Development and validation of the Perceived Effectiveness of Nutrition Messages Scale.

An understanding of the extent to which target audiences consider different nutrition-related messages to be effective could assist campaign developers design more persuasive communications. Accordingly, this study sought to develop and assess the utility of the Perceived Effectiveness of Nutrition Messages Scale (PENMS). A longitudinal online survey was completed by Australian adults (n = 5,014 at Time 1 and 2,880 at Time 2). At T1, respondents saw one of two messages promoting healthy eating. They were then administered the PENMS, and asked how likely they were to engage in the behaviour specified in the message. Respondents completed the PENMS again at T2. An exploratory factor analysis was performed on PENMS scores and measures of reliability and validity obtained. Two factors were identified: 'effects perceptions' (Factor 1) and 'message perceptions' (Factor 2). Internal consistency of scores was 0.82 for Factor 1 and 0.70 for Factor 2. Test re-test reliability was 0.76 and 0.69 for Factors 1 and 2, respectively. Scores on both factors were moderately correlated with behavioural intentions. The favourable results for PENMS scores suggest the scale may be a useful tool for assessing the extent to which target audiences consider different nutrition-related messages to be effective.

Psychological distress and e-cigarette use among young Australians: An exploratory, qualitative study.

INTRODUCTION: Emerging research suggests an association between psychological distress and e-cigarette use. However, our understanding of young adults' experiences of this relationship is limited. We explored young adults' experiences of psychological distress and e-cigarette use. METHODS: We conducted semi-structured interviews with 18- to 24-year-old university students (n=13; 77% female; mean age=21.5 years) based in Victoria, Australia. Interviews were conducted May-June 2023. Data were subject to reflexive thematic analysis. RESULTS: Individuals reported that they or their friends had initiated e-cigarette use to manage their psychological distress (e.g. low mood, social isolation, stress). Immediate stress reduction following use and subsequent nicotine dependence appeared to maintain use. CONCLUSIONS: A reciprocal relationship likely exists between psychological distress and e-cigarette use whereby psychological distress contributes to use initiation and use maintains distress. Public campaigns and health services should provide: 1) education on adaptive coping/stress management strategies and the signs of nicotine dependence, and 2) support to manage nicotine dependence and the psychological distress that can arise from addiction.

Impact of product-based e-cigarette marketing on the attitudes and behavioural intentions of young Australians: an experimental study.

BACKGROUND: The tobacco industry has a history of using language to downplay the harms associated with cigarettes and mislead consumers and policymakers. Emerging evidence suggests similar tactics are being used in the context of e-cigarettes; however, exploration of the impact of product name on attitudes towards e-cigarettes and susceptibility to use is lacking. This experimental study explored whether attitudes towards e-cigarettes and susceptibility to use are influenced by the names used by the industry to describe and market these products. METHOD: An accredited web panel provider recruited a sample of 383 Australians aged 12-29 years who had never smoked to participate in an online survey that featured an embedded experiment. Participants were randomly allocated to one of three conditions, each of which used a different name to describe e-cigarettes (condition 1: 'e-cigarettes', condition 2: 'vapes'; condition 3: either 'IGETS', 'Puff Bars', 'HQD Cuvies' or 'Gunnpods'). The survey assessed respondents' overall opinion of the product described; attitudes towards the product; liking of the product; and curiosity, willingness and intentions to use the product. RESULTS: Those in the 'brand name' condition scored higher than those in the 'e-cigarettes' condition on all dependent variables. Those in the 'vapes' condition scored higher than those in the 'e-cigarettes' condition on product attitude. CONCLUSION: Findings indicate that the use of brand names and terms such as 'vapes' instead of 'e-cigarettes' results in more favourable attitudes towards e-cigarettes and susceptibility to use among young Australians. Results highlight the problematic influence of promotional language use favoured by industry.

Barriers and enablers to promoting grandchildren's physical activity and reducing screen time: a qualitative study with Australian grandparents.

