Background Nicotine vaping products (NVPs) remain prevalent among Australian adolescents and young adults (AYAs), despite increasing evidence of associated health risks and evolving regulatory restrictions. While some youth acknowledge potential harms, many continue vaping, raising questions about the role of uncertainty tolerance in sustaining use. This study aimed to examine how AYAs perceive vaping-related health risks, experience uncertainty, and tolerate known and perceived harms. Methods Seven online semi-structured focus groups were conducted with 27 AYAs aged 16-26 in South Australia. Participants included people who vaped, who smoked tobacco, those who did both, and those who neither vaped nor smoked. Discussions examined perceptions of vaping-related health risks, exposure to public health messaging, and tolerance of uncertainty and views on health risks. Transcript data were analyzed using descriptive content analysis. Findings Participants rarely considered health risks unless prompted and described vaping as normalized and socially embedded, with high product accessibility a concern. Participants discounted prevention messaging, citing low personal relevance and limited credibility. Many framed health harms as distant or hypothetical, enabling continued use. Uncertainty about long-term consequences was not only tolerated but often used to justify risk-taking. Conclusions Australian AYAs navigate vaping by rationalizing and deferring engagement with risk. Uncertainty tolerance played a role in continued vaping, particularly in the absence of visible harms. Prevention strategies should address this tolerance directly and leverage social and peer-based messaging to counteract normalization. Findings highlighted the need for tailored messaging interventions designed to disrupt vaping risk minimization.

BACKGROUND:Although evidence-based smoking cessation interventions are widely recommended in lung cancer screening programs, real-world implementation remains poorly understood. METHODS:This scoping review aimed to identify and characterize smoking cessation interventions implemented in lung cancer screening programs, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Eligible sources described real-world (nontrial) lung cancer screening programs from 2013 onward. We searched 6 databases in February 2025 and multiple grey literature sources and categorized implementation data by RE-AIM domains in narrative form. RESULTS:Of 55 unique studies, most were from the United States (84%), described a wide range of behavioral support (96%) and/or pharmacological (58%) interventions, and focused primarily on individual-level outcomes across RE-AIM domains. Reflecting strong Reach, most cessation interventions offered were generally acceptable to lung cancer screening participants and providers. Opt-out referral to embedded programs showed consistently high uptake. More intensive (eg, group/multicomponent) interventions had evidence of relatively high cessation (ie, Effectiveness) outcomes. Implementation most often involved delivery of low-intensity behavioral interventions. Program-level implementation factors under the Adoption (eg, provider readiness to adopt: 7%), Implementation (time and cost: 5%), and Maintenance (sustained intervention delivery: 4%) domains were rarely reported. CONCLUSIONS:Future real-world studies should generate and comprehensively report implementation data across key domains, particularly program-level conditions that support sustainable, long-term integration of cessation into lung cancer screening. This is critical given that many lung cancer screening programs globally still have not implemented formal cessation supports. Strengthening the evidence base will inform scalable, context-specific approaches and maximize reach across the diverse populations and settings of jurisdictions implementing lung cancer screening.

