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Externalizing behavior problems are the most common mental health concern of early childhood, but only a minority of families access parent management training (PMT) programs that are empirically-supported for reducing and preventing these behaviors. This study aimed to evaluate the acceptability and preliminary efficacy of a group-based universal PMT program developed in the United States (US) and adapted for Australia. The program was "Helping Our Toddlers, Developing Our Children's Skills" (HOT DOCS), designed to teach parents a personalized problem-solving approach to address their young children's challenging behaviors. This paper describes the four-stage adaptation and implementation process and presents results from a feasibility study with pre-intervention, post-intervention, and 2-month follow-up data. Participants were 40 parents of 36 children (M age = 2.85 years). Retention in the program (92.5%) and attendance (M = 6.16 of 7 total sessions, SD = 1.09) were high, and parents reported using the recommended parenting strategies multiple times per week throughout the program (M = 3.31 to 5.57 times per week, SD = 1.86 to 2.03). Parent satisfaction with the program was high; feedback from participants suggested that acceptability could be improved by including Australian video examples. At post-intervention, parents reported significant improvements in parenting knowledge, parenting self-efficacy and parenting stress (Cohen's d = 1.02 to 1.28), and parent reports of child behavior indicated significant improvements in challenging behaviors (d = 0.49 to 0.64), with all effects maintained at 2 months. These preliminary results suggest that the Australian adaptation of HOT DOCS should continue to be implemented and further investigated, with modifications to video examples to increase relevance for culturally-diverse Australian families. [ABSTRACT FROM AUTHOR]

Introduction: The Australian states of New South Wales (NSW) and Queensland implemented bans on tobacco pack displays at point-of-sale (PoS) in July 2010 and November 2011, respectively. This study evaluated the medium-term impact of the bans on youth. Methods: Data were drawn from the Tobacco Promotion Impact Study, a repeated cross-sectional survey of youth (12-24 years) in NSW and Queensland conducted yearly 2010-2012 (n = 6,014). Regression analyses examined differences in youth's recall of PoS tobacco displays, smokingrelated beliefs, and smoking behaviors in relation to the timing of the PoS display bans. Results: Recall of PoS tobacco displays was significantly less likely for youth interviewed after the bans versus before (OR = 0.45, 95% CI = 0.39, 0.52, p < .01). They were also less likely to report tobacco brand awareness (OR = 0.76, 95% CI = 0.62, 0.92, p < .01), to over-estimate peer smoking (OR = 0.84, 95% CI = 0.74, 0.96, p < .01), or be current smokers (OR = 0.73, 95% CI = 0.55, 0.96, p < .05). Stratified analyses showed that these differences were primarily apparent in the group of youth most likely to be affected by tobacco PoS displays: those who visit tobacco retailers most frequently. After the bans, smokers were less likely to report that they think about smoking as a result of seeing PoS tobacco displays (OR = 0.60, 95% CI = 0.37, 0.97, p < .039). Conclusions: Our findings suggest an immediate impact of display bans on youth's exposure to tobacco pack displays, and likely impacts on smoking-related outcomes. These results suggest that removing tobacco displays from retail environments can positively contribute to the denormalization of smoking among youth. [ABSTRACT FROM AUTHOR]

Issue addressed: Australia has smoking prevalence of less than 15% among adults, but there are concerns that the rates of decline have stabilised. Sustained mass media campaigns are central to decreasing prevalence, and the emotions evoked by campaigns contribute to their impact. This study investigates the association between potential exposure to campaigns that evoke different emotions on quitting salience (thinking about quitting), quitting intentions and quitting attempts. Methods: Data on quitting outcomes were obtained from weekly cross‐sectional telephone surveys with adult smokers and recent quitters between 2013 and 2018. Campaign activity data were collated, and population‐level potential campaign exposure was measured by time and dose. Results: Using multivariate analyses, a positive association between potential exposure to 'hope' campaigns and thinking about quitting and intending to quit was noted, but no association was seen with quit attempts. Potential exposure to 'sadness' evoking campaigns was positively associated with quitting salience and negatively associated with quit attempts, whereas those potentially exposed to campaigns evoking multiple negative emotions (fear, guilt and sadness) were approximately 30% more likely to make a quit attempt. Conclusions: This study suggests a relationship between the emotional content of campaigns, quitting behaviours. Campaign planners should consider campaigns that evoke negative emotions for population‐wide efforts to bring about quitting activity alongside hopeful campaigns that promote quitting salience and quitting intentions. The emotional content of campaigns provides an additional consideration for campaigns targeting smokers and influencing quitting activity. So what?: This study demonstrates the importance of balancing the emotional content of campaigns to ensure that campaign advertising is given the greatest chance to achieve its objectives. Utilising campaigns that evoke negative emotions appear to be needed to encourage quitting attempts but maintaining hopeful campaigns to promote thinking about quitting and intending to quit is also an important component of the mix of tobacco control campaigns. [ABSTRACT FROM AUTHOR]

