Academic literature on the topic 'Smoking cessation Australia'

Smoking among Aboriginal people is extremely widespread (50 v. 17% of the general population). Aboriginal Health Workers (AHW) are at the vanguard of tackling this problem but many themselves smoke and little is known of their knowledge, attitudes and practices regarding smoking cessation. Structured telephone interviews were conducted with 36 AHW, including 31% current smokers, 31% ex-smokers and 38% non-smokers, to assess their current smoking cessation practices and knowledge of health risks, nicotine dependence, cessation strategies and pharmacotherapies. AHW considered diabetes, alcohol use and heart disease more problematic than smoking among Aboriginal people. Fear of appearing hypocritical stopped many who smoke from discussing smoking cessation with clients but also stopped some non-smoking AHW whose colleagues or family smoked. Cultural concerns about telling others ‘what to do’ was also a major impediment. Knowledge of the health effects of smoking was good, but knowledge of appropriate advice around cessation pharmacotherapies was suboptimal. AHW trained in smoking cessation were more knowledgeable and active in smoking cessation, but most AHW had received no training, despite being keen to do so. Specific smoking cessation training is sought and appears needed by AHW, particularly in the areas of brief interventions, motivational interviewing, dependence assessment and pharmacotherapies.

Smoking cessation interventions during routine clinical encounters by health professionals have the potential to reach smokers and facilitate cessation. Although psychologists might appear to be ideal providers of such interventions, international research suggests that their provision is limited. This paper reports the results of a survey conducted in NSW, Australia, of psychologists’ (n = 72) smoking intervention practices, attitudes, and barriers to providing such care. Less than half of the respondents reported assessing smoking status for ‘all or nearly all’ of their clients. Across a range of smoking cessation intervention types, the most frequent response given indicated provision to ‘none or almost none’ of clients who smoked. Only 13% of respondents indicated even ‘advising cessation’ to ‘all or nearly all’ of their smoking clients. Barriers included concern about negative influence on the therapeutic relationship, inadequacy of training and lack of confidence to intervene. Respondents were less likely to provide intervention for smoking than for cannabis, methamphetamine ‘ice’, and alcohol. The study suggests that the potential of Australian psychologists to assist smokers to quit is not being realised, and that there is a need to address the barriers to care provision.

IntroductionIn Australia, an estimated 90% of those entering prison are current tobacco smokers and three-quarters of current prisoners are tobacco smokers.AimsTo identify factors and their relative contributions to smoking cessation among male prisoners.MethodsA total of 425 male tobacco smokers with a median age of 32 years in Australian prisons. The primary outcome was continuous abstinence at 3, 6 and 12 months. We measured various sociodemographic characteristics, drug use, psychological distress and the mental and physical health status of the participants. Multivariate logistic regression models and population attributable risks (PAR%) were used to identify the significant factors and their contributions to smoking cessation rates.ResultsThe median age of participants was 32 years (IQR 25–41 years). High smoking cessation rates were collectively associated with not using drugs, lower psychological distress, good mental health scores and better physical health (PAR%: 93%, 98% and 88% at 3, 6 and 12 months).ConclusionOur study suggests that not using drugs and being in good mental/physical health are the important contributors to continuous abstinence among prisoners. Thus, effective smoking cessation programmes require a multicomponent approach that includes addressing drug problems and mental health functioning.Trial registration number12606000229572.