BACKGROUND: With an increasing number of grandparents providing care to their grandchildren, calls have been made for these caregivers to be considered important stakeholders in encouraging children's engagement in health-promoting behaviors, such as physical activity. Understanding the perspectives of grandparents who provide care is crucial to informing efforts that aim to increase children's physical activity, yet little is understood about their perceptions of specific barriers and enablers to promoting children's physical activity and reducing screen time. The present study sought to explore these perceptions. METHODS: Semi-structured focus groups and individual interviews were conducted with grandparents who reported providing care to a grandchild aged 3 to 14 years. A total of 20 grandparents were sampled (mean age = 67.8 years). Data were subjected to reflexive thematic analysis. RESULTS: Key reported barriers to physical activity included (i) the effort (physical and logistical) and financial cost associated with organizing physical activities, (ii) grandparents' age and mobility issues (e.g., due to injury or illness), (iii) caring for children of different ages (e.g., older children having different physical activity interests than younger children), and (iv) a local environment that is not conducive to physical activity (e.g., lack of appropriate facilities). Barriers to reducing screen time included (i) parents sending children to care with electronic devices and (ii) children's fear of missing out on social connection that occurs electronically. Strategies and enablers of physical activity included (i) integrating activity into caregiving routines (e.g., walking the dog), (ii) involving grandchildren in decision making (e.g., asking them in which physical activities they wish to engage), (iii) encouraging grandchildren to engage in activity with other children, and (iv) creating a physical and social environment that supports activity (e.g., owning play equipment). A common strategy for reducing screen time was the creation of a home environment that is not conducive to this activity (e.g., removing electronic devices from view). CONCLUSIONS: Findings suggest that grandparents may benefit from resources that assist them to identify activities that are inexpensive and require minimal effort to organize. Activities that account for grandparents' age and health status, as well as any environmental barriers, are likely to be well-received.

A systematic review of the modelling and economic evaluation studies assessing regulatory options for e-cigarette use.

BACKGROUND: Governments around the world are considering regulating access to nicotine e-cigarettes to prevent uptake among youth however people that smoke tobacco may use them to assist with smoking cessation. The health and cost implications of regulating e-cigarette use among populations are unknown but have been explored in modelling studies. We reviewed health economic evaluation and simulation modelling studies that assessed long-term consequences and interpret their potential usefulness for decision-makers. METHODS: A systematic review with a narrative synthesis was undertaken. Six databases were searched for modelling studies evaluating population-level e-cigarette control policies or interventions restricting e-cigarette use versus more liberalized use. Studies were required to report the outcomes of life years, quality-adjusted life years (QALYs) and/or healthcare costs. The quality of the studies was assessed using two quality assessment tools. RESULTS: In total, 15 studies were included with nine for the United States and one each for the United Kingdom, Italy, Australia, Singapore, Canada, and New Zealand. Three studies included cost-utility analyses. Most studies involved health state transition (or Markov) closed cohort models. Many studies had limitations with their model structures, data input quality and transparency, and insufficient analyses handling model uncertainty. Findings were mixed with 11 studies concluding that policies permitting e-cigarette use lead to net benefits and 4 studies concluding net losses in life-years or QALYs and/or healthcare costs.Five studies had industry conflicts of interest. CONCLUSIONS: While authors did conclude net benefit than net harm in more of the studies so far conducted, the significant limitations that we identified with many of the studies in this review, make it uncertain whether or not countries can expect net population harms or benefits of restrictive versus unrestrictive e-cigarette policies. The generalizability of the findings is limited for decision-makers. In light of the deep uncertainty around the health and economic outcomes of e-cigarettes, simulation modelling methods and uncertainty analyses should be strengthened.

Quitting intentions and behaviours among young Australian e-cigarette users.

