Adapting and translating the 'Hep B Story' App the right way: A transferable toolkit to develop health resources with, and for, Aboriginal people.

ISSUE ADDRESSED: In 2014 the 'Hep B Story App', the first hepatitis B educational app in an Aboriginal language was released. Subsequently, in 2018, it was assessed and adapted before translation into an additional 10 Aboriginal languages. The translation process developed iteratively into a model that may be applied when creating any health resource in Aboriginal languages. METHODS: The adaptation and translation of the 'Hep B Story' followed a tailored participatory action research (PAR) process involving crucial steps such as extensive community consultation, adaptation of the original material, forward and back translation of the script, content accuracy verification, voiceover recording, and thorough review before the publication of the new version. RESULTS: Iterative PAR cycles shaped the translation process, leading to a refined model applicable to creating health resources in any Aboriginal language. The community-wide consultation yielded widespread chronic hepatitis B education, prompting participants to share the story within their families, advocating for hepatitis B check-ups. The project offered numerous insights and lessons, such as the significance of allocating sufficient time and resources to undertake the process. Additionally, it highlighted the importance of implementing flexible work arrangements and eliminating barriers to work for the translators. CONCLUSIONS: Through our extensive work across the Northern Territory, we produced an educational tool for Aboriginal people in their preferred languages and developed a translation model to create resources for different cultural and linguistic groups. SO WHAT?: This translation model provides a rigorous, transferable method for creating accurate health resources for culturally and linguistically diverse populations.

Using photovoice to generate solutions to improve food security among families living in remote Aboriginal and/or Torres Strait Islander communities in Australia.

The right to food security has been recognised internationally, and nationally in Australia by Aboriginal Community Controlled Health Organisations. This study aims to explore food (in)security and solutions for improvement of food security in remote Aboriginal and/or Torres Strait Islander communities in Australia, from the perspective of caregivers of children within the context of the family using photovoice. Participants took part in workshops discussing participant photographs of food (in)security, including solutions. Themes and sub-themes with associated solutions included traditional food use, sharing as a part of culture, the cost of healthy food, energy and transport, and housing and income. Community leaders used these data in setting priorities for advocacy to improve food security in their communities.

Evaluating the impact of 'Ask the Specialist Plus': a training program for improving cultural safety and communication in hospital-based healthcare.

BACKGROUND: First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants. METHODS: Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia's Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick's evaluation model. RESULTS: Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences. CONCLUSION: The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection.

Improving outcomes for hospitalised First Nations peoples though greater cultural safety and better communication: the Communicate Study Partnership study protocol.

BACKGROUND: The Communicate Study is a partnership project which aims to transform the culture of healthcare systems to achieve excellence in culturally safe care for First Nations people. It responds to the ongoing impact of colonisation which results in First Nations peoples experiencing adverse outcomes of hospitalisation in Australia's Northern Territory. In this setting, the majority of healthcare users are First Nations peoples, but the majority of healthcare providers are not. Our hypotheses are that strategies to ensure cultural safety can be effectively taught, systems can become culturally safe and that the provision of culturally safe healthcare in first languages will improve experiences and outcomes of hospitalisation. METHODS: We will implement a multicomponent intervention at three hospitals over 4 years. The main intervention components are as follows: cultural safety training called 'Ask the Specialist Plus' which incorporates a locally developed, purpose-built podcast, developing a community of practice in cultural safety and improving access to and uptake of Aboriginal language interpreters. Intervention components are informed by the 'behaviour change wheel' and address a supply-demand model for interpreters. The philosophical underpinnings are critical race theory, Freirean pedagogy and cultural safety. There are co-primary qualitative and quantitative outcome measures: cultural safety, as experienced by First Nations peoples at participating hospitals, and proportion of admitted First Nations patients who self-discharge. Qualitative measures of patient and provider experience, and patient-provider interactions, will be examined through interviews and observational data. Quantitative outcomes (documentation of language, uptake of interpreters (booked and completed), proportion of admissions ending in self-discharge, unplanned readmission, hospital length of stay, costs and cost benefits of interpreter use) will be measured using time-series analysis. Continuous quality improvement will use data in a participatory way to motivate change. Programme evaluation will assess Reach, Effectiveness, Adoption, Implementation and Maintenance ('RE-AIM'). DISCUSSION: The intervention components are innovative, sustainable and have been successfully piloted. Refinement and scale-up through this project have the potential to transform First Nations patients' experiences of care and health outcomes. TRIAL REGISTRATION: Registered with ClinicalTrials.gov Protocol Record 2008644.