Background: To better understand the process of quitting from the ex-smokers' perspective, and to explore the role spontaneity and planning play in quitting.Methods: Qualitative grounded theory study using in-depth interviews with 37 Australian adult ex-smokers (24-68 years; 15 males, 22 females) who quit smoking in the past 6-24 months (26 quit unassisted; 11 used assistance).Results: Based on participants' accounts of quitting, we propose a typology of quitting experiences: measured, opportunistic, unexpected and naïve. Two key features integral to participants' accounts of their quitting experiences were used as the basis of the typology: (1) the apparent onset of quitting (gradual through to sudden); and (2) the degree to which the smoker appeared to have prepared for quitting (no evidence through to clear evidence of preparation). The resulting 2 × 2 matrix of quitting experiences took into consideration three additional characteristics: (1) the presence or absence of a clearly identifiable trigger; (2) the amount of effort (cognitive and practical) involved in quitting; and (3) the type of cognitive process that characterised the quitting experience (reflective; impulsive; reflective and impulsive).Conclusions: Quitting typically included elements of spontaneity (impulsive behaviour) and preparation (reflective behaviour), and, importantly, the investment of time and cognitive effort by participants prior to quitting. Remarkably few participants quit completely out-of-the-blue with little or no preparation. Findings are discussed in relation to stages-of-change theory, catastrophe theory, and dual process theories, focusing on how dual process theories may provide a way of conceptualising how quitting can include elements of both spontaneity and preparation. [ABSTRACT FROM AUTHOR]

Background: Unassisted cessation – quitting without pharmacological or professional support – is an enduring phenomenon. Unassisted cessation persists even in nations advanced in tobacco control where cessation assistance such as nicotine replacement therapy, the stop-smoking medications bupropion and varenicline, and behavioural assistance are readily available. We review the qualitative literature on the views and experiences of smokers who quit unassisted. Method: We systematically searched for peer-reviewed qualitative studies reporting on smokers who quit unassisted. We identified 11 studies and used a technique based on Thomas and Harden’s method of thematic synthesis to discern key themes relating to unassisted cessation, and to then group related themes into overarching concepts. Findings: The three concepts identified as important to smokers who quit unassisted were: motivation, willpower and commitment. Motivation, although widely reported, had only one clear meaning, that is ‘the reason for quitting’. Willpower was perceived to be a method of quitting, a strategy to counteract cravings or urges, or a personal quality or trait fundamental to quitting success. Commitment was equated to seriousness or resoluteness, was perceived as key to successful quitting, and was often used to distinguish earlier failed quit attempts from the final successful quit attempt. Commitment had different dimensions. It appeared that commitment could be tentative or provisional, and also cumulative, that is, commitment could be built upon as the quit attempt progressed. Conclusion: A better understanding of what motivation, willpower and commitment mean from the smoker’s perspective may provide new insights and direction for smoking cessation research and practice. [ABSTRACT FROM AUTHOR]

