International evidence increasingly supports integrating smoking cessation services within lung cancer screening programs, yet limited guidance exists for Aotearoa New Zealand, where smoking-related harm and lung cancer disproportionately affect Māori. In this commentary, we summarise literature on smoking cessation interventions delivered alongside lung screening, focusing on intervention modality, intensity, timing and equity implications relevant to a future national program. Evidence from 25 studies and four systematic reviews showed wide variation in reported outcomes, including complete cessation of nicotine use (quitting) and switching from tobacco to less harmful products (switching), reflecting heterogeneity in intervention design and outcome measurement. Overall, intensive, multi-session behavioural support combined with pharmacotherapy achieved higher quit rates than brief advice or single-session interventions, particularly when cessation support was delivered immediately or co-located with screening. Equity considerations were central to the interpretation of the international findings in our review. Māori face structural, systemic and access barriers that limit the effectiveness of standard cessation approaches, highlighting the need for culturally safe, whānau (family)-centred and Māori-led interventions. Integrating intensive smoking cessation support into the lung screening pathway represents a critical opportunity to reduce inequities and improve outcomes for Māori within a future national lung screening program.

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:Lung cancer is the number one cause of cancer death worldwide, including in Australia, where more than 15,000 cases were diagnosed in 2024. The Australian National Lung Cancer Screening Programme commenced in July 2025. Unique barriers to participation in existing cancer screening programmes exist for culturally and linguistically diverse (CALD) communities. Little Australian research has engaged these communities to gauge their acceptability and readiness for the implementation of lung cancer screening (LCS). The aims were to identify barriers and enablers to LCS implementation and determine views about LCS acceptability and feasibility. METHODS:Community-based participatory research principles were used to collaboratively engage CALD stakeholders. The research team worked with highly experienced programme managers, multicultural health workers and bilingual facilitators/translators ('leaders') who provide support and education to Arabic-speaking/Lebanese, Macedonian, Vietnamese and Italian communities. Leaders used culturally appropriate methods to recruit participants and deliver focus groups. Verbatim transcripts were analysed using a coding framework based on the Health Equity Implementation Framework. RESULTS:Seven focus groups were conducted either face to face (n = 5) or online (n = 2) with 57 participants across New South Wales, Australia. Six groups were delivered in community languages. LCS was generally perceived as acceptable across all focus groups. Key enablers towards engagement were understanding the importance of screening for early detection, provision of interpreters and easily accessible locations. Key barriers were financial and language barriers, poor experiences with other cancer screening programmes, concerns about tobacco-related eligibility criteria and cancer-related stigma. CONCLUSIONS:This qualitative study provides crucial foundational evidence from four culturally diverse Australian communities about barriers and enablers to inform Programme implementation. The findings are highly relevant to other jurisdictions that may be preparing for LCS implementation or need to modify programmes to engage culturally diverse populations to screen. PATIENT OR PUBLIC CONTRIBUTION:Members of the public were directly involved as participants in this research. Multicultural health workers and bilingual facilitators/interpreters who work with CALD communities were involved in all phases of the study design and implementation, including recruitment, development of semi-structured focus group guide, focus group facilitation and reviewing the manuscript.

INTRODUCTION:Lung cancer stigma is widespread, with consequences for patients psychologically and clinically. It can also be a barrier to lung cancer screening (LCS), though current evidence is limited. With LCS programs in development globally, this qualitative study explored the views, expectations, and potential impacts of stigma with people eligible for LCS before commencement of the Australian National LCS Program. METHODS:Participants met eligibility criteria for the Australian National LCS Program (asymptomatic of lung cancer; aged 50-70 years; currently smoking tobacco cigarettes or quit within 10 years; ≥30 pack-year smoking history). Abductive thematic analysis was used. Interview questions and theory-based codes were guided by the Health Stigma and Discrimination Framework. RESULTS:Twenty-four participants were interviewed; 50% (n = 12) were currently smoking and 25% (n = 6) were from culturally or linguistically diverse backgrounds. Most participants had high levels of education, high self-reported health literacy and lived in major cities. Four themes were identified: (1) Harmful narratives of personal responsibility and self-infliction; (2) Smoking stigma is a "necessary evil" and is inevitable in LCS; (3) Identity as part of the LCS cohort; (4) Previous perceptions of stigma in healthcare shape expectations for LCS. CONCLUSION:Stigma in LCS - to some degree - is unavoidable given smoking-based eligibility criteria but may be reduced through: (1) messaging that dismantles industry-driven narratives around responsibility, blame and choice in tobacco use (e.g., by referencing external determinants of smoking behavior); (2) privacy and confidentiality of LCS participation; (3) communication training for LCS staff. Further work in priority communities considering intersectional stigmas is needed.

