Publications by authors named "Robyn L Richmond"

35 Publications

Effect of Cytisine vs Varenicline on Smoking Cessation: A Randomized Clinical Trial.

JAMA 2021 07;326(1):56-64

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Importance: Cytisine is more effective than placebo and nicotine replacement therapy for smoking cessation. However, cytisine has not been tested against the most effective smoking cessation medication, varenicline, which is associated with adverse events known to lead to discontinuation of therapy.

Objective: To examine whether standard cytisine treatment (25 days) was at least as effective as standard varenicline treatment (84 days) for smoking cessation.

Design, Setting, And Participants: This noninferiority, open-label randomized clinical trial with allocation concealment and blinded outcome assessment was undertaken in Australia from November 2017 through May 2019; follow-up was completed in January 2020. A total of 1452 Australian adult daily smokers willing to make a quit attempt were included. Data collection was conducted primarily by computer-assisted telephone interview, but there was an in-person visit to validate the primary outcome.

Interventions: Treatments were provided in accordance with the manufacturers' recommended dosage: cytisine (n = 725), 1.5-mg capsules taken 6 times daily initially then gradually reduced over the 25-day course; varenicline (n = 727), 0.5-mg tablets titrated to 1 mg twice daily for 84 days (12 weeks). All participants were offered referral to standard telephone behavioral support.

Main Outcomes And Measures: The primary outcome was 6-month continuous abstinence verified using a carbon monoxide breath test at 7-month follow-up. The noninferiority margin was set at 5% and the 1-sided significance threshold was set at .025.

Results: Among 1452 participants who were randomized (mean [SD] age, 42.9 [12.7] years; 742 [51.1%] women), 1108 (76.3%) completed the trial. Verified 6-month continuous abstinence rates were 11.7% for the cytisine group and 13.3% for the varenicline group (risk difference, -1.62% [1-sided 97.5% CI, -5.02% to ∞]; P = .03 for noninferiority). Self-reported adverse events occurred less frequently in the cytisine group (997 events among 482 participants) compared with the varenicline group (1206 events among 510 participants) and the incident rate ratio was 0.88 (95% CI, 0.81 to 0.95; P = .002).

Conclusions And Relevance: Among daily smokers willing to quit, cytisine treatment for 25 days, compared with varenicline treatment for 84 days, failed to demonstrate noninferiority regarding smoking cessation.

Trial Registration: anzctr.org.au Identifier: ACTRN12616001654448.
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http://dx.doi.org/10.1001/jama.2021.7621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261608PMC
July 2021

No smoker left behind: it's time to tackle tobacco in Australian priority populations.

Med J Aust 2018 01;208(1):52

Menzies School of Health Research, Darwin, NT.

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http://dx.doi.org/10.5694/mja17.00948DOI Listing
January 2018

Plasma apolipoproteins and physical and cognitive health in very old individuals.

Neurobiol Aging 2017 07 1;55:49-60. Epub 2017 Mar 1.

Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia. Electronic address:

Apolipoproteins play a crucial role in lipid metabolism with implications in cardiovascular disease, obesity, diabetes, Alzheimer's disease, and longevity. We quantified 7 apolipoproteins in plasma in 1067 individuals aged 56-105 using immunoassays and explored relationships with APOE polymorphism ε2/3/4, vascular health, frailty, and cognition. ApoA1, ApoA2, ApoB, ApoC3, ApoE, ApoH, and ApoJ decreased from mid-life, although ApoE and ApoJ had U-shaped trends. Centenarians had the highest ApoE levels and the lowest frequency of APOE ε4 allele relative to younger groups. Apolipoprotein levels trended lower in APOE ε4 homozygotes and heterozygotes compared with noncarriers, with ApoE and ApoJ being significantly lower. Levels of all apolipoproteins except ApoH were higher in females. Sex- and age-related differences were apparent in the association of apolipoproteins with cognitive performance, as only women had significant negative associations of ApoB, ApoE, ApoH, and ApoJ in mid-life, whereas associations at older age were nonsignificant or positive. Our findings suggest levels of some apolipoproteins, especially ApoE, are associated with lifespan and cognitive function in exceptionally long-lived individuals.
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http://dx.doi.org/10.1016/j.neurobiolaging.2017.02.017DOI Listing
July 2017

Age-associated differences on structural brain MRI in nondemented individuals from 71 to 103 years.

