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Abstract. Background: The prevalence of tobacco smoking among people with severe mental illness (SMI) substantially exceeds smoking rates in the general population and has been identified as the largest contributor to health inequalities in this group. Historically deeply embedded in the culture of mental health treatment environments, smoking until very recently was the norm in inpatient settings and still prevails in many settings internationally. In England however, mental health Trusts are currently implementing recent national guidance, according to which mental health settings will become entirely smokefree, with no exemptions, providing comprehensive evidence-based support to patients for smoking cessation and smoking abstinence during the inpatient stay. Aim: The aim of this article is to summarise the rationale for and the debate surrounding smokefree mental health inpatient settings, and to review and discuss the evidence on challenges, opportunities and impact of smokefree policy implementation in these settings, with a focus on the English debate and experience to date.

Context The Covid-19 pandemic led to increased use of green/blue space as indoor spaces became frequently inaccessible. These changes affected the direct interactions between humans and nature. Aims To investigate the links between mental health, loneliness, wellbeing, and interaction with non-companion animals, proximity to and use of green/blue space. Methods A cross-sectional online survey of adult UK residents was conducted between April and June 2020. The questionnaire included validated and bespoke items measuring demographics and exposures and outcomes related to mental health, wellbeing, loneliness, human–animal interactions with non-companion animals (wildlife/farm animals), and proximity to and use of green/blue space before and since the first UK Covid-19 lockdown. Key results Of 5926 participants, 4408 (74.4%) reported interacting with non-companion animals at least every other day. Frequent engagement with non-companion animals was significantly associated with smaller decreases in mental health scores (b = 0.131, 95% CI [0.007–0.256], P = 0.038) and smaller increases in loneliness scores (b = −0.135, 95% CI [−0.241–0.030], P = 0.012). Just under half (48.4%, n = 2867) reported living directly next to a green/blue space, and over half (52.3%; n = 3097) reported using such space at least every day since lockdown. Regular use of green/blue space since lockdown was significantly associated with higher mental health (b = 0.154, 95% CI [0.037–0.272], P = 0.010), lower loneliness (b = −0.334, 95% CI [−0.430 – −0.238], P = 0.001), and higher wellbeing (b = 0.810, 95% CI [0.572–1.047], P = 0.001). Closer proximity to such space was significantly associated with lower loneliness scores (b = −0.224, 95% CI [−0.319 – −0.130], P = 0.001), and higher wellbeing scores (b = 0.632, 95% CI [0.391–0.873], P = 0.001). Conclusion The multi-faceted human–nature relationship may promote key human health benefits in the context of the lockdown. Implications These findings have highlighted the importance of green/blue space and the human–animal relationship, and how they might play a critical role in maintaining people's mental health within a pandemic context. Further targeted investigations relating to these areas and links with human health are important within both pandemic and non-pandemic contexts.

Background: In 2008, mental health units in England went smoke-free by law. This study explores inpatients' experience with a smoke-free policy, their smoking behaviour, dependence, withdrawal and related issues. Material: Semi-structured interviews in a criterion sample of 15 inpatient smokers. Discussion: Patients generally approved of the smoke-free policy, provided they could smoke outside. Most participants had changed their smoking behaviour following admission. Most had little knowledge of nicotine dependence, reported a lack of structured support for smoking cessation, and a general interest in this being made available. Nicotine dependence was reportedly lower in the ward than in the home setting. Conclusions: More structured support is needed to ensure that opportunities for health promotion in a vulnerable population are not being missed.

Zusammenfassung. Zielsetzung: Die Motivation to Stop Scale (MTSS) ist eine englischsprachige Single-Item Skala zur Vorhersage von Rauchstoppversuchen. Ziel dieser Arbeit war die externe Validierung der deutschsprachigen Version der MTSS (Motivation zum Rauchstopp Skala, MRS) an einer Stichprobe von aktuell Tabakrauchenden in Deutschland. Methodik: Datenbasis war die Deutsche Befragung zum Rauchverhalten (DEBRA), eine deutschlandweite, persönlich-mündliche Haushaltsbefragung von Personen ab 14 Jahren mit telefonischer Nachbefragung nach 6 Monaten. Analysiert wurden Daten aus den ersten 18 Wellen (Juni 2016–Mai 2019) von 767 aktuell Tabakrauchenden. Die MRS (Stufe 1–7 = keine bis höchste Motivation) wurde bei der Erstbefragung eingesetzt. Bei der Nachbefragung wurde die Anzahl der Rauchstoppversuche seit Erstbefragung erfasst. Logistische Regression wurde durchgeführt und die diskriminative Genauigkeit der MRS mittels Area Under the Receiver Operating Characteristic Curve (ROC-AUC) berechnet. Ergebnisse: Bei Erstbefragung waren 61,1 % ( n = 469; 95 % Konfidenzintervall (KI) = 57.7–64.6) der 767 Rauchenden nicht zum Rauchstopp motiviert (MRS-Stufe 1–2). Insgesamt unternahmen 185 der 767 Rauchenden (24,1 %; 95 % KI = 21.1–27.1) zwischen der Erst- und Nachbefragung mindestens einen Rauchstoppversuch. Mit steigender Motivationsstufe auf der MRS nahm die Wahrscheinlichkeit für einen Rauchstoppversuch zu: Odds Ratio = 1.37, 95 % KI = 1.25–1.51, bei einer diskriminativen Genauigkeit von ROC-AUC = 0.64. Schlussfolgerung: Die MRS ist ein kurzes und valides Messinstrument zur Erfassung der Rauchstoppmotivation im deutschen Sprachraum.