Introduction The rapid expansion of zero alcohol products (ZAP) and associated marketing is of increasing public health interest. Investigating marketing approaches can provide insights to inform policy responses to this emerging issue.Methods We conducted a content analysis of marketing campaigns by alcohol-branded ZAPs in Australia and Aotearoa New Zealand (NZ). We used publicly available information to systematically: (i) identify alcohol-branded ZAPs available in each country; (ii) collect information about marketing campaigns for each product; (iii) collect marketing assets; and (iv) identify campaign marketing strategies. The coding frame incorporated a combination of deductive (based on existing literature) and inductive codes.Results We identified 13 alcohol-branded ZAPs in Australia and six in NZ that were promoted in 20 and 10 marketing campaigns, respectively, between 2018 and 2024. Mateship/friendship was the most common strategy, present in 80% of campaigns. Almost two-thirds of all campaigns (63%) promoted the product in the context of new drinking occasions (e.g., at the gym, while driving). Benefits of ZAP use included providing choice of a viable alcohol alternative (73% of campaigns), taste (47%), fitness/health (27%) and productivity (23%).Discussion and Conclusions This study provides evidence from Australia and NZ of alcohol-branded ZAP marketing campaigns promoting novel drinking occasions, adding to concerns raised by public health professionals. Stronger community protections for alcohol marketing, including marketing of ZAPs that share branding with alcoholic products, are warranted. Established alcohol brands appear to be using ZAP marketing campaigns to also promote alcohol branding in new drinking contexts.

ABSTRACT Introduction Organised lung cancer screening (LCS) programs are being developed worldwide in response to recent landmark trial evidence. Targeting high‐risk individuals primarily based on smoking history, LCS faces challenges from smoking‐related stigma, which can cause psychological harm and hinder participation. With limited interventions addressing this issue, this study aimed to co‐design a communication‐based strategy to reduce stigma in the LCS context. Methods Using best‐practice co‐design principles, this study involved workshops, focus groups, and interviews with 5 consumers (people eligible for LCS in Australia) and 44 health professionals and other experts (including clinicians, radiographers, behavioural scientists, and health managers). Participants were purposively sampled to achieve representation across key variables – e.g., smoking history for consumers, professional roles for experts. Consultation with experts was conducted as part of a larger project developing a suite of information materials for the National Lung Cancer Screening Program in Australia. Key literature and concurrent qualitative research with consumers (n = 24) also informed co‐design. Qualitative data were analysed using abductive thematic analysis. Results Early consultation identified the preferred format for the strategy as a resource targeted for health professionals involved in the LCS pathway. Resource content was iteratively revised, with three key themes developed: (1) Taking the onus off the individual; (2) Fostering understanding and empathy; (3) Positive framing. A lexicon guide promoting person‐first and empowerment language was also included guided by previous literature. The final resource was a four‐page A4 document for health professionals and LCS staff, designed to support effective, stigma‐sensitive communication during LCS. Conclusion We co‐designed a practical, scalable resource to reduce stigma for use in the Australian National Lung Cancer Screening Program, expected to ultimately reduce psychological harm for LCS participants and enhance screening participation. Future research should evaluate the resource as an implementation strategy for LCS uptake. Cultural adaptation and tailoring of the resource for specific populations considering intersectional stigmas is also needed. Patient or Public Contribution We collaborated with a consumer advisor for the project's duration, including study design, co‐facilitation of consumer workshops, analysis and manuscript writing.

