Objective Tobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities. Data sources Guided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched. Study selection Two reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation. Data extraction We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Data synthesis Eight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26); product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1); moving consumers to reduced risk products (n=8); tobacco-free generation (n=4); ending sales (n=2); sinking lid (n=2); tax increases (n=7); and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised. Conclusions VLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Mobile health (mHealth) apps have potential to increase smoking cessation but little research has been conducted with Aboriginal communities in Australia. Objective: We conducted a pilot study to assess the feasibility, acceptability and explore the effectiveness of a novel mHealth application to assist Aboriginal people to quit smoking. Methods: Design: A single-blinded, pilot, randomised, controlled trial (RCT) and a process evaluation comprising usage analytics data and in-depth interviews Setting and participants: Aboriginal current smokers (aged >16 years willing to make a quit attempt in the next month) recruited from Aboriginal Community Controlled Health Services and a government telephone coaching service in New South Wales Intervention: A multifaceted Android or iOS app comprising a personalised profile and quit plan, text and in app motivational messages, and a challenge feature allowing users to ‘compete’ with others vs usual cessation support services Outcomes: Self-reported continuous smoking abstinence, verified by carbon monoxide breath testing at 6 months. Secondary outcomes included point prevalence of abstinence and use of smoking cessation therapies and services. Results: A total of 49 participants were recruited for the pilot RCT. Competing service delivery priorities, the lack of resources for research and lack of support for randomisation to a control group were the major recruitment barriers. At baseline, 47% of participants had tried to quit in recent weeks with very few having accessed support services, medication or nicotine replacement therapy. At 6 months follow-up only one participant (intervention arm) was abstinent. There were however, non-significant increases in smoking cessation medication/ nicotine replacement use in the intervention arm (18% intervention vs 9% control) and use of cessation support services (41% intervention vs 28% control). The process evaluation highlighted low to moderate app usage (3-10 new users/ month and 4–8 returning users/month), an average of 2.9 sessions/user/month and 6.3 minutes per session. Key themes from interviews with intervention participants (n=15) included: (1) the powerful influence of prevailing social norms around acceptability of smoking; (2) high usage of mobile devices for phone, text and social media but very low use of other smartphone apps; (3) the role of family and social group support in supporting quit attempts; and (4) low awareness and utilisation of smoking cessation support services. Despite broad acceptability of the app, participants also recommended technical improvements to improve functionality, greater customisation of text messages, integration with existing social media platforms and gamification features. Conclusions: Smoking cessation apps need to be integrated with commonly used functions of mobile phones and draw on social networks to support their use. Although they have potential to increase utilisation of cessation support services and treatments, more research is needed to identify optimal implementation models. Robust evaluation is critical to determine their impact, however, an RCT design is unlikely to be feasible in this setting and alternative approaches are recommended. Clinical Trial: ACTRN12616001550493

Objective: To examine trends in Northern Territory Indigenous mortality from chronic diseases other than cancer. Design: A comparison of trends in rates of mortality from six chronic diseases (ischae...

Tobacco smoking is a leading cause of disease and premature mortality among Aboriginal and Torres Strait Islander (Indigenous) Australians. While the daily smoking prevalence among Indigenous Australians has declined significantly from 49% in 2001, it remains about three times higher than that of non-Indigenous Australians (39 and 14%, respectively, for age ≥15 years in 2014–15). This overview of systematic reviews aimed to synthesise evidence about reducing tobacco consumption among Indigenous peoples using a comprehensive framework for Indigenous tobacco control in Australia comprised of the National Tobacco Strategy (NTS) and National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) principles and priorities. MEDLINE, EMBASE, systematic review and Indigenous health databases were searched (2000 to Jan 2016) for reviews examining the effects of tobacco control interventions among Indigenous peoples. Two reviewers independently screened reviews, extracted data, and assessed review quality using Assessing the Methodological Quality of Systematic Reviews. Data were synthesised narratively by framework domain. Reporting followed the PRISMA statement. Twenty-one reviews of varying quality were included. There was generally limited Indigenous-specific evidence of effective interventions for reducing smoking; however, many reviewers recommended multifaceted interventions which incorporate Indigenous leadership, partnership and engagement and cultural tailoring. Under the NTS priority areas, reviewers reported evidence for brief smoking cessation interventions and pharmacological support, mass media campaigns (on knowledge and attitudes) and reducing affordability and regulation of tobacco sales. Aspects of intervention implementation related to the NATSIHP domains were less well described and evidence was limited; however, reviewers suggested that cultural tailoring, holistic approaches and building workforce capacity were important strategies to address barriers. There was limited evidence regarding social media and mobile applications, for Indigenous youth, pregnant women and prisoners, and no evidence regarding interventions to protect communities from industry interference, the use of electronic cigarettes, interventions for people experiencing mental illness, juvenile justice, linguistic diversity or ‘pubs, clubs and restaurants’. There is limited Indigenous-specific evidence for most tobacco interventions. A ‘comprehensive approach’ incorporating NTS and NATSIHP Principles and Priorities of partnership and engagement, evidence from other settings, programme logic and responsive evaluation plans may improve intervention acceptability, effectiveness and implementation and mitigate risks of adapting tobacco evidence for Indigenous Australians.

Adult smoking has its roots in adolescence. If individuals do not initiate smoking during this period it is unlikely they ever will. In high income countries, smoking rates among Indigenous youth are disproportionately high. However, despite a wealth of literature in other populations, there is less evidence on the determinants of smoking initiation among Indigenous youth. The aim of this study was to explore the determinants of smoking among Australian Indigenous young people with a particular emphasis on the social and cultural processes that underlie tobacco use patterns among this group.