Neurobiol Aging 2016 Apr 21;40:86-97. Epub 2016 Jan 21.

Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW) Australia, Sydney, New South Wales, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia. Electronic address:

Successful brain aging in the oldest old (≥90 years) is underexplored. This study examined cross-sectional brain morphological differences from 8th to 11th decades of life in nondemented individuals by high-resolution magnetic resonance imaging. Two hundred seventy-seven nondemented community-dwelling participants (71-103 years) from Sydney Memory and Ageing Study and Sydney Centenarian Study comprised the sample, including a subsample of 160 cognitively high-functioning elders. Relationships between age and magnetic resonance imaging-derived measurements were studied using general linear models; and structural profiles of the ≥90 years were delineated. In full sample and the subsample, significant linear negative relationship of gray matter with age was found, with the greatest age effects in the medial temporal lobe and parietal and occipital cortices. This pattern was further confirmed by comparing directly the ≥90 years to the 71-89 years groups. Significant quadratic age effects on total white matter and white matter hyperintensities were observed. Our study demonstrated heterogeneous differences across brain regions between the oldest old and young old, with an emphasis on hippocampus, temporoposterior cortex, and white matter hyperintensities.
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http://dx.doi.org/10.1016/j.neurobiolaging.2016.01.006DOI Listing
April 2016

Structural MRI Biomarkers of Mild Cognitive Impairment from Young Elders to Centenarians.

Curr Alzheimer Res 2016 ;13(3):256-67

Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia; NPI Euroa Centre, Prince of Wales Hospital, Barker Street, Randwick NSW 2031, Australia.

Unlabelled: Underpinnings of mild cognitive impairment (MCI) change with increasing age. We hypothesize that MRI signatures of mild cognitive impairment (MCI) would be different at a higher age compared to younger elders.

Methods: 244 participants (71-103 years) from the Sydney Memory and Ageing Study and the Sydney Centenarian Study were categorized as amnestic MCI (aMCI), non-amnestic MCI (naMCI) or cognitively normal (CN). Brain "atrophy" and white matter hyper-intensities (WMHs) associated with MCI subtypes and age effects were examined by general linear models, controlling for confounding factors. Reduced logistic regressions were performed to determine structures that best discriminated aMCI from CN in individuals <85 and those ≥85 years.

Results: aMCI was associated with smaller volumes of overall cortex, medial temporal structures, anterior corpus callosum, and select frontal and parietal regions compared to CN; such associations did not significantly change with age. Structures that best discriminated aMCI from CN differed however in the <85 and ≥85 age groups: cortex, putamen, parahippocampal, precuneus and superior frontal cortices in <85 years, and the hippocampus, pars triangularis and temporal pole in ≥85 years. Differences between naMCI and CN were small and non-significant in the sample. WMHs were not significantly associated with MCI subtypes.

Conclusions: Structural MRI distinguishes aMCI, but not naMCI, from CN in elderly individuals. The structures that best distinguish aMCI from CN differ in those <85 from those ≥85, suggesting different neuropathological underpinnings of cognitive impairment in the very old.
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http://dx.doi.org/10.2174/1567205013666151218150534DOI Listing
December 2016

Process evaluation of a practice nurse-led smoking cessation trial in Australian general practice: views of general practitioners and practice nurses.

Fam Pract 2015 Aug 29;32(4):468-73. Epub 2015 May 29.

School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales.

Background: Support in primary care can assist smokers to quit successfully, but there are barriers to general practitioners (GPs) providing this support routinely. Practice nurses (PNs) may be able to effectively take on this role.

Objectives: The aim of this study was to perform a process evaluation of a PN-led smoking cessation intervention being tested in a randomized controlled trial in Australian general practice.

Methods: Process evaluation was conducted by means of semi-structured telephone interviews with GPs and PNs allocated in the intervention arm (Quit with PN) of the Quit in General Practice trial. Interviews focussed on nurse training, content and implementation of the intervention.

Results: Twenty-two PNs and 15 GPs participated in the interviews. The Quit with PN intervention was viewed positively. Most PNs were satisfied with the training and the materials provided. Some challenges in managing patient data and follow-up were identified.

