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Integrating primary care with the health response is key to managing pandemics and other health emergencies. In recognition of this, the Australian Government established a network of respiratory clinics led by general practitioners in response to the coronavirus disease 2019 (COVID-19) pandemic as part of broader measures aimed at supporting primary care. General practitioner (GP) respiratory clinics provide holistic face-to-face assessment and treatment to those with respiratory symptoms in an environment with strict protocols for infection prevention and control. This ensures that these patients are able to access high quality primary care while protecting the general practice workforce and other patients. The GP respiratory clinic model was developed and operationalized 10 days after the policy was announced, with the first 2 respiratory clinics opening on March 21, 2020. Subsequently a total of 150 respiratory clinics were opened and served over 800,000 patients within more than 99% of Australia's postcodes. These clinics used a standardized data collection tool that has provided the largest and most complete primary care surveillance database of respiratory illness in Australia. The success of the GP respiratory clinic model was made possible due to strong partnerships with Primary Health Networks and individual general practices that rapidly shifted operations to embrace this new approach. This article describes the development and early implementation of this model.

Introduction There is significant variation in the format and delivery of group-based smoking cessation programs. To guide research and healthcare program implementation, it is important to understand the active components of interventions. Aims and Methods This review aimed to (1) identify behavior change techniques (BCTs) used in effective group-based smoking cessation interventions, (2) determine the effectiveness of group-based smoking cessation interventions on smoking cessation at 6-month follow-up, and (3) identify the behavior change techniques (BCTs) related to effective group-based smoking cessation. The following databases were searched in January 2000 and March 2022: MEDLINE, EMBASE, CINAHL, PsycINFO, The Cochrane Library, and Web of Science. BCTs used in each study were extracted using the BCT Taxonomy. Studies that included identified BCTs were computed, and meta-analyses were conducted to evaluate smoking cessation at 6-month follow-up. Results A total of 28 BCTs were identified from 19 randomized controlled trials. Studies included an average of 5.42 ± 2.0 BCTs. The most frequent BCTs were “information about health consequences” and “problem solving.” The pooled 6-month smoking cessation was higher in the group-based intervention group (OR = 1.75, 95% CI = 1.12 to 2.72, p Conclusions Group-based smoking cessation interventions doubles the rate of smoking cessation at 6-month follow-up. Implementing group-based smoking cessation programs, that incorporate multiple BCTs, is recommended for an effective smoking cessation care. Implications Group-based smoking cessation programs improves smoking cessation outcomes in clinical trials. There is a need to incorporate effective individual BCTs techniques to enhance smoking cessation treatment outcomes. A robust evaluation is required to assess the effectiveness of group-based cessation programs in real world settings. There is also a need to consider the differential effectiveness of group-based programs and BCT impacts on populations, for example, indigenous peoples.

IntroductionSmoking remains the leading preventable cause of death for Aboriginal and Torres Strait Islander people in Australia. Aboriginal and Torres Strait Islander people who smoke are more likely to make a quit attempt than their non-Aboriginal counterparts but less likely to sustain the quit attempt. There is little available evidence specifically for and by Indigenous peoples to inform best practice smoking cessation care.The provision of a free Koori Quit Pack with optional nicotine replacement therapy sent by mail may be a feasible, acceptable and effective way to access stop smoking support for Aboriginal and Torres Strait Islander peoples.Methods and analysisAn Aboriginal-led, multisite non-randomised single-group, pre–post feasibility study across three states in Australia will be conducted. Participants will be recruited via service-targeted social media advertising and during usual care at their Aboriginal Community Controlled Health Services. Through a process of self-referral, Aboriginal and Torres Strait Islander people who smoke daily will complete a survey and receive mailout smoking cessation support. Data will be collected over the phone by an Aboriginal Research Assistant. This pilot study will inform the development of a larger, powered trial.Ethics and disseminationEthics approval has been obtained from the Aboriginal Health & Medical Research Council Ethics Committee of New South Wales (NSW) (#1894/21) and the University of Newcastle (#H-2022-0174). Findings will be reported through peer-reviewed journals and presentations at relevant local, national and international conferences. The findings will be shared with the NSW and Victoria Quitline, Aboriginal Health and Medical Research Council and Victorian Aboriginal Community Controlled Organisation and the National Heart Foundation.Trial registration numberACTRN12622000654752.