Context A significant proportion of smokers who quit do so on their own without formal help (ie, without professionally or pharmacologically mediated assistance), yet research into how smokers quit focuses primarily on assisted methods of cessation. Objective The aim of the present work was to systematically review recent smoking cessation research in Australia, a nation advanced in tobacco control, to determine what is known about smokers who quit unassisted in order to (1) inform a research agenda to develop greater understanding of the many smokers who quit unassisted and (2) elucidate possible lessons for policy and mass communication about cessation. Methods In January 2013, four e-databases and the grey literature were searched for articles published between 2005 and 2012 on smoking cessation in Australia. Articles focusing solely on interventions designed to stimulate cessation were excluded, as were articles focusing solely on assisted cessation, leaving articles reporting on smokers who quit unassisted. Data from articles reporting on unassisted cessation were extracted and grouped into related categories. Results A total of 248 articles reported on smoking cessation, of which 63 focused solely on interventions designed to stimulate cessation, leaving 185 reporting on the method of cessation (‘how' a smoker quits). Of these, 166 focused solely on assisted cessation, leaving 19 reporting, either directly or indirectly, on smokers who quit unassisted. Data from these studies indicated 54% to 69% of ex-smokers quit unassisted and 41% to 58% of current smokers had attempted to quit unassisted. Conclusions The majority of Australian smokers quit or attempt to quit unassisted, yet little research has been dedicated to understanding this process. Almost all research that reported unassisted cessation referenced it as a comparator to the focal point of assisted cessation. Public health may benefit from insights gained from greater research into the cessation method used by most smokers. Suggestions and a rationale for such research are provided. [ABSTRACT FROM AUTHOR]

Issue addressed To describe self-reported bowel cancer screening participation, beliefs and attitudes in a sample of New South Wales (NSW) adults, and to identify beliefs and demographic factors associated with self-reported bowel cancer screening participation. Methods This study used data from the International Cancer Benchmarking Partnership Module 2, a representative population-based telephone survey. Self-reported participation in and beliefs about bowel cancer screening were measured using the Awareness and Beliefs about Cancer survey of people aged 50 years and over living in NSW, Australia (n=2001). Logistic regression modelling was used to identify explanatory variables associated with bowel cancer screening participation. Results Half of all women (54.1%, 95% CI: 50.8-57.4%) and two-thirds of men (65.7%, 95% CI: 61.5-69.9%) reported screening for bowel cancer within the previous 5 years. Believing that screening was only necessary when experiencing symptoms was more likely to be endorsed by people aged 65 years and over (25.5%, 95% CI: 22.2-28.7%) rather than younger (50-64 years; 16.7%, 95% CI: 13.8-19.7%), non-English-speaking migrants (35.4%, 95% CI: 26.7-44.1%) versus others (18.6%, 95% CI: 16.4-20.7%), and people in metropolitan (23.3%, 95% CI: 20.4-26.1%) versus non-metropolitan areas (16.4%, 95% CI: 12.8-20%). People who disagreed that screening was only necessary when experiencing symptoms were four times more likely to report screening participation (OR 3.96, 95% CI: 3.11-5.03). Conclusions Community education about bowel cancer screening is needed to correct misperceptions regarding screening in the absence of symptoms. Tailored strategies for older, migrant and urban communities may be beneficial. So what? Education strategies that promote the need for screening in the absence of symptoms and correct misconceptions about bowel cancer screening amongst subgroups of the NSW population may improve screening rates and decrease the burden of bowel cancer in NSW. [ABSTRACT FROM AUTHOR]

Issue addressed: To describe self-reported bowel cancer screening participation, beliefs and attitudes in a sample of New South Wales (NSW) adults, and to identify beliefs and demographic factors associated with self-reported bowel cancer screening participation. Methods: This study used data from the International Cancer Benchmarking Partnership Module 2, a representative populationbased telephone survey. Self-reported participation in and beliefs about bowel cancer screening were measured using the Awareness and Beliefs about Cancer survey of people aged 50 years and over living in NSW, Australia (n = 2001). Logistic regression modelling was used to identify explanatory variables associated with bowel cancer screening participation. Results: Half of all women (54.1%, 95% CI: 50.8-57.4%) and two-thirds of men (65.7%, 95% CI: 61.5-69.9%) reported screening for bowel cancer within the previous 5 years. Believing that screening was only necessary when experiencing symptoms was more likely to be endorsed by people aged 65 years and over (25.5%, 95% CI: 22.2-28.7%) rather than younger (50-64 years; 16.7%, 95% CI: 13.8-19.7%), non-English-speaking migrants (35.4%, 95% CI: 26.7-44.1%) versus others (18.6%, 95% CI: 16.4-20.7%), and people in metropolitan (23.3%, 95% CI: 20.4-26.1%) versus non-metropolitan areas (16.4%, 95% CI: 12.8-20%). People who disagreed that screening was only necessary when experiencing symptoms were four times more likely to report screening participation (OR 3.96, 95% CI: 3.11-5.03). Conclusions: Community education about bowel cancer screening is needed to correct misperceptions regarding screening in the absence of symptoms. Tailored strategies for older, migrant and urban communities may be beneficial. [ABSTRACT FROM AUTHOR]