Research translation to improve carer smoking cessation support in a paediatric ward of a regional hospital in the Northern Territory.

ISSUE ADDRESSED: Health professionals have described barriers to providing carer smoking cessation support in children's wards. This article reports the findings of a research translation process that explored opportunities and developed pathways for change. METHODS: A facilitated discussion workshop and scheduled stakeholder meetings were used to evaluate research evidence and translate it to an evidence-informed organisational change process, with actions for implementation. Workshop and meeting participants were senior health staff with either a pharmacist, personnel with expertise in alcohol and other drugs, medical or nursing backgrounds, and who held senior managerial roles who worked in a hospital in the Northern Territory. A qualitative approach was used. The data from the workshop were transcribed and analysed using thematic analysis. The first author took notes for meetings that were not recorded and analysed these alongside the transcripts. RESULTS: The process was able to initiate change to overcome barriers to providing carer smoking cessation support. All participants agreed to prioritise and make carer smoking cessation everybody's responsibility and supported a systematic approach, including provision of nicotine replacement therapy, new record-keeping systems, and training to address staff knowledge deficits and skills gaps. This movement to solution-focused change continued after the workshop. CONCLUSIONS: With some preparation, a research translation workshop and meetings with selected leaders can initiate organisational change in similar settings and is consistent with theories of planned change. SO WHAT?: This article describes the use of a process to support health promotion through new policies and practices following research which identified barriers in a hospital ward.

Tobacco endgame and priority populations: a scoping review.

AIM: To summarise the research literature on the impacts or perceptions of policies to end tobacco use at a population level (ie, tobacco endgame policies) among people from eight priority population groups (experiencing mental illness, substance use disorders, HIV, homelessness, unemployment or low incomes, who identify as lesbian, gay, bisexual, transgender, queer or intersex (LGBTQI+) or who have experienced incarceration). METHODS: Guided by JBI Scoping Review Methodology, we searched six databases for original research examining the impacts or perceptions of 12 tobacco endgame policies among eight priority populations published since 2000. We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. RESULTS: Of the 18 included studies, one described perceptions of five endgame policies among people on low incomes in Aotearoa (New Zealand), and 17 focused on the effectiveness or impacts of a very low nicotine content (VLNC) cigarette standard among people experiencing mental illness (n=14), substance use disorders (n=8), low incomes (n=6), unemployment (n=1) or who identify as LGBTQI+ (n=1) in the USA. These studies provide evidence that VLNC cigarettes can reduce tobacco smoking, cigarette cravings, nicotine withdrawal and nicotine dependence among these populations. CONCLUSIONS: Most of the tobacco endgame literature related to these priority populations focuses on VLNC cigarettes. Identified research gaps include the effectiveness of endgame policies for reducing smoking, impacts (both expected and unexpected) and policy perceptions among these priority populations.

Progress, challenges and the need to set concrete goals in the global tobacco endgame.

The tobacco endgame is rapidly moving from aspirational and theoretical toward a concrete and achievable goal and, in some cases, enacted policy. Endgame policies differ from traditional tobacco control measures by explicitly aiming to permanently end, rather than simply minimize, tobacco use. The purpose of this paper is to outline recent progress made in the tobacco endgame, its relationship to existing tobacco control policies, the challenges and how endgame planning can be adapted to different tobacco control contexts. Examples of implemented policies in three cities in the United States and national policies in the Netherlands and New Zealand are outlined, as well as recent endgame planning developments in Europe. Justifications for integrating endgame targets into tobacco control policy and the need to set concrete time frames are discussed, including planning for ending the sale of tobacco products. Tobacco endgame planning must consider the jurisdiction-specific tobacco control context, including the current prevalence of tobacco use, existing policies, implementation of the World Health Organization's Framework Convention on Tobacco Control, and public support. However, the current tobacco control context should not determine whether endgame planning should happen, but rather how and when different endgame approaches can occur. Potential challenges include legal challenges, the contested role of e-cigarettes and the tobacco industry's attempt to co-opt the rhetoric of smoke-free policies. While acknowledging the different views regarding e-cigarettes and other products, we argue for a contractionary approach to the tobacco product market. The tobacco control community should capitalize on the growing theoretical and empirical evidence, political will and public support for the tobacco endgame, and set concrete goals for finally ending the tobacco epidemic.