Background: Aboriginal and Torres Strait Islander women deserve improved smoking cessation support. Aboriginal health workers (AHW) and practitioners (AHP) can be central to the provision of culturally safe smoking cessation care (SCC). The objective of this study is to explore attitudes and the perceived role of AHWs/AHPs toward providing SCC to Aboriginal and Torres Strait Islander pregnant women. Method: A mixed-method study using quantitative and qualitative data was conducted among AHW/AHPs in 2021 across Australia. Descriptive and analytical statistics were used to characterise AHWs’/AHPs’ attitudes towards SCC and to evaluate the factors associated with perceptions of who is best placed to provide SCC. Results: From the total AHW/AHP workforce, 21.2% (223) completed the survey. Less than half (48.4%) believed that AHW/AHP were best placed to provide SCC for pregnant women. The majority believed that group-based supports (82.5%) and cultural support programs (63.7%) were the best strategies to support Aboriginal and Torres Strait Islander pregnant women to quit smoking. Conclusion: This study highlights the need to enhance SCC offered to Aboriginal and Torres Strait Islander pregnant women. A targeted workforce dedicated to smoking cessation should be resourced, including funding, standardised training, and ongoing SCC support tailored to Aboriginal and Torres Strait Islander pregnant women.

Background: Aboriginal and Torres Strait Islander women deserve improved smoking cessation support. Aboriginal health workers (AHW) and practitioners (AHP) can be central to the provision of culturally safe smoking cessation care (SCC). The objective of this study is to explore attitudes and the perceived role of AHWs/AHPs toward providing SCC to Aboriginal and Torres Strait Islander pregnant women. Method: A mixed-method study using quantitative and qualitative data was conducted among AHW/AHPs in 2021 across Australia. Descriptive and analytical statistics were used to characterise AHWs’/AHPs’ attitudes towards SCC and to evaluate the factors associated with perceptions of who is best placed to provide SCC. Results: From the total AHW/AHP workforce, 21.2% (223) completed the survey. Less than half (48.4%) believed that AHW/AHP were best placed to provide SCC for pregnant women. The majority believed that group-based supports (82.5%) and cultural support programs (63.7%) were the best strategies to support Aboriginal and Torres Strait Islander pregnant women to quit smoking. Conclusion: This study highlights the need to enhance SCC offered to Aboriginal and Torres Strait Islander pregnant women. A targeted workforce dedicated to smoking cessation should be resourced, including funding, standardised training, and ongoing SCC support tailored to Aboriginal and Torres Strait Islander pregnant women.

This study systematically reviewed evidence regarding health program and service evaluations in Indigenous contexts. Following the PRISMA guidelines and combining terms for ‘Indigenous populations’ and ‘health programs and services’. Eight principles emerged: Principle 1: Adopting Indigenous led or co-led approaches is vital to balance power relationships by prioritizing self-determination, Principle 2: Evaluation team should include local Indigenous community members, Principle 3: Indigenous community knowledge and practice should be foundational, Principle 4: Evaluations must be responsive and flexible to meet the needs of the local community, Principle 5: Evaluations should respect and adhere to local Indigenous protocols, culture, wisdom and language, Principle 6: Evaluations should emphasize reciprocity, shared learnings and capacity building, Principle 7: It is important to build strong relationships and trust between and within researcher teams, evaluators and communities, and Principle 8: The evaluation team must acknowledge community capacity and resources by investing in time and relationships.

Methods for calculating health indicators profoundly influence understanding of and action on population health and inequities. Age-standardization can be useful and is commonly applied to account for differences in age structures when comparing health indicators across groups. Age-standardized rates have well-acknowledged limitations, including that they are relative indices for comparison, and not accurate measures of actual rates where the age structures of groups diverge. This paper explores these limitations, and demonstrates alternative approaches through a case study quantifying mortality rates within the Aboriginal and Torres Strait Islander (Indigenous) population of Australia and inequities compared with the non-Indigenous population, over 2001–16. Applying the Australian Standard Population, the Aboriginal and Torres Strait Islander age-standardized mortality rate was more than double the crude mortality rate in 2001 and 2016, inflated through high weighting of older age groups. Despite divergent population age structures, age-standardized mortality rates remain a key policy metric for measuring progress in reducing Indigenous-non-Indigenous inequities in Australia. Focusing on outcomes age-standardized to the total population can obscure inequities, and denies Aboriginal and Torres Strait Islander peoples and communities valid, actionable information about their health and well-being. Age-specific statistics convey the true magnitude of health risks and highlight high-risk subgroups. When requiring standardization, standardizing to a population-specific standard (here, an Indigenous standard) generates metrics centred around and reflective of reality for the population of focus, supporting communities’ self-determination to identify priorities and informing resource allocation and service delivery. The principles outlined here apply across populations, including Indigenous and other populations internationally.

With lifetime intimate partner violence (IPV) victimization rates for self-identified men between 14% and 20%, and an expanding understanding of gender as a nonbinary construct, practitioners in some clinical environments have expressed interest in screening all patients for IPV. Yet, few IPV screening instruments have been validated for use in nonfemale populations. This research tests the appropriateness and acceptability of a screening instrument developed for use with women. A literature review was completed to determine the current state of research into IPV screening practices tailored to men. Next, cognitive interviews were conducted to test a 9-question IPV screening instrument with men considered at average and elevated risk for experiencing partner violence. Participants were read the questions aloud and asked about item comprehension and question appropriateness and acceptability. The literature review uncovered no published reports describing routine clinic based IPV screening of men, and only two screening instruments had been validated with men. Twenty men participated in cognitive interviews from a variety of settings in a large urban center. All participants accurately described the intended meaning of each question and verified the appropriateness of asking the questions. This work addresses the gap in research on routine IPV screening with men, building on efforts to screen individuals and support improved health and response to violence to those across the gender spectrum.

