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This study identified major challenges to be addressed before student nurses can achieve their full potential in providing effective and comprehensive smoking cessation interventions. Smoking behaviors were assessed among undergraduate nursing students. In addition, students' attitudes, confidence levels, and support for extra training in tobacco control were examined. A nonprobability sample of 381 students at an Australian university was surveyed. The consent rate was 81%. Prevalence of current smoking was 21%. In the regression analysis, age group was the only statistically significant predictor of smoking status. Over one third (36%) did not endorse the nonsmoking exemplar role of their future profession. Most (60%) did not support the concept of routine smoking cessation intervention. Students who were smokers had significantly higher tobacco control confidence levels than nonsmokers. Smoking-related variables did not differ between students in different years of the course. Improved tobacco control training is needed at undergraduate level.

Issue Addressed: Little research has examined issues surrounding employee smoking outside smoke-free workplaces. The study's aims were to: 1) document the proportion of NSW indoor employees covered by total workplace smoking bans; 2) examine community perceptions of employee smoking during working hours; 3) identify the characteristics of having a supportive attitude toward tobacco control in the workplace; and 4) describe relationships between smoking relapse and workplace-related smoking., Methods: Two cross-sectional, computer-assisted telephone interview surveys of randomly selected adults were conducted. Consent rates were 49.1% in 2004 and 45.8% in 2006, with sample sizes of 1,158 and 2,393 respectively., Results: Total workplace bans were reported by 92.9% of indoor employees. Community attitudes to smoking in working hours were highly negative: 77.7% agreed smoking breaks waste too much time and 85.1% opposed smoking near workplace doorways. Being female, born in Australia and a non-smoker were associated with more negative attitudes. A higher proportion of smokers (78.3%) perceived smoking was more common outside their place of work or study than at five other locations: rail/bus stop (60.2%), friends' houses (59.3%), own street (35.2%), parks (34.3%), and outside school (22.6%). Of smokers making a quit attempt in the past year, 42.1% relapsed at home, 22.1% at licensed premises and 18.7% at work., Conclusions: Findings emphasise the low support for smoking during or near work. Smoking outside workplaces is highly visible. Data on relapse suggest a modest relationship with workplace-related smoking.

Relatively little attention has been given to the retail availability of tobacco products despite the likelihood that ubiquitous supply may represent a primary form of tobacco promotion in Australia. This study aimed to explore the number and distribution of tobacco outlets, smokers' perceptions about the availability of tobacco and the role availability may play in tobacco consumption and quitting attempts in Australia. The study comprised two parts: Part A involved mapping retail tobacco outlets in the Hunter Region of NSW, Australia. Part B involved a statewide telephone survey of 539 current smokers aged 18 years and over in NSW. Part A identified 1270 retail tobacco outlets, giving a density of one outlet per 384 persons aged over 15 years, or one outlet per 77 smokers. Associations between socioeconomic status of areas and retail availability of tobacco were not found. Of the survey respondents in Part B, 87.5% indicated that they would be within walking distance of a retail tobacco outlet during their daily activities. Those who were younger, male and single were more likely to purchase tobacco at convenience-type outlets. We therefore conclude that some groups of smokers appear vulnerable to the availability of tobacco and a reduction in the availability of tobacco is likely to benefit smokers who wish to quit., ((c) 2010 Elsevier Ltd. All rights reserved.)

