Levels of Parental Drinking in the Presence of Children: An Exploration of Attitudinal Correlates.

AIMS: This study aimed to examine perceived social norms, the effect of parental drinking on these norms, alcohol use in front of children, and how norms and consumption vary based on child age and gender of the parent. METHODS: A cross-sectional online panel survey was undertaken with n = 1000 Australian adults (including 670 parents) aged 18-59 years. The survey assessed: alcohol consumption in front of children; normative attitudes towards drinking in the presence of children; and perceived social norms. RESULTS: Overall, 33.9% of parents reported drinking a glass of alcohol each day or a couple of times a week, 18.2% reported getting slightly drunk and 7.8% indicated getting visibly drunk each day or a couple of times a week with their children present. In total, 37.5% reported drinking in front of their children at least weekly. Fathers were more likely to drink in front of children than mothers. Most parents deemed drinking small amounts of alcohol in front of children as acceptable but did not accept drunkenness. Respondents were less concerned about a father drinking one or two drinks in front of their children than a mother. Social expectations were not related to child age, but norms related to others' perceived behaviour were. CONCLUSIONS: Many parents, particularly fathers consume alcohol in front of their children. There is a need to target health promotion strategies to adults and parents consuming in excess of health guidelines, and to the many parents who are consuming alcohol at higher levels in front of their children.

Investigating the breast cancer screening-treatment-mortality pathway of women diagnosed with invasive breast cancer: Results from linked health data.

OBJECTIVE: To examine the screening-treatment-mortality pathway among women with invasive breast cancer in 2006-2014 using linked data. METHODS: BreastScreen histories of South Australian women diagnosed with breast cancer (n = 8453) were investigated. Treatments recorded within 12 months from diagnosis were obtained from linked registry and administrative data. Associations of screening history with treatment were investigated using logistic regression and with cancer mortality outcomes using competing risk analyses, adjusting for socio-demographic, cancer and comorbidity characteristics. RESULTS AND CONCLUSION: For screening ages of 50-69 years, 70% had participated in BreastScreen SA ≤ 5 years and 53% ≤ 2 years of diagnosis. Five-year disease-specific survival post-diagnosis was 90%. Compared with those not screened ≤5 years, women screened ≤2 years had higher odds, adjusted for socio-demographic, cancer and comorbidity characteristics, and diagnostic period, of breast-conserving surgery (aOR 2.5, 95% CI 1.9-3.2) and radiotherapy (aOR 1.2, 95% CI 1.1-1.3). These women had a lower unadjusted risk of post-diagnostic cancer mortality (SHR 0.33, 95% CI 0.27-0.41), partly mediated by stage (aSHR 0.65, 95% CI 0.51-0.81), and less breast surgery (aSHR 0.78, 95% CI 0.62-0.99). Screening ≤2 years and conserving surgery appeared to have a greater than additive association with lower post-diagnostic mortality (interaction term SHR 0.42, 95% CI 0.23-0.78). The screening-treatment-mortality pathway was investigated using linked data.

Intentions to reduce sugar-sweetened beverage consumption: the importance of perceived susceptibility to health risks.