ObjectiveTo estimate the health gains and Māori:non-Māori health inequality reductions of the Aotearoa/New Zealand Government’s proposed endgame strategy.DesignSimulation modelling: a Markov model to estimate future yearly smoking and vaping prevalence (for business-as-usual [BAU] and intervention scenarios) linked to a proportional multistate lifetable model with 16 tobacco-related diseases to estimate future morbidity and mortality rates, and health adjusted life years (HALYs).SettingAotearoa.ParticipantsPopulation alive in 2020 (5.08 million) simulated over the rest of their lifespan.Interventions1. Denicotinisation of all retail tobacco in 2023, 2. 1 plus media promotion, 3. 95% reduction in tobacco retail outlets in 2023, 4. a tobacco free-generation whereby people born in 2006 and later are never legally able to purchase tobacco, 5. combined package of 2, 3 and 4.Main Outcome MeasuresFuture smoking prevalence, deaths averted and HALYs by sex and ethnic group. Percent reduction in Māori:non-Māori all-cause mortality rate difference in 2040 under interventions compared to business as usual (BAU).ResultsThe combined package of strategies was estimated to reduce adult smoking prevalence from 31.8% in 2022 to 7.3% in 2025 for Māori, and 11.8% to 2.7% for non-Māori. The 5% smoking prevalence target was forecast to be achieved in 2026 and 2027 for Māori males and females, respectively.The HALY gains for the combined package (compared to BAU) over the population’s remaining lifespan was estimated to be 594,000 (95%UI: 443,000 to 738,000; 3% discount rate). The denicotinisation strategy alone achieved 97% of these HALYs, the retail strategy 19%, and tobacco-free generation 12%.The future per capita HALY gains for the combined package for Māori were estimated to be 4.75 and 2.14 times higher than for non-Māori females and males, respectively. The absolute difference between Māori and non-Māori all-cause mortality for 45+ year olds in 2040 was estimated to be 23.4% (19.1% to 27.6%) less for females under the combined package compared to BAU, and 9.5% (7.5% to 11.3%) less for males.ConclusionA tobacco endgame strategy, especially denicotinisation, could dramatically reduce health inequities.FundingNew Zealand Ministry of Health.Summary boxesWhat is already known on this topicModelling of health gains and health inequality reductions for some tobacco endgame strategies has been undertaken internationally, and specifically in Aotearoa (tobacco free generation policy, substantial reductions in the number of tobacco outlets including, a sinking lid that gradually phased out all tobacco supply between 2011 to 2025, restricting tobacco sales to pharmacies only with brief cessation advice provided to consumers). All modelling suggested that these interventions improved equity, of varying magnitude, in either smoking prevalence or health gain for Māori compared to non-Māori.Endgame modelling of denicotinisation has not been undertaken, alone or in combination with other interventions. The interplay of tobacco smoking and vaping has not been explicitly included in endgame modelling. The package of endgame strategies in the Aotearoa-New Zealand Government’s Smokefree Action Plan (Dec 2021) have not been modelled.What this study addsThe Government’s package (denicotinisation of retail tobacco, 95% reduction in the number of tobacco retail outlets; and a tobacco-free generation) if implemented in 2023 is forecast to achieve less than 5% smoking prevalence by 2025 for non-Māori, and by 2027 for Māori.Denicotinisation is estimated to achieve the majority of the health gains.A 95% retail outlet reduction and a tobacco-free generation, on their own, are unlikely to achieve a 5% smoking prevalence for any sex by ethnic groups until at least 2040.The combined package, compared to BAU, is estimated to reduce the Māori:non-Māori gap in 45+ year old all-cause mortality in 2040 by 22.9% (95% uncertainty interval 19.9% to 26.2%) for females and 9.6% (8.4% to 11.0%) males.