BACKGROUND AND AIMS: With the prevalence of e-cigarette use among Australian youth increasing significantly in recent years, greater attention is being paid to encouraging and supporting cessation. However, research to inform such efforts is lacking. The present study sought to (i) measure desire to quit e-cigarette use and actual quitting attempts among young Australians and (ii) explore correlates of quitting-related cognitions and behaviours. DESIGN, SETTING AND PARTICIPANTS: This was a cross-sectional on-line survey conducted in Australia. The participants were 14-25-year-old e-cigarette users (n = 602; 53% women). MEASUREMENTS: Desire to quit vaping and attempts to quit vaping were the primary dependent variables. The independent variables included several individual (e.g. harm perceptions, perceived appeal of vapes), social (descriptive norms) and environmental (e.g. ease of e-cigarette access) factors. FINDINGS: A majority of respondents (61%) expressed a desire to quit vaping, and just over half (55%) had made a quit attempt. Finding vapes easy to access was associated with both a lack of desire [odds ratio (OR) = 0.71] and attempts to quit (OR = 0.77), while self-reported addiction to vaping (OR = 1.42 and OR = 3.11) and perceiving vaping to be associated with mental health risks (OR = 1.30 and OR = 1.40) were positively correlated with these variables. Perceiving that vaping is common among people of one's age (OR = 0.82) and finding vapes appealing (OR = 0.55) were associated with a lack of desire to quit, while perceiving vaping to have physical health risks was positively associated with quitting desire (OR = 1.58). School-based education on vaping was associated with reporting an attempt/s to quit (OR = 0.47). CONCLUSIONS: This survey of young Australian e-cigarette users suggests a high level of desire to quit using e-cigarettes and attempts to quit. Increasing knowledge regarding the physical and mental health risks associated with e-cigarette use may assist with promoting quitting-related intentions. Changing social norms, reducing the accessibility of e-cigarettes and reducing the appeal of the products also constitute potential means of increasing the desire to quit.

Australian children's physical activity and screen time while in grandparental care.

OBJECTIVE: The objective of this study was to explore Australian children's engagement in physical activity and screen time while being cared for by their grandparents. METHOD: Grandparents (N = 1,190) providing ≥3 hours of weekly care to a grandchild aged 3-14 years completed an online survey assessing their grandchildren's movement behaviours while in their care. Descriptive statistics were computed for frequency of engagement in unstructured and structured physical activities, minutes spent playing outdoors, and minutes spent engaged in screen time. Regression analyses were conducted to assess socio-demographic predictors of movement behaviours. RESULTS: Playing in the yard was the most common form of physical activity in which grandchildren reportedly participated (77% 'usually' or 'always'), followed by playing with toys/equipment (62%). Few (14-36%) frequently engaged in active transport. Children spent an average of 181 minutes per week engaged in screen-based activities. CONCLUSIONS: There is an opportunity to improve children's movement behaviours while in grandparental care. Communicating to grandparents their importance in supporting an active lifestyle is warranted. IMPLICATIONS FOR PUBLIC HEALTH: Findings highlight the importance of creating environments that facilitate play-based, outdoor activities. Ensuring children have access to play equipment while in the care of grandparents and improving access to and quality of neighbourhood parks may assist with activity promotion.

The lasting impact of the Go for 2&5 campaign.

ISSUE ADDRESSED: Little is known about the executional techniques that are most likely to make healthy eating messages memorable over the longer term. The aim of this exploratory study was to identify factors contributing to the ongoing salience of the Go for 2&5 social marketing campaign among older audience members. METHODS: Interviews were conducted with 75 Western Australians aged 60+ years. A peer-interviewing method was used whereby eight older people recruited and interviewed members of their extended peer groups. The interview guide included questions about interviewees' recollections of healthy eating messages across their lifespans. RESULTS: Around one in five interviewees discussed the Go for 2&5 campaign that was on air in Western Australia between 2002 and 2011. These discussions focused on either specific advertisement features that were considered to be especially memorable (in particular, humour and the use of anthropomorphised depictions of produce) and/or their recollection of the number of daily servings of fruits and vegetables recommended in the campaign. Few were able to recall other healthy eating campaigns, and in some cases it was assumed that advertisements for specific food stores or products constituted health advice. CONCLUSIONS: Different campaign attributes may influence shorter-term attitudinal and behavioural responses versus longer-term recall. The characteristics of the Go for 2&5 campaign appear to have enabled it to achieve relatively high levels of recall among older people. SO WHAT?: The study results suggest that some advertising approaches that activate the peripheral route to persuasion may achieve recall over a longer period of time.

