Justine Daly

A randomised controlled trial of proactive telephone counselling on cold-called smokers' cessation rates

Objectives Active telephone recruitment (‘cold calling’) can enrol almost 45 times more smokers to cessation services than media. However, the effectiveness of proactive telephone counselling with cold-called smokers from the broader community is unknown. This study examined whether proactive telephone counselling improved abstinence, quit attempts and reduced cigarette consumption among cold-called smokers. Methods From 48 014 randomly selected electronic telephone directory numbers, 3008 eligible smokers were identified and 1562 (51.9%) smokers recruited into the randomised controlled trial. Of these, 769 smokers were randomly allocated to proactive telephone counselling and 793 to the control (ie, mailed self-help) conditions. Six counselling calls were offered to intervention smokers willing to quit within a month and four to those not ready to quit. The 4-month, 7-month and 13-month follow-up interviews were completed by 1369 (87.6%), 1278 (81.8%) and 1245 (79.9%) participants, respectively. Results Proactive telephone counselling participants were significantly more likely than controls to achieve 7-day point prevalence abstinence at 4 months (13.8% vs 9.6%, p=0.005) and 7 months (14.3% vs 11.0%, p=0.02) but not at 13 months. There was a significant impact of telephone counselling on prolonged abstinence at 4 months (3.4% vs 1.8%, p=0.02) and at 7 months (2.2% vs 0.9%, p=0.02). At 4 months post recruitment, telephone counselling participants were significantly more likely than controls to have made a quit attempt (48.6% vs 42.9%, p=0.01) and reduced cigarette consumption (16.9% vs 9.0%, p=0.0002). Conclusions Proactive telephone counselling initially increased abstinence and quitting behaviours among cold-called smokers. Given its superior reach, quitlines should consider active telephone recruitment, provided relapse can be reduced. Trial registration Australian New Zealand Clinical Trial Registry; ACTRN012606000221550.

A school-based resilience intervention to decrease tobacco, alcohol and marijuana use in high school students

BackgroundDespite schools theoretically being an ideal setting for accessing adolescents and preventing initiation of substance use, there is limited evidence of effective interventions in this setting. Resilience theory provides one approach to achieving such an outcome through improving adolescent mental well-being and resilience. A study was undertaken to examine the potential effectiveness of such an intervention approach in improving adolescent resilience and protective factor scores; and reducing the prevalence of adolescent tobacco, alcohol and marijuana use in three high schools.MethodsA non-controlled before and after study was undertaken. Data regarding student resilience and protective factors, and measures of tobacco, alcohol and marijuana use were collected from grade 7 to 10 students at baseline (n = 1449) and one year following a three year intervention (n = 1205).ResultsSignificantly higher resilience and protective factors scores, and significantly lower prevalence of substance use were evident at follow up.ConclusionsThe results suggest that the intervention has the potential to increase resilience and protective factors, and to decrease the use of tobacco, alcohol and marijuana by adolescents. Further more rigorous research is required to confirm this potential.

Telephone recruitment into a randomized controlled trial of quitline support.

BACKGROUND Only 1%-7% of adult smokers use quitlines annually. Active telephone recruitment may increase utilization and enroll new groups of quitline users. PURPOSE This study aimed to (1) determine the proportion of adult daily smokers actively recruited by telephone to quitline support; (2) calculate the cost per smoker recruited; and (3) compare the characteristics of participants to smokers in the New South Wales (NSW, Australia) general population. METHODS Between September 2005 and April 2007, 1562 adult daily smokers randomly selected from the electronic NSW telephone directory were recruited into an RCT. The proportion of smokers and the cost per smoker recruited were examined. Participants were compared to NSW adult daily smokers from the NSW Population Health Survey and the Centre for Health Research & Psycho-oncology Smoking Community Survey. Analysis was completed in 2008. RESULTS More than half (52%) of eligible smokers contacted by telephone were recruited into cessation support. The cost per smoker recruited was AU

Infant exposure to environmental tobacco smoke: A prevalence study in Australia

71 (US

Increasing the Practice of Health Promotion Initiatives by Licensed Premises

59). Active telephone recruitment successfully enrolled smokers who are currently under-represented among quitline users. For instance, more than two thirds (68%) of participants were not intending to quit within 1 month. Compared with NSW adult daily smokers, participants were significantly more likely to be older; more highly educated; married/living with partner or divorced/separated; a nonmetropolitan resident; more nicotine dependent; more ready to quit; and have fewer household members. Participants were significantly less likely to live with a smoker than were NSW adult daily smokers. CONCLUSIONS Active telephone recruitment has the potential to substantially increase the proportion of smokers using quitline services at a reasonable cost. This method also engages smokers currently under-represented in quitline populations.

Police knowledge and attitudes regarding crime, the responsible service of alcohol and a proactive alcohol policing strategy

Objective: To determine: the prevalence of exposure to environmental tobacco smoke among infants aged 0–12 months in two child health care settings; the accuracy of parent report indicators of exposure; and the factors associated with exposure to environmental tobacco smoke.

Interventions by Health Care Professionals Who Provide Routine Child Health Care to Reduce Tobacco Smoke Exposure in Children: A Review and Meta-analysis.