Introduction: Passive recruitment strategies relying on smoker-initiated contact probably contribute to particular groups of smokers using quitlines. Compared with the smoking population, smokers who call quitlines are more likely to be female, younger, higher educated, more addicted, quit previously, and motivated to quit. Quitlines could adopt new recruitment approaches such as active telephone recruitment involving recruiter-initiated contact, since this may enroll a broader representation of smokers. This study explored acceptability of active telephone recruitment to quitline support, smokers' use, and acceptability of assistance and predictors of acceptability., Methods: Smokers (N = 1,562) randomly selected from the New South Wales telephone directory were actively recruited by telephone into a randomized controlled trial that offered proactive telephone counseling (n = 769) or self-help materials (control: n = 793). Overall, 1,369 completed the 4-month postrecruitment interview, which examined acceptability., Results: More than 90% of 4-month interview respondents found active telephone recruitment to cessation assistance acceptable. Of smokers allocated to proactive telephone counseling (n = 769), 90% accepted at least one and 65% three or more counseling calls. Of control participants who completed the 4-month interview, 84% read at least some self-help materials. Proactive telephone counseling recipients were significantly more likely than self-help material users to find the advice useful. Few characteristics predicted acceptability of proactive telephone counseling or self-help materials, suggesting that many types of smokers actively recruited by telephone are receptive to support., Discussion: Active telephone recruitment could potentially enroll a broader representation of smokers to quitline services. Given these smokers are receptive to cessation assistance, quitlines should consider active telephone recruitment.

Unlabelled: AIMS, DESIGN AND INTERVENTION: Smoking care provision to in-patients is important in assisting smoking cessation and for management of nicotine withdrawal. Limited studies have reported the effectiveness of interventions designed to increase the hospital-wide provision of such care. A quasi-experimental matched-pair trial, involving two intervention and two control hospitals in NSW, Australia, investigated whether a multi-strategic intervention increased hospital-wide smoking care provision., Participants and Measurements: Patient surveys (n = 274-347 per experimental condition), medical notes audits (n = 181-228) and health professional surveys (n = 229-302) were used to collect outcome data at baseline and follow-up., Findings: Significantly greater increases in intervention hospitals compared to control hospitals were found for patient-reported offer of nicotine replacement therapy (NRT) (intervention 34% versus control 12%), provision of NRT (16% versus 4%) and provision of written resources (11% versus 2%), and for the recording in medical notes of smoking management discussion (13% versus 3%), offer of NRT (24% versus 3%) and provision of NRT (21% versus 5%). Intervention group health professionals reported significantly greater increases in the mean estimate of patients who: had their smoking management discussed (30% versus 17%); were offered or provided with NRT (30% versus 18%); were asked their intention to smoke post-discharge (22% versus 10%); and were provided with discharge NRT (21% versus 4%)., Conclusions: Implementation of a multi-strategic intervention is effective in increasing hospital smoking care delivery, particularly the provision of NRT. Research is required to identify methods to increase further the delivery of this and other forms of smoking care.

Objective: This study aimed to examine recent levels of exposure to smoking in movies, how the community perceived the level of smoking they saw in recently-viewed movies and whether there was community support for any form of regulation., Methods: As part of a 2004 New South Wales survey of smoking-related perceptions and practices, 1,154 adults participated in a computer-assisted telephone interview about perceptions relating to smoking depiction in movies and television., Results: More than one-quarter of those who had seen a recent movie in the cinema (28.5%) or on DVD (33.9%) thought that the movie contained excessive or inappropriate smoking. More than half the sample (59.1%) considered it likely the tobacco industry played a role in the level of smoking depiction, although only 18% of those who thought a recent movie contained excessive smoking attributed this to the tobacco industry. Almost two-thirds of respondents favoured screening anti-tobacco advertisements prior to movies with smoking., Conclusion: Cinema and DVD movies commonly include scenes where there is excessive or inappropriate smoking. It is widely believed that the tobacco industry is contributing to this, and there is strong community support for action to curb the harmful influences this may be having.

Adolescent smoking prevalence is usually assessed via self-complete questionnaires. However, concern has been expressed about the validity of such self-report. One approach to increase validity involves the threat of biological validation, known as the bogus pipeline method (BPL).This study aimed to assess the effects of BPL, using an expired air carbon monoxide monitor, and of questionnaire anonymity on student smoking self-report data. High school students (n=801) were randomly allocated to one of four conditions: anonymous questionnaire+BPL, named questionnaire+BPL, anonymous questionnaire without BPL and named questionnaire without BPL. Overall, 37% of students agreed that questionnaires were a good way to obtain honest answers. In a logistic regression analysis, students in the BPL condition had significantly higher odds of reporting weekly smoking (OR=1.83 95% CI 1.27-2.65) and monthly smoking (OR=1.66 95% CI 1.21-2.28) but not of lifetime smoking compared with non-BPL students. Students in the named questionnaire condition had a significantly higher odds of reporting lifetime smoking (OR=1.49 95% CI 1.08-2.04) compared with anonymous students. Studies assessing current smoking patterns in adolescents should consider incorporating a BPL method.

