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These measures could be used, alongside national guidance from NICE, PHE and NHS England, in assessing progress: universal recording of patients smoking status on admission to acute mental health services (45% of trusts in 2019) the provision of treatment and behavioural support for tobacco dependence to inpatients of acute mental health services (93% of trusts in 2019) the offer within acute services of the choice of combination NRT or varenicline (47%) reduction of the frequency of smoking incidents within private bedrooms and adult mental health wards to less than once a week (52% of trusts in 2019) investment in stop smoking support within community mental health services (62% of trusts in 2019)

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In accordance with these results, upregulation of filaggrin was also observed in oral keratinocytes of smokers 19 , in keratinocyte cell cultures 19, 20 or in reconstructed human epidermis 21 exposed to cigarette smoke extract, and porcine skin explants exposed to cigarette smoke (our unpublished data)

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