Introduction Mailed smoking and vaping cessation support provided through the Which Way? Quit Pack programme has demonstrated acceptability and preliminary effectiveness in delivering culturally grounded support. However, there is no evidence of the effectiveness of mailed cessation programmes for Aboriginal and Torres Strait Islander people when implemented on a national scale. Building on previous work, this study aims to evaluate both the implementation effectiveness and cost-effectiveness analysis of the Which Way? Quit Pack mailed smoking and vaping cessation intervention for Aboriginal and Torres Strait Islander people. Methods and analysis A national single-group hybrid type 2 effectiveness-implementation study with 2000 Aboriginal and/or Torres Strait Islander people who use cigarettes and/or e-cigarettes (vapes) daily, want to quit and are aged ≥18 years. Participants will receive access to a culturally tailored mailed quit pack that includes up to a 12-week supply of nicotine replacement therapy, phone-based behavioural counselling and access to an online support forum. Cessation outcomes including 7-day point prevalence abstinence, prolonged abstinence and quit rates will be evaluated at 3, 6 and 12 months. An intention-to-treat approach will be used for cessation outcomes, with participants lost to follow-up classified as smokers or vapers. Exploratory logistic regression analyses will examine factors associated with quitting, and causal machine learning methods will be used to explore variation in intervention effectiveness across participant subgroups. The Reach-Effectiveness-Adoption-Implementation-Maintenance framework will guide evaluation of implementation and effectiveness outcomes. Analysis measures include cessation and quit attempt rates, number of participants recruited, representativeness and intervention uptake. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) will guide the cost-effectiveness analysis. Ethics and dissemination This study is governed by Aboriginal and Torres Strait Islander leadership and community-controlled partnerships and is conducted in line with Indigenous data sovereignty and Indigenous research ethics principles. The study has also received approval from the following human research ethics committees: Aboriginal Health & Medical Research Council of NSW (2493/25), Aboriginal Health Committee South Australia (04-25-1209), the Western Australian Aboriginal Health (HREC1474), the Victorian Aboriginal Community Controlled Health Organisation (2025/HREC0061) and the University of Newcastle Human Research (H-2025-0311). Findings will be disseminated in forms determined, governed and endorsed by Aboriginal and Torres Strait Islander people and communities through the project Governance, including peer-reviewed publications, policy briefs, community-led knowledge translation activities and presentations at local, national and international conferences. Trial registration number ACTRN12626000459325.

IntroductionTobacco endgame strategy includes policies to end the tobacco epidemic. As tobacco smoking prevalence is higher among people with mental health conditions (MHC), understanding the impact of rigorous tobacco control strategies for this group is critical. This study examined support for five tobacco control strategies among people with MHCs: increasing tobacco product tax, reducing tobacco retail locations, ending tobacco sales in alcohol-licensed venues, limiting retailers to one tobacco point of sale and reduced nicotine in smoked tobacco.MethodsCross-sectional surveying of a representative sample of 3006 South Australians in 2021 aged ≥15 years included demographic, tobacco control strategy, smoking status and mental health indicators. Multivariable logistic regression was used to examine the influence of mental health on strategy support.ResultsSupport was high for all tobacco control strategies, highest for reducing nicotine content (80.4%) and lowest for increasing tobacco tax (67.2%). Support for increased tobacco tax was lower among people with MHCs than for those without by 7.8% (aged 18+ years) to 9.5% (aged 15+ years). People who smoked had significantly lower support for all strategies, and smoking status and MHC did not interact in influencing support.ConclusionsSupport for tax-focused strategies was lower among people with MHCs. Retail and product-focused strategies may support equity in public acceptability of tobacco control action. Policy-makers must aim to maximise tobacco endgame support from populations most impacted by tobacco harms when implementing tobacco control strategies. Tax-focused approaches might be enhanced with consultation and advocacy for people with MHCs.

Background: Out-of-pocket healthcare expenditure (OOPHE) drives health inequities for Australian First Nations Peoples, particularly in rural and remote areas. While financial barriers are well documented, less is known about the cultural, social and emotional consequences of travelling away from Country for healthcare. Methods: Aboriginal yarning methodologies informed by Knowledge-Interface approaches were used across eleven yarning sessions with 22 Aboriginal participants living on Kokatha, Mirning and Wirangu Country in the Far West of South Australia. Data were analysed thematically through deep listening and iterative coding, guided by Aboriginal researchers and an Aboriginal Governance Group. Findings were presented through three consolidated stories to maintain relational meaning, cultural integrity, and participant voices. Results: Participant stories revealed how repeated travel for healthcare creates cumulative financial, cultural, and emotional consequences. Leaving Country disrupted kinship networks, reduced cultural safety, and exposed participants to unfamiliar and culturally unsafe environments, contributing to distress and erosion of identity during periods of vulnerability. For many, these impacts led to delayed, rationed, or forgone care. Discussion: This study extends existing OOPHE literature by foregrounding cultural disconnection as a central mechanism shaping healthcare access. These impacts are fundamental, shaping decisions about when, how and if care is sought, contributing to ongoing inequities and extended periods off Country. Conclusion: Travelling for healthcare is not simply a logistical or financial challenge but a deeply personal and culturally disruptive experience. Addressing OOPHE requires system-level reform that prioritises culturally safe and locally delivered care and supports on Country.