Licensees of all licensed premises in the Hunter Region of New South Wales, Australia, were offered free services to encourage adoption of health promotion initiatives relating to responsible service of alcohol, environmental tobacco smoke, healthy food choices, breast and cervical cancer prevention, and the prevention of HIV/AIDS. A total of 239 premises participated in the follow-up survey. Increases in prevalence ranged between 11% and 59% for alcohol-related initiatives. The prevalence of smoke-free areas and healthy food choices increased from 32% to 65% and 42% to 96%, respectively, and the provision of cancer prevention information increased from 3% to 59%. Licensed premises represent a particularly challenging sector for health promotion practitioners to work in. The results of this study suggest that the adoption of health promotion initiatives by licensed premises can be increased. A considerable opportunity therefore exists for health promotion practitioners to become more actively involved in facilitating the adoption of such initiatives in this setting.

Increasing the health promotion practices of workplaces in Australia with a proactive telephone-based intervention.

The purpose of this study was to investigate the pattern and predictors of police knowledge and attitudes regarding alcohol and crime, the responsible service of alcohol by licensees and proactive alcohol policing strategies. Operational police in the Hunter region of NSW, Australia who attended for duty on a selected weekday were invited to complete a questionnaire during their shift. Two hundred and ninety-eight police participated (77%). Police estimated that 60% of the incidents that they attend are related to the consumption of alcohol, with 44% of such incidents relating to alcohol consumed on licensed premises. Three-quarters of police were able to identify correctly responsible service components of the Liquor Act. A large proportion of police (93%) considered that alcohol servers are responsible for preventing intoxication and that trying to improve licensee serving practices is not a waste of police time (89%). Considerable support (67%) was shown for police using education rather than enforcement as a method for improving licensee responsible service practices. Strong support (92%) was shown for providing information to licensees about alcohol-related incidents associated with their premises. Only 55% of police reported having sufficient skills and 17% reported that sufficient police resources were used to enhance licensee alcohol service practices. The introduction of liquor legislation, with an explicit “responsible service of alcohol” emphasis, provides police with considerable opportunity to improve the serving practices of licensed premises and to reduce alcohol-related harm. The perception by police of a lack of skill, a low prioritization for alcohol policing, limited time availability and inadequate penalties may prevent the realization of these benefits. Enhanced police training and the development of alternative responsible service of alcohol policing strategies are needed if these benefits are to be achieved.

Prevalence and acceptability of public health initiatives in licensed premises

IMPORTANCE Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children. OBJECTIVE To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children. DATA SOURCES A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended search was performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions, were identified. Secondary data extraction was performed in August 2015. STUDY SELECTION Controlled trials of routine child health care delivered by health care professionals (physicians, nurses, medical assistants, health educators, and dieticians) that addressed the outcomes of interest (TSE reduction in children and parental smoking behaviors) were eligible for inclusion in this review and meta-analysis. DATA EXTRACTION AND SYNTHESIS Study details and quality characteristics were independently extracted by 2 authors. If outcome measures were sufficiently similar, meta-analysis was performed using the random-effects model by DerSimonian and Laird. Otherwise, the results were described narratively. MAIN OUTCOMES AND MEASURES The primary outcome measure was reduction in child TSE. Secondary outcomes of interest were parental smoking cessation, parental smoking reduction, and maternal postpartum smoking relapse prevention. RESULTS Sixteen studies met the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05; 95% CI, 0.74-1.50; P = .78). Meta-analysis of the 3 trials that measured maternal postpartum smoking relapse prevention demonstrated a significant overall intervention effect (n = 1293) (risk ratio 1.53; 95% CI, 1.10-2.14; P = .01). High levels of study heterogeneity likely resulted from variability in outcome measures, length of follow up, intervention strategies, and unknown intervention fidelity. CONCLUSIONS AND RELEVANCE Interventions delivered by health care professionals who provide routine child health care may be effective in preventing maternal smoking relapse. Further research is required to improve the effectiveness of such interventions in reducing child TSE and increasing parental smoking cessation. The findings of this meta-analysis have policy and practice implications relating to interventions by routine pediatric health care professionals that aim to reduce child exposure to tobacco smoke.

Household smoking behaviours and exposure to environmental tobacco smoke among infants: are current strategies effectively protecting our young?

Purpose. The aim of this study was to explore the potential effectiveness of a proactive telephone-based intervention in increasing workplace adoption of health promotion initiatives. Methods. A telephone-based direct marketing strategy was used to contact a sample of Australian workplaces to encourage the adoption of health promotion initiatives. Workplaces were offered free services and resources designed to facilitate adoption of health promotion initiatives. Results. A total of 227 (71%) workplaces provided informed consent to participate in both baseline and 4-year follow-up surveys. Significant increases were evident for seven of the eight health promotion initiatives. Discussion. The findings of this study suggest that a proactive telephone-based intervention has the potential to be effective in increasing the prevalence of health promotion initiatives across a range of health topics in a large population of workplaces. Given the capacity to reach an entire population of workplaces, this approach represents a promising means of achieving the established potential of workplace health promotion.