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Eating disorders have the highest mortality rate of any psychiatric condition. Since the COVID-19 pandemic, the number of patients who have required medical stabilisation on paediatric wards has increased significantly. Likewise, the number of patients who have required medical stabilisation against their will as a lifesaving intervention has increased. This paper highlights a fictional case study aiming to explore the legal, ethical and practical considerations a trainee should be aware of. By the end of this article, readers will be more aware of this complex issue and how it might be managed, as well as the impact it can have on the patient, their family and ward staff.

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

Background While having the largest population of smokers in the world, China is among countries with the lowest percentage of male smokers who have an intention to quit. Smoking rationalization is negatively associated with quit intention in developed countries. Our previous study has showed smoking rationalization is common among Chinese male smokers and some beliefs of smoking rationalization seem to be peculiar to China. Whether the association is generalizable to Chinese smokers remains unknown. This study aims to examine the association between smoking rationalization and quit intention among a sample of male Chinese smokers. Methods A cross-sectional survey was conducted among male smokers in China in 2013. Smoking rationalization was assessed through a newly developed Chinese rationalizations scale (including 26 items under six subscales, smoking functional beliefs, risk generalization beliefs, social acceptability beliefs, safe smoking beliefs, self-exempting beliefs and quitting is harmful beliefs). Items in the scale were rated on a 5-likert scale (1 = totally disagree to 5 = totally agree). Multivariable logistic regression was performed to examine the relationship between rationalization and intention to quit, adjusted for sociodemographic variables and smoking-related variables. Results A total of 3710 participants were included in the analyses. Smoking rationalization was prevalent (mean score 3.32). With 1 point increase in total rationalization scale, the odds for smokers intention to quit in the next 6 months decreased 48% (OR=0.52, 95%CI: 0.44-0.61; p< 0.001). Separate logistic regressions for six subscale of rationalization showed consistent associations with intention to quit (all p-values < 0.001). Particularly the “social acceptability beliefs” was the strongest predictor (OR=0.62, 95%CI: 0.55-0.71; p< 0.001). Conclusions Smoking rationalization beliefs could be important barriers for male Chinese smokers to develop quit intention. Some beliefs have stronger association with quit intention than others. Tackling rationalization beliefs endorsed by smokers is a potential strategy for smoking cessation intervention.

Anti-wind farm activists repeatedly claim that families said to be adversely affected by noise from wind turbines "abandon" their homes. In Australia, a claim of "more than 40 families" has been made by a prominent anti-wind farm activist. Six sources (parliamentary submissions, media reports, an anti-wind farm website, wind industry sources, correspondence with known anti-wind farm activists and with three politicians opposed to wind farms) were used to find evidence of home "abandonments." Claims about 12 Australian households permanently (n = 10) or periodically (n = 2) leaving their homes were found. However, no house appears to have been permanently "abandoned" without sale, as the expression implies. These 12 cases need contextualizing against considerations that several of those involved were either dedicated activists against wind farms from times sometimes pre-dating their construction, were engaged in protracted negotiations for home purchase with wind companies, had pre-existing health problems, grievances with the wind company over employment or had left the area for unrelated reasons of employment elsewhere. The statement that "more than 40" houses have been "abandoned" because of wind turbines in Australia is a factoid promoted by wind farm opponents for dramatic, rhetorical impact. Other considerations are often involved in abandonment unrelated to the claims made about wind farm noise.

Abstract Objective : In recent years, claims have proliferated in cyberspace that wind turbines cause a large variety of symptoms and diseases. One of these, “vibroacoustic disease” (VAD) is frequently mentioned. The aim of this study is to examine the quality of the evidence on how VAD came to be associated with wind turbine exposure by wind farm opponents. Methods: Searches of the web (Google advanced) and major research databases for papers on VAD and wind turbines. Self‐citation analysis of research papers on VAD. Results: Google returned 24,700 hits for VAD and wind turbines. Thirty‐five research papers on VAD were found, none reporting any association between VAD and wind turbines. Of the 35 papers, 34 had a first author from a single Portuguese research group. Seventy‐four per cent of citations to these papers were self‐citations by the group. Median self‐citation rates in science are around 7%. Two unpublished case reports presented at conferences were found asserting that VAD was “irrefutably demonstrated” to be caused by wind turbines. The quality of these reports was abject. Conclusions: VAD has received virtually no scientific recognition beyond the group who coined and promoted the concept. There is no evidence of even rudimentary quality that vibroacoustic disease is associated with or caused by wind turbines. Implications: The claim that wind turbines cause VAD is a factoid that has gone ‘viral’ in cyberspace and may be contributing to nocebo effects among those living near turbines.