INTRODUCTION:To compare the characteristics of people who vape, smoke commercial tobacco, or engage in dual use among a cohort of Aboriginal and Torres Strait Islander people participating in the Which Way? Quit Pack study. METHODS:An online cross-sectional survey was conducted with Aboriginal and Torres Strait Islander people who: were aged 16 and above; resided in New South Wales, Victoria, and the Australian Capital Territory; smoked commercial tobacco and/or vaped; and wanted to quit. Data were collected from 2 October 2023 to 9 August 2024. Self-reported sociodemographic characteristics and cessation experiences were assessed, and differences were examined based on whether participants used commercial tobacco only, vaping only, or both. RESULTS:A total of 880 participants completed the survey and were included for analysis. Participants predominantly smoked commercial tobacco only (n=614; 69.8%), followed by dual-use (n=170; 19.3%) and vaping only (n=96; 10.9%). Participants < 25 years were significantly more likely to engage in vaping and dual-use compared with all other age groups. Participants living in outer regional and remote areas were less likely to report dual-use (95% CI: 0.32, 1.00; p=0.049) and less likely to use vapes (95% CI: 0.11, 0.56; p<0.001) than those in major cities. Women were more likely to use vapes than men (95% CI: 1.46, 5.90; p=0.002). Regardless of use type, participants reported interest in cessation medications. CONCLUSION:This study highlights important differences in smoking and vaping behaviours among Aboriginal and Torres Strait Islander people seeking to quit warranting further investment and research. Tailored cessation support that reflects the diverse experiences and needs of Aboriginal and Torres Strait Islander peoples, particularly in relation to age, gender, and geographic location is needed.

Uptake of lung cancer screening (LCS) in high-risk populations remains suboptimal internationally. Primary care practitioners play a critical role in identifying eligible patients and initiating referrals for LCS. Targeted implementation strategies are needed to address health care barriers to the uptake of LCS such as limited awareness, eligibility assessment, low engagement, and poor health system preparedness. Implementation trials are needed to determine optimal decision-making and participant knowledge gains to ultimately increase screening uptake. The Ready to Screen trial is a cluster randomized controlled implementation trial to compare participants’ intention to screen for lung cancer in the Australian National Lung Cancer Screening Program (hereafter ‘the Program’) between bundled (intervention: core + link to multilingual trial website + SMS and email reminders, clinical decision support prompts for general practitioners) and core (control (core): initial letter mail out with LCS brochure only) implementation strategies. Twenty-eight general practices recruited across Australia will be randomly allocated (1:1 ratio) to either control or intervention. Practices will generate eligible patient lists using medical records to issue participation invitations. Eligible patients are aged 50–70 years and currently smoke or have quit within the past 10 years or have an unknown quit date. The primary outcome is participant intention to screen from self-report survey at patient recruitment. Secondary outcomes will be evaluated using the RE-AIM framework—examining Reach, Effectiveness (including cost-effectiveness), Adoption, Implementation and Maintenance. The PRISM framework will guide assessment of multi-level contextual factors hypothesized to influence these outcomes. Data collection will include trial recruitment and practice records, participant and provider self-report surveys, and semi-structured interviews. This trial will generate timely evidence about the effectiveness and cost-effectiveness of the bundled implementation strategy to support delivery of the Program within primary care practices. Findings will provide insights into contextual factors shaping implementation success and inform the future scaling and sustainability of LCS in Australia and internationally. ACTRN12625000045415 registered on 20/01/2025.