OBJECTIVE: There are numerous health effects associated with excess sugar-sweetened beverage (SSB) consumption. Interventions aimed at reducing population-level consumption require understanding of the relevant barriers and facilitators. This study aimed to identify the variables with the strongest relationship with intentions to reduce SSB consumption from a suite of variables derived from the literature. DESIGN: Random-digit dialling of landline and mobile phones was used to survey adults using computer-assisted telephone interviews. The outcome variable was 'likelihood of reducing SSB consumption in next 6 months', and the predictor variables were demographics, SSB attitudes and behaviour, health risk perceptions and social/environmental exposure. SETTING: Australia. PARTICIPANTS: A subsample of 1630 regular SSB consumers from a nationally representative sample of 3430 Australian adults (38 % female, 51 % aged 18-45 years, 56 % overweight or obese). RESULTS: Respondents indicated that they were 'not at all' (30·1 %), 'somewhat' (43·9 %) and 'very likely' (25·3 %) to reduce SSB consumption. Multivariate nominal logistic regressions showed that perceiving future health to be 'very much' at risk was the strongest predictor of intention to reduce SSB consumption (OR = 8·1, 95 % CI 1·8, 37·0, P < 0·01). Other significant predictors (P < 0·01) included self-perceptions about too much consumption, habitual consumption, difficulty reducing consumption and likelihood of benefitting from reduced consumption. CONCLUSIONS: Health risk perceptions had the strongest relationship with intentions to reduce consumption. Age and consumption perceptions were also predictors in the multivariate models, whereas social/environmental exposure variables were not. Interventions may seek to incorporate strategies to denormalise consumption practices and increase knowledge about perceived susceptibility to health risks.

Selling function: the advertising of sugar-containing beverages on Australian television.

Reducing population consumption of sugar-containing beverages has become a public health priority in many countries due to causal evidence between high consumption, weight gain and non-communicable diseases. This study aims to explore how sugar-containing beverages are associated with health and wellness in television advertisements. Our sample consisted of all televised advertisements from sugar-containing beverage manufacturers aired on free-to-air television from one Australian network (four channels) in 2016 (n = 30 unique advertisements). We transcribed advertisements for audio and visual information. We analysed data inductively using methods from thematic, discourse and multi-modal analysis. Advertisements for sugar-containing beverages reflected both traditional (physical health and reduced risk of disease) and broader (wellbeing) conceptualizations of health. Beverages were positioned in advertisements as contributing a functional role to promote and enhance health and wellbeing within the physical, mental and social domains. Beverages were advertised as correcting suboptimal states of being to achieve desirable outcomes, including relaxation, increased resistance to disease, enhanced performance, better cognitive functioning and improved social connections. Positioning beverages within a wider conceptualization of health and wellbeing aligns with how health and nutrition are increasingly being understood and sought out by consumers, creating increased opportunities for the marketing of sugar-containing beverages as 'healthy'.

Depictions of Alcohol in Australian TV 'Bachelor In Paradise': A Content Analysis.

AIMS: To quantify the depictions of alcohol in the popular Australian reality TV show-Bachelor in Paradise (season 1: 2018). METHODS: All 16 episodes were coded in 1-min intervals for the presence of alcoholic beverage related content and non-alcoholic beverage content, and the categories of actual use, implied use and other references. RESULTS: Alcohol was highly prevalent in all episodes. Alcohol content occurred frequently, with 70.7% of intervals having any alcohol content. Actual alcohol use occurred in 31.9% of 1-min intervals, implied alcohol use occurred in 63.4% of intervals and other alcohol references occurred in 14.0% of intervals. Alcohol content was present in the first or second 1-min interval of all 16 episodes. Alcohol content was more than twice as prevalent as non-alcoholic content (34.0%). CONCLUSIONS: The high volume of alcohol content depicted in the show is of concern, due to the important influence it may have on the audience. Vulnerable viewers, especially minors and young adults, are being exposed to ubiquitous alcohol references. This may influence their perceptions of normal alcohol use, their attitudes toward alcohol and their own consumption of alcohol. A stronger regulatory regime is required in Australia to protect young people more effectively from depictions in television programs.

What makes a beverage healthy? A qualitative study of young adults' conceptualisation of sugar-containing beverage healthfulness.