For patients who smoke, electronic cigarettes may offer a pathway to achieve tobacco abstinence and reduce the risk of postoperative complications. Clinicians have a pivotal role in supporting smoking cessation by patients with lung cancer and coronary artery disease throughout the perioperative period of cardiothoracic surgery. However, the views of Australian cardiothoracic clinicians on electronic cigarettes and smoking cessation are unknown. Semi-structured interviews were conducted with 52 cardiothoracic surgeons, anaesthetists, nurses and physiotherapists in six hospitals in Sydney and thematically analysed. Clinicians’ knowledge about electronic cigarettes and the regulatory environment surrounding them was limited. Clinicians believed that: electronic cigarettes, though unlikely to be safe, were safer than tobacco cigarettes; electronic cigarettes may have a harm reduction role in public health; and electronic cigarettes were a potential smoking cessation tool for the extraordinary circumstances of surgery. The professional role of a clinician and their views about electronic cigarettes as a perioperative smoking cessation aid had an influence on future clinician-patient interactions. Electronic cigarette use is increasing in Australia and clinicians are likely to receive more frequent questions about electronic cigarettes as a cessation aid. Stronger guidance for clinicians is needed on the topic of electronic cigarettes and cardiothoracic surgery.

Introduction: Single-session group smoking cessation interventions have received little attention in the literature.Aims: This study aimed to test the feasibility and outcomes of a single-session large group smoking cessation intervention in a rural area of New South Wales.Methods: Participants from a smoking cessation course (N = 42) were asked about cigarette consumption, quit attempts, and readiness and confidence to quit at registration and six months. The two-hour intervention occurred in a group setting and comprised of cognitive behaviour therapy and pharmacotherapy advice.Results: The analysis revealed a 26.2% (N = 11) quit rate based on self-report and/or carbon monoxide validation at 6 months (intention to treat). Those who quit all used pharmacotherapy: eight (73%) Nicotine Replacement Therapy (NRT); two (18%) varenicline and one (9%) bupropion with NRT. Seven people (17%) used medicines to reduce consumption of cigarettes. A paired samples t test of those still smoking showed a statistically significant decrease in the numbers of cigarettes smoked per day (p<.001).Conclusion: The quit rate of 26.2% from this large single-session smoking cessation course is comparable to that expected from groups having multiple sessions. As a pilot study, these data suggest that a multi-faceted single-session two-hour smoking cessation intervention can successfully support quit attempts in a rural location.

ObjectiveTo explore the perspectives of hospital staff regarding the provision of smoking cessation care.Study designA qualitative description study using focus group discussions.Study settingData were collected across metropolitan regional and rural hospitals in Victoria, Australia, between November and December 2019.ParticipantsClinical and non-clinical hospital staff.ResultsFive focus groups were conducted across four hospitals. Staff (n=38) across metropolitan regional and rural hospitals shared similar views with regards to barriers and facilitators of smoking cessation care. Four themes were present: (1) Clinical Setting wherein views about opportunity and capacity to embed smoking cessation care, relevant policies and procedures and guidelines were discussed; (2) Knowledge consisted of the need for training on the provision of pharmacotherapy and behavioural interventions, and awareness of resources; (3) Consistency represented the need for a consistently applied approach to smoking cessation care by all staff and included issues of staff smoking; and (4) Appropriateness consisted of questions around how smoking cessation care can be safely delivered in the context of challenging patient groups and different settings.ConclusionsStaff across metropolitan regional and rural hospitals experience similar views and identified shared barriers in implementing smoking cessation care. Responding to staff concerns and providing support to address smoking with patients will help to foster a consistent approach to cessation care. Clear practice guidelines for multidisciplinary clinical roles need to underpin staff training in communication skills, include priorities around smoking cessation care, and provide the authorising environment in which clinical staff actively provide smoking cessation care.

This study investigated the impact of a behaviorally based intervention designed to increase the number of hospitals that routinely provide effective smoking cessation programs for pregnant women. In Queensland, Australia, 70 publicly funded hospitals were matched on numbers of births and maternal socioeconomic status and randomly allocated to an awareness-only intervention group or a behaviorally based intervention group. Success was defined as the routine offer of an evidence-based smoking cessation program to at least 80% of the pregnant clients who smoke. At 1 month, 65% of the behaviorally based intervention hospitals agreed to provide materials about smoking cessation programs for their antenatal patients, compared with 3% of the awarenessonly hospitals. After 1 year, 43% of the intervention hospitals still provided the material, compared with 9% of the awareness-only hospitals. These findings showthat a brief intervention to hospitals can encourage antenatal staff to provide smoking cessation materials to pregnant women.