Abstract Objective: To describe television news coverage between 2005 and 2010 of alcohol, health and relevant alcohol‐control policies, with a view to informing policy advocacy. Methods: A content analysis of all alcohol stories archived by the Australian Health News Research Collaboration. We recorded what triggered a news item, the main topics covered, whether risks to health were communicated, whether alcohol‐control policies were featured and which news‐actors appeared. Results: We identified 612 stories, where 69.2% were triggered by a particular newsworthy incident or the release of new findings. The most frequently reported alcohol stories were focused on associated harms (30.2%) and ‘binge drinking’ (19.0%). A majority (75.3%) reported a variety of positive and negative health effects, yet mainly focused on short‐term consequences. Combined, 63% mentioned an alcohol‐control policy, yet no one particular policy was featured in more than 10% of all stories. The most commonly featured news‐actors included public‐health professionals (50.0%), members of affected communities (28.4%) and government representatives (24.3%) Conclusions: Problems related to alcohol were well‐established foci of news attention and reportage and covered a broad spectrum of issues related to public health goals, yet less coverage centred on long‐term health consequences or effective policy solutions. Implications: Future policy advocacy could focus on moving the debate away from simple problem definition to better communication of long‐term health risks, existing policies, and evidence of their effectiveness and arguments for their adoption. Future research might consider audience understanding of the information.

Abstract Objective: To determine the growth patterns and citation volume of research publications referring to Indigenous health in Australia from 1972 to 2008 compared to seven selected health fields. Methods: Web of Science was used to identify all publications (n=820) referring to the health of Indigenous Australians authored by Australian researchers, 1972 to 2008. Citations for each publication were also captured. Growth was compared with selected health fields as well as with overall Australian research publications. Results: Research publications referring to Indigenous health, while remaining relatively small in number, grew at an average annual rate of 14.1%, compared with 8.2% across all fields of Australian research. The growth rate shown was equal second highest in our seven categories of health and medical research. However, Indigenous publications were cited significantly less than the Australian average. Conclusions: While there has been positive growth in publications referring to Indigenous health, the attention paid to this research through citations remains disappointingly low. Implications: Given that research concentration and impact can be an index of how seriously a nation considers a health problem, the low visibility of Australian research examining Indigenous health does not demonstrate a level of concern commensurate with the gravity of Indigenous health problems. Further investigation for the reasons for lower citations may identify potential intervention strategies.

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

BACKGROUND: Although China ratified the WHO Framework Convention on Tobacco Control [FCTC] in 2005, the partial ban on tobacco advertising does not cover the internet. Weibo is one of the most important social media channels in China, using a format similar to its global counterpart, Twitter. The Weibo homepage is a platform to present products, brands and corporate culture. There is great potential for the tobacco industry to exploit Weibo to promote products. METHODS: Seven tobacco industry Weibo accounts that each had more than 5000 fans were selected to examine the content of Weibos established by tobacco companies or their advertising agents. RESULTS: Of the 12073 posts found on the seven accounts, 92.3% (11143) could be classified into six main themes: traditional culture, popular culture, social and business affairs, advertisement, public relations and tobacco culture. Posts under the theme of popular culture accounted for about half of total posts (49%), followed by 'advertisement' and 'tobacco culture' (both at 12%), 'traditional culture' and 'public relations' (both at 11%), and finally 'social and business affairs' (5%). 33% of posts included the words 'cigarette' or 'smoking' and 53% of posts included the tobacco brand name, indicating that tobacco companies carefully construct the topic and content of posts. CONCLUSIONS: Weibo is an important new online marketing tool for the Chinese tobacco industry. Tobacco industry use of Weibo to promote brands and normalize smoking subverts China's ratification of the WHO FCTC. Policy to control tobacco promotion needs reforming to address this widespread circumvention of China's tobacco advertising ban.