La fase final para poner fin al consumo de tabaco está rápidamente dejando de ser una aspiración y una teoría y se está convirtiendo en un objetivo concreto y alcanzable y, en algunos casos, una política promulgada. Las políticas para poner fin al consumo de tabaco difieren de las medidas tradicionales de control porque están dirigidas explícitamente a poner fin al consumo de tabaco de forma permanente, en lugar de solo minimizarlo. El propósito de este artículo es describir los progresos recientes en la fase final para poner fin al consumo de tabaco, su relación con las políticas existentes de control del tabaco, los desafíos que se enfrentan y cómo la planificación de la fase final se puede adaptar a los diferentes contextos de control del tabaco. Se describen ejemplos de políticas implementadas en tres ciudades de los Estados Unidos y de políticas nacionales en los Países Bajos y Nueva Zelanda, así como los progresos recientes en la planificación de la fase final en Europa. Se abordan las justificaciones para integrar los objetivos de fase final en las políticas de control del tabaco y la necesidad de establecer plazos concretos, incluida la planificación para poner fin a la venta de productos de tabaco. La planificación de la fase final para poner fin al consumo de tabaco debe considerar el contexto de control del tabaco específico según la jurisdicción, así como la prevalencia actual del consumo, las políticas existentes, la aplicación del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco y el apoyo público. Sin embargo, el contexto actual no debe determinar si se debe realizar la planificación de la fase final, sino más bien cómo y cuándo pueden desarrollarse los diferentes planteamientos de la fase. Entre los posibles desafíos se encuentran los legales, el controvertido papel de los cigarrillos electrónicos y el intento de la industria tabacalera de incorporarse a la retórica de las políticas libres de humo. Si bien reconocemos las diferentes opiniones con respecto a los cigarrillos electrónicos y otros productos, abogamos por un enfoque restrictivo con respecto al mercado de productos de tabaco. La comunidad que trabaja por el control del tabaco debe capitalizar la creciente evidencia teórica y empírica, la voluntad política y el apoyo público para lograr la fase final para poner fin al consumo de tabaco, y establecer objetivos concretos para acabar finalmente con la epidemia de tabaquismo.

A erradicação do tabaco está passando rapidamente de uma aspiração teórica para um objetivo concreto e alcançável e, em alguns casos, está se tornando política em vigor. As políticas de erradicação diferem das medidas tradicionais de controle do tabagismo pois visam explicitamente ao fim permanente do consumo de tabaco, ao invés de simplesmente minimizá-lo. O objetivo deste artigo é delinear os avanços recentes rumo à erradicação do tabaco, sua relação com as políticas existentes de controle do tabaco, os desafios e como o planejamento da erradicação pode ser adaptado aos diferentes contextos de controle do tabaco. São apresentados exemplos de políticas implementadas em três cidades nos Estados Unidos e políticas nacionais na Holanda e Nova Zelândia, assim como desdobramentos recentes do planejamento da erradicação na Europa. São discutidas justificativas para integrar metas de erradicação nas políticas de controle do tabaco e a necessidade de estabelecer prazos concretos, incluindo o planejamento para encerrar a venda de produtos de tabaco. O planejamento da erradicação do tabaco deve considerar o contexto do controle do tabaco específico a cada jurisdição, incluindo a prevalência atual do consumo de tabaco, as políticas existentes, a implementação da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde e o apoio do público. Porém, o contexto atual de controle do tabaco não deve determinar se o planejamento da erradicação deve acontecer, mas sim, como e quando diferentes abordagens à erradicação podem ocorrer. Os desafios potenciais incluem recursos judiciais, o papel polêmico dos cigarros eletrônicos e a tentativa da indústria do tabaco de cooptar a retórica das políticas antitabagistas. Embora reconhecendo os diferentes pontos de vista em relação aos cigarros eletrônicos e outros produtos, defendemos uma abordagem contracionista ao mercado de produtos de tabaco. A comunidade de controle do tabaco deve aproveitar as crescentes evidências teóricas e empíricas, a vontade política e o apoio do público à erradicação do tabaco para estabelecer metas concretas e, finalmente, pôr fim à epidemia de tabagismo.