Objective: To assess community attitudes towards smoking bans, tobacco availability, promotion and product regulation, tobacco industry donations to political parties, and government spending on tobacco control activities. To compare public preferences on these issues with policies of the NSW and Commonwealth governments., Method: Anonymous, computer assisted telephone interviews of adults from randomly selected households in the NSW Electronic White Pages conducted in 2004. All subjects completed a core question set and subsequently, one of three sub-sets., Results: Overall 49.1% of eligible subjects consented. Data from two sub-samples containing 1,191 and 1,158 subjects are reported. Majority support existed for smoking bans in all six settings assessed: children's playgrounds (89%), sports stadia (77%), licensed premises (72%), outdoor dining (69%), beaches (55%) and motor vehicles carrying children (55%). Respondents nominated vastly higher tobacco control budgets than current levels of government expenditure. On a scale assessing support for tobacco control (maximum score = 13), the mean scores of both non-smokers (10.4) and smokers (8.0) were high. Of seven variables tested, only two: living with a smoker and personal smoking status were independent predictors of having a high pro-tobacco control score., Conclusion: There is strong community support for additional government regulation mandating smoke-free provision and other counter tobacco measures., Implications: Continued advocacy campaigns are required to align government tobacco control agenda more closely with public preferences.

Introduction and Aims: Increased access for smokers to pharmacotherapies for smoking cessation suggests that pharmacists have a potential role in influencing how these pharmacotherapies are used in the community. This study aimed to identify the extent and type of advice provided by pharmacists to customers purchasing nicotine replacement therapy (NRT) or bupropion and to identify pharmacists' perceptions about the desirability and feasibility of providing such advice., Design and Methods: A sample of 700 pharmacies was selected at random from the NSW Electronic Yellow Pages and a questionnaire was sent by mail, fax or e-mail to the pharmacist in charge., Results: From 665 eligible pharmacies, 375 pharmacists returned completed questionnaires, giving a response rate of 56.4%. Participants reported providing a mean of 5 minutes of advice to both bupropion and NRT purchasers, with 59.5% reporting the provision of behavioural advice to NRT purchasers. Although over 70% of pharmacists perceived the provision of a brochure about NRT or bupropion as desirable and feasible, brochures were provided to less than one-third of NRT purchasers., Discussion and Conclusions: Pharmacists report providing a sizeable amount of advice to purchasers of NRT and bupropion. Recommendations for enhancing the role of pharmacists in influencing the use of cessation pharmacotherapies are discussed briefly.

In Australia, the prevalence of smoking is higher among certain sub-populations compared to the general population. These sub-populations include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, as well as people with mental and substance use disorders and prisoners. The aims of this paper are to: describe the high prevalence of smoking among these particular sub-populations and harms associated with smoking; explore possible reasons for such high prevalence of smoking; review the evidence regarding the efficacy of existing smoking cessation interventions; and make recommendations for smoking interventions and further research among these groups. In addition to low socio-economic status, limited education and other factors, there are social, systems and psychobiological features associated with the high prevalence of smoking in these sub-groups. General population-based approaches to reducing smoking prevalence have been pursued for decades with great success and should be continued with further developments that aim specifically to affect Aboriginal and Torres Strait Islander people and some cultural groups. However, increasing attention, more specific targeting and flexible goals and interventions are also required for these and other distinct sub-populations with high smoking prevalence. Recommendations include: more funding and increased resources to examine the most appropriate education and treatment strategies to promote smoking cessation among people from Aboriginal and Torres Strait Islander and some culturally and linguistically diverse backgrounds; larger and better-designed studies evaluating smoking cessation/reduction interventions among distinct sub-groups; and system-wide interventions requiring strong leadership among clients and staff within mental health, drug and alcohol and prison settings.

