Facilitators and Barriers to Lung Cancer Screening during Long COVID: A Global Systematic Review and Meta-Study Synthesis of Qualitative Research.

Background: Participation in targeted screening reduces lung cancer mortality by 30-60%, but screening is not universally available. Therefore, the study aimed to synthesize the evidence and identify facilitators and barriers to lung cancer screening participation globally. Methods: Two reviewers screened primary studies using qualitative methods published up to February 2023. We used two-phase synthesis consistent with a meta-study methodology to create an interpretation of lung cancer screening decisions grounded in primary studies, carried out a thematic analysis of group themes as specific facilitators and barriers, systematically compared investigations for similarities and differences, and performed meta-synthesis to generate an expanded theory of lung cancer screening participation. We used the Social Ecological Model to organize and interpret the themes: individual, interpersonal, social/cultural, and organizational/structural levels. Results: Fifty-two articles met the final inclusion criteria. Themes identified as facilitating lung cancer screening included prioritizing patient education, quality of communication, and quality of provider-initiated encounter/coordination of care (individual patient and provider level), quality of the patient-provider relationship (interpersonal group), perception of a life's value and purpose (cultural status), quality of tools designed, and care coordination (and organizational level). Themes coded as barriers included low awareness, fear of cancer diagnosis, low perceived benefit, high perceived risk of low-dose computerized tomography, concern about cancer itself, practical obstacle, futility, stigma, lack of family support, COVID-19 fear, disruptions in cancer care due to COVID-19, inadequate knowledge of care providers, shared decision, and inadequate time (individual level), patient misunderstanding, poor rapport, provider recommendation, lack of established relationship, and confusing decision aid tools (interpersonal group), distrust in the service, fatalistic beliefs, and perception of aging (cultural level), and lack of institutional policy, lack of care coordinators, inadequate infrastructure, absence of insurance coverage, and costs (and organizational status). Conclusions: This study identified critical barriers, facilitators, and implications to lung cancer screening participation. Therefore, we employed strategies for a new digital medicine (artificial intelligence) screening method to balance the cost-benefit, "workdays" lost in case of disease, and family hardship, which is essential to improve lung cancer screening uptake.

A qualitative study of using nicotine products for smoking cessation after discharge from residential drug and alcohol treatment in Australia.

INTRODUCTION: Tobacco smoking is highly prevalent among alcohol and other drugs (AOD) service clients and, despite interest in quitting, abstinence is rarely sustained. Nicotine products may assist after discharge from residential treatment services, but little is known about client receptivity to them. This study examined AOD withdrawal service clients' experiences of two types of nicotine products for smoking cessation post-discharge, combination nicotine replacement therapy (cNRT) and nicotine vaping products (NVP). METHODS: We held semi-structured telephone interviews with 31 Australian AOD service clients in a clinical trial of a 12-week smoking cessation intervention using Quitline support plus cNRT or NVP delivered post-discharge from a smoke-free residential service. We asked about health and social factors, nicotine cravings, Quitline experience, and barriers and facilitators to cNRT or NVP, then thematically analysed data. RESULTS: cNRT and NVP were described by participants as feasible and acceptable for smoking cessation. For most participants, cost limited cNRT access post study, as did difficulty navigating NVP prescription access. Quitline support was valued, but not consistently used, with participants noting low assistance with NVP-facilitated cessation. Participants considered both cessation methods acceptable and socially supported, and sought information on decreasing nicotine use via NVP. DISCUSSION AND CONCLUSIONS: AOD service clients highly valued receiving cNRT or NVP with behavioural support for smoking reduction or abstinence. Both interventions were acceptable to service clients. Findings suggest a potential need to examine both whether NVP use should be permitted in this context, and guidance on the individual suitability of cNRT or NVP.

Attitudes of people diagnosed with cancer and cancer care providers towards use of nicotine vaping products in high-income countries: a scoping review.