Sugar-containing beverages are the leading source of added sugar consumption among young adults. The aim of this study was to explore how young adults conceptualise what influences the healthfulness of sugar-containing beverages. Seven focus groups stratified by gender and educational institute were conducted with South Australians aged 18-25 years (n = 32). Focus groups were semi-structured and included a ranking activity where participants individually ranked eight beverages from least to most healthy. Focus groups were recorded, transcribed verbatim and thematically analysed. Participants commonly selected soda (soft drink) and energy drink as the least healthy beverage and water as the healthiest, but those between varied in rankings. Four themes were identified relating to how participants conceptualise beverage healthfulness in the thematic analysis: ingredients harmful to health, properties beneficial to health, functionality, and packaging. While participants were aware that beverages can contain high amounts of sugar, and that this can be harmful to health, many other factors influence the perceptions of beverage healthfulness and these can outweigh the perceived harms of consumption. Public health interventions and policies are needed to address misperceptions about the healthfulness of sugar-containing beverages to better put the harms of high sugar consumption in perspective for consumers.

Industry use of 'better-for-you' features on labels of sugar-containing beverages.

OBJECTIVE: To examine the ways in which sugar-containing beverages are being portrayed as 'better-for-you' (BFY) via features on product labels. DESIGN: Cross-sectional audit of beverage labels. SETTING: Adelaide, Australia. Data on beverage labels were collected from seventeen grocery stores during September to November 2016. SUBJECTS: The content of 945 sugar-containing beverages labels were analysed for explicit and implicit features positioning them as healthy or BFY. RESULTS: The mean sugar content of beverages was high at 8·3 g/100 ml and most sugar-containing beverages (87·7 %) displayed features that position them as BFY. This was most commonly achieved by indicating the beverages are natural (76·8 %), or contain reduced or natural energy/sugar content (48·4 %), or through suggesting that they contribute to meeting bodily needs for nutrition (28·9 %) or health (15·1 %). Features positioning beverages as BFY were more common among certain categories of beverages, namely coconut waters, iced teas, sports drinks and juices. CONCLUSIONS: A large proportion of sugar-containing beverages use features on labels that position them as healthy or BFY despite containing high amounts of sugar.

Measuring research impact: a large cancer research funding programme in Australia.

BACKGROUND: Measuring research impact is of critical interest to philanthropic and government funding agencies interested in ensuring that the research they fund is both scientifically excellent and has meaningful impact into health and other outcomes. The Beat Cancer Project (BCP) is a AUD $34 m cancer research funding scheme that commenced in 2011. It was initiated by an Australian charity (Cancer Council SA), and supported by the South Australian Government and the state's major universities. METHODS: This study applied Buxton and Hanney's Payback Framework to assess research impact generated from the BCP after 3 years of funding. Data sources were an audit of peer-reviewed publications from January 2011 to September 2014 from Web of Knowledge and a self-report survey of investigators awarded BCP research funding during its first 3 years of implementation (2011-2013). Of the 104 surveys, 92 (88%) were completed. RESULTS: The BCP performed well across all five categories of the Payback Framework. In terms of knowledge production, 1257 peer-reviewed publications were generated and the mean impact factor of publishing journals increased annually. There were many benefits to future research with 21 respondents (23%) reporting career advancement, and 110 higher degrees obtained or expected (including 84 PhDs). Overall, 52% of funded projects generated tools for future research. The funded research attracted substantial further income yielding a very high rate of leverage. For every AUD $1 that the cancer charity invested, the BCP gained an additional AUD $6.06. Five projects (5%) had informed policy and 5 (5%) informed product development, with an additional 31 (34%) and 35 (38%) projects, respectively, anticipating doing so. In terms of health and sector and broader economic benefits, 8 (9%) projects had influenced practice or behaviour of health staff and 32 (34%) would reportedly to do so in the future. CONCLUSIONS: Research impact was a priority of charity and government funders and led to a deliberate funding strategy. Emphasising research impact while maintaining rigorous, competitive processes can achieve the joint objectives of excellence in research, yielding good research impact and a high rate of leverage for philanthropic and public investment, as indicated by these early results.

Prevalence, perceptions and predictors of alcohol consumption and abstinence among South Australian school students: a cross-sectional analysis.