Background and objectivesWith often florid allegations about health problems arising from wind turbine exposure now widespread, nocebo effects potentially confound any future investigation of turbine health impact. Historical audits of health complaints are therefore important. We test 4 hypotheses relevant to psychogenic explanations of the variable timing and distribution of health and noise complaints about wind farms in Australia.SettingAll Australian wind farms (51 with 1634 turbines) operating 1993-2012.MethodsRecords of complaints about noise or health from residents living near 51 Australian wind farms were obtained from all wind farm companies, and corroborated with complaints in submissions to 3 government public enquiries and news media records and court affidavits. These are expressed as proportions of estimated populations residing within 5 km of wind farms.ResultsThere are large historical and geographical variations in wind farm complaints. 33/51 (64.7%) of Australian wind farms including 18/34 (52.9%) with turbine size >1 MW have never been subject to noise or health complaints. These 33 farms have an estimated 21,633 residents within 5 km and have operated complaint-free for a cumulative 267 years. Western Australia and Tasmania have seen no complaints. 129 individuals across Australia (1 in 254 residents) appear to have ever complained, with 94 (73%) being residents near 6 wind farms targeted by anti wind farm groups. The large majority 116/129(90%) of complainants made their first complaint after 2009 when anti wind farm groups began to add health concerns to their wider opposition. In the preceding years, health or noise complaints were rare despite large and small-turbine wind farms having operated for many years.ConclusionsThe reported historical and geographical variations in complaints are consistent with psychogenic hypotheses that expressed health problems are "communicated diseases" with nocebo effects likely to play an important role in the aetiology of complaints.

INTRODUCTION: Policies affecting alcohol's price and promotion are effective measures to reduce harms. Yet policies targeting populations are unpopular with the public, whose views can be influenced by news framings of policy narratives. In Australia, alcohol taxation receives high news coverage, while advertising restrictions have not until recently, and narratives are highly contested for each. However, research specifically examining how audiences respond to such news stories is scant. We sought to explore audience understanding of news reports about two alcohol policy proposals. METHOD: From June to August 2012, 46 participants were recruited for 8 focus groups in age-brackets of young people aged 18-25 years, parents of young people, and adults aged 25 or older. Groups were split by education. Participants were asked their prior knowledge of alcohol policies, before watching and discussing four news stories about alcohol taxation and advertising. RESULTS: Participants were clear that alcohol poses problems, yet thought policy solutions were ineffective in a drinking culture they viewed as unamenable to change and unaffected by alcohol's price or promotion. Without knowledge of its actual effect on consumption, they cited the 2008 alcopops tax as a policy failure, blaming cheaper substitution. Participants had low knowledge of advertising restrictions, yet were concerned about underage exposure. They offered conditional support for restrictions, while doubting its effectiveness. There was marked distrust of statistics and news actors in broadcasts, yet discussions matched previous research findings. CONCLUSIONS: News coverage has resulted in strong audience understanding of alcohol related problems but framed solutions have not always provided clear messages, despite audience support for policies. Future advocacy will need to continue recent moves to address the links between alcohol's price and promotion with the drinking culture, as well as facilitate understandings of how this culture is amenable to change through the use of evidence-based policies.

BACKGROUND TO THE DEBATE:Tobacco continues to kill millions of people around the world each year and its use is increasing in some countries, which makes the need for new, creative, and radical efforts to achieve the tobacco control endgame vitally important. One such effort is discussed in this PLOS Medicine Debate, where Simon Chapman presents his proposal for a "smoker's license" and Jeff Collin argues against. Chapman sets out a case for introducing a smart card license for smokers designed to limit access to tobacco products and encourage cessation. Key elements of the smoker's license include smokers setting daily limits, financial incentives for permanent license surrender, and a test of health risk knowledge for commencing smokers. Collin argues against the proposal, saying that it would shift focus away from the real vector of the epidemic--the tobacco industry--and that by focusing on individuals it would censure victims, increase stigmatization of smokers, and marginalize the poor.