Conclusion: The Quit with PN intervention was acceptable to participating PNs and GPs. Issues to be addressed in the planning and wider implementation of future trials of nurse-led intervention in general practice include providing ongoing mentoring support, integration into practice management systems and strategies to promote greater collaboration in GPs and PN teams in general practice. The ongoing feasibility of the intervention was impacted by the funding model supporting PN employment and the competing demands on the PNs time.
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http://dx.doi.org/10.1093/fampra/cmv041DOI Listing
August 2015

Nutrition among men and household food security in an internally displaced persons camp in Kenya.

Public Health Nutr 2016 Mar 28;19(4):723-31. Epub 2015 Apr 28.

School of Public Health and Community Medicine,University of New South Wales,Sydney,NSW 2052,Australia.

Objective: To determine the nutritional status of men and the food security status of their households in an internally displaced persons (IDP) camp in Kenya.

Design: A descriptive, cross-sectional study using a questionnaire and biometric measurements was completed in June 2013.

Setting: IDP camp, Rongai, Kenya.

Subjects: A total of 267 men aged ≥18 years residing within the camp were recruited via respondent-driven sampling. Statistical associations between categorical variables were analysed using Pearson's χ 2 tests, while independent t tests were used for continuous variables.

Results: Among the men surveyed, we found a mean BMI of 20·3 (sd 2·5) kg/m2, with 23·9% of participants in the underweight category (BMI<18·5 kg/m2). The mean Individual Dietary Diversity Score was 6 out of a maximum score of 9. The mean Household Food Insecurity Access Scale score was 11·6 (sd 6·8), with 180 participants (71·7%) residing in households categorised as severely food insecure. Low monthly household income (<2000 Kenyan Shillings, or $US 25) was associated with a higher food insecurity score (P<0·001), greater likelihood of residing in a severely food-insecure household (P<0·001), low dietary diversity score (P<0·05) and being underweight (P<0·01).

Conclusions: While the nutritional status of men in the IDP camp is comparable to non-displaced men in Kenya, household food insecurity is relatively high. Efforts to improve food security for the future are essential to minimise the impact of severe food insecurity on mental health, disease profiles and family well-being reported in other IDP settings.
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http://dx.doi.org/10.1017/S1368980015001275DOI Listing
March 2016

Quit in general practice: a cluster randomized trial of enhanced in-practice support for smoking cessation.

Fam Pract 2015 Apr 9;32(2):173-80. Epub 2015 Feb 9.

Cancer Council Victoria, Melbourne, Victoria, Australia.

Objectives: To evaluate the uptake and effectiveness of tailored smoking cessation support, provided primarily by the practice nurse (PN), and compare this to other forms of cessation support.

Methods: Three arm cluster randomized controlled trial conducted in 101 general practices in Sydney and Melbourne involving 2390 smokers. The Quit with PN intervention was compared to Quitline referral and a usual care control group. Smoking cessation pharmacotherapy was recommended to all groups. Outcomes were assessed by self-report at 3- and 12-month follow-up. Uptake of the interventions is also reported.

Results: The three groups were similar at baseline. Follow-up at 12 months was 82%. The sustained and point prevalence abstinence rates, respectively, at 3 months by group were: PN intervention 13.1% and 16.3%; Quitline referral 10.8% and 14.2%; Usual GP care 11.4% and 15.0%. At 12 months, the rates were: PN intervention 5.4% and 17.1%; Quitline referral 4.4% and 18.8%; Usual GP care 2.9% and 16.4%. Only 43% of patients in the PN intervention group attended to see the nurse. Multilevel regression analysis showed no effect of the intervention overall, but patients who received partial or complete PN support were more likely to report sustained abstinence [partial support odds ratio (OR) 2.27; complete support OR 5.34].

Conclusion: The results show no difference by group on intention to treat analysis. Those patients who received more intensive PN intervention were more likely to quit. This may have been related to patient motivation or an effect of PN led cessation support.
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http://dx.doi.org/10.1093/fampra/cmu089DOI Listing
April 2015

Smoke-free outdoor areas: supporting local government to introduce tobacco control policies.

Aust N Z J Public Health 2014 Dec 12;38(6):518-23. Epub 2014 Oct 12.

Cardiovascular Health, National Heart Foundation of Australia, New South Wales; School of Public Health and Community Medicine, University of New South Wales.

Objectives: To ascertain the proportion of councils with smoke-free outdoor areas (SFOA) policies in New South Wales (NSW), Australia and to explore the enablers and barriers to local governments introducing such policies.

Methods: A structured survey of council staff at NSW councils was conducted by telephone in 2011. Participants were asked about the existence of any SFOA policy, and enablers and barriers of the policy.