Perceptions of Australia's e-cigarette regulations and recommendations for future reforms: a qualitative study of adolescents and adults.

OBJECTIVE: To assess public perceptions of the effectiveness of e-cigarette regulations in minimising use among adolescents and those who have never smoked. Specifically, we explored (1) perceived effectiveness of current regulations relating to e-cigarettes and (2) ideas for further regulations that could reduce use. DESIGN AND PARTICIPANTS: Focus groups (n=16) were conducted with Australian adolescents (14-17 years), young adults (18-24 years) and adults (25-39 years). Groups were stratified by age, gender and e-cigarette use status. Data were analysed using reflexive thematic analysis. SETTING: Focus groups were conducted in-person in two major Australian cities. RESULTS: Groups lacked a comprehensive understanding of e-cigarette regulations in Australia. When informed of these regulations, half of the groups considered the prescription model for nicotine e-cigarette products to be effective when enforced appropriately. Almost all groups considered access to non-nicotine products problematic. All groups suggested a range of demand reduction regulations, including plain packaging, health warnings, flavour restrictions and increased vape-free areas. Most groups (predominantly those who had never vaped) also recommended supply reduction regulations such as banning all e-cigarettes. The need for supply reduction measures to include addiction and mental health supports was discussed. CONCLUSIONS: The regulations recommended by participants largely align with those that are to be introduced in Australia, indicating that these reforms are likely to be accepted by the public. Ensuring these reforms are complemented by formal supports for young people experiencing nicotine dependence and related mental health concerns is critical.

The Ability of Nutrition Warning Labels to Improve Understanding and Choice Outcomes Among Consumers Demonstrating Preferences for Unhealthy Foods.

BACKGROUND: Given growing interest in warning labels as a form of front-of-pack nutrition label, it is important to better understand the mechanisms via which these labels may exert their effects, especially among those making suboptimal food choices. OBJECTIVE: The study aim was to assess the extent to which consumers with the weakest outcomes for objective understanding and choice in no-label conditions were able to improve their understanding and choices after exposure to warning labels on food product options. DESIGN: Post-hoc analyses of the cross-sectional FOP-ICE (Front-of-Pack International Comparative Experimental) study data generated from an online survey that included simulated food choice and nutritional quality ranking scenarios. PARTICIPANTS/SETTING: Participants included 3,680 adults from the following 18 countries: Argentina, Australia, Belgium, Bulgaria, Canada, Denmark, France, Germany, Italy, Mexico, Netherlands, Poland, Portugal, Singapore, Spain, Switzerland, United Kingdom, and United States. INTERVENTION: Survey respondents selected their preferred product options and ranked foods according to their healthiness before and after exposure to mock breakfast cereal, cake, and pizza products displaying warning labels. MAIN OUTCOME MEASURES: Objective understanding and food choice were measured. STATISTICAL ANALYSES PERFORMED: Within each product category, analyses were conducted on respondents who initially incorrectly identified the healthiest option and/or selected the unhealthiest option as their preferred choice. Significant differences between proportions selecting each understanding and choice response option were assessed using 2-sample z tests for proportions. RESULTS: Salience of the warning labels was low; 46% reported noticing the labels while completing the survey. Just over one-third of those aware of the presence of warning labels were able to identify the least healthy option in the post-exposure condition. Approximately one-half reselected the least healthy option post exposure and just over one-fourth switched to the healthiest option. CONCLUSIONS: The results indicated that warning labels can assist some consumers to improve their food quality assessments and choices. However, design improvements could enhance the salience and interpretability of this label format.

Motivators of e-cigarette use among Australian adolescents, young adults, and adults.