ObjectivesTo assess smoking habits, nicotine use, exposure to passive smoking, awareness of associated harms, and experiences with and preferences for smoking cessation support among people with multiple sclerosis (MS).DesignOnline survey, convenience sampling.SettingCommunity setting, Australia.ParticipantsAdults living in Australia with probable or diagnosed MS were recruited via social media and newsletters to participate in 2020.ResultsOf the 284 participants in our convenience sample, 25.7% were current smokers (n=73) and 38.0% were former smokers (n=108). Awareness of the harms of smoking on MS onset (n=68, 24.3%) and progression (n=116, 41.6%) was low. Almost a quarter (n=67, 23.8%) of participants were regularly exposed to passive smoke, and awareness of associated harm was also low (n=47, 16.8%). Among current smokers, 76.1% (n=54) had tried quitting and 73.2% considered quitting within 6 months (n=52). Many participants reported perceived short-term benefits of smoking, and long-term benefits of quitting, on MS symptoms and general well-being (short-term n=28, 40.0%; long-term n=28, 82.4%). While most participants reported that their neurologist (n=126, 75.4%) or other healthcare providers (n=125, 74.9%) had assessed smoking status, very few neurologists (n=3, 1.8%) or other healthcare providers (n=14, 8.4%) had provided help with quitting. Most current smokers preferred speaking about smoking to a neurologist (n=36, 52.2%) or general practitioner (n=41, 59.4%). Almost 60% of the current smokers wanted additional cessation information specific to MS (n=41, 59.4%), and 45.5% said this information would motivate them to quit smoking (n=30).ConclusionsOur convenience sample, which may not be representative, indicated an urgent need for regular evidence-based smoking cessation supports for people with MS. Most participants felt they would benefit from smoking cessation advice. MS clinicians, in collaboration with patient organisations, smoking cessation services and general practitioners, should make smoking cessation promotion with people with MS a priority.

Introduction: Smoking prevalence remains high among people with a mental illness, contributing to higher levels of morbidity and mortality. Health and community services are an opportune setting for the provision of smoking cessation care. Although family carers are acknowledged to play a critical role in supporting the care and assistance provided by such services to people with a mental illness, their expectations regarding the delivery of smoking cessation care have not been examined.Aims: To explore family carer expectations of smoking cessation care provision by four types of health services, to clients with a mental illness, and factors associated with expectations.Methods: A cross-sectional survey was conducted with carers of a person with a mental illness residing in New South Wales, Australia. Carers were surveyed regarding their expectations of smoking cessation care provision from four types of health services. Possible associations between carer expectation of smoking cessation care provision and socio-demographic and attitudinal variables were explored.Results: Of 144 carers, the majority of carers considered that smoking cessation care should be provided by: mental health hospitals (71.4%), community mental health services (78.0%), general practice (82.7%), and non-government organisations (56.6%). The factor most consistently related to expectation of care was a belief that smoking cessation could positively impact mental health.Conclusions: The majority of carers expected smoking cessation treatment to be provided by all services catering for people with a mental illness, reinforcing the appropriateness for such services to provide smoking cessation care for clients in an effective and systematic manner.

Issue addressed: Australia has succeeded in lowering the overall prevalence of tobacco smoking in the last four decades and has enjoyed a worldwide reputation for innovative policy. However, this success has not extended to Indigenous Australians. Method: Narrative review and critique of literature from government, public health, health promotion, marketing and communication on smoking cessation in Australia. Main points: We first consider the history of government anti-smoking measures including legislation and communication initiatives including advertising and sponsorship bans, health warnings and ‘no smoking’ rules affecting anti-smoking norms, culminating in the banning of branding and the advent of tobacco plain packaging. We also review the effects of excise increases and smoking cessation aids such as quit lines and nicotine replacement therapy. For each type of intervention, both population-wide and those specifically directed at Indigenous people, we consider the probable reasons for the failure to reach Aboriginal and Torres Strait Islander people or alter their smoking patterns, and make suggestions for improvements in interventions and their evaluation. Conclusion: The history of anti-smoking initiatives in Australia suggests that community-based health initiatives are likely to be more effective in addressing Indigenous people and helping smokers to quit.