PURPOSE: To investigate the attitudes, beliefs and perceptions of people diagnosed with cancer and health practitioners on use of nicotine vaping products. METHODS: Scopus and OVID Medline were searched for papers published between 2013 and 2023. Two authors independently selected the studies and extracted data, with conflicts resolved through discussion. Nine studies were selected for further synthesis. Reporting follows the PRISMA Scoping Reviews checklist. RESULTS: E-cigarettes were commonly perceived as less harmful compared to conventional cigarettes and less detrimental to cancer treatment effectiveness among people with a current or previous cancer diagnosis. This population also cited smoking cessation, smoking in non-smoking areas and less risky alternative as the most common reasons for e-cigarette use. Nevertheless, low levels of clinician support on the effectiveness of e-cigarettes as a smoking cessation tool/alternative were identified. CONCLUSION: Findings show differences in beliefs and attitudes of e-cigarettes between clinicians and people diagnosed with cancer. Additional research into the health impacts of e-cigarettes in people with a current or previous cancer diagnosis will allow for greater congruence between patients and clinicians and assist providers in recommending effective tools for smoking cessation within this population. IMPLICATIONS FOR CANCER SURVIVORS: This study provides an overview of the attitudes, beliefs and perceptions of e-cigarette use among people with a current or previous diagnosis of cancer and health practitioners. Given the increased prevalence of e-cigarette use within this population, these findings highlight a greater need for dialogue between patients and clinicians regarding the safety and efficacy of these devices.

Association of anxiety and depression symptoms with perceived health risk of nicotine vaping products for smoking cessation.

As tobacco smoking prevalence is unacceptably high for the one in five Australians reporting a mental health condition in the past year, multiple cessation supports are needed to reduce tobacco-related disease. Nicotine vaping product (NVP)-facilitated smoking cessation is one option requiring a medical prescription in Australia. Yet, people easily obtain NVPs via non-prescription channels. As mental health impacts quitting intentions and health system engagement, this study examined how presence of anxiety and depression symptoms may be associated with perceived health risk of using NVPs from prescription or non-prescription sources for smoking cessation. We used cross-sectional South Australian (15 years +) 2022 survey data on vaping, smoking, anxiety, and depression. Robust linear regression was used to examine the association of anxiety and depression symptoms and nicotine addiction concern on perceived health risk of using NVPs from prescription or non-prescription sources. For prescription NVPs, vaping was associated with lower perceived health risk (b=-0.732). Higher perceived addiction risk was associated with higher perceived health risk from prescription NVPs (b=0.784). For non-prescription NVPs, vaping (b=-0.661) or smoking (b=-0.310) was associated with lower perceived health risk, and higher perceived addiction risk (b=0.733) was associated with a higher perceived health risk. Although anxiety and depression were not directly associated with NVP health risk perceptions, vaping while having depression symptoms was associated with higher perceived health risk ratings for prescription (b=0.700) but not non-prescription sources. People with depression who vape may see health risk barriers in NVP prescription access for smoking cessation, a smoking cessation support gap.

A systematic review of migrant women's experiences of successful exclusive breastfeeding in high-income countries.

The World Health Organisation recommends exclusive breastfeeding for the first 6 months after childbirth. However, since breastfeeding is influenced by cultural practice, it differs between migrant mothers and nonmigrant mothers. This systematic review examined migrant mothers' perceptions and experiences impacting achievement of exclusive breastfeeding after immigration from a low-middle-income country to a high-income country. CINAHL, Medline, Scopus, Web of Science, PsycINFO and Emcare were searched for qualitative studies published from 2010 to August 2022. Eleven studies met inclusion criteria. We used meta-ethnographic synthesis to identify overarching themes, resulting in five themes: Migrant mothers (1) 'recognised the differences in breastfeeding practice between their home and host country'. During acculturation, mothers modify or stick to their breastfeeding practice in their host country based on their (2) 'breastfeeding knowledge' by combining their (3) 'original ethnic identity' with the (4) 'influence of family members, healthcare workers, infants, peers and workplace'. Although they face barriers, their (5) 'autonomy' motivated them to continue breastfeeding in a country where the breastfeeding norm differs from where they come from. Intrapersonal and interpersonal socio-ecological factors played a significant role in their breastfeeding practice in the host country. Findings indicate public health policy and practice to support breastfeeding for migrant women in high-income countries can be improved, particularly by emphasising the importance of providing affirmative, comprehensive and practical support from healthcare professionals.

Vaping harms awareness messaging: exploring young South Australians' responses to vaping prevention campaign materials.