Results: The study was completed by 148 of 152 NSW councils. Eighty five (57%) councils had an SFOA policy, with playgrounds most likely to be covered by the policy. The most frequently cited enabler for the introduction of SFOA policy was direct advocacy letters, while the most commonly mentioned barrier was a lack of resources.

Conclusion And Implications: In the absence of state or federal legislation, local government or councils may respond to community expectations for smoke-free outdoor areas by introducing policy. Advocacy and support from non-government health organisations can increase the likelihood of this occurring and address barriers facing councils, with rural councils most likely to benefit from such support. Interest from councils can influence the adoption of state-wide smoke-free outdoor areas legislation.
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http://dx.doi.org/10.1111/1753-6405.12265DOI Listing
December 2014

The contribution of personality to longevity: findings from the Australian Centenarian Study.

Arch Gerontol Geriatr 2014 Nov-Dec;59(3):528-35. Epub 2014 Jul 6.

Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Centre for Translational Neuroscience and Mental Health, University of Newcastle, NSW 2308, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.

Objectives: To examine whether centenarians have a unique set of personality traits, which may in part explain their longevity.

Methods: 79 Australian centenarians completed the NEO Five Factory Inventory (NEO-FFI), Connor-Davidson Resilience Scale (CD-RISC) and Life Orientation Test Revised (LOT-R) to assess different dimensions of their personalities. Centenarians were asked to answer items of the NEO-FFI, CD-RISC and LOT-R based on current views, and were then asked to recall in the presence of an informant (e.g. carers, offspring) on past personality (i.e. at mid-adult-life). Both sets of answers were recorded and analysed.

Results: Centenarians were currently low in Openness and Extraversion and high in Neuroticism, but were low in Openness and high in Neuroticism, Conscientiousness and Extraversion when reflecting on past traits. Currently, centenarians in high care facilities reported higher levels of Neuroticism, as did centenarians who did not socialize. Cognitively intact centenarians reported higher levels of Agreeableness; and males reported lower Neuroticism compared to females when reflecting on past experiences.

Discussion: Centenarians were characterized by several personality traits, which facilitated positive health behaviors and thus contributed to their longevity. It is possible that personality may not be static across the lifespan, but instead, reflect advancing age, psychosocial factors and changes in life circumstances.
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http://dx.doi.org/10.1016/j.archger.2014.06.007DOI Listing
February 2015

Tobacco smoking: options for helping smokers to quit.

Aust Fam Physician 2014 Jun;43(6):348-54

MBBS, MPH, PhD, FRACGP, is Professor of General Practice, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales.

Background: Although great progress has been made on tobacco control, smoking remains one of the most important causes of preventable disease and death in the Australian population. The general practice team has much to offer in helping smokers to quit.

Objective: This article provides practical advice on structuring smoking cessation support in primary care using the 5As (Ask, Assess, Advise, Assist and Arrange follow-up) framework. Up-to-date information on pharmacotherapy and issues for special groups are also covered.

Discussion: The chances of successful quitting are maximised if the patient receives behavioural support combined with drug treatment, if nicotine-dependent. Special groups needing support include Aboriginal and Torres Strait Islander peoples, people with mental illness and pregnant women.
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June 2014

Supporting smoking cessation.

BMJ 2014 Jan 14;348:f7535. Epub 2014 Jan 14.

School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia.

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http://dx.doi.org/10.1136/bmj.f7535DOI Listing
January 2014

Heroin use impairs smoking cessation among Australian prisoners.

BMC Public Health 2013 Dec 19;13:1200. Epub 2013 Dec 19.

Justice & Forensic Mental Health Network, Centre for Health Research in Criminal Justice, Suite 302, Level 2, 152 Bunnerong Road, Pagewood, NSW 2035, Australia.

Background: Prisoners have extremely high rates of smoking with rates 3-4 times higher than the general community. Many prisoners have used heroin. The aims of this study were to investigate the impact of heroin use on smoking cessation and the social determinants of health among prisoners.

Methods: Secondary analysis of data from a randomised controlled trial of a multi-component smoking cessation intervention involving 425 Australian male prisoners. Inmates who, prior to imprisonment, used heroin regularly were compared to those who did not use heroin regularly. Self-reported smoking status was validated at baseline and each follow-up by measuring carbon monoxide levels. Readings exceeding 10 ppm were defined as indicating current smoking.