OBJECTIVE: There is limited research examining motivators of e-cigarette use among never smokers, a group for whom vaping has no benefits and many harms. To inform programs and policies that aim to prevent initiation and encourage cessation of e-cigarette use, this study investigated reasons for intended use, initiation, and continued use of e-cigarettes among various age and user groups in Australia. METHODS: An online survey was administered to 4617 respondents. Never users of e-cigarettes and never smokers who reported intending to try e-cigarettes (n = 348), current e-cigarette users and never smokers (n = 121), and current e-cigarette users and current smokers (n = 354) were of interest to this study. RESULTS: Among never smokers, curiosity was the most commonly reported reason for intended use and use initiation, whereas the taste of e-cigarettes and their appealing flavours were the most frequently reported motivators of current e-cigarette use. Among smokers, taste and flavourings were the most commonly reported motivators of current use, not smoking cessation. Adolescents and young adults in most user groups were more likely than adults to report using e-cigarettes out of curiosity and because they taste good, whereas adults were more likely to use for smoking cessation purposes and because they perceived e-cigarettes to be more acceptable and cheaper than tobacco cigarettes. CONCLUSIONS: Results suggest that (i) prohibiting flavourings and (ii) restricting advertising that highlights the pleasurable effects of e-cigarettes could constitute potential means of preventing e-cigarette initiation and encouraging cessation among never smokers, especially adolescents.

Factors associated with susceptibility to e-cigarette use among Australian adolescents.

BACKGROUND: Preventing uptake of e-cigarette use among adolescents is critical to minimizing vaping-related harms. To inform the development of effective prevention programs and policies, this study explored potential determinants of susceptibility to e-cigarette use among young Australians. METHODS: A cross-sectional online survey was administered to 12- to 17-year-old Australians who had never smoked nor vaped (N = 973; 53 % women). The survey assessed susceptibility to e-cigarette use (curiosity about use, willingness to use, and intentions to use) and a comprehensive range of potential correlates that included individual, social, and environmental factors. Regression analyses were conducted to identify factors significantly correlated with each of the dependent variables. RESULTS: Susceptibility to e-cigarette use was observed in 45 % of respondents. Individual factors associated with susceptibility included respondents' (i) overall opinion of e-cigarettes, (ii) attitudes toward e-cigarettes, (iii) affect regulation expectancies, and (iv) quitting perceptions. Significant social factors included both descriptive and injunctive norms, specifically: perceiving that use is ok for people of one's age, approval from important others to use, and having at least one family member or close friend who vapes. CONCLUSION: Susceptibility to vaping was observed in a substantial proportion of adolescents who have never smoked. Shifting attitudes and social norms around e-cigarette use appears critical to reducing susceptibility. Recommended prevention efforts include the development of communications addressing misperceptions about the benefits of vaping on affect regulation and stricter regulations on e-cigarette advertising to reduce young Australians' exposure to claims that may result in favourable attitudes to e-cigarette use.

The lived experiences of hematology healthcare providers during and beyond the COVID-19 crisis: A qualitative study.

OBJECTIVE: Amid the COVID-19 pandemic, healthcare providers (HCPs) of hematology patients face unique challenges due to the vulnerability of their patients. This study explores the lived experiences of these providers during and beyond the crisis. METHODS: Twenty-one Australian HCPs caring for hematology patients completed semi-structured interviews exploring their experiences and needs during the COVID-19 pandemic, adequacy of support and information provided by healthcare organizations, impact on hematology patients, and the benefits and challenges of telehealth care. Data were analyzed using reflexive thematic analysis. RESULTS: Four themes were identified: (1) Managing an initial state of flux (unsettling uncertainty and fear, unique needs of hematology patients, getting on with the job together); (2) Concerns about care provision (questioning care efficacy, burden of compassion); (3) Disconnect between HCP needs and system-level responses (burnout, isolation, and poor work-life balance, broadcast fatigue, protecting mental health), and; (4) Reflecting on the future (ongoing challenges for hematology patients, higher staff turnover and heavier workloads, innovation in the healthcare field). CONCLUSION: This study sheds light on the challenges that hematology HCPs face during and beyond the COVID-19 crisis, impacting their wellbeing. Addressing these challenges is paramount for the healthcare system at large. Provider-led peer support programs may be beneficial for addressing moral distress and building resilience. Additionally, specific consideration for the ongoing vulnerability of hematology patients could have positive impacts on providers' professional satisfaction.