Nicotine vaping products (NVPs) pose health risks associated with nicotine dependence and increased likelihood of tobacco consumption. Despite having a secondary role in smoking cessation, recreational NVP use is increasing among younger people. Vaping prevention campaigns aim to influence views on the health risks of vaping. This study examined perceptions of Australian and international vaping prevention campaigns among 27 young South Australians aged 16-26 years who do and do not use NVPs, to inform targeting and framing of vaping risk messaging. Participants viewed example materials from three vaping prevention campaigns: 'Epidemic', 'Do you know what you're vaping' and 'Unveil what you inhale'. Focus groups and interviews assessed whether materials were easily understood, appropriate, relevant, credible and effective in health communication. Participants indicated that all campaigns would influence their thoughts and actions related to vaping. The 'Do you know what you're vaping' campaign prompted thoughts about uncertainty about individual health risks, though participants did not indicate that this was enough to motivate vaping cessation. Participants considered the 'Unveil' campaign effective, with those who did not vape indicating they would click through to access resources, and those who did vape responding well to the 'challenge' aspect of the messaging. The 'Epidemic' campaign fear appeal did not clearly prompt change in vaping views or behaviours. Campaigns using a challenge approach may generate conversation about vaping harms, while fear appeals can be dismissed by younger audiences. Evidence-based short messages and the presentation of multiple versions of content were considered effective approaches.

Vaping industry participation standards in health organizations: an exploratory policy content analysis.

The vaping industry has been found to employ similar tactics to tobacco industry actors to seek credibility and distort the scientific evidence base around the health harms of nicotine vaping products. As vaping industry interests undermine vaping control efforts, safeguards are necessary to protect against this influence. We aimed to examine health organizations' policies on vaping industry participation in their activities in Australia. A descriptive approach integrating policy analysis and key informant surveys was used to obtain vaping industry participation information from health research stakeholders. Descriptive statistics on organization type, policy document type, policy document industry focus (tobacco or vaping) and respondent role and responsibility were collected. We used framework analysis to identify themes describing organizational allowances, constraints, and rationale for vaping industry research participation. Relevant health organizations were identified within Australia for policy searching (n = 156), which identified 47 unique policy documents. After contacting 267 key stakeholders from eligible organizations, 31 survey responses were analysed. Research organizations and universities were highly represented in both the policy and survey data. Most health research stakeholders recognized that vaping industry interests counteract public health priorities and opposed vaping industry participation. However, many organizations lacked clear, vaping industry-specific participation policies. To protect the integrity of the emerging evidence base around vaping harms which inform vaping policy, health organizations require strong, comprehensive policies to resist vaping industry participation in research.

Perspectives on limiting tobacco access and supporting access to nicotine vaping products among clients of residential drug and alcohol treatment services in Australia.

INTRODUCTION: Tobacco endgame strategies aim to drive down population smoking rates, the success of which can be improved with public buy-in, including from populations with high smoking rates such as alcohol and other drug (AOD) service clients. This study aimed to explore acceptability of tobacco retail and nicotine reduction, and subsidised nicotine vaping to support AOD service clients following a smoking cessation attempt. METHODS: We interviewed 31 Australian AOD service clients who currently or previously smoked, following a 12-week randomised trial comparing nicotine replacement therapy with nicotine vaping product (NVP) for smoking cessation. Participants were asked how effectively three scenarios would support tobacco cessation: tobacco retailer reduction, very low-nicotine cigarette standard and subsidised NVP access. We thematically analysed participant views on how each approach would support tobacco abstinence. RESULTS: Tobacco retailer reduction raised concerns about increasing travel and accessing cigarettes from alternate sources, with generally lower acceptability, though a range of perspectives were provided. Reducing nicotine in tobacco products was described as reducing appeal of smoking and potentially increasing illicit purchases of non-reduced nicotine products. Clients of AOD services were highly accepting of subsidised NVP access for tobacco cessation, as this would partly address financial and socioeconomic barriers. CONCLUSIONS: Australian tobacco control policy should consider how these approaches impact ease and likelihood of tobacco access by AOD service clients in relation to the general population. Understanding clients' acceptability of tobacco control and endgame measures can inform how to avoid potential unintended consequences for these clients.

South Australia's tobacco retail landscape and its intersection with socioeconomic factors and smoking prevalence.