Introduction: Exposure to alcohol advertising is a key influence on adolescent alcohol consumption. Zero-alcohol drinks (<0.5% alcohol by volume) resemble and often share brands with alcoholic drinks, so may function as surrogate alcohol marketing. We examined whether exposure to zero-alcohol advertising was associated with adolescents’ attitudes and consumption intentions toward alcohol. Methods: N=382 Australians aged 15 to 17 years completed an online survey where they viewed zero-alcohol advertisements from four parent alcohol brands and reported past exposure and liking of each advertisement, attitudes and consumption intentions toward alcohol products from the parent brand, general attitudes and consumption intentions toward alcohol, self-reported location-based exposure to zero-alcohol advertising, prior consumption of alcohol and zero-alcohol, and demographics. Associations between exposure and liking, attitudes, and consumption intentions were examined using linear mixed effect models and linear regression. Results: In unadjusted models, attitudes toward and intentions to consume alcohol from the parent brand were associated with advertisment exposure (attitudes: B=0.55, p<0.001; intentions: B=0.37, p<0.001) and liking (attitudes: B=1.45, p<0.001; intentions: B=0.70, p<0.001). Adjusting for prior zero-alcohol and alcohol consumption, gender, and parent presence during survey completion, associations with liking remained significant (attitudes: B=1.42, p<0.001; intentions: B=0.66, p<0.001). No associations were found between self-reported location-based exposure to zero-alcohol advertising and general attitudes and consumption intentions toward alcohol. Discussion and Conclusions: Findings that adolescents who see and like zero-alcohol advertisements have more favourable attitudes toward and stronger intentions to consume parent alcohol brands suggest these advertisements serve as surrogate marketing and should be included within alcohol advertising regulations.

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.

The National Lung Cancer Screening Program is commencing in Australia in July 2025. This significant public health initiative will maximise earlier detection of lung cancer and improve outcomes for many Australians. However, the adoption of a screening program for a disease that is stigmatised, given the known links between tobacco smoking and lung cancer, creates barriers for participation. In this perspective, we argue the need to challenge public rhetoric around smoking being a 'choice' and the importance of dialogue that is free of judgement and blame towards individuals. We briefly examine initiatives that have been implemented to reduce public stigma and highlight the multi-level considerations to ensure that everyone, regardless of having smoked or not, receives the quality care and support that they deserve.

BACKGROUND:Zero-alcohol drinks (<0.5 % alcohol by volume) appear and taste like alcoholic drinks; they may feature brands from alcoholic drinks ("brand extensions") or "new-to-world" brands. These drinks are not consistently included within many restrictions aimed at reducing adolescents' exposure to alcohol products and advertising. This online study examined whether adolescents implicitly categorise images of zero-alcohol drinks as alcoholic beverages. METHODS:331 Australian adolescents aged 15-17 years participated in an online within-subjects reaction time experiment. Participants viewed 20 randomly-ordered images of alcohol, zero-alcohol, and soft drink products and were asked to indicate as quickly as possible whether these images made them think of alcohol, with both response time and agreement recorded. Generalised linear mixed effects models were used to examine differences in response time and agreement by drink type, adjusting for clustering of responses within participants, recent consumption, survey device (mobile/computer), and parental presence. RESULTS:Most images of alcoholic (94.4 %), brand extension zero-alcohol (90.7 %), and "new-to-world" zero-alcohol (85.6 %) drinks prompted participants to think of alcohol, compared to 5.2 % of soft drinks. In the mixed effects model, compared to alcoholic drinks, participants on average responded 72 ms slower to brand extension zero-alcohol drinks and 215 ms slower to "new-to-world" brand zero-alcohol drinks. CONCLUSIONS:The combination of high levels of agreement and slower reaction times suggest that adolescents categorise zero-alcohol drinks as non-typical alcoholic drinks, rather than soft drinks. Thus, exposure to zero-alcohol drinks had similar effects to exposure to alcoholic drinks. Urgent regulatory action is required to ensure that restrictions on alcohol advertising and availability to minors extend to zero-alcohol drinks.