This paper reports data from semi-structured interviews on how 26 Australian civil servants, ministers and ministerial advisors find and evaluate researchers with whom they wish to consult or collaborate. Policymakers valued researchers who had credibility across the three attributes seen as contributing to trustworthiness: competence (an exemplary academic reputation complemented by pragmatism, understanding of government processes, and effective collaboration and communication skills); integrity (independence, "authenticity", and faithful reporting of research); and benevolence (commitment to the policy reform agenda). The emphases given to these assessment criteria appeared to be shaped in part by policymakers' roles and the type and phase of policy development in which they were engaged. Policymakers are encouraged to reassess their methods for engaging researchers and to maximise information flow and support in these relationships. Researchers who wish to influence policy are advised to develop relationships across the policy community, but also to engage in other complementary strategies for promoting research-informed policy, including the strategic use of mass media.

Doubt about the relevance, appropriateness and transparency of peer review has promoted the use of citation metrics as a viable adjunct or alternative in the assessment of research impact. It is also commonly acknowledged that research metrics will not replace peer review unless they are shown to correspond with the assessment of peers. This paper evaluates the relationship between researchers' influence as evaluated by their peers and various citation metrics representing different aspects of research output in 6 fields of public health in Australia. For four fields, the results showed a modest positive correlation between different research metrics and peer assessments of research influence. However, for two fields, tobacco and injury, negative or no correlations were found. This suggests a peer understanding of research influence within these fields differed from visibility in the mainstream, peer-reviewed scientific literature. This research therefore recommends the use of both peer review and metrics in a combined approach in assessing research influence. Future research evaluation frameworks intent on incorporating metrics should first analyse each field closely to determine what measures of research influence are valued highly by members of that research community. This will aid the development of comprehensive and relevant frameworks with which to fairly and transparently distribute research funds or approve promotion applications.

BackgroundIn high-income nations mainstream television news remains an important source of information about both general health issues and low- and middle-income countries (LMICs). However, research on news coverage of health in LMICs is scarce.Principal findingsThe present paper examines the general features of Australian television coverage of LMIC health issues, testing the hypotheses that this coverage conforms to the general patterns of foreign news reporting in high-income countries and, in particular, that LMIC health coverage will largely reflect Australian interests. We analysed relevant items from May 2005 - December 2009 from the largest health-related television dataset of its kind, classifying each story on the basis of the region(s) it covered, principal content relating to health in LMICs and the presence of an Australian reference point. LMICs that are culturally proximate and politically significant to Australia had higher levels of reportage than more distant and unengaged nations. Items concerning communicable diseases, injury and aspects of child health generally consonant with 'disease, disaster and despair' news frames predominated, with relatively little emphasis given to chronic diseases which are increasingly prevalent in many LMICs. Forty-two percent of LMIC stories had explicit Australian content, such as imported medical expertise or health risk to Australians in LMICs.SignificanceMedia consumers' perceptions of disease burdens in LMICs and of these nations' capacity to identify and manage their own health priorities may be distorted by the major news emphasis on exotic disease, disaster and despair stories. Such perceptions may inhibit the development of appropriate policy emphases in high-income countries. In this context, non-government organisations concerned with international development may find it more difficult to strike a balance between crises and enduring issues in their health programming and fundraising efforts.

Background to the debateThe tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus) is less hazardous to health than smoking tobacco. Proponents of "harm reduction" point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the benefits of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden's experience is likely to be specific to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a "gateway" to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control) have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction.

The global Framework Convention on Tobacco Control (FCTC) requires nations to ban all tobacco advertising and promotion. In the face of these restrictions, tobacco packaging has become the key promotional vehicle for the tobacco industry to interest smokers and potential smokers in tobacco products. This paper reviews available research into the likely impact of mandatory plain packaging and internal tobacco industry statements about the importance of packs as promotional vehicles. It critiques legal objections raised by the industry about plain packaging violating laws and international trade agreements, showing these to be without foundation. Plain packaging of all tobacco products would remove a key remaining means for the industry to promote its products to billions of the world’s smokers and future smokers. Governments have appropriated large surface areas of tobacco packs for health warnings without legal impediment or need to compensate tobacco companies. Requiring plain packaging is consistent with the intention to ban all tobacco promotions. There is no impediment in the FCTC to interpreting tobacco advertising and promotion to include tobacco packs.