Perceptions of social media harms and potential management strategies: vaping case study.

BACKGROUND: The social media landscape is now ubiquitous in people's everyday lives. It is a space where culture, politics, economics and sociological and public health discourses occur. There is mounting evidence that e-cigarette products are being promoted and advertised on social media, a media platform particularly popular with young people. Our research aimed to understand industry professionals' perceptions of social media harms and potential management strategies using vaping as a case study. METHODS: A critical realist perspective guided reflexive thematic analysis of the qualitative in depth, semi structured interviews. Data collection occurred in January and February 2023 with 13 participants working in the areas of public health, digital media, law, governance, tobacco control and advocacy. RESULTS: Two superordinate themes emerged from the data: (1) Fathoming a complex system (social media) that contained the subordinate themes of Traversing Boundaries (crossing borders, crossing sectors) and Ungovernable (global and local landscapes, vested interests, self-regulation and opacity). (2) Addressing complexity (social media)- that contained the subordinate themes of Strengthening Institutions (global to local, policy and legislation, individuals and organisations); Defanging Industry (responsibility and transparency, moderation and algorithms, complaints); and Engaging Citizens (raising awareness, framing messaging). CONCLUSIONS: There was consensus among participants that e-cigarette related social media content can be harmful and government action is urgently needed. There was an identified need for the development of government led national-level regulatory frameworks, with government led appropriate legislation; identification of an organisation or organisations with suitable levels of regulatory power and resources to monitor, enforce and penalise noncompliant social media companies; accompanied by increased community awareness raising of harmful social media content and improved digital literacy.

University Student Health and Wellbeing Study: A test-retest reliability study of a web-based survey investigating undergraduate student health and wellbeing.

ISSUE ADDRESSED: Understanding the health behaviours of Australian university students and their impact on wellbeing and academic success is important; however, there are limited reliable, population level survey tools to measure student health across a range of domains. The purpose of the research was to determine the reliability of the web-based University Student Health and Wellbeing Study (USHWS) survey via a test-retest reliability study within a large Australian university student population. METHODS: A test-retest of the measurement instrument was completed by a sample of university students (n = 195) over a two-week period. The instrument assessed alcohol and tobacco use, mental health, sexual health, physical activity, nutrition and sun protective behaviours. Test-retest reliability was analysed using two-way random effects model of intraclass correlations (ICC) and AC1 coefficient for individual measurements with 95% confidence intervals (95% CI). RESULTS: Questions on demographics, general health, nutrition, sun protection, alcohol and tobacco use, mental health and sexual health had fair to high reliability (ICCs range from 0.32 to 1.00). Reliability of some physical activity items were poor with large variability (ICC = 0.15, 95% CI 0.01-0.28 to 0.86, 95% CI 0.82-0.89). CONCLUSIONS: A majority of the USHWS survey items represented a moderate to high test-retest reliability. Variability and poor reliability of physical activity questions may be due to survey implementation time and usual behaviour changes. SO WHAT?: The USHWS survey is reliable instrument to assess Australian university student health at a population level with the aim of informing effective programming, policy and initiatives. SUMMARY: The University Student Health and Wellbeing Study (USHWS) survey is a foundational tool to understand university student's health in Australia. The USHWS reported fair to high reliability with few physical activity items showing lower reliability. Greater variability may be due to usual day-to-day fluctuations in behaviour.

Why I Can't, Won't or Don't Test for HIV: Insights from Australian Migrants Born in Sub-Saharan Africa, Southeast Asia and Northeast Asia.

People born in sub-Saharan Africa and Southeast Asia are overrepresented in HIV notifications in Australia. Just under half of all notifications among people from sub-Saharan Africa and Southeast Asia are diagnosed late. Increased HIV testing among these communities is necessary to ensure early diagnosis, better care and reduce likelihood of HIV onward transmission. Recently, Australia has made new HIV testing methods available: rapid HIV testing and self-testing kits. We conducted 11 focus groups with 77 participants with people from sub-Saharan Africa, Southeast Asia and Northeast Asia in four jurisdictions in Australia. Focus groups discussed barriers to HIV testing and the acceptability of new testing methods. Barriers to HIV testing included: cost and eligibility of health services, low visibility of HIV in Australia, HIV-related stigma, and missed opportunities by general practitioners (GPs) for early diagnosis of HIV and linkage into care. Participants had low levels of knowledge on where to test for HIV and the different methods available. Diverse opportunities for testing were considered important. Interventions to increase HIV testing rates among sub-Saharan African, Southeast Asia and Northeast Asian migrants in Australia need to be multi-strategic and aimed at individual, community and policy levels. New methods of HIV testing, including rapid HIV testing and self-testing, present an opportunity to engage with migrants outside of traditional health care settings.

A cross sectional evaluation of a total smoking ban at a large Australian university.