ISSUES ADDRESSED: Tobacco product availability is higher in socioeconomically disadvantaged areas, which can further widen tobacco-related health and disease burden inequities. This study aimed to describe retail availability of tobacco products in South Australia and examine the association between tobacco vendor location, population's socioeconomic status (SES) and tobacco smoking prevalence. METHODS: Cross-sectional 2022 tobacco vendor licence data and 2021-2022 state-wide population health survey data from the South Australian Department of Health were used. Tobacco vendors were enumerated by Statistical Area 2 (SA2) using geocoding software, with SA2s assigned health survey derived smoking prevalence, SES, remoteness category, area size, and population size. RESULTS: As of 2022, there were 1723 tobacco vendors in South Australia and the overall tobacco smoking prevalence across the state was 11.8%. Regression analyses indicated that tobacco vendor density increased with socioeconomic disadvantage and geographic remoteness, and that smoking prevalence was higher in low SES areas. Vendor density was not related to smoking prevalence. CONCLUSIONS: Findings are consistent with existing research indicating greater tobacco availability in socially disadvantaged areas. This supports that tobacco vendor saturation may be directed to areas in a way that promotes tobacco availability for vulnerable populations. Our finding that smoking prevalence was unrelated to tobacco availability contrasts existing literature and should be carefully interpreted. SO WHAT?: This is the first study to map tobacco retailers across South Australia, contributing needed evidence on the intersection of tobacco vendor density, social disadvantage, and smoking prevalence.

Smoking Cessation Interventions and Abstinence Outcomes for People Living in Rural, Regional, and Remote Areas of Three High-Income Countries: A Systematic Review.

INTRODUCTION: Tobacco smoking rates in high-income countries are greater in rural, regional, and remote (RRR) areas compared to cities. Yet, there is limited knowledge about interventions targeted to RRR smokers. This review describes the effectiveness of smoking cessation interventions for RRR smokers in supporting smoking abstinence. AIMS AND METHODS: Seven academic databases were searched (inception-June 2022) for smoking cessation intervention studies to include if they reported on RRR residents of Australia, Canada, or the United States, and short- (<6 months) or long-term (≥6 months) smoking abstinence outcomes. Two researchers assessed study quality, and narratively summarized findings. RESULTS: Included studies (n = 26) were primarily randomized control (12) or pre-post (7) designs, from the United States (16) or Australia (8). Five systems change interventions were included. Interventions included cessation education or brief advice, and few included nicotine monotherapies, cessation counseling, motivational interviewing, or cognitive behavioral therapy. Interventions had limited short-term effects on RRR smoking abstinence, decreasing markedly beyond 6 months. Short-term abstinence was best supported by contingency, incentive, and online cessation interventions, and long-term abstinence by pharmacotherapy. CONCLUSIONS: Cessation interventions for RRR smokers should include pharmacotherapy and psychological cessation counseling to establish short-term abstinence, and identify effective means of maintaining abstinence beyond 6 months. Contingency designs are a suitable vehicle for psychological and pharmacotherapy support for RRR people who smoke, and intervention tailoring should be explicitly considered. IMPLICATIONS: Smoking disproportionately harms RRR residents, who can encounter access barriers to smoking cessation support. High-quality intervention evidence and outcome standardization are still required to support long-term RRR smoking abstinence.

Examining the role of pets in cancer survivors' physical and mental wellbeing.

PURPOSE: Australian cancer survivors have multiple wellbeing support needs, and Australians frequently keep pets, a practice associated with physical and mental health benefits. This mixed-methods study explores the influence of relationships of PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) wellbeing domains and pet ownership on cancer survivors' physical and mental wellbeing and quality of life. METHODS: A convenience sample of Australian cancer survivors (N = 162) were surveyed, recording demographic, pet ownership, PERMA wellbeing, physical and mental health characteristics, and support needs. Quality of life and health scores were predicted from PERMA domains and pet ownership. RESULTS: Pet ownership was highly prevalent in participating cancer survivors, predicting increased mental health scores. No associations were seen for physical health. Cancer survivors sought instrumental pet care support and pet-owner relationship maintenance during survivorship.Implications: Pet ownership may be leverageable in interventions for mental health and wellbeing improvement during cancer recovery. Research should next clarify pet ownership prevalence in this population.

Exploring the potential of citizen science for public health through an alcohol advertising case study.