Background Despite generally high smoking prevalences, stemming from colonization, the relationship of smoking to mortality has not been quantified reliably in an Indigenous population. We investigate smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia, where current adult daily smoking prevalence is 40.2%. Methods A prospective study of 1388 cardiovascular disease- and cancer-free Aboriginal adults aged ≥45 years, of the 267 153 45 and Up Study participants randomly sampled from the New South Wales general population over 2006–09. Questionnaire and mortality data were linked (through the Centre for Health Record Linkage) to mid-2019. Adjusted hazard ratios (called relative risks, RRs) for all-cause mortality—among current- and past- versus never-smokers—were estimated overall, by smoking intensity and by age at cessation. Smoking-attributable fractions and associated deaths were estimated. Results Over 14 586 person-years’ follow-up (median 10.6 years), 162 deaths accrued. Mortality RRs [95% confidence interval (CI)] were 3.90 (2.52–6.04) for current- and 1.95 (1.32–2.90) for past- versus never-smokers, with age heterogeneity. RRs increased with smoking intensity, to 4.29 (2.15–8.57) in current-smokers of ≥25 cigarettes/day. Compared with never-smokers, RRs were 1.48 (0.85–2.57) for those quitting at 10 years longer than current-smokers. Around half of deaths among adults aged ≥45 years were attributable to smoking, exceeding 10 000 deaths in the past decade. Conclusions In this population, >80% of never-smokers would survive to 75 years, versus ∼40% of current-smokers. Quitting at all ages examined had substantial benefits versus continuing smoking; those quitting before age 45 years had mortality risks similar to never-smokers. Smoking causes half of deaths in older Aboriginal and Torres Strait Islander adults; Indigenous tobacco control must receive increased priority.

Objective: To describe smoking characteristics, quitting behaviour and other factors associated with longest quit attempt and the use of nicotine replacement therapy (NRT) and stop-smoking medication (SSM) in a population of Indigenous Australian women of reproductive age. Design, setting and participants: A national cross-sectional survey of Aboriginal and Torres Strait Islander women aged 16–49 years who were smokers or ex-smokers was conducted online during the period July to October 2020. Main outcome measures: Quitting experience: attempt to cut down, time since last quit attempt, longest period without smoking, attempt to cut down during last quit attempt, any use of NRT and/or SSM. Results: Most of the 428 participating women (302 [70.6%]) reported using an Aboriginal health service. Younger women (16–20-year-olds) smoked fewer cigarettes daily (24/42 [57.1%], 0–5 cigarettes per day), waited longer to smoke after waking (20/42 [47.6%], > 60 minutes after waking), and were categorised as low smoking dependency compared with those aged 35 years and over. One-third of women (153 [35.7%]) had ever used NRT and/or SSM. A greater proportion of older women (35–49-year-olds) had sustained a quit attempt for years (62/149 [45.6%]) and reported trying NRT and/or SSM (78/149 [52.4%]) than women in younger age groups. Quitting suddenly rather than gradually was significantly associated with sustained abstinence (prevalence ratio, 1.27 [95% CI, 1.10–1.48]). Among women who had never used NRT or SSM, most (219/275 [79.6%]) reported reasons for this in the category of attitudes and beliefs. NRT and SSM use was also more likely among women who were confident talking to their doctor about quitting (odds ratio, 2.50 [95% CI, 1.23–5.10]) and those who received most of their information from a health professional (odds ratio, 1.71 [95% CI, 1.11–2.63]). Conclusion: Aboriginal and Torres Strait Islander women want to quit smoking and are making attempts to quit. Quitting suddenly, rather than reducing cigarette consumption, is associated with increased sustained abstinence. Health providers can enable access and uptake of NRT and/or SSM and should recognise that NRT and/or SSM use may change over time. Consistent messaging, frequent offers of smoking cessation support, and access to a range of smoking cessation supports should be provided to Aboriginal and Torres Strait Islander women to enable them to be smoke-free.

Introduction Tobacco is the leading preventable cause of morbidity and mortality for Aboriginal and Torres Strait Islander people. Accordingly, the provisions of culturally safe and effective smoking cessation strategies are crucial. While previous research has suggested Aboriginal Health Workers/Practitioners are well placed to provide smoking cessation care, no research to date has explored the workforce knowledge, attitudes and practices in offering best practice cessation care. Methods A cross-sectional study was conducted among Aboriginal Health Workers/Practitioners from June to September 2021. Descriptive and inferential statistics were conducted to examine participant characteristics, provision of smoking cessation care, and explore the factors associated with smoking cessation care. Results Out of 1052 registered Aboriginal Health Workers/Practitioners, 256 participants completed the full survey (24.3%). Smoking cessation counseling was always provided by 41.9%; provided some of the time by 42.4%, and never provided by 12.9%. Combination NRT and Quitline referral were always offered by 23.1% and 44.9% of participants, respectively. Those that received training, felt smoking cessation care was part of their role, and were based in Aboriginal Community Controlled Health Organization were significantly more likely to offer best practice smoking cessation care. Conclusion Aboriginal Health Workers/Practitioners and Aboriginal Community Controlled Health Organizations play a critical role in delivering high quality, evidence based and culturally safe care to Aboriginal and Torres Strait Islander people. Aboriginal Health Workers/Practitioners are well placed to offer smoking cessation care. Ongoing funding and implementation of a targeted smoking cessation workforce with appropriate training and resources are urgently required. Implications Aboriginal Health Workers/Practitioners are well placed to offer culturally safe, best practice smoking cessation care. However, due to the magnitude and complexity of Aboriginal Health Workers/Practitioners roles, it is challenging for smoking cessation care to be consistently and feasibly integrated into usual care. Acknowledging Australia’s National Preventative Health Strategy target of 27% or less Aboriginal and Torres Strait Islander people smoking by 2030, urgent investment and resourcing must be directed to building a skilled workforce to support quitting and maintaining smokefree behaviors, ensuring equitable access to smoking cessation care for Aboriginal and Torres Strait Islander peoples.