Dimensions of the diet-exercise relationship in later life: A qualitative study.

OBJECTIVE: Diet and physical activity are two lifestyle behaviours that are critical for healthy ageing. The aim of this study was to explore how older adults negotiate dietary and physical activity decisions to identify areas of intersection between these two behaviours and inform health promotion interventions targeting both diet and exercise. METHODS: This exploratory study utilised a novel data collection approach that involved lay interviewers recruiting their peers to (i) participate in two interviews over a period of six months and (ii) make notes on their thoughts relating to diet and physical activity. Participants were 75 adults aged 60+ years in Western Australia (n = 64 females). RESULTS: Three primary themes were identified: (i) the importance but difficulty of achieving energy balance; (ii) issues relating to managing food intake before, during, and after physical activity; and (iii) reciprocal opportunities for eating and physical activity. CONCLUSIONS: Diet and physical activity are linked in complex ways, highlighting the need for multi-factorial interventions. IMPLICATIONS FOR PUBLIC HEALTH: When developing communications strategies designed to encourage older people to both improve their diets and increase their physical activity, consideration could be given to leveraging existing perceived alignments between healthy eating and being active.

Testing campaign slogans designed to motivate older people to be more physically active.

Objectives and importance of study: Being physically active is critical for healthy ageing, yet many older people do not meet physical activity guidelines. The aim of this study was to test the relative effectiveness of five previously identified campaign slogans designed to encourage older people to be more physically active: 'Be active 30-60 minutes a day to stay fit and well'; 'Move more, live longer'; 'Stay fit to stay functional'; 'This is your time - enjoy being strong and active'; and 'Use it or lose it'. STUDY TYPE: Online experiment Methods: A total of 1200 Australians aged 50 years and older (50% female, mean age 65 years) were recruited to complete an online survey, with respondents randomised to answer a series of questions on a video featuring one of the five slogan conditions. One-way ANOVAs with Tukey's post-hoc tests were used to identify differences in outcomes between slogans. RESULTS: Overall, the slogans were assessed favourably, suggesting older adults may be receptive to messages about increasing their physical activity. 'Use it or lose it 'performed best across the outcome measures of internal and external motivation, perceived effectiveness, liking, believability, and personal relevance. CONCLUSION: Efforts to encourage physical activity among older Australians could use the slogan 'Use it or lose it' as an evidence-based tagline.

Perceptions of a prescription model for accessing nicotine vaping products: an examination of submissions made by self-reported e-cigarette users to an Australian consultation.

In response to rapid and substantial increases in rates of e-cigarette use among young people, Australia's Therapeutic Goods Administration (TGA) made changes to the regulations governing nicotine vaping products. As part of the regulatory change process, Australians were invited to comment on the proposed regulations, which featured the introduction of a prescription model for nicotine vaping products. To inform strategies to enhance compliance with the tightened regulations, this study examined submissions made by self-reported e-cigarette users to the TGA's public consultation (n = 1405). A content analysis was conducted to identify and quantify key arguments. Claims about possible negative consequences associated with the regulations (e.g. people will return to smoking, inconvenience) featured in most submissions (84%). Around half (55%) of submissions mentioned perceived benefits of e-cigarettes, including favourable health outcomes (e.g. improved breathing) and enhanced tobacco cessation. Around half (52%) featured concerns about inconsistency in treatment and the argument that e-cigarettes should not be restricted when more harmful tobacco products are readily available. Alternative approaches to a prescription model were offered in nearly one-third (31%) of submissions. One-quarter (26%) included text provided by an industry-led astroturfing campaign. The arguments made in the analysed submissions suggest a lack of appreciation of (i) the negative health outcomes associated with e-cigarette use and (ii) evidence linking these devices to smoking relapse. Results highlight the need for targeted health campaigns that address (i) gaps in consumers' knowledge and (ii) vaping-related misinformation being promulgated by the industry and its allies.