OBJECTIVE:Zero-alcohol beverages containing 0.0-0.5% alcohol by volume may offer public health benefits if individuals use them to substitute for alcohol-containing products, thereby reducing alcohol use. There are, however, concerns that zero-alcohol beverages may encourage adolescents' earlier interest in alcohol and increase exposure to alcohol company branding. As this poses a challenge for parents, we studied parents' views on zero-alcohol beverages and their provision to adolescents. METHODS:We interviewed n=38 parents of 12-17-year-olds and used reflexive thematic analysis to interpret interview data. RESULTS:Parents considered zero-alcohol beverages to be 'adult beverages' that potentially supported reduced adult drinking but were unnecessary for adolescents. Parents were concerned that adolescent zero-alcohol beverage use could normalise alcohol consumption and be a precursor to alcohol initiation. There was a potential conflict between moderate provision in 'appropriate' contexts, and potential benefits, which were each supported by some parents. Uncertainty on health qualities was also reported. CONCLUSIONS:Parents reported conflicting and cautious views on zero-alcohol beverage provision to adolescents. IMPLICATIONS FOR PUBLIC HEALTH:As evidence on the impacts of zero-alcohol beverage availability develops, parent-targeted messages highlighting the potential risk of normalisation of alcohol use for young people could be developed, in conjunction with broader policy responses.

Introduction Lung cancer screening (LCS) trials, targeting people with a smoking history, have demonstrated reduced mortality. How to optimally embed evidence-based smoking cessation support in LCS, including in Australia, needs to be better understood. We sought experts' perspectives to identify potential barriers and effective implementation strategies.Aims and Methods Perceptions of providing smoking cessation support in LCS were elicited in 24 focus groups and three individual interviews with clinicians, cancer screening program managers/policymakers, and researchers during 2021. We conducted framework analysis and mapped key topics to the updated Consolidated Framework for Implementation Research (CFIR).Results Experts (N = 84 participants) strongly supported capitalizing on an "opportune time" for smoking cessation and new LCS participant contact opportunities throughout the screening and assessment pathway. Many advocated for adapting existing cessation resources to the LCS setting and providing support without participant costs. Experts generally considered referral alone to established programs (eg, telephone Quitline) as insufficient, but likely helpful in follow-up, and dedicated cessation specialist roles as essential. Broader cessation messaging (via mass media/community channels) was also suggested to reinforce individualized support. Experts described inherent alignment, and an ethical responsibility, to deliver smoking cessation as a core LCS component. It was suggested that LCS-eligible participants' varied experiences of stigma, health literacy, and motivation, be considered in cessation support. Primary care support and individualized interventions were suggested to facilitate implementation.Conclusions Experts considered smoking cessation support essential in LCS. The expert-identified and multi-level implementation strategies described here can directly inform smoking cessation-specific planning for Australia's forthcoming National LCS Program.Implications The international literature includes few examples considering how best to provide smoking cessation support within a LCS program in advance of program commencement. Our analysis, using the updated CFIR, is one of the first to explore experts' perspectives within this context. Experts identified multiple implementation barriers to providing smoking cessation support within and outside of an Australian LCS program, including key work infrastructure barriers, and advocated for providing tailored interventions within this program. Our foundational work in a new targeted screening program's preimplementation phase will allow international comparisons to be made.