Healthcare costs not subsidized by the government and are covered by patients, are known as out-of-pocket healthcare expenditure (OOPHE). In Australia, OOPHE disproportionately impacts Aboriginal households, particularly in rural and remote regions. Currently no patient reported measures (PRM) to assess OOPHE exist, despite being an identified priority in Aboriginal communities. This study developed and psychometrically evaluated (validity and test-retest reliability) of an OOPHE PRM for Aboriginal households in outer regional to remote areas. This Aboriginal led study was governed by an Aboriginal Governance Group, which involved a 4-stage process: (i) identification of community-derived OOPHE themes; (ii) item development and expert judgment quantification; (iii) exploratory factor analysis (EFA) to determine factor structure through pilot testing with Aboriginal participants; and (iv) assessment of reliability and stability through test-retest methods. Stage 1 identified OOPHE themes (i.e. barriers, financial strain), informing development of a 15 item PRM in Stage 2. In Stage 3, 39 Aboriginal participants completed Test 1, with EFA revealing a two-factor model; Factor 1 (8 items, internal consistency = 0.91) and Factor 2 (6 items, internal consistency = 0.85). In Stage 4, 32 participants completed Test 2, with over 60% of items showing substantial to perfect agreement (κ = 0.61-0.87) and scale-level reliability as good to excellent (ICC = 0.75-0.92). Two items performed poorly and were removed, resulting in a final 13-item PRM. The OOPHE PRM demonstrates promising psychometric properties as a culturally grounded measure of OOPHE burden among Aboriginal families, supporting advocacy for equitable policy, funding, and health system reform.

BackgroundDigital health innovations are frequently used to support people in managing chronic health conditions. Stroke is common, and people who have survived a stroke and live in the community must learn to manage their health independently. Digital tools can help, but only if designed to match survivors’ specific needs. In response to a need expressed by people living with chronic health conditions, the Australian government created a funding stream to support the development of a digital resource to help individuals gain confidence in managing their health. ObjectiveThis study aimed to co-design a digital resource to promote self-efficacy to manage life after stroke in community-dwelling survivors of stroke. MethodsCo-design methodology, which emphasized meaningful engagement with intended end-users throughout the design of the website, was used. The project steering group comprised health professional researchers, digital designers, people with lived experience of stroke (survivors and carers), and representatives from the Stroke Foundation (Australia). A systematic review was conducted to inform the core components of the resource. A lived experience workgroup was convened to advise on features of the digital resource and aspects of its evaluation. Iterative review stages and frequent consultation between the steering group and the lived experience workgroup occurred. Online and in-person usability testing was conducted with survivors and carers. ResultsThe lived experience workgroup (workgroup) initially comprised 14 survivors and 1 carer. In total, 11 survivors and 1 carer remained engaged throughout the co-design period. One workgroup member was invited to join the steering group and co-facilitated all co-design workgroup meetings. Defining features of the digital resource were identified by the steering group and the workgroup, including that the resource would be a website that augmented (not reproduced) existing resources, and it needed to be accessible to survivors of stroke with communication changes. Website specifications were determined by the workgroup and included that information needed to be tailored to the individual user, and specific accessibility features were recommended. The workgroup prioritized what content to include on the website and recommended the creation of video stories by Australian survivors and carers. A resource-tailoring tool was created so information could be individualized to the interests of the website user. Overall, 9 web pages containing high-priority content were created, comprising text, video stories, and a downloadable PDF that summarized key information for that page. More than 150 short video stories were created by 26 survivors of stroke and 10 carers for the website. Usability testing indicated that the website was more usable than 83% of all websites. ConclusionsAuthentic co-design with inclusion of people with lived experience of stroke at all stages of development enabled the successful build of a digital resource (website) to improve self-efficacy. An evaluation of the website is underway. Trial RegistrationAustralia New Zealand Clinical Trials Registry ACTRN12624001018505; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=388255