The Influence of Grandparents on Children's Dietary Health: A Narrative Review.

PURPOSE OF REVIEW: To examine and synthesise recent evidence on the role of grandparents in shaping children's dietary health. RECENT FINDINGS: The influence of grandparents on children's dietary health was evident across studies. Grandparents frequently provide their grandchildren with meals and snacks, and engage in many of the same feeding practices used by parents. Although grandparents report providing their grandchildren with healthy foods, the provision of treat foods high in sugar or fat was a common finding. This provision led to family conflict, with the indulgent behaviours of grandparents seen by parents as a barrier to healthy eating. Grandparents are exerting significant influence on child dietary health. Efforts are needed to ensure these care providers are considered key stakeholders in the promotion of healthy eating and are targeted in policies and programs addressing children's diets. Research that determines how to best support grandparents to foster healthy behaviours in children is critical.

Perceptions of e-cigarettes among Australian adolescents, young adults, and adults.

Increases in e-cigarette use are of concern to public health authorities given the harms associated with vaping. Understanding people's perceptions of the risks and benefits of e-cigarette use has the potential to assist with prevention efforts. However, research assessing the perceptions of Australian adolescents and any differences in perceptions between adolescents, young adults, and adults is limited. Additionally, research exploring perceptions of various types of e-cigarettes is lacking. To inform the development of prevention and intervention programs and policies, this study aimed to explore Australians' perceptions of the risks and benefits associated with e-cigarette use and whether perceptions differ by age and user status. A sample of 4,617 Australians aged 12 + years completed an online survey that assessed (i) smoking and e-cigarette user status, (ii) e-cigarette risk perceptions, (iii) beliefs about e-cigarettes as a smoking cessation tool, and (iv) positive e-cigarette outcome expectancies. Across all age groups, respondents perceived non-nicotine and flavoured e-cigarettes as less harmful than nicotine e-cigarettes. Significantly more adolescents and young adults than adults held positive outcome expectancies, and a substantial minority of non-users and never users in all age groups believed that using e-cigarettes confers social and mental health benefits. Given the potential benefits they perceived to be associated with e-cigarette use, a substantial proportion of adolescent and young adult never users may be vulnerable to initiation. These findings highlight the importance of (i) adequately communicating the risks associated with non-nicotine e-cigarette use and (ii) addressing misperceptions about use, especially among youth.

Educators' perceptions of e-cigarettes in Australian secondary schools.

INTRODUCTION: Secondary schools are a setting in which e-cigarette use among students has increased significantly, resulting in an urgent need for educators to develop and implement strategies to curb youth vaping. Research assessing school-based vaping prevention efforts is limited and largely confined to the US. This study assessed Australian secondary school staff members' experiences with e-cigarettes and explored (i) the presence of e-cigarette policies and educational programs, (ii) barriers to policy development and implementation, and (iii) desired support. METHODS: Public, Catholic, and Independent secondary schools across Australia were sent an invitation to participate in this study, which involved completion of an online survey. A total of 218 school staff members (55% women) participated. Respondents included school principals, teachers, and other staff members. Data collection occurred May to September 2022. Both quantitative and qualitative data were collected. RESULTS: Nearly half (46%) of all school staff members surveyed reported finding a student with an e-cigarette on campus at least monthly, and one-third (36%) of principals reported suspending or expelling students at least monthly for e-cigarette possession or use. The vast majority of those surveyed agreed that e-cigarette use is increasingly becoming a problem in secondary schools (93%) and reported being concerned about e-cigarette use by students (94%). Only half (51%) reported that their school had an e-cigarette policy in place. The discreet appearance of e-cigarettes (83%) and difficulties pinpointing from where the vapor/scent is coming (73%) were the most frequently reported barriers to policy enforcement. CONCLUSIONS: The results of this study suggest that e-cigarettes present a threat to secondary school environments. There is an urgent need to develop, implement, and enforce both school- and government-level e-cigarette policies to prevent and reduce youth vaping in Australian secondary schools.