Background: In England, point-of-sale (PoS) displays in larger shops were prohibited in April 2012, with an exemption for smaller retailers until 2015. The aim of this study was to examine the association between tobacco displays and brand communication at the PoS and adolescent smoking behaviour, and to assess the potential benefits likely to accrue from this legislation. Methods: Self-completion questionnaire survey in students aged 11–15 years in March 2011. Results The odds of ever-smoking doubled for those visiting shops almost daily relative to less than once a week (OR 2.23, 95% CI 1.40 to 3.55), and susceptibility increased by around 60% (OR 1.62, 95% CI 1.25 to 2.10). Noticing tobacco on display every time during store visits increased the odds of susceptibility more than threefold compared with never noticing tobacco (OR 3.15, 95% CI 1.52 to 6.54). For each additional tobacco brand recognised at the PoS, the adjusted odds of being an ever-smoker increased by 5% (OR 1.05, 95% CI 1.03 to 1.06) and of susceptibility by 4% (OR 1.04, 95% CI 1.02 to 1.05). The association between frequency of visiting stores and susceptibility was predominantly due to exposure in small shops. Conclusions: Exposure to and awareness of PoS displays and brands in displays were associated with smoking susceptibility. The association between PoS display exposure and smoking susceptibility was predominantly due to exposure in small shops. These findings suggest that a one-off, comprehensive tobacco display ban is the recommended approach for countries considering a display ban.

Background: In England, point-of-sale (PoS) displays in larger shops were prohibited in April 2012, with an exemption for smaller retailers until 2015. The aim of this study was to examine the association between tobacco displays and brand communication at the PoS and adolescent smoking behaviour, and to assess the potential benefits likely to accrue from this legislation. Methods: Self-completion questionnaire survey in students aged 11-15 years in March 2011. Results: The odds of ever-smoking doubled for those visiting shops almost daily relative to less than once a week (OR 2.23, 95% CI 1.40 to 3.55), and susceptibility increased by around 60% (OR 1.62, 95% CI 1.25 to 2.10). Noticing tobacco on display every time during store visits increased the odds of susceptibility more than threefold compared with never noticing tobacco (OR 3.15, 95% CI 1.52 to 6.54). For each additional tobacco brand recognised at the PoS, the adjusted odds of being an ever-smoker increased by 5% (OR 1.05, 95% CI 1.03 to 1.06) and of susceptibility by 4% (OR 1.04, 95% CI 1.02 to 1.05). The association between frequency of visiting stores and susceptibility was predominantly due to exposure in small shops. Conclusions: Exposure to and awareness of PoS displays and brands in displays were associated with smoking susceptibility. The association between PoS display exposure and smoking susceptibility was predominantly due to exposure in small shops. These findings suggest that a one-off, comprehensive tobacco display ban is the recommended approach for countries considering a display ban.

Objectives High levels of particulate pollution due to second-hand smoke (SHS) have previously been recorded in English prisons. As part of an evaluation to ascertain whether a new comprehensive smoke-free policy introduced in the first four prisons in England was successfully implemented, this study compares indoor air quality on prison wing landing locations three months before and three months after going smoke-free. DesignAn indoor air quality monitoring study, comparing SHS levels before and after a comprehensive smoke-free prison policy. Setting The first four prisons in England to implement a comprehensive smoke-free policy. Primary and secondary measures We compared concentrations of airborne particulate matter [less than] 2.5 microns in diameter (PM₂.₅), as a marker for SHS, on wing landing locations three months before and three months after the smoke-free policy was implemented. Static battery operated aerosol monitors were used to sample concentrations of PM₂.₅ on wing landings. Results After discarding data from monitors that had been tampered with we were able to analyse paired data across four prisons from 74 locations, across 29 wing landing locations, for an average sampling time of five hours and eight minutes. When comparing samples taken three months before with the paired samples taken three months after policy implementation (paired for prison, day of the week, time of day, wing location and position of monitor), there was a statistically significant (p [less than] 0.001) 66% reduction in mean PM₂.₅ concentrations at each of the four prisons sampled, from 39 µg/m³ to 13µg/m³ (difference 26 µg/m³, 95% CI 25 µg/m³ to 26 µg/m³). ConclusionPrison smoke-free policies achieve significant improvements in indoor air quality. A national smoke-free policy would therefore be an effective means of protecting prisoners and staff from harm due to SHS exposure in the prison environment.