Results: Over half (56.5%) of the participants had ever used heroin while 37.7% regularly (daily or almost daily) used heroin in the year prior to entering prison. Prisoners who regularly used heroin had significantly worse social determinants of health and smoking behaviours, including lower educational attainment, more frequent incarceration and earlier initiation into smoking. Prisoners who regularly used heroin also used and injected other drugs significantly more frequently. At 12-month follow-up, the smoking cessation of prisoners who had regularly used heroin was also significantly lower than prisoners who did not regularly use heroin, a finding confirmed by logistic regression.

Conclusions: Regular heroin use prior to imprisonment is an important risk factor for unsuccessful attempts to quit smoking among prisoners and is also associated with worse social determinants of health, higher drug use, and worse smoking behaviours. More effective and earlier smoking cessation interventions are required for particularly disadvantaged groups.

Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry 12606000229572.
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http://dx.doi.org/10.1186/1471-2458-13-1200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878343PMC
December 2013

Smoking and other drug characteristics of aboriginal and non-aboriginal prisoners in australia.

J Addict 2013 31;2013:516342. Epub 2013 Mar 31.

Alcohol and Drug Service, St. Vincent's Hospital, Darlinghurst, NSW 2010, Australia.

Introduction and Aim. Although tobacco and alcohol use have declined substantially in the Australian community, substance use among prisoners remains high. The aim was to compare the smoking, drug, and alcohol characteristics, sociodemographic profile, and general health of Aboriginal and non-Aboriginal male prisoners in a smoking cessation intervention. Design and Methods. This study was a descriptive cross-sectional analysis of data from 425 male prisoners who joined a quit smoking trial conducted at 18 correctional centres in NSW and Queensland using data collected by standardised self-report instruments. Results. Average age was 33 years with 15% from Aboriginal descent. Compared to non-Aboriginal prisoners, Aboriginal prisoners were significantly more likely to have left school with no qualifications, to have been institutionalised as a child, to be previously incarcerated, and commenced smoking at a younger age. The tobacco use profile of both groups was similar; most of them had a medium to high level of nicotine dependence, smoked roll your own tobacco, and were "serious" about quitting. Discussion and Conclusion. Despite differences in terms of sociodemographic characteristics and offending history, the smoking characteristics of Aboriginal and non- Aboriginal prisoners were similar. Incarceration offers an opportunity to encourage smoking cessation and reduction of drug use.
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http://dx.doi.org/10.1155/2013/516342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008511PMC
June 2014

Morbidity profiles and lifetime health of Australian centenarians.

Australas J Ageing 2012 Dec 28;31(4):227-32. Epub 2012 Mar 28.

Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.

Aim: To examine the lifetime prevalence and initial onset of diseases among centenarians.

Methods: In this descriptive study, we administered structured questionnaires by interview to 188 centenarians and asked about the presence and timing of 14 common age-related diseases.

Results: The most common conditions were ocular disease (70%), arthritis (58%) and hypertension (40%). Average age at disease onset was 80 years, and average number of comorbidities was 3. Participants were characterised into three morbidity profiles - survivors (46%), delayers (34%) and escapers (19%). No participants had a diagnosis of dementia or osteoporosis before age 80 years.

Conclusion: Relative to the general population, a select sample of Australian centenarians reported lower rates of chronic conditions, with many escaping osteoporosis, dementia, cardiovascular disease, respiratory illnesses, cancers, anxiety and depression. Increasing age is correlated with increasing morbidity but a few centenarians reached 100 years of age without disease.
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http://dx.doi.org/10.1111/j.1741-6612.2011.00570.xDOI Listing
December 2012

The challenges of reducing tobacco use among prisoners.

Drug Alcohol Rev 2012 Jul 26;31(5):625-30. Epub 2012 Mar 26.

School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.

Issue: The prevalence of smoking among prisoners is exceptionally high and is often comorbid with alcohol and drug problems, mental illness and other health problems. This review paper summarises the literature and available research related to smoking prevalence and smoking cessation initiatives among prisoners and identifies areas of need for further research and intervention.

Approach: This paper highlights three studies conducted in the New South Wales prison system which attempt to address these high rates of smoking including a feasibility study, a focus group study and a randomised controlled trial.

Key Findings: The challenges of making systems-level changes to address these high rates of smoking are discussed including a recent National Summit on Tobacco Smoking in Prisons.

