Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019

Background and aimIn 2016, England initiated the implementation of standardised tobacco packaging, introduced in conjunction with minimum pack sizes and other measures included in the 2014 European Tobacco Products Directive, over the course of a 1-year sell-off period ending in May 2017. These measures have been shown to have been associated with increases in tobacco prices and product diversity. We now investigate the association between implementation of the new legislation and smoking status in England.DesignSegmented regression analysis of repeated cross-sectional surveys using a generalised linear model with individual-level data to test for a change in trend and immediate step change.SettingEngland.ParticipantsParticipants in the Smoking Toolkit Study, which involves repeated, cross‐sectional household surveys of individuals aged 16 years and older in England. The sample included 278 219 individual observations collected between November 2006 and December 2019.InterventionImplementation of standardised packaging legislation (May 2016 and May 2017).MeasurementsIndividual-level current smoking status adjusted for implementation of tobacco control policies, cigarette price, seasonality and autocorrelation.FindingsThe implementation of standardised packaging was associated with a significant step reduction in the odds of being a smoker after May 2017 (OR: 0.93; 95% CI 0.87 to 0.99). The magnitude of the association was similar when modelling the step change in May 2016 at the start of the 1-year policy implementation period (OR: 0.90; 95% CI: 0.83 to 0.97).ConclusionsThis is the first independent study demonstrating that implementation of standardised packaging was associated with a reduction in smoking in England which occurred in anticipation of, rather than after, full policy implementation. It appears that the odds of being a smoker were affected by the prospect of the move to standardised packs and accompanying legislation.

From a Deliberative to an Implementing Mindset a Process-oriented View of the Formation of Academic Entrepreneurial Intention

Background: Previous intention-based research has not considered whether participants are in the motivational or in the actional phase. In turn, this creates a gap of knowledge concerning the cognitive and motivational processes involved in the formation of Entrepreneurial Intention (EI). By applying the Theory of Planned Behavior (TPB), the present study addresses the formation of EI to commercialize research knowledge, focusing on the transition from motivation to implementation in the context of academia. Methods: Drawing on cross-sectional data of 490 researchers, segmented regression analysis was conducted to analyze the influence of entrepreneurial engagement on EI-growth. Multi-group Structural Equalization Modeling (SEM) was then used to test the moderation effects of engagement on the relationship between motivational factors and entrepreneurial intention. Results and Discussion: The analysis revealed a direct influence of engagement on EI, as well as a threshold of EI-growth per the context of a Rubicon crossing after the initiation of the first gestation action. Our data also show a growing influence of endogenous factors (e.g., attitudes and perceived behavior control) on EI during the venture creation process. The second part of the study contributes by testing the effects of entrepreneurial rewards on TPB-antecedents moderated by engagement. Conclusion: Until today, research mostly relied on cross-sectional data to predict and measure the strength of EI in the phase preceding the launch of a new business without considering whether participants are in the motivational or in the actional phase. Our finding highlights the need to shift from focusing entrepreneurship research solely on intentions to now on the process and implementation perspective.

Abstract P121: Update on Regional Stroke Activation Trends During Covid-19 Mitigation

Background: The University of Cincinnati Stroke Team provides acute stroke care to the southwest Ohio, northern Kentucky, and southeast Indiana catchment area of ~2 million people and 30 healthcare facilities. We previously published a significant decline in stroke activations and reperfusion treatment (IV thrombolysis and EVT) rates following state announcements of COVID-19 mitigation measures. Here, we update these trends after state reopening guidelines. Methods: We compared Stroke Team activations and reperfusion treatments logged in a prospectively collected database, comparing the same period in 2020 versus 2019. Kentucky and Ohio announced school and restaurant closures on March 12 and 13, respectively, followed by Indiana. A stepwise reopening of our tristate area started on May 1, 2020. We also compared trends in activations and treatment rates before (Weeks 1-10), during (Weeks 11-17), and after (Weeks 18-26) the lifting of COVID-19 mitigation efforts using the Poisson test, and graphically with segmented regression analysis. Results: Compared to 2019, stroke team activations declined by 12% in 2020 (95% CI 7 - 16%; p<0.01). During 2020, an initial decline in stroke activations following COVID-19 mitigation announcements was followed by a 28% increase in activations after reopening (Weeks 18-26: 95% CI 15 - 42%; p<0.01). In contrast, compared to 2019, treatment rates were unchanged (0%, 95% CI -15 - 18%; p=1.00), including specifically IV thrombolysis and thrombectomy rates. Similarly, an initial decline in reperfusion treatments was followed by a 24% nonsignificant increase after reopening (95% CI -10 - 71%; p=0.19) in 2020. Conclusion: The initial decline in stroke team activations during COVID-19 mitigation efforts was followed by an increase in activations after reopening. Hospital capacity and 911 services remained fully intact, suggesting that the reduction in activations were related to reduced presentation by patients for emergent stroke care.

A Reappraisal of the Threshold Hypothesis of Creativity and Intelligence

Intelligence has been declared as a necessary but not sufficient condition for creativity, which was subsequently (erroneously) translated into the so-called threshold hypothesis. This hypothesis predicts a change in the correlation between creativity and intelligence at around 1.33 standard deviations above the population mean. A closer inspection of previous inconclusive results suggests that the heterogeneity is mostly due to the use of suboptimal data analytical procedures. Herein, we applied and compared three methods that allowed us to handle intelligence as a continuous variable. In more detail, we examined the threshold of the creativity-intelligence relation with (a) scatterplots and heteroscedasticity analysis, (b) segmented regression analysis, and (c) local structural equation models in two multivariate studies (N1 = 456; N2 = 438). We found no evidence for the threshold hypothesis of creativity across different analytical procedures in both studies. Given the problematic history of the threshold hypothesis and its unequivocal rejection with appropriate multivariate methods, we recommend the total abandonment of the threshold.

706. Impact of Infectious Disease Consultation on Management and Clinical Outcomes of Infective Endocarditis: Results of an interrupted time series analysis

Background Infective endocarditis (IE) is associated with significant morbidity and mortality, and successful management requires expertise in both cardiac surgery and infectious disease (ID). However, the impact of ID consultation on clinical outcomes of IE is not clear. Methods The present study was a quasi-experimental, interrupted time series analysis of the clinical outcomes of patients with IE before (April 1998–April 2008) and after (May 2008–March 2019) the establishment of an ID department at a tertiary care hospital in Japan. The primary outcome was clinical failure within 90 days, defined as a composite of all-cause mortality, unplanned cardiac surgery, new-onset embolic events, and relapse of bacteremia caused by the original pathogen. Results Of 238 IE patients, 59 patients (25%) were treated in the pre-intervention period, and 179 patients (75%) were treated in the post-intervention period. Establishment of an ID department was associated with a 54% reduction in clinical failure (relative risk [RR], 0.46; 95% confidence interval [CI], 0.21–1.02; P=0.054) and a 79% reduction in new-onset embolic events (RR, 0.21; 95% CI, 0.07–0.71; P=0.01). In addition, the rate of inappropriate IE management significantly decreased (RR, 0.06; 95% CI, 0.02–0.22; P&lt; 0.01). Segmented regression analysis for monthly rates of clinical failure. Table 1. Comparison of the clinical characteristics of the patients between the pre-intervention and post-intervention periods Table 2. Segmented regression analysis for primary and secondary outcomes Conclusion Establishment of an ID department at a tertiary care hospital was associated with improved management, better clinical outcomes, and reduced embolic events in patients with IE admitted to the hospital. Disclosures All Authors: No reported disclosures