Tobacco sales through vending machines: Insights from owners and managers of Australian alcohol-licenced premises with different licencing schemes.

OBJECTIVE: Tobacco sales in alcohol-licenced premises present a very problematic trigger for tobacco sales-a trigger that is particularly problematic for attempting quitters and people who smoke occasionally. This study reports on the attitudes, beliefs, and experiences of owners or managers of alcohol-licenced venues that sell tobacco exclusively through vending machines. METHODS: The study involved a telephone survey of alcohol-licenced venue owners or managers in New South Wales, Queensland, and Western Australia. Associations between outlet characteristics and current selling of tobacco exclusively via vending machines were examined, and responses to the open-ended question asking why the venue was likely or unlikely to stop selling cigarettes were manually coded. RESULTS: For most alcohol-licenced venues that sold tobacco exclusively through a vending machine, the profit from these sales was not considered important for the business. However, only a small minority (4%) of these venues reported that they were likely to stop selling tobacco. The most commonly cited concerns about stopping were customer dissatisfaction and potential loss of customers. CONCLUSION: The study provides the first evidence on the attitudes of owners/managers to the importance of tobacco sales, revealing that the vast majority of those owners/managers do not believe that tobacco sales are important for their venue. IMPLICATIONS FOR PUBLIC HEALTH: The presence of tobacco vending machines implicitly promotes tobacco products and therefore contravenes Australia's obligations under the World Health Organization Framework Convention on Tobacco Control. The results provide powerful evidence that restrictions on tobacco sales can be implemented without major financial damage to those vendors.

Vape stores in Western Australia: growth, proximity to schools and socio-economic gradient of density.

OBJECTIVE: To audit the number and location of dedicated e-cigarette retailers ("vape stores") in Western Australian (WA), measure proximity to schools and model the association between vape store density and socio-economic disadvantage. METHODS: Vape stores were identified via internet search and geocoded. Proximity to schools was measured. Regression modelling was used to investigate the association between vape store density and socio-economic disadvantage. RESULTS: 194 stores were identified, with 88% located within one kilometre of a school. In metropolitan WA, vape store density was nearly seven times higher in the most socio-economically disadvantaged areas than in the least disadvantaged areas (rate ratio 6.9, 95% confidence interval 3.4-15.5). CONCLUSIONS: There has been rapid, recent growth in the number of vape stores in WA, with most located within walking distance of schools. In metropolitan WA, vape store density is strongly associated with socio-economic disadvantage, mirroring the pattern observed globally for tobacco outlets. IMPLICATIONS FOR PUBLIC HEALTH: This is the first Australian study demonstrating that vape stores are more densely located in socio-economically disadvantaged areas. Vape stores' proximity to schools may increase young people's access and exposure to promotional signage. There is a need to address ready e-cigarette availability through strong regulatory and compliance measures.

Hospital length of stay and readmission after elective surgery: a comparison of current and former smokers with non-smokers.

BACKGROUND: The purpose of this study was to investigate differences between non-smokers, ex-smokers and current smokers in hospital length of stay (LOS), readmission (seven and 28 days) and cost of readmission for patients admitted for elective surgery. METHODS: A retrospective cohort study of administrative inpatient data from 24, 818 patients admitted to seven metropolitan hospitals in Western Australia between 1 July 2016 and 30 June 2019 for multiday elective surgery was conducted. Data included smoking status, LOS, procedure type, age, sex and Indigenous status. LOS for smoking status was compared using multivariable negative binomial regression. Odds of readmission were compared for non-smokers and both ex-smokers and current smokers using separate multivariable logistic regression models. RESULTS: Mean LOS for non-smokers (4.7 days, SD=5.7) was significantly lower than both ex-smokers (6.2 days SD 7.9) and current smokers (6.1 days, SD=8.2). Compared to non-smokers, current smokers and ex-smokers had significantly higher odds of readmission within seven (OR=1.29; 95% CI: 1.13, 1.47, and OR=1.37; 95% CI: 1.19, 1.59, respectively) and 28 days (OR=1.35; 95% CI: 1.23, 1.49, and OR=1.53; 95% CI: 1.39, 1.69, respectively) of discharge. The cost of readmission for seven and 28-day readmission was significantly higher for current smokers compared to non-smokers (RR=1.52; 95% CI: 1.1.6, 2.0; RR=1.39; 95% CI: 1.18, 1.65, respectively). CONCLUSION: Among patients admitted for elective surgery, hospital LOS, readmission risk and readmission costs were all higher for smokers compared with non-smokers. The findings indicate that provision of smoking cessation treatment for adults undergoing elective surgery is likely to produce multiple benefits.