Objective: To identify smoking cessation support strategies that resonate with Aboriginal and Torres Strait Islander women. Design, setting and participants: A national cross-sectional survey of Aboriginal and Torres Strait Islander women aged 16–49 years who were smokers or ex-smokers was conducted online during the period July to October 2020. Main outcome measures: Preferred strategies, providers and locations for smoking cessation support. Results: Among a total of 428 women who participated in the survey, group-based support and holistic support were the most preferred strategies (preferred by 31.8% and 22.2% of women, respectively). Use of an Aboriginal health service was positively associated with choosing holistic support programs (prevalence ratio, 1.14 [95% CI, ≥ 1.00–1.28]). Women with high or moderate nicotine dependency were more likely to consider group-based support to be helpful (prevalence ratio, 1.13 [95% CI, ≥ 1.00–1.27]) than those with low nicotine dependency. The most preferred providers for smoking cessation support were Aboriginal health workers (64.3%). Most women (73.4%) preferred face-to-face support at an Aboriginal health service, 38.8% preferred online support and 34.8% preferred phone support. A higher percentage of older women (≥ 35 years) preferred online or phone support (prevalence ratio, 1.70 [95% CI, 1.03–2.80]) compared with younger women (16–20 years). Use of an Aboriginal health service was positively associated with preference for an Aboriginal health worker (prevalence ratio, 1.35 [95% CI, 1.12–1.62]), and receiving face-to-face support at an Aboriginal health service (prevalence ratio, 1.28 [95% CI, 1.10–1.49]). Conclusion: Aboriginal and Torres Strait Islander women prefer a range of cessation supports, with most women preferring group support and holistic approaches. Cessation supports that resonated with women varied by age, remoteness, nicotine dependence, and whether participants used an Aboriginal health service. Women want support to quit smoking from the Aboriginal health workers at their Aboriginal health service, at their health care providers and in their community. Comprehensive, multifaceted supports are required. Online support and phone-based support are also preferred by some women, which helps to increase accessibility. Appropriate models of care — including sufficient funding for Aboriginal health services and Aboriginal health workers — are required and should be developed in partnership with communities to implement meaningful and culturally safe cessation care. This research demonstrates the need for and importance of multifaceted, comprehensive cessation support strategies.

The tobacco industry has a long and well-documented history of influencing, exploiting and misleading public health and research communities.1–4 Starting with the 1953 ‘Tobacco Industry Research Committee’5, stakeholders affiliated with the tobacco industry have strategically promoted industry interests through the funding of research programmes and public health initiatives, in order to influence research agendas, manipulate the design, methods and conduct of research, affect interpretation of findings and selectively disseminate information through publications, conferences, forums and panels.1–4 These activities have enabled the tobacco industry to promote its versions of ‘sound science’ and ‘good epidemiology’ which have been designed to weaken consensus about the harms of tobacco use and second-hand smoke exposure.6 Academics and public health communities have sought to raise awareness about and challenge industry interference and manipulation,7–9 and some industry-funded research organisations such as the Council for Tobacco Research and the Center for Indoor Air Research were disbanded as part of the 1998 Master Settlement Agreement in the USA due to their extensively documented role in industry efforts to defraud the public.7 8 However, as Legg et al 10 highlight, the approach has intensified and become more sophisticated over time. A central tenet of the World Health Organization’s Framework Convention on Tobacco Control (FCTC),11 Article 5.3, states: ‘In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law’.11 There is now increasing evidence on the ways in which tobacco companies seek to position the industry as a strategic partner to public health, presenting themselves as scientific authorities who are promoting new products as solutions to concerns about commercial tobacco and as legitimate commentators on science and health …