Objective: A novel quitline intervention (counseling plus provision of alternative forms of nicotine) was developed for people using a smoke-free, alcohol and other drug (AOD) withdrawal service. The objectives were: to code the intervention manual for behavior change techniques (BCTs) and to evaluate bespoke training, delivery of counseling provided (quality, number of BCTs) and acceptability. Methods: The manual was coded for 29 BCTs. Training outcomes were measured by counselor self-reported confidence. Delivery of counseling was analyzed by independent rating of the quality (maximum 100, all components delivered) and number of BCTs used in all recorded calls (n = 71) for randomly selected clients (n = 30). Acceptability was measured by uptake, clients' acceptability item ratings (n = 37) and recall of counseling content (n = 38) at six weeks post-baseline. Results: Coding of the manual identified 25/29 BCTs. Counselor (n = 10) self-reported confidence increased posttraining (p = 0.03). High quality calls were delivered with a mean rating of 82.0 (SD13.16) and a mean of 8.50 (SD3.10) BCTs delivered per call. The BCTs assessment, pharmacological support and advising distraction were used frequently. Acceptability of counseling was good, with high uptake (77%; 68/88 clients contacted), counselors were rated as supportive (92%; 34/37), the majority of clients felt encouraged (87%; 32/37) and recalled counseling content for pharmacotherapy (79%; 30/38) and how to manage cravings (76%, 29/38). Conclusion: A novel quitline intervention for residents of smoke-free, AOD withdrawal unit was delivered with high quality, had high acceptability, offered continuity of care pre- to post-discharge and facilitated tobacco cessation. Content of skills training to manage cravings, commenced in residence, was recalled by recipients postdischarge to sustain tobacco abstinence.

INTRODUCTION:Aboriginal and Torres Strait Islander people report disproportionately high rates of tobacco use, driven by the tobacco industry and sustained through coloniality. A gap remains regarding the effectiveness of culturally tailored, community-led cessation strategies. METHODS:A pre-post hybrid type 1 effectiveness-implementation trial was conducted across NSW, ACT, and Victoria, Australia. Eligible participants identified as Aboriginal and/or Torres Strait Islander, current daily smokers aged ≥16 years and willing to quit in the next 30 days. Participants received the Quit Pack intervention, consisting of mailed cessation resources, free combination nicotine replacement therapy (NRT), and behavioral support. Surveys were completed at baseline, 3 months, and 6 months. Data were collected between October 2023 and February 2025. Intention-to-treat (ITT) and complete case (CC) analyzes were conducted. RESULTS:A total of 722 participants were included. At 6-months follow-up, 16% reported 7-day PPA in the ITT analysis (39% CC). At 3-months follow-up, 23% reported 7-day PPA (ITT; 44% CC). At 6-months, continuous abstinence was reported by 11% of participants (30% CC), and 30% of participants reported making a quit attempt lasting at least 24 hours (97% CC). Almost all participants (97.5%) requested NRT at baseline, and 96% reported using NRT at 3 months. Intervention acceptability was high; 88% rated receiving free NRT and having it mailed home as very important. CONCLUSIONS:This Indigenous-led cessation trial, the largest conducted in Australia to date, demonstrates the acceptability and potential effectiveness of culturally responsive mailed cessation support incorporating combination NRT. Findings support national expansion of the intervention. IMPLICATIONS:Urgent investment in cessation supports are required to address the significant burden of disease caused by tobacco on the health of Aboriginal and Torres Strait Islander people. Quit Pack shows promise as both an acceptable and effective smoking cessation intervention for Aboriginal and Torres Strait Islander people in New South Wales, Victoria and the Australian Capital Territory. The program has potential to scale up country-wide with appropriate funding and partnerships with diverse Aboriginal and Torres Strait Islander communities.

