of the 2005 change in BCG policy in England: A retrospective cohort study

2019 ◽  
Author(s):  
Sam Abbott ◽  
Hannah Christensen ◽  
Nicky Welton ◽  
Ellen Brooks-Pollock
Keyword(s):  
High Risk ◽  
Negative Binomial ◽  
Labour Force ◽  
Incidence Rates ◽  
School Age Children ◽  
List Type ◽  
School Age ◽  
Bcg Vaccination ◽  
The Uk ◽  
The Impact

ABSTRACTBackgroundIn 2005, England changed from universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children to targeted BCG vaccination of high-risk children at birth.MethodsWe combined notification data from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts of individuals in England relevant to both the universal, and targeted vaccination programmes between Jan 1, 2000 and Dec 31, 2010. For each cohort, we estimated incidence rates over a 5 year follow-up period and used Poisson and Negative Binomial regression models in order to estimate the impact of the change in policy on TB.ResultsIn the non-UK born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age IRR: 0.74 (95%CI 0.61, 0.88), neonatal IRR: 0.62 (95%CI 0.44, 0.88)). We found some evidence that the change in BCG policy was associated with a increase in incidence rates in the UK born school-age population (IRR: 1.08 (95%CI 0.97, 1.19)) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96 (95%CI 0.82, 1.14)). Overall, we found that the change in BCG policy was associated with directly preventing 385 (95% CI −105, 881) TB cases.ConclusionsWithdrawing universal vaccination at school-age and targeting BCG vaccination towards high-risk neonates was associated with reduced incidence of TB in England. This was largely driven by reductions in the non-UK born. There was a slight increase in UK born school-age cases.Key MessagesThere is little existing literature on the impact of withdrawing universal school-age BCG vaccination and introducing high-risk neonatal BCG vaccination on TB incidence rates in the populations directly affected by the vaccination programmes.There was strong evidence that the change in policy was associated with a decrease in TB incidence rates in non-UK born neonates and school-age children. In the UK born individuals, there was some evidence that the change in policy was associated with an increase in TB incidence rates in those relevant to the universal school-age scheme, with little evidence of a decrease in incidence rates in those relevant to the high-risk neonatal vaccination scheme.Overall the change in vaccination policy was associated with preventing TB cases, mainly in the non-UK born.These results provide an important evaluation of the direct effects of both withdrawing and implementing a BCG vaccination programme in a low incidence, high income, country and are relevant to several other countries that have made similar changes to their vaccination programmes.

scholarly journals Emotional and Mental Wellbeing Following COVID-19 Public Health Measures on People Living With Dementia and Carers

2021 ◽  
pp. 089198872199681
Author(s):  
Kerry Hanna ◽  
Clarissa Giebel ◽  
Hilary Tetlow ◽  
Kym Ward ◽  
Justine Shenton ◽  
...  
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Social Support ◽  
Support Services ◽  
Mental Wellbeing ◽  
Daily Lives ◽  
Health Measures ◽  
Social Support Services ◽  
The Uk ◽  
The Impact

Background: To date, there appears to be no evidence on the longer-term impacts caused by COVID-19 and its related public health restrictions on some of the most vulnerable in our societies. The aim of this research was to explore the change in impact of COVID-19 public health measures on the mental wellbeing of people living with dementia (PLWD) and unpaid carers. Method: Semi-structured, follow-up telephone interviews were conducted with PLWD and unpaid carers between June and July 2020. Participants were asked about their experiences of accessing social support services during the pandemic, and the impact of restrictions on their daily lives. Results: 20 interviews were conducted and thematically analyzed, which produced 3 primary themes concerning emotional responses and impact to mental health and wellbeing during the course of the pandemic: 1) Impact on mental health during lockdown, 2) Changes to mental health following easing of public health, and 3) The long-term effect of public health measures. Conclusions: The findings from this research shed light on the longer-term psychological impacts of the UK Government’s public health measures on PLWD and their carers. The loss of social support services was key in impacting this cohort mentally and emotionally, displaying a need for better psychological support, for both carers and PLWD.

scholarly journals The development of a digital intervention to increase influenza vaccination amongst pregnant women

2021 ◽  
Vol 7 ◽  
pp. 205520762110121
Author(s):  
Joanne E Parsons ◽  
Katie V Newby ◽  
David P French ◽  
Elizabeth Bailey ◽  
Nadia Inglis
Keyword(s):  
Pregnant Women ◽  
Qualitative Methodology ◽  
Intervention Mapping ◽  
Vaccine Uptake ◽  
Flu Vaccination ◽  
Increased Risk ◽  
Diverse Area ◽  
Seasonal Flu ◽  
Flu Vaccine ◽  
The Uk