Background: Tobacco smoking leads to death or disability and a drain on national resources. The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18–30 years are relatively resistant to anti-smoking messages.Aims: This research project aimed to test a digital ageing intervention to promote smoking cessation among young adult smokers within a community pharmacy setting and explore the value of the unfunded intervention within pharmacy practice.The primary outcomes were efficacy of the intervention measured by quit attempts and nicotine dependence and the secondary outcomes were cost-effectiveness of the intervention from a health sector perspective and community pharmacy business viability.Methods: This research project was named ‘Pharmacy PAINT’ (Photo-Ageing INTervention) and was conducted in community pharmacies in Perth, Western Australia in two trials: i) a pilot study; ii) a full Randomised Controlled Trial (RCT).The research was underpinned by the Medical Research Council (MRC) – Framework for design and evaluation of complex interventions, to improve health and the complex intervention was delivered by a qualified, registered pharmacist.Young smokers, aged 18 – 30 years who randomly entered the pharmacy, either to have a prescription dispensed or purchase an OTC (Over the Counter) medication were eligible to be recruited for the research if they were English speaking and able to give informed consent, did not have beards, moustaches or facial accessories that couldn’t be removed, were available for phone survey follow-ups and were not using Nicotine Replacement Therapy (NRT) or taking nicotine dependence medications.Consenting participants were randomised into two groups: a control group and an intervention group with equal numbers in each. Allocation into the groups alternated weekly so that all participants recruited in any specific week received the same treatment.Participants in the control group received standard smoking cessation advice from a pharmacist-researcher. Participants in the intervention group received the same standard smoking cessation advice from the pharmacist-researcher but in addition, they were photographed and their images digitally aged, as a smoker and non-smoker and then invited to view the age-processed images.The intervention involved using a photo-ageing tool (APRIL® Age Progression Software, 3D age progression software based upon Canadian normative ageing data) to deliver the non-smoking message by exposing the young smokers to graphic images of the detrimental effects of smoking on their future facial appearance.Results: The pilot study recruited 50 participants, 25 allocated to the control group and 25 to the intervention group and participants were followed-up for a three-month period. The pilot study was conducted between February 2008 to December 2008 and the results informed the feasibility, recruitment strategy, outcome measure, effect size and attrition rate for the subsequent RCT.The RCT was conducted from January 2010 to June 2011 and involved 160 participants, with 80 allocated in each of the control and intervention groups. Participants were followed-up for a six-month period. At the final six-month follow-up, five (8%) in the control group declared that they had quit smoking, however, only one (1.3%) of these subjects was an objectively confirmed non-smoker (validated on carbon monoxide (CO) testing). For the intervention group, 22 (38%) declared they had quit, with 11 (13.8%) confirmed by CO testing. This difference in these proportions between groups was highly significant (p = 0.005 by Fisher’s exact test). Results for the change in nicotine dependence score using the Fagerström Scale, showed a greater proportion of the subjects in the intervention group moving to a lower smoking dependence score than the control subjects (p<0.0001).Total costs of implementing the intervention from a health sector perspective were AUD 366 or the equivalent of AUD 4.58 per participant (Table 7). With an additional 10 quitters in the intervention group compared with the control group (11 versus one respectively), the incremental cost-effectiveness ratio (ICER) was AUD 37 per additional quitter. Cost offsets of AUD 2,144 from a reduction in the health care costs of quitters resulted in the intervention potentially generating net total cost savings of AUD 1,778.Participants indicated a mean willingness to pay for the digital ageing service of AUD 20.25, which exceeded the mean cost per participant for delivering the service of AUD 4.58. This suggested the service may be viable if the customer was charged in the pharmacy if not subsidised by government. The median willingness to pay of AUD 20.00 was similar to the mean value. Ten respondents thought aspects of the service could be improved and so made the following recommendations: to also provide information on methods to quit; to also offer a support program; to also show the effects of smoking on major organs. Over 80% of participants said they would be more likely both to use the pharmacy to purchase future smoking cessation therapies and to use it more generally for other purchases. Over 80% of participants also thought their friends would be willing to pay for the service and the vast majority of participants said they would recommend photo-ageing to one or more friends who were smokers.CONCLUSION: Emphasising the link of smoking to the detrimental effects on skin and physical appearance using a personalised promotion intervention can be an effective motivator to persuade younger adult smokers to quit. This intervention can be proactively and economically delivered by a pharmacist as primary health care counselling in a community pharmacy setting.

