To monitor patterns of use of e‐cigarettes to understand their potential impact on the New South Wales (NSW) population in Australia.
A cross‐sectional online survey was carried out with a sample of ...adults in NSW in February 2016. Ever and past 30‐day use of e‐cigarettes, reasons for use, place of purchase and use within outdoor and enclosed public places were assessed along with sociodemographic characteristics.
Ever and past 30‐day use was reported by 13% and 4% of the sample, respectively. More than one‐third of participants did not purchase their own e‐cigarette (36.3%). The most frequently reported reason for using an e‐cigarette for smokers and ex‐smokers was to help quit smoking (45.3% and 44.7%, respectively) while for non‐smokers it was novelty (40%). E‐cigarettes were most commonly used at home (59.4%), in outdoor dining areas (36.8%) and in the workplace (27.8%).
E‐cigarettes are being used by a small percentage of the NSW population. Reasons for e‐cigarette use varied with smoking status. Different sociodemographic characteristics were associated with ever and past 30‐day use of e‐cigarettes. E‐cigarettes are being used in areas that are covered by smoke‐free legislation.
Given e‐cigarettes are being used in smoke‐free areas, policy‐makers could take a precautionary approach by including e‐cigarette use under smoke‐free legislation.
IntroductionSmoking cessation in pregnancy remains a public health priority. Our team used the Behaviour Change Wheel to develop the Midwives and Obstetricians Helping Mothers to Quit smoking ...(MOHMQuit) intervention with health system, leader (including managers and educators) and clinician components. MOHMQuit addresses a critical evidence to practice gap in the provision of smoking cessation support in antenatal care. It involves nine maternity services in New South Wales in a cluster randomised stepped-wedge controlled trial of effectiveness. This paper describes the design and rationale for the process evaluation of MOHMQuit. The process evaluation aims to assess to what extent and how MOHMQuit is being implemented (acceptability; adoption/uptake; appropriateness; feasibility; fidelity; penetration and sustainability), and the context in which it is implemented, in order to support further refinement of MOHMQuit throughout the trial, and aid understanding and interpretation of the results of the trial.Methods and analysisThe process evaluation is an integral part of the stepped-wedge trial. Its design is underpinned by implementation science frameworks and adopts a mixed methods approach. Quantitative evidence from participating leaders and clinicians in our study will be used to produce individual and site-level descriptive statistics. Qualitative evidence of leaders’ perceptions about the implementation will be collected using semistructured interviews and will be analysed descriptively within-site and thematically across the dataset. The process evaluation will also use publicly available data and observations from the research team implementing MOHMQuit, for example, training logs. These data will be synthesised to provide site-level as well as individual-level implementation outcomes.Ethics and disseminationThe study received ethical approval from the Population Health Services Research Ethics Committee for NSW, Australia (Reference 2021/ETH00887). Results will be communicated via the study’s steering committee and will also be published in peer-reviewed journals and presented at conferences.Trial registration numberAustralian New Zealand Trials Registry ACTRN12622000167763. https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12622000167763.
Smoking during pregnancy is the most important preventable cause of adverse pregnancy outcomes, yet smoking cessation support (SCS) is inconsistently provided. The MOMHQUIT intervention was developed ...to address this evidence-practice gap, using the Behaviour Change Wheel method by mapping barriers to intervention strategies. MOHMQuit includes systems, leadership and clinician elements. This implementation trial will determine the effectiveness and cost-effectiveness of MOHMQuit in improving smoking cessation rates in pregnant women in public maternity care services in Australia; test the mechanisms of action of the intervention strategies; and examine implementation outcomes.