Objective Pregnant women and unborn babies are at increased risk of complications from influenza, including pneumonia, yet in the UK, uptake of flu vaccination amongst this population remains <50%. Pregnant women hold beliefs about risks of flu and efficacy of vaccination that consistently predict them to decline vaccination. This study aimed to develop a theory and evidence-based intervention addressing these beliefs to promote flu vaccine uptake. Methods The intervention was developed by behavioural scientists, pregnant women, midwives, clinicians and Public Health professionals, informed by Intervention Mapping. Six predefined steps were performed in line with Intervention Mapping. Results The intervention is an animation addressing beliefs about risks of flu and efficacy of vaccination. Preliminary testing using qualitative methodology indicates the information within the animation is appropriate, and the animation is acceptable to pregnant women. Conclusions This is the first known intervention for pregnant women, aiming to increase flu vaccination through addressing risk and efficacy appraisals. It has been implemented within seasonal flu vaccination campaigns during 2018/19 and 2019/20 within one geographically and ethnically diverse area of the UK.

OPINION OF PARENTS OF SCHOOLCHILDREN AND TEACHERS OF SCHOOLS ON THE EXPEDIENCY OF CARRYING OUT MEASURES TO PROMOTE A HEALTHY LIFESTYLE OF SCHOOLCHILDREN

2021 ◽  
pp. 204-209
Author(s):  
Khikhlich O.S. ◽  
Bortsov V.A. ◽  
Gurinovich E.G.
Keyword(s):  
General Education ◽  
Healthy Lifestyle ◽  
School Age Children ◽  
Teaching Staff ◽  
School Age ◽  
Sociological Study ◽  
School Teachers ◽  
Primary Health ◽  
Sociological Studies ◽  
To Receive

Currently, the organization of primary health prevention in secondary schools is a complex interaction between the health and education systems. In order to determine the need and scope of optimizing the organization of primary medical prevention for school-age children and develop measures to increase its availability, sociological studies were conducted of 400 parents of children studying in secondary educational schools and 403 teaching staff of secondary general education schools. According to the results of a survey of parents of school-age children, the following conclusions can be drawn: parents with children visit polyclinics for the treatment of diseases or for preventive examinations, and they do not have enough time and opportunity to solve issues related to the formation of a healthy lifestyle and have to get the necessary information on their own. The majority (77.8±2.1%) of respondents believe that school teachers can conduct conversations with schoolchildren on the formation of a healthy lifestyle and the prevention of diseases in school-age children. Parents also pointed out that school teachers with varying frequency already conduct conversations with students on the formation of a healthy lifestyle and the prevention of diseases in children. When analyzing the results of a sociological study of teachers, it was revealed that the majority (80.6±2.0%) of respondents consider it appropriate to conduct work with the population on the formation of a healthy lifestyle. More than half (54.8±2.5%) of the respondents consider it appropriate to receive training on healthy lifestyle issues in the future, and 19.5±2.0% - at the first opportunity.

The impact of an unconditional parental benefit on employment of mothers

2017 ◽  
Vol 37 (1/2) ◽  
pp. 33-50 ◽  
Author(s):  
Anna Kurowska
Keyword(s):  
Maternal Employment ◽  
Parental Leave ◽  
School Age Children ◽  
Employment Rate ◽  
School Age ◽  
Older Children ◽  
Cultural Economic ◽  
Similar System ◽  
Content Type ◽  
The Impact

Purpose The purpose of this paper is to solve the puzzle of the disproportionately lower employment rate of mothers of toddlers with relation to the employment rate of mothers of preschool and school-age children in Estonia. Design/methodology/approach The research is based on the Most Similar System Design and compares Estonia with Lithuania. The applied methods include inferential statistics and microsimulation techniques, employing the OECD Benefits and Wages Calculator, the OECD Family Support Calculator and EUROMOD – the European tax-benefit microsimulation model. Findings The comparison revealed that the overwhelming majority of the crucial aspects of socio-cultural, economic and institutional conditions were more favourable for maternal employment in Estonia than in Lithuania. This explains the higher maternal employment rates both for mothers of pre-schoolers and school-age children in Estonia. However, one particular element of the institutional context targeted to the mothers of toddlers – the unconditional parental benefit – had an entirely opposite character. This particular feature of the parental leave scheme was the only factor that could explain why the employment rate of mothers of toddlers is disproportionately lower than the employment rate of mothers of older children in Estonia and much lower than the employment of mothers of toddlers in Lithuania. Originality/value This study complements previous research by providing evidence on the relative importance of universal parental benefit schemes in the context of other country-specific conditions for maternal employment, including the availability of institutional childcare. Furthermore, the results presented show that childcare regime typologies, at least those that characterise Eastern European countries, should be more sensitive to children’s age.