Includes examples of information booklets as appendices
Includes bibliographical references: p. 232-251
xiv, 251 p. : photo. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Community Medicine, 1994

This qualitative study into the effective use of fear arousal in social marketing advertising, focused on exploring gender differences in smokers' attitudes towards threats in anti-smoking messages in the 40 to 50 year old age group. This age group of smokers has received relatively little attention in the fear arousal literature to date, presumably because their 'hard core' attitudes are perceived as difficult to change by social marketing and medical practitioners. The key purpose of this study was to explore the attitudinal responses of male and female smokers in the 40 to 50 year old age group to anti-smoking messages and in particular to those using death and non-death threats. Unexpected findings from a previous study (Henley 1997) were the first to indicate that significant gender differences occurred in this age group to anti-smoking messages. Henley's (1997) study focused on death versus non-death threats in social marketing messages in two age groups of smokers: 16 to 25 and 40 to 50 year aids. Response to the death threat, 'Quit smoking or you'll die of emphysema' was compared to the response of the non-death threat, 'Quit smoking or you'll be disabled by emphysema', in producing change in attitude, motivation and intention to adopt the recommended behaviour. The appropriateness of these threat messages was considered in relation to male and female smokers in two age groups, 16-25 years and 40-50 years. Henley (1997) found that significant differences occurred between older male and female smokers' responses to death and non-death threats in social marketing messages, and that in general, 40-50 year old males responded more to death threats and 40-50 year old females responded more to non-death threats, with the exception of death threats and loved ones. Focus groups were the qualitative method used for data collection in this study. Data was collected from four focus groups (2 male and 2 female), that consisted of 40 to 50 year old regular smokers. Group interviews were conducted as free flowing discussions interspersed with questions pertaining to the major objectives of the study. Projective questioning techniques were used to draw out participants' deeply held beliefs rather than their more easily accessible altitudes. As such, they were not asked direct questions pertaining to attitudes or specifically prompted for response to death and non-death threats. The men and women in this study fitted the characteristics of 'hard core', precontemplative smokers due to their long term smoking behaviour and low-involvement with anti-smoking information. Data were analysed manually according to themes in relation to the major objectives with special consideration given to gender differences that emerged. Attitudes were examined according to emotional, cognitive and behavioural responses. Gender differences are discussed in relation to how responses were articulated. Significant gender differences occurred in attitudinal response to threat in antismoking messages. In particular, gender differences occurred in relation to perceived self-efficacy, and strategies employed to cope with cognitive dissonance and negative emotions that emerged from exposure to anti-smoking messages. Men in this study revealed low levels of perceived self-efficacy, self-esteem and a sense of helplessness and powerlessness over their smoking behaviour. Discussions revealed the men had adopted maladaptive coping responses such as avoidance behaviour and denial in relation to anti-smoking messages. Women in this study revealed higher levels of self-efficacy and derived more benefits from smoking than men. However, their responses indicated anger towards patriarchal and authoritarian anti-smoking messages. Data also revealed that women had adopted maladaptive coping responses such as defiance, reactance and avoidance behaviour in relation to anti-smoking messages. An unexpected finding in this study was that both genders were clearly more accepting of positively framed anti-smoking messages that engendered self-esteem and higher efficacy. The implications for practitioners and researchers are that market segmentation is advisable for older smokers. 'Hard core' smokers may be a difficult group to reach via negatively framed anti-smoking messages and it is possible that positively framed messages may offer a solution. Further quantitative research is indicated into the relative effectiveness of positively framed messages and 'hard core' smokers.