RATIONALE:Tobacco smoking is a leading preventable cause of premature morbidity and mortality in people living with severe mental illness. Smoking rates are disproportionately high and abstinence rates low in people with severe mental illness, despite their reported interest in quitting being comparable to that of the general population. Inpatient psychiatry settings have been identified as opportune places to promote and support tobacco cessation amongst people with severe mental illness who smoke, particularly since many hospitals have implemented smoke-free policies. Evidence is needed to guide policy and practice for tobacco cessation interventions within inpatient psychiatry settings. OBJECTIVES:To assess the effects of smoking cessation interventions on tobacco smoking in adults receiving inpatient psychiatry treatment. SEARCH METHODS:We searched the following bibliographical databases and clinical trial registers from inception until 10 February 2026: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase (Elsevier), PubMed, PsycINFO (EBSCOhost), CINAHL Complete (EBSCOhost), ProQuest Dissertations and Theses Global, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also handsearched the annual meeting abstracts for the Society for Research on Nicotine and Tobacco (SRNT) and screened reference lists of eligible studies. ELIGIBILITY CRITERIA:We included randomised controlled trials (RCTs) and cluster-RCTs that assessed interventions for tobacco cessation amongst people of 18 years and older who were inpatients in psychiatry settings. Interventions had to be initiated in the psychiatry inpatient setting and aimed at supporting smoking cessation. OUTCOMES:Our critical outcome was smoking abstinence at six months (biochemically verified) and our important outcomes included serious adverse events. RISK OF BIAS:We used the Cochrane risk of bias tool (RoB 2) to assess the outcomes of our review. SYNTHESIS METHODS:We synthesised results using meta-analysis where appropriate, calculating risk ratios using the inverse-variance random-effects model. Where this was not possible, we synthesised results following Synthesis Without Meta-analysis (SWiM) guidelines. We used GRADE to assess our level of certainty in the evidence for our two key outcomes. INCLUDED STUDIES:We included 10 studies that involved 2262 people in total. Three trials were conducted in the USA, two in Australia, two in Taiwan, two in Iran, and one in Israel. The studies took place in emergency or acute and long-stay psychiatric settings. In most studies, the participants had a mix of diagnoses (e.g. mood disorders, anxiety disorders, schizophrenia), and three studies involved only participants with schizophrenia or schizophrenia-type disorders. Five studies tested smoking cessation counselling plus nicotine replacement therapy with post-discharge follow-up support versus usual care; one study tested a group behavioural programme for smoking reduction versus waitlist control; and four studies tested pharmacotherapy interventions including smoking medications (bupropion versus placebo, cytisine versus nicotine replacement therapy) and nicotine replacement therapy (different types and doses). SYNTHESIS OF RESULTS:We found low-certainty evidence of increased smoking abstinence from interventions that provided counselling with nicotine replacement therapy and post-discharge support, compared to usual care, when measured six months after the start of the intervention or hospital discharge (RR 1.81, 95% CI 1.33 to 2.47; P < 0.001, I2 = 0%; 5 studies, 1611 participants; low-certainty evidence). Across studies, serious adverse events (SAEs) were low. We pooled four studies reporting deaths at 6 to 18 months after the start of the intervention or hospital discharge. We found that the intervention of smoking cessation counselling plus nicotine replacement therapy with post-discharge support may result in a slight reduction in deaths compared to usual care, but the results are very uncertain due to low event numbers (22), considerable imprecision, and some concerns about risk of bias (RR 0.81, 95% CI 0.34 to 1.96; P = 0.50, I2 = 0%; 4 studies, 1431 participants; very low certainty evidence). AUTHORS' CONCLUSIONS:People receiving inpatient psychiatry treatment may be more likely to have successfully stopped smoking six months after the inpatient intervention when offered smoking cessation counselling plus nicotine replacement therapy with continued post-discharge support, compared with usual care, but the certainty of the evidence is low. There was insufficient evidence to determine the effectiveness of other smoking cessation interventions initiated in the psychiatry inpatient setting. More randomised controlled trials, especially those evaluating pharmacological interventions, are needed to strengthen conclusions about treatment effects. FUNDING:This Cochrane review had no dedicated funding. REGISTRATION:Protocol (2024) DOI: 10.1002/14651858.CD015934.