BACKGROUND: Alcohol consumption by young people (particularly early initiation) is a predictor for poorer health in later life. In addition, evidence now clearly shows a causal link between alcohol and cancer. This study investigated prevalence, predictors of alcohol consumption among adolescents including perceptions of the link between alcohol and cancer, and the role of parents and peers. METHODS: A sample of Australian school students aged 12-17 years participated in a survey (n = 2885). Logistic regression analysis was undertaken to determine predictors. RESULTS: Alcohol use increased with age and by 16, most had tried alcohol with 33.1% of students aged 12-17 reporting that they drank at least occasionally (95% CI = 31.0-35.2). Awareness of the link between alcohol and cancer was low (28.5%). Smoking status and friends' approval were predictive of drinking, whereas parental disapproval was protective. Those aged 14-17 who did not think the link between alcohol and cancer was important were more likely to drink, as were those living in areas of least disadvantage. The only factors that predicted recent drinking were smoking and the perception that alcohol was easy to purchase. CONCLUSIONS: An education campaign highlighting the link between alcohol and cancer may have positive flow-on effects for young people, and schools should incorporate this messaging into any alcohol education programs. Consideration should be given to factors that serve to regulate under-aged accessibility of alcohol.

Integrating consumer engagement in health and medical research - an Australian framework.

BACKGROUND: Quality practice of consumer engagement is still in its infancy in many sectors of medical research. The South Australian Health and Medical Research Institute (SAHMRI) identified, early in its development, the opportunity to integrate evidence-driven consumer and community engagement into its operations. PROCESS: SAHMRI partnered with Health Consumers Alliance and consumers in evidence generation. A Partnership Steering Committee of researchers and consumers was formed for the project. An iterative mixed-method qualitative process was used to generate a framework for consumer engagement. This process included a literature review followed by semi-structured interviews with experts in consumer engagement and lead medical researchers, group discussions and a consensus workshop with the Partnership Steering Committee, facilitated by Health Consumer Alliance. OUTCOMES: The literature revealed a dearth of evidence about effective consumer engagement methodologies. Four organisational dimensions are reported to contribute to success, namely governance, infrastructure, capacity and advocacy. Key themes identified through the stakeholder interviews included sustained leadership, tangible benefits, engagement strategies should be varied, resourcing, a moral dimension, and challenges. The consensus workshop produced a framework and tangible strategies. CONCLUSION: Comprehensive examples of consumer participation in health and medical research are limited. There are few documented studies of what techniques are effective. This evidence-driven framework, developed in collaboration with consumers, is being integrated in a health and medical research institute with diverse programs of research. This framework is offered as a contribution to the evidence base around meaningful consumer engagement and as a template for other research institutions to utilise.

"You're made to feel like a dirty filthy smoker when you're not, cigar smoking is another thing all together." Responses of Australian cigar and cigarillo smokers to plain packaging.

OBJECTIVE: To explore experiences of cigar and cigarillo smokers under Australian laws requiring plain packaging (PP) and strengthened graphic health warnings (GHWs). METHODS: In February/March 2014, we conducted: in-depth interviews with 10 regular premium cigar smokers; two focus groups with occasional premium cigar and premium cigarillo smokers (n=14); four focus groups with non-premium cigarillo smokers (n=28); and a national online survey of cigar and/or cigarillo smokers (n=268). RESULTS: Premium cigar smokers had limited exposure to PP, with many purchasing fully branded cigars in boxes duty free or online and singles in non-compliant packaging. Those who were exposed noticed and were concerned by the warnings, tried to avoid them and felt more like 'dirty smokers'. Changes in perceived taste, harm and value were minimal for experienced premium cigar smokers. Occasional premium cigar and premium cigarillo smokers with higher PP exposure (gained by purchasing boxes rather than singles) perceived cigar/package appeal and value had declined and noticed the GHWs. Non-premium cigarillo smokers reported high PP exposure, reduced perceived appeal, quality, taste, enjoyment and value, somewhat increased perceived harm, greater noticeability of GHWs and concealment of packs and more contemplation of quitting. Online survey participants reported increased noticeability of GHWs (33%), decreased appeal of packaging (53%) and reduced consumption of cigars (42%) and cigarillos (44%) since PP implementation. CONCLUSIONS: Non-premium cigarillo smokers appear to have been most exposed and influenced by PP, with cigar smokers less so, especially regular premium cigar smokers who have maintained access to fully branded products.