Ethical publishing practices are vital to tobacco control research practice, particularly research involving Indigenous (Indigenous peoples: For the purposes of this Special Communication, we use the term Indigenous people(s) to include self-identified individuals and communities who frequently have historical continuity with precolonial/presettler societies; are strongly linked to the land on which they or their societies reside; and often maintain their own distinct language(s), belief and social-political systems, economies and sciences. The authors humbly acknowledge, respect and value that Indigenous peoples are diverse and constitute many nations, cultures and language groups. Many Indigenous peoples also exist as governments in treaty relations with settler-colonial societies, and all Indigenous peoples have inherent rights under international law. The language and terminology used should reflect the local context(s) and could include, but are not limited to, terms such as Aboriginal, Bagumani, Cherokee, First Peoples, First Nations, Inuit, Iwaidja, Kungarakan, Lakota, Māori, Mѐtis, American Indian, Navajo, Wagadagam, Wiradjuri, Yurok, etc) people. These practices can minimise, correct and address biases that tend to privilege Euro-Western perspectives. Ethical publishing practices can minimise and address harms, such as appropriation and misuse of knowledges; strengthen mechanisms of accountability to Indigenous peoples and communities; ensure that tobacco control research is beneficial and meaningful to Indigenous peoples and communities; and support Indigenous agency, sovereignty and self-determination. To ensure ethical practice in tobacco control, the research methodology and methods must incorporate tangible mechanisms to include and engage those Indigenous peoples that the research concerns, affects and impacts.Tobacco Controlis currently missing an ethical research and evaluation publishing protocol to help uphold ethical practice. The supporters of this Special Communication call onTobacco Controlto adopt publication practice that explicitly upholds ethical research and evaluation practices, particularly in Indigenous contexts. We encourage researchers, editors, peer reviewers, funding bodies and those publishing inTobacco Controlto reflect on their conduct and decision-making when working, developing and undertaking research and evaluation of relevance to Indigenous peoples.Tobacco Controland other publishers, funding bodies, institutions and research teams have a fundamental role in ensuring that the right peoples are doing the right work in the right way. We call forTobacco Controlto recognise, value and support ethical principles, processes and practices that underpin high-quality, culturally safe and priority-driven research, evaluation and science that will move us to a future that is commercial tobacco and nicotine free.

Smoking is the leading contributor to the burden of disease and mortality for Aboriginal and Torres Strait Islander peoples, with an estimated 37% of all Aboriginal and Torres Strait Islander deaths attributed to smoking. The Tackling Indigenous Smoking (TIS) program was implemented to support people to quit smoking, prevent initiation, and reduce exposure to second-hand smoke. Analysis of baseline (2018–2020) data from a large-scale cohort study was conducted to quantify smoking-related attitudes and behaviours among Aboriginal and Torres Strait Islander adults, overall and in relation to exposure to the TIS program. Most results were similar for TIS and non-TIS, but there was a significantly lower prevalence of smoking inside households (PR0.95, 95% CI: 0.74, 0.97), smoking ≥21 cigarettes per day (PR0.79, 95% CI: 0.62, &lt, 1.00), and smoking a first cigarette within 5 min of waking (PR0.87, 95% CI: 0.76, &lt, 1.00) in TIS-funded compared to non-TIS-funded areas. Findings from the analysis highlight encouraging anti-smoking attitudes and behaviours across TIS-funded and non-TIS-funded areas, and serve as a basis for future analysis of change in outcomes over time associated with exposure to a large multi-mode population health program (TIS).

Knowledge translation (KT) is a critical component of any applied health research. Indigenous Peoples' health research and KT largely continues to be taught, developed, designed, regulated, and conducted in ways that do not prioritize local Indigenous Peoples' ways of sharing knowledges. This review was governed and informed by Indigenous health scholars, Knowledge Guardians, and Elders. Our systematic review focused on answering, what are the promising and wise practices for KT in the Indigenous health research field? Fifty-one documents were included after screening published literature from any country and grey literature from what is now known as Canada. This included contacting 73 government agencies at the federal, territorial, and provincial levels that may have funded Indigenous health research. Only studies that: a) focused on Indigenous Peoples' health and wellness; b) documented knowledge sharing activities and rationale; c) evaluated the knowledge sharing processes or outcomes; and d) printed in English were included and appraised using the Well Living House quality appraisal tool. The analysis was completed using an iterative and narrative synthesis approach. Our systematic review protocol has been published elsewhere. We highlight and summarize the varied aims of Indigenous health research KT, types of KT methodologies and methods used, effectiveness of KT efforts, impacts of KT on Indigenous Peoples' health and wellness, as well as recommendations and lessons learned. Few authors reported using rigorous KT evaluation or disclosed their identity and relationship with the Indigenous communities involved in research (i.e. self-locate). The findings from this review accentuate, reiterate and reinforce that KT is inherent in Indigenous health research processes and content, as a form of knowing and doing. Indigenous health research must include inherent KT processes, if the research is by, for, and/or with Indigenous Peoples.