ABSTRACT Background Targeted lung cancer screening (LCS) presents unique opportunities for smoking cessation among high‐risk individuals. Implementation requires consideration of context‐specific determinants. We sought perspectives from tobacco control/smoking cessation experts on optimally implementing smoking cessation interventions in an Australian LCS program. Methods Recruitment was via maximum variation and snowball sampling in 2022. Individual/pair interviews explored factors that may influence acceptability and feasibility, potential delivery models, and implementation strategies. We interpreted interview data using codebook thematic analysis, then mapped key topics against the Consolidated Framework for Implementation Research and previous LCS expert‐identified determinants. Results Expert participants' (N = 30) roles included program/policy managers, researchers and clinicians, working in academia, not‐for‐profits/peak bodies and health departments. They emphasised the benefits of integrating smoking cessation interventions into routine LCS encounters. Key barriers included perceived professional and LCS participant reluctance, stigma, and rural access. Experts discouraged duplicating current cessation resources, and suggested prioritising implementation efforts. Flexible delivery models, addressing needs of priority populations (e.g., rural/remote, culturally and linguistically diverse), were recommended. Experts generally favoured a ‘hybrid’ intervention pathway, combining internal and external cessation services, to maximise feasibility and uptake. Training program staff on cessation intervention delivery and leadership buy‐in were emphasised as essential requirements. Discussion In this Australian tobacco control expert sample, there was near‐unanimous support for embedding cessation interventions within routine LCS delivery and capitalising on opportunities to overcome current service delivery barriers. In conjunction with LCS participant perspectives, findings are relevant to planning and implementing cessation interventions in LCS contexts.

Background There is limited evidence of high-quality, accessible, culturally safe, and effective digital health interventions for Indigenous mothers and babies. Like any other intervention, the feasibility and efficacy of digital health interventions depend on how well they are co-designed with Indigenous communities and their adaptability to intracultural diversity. Objective This study aims to adapt an existing co-designed mobile health (mHealth) intervention app with health professionals and Aboriginal and/or Torres Strait Islander mothers living in South Australia. Methods Potential participants include Aboriginal and/or Torres Strait Islander pregnant women and mothers of children aged 0-5 years, non-Aboriginal and/or Torres Strait Islander women who are mothers of Aboriginal and/or Torres Strait Islander babies, and health professionals who predominantly care for Aboriginal and/or Torres Strait Islander mothers and babies. Participants will be recruited from multiple Aboriginal and/or Torres Strait Islander–specific health services under the local health networks around metropolitan South Australia. In this study, data collection will be carried out via culturally safe, and family-friendly yarning circles, facilitated by Aboriginal research staff to collect feedback on the existing mHealth app from approximately 20 women and 10 health professionals, with the aim to achieve data saturation. This will inform the changes required to the mHealth app. All focus groups and interviews will be audio recorded and transcribed verbatim. Data will be inductively analyzed using realist epistemology via NVivo software (Lumivero). Themes about the mHealth app’s cultural acceptability, usability, and appropriateness will be used to inform the changes applied to the app. Results With the feedback received from participating women and health professionals, changes in the smartphone app will be made to ensure the intervention is supportive and meets the needs of Aboriginal and/or Torres Strait Islander mothers and families in South Australia. Participation of community members will promote ownership, community engagement, and implementation. Conclusions A co-designed, culturally sensitive, and effective digital health intervention is likely to support Indigenous mothers and their children facing health disparities due to the disruption of Indigenous culture by colaying a foundation for a potential clinical trial and wider implementation. International Registered Report Identifier (IRRID) PRR1-10.2196/53748