scholarly journals Impact of tobacco tax increases and industry pricing on smoking behaviours and inequalities: a mixed-methods study

2020 ◽  
Vol 8 (6) ◽  
pp. 1-140
Author(s):  
Timea R Partos ◽  
Rosemary Hiscock ◽  
Anna B Gilmore ◽  
J Robert Branston ◽  
Sara Hitchman ◽  
...  
Keyword(s):  
Public Health ◽  
Health Research ◽  
Tobacco Industry ◽  
Control Policy ◽  
Public Health Research ◽  
Pricing Strategies ◽  
The Uk ◽  
Tax Changes ◽  
The Impact ◽  
Evaluation Project

Background Increasing tobacco prices through taxation is very effective for reducing smoking prevalence and inequalities. For optimum effect, understanding how the tobacco industry and smokers respond is essential. Tobacco taxation changes occurred in the UK over the study period, including annual increases, a shift in structure from ad valorem to specific taxation and relatively higher increases on roll-your-own tobacco than on factory-made cigarettes. Objectives Understanding tobacco industry pricing strategies in response to tax changes and the impact of tax on smokers’ behaviour, including tax evasion and avoidance, as well as the effect on smoking inequalities. Synthesising findings to inform how taxation can be improved as a public health intervention. Design Qualitative analysis and evidence synthesis (commercial and Nielsen data) and longitudinal and aggregate cross-sectional analyses (International Tobacco Control Policy Evaluation Project data). Setting The UK, from 2002 to 2016. Data sources and participants Data were from the tobacco industry commercial literature and retail tobacco sales data (Nielsen, New York, NY, USA). Participants were a longitudinal cohort (with replenishment) of smokers and ex-smokers from 10 surveys of the International Tobacco Control Policy Evaluation Project (around 1500 participants per survey). Main outcome measures (1) Tobacco industry pricing strategies, (2) sales volumes and prices by segments over time and (3) smokers’ behaviours, including products purchased, sources, brands, consumption, quit attempts, success and sociodemographic differences. Review methods Tobacco industry commercial literature was searched for mentions of tobacco products and price segments, with 517 articles extracted. Results The tobacco industry increased prices on top of tax increases (overshifting), particularly on premium products, and, recently, the tobacco industry overshifted more on cheap roll-your-own tobacco than on factory-made cigarettes. Increasingly, price rises were from industry revenue generation rather than tax. The tobacco industry raised prices gradually to soften impact; this was less possible with larger tax increases. Budget measures to reduce cheap product availability failed due to new cheap factory-made products, price marking and small packs. In 2014, smokers could buy factory-made (roll-your-own tobacco) cigarettes at real prices similar to 2002. Exclusive roll-your-own tobacco and mixed factory-made cigarettes and roll-your-own tobacco use increased, whereas exclusive factory-made cigarette use decreased, alongside increased cheap product use, rather than quitting. Quitting behaviours were associated with higher taxes. Smokers consumed fewer factory-made cigarettes and reduced roll-your-own tobacco weight over time. Apparent illicit purchasing did not increase. Disadvantaged and dependent smokers struggled with tobacco affordability and were more likely to smoke cheaper products, but disadvantage did not affect quit success. Limitations Different for each data set; triangulation increased confidence. Conclusions The tobacco industry overshifted taxes and increased revenues, even when tax increases were high. Therefore, tobacco taxes can be further increased to reduce price differentials and recoup public health costs. Government strategies on illicit tobacco appear effective. Large, sudden tax increases would reduce the industry’s ability to manipulate prices, decrease affordability and increase quitting behaviours. More disadvantaged, and dependent, smokers need more help with quitting. Future work Assessing the impact of tax changes made since 2014; changing how tax changes are introduced (e.g. sudden intermittent or smaller continuous); and tax changes on tobacco initiation. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.

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