A stepped-wedge cluster-randomised design will be used. Implementation of MOHMQuit will include reinforcing leadership investment in SCS as a clinical priority, strengthening maternity care clinicians' knowledge, skills, confidence and attitudes towards the provision of SCS, and clinicians' documentation of guideline-recommended SCS provided during antenatal care. Approximately, 4000 women who report smoking during pregnancy will be recruited across nine sites. The intervention and its implementation will be evaluated using a mixed methods approach. The primary outcome will be 7-day point prevalence abstinence at the end of pregnancy, among pregnant smokers, verified by salivary cotinine testing. Continuous data collection from electronic medical records and telephone interviews with postpartum women will occur throughout 32 months of the trial to assess changes in cessation rates reported by women, and SCS documented by clinicians and reported by women. Data collection to assess changes in clinicians' knowledge, skills, confidence and attitudes will occur prior to and immediately after the intervention at each site, and again 6 months later. Questionnaires at 3 months following the intervention, and semi-structured interviews at 6 months with maternity service leaders will explore leaders' perceptions of acceptability, adoption, appropriateness, feasibility, adaptations and fidelity of delivery of the MOHMQuit intervention. Structural equation modelling will examine causal linkages between the strategies, mediators and outcomes. Cost-effectiveness analyses will also be undertaken.
This study will provide evidence of the effectiveness of a multi-level implementation intervention to support policy decisions; and evidence regarding mechanisms of action of the intervention strategies (how the strategies effected outcomes) to support further theoretical developments in implementation science.
ACTRN12622000167763, registered February 2nd 2022.
The prevalence of modifiable health risk factors and psychological distress following a stroke is high and markedly increase the chance of a second stroke. This study aimed to examine the usability ...and acceptability of an online secondary prevention program addressing modifiable psycho‐behavioural risk factors for stroke survivors.
A pre–post pilot study was conducted in Australia between 2016 and 2017. Participants were recruited through the Australian Stroke Clinical Registry and completed measures of health‐related quality of life, physical activity, smoking status, depression and anxiety, alcohol status, nutrition and internet use. Participants also used an online secondary prevention program (Prevent 2nd Stroke) over a two‐week period. At follow‐up, acceptability and usability of the program were assessed.
A total of 18 out of 19 participants reported engaging in multiple health risk behaviours. Participants reported that they were interested in receiving an online program that provided health information (73.7%). Participants indicated Prevent 2nd Stroke was easy to use (63.1%) and that they would recommend the program to other stroke survivors (63.1%).
The results indicated that online programs are an acceptable way to address these health outcomes.
Further research is needed to assess the effectiveness of these interventions using powered trials.
BackgroundPregnancy is an opportunity for health providers to support women to stop smoking.ObjectivesIdentify the pooled prevalence for health providers in providing components of smoking cessation ...care to women who smoke during pregnancy.DesignA systematic review synthesising original articles that reported on (1) prevalence of health providers’ performing the 5As (‘Ask’, ‘Advise’, ‘Assess’, ‘Assist’, ‘Arrange’), prescribing nicotine replacement therapy (NRT) and (2) factors associated with smoking cessation care.Data sourcesMEDLINE, EMBASE, CINAHL and PsycINFO databases searched using ‘smoking’, ‘pregnancy’ and ‘health provider practices’.Eligibility criteria for selecting studiesStudies included any design except interventions (self-report, audit, observed consultations and women’s reports), in English, with no date restriction, up to June 2017.ParticipantsHealth providers of any profession.Data extraction, appraisal and analysisData were extracted, then appraised with the Hawker tool. Meta-analyses pooled percentages for performing each of the 5As and prescribing NRT, using, for example, ‘often/always’ and ‘always/all’. Meta-regressions were performed of 5As for ‘often/always’.ResultsOf 3933 papers, 54 were included (n=29 225 participants): 33 for meta-analysis. Health providers included general practitioners, obstetricians, midwives and others from 10 countries. Pooled percentages of studies reporting practices ‘often/always’ were: ‘Ask’ (n=9) 91.6% (95% CI 88.2% to 95%); ‘Advise’ (n=7) 90% (95% CI 72.5% to 99.3%), ‘Assess’ (n=3) 79.2% (95% CI 76.5% to 81.8%), ‘Assist (cessation support)’ (n=5) 59.1% (95% CI 56% to 62.2%), ‘Arrange (referral)’ (n=6) 33.3% (95% CI 20.4% to 46.2%) and ‘prescribing NRT’ (n=6) 25.4% (95% CI 12.8% to 38%). Heterogeneity (I2) was 95.9%–99.1%. Meta-regressions for ‘Arrange’ were significant for year (p=0.013) and country (p=0.037).ConclusionsHealth providers ‘Ask’, ‘Advise’ and ‘Assess’ most pregnant women about smoking. ‘Assist’, ‘Arrange’ and ‘prescribing NRT’ are reported at lower rates: strategies to improve these should be considered.PROSPERO registration numberCRD42015029989.