Progress, challenges and the need to set concrete goals in the global tobacco endgame

[ABSTRACT]. The tobacco endgame is rapidly moving from aspirational and theoretical toward a concrete and achievable goal and, in some cases, enacted policy. Endgame policies differ from traditional tobacco control measures by explicitly aiming to permanently end, rather than simply minimize, tobacco use. The purpose of this paper is to outline recent progress made in the tobacco endgame, its relationship to existing tobacco control policies, the challenges and how endgame planning can be adapted to different tobacco control contexts. Examples of implemented policies in three cities in the United States and national policies in the Netherlands and New Zealand are outlined, as well as recent endgame planning developments in Europe. Justifications for inte- grating endgame targets into tobacco control policy and the need to set concrete time frames are discussed, including planning for ending the sale of tobacco products. Tobacco endgame planning must consider the jurisdiction-specific tobacco control context, including the current prevalence of tobacco use, existing pol- icies, implementation of the World Health Organization’s Framework Convention on Tobacco Control, and public support. However, the current tobacco control context should not determine whether endgame plan- ning should happen, but rather how and when different endgame approaches can occur. Potential challenges include legal challenges, the contested role of e-cigarettes and the tobacco industry’s attempt to co-opt the rhetoric of smoke-free policies. While acknowledging the different views regarding e-cigarettes and other products, we argue for a contractionary approach to the tobacco product market. The tobacco control com- munity should capitalize on the growing theoretical and empirical evidence, political will and public support for the tobacco endgame, and set concrete goals for finally ending the tobacco epidemic.

[RESUMEN]. La fase final para poner fin al consumo de tabaco está rápidamente dejando de ser una aspiración y una teoría y se está convirtiendo en un objetivo concreto y alcanzable y, en algunos casos, una política promulgada. Las políticas para poner fin al consumo de tabaco difieren de las medidas tradicionales de control porque están dirigidas explícitamente a poner fin al consumo de tabaco de forma permanente, en lugar de solo minimizarlo. El propósito de este artículo es describir los progresos recientes en la fase final para poner fin al consumo de tabaco, su relación con las políticas existentes de control del tabaco, los desafíos que se enfrentan y cómo la planificación de la fase final se puede adaptar a los diferentes contextos de control del tabaco. Se describen ejemplos de políticas implementadas en tres ciudades de los Estados Unidos y de políticas nacionales en los Países Bajos y Nueva Zelanda, así como los progresos recientes en la planificación de la fase final en Europa. Se abordan las justificaciones para integrar los objetivos de fase final en las políticas de control del tabaco y la necesidad de establecer plazos concretos, incluida la planificación para poner fin a la venta de productos de tabaco. La planificación de la fase final para poner fin al consumo de tabaco debe considerar el contexto de control del tabaco específico según la jurisdicción, así como la prevalencia actual del consumo, las políti- cas existentes, la aplicación del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco y el apoyo público. Sin embargo, el contexto actual no debe determinar si se debe realizar la planifi- cación de la fase final, sino más bien cómo y cuándo pueden desarrollarse los diferentes planteamientos de la fase. Entre los posibles desafíos se encuentran los legales, el controvertido papel de los cigarrillos electróni- cos y el intento de la industria tabacalera de incorporarse a la retórica de las políticas libres de humo. Si bien reconocemos las diferentes opiniones con respecto a los cigarrillos electrónicos y otros productos, abogamos por un enfoque restrictivo con respecto al mercado de productos de tabaco. La comunidad que trabaja por el control del tabaco debe capitalizar la creciente evidencia teórica y empírica, la voluntad política y el apoyo público para lograr la fase final para poner fin al consumo de tabaco, y establecer objetivos concretos para acabar finalmente con la epidemia de tabaquismo.