Background Reducing youth (15-17 years) smoking uptake is critical to tobacco control; accordingly, youth smoking prevalence is a key monitoring and evaluation outcome. Many nationally representative surveys collect youth smoking behaviour data from, or in the presence of, the youth’s parent or caregiver. We aimed to quantify the potential bias conferred by this. Methods We compared youth smoking prevalence when reported by parent proxy, with parent present or by private self-report, in Australian Bureau of Statistics Health Surveys. National youth current smoking prevalence if all data were collected by youth self-report was estimated. Results Smoking behaviour data for over 75% of youth participants in the health survey were collected by proxy or with parent present. Ever-smoking prevalence using private self-report versus report by proxy was 1.29 (95%CI:0.96-1.73) to 1.99 (1.39-2.85) times as high in Aboriginal and Torres Strait Islander youth, and 1.83 (0.92-2.63) to 2.72 (1.68-4.41) times as high in total population youth. Predicted national current smoking prevalence if all youth were to self-report alone was substantively higher than the estimated national prevalence based on actual responses, but still reveals a decline over time. Conclusions Youth smoking estimates drawn from data collected by proxy/with parent present are unlikely to be accurate. Increased youth self-report is crucial to ensure data accuracy to inform effective tobacco control. Key messages The accuracy of youth smoking data collected by proxy/with parent present should be further scrutinised before it is used to inform assessment of national prevalence and trends.

Abstract: A group of Indigenous health and social service evaluators called the “Three Ribbon” panel came together in Toronto in 2015/16 with the goal of informing a set of evidence-based guidelines for urban Indigenous health and social service and program evaluation. The collective knowledge and experiences of the Three Ribbon panel was gathered through discussion circles and synthesized around the following areas: barriers to conducting Indigenous health and social service evaluation; decolonizing principles and protocols that support community self-determination and centralize Indigenous culture and worldviews; and guidelines to inform health and social service evaluation moving forward. The wisdom and contributions of the Three Ribbon Panel creates space for Indigenous worldviews, values, and beliefs within program evaluation practice and has important implications for evaluation research and application.

Objectives Inequalities between Indigenous and non-Indigenous peoples in Canada persist. Despite the growth of Indigenous populations in urban settings, information on their health is scarce. The objective of this study is to assess the association between experience of discrimination by healthcare providers and having unmet health needs within the Indigenous population of Toronto. Methods The Our Health Counts Toronto (OHCT) database was generated using respondent-driven sampling (RDS) to recruit 917 self-identified Indigenous adults within Toronto for a comprehensive health assessment survey. This cross-sectional study draws on information from 836 OHCT participants with responses to all study variables. Odds ratios and 95% confidence intervals were estimated to examine the relationship between lifetime experience of discrimination by a healthcare provider and having an unmet health need in the 12 months prior to the study. Stratified analysis was conducted to understand how information on access to primary care and socio-demographic factors influenced this relationship. Results The RDS-adjusted prevalence of discrimination by a healthcare provider was 28.5% (95% CI 20.4–36.5) and of unmet health needs was 27.3% (95% CI 19.1–35.5). Discrimination by a healthcare provider was positively associated with unmet health needs (OR 3.1, 95% CI 1.3–7.3). Conclusion This analysis provides new evidence linking discrimination in healthcare settings to disparities in healthcare access among urban Indigenous people, reinforcing existing recommendations regarding Indigenous cultural safety training for healthcare providers. Our study further demonstrates Our Health Counts methodologies, which employ robust community partnerships and RDS to address gaps in health information for urban Indigenous populations.

BackgroundThe paper focuses on the geographical region of Oceania. We highlight the tobacco control leadership demonstrated in this region and describe the challenges and opportunities to achieving country-specific smoke-free goals.ResultsSignificant achievements include smoke-free nation goals, world-leading initiatives such as plain packaging, and a bold plan by New Zealand to reduce the retail availability of smoked tobacco products and remove virtually all the nicotine from cigarettes and rolling tobacco. There are significant challenges and opportunities before reaching smoke-free status including implementation pathways requiring strong governance and leadership and compliance monitoring and enforcement.ConclusionsWe conclude that achieving a smoke-free Oceania is possible through already existing bold country and regional smoke-free goals, excellent tobacco control leadership, experience and resources, and an understanding of how to work collectively. However, a commitment to focus tobacco control efforts regionally is required to achieve a smoke-free Oceania together.