Background: Evidence-based policy making (EBPM) has become an article of faith. While critiques have begun to emerge, they are predominately based on theory or opinion. This thesis uses the 2008 case study of tobacco control policy making for Indigenous Australians to analyse empirically the concept of EBPM. Research questions: (1) How, if at all, did the Government use evidence in Indigenous tobacco control policy making? (2) What were the facilitators of and barriers to the use of evidence? (3) Does the case study augment or challenge the apparent inviolability of EBPM? Methods: Data were collected through: (1) a review of primary documents largely obtained under the Freedom of Information Act 1982; and (2) interviews with senior politicians, senior bureaucrats, government advisors, Indigenous health advocates and academics. Results: Historically, Indigenous smoking was not problematised because Indigenous people faced other urgent health/social problems and smoking was considered a coping mechanism. High prevalence data acquired salience in 2007/08 in the context of a campaign to reduce disparities between Indigenous and non-Indigenous health outcomes. Ensuing policy proposals were based on recommendations from literature reviews, but evidence contained in those reviews was weak; notwithstanding this, the proposals were adopted. Historical experiences led policy makers to give special weight to proposals supported by Indigenous stakeholders. Moreover, the perceived urgency of the problem was cited to justify a trial-and-evaluate approach. Conclusion: While the policies were not based on quality evidence, their formulation/adoption was neither irrational nor reckless. Rather, the process was a justifiable response to a pressing problem affecting a population for which barriers existed to data collection, and historical experiences meant that evidence was not the only determinant of policy success. The thesis proposes a more nuanced appraoch to conceptualising EBPM wherein evidence is neither a necessary nor a sufficient condition for policy. The approach recognises that rigorous evidence is always desirable but that, where circumstances affect the ability of such research being conducted, consideration must be given to acting on the basis of other knowledge (e.g. expert opinion, small-scale studies). Such an approach is justifiable where: (1) inaction is likely to lead to new/continued harm; and (2) there is little/no prospect of the intervention causing additional harm. Under this approach, non-evidentiary considerations (e.g. community acceptability) must be taken into account.

"This report is submitted in partial requirement for the award of the Master of Public Health at the University of Queensland" Thesis (M.P.H.) - University of Queensland, 2004.
Includes bibliography.

Research Doctorate - Doctor of Philosophy (PhD)
Over four million people world wide die of smoking related disease each year. In Australia, tobacco smoking is the single largest cause of preventable death and disability. While hospitals have been identified as a potentially valuable setting in which to encourage patient cessation, research in Australia and overseas suggests that hospital staff do not routinely provide effective smoking cessation care to their patients. This thesis consists of a number of studies addressing this issue.

Research Doctorate - Doctor of Philosophy (PhD)
This thesis by publication is composed of an introduction, seven papers and a final chapter with conclusions. All papers relate to developing an understanding of the factors contributing to the high prevalence of smoking among pregnant Aboriginal and Torres Strait Islander women, or to approaches to supporting women to quit smoking. At the time of submission of this thesis, six of the seven papers have been published or accepted for publication in peer-reviewed journals, and the other paper is under review. The final chapter, Conclusions, lessons learnt and next steps, discusses the findings from these papers under three conceptual areas: the social and structural drivers of smoking; the role of individual characteristics; and support from antenatal providers. For each area it identifies the implications of reducing maternal smoking and suggests areas where future research is required. It argues for more intervention research in this field and discusses the challenges inherent in achieving this.