[RESUMO]. A erradicação do tabaco está passando rapidamente de uma aspiração teórica para um objetivo concreto e alcançável e, em alguns casos, está se tornando política em vigor. As políticas de erradicação diferem das medidas tradicionais de controle do tabagismo pois visam explicitamente ao fim permanente do consumo de tabaco, ao invés de simplesmente minimizá-lo. O objetivo deste artigo é delinear os avanços recentes rumo à erradicação do tabaco, sua relação com as políticas existentes de controle do tabaco, os desafios e como o planejamento da erradicação pode ser adaptado aos diferentes contextos de controle do tabaco. São apre- sentados exemplos de políticas implementadas em três cidades nos Estados Unidos e políticas nacionais na Holanda e Nova Zelândia, assim como desdobramentos recentes do planejamento da erradicação na Europa. São discutidas justificativas para integrar metas de erradicação nas políticas de controle do tabaco e a necessidade de estabelecer prazos concretos, incluindo o planejamento para encerrar a venda de produ- tos de tabaco. O planejamento da erradicação do tabaco deve considerar o contexto do controle do tabaco específico a cada jurisdição, incluindo a prevalência atual do consumo de tabaco, as políticas existentes, a implementação da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde e o apoio do público. Porém, o contexto atual de controle do tabaco não deve determinar se o planejamento da erradicação deve acontecer, mas sim, como e quando diferentes abordagens à erradicação podem ocorrer. Os desafios potenciais incluem recursos judiciais, o papel polêmico dos cigarros eletrônicos e a tentativa da indústria do tabaco de cooptar a retórica das políticas antitabagistas. Embora reconhecendo os diferen- tes pontos de vista em relação aos cigarros eletrônicos e outros produtos, defendemos uma abordagem contracionista ao mercado de produtos de tabaco. A comunidade de controle do tabaco deve aproveitar as crescentes evidências teóricas e empíricas, a vontade política e o apoio do público à erradicação do tabaco para estabelecer metas concretas e, finalmente, pôr fim à epidemia de tabagismo.

A qualitative exploration of the provision and prioritisation of smoking cessation support to patient carers in a paediatric ward in Australia.

BACKGROUND: Hospitalisation of a child is a unique opportunity for health staff to offer smoking cessation support; that is screening for carer smoking status, discussing cessation and providing interventions to carers who smoke. This has the potential to reduce the child's exposure to second-hand smoke, and in turn tobacco related illnesses in children. However, these interventions are not always offered in paediatric wards. The aim of this study was to explore the provision and prioritisation of smoking cessation support to patient carers in a paediatric ward with a high proportion of Aboriginal patients and carers in a regional area of Australia's Northern Territory. METHODS: This is a qualitative descriptive study of data collected through semi-structured interviews with 19 health staff. The interviews were audio recorded and transcribed verbatim. Thematic analysis was performed on the transcripts. RESULTS: We found low prioritisation of addressing carer smoking due to, a lack of systems and procedures to screen for smoking and provide quitting advice and unclear systems for providing more detailed cessation support to carers. Staff were demotivated by the lack of clear referral pathways. There were gaps in skills and knowledge, and health staff expressed a need for training opportunities in smoking cessation. CONCLUSION: Health staff perceived they would provide more cessation support if there was a systematic approach with evidence-based resources for smoking cessation. These resources would include guidelines and clinical record systems with screening tools, clear action plans and referral pathways to guide clinical practice. Health staff requested support to identify existing training opportunities on smoking cessation.

Evaluation of 'Ask the Specialist': a cultural education podcast to inspire improved healthcare for Aboriginal peoples in Northern Australia.

In Australia's Northern Territory (NT) most people who access health services are Aboriginal and most healthcare providers are non-Indigenous; many providers struggle to deliver culturally competent care. Cultural awareness training is offered however, dissatisfaction exists with the limited scope of training and the face-to-face or online delivery format. Therefore, we developed and evaluated Ask the Specialist: Larrakia, Tiwi and Yolŋu stories to inspire better healthcare, a cultural education podcast in which Aboriginal leaders of Larrakia, Tiwi and Yolŋu nations, known as the Specialists, answer doctors' questions about working with Aboriginal patients. The Specialists offer 'counterstories' which encourage the development of critical consciousness thereby challenging racist narratives in healthcare. After listening to the podcast, doctors reported attitudinal and behavioural changes which led to stereotypes being overturned and more culturally competent care delivery. While the podcast was purposefully local, issues raised had applicability beyond the NT and outside of healthcare. Our approach was shaped by cultural safety, critical race theory and Freirean pedagogy. This pilot is embedded in a Participatory Action Research study which explores strategies to improve culturally safe communication at the main NT hospital Royal Darwin Hospital.

