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Responds to J.R. Hughes' rebuttal of the authors' editorial regarding the effectiveness of over-the-counter nicotine replacement therapy. Summary of points of agreement between Hughes and the authors; Restatement of the central argument of the editorial; Critique of four studies identified by Hughes in support of his arguments; Points of difference between Hughes' and the authors' arguments.

The article presents a study which examined the validity of self-reported smoking among women hospital staff in Tunisia. It states that despite the prevalence of smoking in Tunisia, under-reporting of smoking could occur especially among women from cultures where social proscriptions exist. It mentions that the validity of self-reported smoking was the same among subjects from different areas, ages and occupational groups.

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. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact on hospital admissions produced by trees and other falling objects, to examine these accidents' circumstances, and to investigate the degree of support provided by the data for tree-related accident prevention., Methods: Admissions to emergency departments in the Hunter Region for the period 2008-2012 allocated the International Classification of Disease 10 code W20 (struck by falling object) were analysed., Results: Of 620 admissions, 125 files were incorrectly coded leaving an eligible sample of 495 W20 admissions. Males made up 79.4% of admissions. Where recorded, the commonest accident locations were workplaces (63.2%) and homes (31.5%). Trees/branches caused only 24 (4.8%) of such accidents with an age-adjusted admission rate of 0.28 per 10,000 people compared with 6.84 per 10,000 for all falling objects combined. Most tree-related admissions (at least 62.5%) occurred to persons actively interacting with the tree. Being male (p=0.04) and living in an outer regional area (p=0.001) increased the incidence of tree injuries., Conclusions: Hospital admissions caused by falling objects especially trees are uncommon. Implications for public health: It is difficult to justify any major health promotion expenditure to reduce tree-related accidents, given their especial rarity. Any funds allocated should focus on preventing falling object injuries in workplaces and homes., (© 2016 Public Health Association of Australia.)

Introduction: Understanding the characteristics of smokers who enroll in a trial of quitline support and those who decline could guide recruitment approaches and service delivery to better engage smokers and increase successful quitting. However, it is unknown whether factors such as smokers' perceived effectiveness of using quitting aids or self-exempting beliefs are associated with quitline uptake. We compared the sociodemographic characteristics, smoking behaviours, perceived effectiveness of using quitting aids, and self-exempting beliefs of participants and nonparticipants who were actively telephoned and offered quitline support as part of a randomized controlled trial., Methods: Overall, 48,014 telephone numbers were randomly selected from the electronic telephone directory and contacted. A total of 3,008 eligible smokers were identified and invited to participate in a trial of quitline support. Consenting trial participants (n = 1,562) and nonparticipants (n = 500) completed a baseline interview., Results: Multivariate analysis showed that the following factors were associated with trial participation: consumption of 21 or more cigarettes per day (odds ratio [OR] = 1.45 [1.07-1.99]), readiness to quit within 30 days (OR = 4.45 [3.20-6.19]) or 6 months (OR = 3.22 [2.46-4.23]), perceiving that calling the quitline was definitely (OR = 2.34 [1.62-3.39]) or partly effective (OR = 2.15 [1.63-2.83]), believing that using self-help materials was partly effective (OR = 1.50 [1.16-1.94]), thinking that nicotine replacement therapy was partly effective (OR = 1.38 [1.04-1.84]), perceiving that using willpower alone was partly (OR = 1.99 [1.48-2.67]) or not effective (OR = 2.60 [1.95-3.46]), and not holding a self-exempting belief (OR = 1.45 [1.11-1.89])., Conclusions: Increasing smokers' utilization of quitlines is likely to require changing their perceptions of the effectiveness of quitting strategies compared with using willpower alone and addressing self-exempting beliefs.

Introduction: Only 1%-7% of smokers use quitlines annually. Active telephone recruitment ("cold calling") can enroll about 50% of community smokers to quitline services. However, whether cold-called smokers' characteristics differ from traditional quitline clients is unknown. To assess whether active telephone recruitment reaches new groups of smokers, New South Wales (NSW) Quitline callers were compared with cold-called smokers who received telephone counseling as part of a randomized controlled trial., Methods: Data were extracted from the NSW Quitline database from September 13, 2005, to April 10, 2007, to coincide with the trial's recruitment period. Records (n = 18,584) of first-time quitline callers, who smoked daily, resided in NSW, Australia, and received telephone counseling were included. Cold-called participants who received telephone counseling (n = 695) were recruited by telephone from the electronic NSW telephone directory. Eligibility requirements were daily tobacco use, aged 18 or older, NSW resident, and English speaking. Smokers were eligible regardless of their quitting intention., Results: Male smokers, older age groups, those living in nonmetropolitan areas, smokers who took longer to smoke their first cigarette after waking, consumed fewer cigarettes per day, and were less motivated to quit had greater odds of being referred to the quitline through cold calling., Conclusions: Active telephone recruitment enrolls new groups of smokers to quitlines. The reach of quitlines could be improved if quitlines incorporated cold calling into their recruitment strategies.