Studies have highlighted the inequities between the Indigenous and non-Indigenous populations with respect to the burden of cardiovascular disease and prevalence of predisposing risks resulting from historical and ongoing impacts of colonization. The objective of this study was to investigate factors associated with cardiovascular disease (CVD) within and specific to the Indigenous peoples living in Toronto, Ontario, and to evaluate the reliability and validity of the resulting model in a similar population.The Our Health Counts Toronto study measured the baseline health of Indigenous community members living in Toronto, Canada, using respondent-driven sampling. An iterative approach, valuing information from the literature, clinical insight and Indigenous lived experiences, as well as statistical measures was used to evaluate candidate predictors of CVD (self-reported experience of discrimination, ethnic identity, health conditions, income, education, age, gender and body size) prior to multivariable modelling. The resulting model was then validated using a distinct, geographically similar sample of Indigenous people living in Hamilton, Ontario, Canada.The multivariable model of risk factors associated with prevalent CVD included age, diabetes, hypertension, body mass index and exposure to discrimination. The combined presence of diabetes and hypertension was associated with a greater risk of CVD relative to those with either condition and was the strongest predictor of CVD. Those who reported previous experiences of discrimination were also more likely to have CVD. Further study is needed to determine the effect of body size on risk of CVD in the urban Indigenous population. The final model had good discriminative ability and adequate calibration when applied to the Hamilton sample.Our modelling identified hypertension, diabetes and exposure to discrimination as factors associated with cardiovascular disease. Discrimination is a modifiable exposure that must be addressed to improve cardiovascular health among Indigenous populations.RéSUMé: OBJECTIF: Des études ont souligné les iniquités entre les populations autochtones et non autochtones en ce qui a trait au fardeau des maladies cardiovasculaires et à la prévalence des risques prédisposants qui résultent des impacts historiques et continus de la colonisation. Nous avons voulu étudier les facteurs associés aux maladies cardiovasculaires (MCV) au sein des populations autochtones vivant à Toronto (Ontario) et spécifiques à ces populations, puis évaluer la fiabilité et la validité du modèle ainsi obtenu dans une population semblable. MéTHODE: L’étude Our Health Counts Toronto a mesuré l’état de santé de départ de membres de communautés autochtones vivant à Toronto, au Canada, à l’aide d’un échantillonnage en fonction des répondants. Une approche itérative, valorisant à la fois les données d’études scientifiques, l’expérience clinique, le vécu de personnes autochtones et les mesures statistiques, a été employée pour évaluer les candidats prédicteurs des MCV (expérience autodéclarée de discrimination, identité ethnique, affections médicales, revenu, instruction, âge, genre et taille) avant la modélisation multivariée. Le modèle ainsi obtenu a ensuite été validé à l’aide d’un échantillon distinct, mais géographiquement similaire, de personnes autochtones vivant à Hamilton (Ontario), au Canada. RéSULTATS: Le modèle multivarié des facteurs de risque associés aux MCV prévalentes incluait l’âge, le diabète, l’hypertension artérielle, l’indice de masse corporelle et l’exposition à la discrimination. La présence combinée du diabète et de l’hypertension artérielle était associée à un risque accru de MCV comparativement à l’une ou l’autre de ces deux affections médicales; c’était aussi la plus forte variable prédictive des MCV. Les personnes ayant déclaré des expériences passées de discrimination étaient aussi plus susceptibles d’être atteintes de MCV. D’autres études sont nécessaires pour déterminer l’effet de la taille sur le risque de MCV dans la population autochtone urbaine. Le modèle final avait un bon pouvoir discriminant et une calibration adéquate lorsqu’il a été appliqué à l’échantillon de Hamilton. CONCLUSION: Notre modélisation a cerné l’hypertension artérielle, le diabète et l’exposition à la discrimination comme facteurs associés aux maladies cardiovasculaires. La discrimination est un risque modifiable qui doit être abordé pour améliorer la santé cardiovasculaire au sein des populations autochtones.

Background COVID-19 is the fifth and most significant infectious disease epidemic this century. Primary health care providers, which include those working in primary care and public health roles, have critical responsibilities in the management of health emergencies. Objective To synthesize accounts of primary care lessons learnt from past epidemics and their relevance to COVID-19. Methods We conducted a review of lessons learnt from previous infectious disease epidemics for primary care, and their relevance to COVID-19. We searched PubMed/MEDLINE, PROQUEST and Google Scholar, hand-searched reference lists of included studies, and included research identified through professional contacts. Results Of 173 publications identified, 31 publications describing experiences of four epidemics in 11 countries were included. Synthesis of findings identified six key lessons: (i) improve collaboration, communication and integration between public health and primary care; (ii) strengthen the primary health care system; (iii) provide consistent, coordinated and reliable information emanating from a trusted source; (iv) define the role of primary care during pandemics; (v) protect the primary care workforce and the community and (vi) evaluate the effectiveness of interventions. Conclusions Evidence highlights distinct challenges to integrating and supporting primary care in response to infectious disease epidemics that have persisted over time, emerging again during COVID-19. These insights provide an opportunity for strengthening, and improved preparedness, that cannot be ignored in a world where the frequency, virility and global reach of infectious disease outbreaks are increasing. It is not too soon to plan for the next pandemic, which may already be on the horizon., Infectious disease epidemics are increasing in frequency and spread. Primary health care providers are at the forefront of community health care, and have an important role in managing health emergencies such as infectious disease epidemics. It is important to use lessons learnt from past epidemics to inform current health system responses. We examined evidence from past epidemics and identified six key lessons that have emerged in 11 countries during four previous epidemics and again during the COVID-19 pandemic. These lessons highlight the importance of integrating pandemic responses across health care disciplines, strengthening the primary health care system, defining the role of primary care during epidemics, protecting the health care workforce and the community, providing clear and consistent information and evaluating the effectiveness of health care responses. Health system weaknesses are exposed to health emergencies. Identification of these recurring lessons for primary health care provides an opportunity to definitively prepare for future infectious disease epidemics.