What facilitates policy audacity in tobacco control? An analysis of approaches and supportive factors for innovation in seven countries.

BACKGROUND: Tobacco control policy audacity can make radical ideas seem possible, and set in motion a 'domino' effect, where precedents in one jurisdiction are followed by others. This review examines tobacco control policy audacity from seven countries to identify and compare factors that facilitated it. METHODS: A targeted search strategy and purposive sampling approach was used to identify information from a range of sources and analyse key supportive factors for policy audacity. Each case was summarised, then key themes identified and compared across jurisdictions to identify similarities and differences. RESULTS: Included cases were Mauritius' ban on tobacco industry corporate social responsibility, Uruguay's tobacco single brand presentation regulations, New Zealand's Smokefree Aotearoa 2025 Action Plan proposals and 2010 parliamentary Maori Affairs Select Committee Inquiry into the Tobacco Industry, Australia's plain packaging legislation, Balanga City's (Philippines) tobacco-free generation ordinance, Beverly Hills City Council's (USA) ordinance to ban tobacco sales and the Netherlands' policy plan to phase out online and supermarket tobacco sales. Each case was one strategy within a well-established comprehensive tobacco control and public health approach. Intersectoral and multijurisdiction collaboration, community engagement and public support, a strong theoretical evidence base and lessons learnt from previous tobacco control policies were important supportive factors, as was public support to ensure low political risk for policy makers. CONCLUSIONS: Tobacco control policy audacity is usually an extension of existing measures and typically appears as 'the next logical step' and therefore within the risk appetite of policy makers in settings where it occurs.

Closing the gaps in tobacco endgame evidence: a scoping review.

OBJECTIVE: Tobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities. DATA SOURCES: Guided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched. STUDY SELECTION: Two reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation. DATA EXTRACTION: We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS: Eight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26); product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1); moving consumers to reduced risk products (n=8); tobacco-free generation (n=4); ending sales (n=2); sinking lid (n=2); tax increases (n=7); and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised. CONCLUSIONS: VLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.

Progress, challenges and the need to set concrete goals in the global tobacco endgame / Progresos, desafíos y necesidad de establecer objetivos concretos en la fase final para poner fin al consumo tabaco en todo el mundo / Avanços, desafios e a necessidade de estabelecer metas concretas para a erradicação global do tabaco

ABSTRACT The tobacco endgame is rapidly moving from aspirational and theoretical toward a concrete and achievable goal and, in some cases, enacted policy. Endgame policies differ from traditional tobacco control measures by explicitly aiming to permanently end, rather than simply minimize, tobacco use. The purpose of this paper is to outline recent progress made in the tobacco endgame, its relationship to existing tobacco control policies, the challenges and how endgame planning can be adapted to different tobacco control contexts. Examples of implemented policies in three cities in the United States and national policies in the Netherlands and New Zealand are outlined, as well as recent endgame planning developments in Europe. Justifications for integrating endgame targets into tobacco control policy and the need to set concrete time frames are discussed, including planning for ending the sale of tobacco products. Tobacco endgame planning must consider the jurisdiction-specific tobacco control context, including the current prevalence of tobacco use, existing policies, implementation of the World Health Organization's Framework Convention on Tobacco Control, and public support. However, the current tobacco control context should not determine whether endgame planning should happen, but rather how and when different endgame approaches can occur. Potential challenges include legal challenges, the contested role of e-cigarettes and the tobacco industry's attempt to co-opt the rhetoric of smoke-free policies. While acknowledging the different views regarding e-cigarettes and other products, we argue for a contractionary approach to the tobacco product market. The tobacco control community should capitalize on the growing theoretical and empirical evidence, political will and public support for the tobacco endgame, and set concrete goals for finally ending the tobacco epidemic.