Purpose: This study compared the unmet needs, quality of life, and health behaviors (smoking, alcohol, and physical activity) of young adult cancer survivors to their older counterparts and age-related peers., Methods: We conducted a subset analysis of the Cancer Survival Study baseline data collected from participants surveyed at approximately 6-7 months post-diagnosis. All 58 young adults aged 18-40 years at the time of first primary cancer diagnosis and participating in the study were included. Their responses to the self-administered SCNS-SF34, EORTC QLQ-C30, and standard items assessing smoking, alcohol consumption, and physical activity were compared to a random sample (n = 58) of gender and cancer-type matched older adults (64+ years) participating in the same study. Young adult survivors' health behaviors were also compared to previously published data for age-related peers from the Australian general population., Results: Young adult cancer survivors reported significantly lower levels of social functioning; higher levels of financial difficulties, sexuality needs, health systems and information needs; and better physical functioning than their older counterparts. A significantly higher percentage of young cancer survivors were current smokers compared to older survivors (16.1% vs. 3.7%, p = 0.03), but is lower than that reported by age-related peers (24.8%). Compared to young cancer survivors (27.3%), significantly fewer older cancer survivors (8.3%, p = 0.046) and more age-related peers (53.6%) engaged in sufficient levels of physical activity., Conclusions: The impact of cancer on young adults seems to be specific. Future research should verify the unique concerns of young adult cancer survivors in large and diverse samples.

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.

Objectives: Active telephone recruitment ('cold calling') can enroll almost 45 times more smokers to cessation services than media. However, the effectiveness of proactive telephone counselling with cold-called smokers from the broader community is unknown. This study examined whether proactive telephone counselling improved abstinence, quit attempts and reduced cigarette consumption among cold-called smokers., Methods: From 48,014 randomly selected electronic telephone directory numbers, 3008 eligible smokers were identified and 1562 (51.9%) smokers recruited into the randomised controlled trial. Of these, 769 smokers were randomly allocated to proactive telephone counselling and 793 to the control (ie, mailed self-help) conditions. Six counselling calls were offered to intervention smokers willing to quit within a month and four to those not ready to quit. The 4-month, 7-month and 13-month follow-up interviews were completed by 1369 (87.6%), 1278 (81.8%) and 1245 (79.9%) participants, respectively., Results: Proactive telephone counselling participants were significantly more likely than controls to achieve 7-day point prevalence abstinence at 4 months (13.8% vs 9.6%, p=0.005) and 7 months (14.3% vs 11.0%, p=0.02) but not at 13 months. There was a significant impact of telephone counselling on prolonged abstinence at 4 months (3.4% vs 1.8%, p=0.02) and at 7 months (2.2% vs 0.9%, p=0.02). At 4 months post recruitment, telephone counselling participants were significantly more likely than controls to have made a quit attempt (48.6% vs 42.9%, p=0.01) and reduced cigarette consumption (16.9% vs 9.0%, p=0.0002)., Conclusions: Proactive telephone counselling initially increased abstinence and quitting behaviours among cold-called smokers. Given its superior reach, quitlines should consider active telephone recruitment, provided relapse can be reduced., Trial Registration: Australian New Zealand Clinical Trial Registry; ACTRN012606000221550.

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.

Introduction: Levels of hospital smoking cessation care are less than optimal. This study aimed to synthesize the evidence regarding the effectiveness of interventions in increasing smoking cessation care provision in hospitals., Methods: A review identified relevant studies published between 1994 and 2006. A description of studies, including methodological quality, was undertaken. Intervention effectiveness in increasing smoking cessation care practices was examined for controlled studies using meta-analysis. Care practices examined were assessment of smoking status; advice to quit; counseling or assistance to quit; advising, offering, or providing nicotine replacement therapy (NRT); and follow-up or referral., Results: Of the 25 identified studies, 18 were U.S. based and in inpatient settings. Of the 10 controlled trials, 4 addressed cardiac patients, 5 measured one smoking cessation care practice, and 9 implemented multistrategic interventions (e.g., combining educational meetings with reminders and written resources). The methodology described in these studies was generally of poor quality. Meta-analysis of controlled trials demonstrated a significant intervention effect for provision of assistance and counseling to quit (pooled risk difference = 16.6, CI = 4.9-28.3) but not for assessment of smoking status, advice to quit, or the provision or discussion of NRT. Statistical heterogeneity was indicated for all smoking cessation care practices. An insufficient number of studies precluded the use of meta-analysis for follow-up or referral for further assistance., Discussion: Interventions can be effective in increasing the routine provision of hospital smoking cessation care. Future research should use more rigorous study design, examine a broader range of smoking cessation care practices, and focus on hospital-wide intervention implementation.