Implications: Dissemination of research findings has assisted in highlighting the importance of tobacco smoking among prisoners and the need to develop culturally and setting appropriate smoking cessation initiatives for prisoners.

Conclusions: As one of the most marginalised and socially disadvantaged populations in Australia, prisoners represent an important population to target for smoking cessation programs and interventions. This paper highlights a number of initiatives undertaken to address this problem and suggests directions for the future.
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http://dx.doi.org/10.1111/j.1465-3362.2012.00435.xDOI Listing
July 2012

Cardiovascular risk among Aboriginal and non-Aboriginal smoking male prisoners: inequalities compared to the wider community.

BMC Public Health 2011 Oct 10;11:783. Epub 2011 Oct 10.

School of Public Health and Community Medicine, University of New South Wales, Kensington 2052, Australia.

Background: Cardiovascular risk factors (CVRF) were collected as part of a randomised controlled trial of a multi-component intervention to reduce smoking among male prisoners. Cross-sectional baseline data on CVRF were compared among smoking male prisoners and males of similar age in the general population.

Methods: 425 smoking prisoners were recruited (n = 407 in New South Wales; 18 in Queensland), including 15% of Aboriginal descent (mean age 33 years; median sentence length 3.6 years). We measured CVRF such as smoking, physical activity, blood pressure, risky alcohol use, symptoms of depression, and low socioeconomic status.

Results: We found that 39% of prisoners had 3+ CVRF, compared to 10% in a general community sample of most disadvantaged men of a similar age. Significantly more Aboriginal prisoners had 3+ CVRF than non-Aboriginal prisoners (55% vs 36%, p < 0.01) and were twice as likely to have 4+ CVRF (27% vs 12%). In addition to all prisoners in this study being a current smoker (with 70% smoking 20+ cigarettes per day), the prevalence of other CVRF was very high: insufficient physical activity (23%); hypertension (4%), risky drinking (52%), symptoms of depression (14%) and low socioeconomic status (SES) (44%). Aboriginal prisoners had higher levels of risky alcohol use, symptoms of depression, and were more likely to be of low SES.

Conclusion: Prisoners are at high risk for developing cardiovascular disease compared to even the most disadvantaged in their community and should be the focus of specific public health interventions.

Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry ACTRN#12606000229572.
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http://dx.doi.org/10.1186/1471-2458-11-783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198711PMC
October 2011

Physical, mental, and cognitive function in a convenience sample of centenarians in Australia.

J Am Geriatr Soc 2011 Jun 3;59(6):1080-6. Epub 2011 May 3.

School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia.

Objectives: To examine the physical, mental, and cognitive function of centenarians.

Design: Descriptive study using a structured questionnaire and convenience sampling.

Setting: Residential care facilities and private dwellings in Australia.

Participants: A convenience sample of 188 centenarians.

Measurements: The Hospital Anxiety and Depression Scale (HADS) screened for anxiety and depression. The Katz Index of Independence in Activities of Daily Living (Katz ADL) was used to assess functional status. The Quality of Life Scale was used to assess quality of life. The Mini-Mental State Examination (MMSE) was used to screen for dementia. Structured responses were obtained for living arrangement, marital status, social relationships, and supports.

Results: Centenarians had regular contact with friends (59%), neighbors (62%), and families (72%); 54% were religious and 43.5% had received social supports. Average MMSE and Katz ADL scores were 21.5 and 3.7, respectively; 45% had scores on the MMSE indicative of dementia, 10% indicated anxiety and 14% depression on the HADS. Participants with poor ratings of health experienced higher rates of anxiety and depression than their healthier counterparts.

Conclusion: In this convenience sample of Australian centenarians, anxiety and depression was relatively nonexistent, and most reported a high quality of life. This was despite objective deterioration in functional status, paralleling the aging process, and high dependence on others for everyday tasks. Potentially, this is suggestive of a unique ability within the sample to adapt to aging and its limitations.
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http://dx.doi.org/10.1111/j.1532-5415.2011.03404.xDOI Listing
June 2011

Feasibility and effectiveness of nurse-delivered smoking cessation counselling combined with nicotine replacement in Australian general practice.

Drug Alcohol Rev 2011 Nov 6;30(6):583-8. Epub 2010 Sep 6.

School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, Australia.