Objective: To determine how smoking is regulated in alcohol and other drug treatment agencies., Method: Australian drug treatment agencies were mailed questionnaires for completion by the manager and one other staff member (553 packages posted)., Results: Questionnaires were returned by 260 (59.8%) eligible agencies. Most respondents (82.5% managers, 76.7% other staff) indicated their agency had a written policy regulating smoking. The vast majority (88.2% managers, 82.3% other staff) reported smoking was banned inside their agency, with the highest proportion of bans being in the area health category (95.8% managers, 93.7% other staff) and the lowest in the residential rehabilitation category (75.6% managers, 62.8% other staff). Of the respondents reporting a ban, 19.1% of managers and 27.5% of other staff reported their agency's ban was not 'always' enforced. Paired analyses suggested that other staff were more likely to indicate that the agency had no written policy or be unsure and managers were more likely to report that smoking bans were 'always' stringently enforced. Overall, a substantial minority of respondents (managers 28.6%, other staff 40.2%) indicated that smoking occurred inside their agency at least occasionally., Conclusions and Implications: A substantial proportion of Australian drug and alcohol agencies continue to permit smoking inside their premises. Policy initiatives and educational campaigns are required to promote the expansion of smoke-free conditions in this sector. Serious consideration should be given to making the adoption and enforcement of internal smoke-free policies a condition of any continued government funding.

A cross-sectional survey was mailed to all Australian drug and alcohol treatment agencies to assess their smoking cessation policies and practices and related staff attitudes. Barriers to smoking cessation interventions were also examined. Completed questionnaires were returned by 213 managers and 204 other staff representing 260 agencies (59.8% consent rate). Approximately one-quarter of agencies have smoking cessation intervention policies and one-third of clients receive adequate smoking advice. Of 12 intervention strategies, only the recording of smoking status on file occurs in a majority of cases. Concerns about the potential negative impact of smoking interventions and lack of client interest were endorsed as very important barriers by the highest percentage of respondents. 12.6% of managers and 16.5% of other staff agreed that it is occasionally useful for staff to smoke with a client. Smoking cessation receives little systematic attention from drug and alcohol agencies. Training and policy initiatives are needed urgently to address negative staff attitudes impeding progress in this area.

Objective: To examine community attitudes towards environmental tobacco smoke in licensed premises after the Sharp case decision., Method: 723 randomly selected New South Wales residents aged 18 years and over completed a telephone survey in November 2001., Results: The vast majority supported some form of smoking restriction in licensed clubs (92.1%) and hotels (90.0%). Compared with a 2000 survey, respondents in the 2001 survey were significantly more likely to support a total smoking ban in licensed clubs and hotels. When support was assessed using a ban-only question, 66.8% supported banning smoking in pubs/clubs. Approximately half reported being less likely to visit non-eating areas of licensed clubs (51.2%) and hotels (49.8%) if smoking were permitted and these proportions were significantly higher than in the 2000 survey. A majority (83.1%) thought bar workers' health should be a major consideration when deciding how to handle smoking in pubs/clubs. More than half (56.8%) believed pubs/clubs would experience significant financial problems if smoking bans were introduced., Conclusions and Implications: In New South Wales, majority support exists for banning smoking in pubs and clubs. Legislation banning smoking in all indoor drinking and gaming areas should be introduced immediately.

This selective review was undertaken in order to highlight the need for alcohol and other drug treatment services to provide intervention for tobacco smoking to their clients. The reasons for the failure of treatment services to date to deal with nicotine addiction within their programmes are discussed and positive suggestions for change are proferred. In addition to the transformation of institutional culture which will be required, managers and staff of alcohol and other drug agencies need to know how best to implement smoking intervention within the treatment setting. The paper concludes with some practical suggestions for the management of intervention for tobacco smoking within treatment settings. These suggestions include: making decisions and formulating policies and procedures with regard to how tobacco smoking will be addressed; considering the particular physical, psychological and social/environmental factors that apply to substance abuse clients; building intervention around a simple structure such as the '5 A's'; encouraging and facilitating the use of nicotine replacement therapies; and allowing flexibility to tailor intervention to the individual. A great deal of further research is required to inform us as to how to intervene most effectively for tobacco smoking among this population group.