Research Doctorate - Doctor of Philosophy (PhD)
Background. E-cigarette use is a globally contentious topic. Most of the previous studies on e-cigarette use have not examined differences in usage in relation to gender. The findings regarding the association between e-cigarette use and subsequent cigarette smoking initiation and smoking cessation are also inconsistent. In Australia, no studies have investigated the association between e-cigarette use and smoking initiation among young adults who have never smoked. Additionally, few population-based longitudinal studies have investigated the association of e-cigarette use with smoking cessation, either internationally or in Australia. This thesis aims to identity and investigate the risk and protective factors of e-cigarette use and the role that e-cigarettes play in smoking initiation and cessation in Australian women. Methods. This thesis uses online survey data collected from the new young cohort of Australian women who were born between 1989 and 1995 and who participated in the Australian Longitudinal Study on Women’s Health. The research was conducted to identify the risk and protective factors of e-cigarette use and the role that e-cigarettes play in smoking initiation and smoking cessation. Results. Young age, smoking status, alcohol use, intimate partner violence and adverse childhood experiences (i.e., traumatic childhood experiences) were identified as factors that positively associated with e-cigarette use in the study population. This thesis discovered that although ever e-cigarette use is associated with subsequent cigarette smoking among never smokers, it also hinders subsequent cigarette smoking cessation among current smokers. Conversely, an umbrella review found that most nicotine and non-nicotine drugs (e.g., NRT, bupropion and varenicline) are effective treatments for smoking cessation. Conclusions. Certain efforts are required to prevent young people and non-smokers from nicotine addiction that is acquired through e-cigarette use. Subsequent interventions to curb the use of e-cigarettes among young Australian women should target risk factors such as young people, alcoholics, people with a history of intimate partner violence and people exposed to childhood adversities.