RESUMEN La fase final para poner fin al consumo de tabaco está rápidamente dejando de ser una aspiración y una teoría y se está convirtiendo en un objetivo concreto y alcanzable y, en algunos casos, una política promulgada. Las políticas para poner fin al consumo de tabaco difieren de las medidas tradicionales de control porque están dirigidas explícitamente a poner fin al consumo de tabaco de forma permanente, en lugar de solo minimizarlo. El propósito de este artículo es describir los progresos recientes en la fase final para poner fin al consumo de tabaco, su relación con las políticas existentes de control del tabaco, los desafíos que se enfrentan y cómo la planificación de la fase final se puede adaptar a los diferentes contextos de control del tabaco. Se describen ejemplos de políticas implementadas en tres ciudades de los Estados Unidos y de políticas nacionales en los Países Bajos y Nueva Zelanda, así como los progresos recientes en la planificación de la fase final en Europa. Se abordan las justificaciones para integrar los objetivos de fase final en las políticas de control del tabaco y la necesidad de establecer plazos concretos, incluida la planificación para poner fin a la venta de productos de tabaco. La planificación de la fase final para poner fin al consumo de tabaco debe considerar el contexto de control del tabaco específico según la jurisdicción, así como la prevalencia actual del consumo, las políticas existentes, la aplicación del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco y el apoyo público. Sin embargo, el contexto actual no debe determinar si se debe realizar la planificación de la fase final, sino más bien cómo y cuándo pueden desarrollarse los diferentes planteamientos de la fase. Entre los posibles desafíos se encuentran los legales, el controvertido papel de los cigarrillos electrónicos y el intento de la industria tabacalera de incorporarse a la retórica de las políticas libres de humo. Si bien reconocemos las diferentes opiniones con respecto a los cigarrillos electrónicos y otros productos, abogamos por un enfoque restrictivo con respecto al mercado de productos de tabaco. La comunidad que trabaja por el control del tabaco debe capitalizar la creciente evidencia teórica y empírica, la voluntad política y el apoyo público para lograr la fase final para poner fin al consumo de tabaco, y establecer objetivos concretos para acabar finalmente con la epidemia de tabaquismo.

RESUMO A erradicação do tabaco está passando rapidamente de uma aspiração teórica para um objetivo concreto e alcançável e, em alguns casos, está se tornando política em vigor. As políticas de erradicação diferem das medidas tradicionais de controle do tabagismo pois visam explicitamente ao fim permanente do consumo de tabaco, ao invés de simplesmente minimizá-lo. O objetivo deste artigo é delinear os avanços recentes rumo à erradicação do tabaco, sua relação com as políticas existentes de controle do tabaco, os desafios e como o planejamento da erradicação pode ser adaptado aos diferentes contextos de controle do tabaco. São apresentados exemplos de políticas implementadas em três cidades nos Estados Unidos e políticas nacionais na Holanda e Nova Zelândia, assim como desdobramentos recentes do planejamento da erradicação na Europa. São discutidas justificativas para integrar metas de erradicação nas políticas de controle do tabaco e a necessidade de estabelecer prazos concretos, incluindo o planejamento para encerrar a venda de produtos de tabaco. O planejamento da erradicação do tabaco deve considerar o contexto do controle do tabaco específico a cada jurisdição, incluindo a prevalência atual do consumo de tabaco, as políticas existentes, a implementação da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde e o apoio do público. Porém, o contexto atual de controle do tabaco não deve determinar se o planejamento da erradicação deve acontecer, mas sim, como e quando diferentes abordagens à erradicação podem ocorrer. Os desafios potenciais incluem recursos judiciais, o papel polêmico dos cigarros eletrônicos e a tentativa da indústria do tabaco de cooptar a retórica das políticas antitabagistas. Embora reconhecendo os diferentes pontos de vista em relação aos cigarros eletrônicos e outros produtos, defendemos uma abordagem contracionista ao mercado de produtos de tabaco. A comunidade de controle do tabaco deve aproveitar as crescentes evidências teóricas e empíricas, a vontade política e o apoio do público à erradicação do tabaco para estabelecer metas concretas e, finalmente, pôr fim à epidemia de tabagismo.