What happens when the price of a tobacco retailer licence increases?

OBJECTIVE: To measure the impact of a 15-fold licence fee increase on tobacco retailer licence renewals. METHODS: The regulatory change increasing tobacco licence fees (from $A12.90 to $A200 per annum) took effect on 1 January 2007. Government Tobacco Licence records (n=7093) were audited for 1 year prior to, and 2 years after the change. An interrupted time series analysis using ARIMA modelling was conducted to examine the impact of fee increases on the number of active licences. RESULTS: The total number of tobacco licences decreased by 23.7% from December 2007 to December 2009. The increased tobacco licence fee implemented on 1 January 2007, was associated with a significant reduction in the number of tobacco licences purchased or renewed in subsequent years. Of the 1144 entertainment licensees holding valid licences in December 2007, 30.9% no longer held a licence by December 2009, and 19.9% had reduced the number of points of sale within the same venue. CONCLUSIONS: Licensing of tobacco retailers has received little attention in tobacco control in Australia and internationally. Our data add to the growing body of evidence supporting further regulation of retail sale of tobacco. The results demonstrate that a tobacco licence price increase off a low base is a potentially effective method of reducing tobacco points of sale when consumer demand for cigarette products is low. However, further research is needed to identify additional measures that may be necessary to reduce the availability of tobacco products in areas where consumer demand for cigarettes is high.

Shifting sands: changing regional and gender-specific patterns of HIV/AIDS mortality in Canada, 1987 to 2008.

OBJECTIVE: To assess patterns of HIV-related mortality by period, gender and age group in Canada from 1987 to 2008. METHODS: We applied standard demographic techniques to assess changes in HIV/AIDS mortality over five time periods: 1987-1991, 1992-1996, 1997-2001, 2002-2006, and 2007-2008. HIV/AIDS-related mortality was based on deaths in which HIV infection or AIDS was reported as the underlying cause of death. Population figures were obtained from annual estimates. Age-, sex- and province-specific crude and standardized HIV/AIDS mortality rates and ratios were used to examine changes in mortality. RESULTS: In the period from 1987 to 2008, there were 17,287 HIV/AIDS-related deaths; of these, 15,587 (90.2%) occurred among men and 1,700 (9.8%) among women. Standardized and age-specific death rates were generally higher in men than women. Among men, rates of mortality were highest in Quebec and British Columbia; and among women, rates increased over time in British Columbia and the Prairies and decreased in Quebec. In general, rates of death were highest in 1992-1996 and lowest in the latest period. CONCLUSION: We observed a sharp decline in mortality rates with the introduction of HAART; however, the rates were higher among men in Quebec and British Columbia and among women in British Columbia, Quebec and the Prairies.

Alcohol consumption and mental health conditions: Insights from a South Australian population survey to inform policy and practice.

OBJECTIVE: Among individuals with a mental health condition co-occurring alcohol use disorders are common, but less is known about alcohol consumption in excess of recommended drinking guidelines. This study investigated the prevalence of lifetime risky drinking (>2 drinks daily) and single occasion risky drinking (>4 drinks on one occasion) among individuals with mental health conditions of different severities. METHODS: Data from representative cross-sectional population surveys among South Australians aged ≥15 years (n=11,761) were utilised. Logistic regression models assessed associations between risky alcohol consumption, presence of a mental health condition and demographic characteristics. RESULTS: Prevalence of lifetime risky drinking was greater among both males and females with a mental health condition (p>0.001). Single occasion risky drinking was more prevalent among males with a severe mental health condition (p=0.01). Adjusted logistic regressions showed that only females with a mental health condition had greater odds of exceeding lifetime risky drinking levels (OR=1.39, CI 1.11 to1.75). CONCLUSIONS: There are sex-specific relationships between risky alcohol consumption and mental health conditions. IMPLICATIONS FOR PUBLIC HEALTH: Risky alcohol consumption, in excess of guidelines, is of concern among those with a mental health condition and requires attention at an individual and population level.