Citizen science connects academic researchers with the public through combined efforts in scientific inquiry. The importance of involving impacted populations in health research is well established. However, how to achieve meaningful participation and the methodological impact of citizen science needs further examination. We examined the feasibility of using citizen science to understand the impact of alcohol advertising on Australian women through a breast cancer prevention project. Two hundred and eighty-two ('participants') citizen scientists completed demographic and behavioural questions via an online survey. The research participants moved into the role of citizen scientists by completing the data collection tasks of capturing and classifying images of alcohol advertising they saw online. Interrater reliability tests found high levels of agreement between citizen scientists and academic researchers with the classification of alcohol advertising brand (Kappa = 0.964, p < 0.001) and image type (Kappa = 0.936, p < 0.000). The citizen scientists were women aged 18 and over, with 62% between 35 and 55 years old. The majority were from major cities (78%), had attained a bachelor's degree or higher-level education (62%) and were recruited via email or Facebook (86%). The use of citizen science provided methodological gains through the creation of a unique dataset with higher levels of validity than the existing literature, which employed traditional investigator-driven research methodologies. Citizen science enriched the dataset and provided a powerful methodological vehicle to understand an environmental determinant of health. The study illuminates how public participation benefitted the research process, the challenges and the potential for citizen science to improve public health.

Injury by design: A thematic networks and system dynamics analysis of work-related musculoskeletal disorders in tram drivers.

Tram driving is a safety critical task where work-related musculoskeletal disorders (WRMSDs) and injuries are associated with interacting occupational design factors over time. These interactions then carry implications for workforce retention, public safety, workplace relations and supports. To better understand such interactions, this study used thematic networks and system dynamics (causal loop diagrams) analysis with the aim to unearth a global theme underscoring occurrence of WRMSDs, and describe the factors influencing the system dynamics of WRMSD occurrence in tram drivers. Building on earlier work focused on occupational participation, secondary analysis of driver interviews (n = 13) and driving observations (n = 11) produced thematic network and causal loop models of risk factors that highlighted an Injury by Design problem structure as a global theme. Research targeting organisational culture, human factors, and design standards is needed to minimise WRMSDs risk in tram drivers.

Health literacy, digital health literacy and the implementation of digital health technologies in cancer care: the need for a strategic approach.

ISSUE ADDRESSED: Digital health technologies can potentially reduce health disparities in cancer care. However, the benefits of digital health technology depend partly on users' digital health literacy, that is, "capabilities and resources required for individuals to use and benefit from digital health resources," which combines health and digital literacy. We examined issues for digital health technology implementation in cancer care regarding digital health literacy, via stakeholder consultation. METHODS: Consumers, health care professionals, researchers, developers, nongovernment and government/policy stakeholders (N = 51) participated in focus groups/interviews discussing barriers, enablers, needs and opportunities for digital health implementation in cancer care. Researchers applied framework analysis to identify themes of digital health literacy in the context of disparity and inclusion. RESULTS: Limited digital and traditional health literacy were identified as barriers to digital technology engagement, with a range of difficulties identified for older, younger and socio-economically or geographically disadvantaged groups. Digital health technology was a potential enabler of health care access and literacy, affording opportunities to increase reach and engagement. Education combined with targeted design and implementation were identified means of addressing health and digital literacy to effectively implement digital health in cancer care. CONCLUSIONS: Implementing digital health in cancer care must address the variability of digital health literacy in recipients, including groups living with disadvantage and older and younger people, in order to be effective. SO WHAT?: If cancer outcome disparity is to be reduced via digital health technologies, they must be implemented strategically to address digital health literacy needs. Health policy should reflect this approach.

A Multispecies Approach to Co-Sleeping : Integrating Human-Animal Co-Sleeping Practices into Our Understanding of Human Sleep.

Human sleeping arrangements have evolved over time and differ across cultures. The majority of adults share their bed at one time or another with a partner or child, and many also sleep with pets. In fact, around half of dog and cat owners report sharing a bed or bedroom with their pet(s). However, interspecies co-sleeping has been trivialized in the literature relative to interpersonal or human-human co-sleeping, receiving little attention from an interdisciplinary psychological perspective. In this paper, we provide a historical outline of the "civilizing process" that has led to current sociocultural conceptions of sleep as an individual, private function crucial for the functioning of society and the health of individuals. We identify similar historical processes at work in the formation of contemporary constructions of socially normative sleeping arrangements for humans and animals. Importantly, since previous examinations of co-sleeping practices have anthropocentrically framed this topic, the result is an incomplete understanding of co-sleeping practices. By using dogs as an exemplar of human-animal co-sleeping, and comparing human-canine sleeping with adult-child co-sleeping, we determine that both forms of co-sleeping share common factors for establishment and maintenance, and often result in similar benefits and drawbacks. We propose that human-animal and adult-child co-sleeping should be approached as legitimate and socially relevant forms of co-sleeping, and we recommend that co-sleeping be approached broadly as a social practice involving relations with humans and other animals. Because our proposition is speculative and derived from canine-centric data, we recommend ongoing theoretical refinement grounded in empirical research addressing co-sleeping between humans and multiple animal species.