Hospitals are key settings for the provision of smoking cessation care. Limited data are available that describe the prevalence and type of such care delivered routinely in this setting. We reviewed studies conducted in hospitals and published between 1994 and 2005 that reported levels of smoking care delivery. This review describes the proportion of patients receiving, and the proportion of health professionals providing, various smoking cessation care practices. We used both descriptive and meta-analytic methods. According to the meta-analysis, smoking status was assessed in 60% of patients, 42% were advised or counseled to quit, 14% were provided with or advised to use nicotine replacement therapy (NRT), and 12% received referrals or follow-up. Significantly fewer patients received follow-up or referrals than were assessed for smoking status or received advice or counseling to quit. Some 81% of health professionals reported they assessed smoking status, 70% advised or counseled patients to quit, 13% provided NRT or advised its use, and 39% provided referrals or follow-up. Significantly fewer health professionals advised or prescribed NRT than assessed smoking status or advised or counseled patients to quit. Statistical heterogeneity was indicated for all smoking care practices. Levels of smoking cessation care are less than optimal in hospitals, and the levels of some important care practices are particularly low. Future research should identify effective methods for increasing smoking care provision in this setting. In addition, standardized measures of smoking care should be developed. Hospital organizations should enhance and continue to monitor their delivery of smoking care.

There has been no systematic examination of issues surrounding pension funds and their tobacco shareholdings. This paper describes two studies designed to document the tobacco investment policies and practices of pension funds, and to assess community and fund member attitudes to pension fund shareholdings in the tobacco industry. Chief executives (n = 282) of Australian pension funds were mailed questionnaires. Of 241 eligible funds, 107 (44.4%) returned questionnaires, representing about 61% of total Australian primary superannuation accounts. Twelve percent indicated that they did not currently hold tobacco investments, 30% held tobacco shares and 58% did not know or failed to answer. Overall, 6% of respondents said that they held no tobacco investments and would not consider future investments; 2% had formal policies precluding tobacco investments. Funds with 10,000 or more members were more likely (p = 0.0006) to report tobacco investments. External fund manager advice was the most important factor influencing the funds' position. In the second study, a one-third random sub-sample of consenting subjects from 12,000 households randomly selected from the New South Wales Electronic White Pages completed phone interviews. From 7141 eligible households, 3503 (49.1%) subjects consented. One-third (n = 1158) were asked the pension fund questions. Over three-quarters (77.4%) of all respondents disagreed that pension fund investments in tobacco were ethical. Approximately two-thirds (63.6%) of fund members (n = 852) agreed that their funds should not make tobacco investments. There were three statistically significant predictors of opposition to such investments: being female, more highly educated and non-smoking status. Nearly all pension funds treat tobacco investments like any other investment. In contrast, most of the public including fund members are strongly opposed to such investments. Suggestions for public health advocacy strategies to reduce the negative health promotion effects of pension funds in this area are outlined.

Background: Achieving acceptable response rates from health care providers via postal questionnaires is an ongoing challenge. The use of monetary incentives is one of the most effective strategies for increasing response rates. However, the effect and cost of such an incentive on retail pharmacists' response rates has not been well studied., Methods: A sample of 700 pharmacies was selected at random from the electronic Yellow Pages in NSW Australia and mailed a brief survey regarding pharmacotherapies and advice for smoking cessation. Half of the sample was randomly allocated to receive an offer of an 14 US dollars gift voucher., Results: The response rates were 65.9% for the voucher group and 53.5% for the no-voucher group. The odds of response from the voucher group was 1.68 (95%CI = 1.23, 2.30) times greater than for the no-voucher group. The cost per additional respondent was 67.95 US dollars. The incentive also reduced follow up costs by 10%., Conclusions: A moderately sized monetary incentive is able to achieve a significant increase in response rates for retail pharmacists, thereby reducing potential bias in the sample.