Awareness of cancer risk factors and protective factors among Australian adults.

ISSUE ADDRESSED: Up to one-third of incident cancers in Australia are attributable to modifiable factors. Understanding the general public's awareness of cancer risk and protective factors is important for identifying knowledge gaps and informing the development of effective and targeted health promotion strategies. METHODS: In a telephonic survey of 355 Western Australian adults aged 18-54 years (48% male), with a sample skewed towards low-socio-economic status areas, respondents rated the effect on cancer risk of 11 established cancer risk factors and seven established cancer protective factors. RESULTS: Most respondents correctly recognised the increased cancer risk from sun tanning (94%), asbestos (92%), pesticide use (92%) and being overweight or obese (86%), and the protective effect of being physically active (82%). Half (52%) of respondents incorrectly believed that red wine decreased or had no effect on cancer risk. One in five respondents (19%) incorrectly believed that sunscreen use increased cancer risk. Only 18% of respondents were aware that human papillomavirus (HPV) vaccination confers a protective effect, while 17% believed it increases risk. CONCLUSIONS: Although the majority of respondents were aware of certain established cancer risk and protective factors, a sizeable proportion held misconceptions about the cancer risk associated with red wine consumption, sunscreen use and HPV vaccination. SO WHAT?: Health promotion programs designed to educate the public about modifiable cancer risk factors may need to increase public awareness of the safety of preventive factors such as HPV vaccination and sunscreen, and the increased cancer risk from consumption of all alcoholic beverage types, including red wine.

Anti-smoking advertisements are perceived differently by smokers and individuals with health or advertising knowledge.

OBJECTIVE: Several studies have examined the characteristics of anti-smoking advertisements that are associated with quitting behaviour. Some studies use researchers or graduate students to code advertisement characteristics, while others recruit smokers or members of the general public. The aim of this study was to assist future campaign development by assessing whether anti-smoking advertisement characteristics are coded differently by smokers and 'experts' (individuals with knowledge of health promotion, public health or advertising). METHODS: A total of 49 smokers and 42 experts coded anti-smoking advertisements according to four key characteristics (emotional/cognitive approach, negative/positive tone, message frame, and main message) and the use of eight executional techniques. Chi-squared tests were used to measure differences in coding outcomes between smokers and experts. RESULTS: There were significant differences between smokers and experts in the coding of all key characteristics and four of the eight executional techniques. Compared with smokers, experts were more likely to perceive advertisements as negative in tone and as inducing fear. CONCLUSIONS: Smokers and experts perceived the characteristics of anti-smoking advertisements differently. Implications for public health: Differences between smokers and experts may need to be taken into account where studies use either of these groups to code advertisements for campaign development or evaluation purposes.

Self-reported shift work, recall bias, and belief about disease causation in a case-control study of breast cancer.

BACKGROUND: Recall bias is a potential source of misclassification in case-control studies. Studies have shown that the association between exposure and disease can differ according to participants' beliefs or knowledge about the effect of that exposure on disease. We investigated the association between belief about breast cancer causation and self-reported shift work exposure in a case-control study. METHODS: Women completed a questionnaire asking whether they believed that shift work caused cancer either before or after reporting their history of shift work. We measured: whether belief modified the association between reported shift work and disease; whether belief was associated with reported shift work exposure; and whether being prompted to recall shift work exposure was associated with an increased likelihood of believing that shift work increased breast cancer risk. RESULTS: There was a significant association between believing shift work increased breast cancer risk and reporting exposure to shift work. Being prompted to recall shift work was not associated with a belief that shift work increased risk. CONCLUSION: The association between pre-existing belief about breast cancer risk and reported shift work is likely to be due to exposed individuals believing that exposure increases risk, rather than resulting from recall bias.