Tobacco smoking is highest among population groups which are the most socially disadvantaged. Internet-based smoking cessation programs have been found to be effective, though rates of internet ...access are not well known in these groups. This study describes the rates of internet use and types of technology used to access the internet by a population of socially disadvantaged smokers. The study also examined relationships between sociodemographic and smoking behaviours with amount of internet use and type of device used.
A cross-sectional survey of 369 clients (response rate 77%) from two non-government community service organisations in metropolitan New South Wales, Australia was conducted using touchscreen computers. Descriptive statistics and logistic regressions were used to examine results.
Eligible participants ranged from 19 to 88 years old current tobacco users. Over half (58%) of the participants reported weekly or more frequent use of the internet with less than a third (28%) not having any access. The odds of using the internet at least weekly decreased with age and as heaviness of smoking increased (OR = 0.94, p < 0.001; OR = 0.81, p = 0.022, respectively). Odds of internet use were higher as income increased (OR = 2.74, p < 0.001 for individuals earning $201-$400 per week; OR = 2.83, p = 0.006 for individuals earning > $400 per week). Device use differed for age and income.
Internet-based interventions appear to reach the majority of socially disadvantaged populations. It is expected that this reach will continue to grow, making internet-based interventions a potential platform for providing care to low socioeconomic individuals who smoke, however inequalities may be exacerbated for those individual without internet access.
Internet use among socially disadvantaged tobacco users is moderate (58%). An internet-based smoking cessation intervention for socially disadvantaged tobacco users may be an effective intervention however, older, heavier tobacco users may not benefit as easily due to limited internet access and therefore acknowledging these limitations when developing an intervention can help to acknowledge limitation of intervention reach.
Addressing the high prevalence of tobacco use experienced by people with severe mental illness (SMI) requires consideration of the influence of wider cultural, socioeconomic and environmental ...factors. This qualitative study aimed to examine the impact of social and living environments on tobacco use and cessation by people with SMI accessing community managed mental health services. The perspectives of both staff and consumers with SMI were explored.
Semi-structured focus groups were undertaken with a purposive sample of community mental health staff and consumers from three sites in three major cities in NSW, Australia. Two sites provided outreach support, and one site provided residential support. Data were collected (2017-2018) until saturation was reached. Focus groups were audio-recorded and transcribed, and thematic analysis was conducted.
Thirty-one staff and 17 consumers participated separately in six focus groups. Themes identified by staff included a degree of fatalism, conceptualising tobacco use as choice rather than addiction and tensions between cessation support and broader models of care. Staff viewed smoke-free home and mental health service policies as effective at promoting quitting but contradictory to recovery-oriented models of care. Consumers identified smoking as an integral part of life and social networks, as a way of maintaining control and lack of social support to quit as key themes. While many consumers reported smoking inside the home, others described enforcing smoke-free rules.
Social and living environments played an integral role in tobacco use and cessation for both staff and consumers. The role of community managed mental health organisations in addressing tobacco use within social and living environments was not strongly supported by staff and sometimes seen as antithetical to recovery-oriented models of care. Potential ways to address this include education and training for prospective and current community mental health organisation staff highlighting the synergy between the recovery-oriented model and provision of preventive health support.
To describe self‐reported inability to access health care and factors associated with lack of access among a socioeconomically disadvantaged group.