Objective: To document levels of public support in Australia for smoking restrictions in licensed premises, including trends over time, and to examine the potential effects of a ban on patronage., Method: Systematic review of published and unpublished studies of community and staff attitudes towards smoking in bars, gaming areas and related venues were identified using Medline, Current Contents, PsycINFO and AUSTHealth prior to September 2002. State and Territory health departments, cancer organisations and branches of the National Heart Foundation were approached. Cross-sectional surveys reporting data on attitudes towards smoking restrictions and/or perceptions of effects on patronage were sought. Two reviewers assessed studies for inclusion. One extracted data using pre-coded categories with checking by the second., Results: Thirty-four community and seven staff surveys were synthesised qualitatively, with greater emphasis given to surveys using random selection. All surveys conducted since 1993, which included the separate smoking area response option, have demonstrated majority support for some form of smoking restriction on licensed premises. From 2000, surveys with the ban option alone report majority support for prohibiting smoking completely in bars (52-68%) and gaming areas (64-76%). Support increased significantly after the Sharp damages award. Customer preference data indicate banning smoking is most likely to have a neutral or positive effect on patronage., Conclusions and Implications: Support for a ban on smoking in licensed premises has increased by almost 20% in the past decade. State and Territory governments should introduce legislation banning smoking in all indoor drinking and gaming areas immediately.

Despite optimistic predictions when nicotine replacement therapy (NRT) was switched to over-the-counter (OTC) availability, population surveys have failed to demonstrate a positive impact on long-term smoking cessation. This review examined the strength of the evidence from randomised trials and comparison group studies supporting the effectiveness of OTCNRT. Twelve eligible studies were identified: OTCNRT was compared with placebo in four studies and with health professional-delivered NRT in four studies, and four studies involved community-based minimal intervention NRT. These studies were assessed systematically to determine their methodological quality and generalisibility to 'real-world' conditions of NRT use. The review found a number of issues, including provision of free NRT, heavy cigarette intakes (average 25 daily), high levels of personal interactions (7.6 per subject), lack of blindness assessment and failure of most studies to actively follow-up all subjects seriously limit the degree to which studies' results can be applied to non-research OTCNRT users. In addition, several important limitations affecting the meta-analyses of OTCNRT by Hughes et al. were highlighted. The review concluded that the superiority of OTCNRT over unaided smoking cessation has not been demonstrated convincingly. Future directions for research involve more innovative, rigorous controlled trials and prospective cohort studies where nicotine dependence is assessed adequately. [Walsh RA. Over-the-counter nicotine replacement therapy: a methodological review of the evidence supporting its effectiveness. Drug Alcohol Rev 2008;27:529-547] [ABSTRACT FROM AUTHOR]

After a brief overview of adolescent tobacco control, methodological features and content areas of 78 qualitative studies of adolescent smoking published in English prior to September 2002 were assessed. Narrative syntheses of three content areas - peer influences, access/sales issues, and dependence/addiction - were also undertaken. Many studies failed to provide sufficient sampling and subject characterization details and more effort was required to demonstrate data validity and reliability. Syntheses of the content areas revealed important common themes. Relationships to quantitative research were informative and suggested other research questions. The review highlights the heuristic value of qualitative research on adolescent smoking. Funding was provided by The Cancer Council New South Wales and NSW Health/Hunter Medical Research Institute. [ABSTRACT FROM AUTHOR]

Objectives. A randomized trial evaluated the impact of smoking cessation interventions on point prevalence and consecutive quit rates at an Australian public prenatal clinic. Methods. Self-reports and urine cotinine tests confirmed patients' smoking status at the midpoint and end of pregnancy and 6 weeks postpartum. Results. At all points, validated abstinence rates were significantly higher in the experimental group than in the control group. The rate of failed biochemical validation was significantly higher in the control group than in the experimental group. Conclusions. Prenatal clinic staff can significantly increase quit rates by using cognitive-behavioral strategies. Brief advice appears to be ineffective. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the use of varenicline on Australia.