Background Australia is a multi-cultural society with increasing rates of people from culturally and linguistically diverse (CALD) backgrounds. On average, CALD groups have higher rates of tobacco use, lower participation in cancer screening programs, and poorer health outcomes than the general Australian population. Lower cancer screening and smoking cessation rates are due to differing cultural norms, health-related attitudes, and beliefs, and language barriers. Interventions can help address these potential barriers and increase tobacco cessation and cancer screening rates among CALD groups. Cancer Council NSW (CCNSW) aims to reduce the impact of cancer and improve cancer outcomes for priority populations including CALD communities. In line with this objective, CCNSW commissioned this rapid review of interventions implemented in Australia and comparable countries. Review questions This review aimed to address the following specific questions: Question 1 (Q1): What smoking cessation interventions have been proven effective in reducing or preventing smoking among culturally and linguistically diverse communities? Question 2 (Q2): What screening interventions have proven effective in increasing participation in population cancer screening programs among culturally and linguistically diverse populations? This review focused on Chinese-, Vietnamese- and Arabic-speaking people as they are the largest CALD groups in Australia and have high rates of tobacco use and poor screening adherence in NSW. Summary of methods An extensive search of peer-reviewed and grey literature published between January 2013-March 2022 identified 19 eligible studies for inclusion in the Q1 review and 49 studies for the Q2 review. The National Health and Medical Research Council (NHMRC) Levels of Evidence and Joanna Briggs Institute’s (JBI) Critical Appraisal Tools were used to assess the robustness and quality of the included studies, respectively. Key findings Findings are reported by components of an intervention overall and for each CALD group. By understanding the effectiveness of individual components, results will demonstrate key building blocks of an effective intervention. Question 1: What smoking cessation interventions have been proven effective in reducing or preventing smoking among culturally and linguistically diverse communities? Thirteen of the 19 studies were Level IV (L4) evidence, four were Level III (L3), one was Level II (L2), none were L1 (highest level of evidence) and one study’s evidence level was unable to be determined. The quality of included studies varied. Fifteen tobacco cessation intervention components were included, with most interventions involving at least three components (range 2-6). Written information (14 studies), and education sessions (10 studies) were the most common components included in an intervention. Eight of the 15 intervention components explored had promising evidence for use with Chinese-speaking participants (written information, education sessions, visual information, counselling, involving a family member or friend, nicotine replacement therapy, branded merchandise, and mobile messaging). Another two components (media campaign and telephone follow-up) had evidence aggregated across CALD groups (i.e., results for Chinese-speaking participants were combined with other CALD group(s)). No intervention component was deemed of sufficient evidence for use with Vietnamese-speaking participants and four intervention components had aggregated evidence (written information, education sessions, counselling, nicotine replacement therapy). Counselling was the only intervention component to have promising evidence for use with Arabic-speaking participants and one had mixed evidence (written information). Question 2: What screening interventions have proven effective in increasing participation in population cancer screening programs among culturally and linguistically diverse populations? Two of the 49 studies were Level I (L1) evidence, 13 L2, seven L3, 25 L4 and two studies’ level of evidence was unable to be determined. Eighteen intervention components were assessed with most interventions involving 3-4 components (range 1-6). Education sessions (32 studies), written information (23 studies) and patient navigation (10 studies) were the most common components. Seven of the 18 cancer screening intervention components had promising evidence to support their use with Vietnamese-speaking participants (education sessions, written information, patient navigation, visual information, peer/community health worker, counselling, and peer experience). The component, opportunity to be screened (e.g. mailed or handed a bowel screening test), had aggregated evidence regarding its use with Vietnamese-speaking participants. Seven intervention components (education session, written information, visual information, peer/community health worker, opportunity to be screened, counselling, and branded merchandise) also had promising evidence to support their use with Chinese-speaking participants whilst two components had mixed (patient navigation) or aggregated (media campaign) evidence. One intervention component for use with Arabic-speaking participants had promising evidence to support its use (opportunity to be screened) and eight intervention components had mixed or aggregated support (education sessions, written information, patient navigation, visual information, peer/community health worker, peer experience, media campaign, and anatomical models). Gaps in the evidence There were four noteworthy gaps in the evidence: 1. No systematic review was captured for Q1, and only two studies were randomised controlled trials. Much of the evidence is therefore based on lower level study designs, with risk of bias. 2. Many studies provided inadequate detail regarding their intervention design which impacts both the quality appraisal and how mixed finding results can be interpreted. 3. Several intervention components were found to have supportive evidence available only at the aggregate level. Further research is warranted to determine the interventions effectiveness with the individual CALD participant group only. 4. The evidence regarding the effectiveness of certain intervention components were either unknown (no studies) or insufficient (only one study) across CALD groups. This was the predominately the case for Arabic-speaking participants for both Q1 and Q2, and for Vietnamese-speaking participants for Q1. Further research is therefore warranted. Applicability Most of the intervention components included in this review are applicable for use in the Australian context, and NSW specifically. However, intervention components assessed as having insufficient, mixed, or no evidence require further research. Cancer screening and tobacco cessation interventions targeting Chinese-speaking participants were more common and therefore showed more evidence of effectiveness for the intervention components explored. There was support for cancer screening intervention components targeting Vietnamese-speaking participants but not for tobacco cessation interventions. There were few interventions implemented for Arabic-speaking participants that addressed tobacco cessation and screening adherence. Much of the evidence for Vietnamese and Arabic-speaking participants was further limited by studies co-recruiting multiple CALD groups and reporting aggregate results. Conclusion There is sound evidence for use of a range of intervention components to address tobacco cessation and cancer screening adherence among Chinese-speaking populations, and cancer screening adherence among Vietnamese-speaking populations. Evidence is lacking regarding the effectiveness of tobacco cessation interventions with Vietnamese- and Arabic-speaking participants, and cancer screening interventions for Arabic-speaking participants. More research is required to determine whether components considered effective for use in one CALD group are applicable to other CALD populations.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.