A cross‐sectional survey with 906 adult clients of ...a large community welfare agency in New South Wales. Clients attending the service for emergency assistance completed a touchscreen survey.
Inability to access health care in the prior year was reported by more than one‐third of the sample (38%), compared to the 5% found for the general population. Dentists (47%), specialists (43%) or GPs (29%) were the least accessible types of health care. The main reason for inability to access health care was cost, accounting for 60% of responses. Almost half (47%) the sample reported delayed or non‐use of medicines due to cost. Increasing financial stress was associated with increased inability to access GP or specialist care, medicines and imaging. Higher anxiety scores were associated with inability to access health care, and with cost‐related inability to access medicines and imaging.
For disadvantaged groups, cost‐related barriers to accessing care are prominent and are disproportionately high – particularly regarding dentistry, specialist and GP care.
Improvements in health outcomes for disadvantaged groups are likely to require strategies to reduce cost‐related barriers to health care.
Objectives To identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; Indigenous; mental illness and substance abuse; homeless; prisoners; and ...at-risk youth. Design A systematic review was carried out to identify the perceived barriers to smoking cessation within six vulnerable groups. Data sources MEDLINE, EMBASE, CINAHL and PsycInfo were searched using keywords and MeSH terms from each database's inception published prior to March 2014. Study selection Studies that provided either qualitative or quantitative (ie, longitudinal, cross-sectional or cohort surveys) descriptions of self-reported perceived barriers to quitting smoking in one of the six aforementioned vulnerable groups were included. Data extraction Two authors independently assessed studies for inclusion and extracted data. Results 65 eligible papers were identified: 24 with low socioeconomic groups, 16 with Indigenous groups, 18 involving people with a mental illness, 3 with homeless groups, 2 involving prisoners and 1 involving at-risk youth. One study identified was carried out with participants who were homeless and addicted to alcohol and/or other drugs. Barriers common to all vulnerable groups included: smoking for stress management, lack of support from health and other service providers, and the high prevalence and acceptability of smoking in vulnerable communities. Unique barriers were identified for people with a mental illness (eg, maintenance of mental health), Indigenous groups (eg, cultural and historical norms), prisoners (eg, living conditions), people who are homeless (eg, competing priorities) and at-risk youth (eg, high accessibility of tobacco). Conclusions Vulnerable groups experience common barriers to smoking cessation, in addition to barriers that are unique to specific vulnerable groups. Individual-level, community-level and social network-level interventions are priority areas for future smoking cessation interventions within vulnerable groups. Trial registration number: A protocol for this review has been registered with PROSPERO International Prospective Register of Systematic Reviews (Identifier: CRD42013005761).
Background and challenges to implementation: Smoking prevalence is five-times higher among Australian mental health consumers than the general population. Smoking cessation support is not routinely ...provided in community mental health services. Intervention or response: Cancer Council NSW's Tackling Tobacco program partners with not-for-profit community mental health services to assess opportunities for change and develop an action plan for systems change: data collection and monitoring; leadership; policy; supportive systems; staff training and provision of quit support. A simple survey-type tool was developed to identify opportunities for change and completed pre- and post-project to track progress. Pre- and post-surveys have been completed in 11 of services since 2014. Projects aim to achieve at least four systems changes across the six elements. Results and lessons learnt: 100% of the 11 services where pre- and post-surveys were conducted have achieved at least four changes, such as developed a written smoking policy, trained staff, routinely recorded smoking status, and assisted consumers and staff to reduce or quit smoking. The six elements have clarified expectations for systems changes more specific practice guidelines have the potential to improve the quality of smoking care delivered and smoking outcomes for consumers further. Conclusions and key recommendations: Tackling Tobacco has successfully achieved systems changes in all mental health services. Future plans include developing evidence based guidelines to support systems change to address smoking in community mental health services. A consensus process and clustered randomised controlled trial is planned to validate the guidelines and the revised survey, set benchmarks for systems change to address each guideline, and to examine the effectiveness of the systems change intervention at reducing smoking rates amongst consumers attending community managed mental health services.
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