AIM:To test the effectiveness of an organisational change intervention aimed at increasing the offer of nicotine replacement therapy (NRT) in community managed mental health organisations. DESIGN:A pragmatic cluster randomised controlled trial with cluster as the unit of randomisation and six- and nine-month follow-up from baseline. SETTING:Twelve clusters comprising 26 sites providing community based, psychosocial support to people with severe mental illness in New South Wales, Australia, were randomised to control (n = 13 sites, n = 118 consumers) or intervention (n = 13 sites, n = 139 consumers) arms between 2018 and 2019. PARTICIPANTS:Eligible consumers (aged 16 years and older; self-reported daily or occasional cigarette use) completed surveys at baseline (n = 257) and at six- (n = 162, 63%) and nine-month follow-up (n = 144, 56%). INTERVENTION:The intervention included a financial grant, face-to-face and on-line training and proactive monthly support to guide implementation. The active control condition included on-line training and generic, scheduled support via email. MEASUREMENTS:The primary outcome was whether consumers reported receiving an offer of NRT at nine-month follow-up. Secondary outcomes at the consumer, staff and organisational level were also measured. FINDINGS:Consumers in the intervention group had statistically significantly higher odds of being offered NRT at nine-month follow-up compared with control (intention to treat missing = no offer: 38% versus 7%, odds ratio 5.72, 95% confidence interval = 2.2, 14.9). There were no statistically significant differences in seven-day point prevalence or continuous abstinence at six- or nine-month follow-ups. CONCLUSIONS:An organisational change-based program led to an increase in the offer of nicotine replacement therapy (NRT) nine months after program initiation in community managed mental health organisations, compared with active control. There was evidence of greater NRT use in the intervention condition at nine months but no evidence of differences on abstinence measures at six or nine months.

INTRODUCTION:High postpartum smoking relapse rates indicate opportunities to address nicotine dependence. Data on postpartum vaping is scarce. This study explored postpartum women's perspectives on support for quitting or preventing relapse to smoking and vaping. METHODS:Postpartum women who smoked or quit during pregnancy completed brief telephone interviews at two-, four-, six- and twelve-months postpartum (May 2023-December 2024). Interviews included the question: In the ideal world, what support would you need to help you stop smoking or vaping or stay quit? Inductive content analysis was conducted. Responses were examined by timepoint and by four smoking/vaping status groups (quit nicotine products during pregnancy [QPreg]; quit postpartum [QPP]; never quit [NQ]; relapsed postpartum [R]) was explored. RESULTS:Of 832 invited, 770 (93%) consented, 566 (74%) completed at least one interview. The proportion in each group were consistent across timepoints: QPreg (21-23%; n=53-111), QPP (9-11%; n=25-47), NQ (56-57%; n=140-284), and R (10-14%; n=34-57). Also consistent across time were smoking prevalence (59-61%), vaping prevalence (7-8%) and dual use with combustible tobacco (7-9%). Six main categories: I don't know/nothing; Health professional support; Physical health; Mental-emotional health; Social-environmental health; Public health, and 22 generic categories were interpreted. Coding patterns were generally consistent across timepoints, with some subgroup differences: R participants more often referenced Regulation and policy (Public health); NQ and R groups responses cited Stress; QPreg and QPP groups' highlighted Babies and children as motivators; NQ participants more often mentioned NRT/medication and Nothing. Low vaping prevalence and lack of distinction in responses limited conclusions about vaping-specific support. CONCLUSIONS:This study highlights the diverse and evolving support preferences of postpartum women across smoking and vaping trajectories. Women identified interventions addressing stress, mental health, and regulatory environments and supporting parenting motivations as being helpful. Findings underscore the importance of nuanced, subgroup-specific strategies to sustain nicotine cessation postpartum.