BACKGROUND: Total smoking bans have been found to contribute positively to the health of non-smokers by reducing exposure to second-hand smoke, and to enhance the likelihood of cessation among smokers. METHODS: Two cross-sectional electronic surveys of staff and students at a large Australian university were conducted prior (n = 969) and 1 year post (n = 670) the implementation of a smoke free campus policy. Demographics, tobacco use, intention to quit, attitudes towards smoking and smoking restrictions and awareness of and attitudes towards the campus smoking policy were measured. RESULTS: Exposure to second-hand smoke (SHS) reduced significantly (p < 0.001) one year after policy implementation. Smoking prevalence was similar at both time periods (T1 9.3 %; T2 8.4 %) and over half of smokers indicated they were planning to quit smoking in the future (T1 65.5 vs T2 62.3 %). There was a significant increase in positive responses to the statement the campus should be totally smoke free including all outdoor areas at T2 compared to T1 (T1 60.8 vs T2 71.4 %; p < 0.001), however respondents felt there should be places on campus for smokers to smoke (T1 53.6 vs T2 47 %; p < 0.05). CONCLUSIONS: This study found a significant positive difference in exposure SHS after implementation of the total ban. Although prevalence of smoking in this study was low, the proportion of respondents who were contemplating smoking cessation suggests support for smokers would be beneficial. Continued awareness raising, education and enforcement is likely to enhance the long term outcomes of the total ban.

An exploratory study of smokers' and stakeholders' expectations of the implementation of a smoke-free policy in a university setting.

ISSUES ADDRESSED: Smoke-free policies restricting tobacco use in public places are common in many middle- and high-income countries. Implementation of a smoke-free policy does not automatically result in a smoke-free environment, and appropriate enforcement procedures must be clearly communicated and implemented. Safety and restrictions in private spaces, especially student housing, are also issues that need to be explored. This research explored perceptions and attitudes of staff and student smokers and key stakeholders before the implementation of a complete campus ban on smoking at a large Australian university. METHODS: Interviews were conducted with staff and student smokers (n=9) and stakeholders (n=9). The interviews explored attitudes towards a completely smoke-free policy in the university environment, perceptions relating to enforcement of and compliance with a completely smoke-free policy, and support needed from the university for smokers. RESULTS: Participants generally supported a complete smoke-free policy. Key themes associated with the policy implementation included health implications, stigmatisation and labelling, liberty, and enforcement. CONCLUSION: Smoke-free policies require careful planning, evaluation, and appropriate enforcement to ensure maximum impact. Further research is needed to improve compliance with smoke-free policies in outdoor environments and diverse spaces. SO WHAT? A better understanding of attitudes and intentions towards a smoke-free policy before implementation may provide useful insight into the potential challenges and provide guidelines for the development of strategies to improve policy readiness and adherence. University support for smokers to quit is essential when implementing a smoke-free policy.

No smoking here: examining reasons for noncompliance with a smoke-free policy in a large university.

INTRODUCTION: A large Australian university introduced a campuswide smoke-free policy in 2012. Almost 1 year after implementation, reasons for noncompliance among people observed smoking on campus were examined. METHODS: Six smoking locations on campus were identified after a campuswide audit of smoking indicators (i.e., discarded cigarette butts packets and people observed smoking). At these locations, those observed smokers were interviewed. Interview responses were examined to elicit underlying themes. RESULTS: Fifty people were seen smoking during the observation period. Those smokers interviewed comprised staff (27%) and students (73%) aged between 18 and 24 (45.9%). The majority of the students were international students (51.8%). All respondents acknowledged their awareness of the smoke-free policy. Five explanatory themes for noncompliance emerged: defiance against the policy's perceived threat to self-governance; inconvenience to travel off campus to smoke; smoking as a physiological necessity; unintentional noncompliance through unawareness or confusion of policy boundaries; and ease of avoidance of detection or exposing others to cigarette smoke. CONCLUSIONS: Creating a culture of compliance at the university remains a significant challenge, especially considering the size of the campus, the high proportion of international students, and the logistics associated with monitoring smoking behavior in outdoor areas and on-campus student housing.

"Moving forward: a cross sectional baseline study of staff and student attitudes towards a totally smoke free university campus".

BACKGROUND: Baseline data were collected to inform the adoption, implementation and institutionalisation phases of a completely smoke free campus policy at a large Western Australian university with a diverse student and staff community. METHODS: An online survey was randomly emailed to staff and students to measure the attitudes towards and the acceptability and enforcement of the policy prior to implementation. In total, 969 respondents completed the survey. RESULTS: General attitudes towards smoking were negative. While smokers, ex-smokers and non-smokers were supportive of smoke free policy on campus, 65.7% of respondents felt the campus should be completely smoke free. Respondents indicated a smoke free policy should be stringently enforced. The majority of respondents reported that they had been exposed to second-hand smoke on campus (n = 768; 79.5%). CONCLUSION: Theory of Organisational Change provides a useful framework to support the implementation of the completely smoke free policy in the University setting. The implementation process needs to consider the broad range of issues associated with implementing a completely smoke free policy and address issues such as safety of smokers, ensuring smokers are not marginalised and ensuring a comprehensive program is implemented. These baseline findings can be used to advocate for the implementation of a comprehensive range of strategies that recognise the addictive nature of tobacco smoking and address attitude and behaviour change, environmental adaptations and effective implementation of the policy. Administration should consider smokers and non-smokers when policy is implemented.