Highlights • Quantified the number of lung cancer deaths averted in Australia through tobacco control. • Almost 2 million lung cancer deaths have already been prevented over the period 1956–2100. • Lung cancer will continue to be a significant public health concern in Australia. • Achieving zero smoking by 2025 would result in 360,000 more lung cancer deaths being averted by 2100. • Highlighted the urgent need for more effective and targeted tobacco control strategies to be implemented. Abstract Objectives To estimate the number of past and future lung cancer deaths that have already been averted by tobacco control initiatives in Australia, and to estimate the number of additional deaths averted under various smoking scenarios. Methods We predicted lung cancer mortality rates and case numbers to 2100 using a previously validated generalized linear model based on age, birth cohort and population cigarette smoking exposure. We estimated the impact of various tobacco control scenarios: 'actual tobacco control' (incorporating the aggregate effect of past and current taxation, plain packaging, mass media campaigns and other initiatives) and scenarios where 10%, 5% and 0% smoking prevalence was achieved by 2025, all of which were compared to a counterfactual scenario with the highest historical smoking consumption level continuing into the future as if no tobacco control initiatives had been implemented. Results Without tobacco control, there would have been an estimated 392,116 lung cancer deaths over the period 1956–2015; of these 20% (78,925 deaths; 75,839 males, 3086 females) have been averted due to tobacco control. However, if past and current measures continue to have the expected effect, an estimated 1.9 million deaths (1,579,515 males, 320,856 females; 67% of future lung cancer deaths) will be averted in 2016–2100. If smoking prevalence is reduced to 10%, 5% or 0% by 2025, an additional 97,432, 208,714 or 360,557 deaths could be averted from 2016 to 2100, respectively. Conclusion Tobacco control in Australia has had a dramatic impact on the number of people dying from lung cancer. Several hundred thousand more lung cancer deaths could be averted over the course of the century if close-to-zero smoking prevalence could be achieved in the next decade. [ABSTRACT FROM AUTHOR]

Introduction: One population-level solution to smoking cessation are quitlines, telephone-based services to aid quitting. Monitoring the profile of quitline callers in a changing tobacco policy environment is important for informing future policy strategies and identifying target groups to improve the reach and impact of quitline services. Methods: De-identified data from 43,618 new callers to the New South Wales Quitline, Australia between January 2008 and October 2011 (inclusive) were extracted from the Quitline database. Regression analyses explored the effect of year of first call on the distribution of demographic and smoking-related variables. Results: Men calling the Quitline increased proportionately (prevalence ratio [PR] = 1.05, 95% CI = 1.03-1.08), but callers from non-major city areas fell (PR = 0.90, 95% CI = 0.87-0.93) in 2011 versus 2008. The proportion of callers not working demonstrated a significant increasing linear trend (PR = 1.08, p < .001), although area-level socioeconomic status did not change. The proportions of new Quitline callers who had stopped smoking (relative to still smoking) (relative risk ratio [RRR] = 1.29, 95% CI = 1.14-1.46) and who were classified as low nicotine dependent (vs. high nicotine dependent, RRR = 1.60, 95% CI = 1.39-1.83) were higher in 2011 versus 2008. Proportionately, more callers nominated "money" as a motivation to quit in 2010 (PR = 1.58, 95% CI = 1.49-1.66) and 2011 (PR = 1.70, 95% CI = 1.62-1.79) compared with 2008. Conclusions: Quitline callers showed decreasing tobacco consumption and dependence 2008 to 2011, but remained more addicted than the average NSW smoker. Clear effects of tobacco policy were shown, as money as a motivator increased dramatically in conjunction with increased tobacco taxation, highlighting the importance of promoting cessation services concurrent with policy change to capitalize on increased motivation to quit. [ABSTRACT FROM AUTHOR]