Smokers' recall of Australian graphic cigarette packet warnings & awareness of associated health effects, 2005-2008.

BACKGROUND: In 2006, Australia introduced graphic cigarette packet warnings. The new warnings include one of 14 pictures, many depicting tobacco-related pathology. The warnings were introduced in two sets; Set A in March and Set B from November. This study explores their impact on smokers' beliefs about smoking related illnesses. This study also examines the varying impact of different warnings, to see whether warnings with visceral images have greater impact on smokers' beliefs than other images. METHODS: Representative samples of South Australian smokers were interviewed in four independent cross-sectional omnibus surveys; in 2005 (n=504), 2006 (n=525), 2007 (n=414) and 2008 (n=464). RESULTS: Unprompted recall of new graphic cigarette warnings was high in the months following their introduction, demonstrating that smokers' had been exposed to them. Smokers also demonstrated an increase in awareness about smoking-related diseases specific to the warning messages. Warnings that conveyed new information and had emotive images demonstrated greater impact on recall and smokers' beliefs than more familiar information and less emotive images. CONCLUSIONS: Overall graphic pack warnings have had the intended impact on smokers. Some have greater impact than others. The implications for policy makers in countries introducing similar warnings are that fresh messaging and visceral images have the greatest impact.

Smoking and mental illness: a population study in South Australia.

OBJECTIVE: To examine smoking prevalence and smoking behaviour among South Australians with a mental illness and compare findings to those with no mental illness. METHOD: Data were collected in three cross-sectional representative population surveys of South Australians aged ≥15 years from 2005 to 2007. Merged data yielded a total sample size of 8417. The main outcome measures were: smoking prevalence, measures of tobacco dependence, awareness of the health effects of active and passive smoking, smoke-free homes and cars, awareness of health warnings, and use of cessation aids by two measures of mental illness status. RESULTS: Overall 26.4% of the population with a general mental illness and 51.2% of the population with a severe mental illness smoked, compared to 18.7% of the population without a mental illness. People with a mental illness, particularly severe mental illness displayed higher measures of tobacco dependence. Smokers with a severe mental illness were less likely to have smoke-free homes (OR = 0.29, 95%CI 0.16-0.55). Television was an effective medium to present the health effects of smoking to all groups. Those with a general mental illness were more likely than those with no mental illness to have asked a general practitioner for advice to help them quit in the past year (OR = 2.02, 95%CI 1.07-3.84). CONCLUSIONS: Whilst smokers with a mental illness are more dependent on their smoking; they are interested in quitting. There are a number of mainstream tobacco control strategies that could be further utilized (e.g. mass media and health professional referrals to the Quitline) to increase cessation among this disadvantaged group.

Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers.

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156 non-Indigenous smokers from South Australia were shown 10 anti-smoking advertisements representing a range of advertisements typically aired in Australia. Participants rated advertisements on a five-point Likert scale assessing factors including message acceptance and personalized effectiveness. On average, Indigenous people rated the mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. Advertisements featuring real people describing the serious health consequences of smoking received mixed responses. Those featuring an ill person were rated higher by Indigenous people than those featuring the family of the person affected by a smoking-related disease. With limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are likely to be highly motivating for Indigenous smokers.

An integrated brief intervention to address smoking in pregnancy.