It Comes With the Job: Work Organizational, Job Design, and Self-Regulatory Barriers to Improving the Health Status of Train Drivers.

OBJECTIVE: This study aimed to examine the impacts of key barriers to improving the occupational health status of Australian train drivers. METHODS: From May to June, 2015, five semi-structured qualitative focus groups were conducted with 29 train drivers from South Australian, Victorian, and New South Wales-based rail organizations in Australia. RESULTS: Occupational health was impeded by multiple barriers regarding sleep (patterns/fatigue), diet (planning/context), mental health (occupational stress), rostering (low autonomy), sedentary time, low fitness motivation, and family/social life conflicts. Work organizational barriers included communication issues, low organizational support, and existing social norms. Job design barriers included rostering, fatigue, stimulant reliance, and family/social life imbalances. Self-regulatory barriers included dietary and exercise patterns habits and patterns. CONCLUSIONS: Occupational health interventions for Australian train drivers must address work organizational, job design, and self-regulatory barriers to healthier lifestyle behaviors.

Animal Ownership Among Vulnerable Populations in Regional South Australia: Implications for Natural Disaster Preparedness and Resilience.

CONTEXT: Few studies have examined the prevalence of animal ownership among populations likely to be at greater risk from disaster events within a bushfire context. OBJECTIVE: To investigate the proportion of vulnerable community members keeping animals and the types of animals kept, as well as perceived risk of harm to pets, and their inclusion in bushfire survival planning. DESIGN: Statewide anonymous online survey in 2014 of adult South Australian animal owners threatened by bushfire in January 2014. Respondents were asked about animal ownership, their bushfire risk perception, and household survival planning. Descriptive statistics are presented for 5 groups considered likely to contribute to increased risk of harm for households: linguistically diverse, older adults, families with young children, physically frail, and self-identifying disabled, as well as individuals with mental health considerations. SETTING: An opt-in purposively targeted sample of anonymous South Australians living in high fire-risk locations. PARTICIPANTS: Adult South Australian animal owners threatened or directly impacted by bushfire events, including individuals matching 1 of the 5 vulnerable groups. MAIN OUTCOME MEASURES: Self-reported details of animal ownership, perceived fire risk, survival planning, and vulnerability characteristics. RESULTS: Animal ownership was found to be more prevalent in these 5 populations than in the wider South Australian population. Perceived risk to pets was low to moderately low in these individuals. Variation was observed in the role of animals generally and pets specifically as motivators for preparing bushfire survival plans. CONCLUSIONS: Emergency services and associated agencies need to consider how the unique needs of vulnerable populations that keep animals, and their potential differences in risk perception, relate to their bushfire survival planning and preparedness requirements.

No Pet or Their Person Left Behind: Increasing the Disaster Resilience of Vulnerable Groups through Animal Attachment, Activities and Networks.

Increased vulnerability to natural disasters has been associated with particular groups in the community. This includes those who are considered de facto vulnerable (children, older people, those with disabilities etc.) and those who own pets (not to mention pets themselves). The potential for reconfiguring pet ownership from a risk factor to a protective factor for natural disaster survival has been recently proposed. But how might this resilience-building proposition apply to vulnerable members of the community who own pets or other animals? This article addresses this important question by synthesizing information about what makes particular groups vulnerable, the challenges to increasing their resilience and how animals figure in their lives. Despite different vulnerabilities, animals were found to be important to the disaster resilience of seven vulnerable groups in Australia. Animal attachment and animal-related activities and networks are identified as underexplored devices for disseminating or 'piggybacking' disaster-related information and engaging vulnerable people in resilience building behaviors (in addition to including animals in disaster planning initiatives in general). Animals may provide the kind of innovative approach required to overcome the challenges in accessing and engaging vulnerable groups. As the survival of humans and animals are so often intertwined, the benefits of increasing the resilience of vulnerable communities through animal attachment is twofold: human and animal lives can be saved together.