BACKGROUND:Many individuals with lung cancer and chronic obstructive pulmonary disease (COPD) experience high levels of stigma, which is associated with psychological distress and delayed help-seeking. PURPOSE:To identify interventions aimed at reducing the stigma of lung cancer or COPD and to synthesize evidence on their efficacy. METHODS:A systematic review was conducted by searching PubMed, Scopus, PsycINFO, and CINAHL for relevant records until March 1, 2024. Studies were eligible if they described an intervention designed to reduce internalized or external stigma associated with COPD or lung cancer and excluded if they did not report empirical findings. RESULTS:We identified 476 papers, 11 of which were eligible for inclusion. Interventions included educational materials, guided behavior change programs, and psychotherapeutic approaches. Interventions targeted people diagnosed with, or at high risk of developing COPD or lung cancer or clinical staff. No interventions that aimed to reduce stigma associated with lung cancer or COPD in the general community were identified. Most interventions yielded a statistically significant reduction in at least one measure of stigma or a decrease in qualitatively reported stigma. CONCLUSIONS:The emerging literature on interventions to reduce stigma associated with lung cancer and COPD suggests that such interventions can reduce internalized stigma, but larger evaluations using randomized controlled trials are needed. Most studies were in the pilot stage and required further evaluation. Research is needed on campaigns and interventions to reduce stigma at the societal level to reduce exposure to external stigma amongst those with COPD and lung cancer.

IntroductionDespite vulnerability to alcohol-related harms, women have historically been under-represented in alcohol research. This study examined the prevalence and characteristics of women who drink at very high-risk levels (11+ standard drinks monthly), factors associated with this consumption and comparisons with men.MethodsSecondary analyses of 2019 National Drug Strategy Household Survey data were undertaken. Significant differences by sex in the distribution of demographic and alcohol-related variables were explored using chi-squared and Mann-Whitney U tests. Binary logistic regression examined factors associated with very high-risk drinking.ResultsVery high-risk drinking was reported by 10.4% of men and 3.1% of women. Compared to men, women were significantly younger with higher levels of psychological distress/mental health conditions, and were more likely to be unmarried. Both women and men engaged in a range of harm-minimisation strategies. Odds of very high-risk drinking were significantly higher for respondents who were male, younger, employed, lived in a regional/rural/remote area, psychologically distressed, smoked and used illicit drugs. Interactions with sex indicated that very high-risk drinking declined after the age of 24 for men compared to 44 for women. Being married reduced the likelihood of very high-risk drinking more greatly among women compared to men, while living in a major city reduced the likelihood among men (and not women).Discussion and ConclusionsVery high-risk drinking is not limited to Australian men, and the women who drink at these levels have distinct profiles and factors associated with consumption.

Parental supply of alcohol to adolescents is associated with increased risk of subsequent adolescent alcohol use and harms, so identifying factors associated with parents' decision-making is critical. This study examined how parental supply is associated with attitudes toward adolescent alcohol use, perceived norms of parental supply, perceived behavioural control and perceived acceptable age to drink alcohol. A total of 1197 Australian parents with children aged 12-17 years completed an online cross-sectional survey assessing their parental supply behaviours, attitudes and perceptions in April 2022. Logistic regression was used to explore associations between attitudes, perceptions and parental supply of alcohol to their child. Forty-three percent of respondents nominated an acceptable age to drink a full drink of alcohol below 18 years, and 23% reported supplying a full drink of alcohol to their adolescent. Parents were more likely to report supplying a full drink of alcohol if they nominated an acceptable drinking age below 18 years (<16: adjusted odds ratio [AOR] = 14.75, 95% confidence interval [CI] = 8.23-26.42; 16-17: AOR = 5.68, 95% CI = 3.69-8.73), appraised alcohol as more beneficial (AOR = 1.31, 95% CI = 1.02-1.69) and less harmful (AOR = 0.49, 95% CI = 0.36-0.68) for adolescents, and perceived that parent friends (AOR = 2.91, 95% CI = 1.80-4.70) and other parents (AOR = 2.23, 95% CI = 1.37-3.62) supplied alcohol in unsupervised contexts. Perceived behavioural control was not associated with parental supply. These findings suggest there may be value in trialling interventions that target parents' perceptions about the acceptable age to drink a full drink of alcohol, attitudes toward adolescent alcohol consumption, and perceived norms of parental supply to influence parents' supply intentions.