OBJECTIVE: Evaluate the impact of an integrated brief intervention to assist antenatal staff in addressing smoking with pregnant women. DESIGN: Three studies were conducted: (a) antenatal staff surveys pre- and post-training to deliver the brief intervention; (b) retrospective audit of pregnancy records; (c) post-intervention follow-up interviews with a cohort of pregnant women who smoked at baseline. SETTING: South Australia. SAMPLE: (a) Antenatal health professionals at two major birthing hospitals (n = 117 pre-survey and n = 62 post-survey); (b) 1,024 pregnancy records; (c) follow-up interviews with women at one month (n = 58), 6 months (n = 40) and 12 months (n = 31) post-intervention. METHODS: (a) Staff surveys about current practice prior to training (via written questionnaire) and 12 months post-training (by telephone); (b) pregnancy record audit for presence and use of the Smoke-Free Assessment & Intervention Form (SFA&IF) conducted at 12 months; (c) telephone surveys assessing smoking behavior. MAIN OUTCOME MEASURES: Staff practice change and compliance with the intervention. Cessation rates among pregnant women. RESULTS: At 12 months, 89% of staff reported that the intervention integrated well into their work; The SFA&IF was physically present in 80% of pregnancy records and 89% had been completed. Over 65% of current smokers were offered advice about the benefits of quitting; quit rates were highest at 6 months (18, 13% conservative estimate), but women tended to relapse after the birth of their baby. CONCLUSIONS: The intervention was well-received and staff compliance was high. Quit rates exceeded spontaneous quit rates in the community. This project has been expanded nationally.

People with mental illness can tackle tobacco.

OBJECTIVE: To evaluate a smoking reduction and cessation intervention tailored for people with significant disability associated with mental illness. METHOD: The intervention was a 10 week group programme, which tailored smoking cessation interventions to the needs of people living with mental illness. It was facilitated by mental health workers and peer workers and was promoted through mental health services, general practitioners and the Quitline phone service. Participants were people living with mental illness who had asked for help to quit or reduce their tobacco use. Participants were interviewed before starting the course, twice during the course and at 3, 6 and 12 months post course completion. RESULTS: Overall, 226 people expressed interest, 183 attended at least one session of the course and 105 attended at least 10 sessions. Of the 183 participants, 79.8% reported they did not smoke for at least 24 hours, with 30.6% stopping for at least 30 days. At the 12 month follow up 16.6% of participants reported they were not smoking. Of the 105 participants who attended at least 10 sessions of the course, 85.7% reported they did not smoke for at least 24 hours and 37.1% stopping for at least 30 days. At 12 month follow up 21.3% reported they were not smoking. Cigarettes smoked per day declined among those who did not quit, and was still significantly lower after 12 months. Motivation to try to quit was high among those still smoking at 12 months, with 83.9% wanting to try again to quit. CONCLUSIONS: This programme has shown many people with significant disability associated with mental illness are motivated to attend a smoking reduction and cessation group programme. A programme tailored to meet the specific needs of this group can be effective in helping many to quit or reduce their tobacco use.

From participation to diagnostic assessment: a systematic scoping review of the role of the primary healthcare sector in the National Bowel Cancer Screening Program.

Primary health care (PHC) plays a vital support role in organised colorectal cancer (CRC) screening programs by encouraging patient participation and ensuring timely referral for diagnostic assessment follow up. A systematic scoping review of the current evidence was conducted to inform strategies that better engage the PHC sector in organised CRC screening programs. Articles published from 2005 to November 2019 were searched across five databases. Evidence was synthesised and interventions that specifically require PHC involvement were mapped to stages of the CRC screening pathway. Fifty-seven unique studies were identified in which patient, provider and system-level interventions align with defined stages of the CRC screening pathway: namely, identifying/reminding patients who have not responded to CRC screening (non-adherence) (n=46) and follow up of a positive screen referral (n=11). Self-management support initiatives (patient level) and improvement initiatives (system level) demonstrate consistent benefits along the CRC screening pathway. Interventions evaluated as part of a quality-improvement process tended to report effectiveness; however, the variation in reporting makes it difficult to determine which elements contributed to the overall study outcomes. To maximise the benefits of population-based screening programs, better integration into existing primary care services can be achieved through targeting preventive and quality care interventions along the entire screening pathway.