Women's beliefs about breast cancer causation in a breast cancer case-control study.

OBJECTIVE: Our study sought to ascertain women's beliefs about breast cancer risk factors and whether these beliefs differed by demographic factors and personal and family history of breast cancer. METHODS: Participants in a case-control study of breast cancer rated the effect of 37 exposures on the risk of being diagnosed with breast cancer. Chi-square tests were undertaken to measure differences in responses between cases and controls for each exposure. Logistic regression was undertaken to ascertain whether demographic factors and personal and family history of breast cancer affected participants' ability to correctly identify known breast cancer risk factors. RESULTS: A total of 2742 participants completed the questionnaire, comprising 1109 cases and 1633 controls. Significant differences (p < 0.05) between cases and controls were found for 16 of the 37 exposures. Younger women and university-educated women were more likely to correctly identify known breast cancer risk factors. Women's perceptions about the effect of alcohol consumption on breast cancer risk, particularly regarding red wine, differed from that reported in the literature. CONCLUSIONS: Beliefs about risk factors for breast cancer may differ between cases and controls. Public health initiatives aimed at increasing awareness of breast cancer risk factors should consider that women's beliefs may differ by demographic factors and family history of breast cancer.

Keeping primary care "in the loop": General practitioners want better communication with specialists and hospitals when caring for people diagnosed with cancer.

AIM: To investigate general practitioners' (GP) perceptions about communication when providing cancer care. METHODS: A self-report survey, which included an open response section, was mailed to a random sample of 1969 eligible Australian GPs. Content analysis of open response comments pertaining to communication was undertaken in order to ascertain GPs' views about communication issues in the provision of cancer care. RESULTS: Of the 648 GPs who completed the survey, 68 (10%) included open response comments about interprofessional communication. Participants who commented on communication were a median age of 50 years and worked 33 h/week; 28% were male and 59% practiced in the metropolitan area. Comments pertaining to communication were coded using five non-mutually exclusive categories: being kept in the loop; continuity of care; relationships with specialists; positive communication experiences; and strategies for improving communication.GPs repeatedly noted the importance of receiving detailed and timely communication from specialists and hospitals, particularly in relation to patients' treatment regimes and follow-up care. Several GPs remarked that they were left out of "the information loop" and that patients were "lost" or "dumped" after referral. CONCLUSION: While many GPs are currently involved in some aspects of cancer management, detailed and timely communication between specialists and GPs is imperative to support shared care and ensure optimal patient outcomes. This research highlights the need for established channels of communication between specialist and primary care medicine to support greater involvement by GPs in cancer care.

Australian general practitioners' preferences for managing the care of people diagnosed with cancer.

AIM: To investigate general practitioners' (GPs) preferences for involvement in the management of people diagnosed with the seven most frequent cancers and any barriers to or concerns about an expanded role for GPs. METHODS: A self-report survey was mailed to a random sample of 1969 Australian GPs. RESULTS: In all, 33% (648) of GPs participated. Participants were a median of 50 years and worked 38 h per week; 53% were male and 68% practiced in metropolitan areas. Most participants preferred to be involved in cancer prevention (86%) and initial diagnosis (85%). Fewer were interested in monitoring for recurrence (70%), follow up after treatment (68%), coordinating psychological support (70%) and palliative care (68%). Only 52% of GPs had a preference for providing supportive care to manage the symptoms of cancer treatment, 45% for managing postoperative care and 40% for coordinating treatment. On multivariate analysis, preference for involvement in more aspects of cancer management increased with age (P = 0.030), if the GP practiced in rural compared to metropolitan areas (P = 0.005), was a partner in a practice compared to a sole practitioner (P = 0.003), had previously received cancer-specific training (P < 0.001) or was interested in future training (P < 0.001). Open responses identified limited time, communication and information transfer between GP and specialists as important barriers to involvement in cancer management. CONCLUSION: While many GPs are currently involved in some aspects of cancer management, with training, good communication and support from specialists this role may be successfully expanded.