Introduction And Aims: Practice nurses (PN) are an alternative workforce for cessation support in primary care, but their role and effectiveness is underdeveloped and underresearched. This study evaluated a model of smoking cessation intervention in Australian general practice based on PNs. Smokers were identified by their general practitioner (GP) and referred to the PN for cessation support over four counselling visits and offered free nicotine patches.

Design And Methods: Pre- and post-study using mixed quantitative and qualitative methods. Cessation outcomes were collected by patient self-report at 6 months. Semistructured interviews were conducted with PNs and GPs to provide qualitative data on the acceptability of the model.

Results: The project involved 31 PNs, 35 GPs and 498 patients from 19 general practices in Sydney. Mean age of participating patients was 46 years and 61% were female. Mean number of PN counselling visits was 3.1. At 6 month follow up the point prevalence abstinence rate was 22% and continuous abstinence rate was 16%. Participants who had attended for four or more counselling visits with the PN were significantly more likely to quit. PNs and GPs expressed enthusiasm for the PN role in smoking cessation and belief in its value and feasibility.

Discussion And Conclusions: Substantial rates of cessation were found in this uncontrolled study and the role was well accepted by PNs and GPs. The model shows promise as a means of providing cessation support in Australian primary care and further research in a randomised trial is warranted.
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http://dx.doi.org/10.1111/j.1465-3362.2010.00243.xDOI Listing
November 2011

Postgraduate education for doctors in smoking cessation.

Drug Alcohol Rev 2009 Sep;28(5):466-73

School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.

Introduction And Aims: Smoking cessation advice from doctors helps improve quit rates but the opportunity to provide this advice is often missed. Postgraduate education is one strategy to improve the amount and quality of cessation support provided. This paper describes a sample of postgraduate education programs for doctors in smoking cessation and suggests future directions to improve reach and quality.

Design And Methods: Survey of key informants identified through tobacco control listserves supplemented by a review of the published literature on education programs since 2000. Programs and publications from Europe were not included as these are covered in another paper in this Special Issue.

Results: Responses were received from only 21 key informants from eight countries. Two further training programs were identified from the literature review. The following components were present in the majority of programs: 5 As (Ask, Advise, Assess, Assist and Arrange) approach (72%), stage of change (64%), motivational interviewing (72%), pharmacotherapies (84%). Reference to clinical practice guidelines was very common (84%). The most common model of delivery of training was face to face. Lack of interest from doctors and lack of funding were identified as the main barriers to uptake and sustainability of training programs.

Discussion And Conclusions: Identifying programs proved difficult and only a limited number were identified by the methods used. There was a high level of consistency in program content and a strong link to clinical practice guidelines. Key informants identified limited reach into the medical profession as an important issue. New approaches are needed to expand the availability and uptake of postgraduate education in smoking cessation
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http://dx.doi.org/10.1111/j.1465-3362.2009.00103.xDOI Listing
September 2009

The changing face of the Australian population: growth in centenarians.

Authors:
Robyn L Richmond

Med J Aust 2008 Jun;188(12):720-3

School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW.

At the time of the 2006 Census, there were 3154 centenarians in Australia, 797 men (25%) and 2357 women (75%). This number is expected to increase to 12,000 by 2020. In Australia we are experiencing a demographic transition in which the proportions of people in the oldest age groups are increasing while the proportions in the youngest age groups are decreasing. Centenarians are the fastest growing age segment of the Australian population. Their numbers have increased by 8.5% per year over the past 25 years. In 2006, they represented 0.12% (3154/2,644,469) of the population aged 65 years and over. More than half of centenarians live in private dwellings, with 27% of men and 14% of women living on their own. Government policies are starting to address the issues of an ageing population, including provisions for financial support, improved access to medical services, and appropriate housing and transport facilities. However, we need specific social, medical and financial estimates of the impact of living to 100 years and beyond.
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http://dx.doi.org/10.5694/j.1326-5377.2008.tb01854.xDOI Listing
June 2008

General practice patients--their readiness to quit smoking.

Aust Fam Physician 2008 Jan-Feb;37(1-2):81-3

School of Public Health and Community Medicine, University of New South Wales.

Background: This article examines the prevalence of smoking among general practice patients and assesses their stage of readiness to quit.

Method: Descriptive study involving eight general practice registrars working in teaching practices in metropolitan Sydney (New South Wales) who surveyed 1069 consecutive patients over 16 years of age to determine their smoking status; and for smokers, their stage of readiness to stop smoking.

Results: Of these patients 375 (35%) were current smokers, with smoking more common among men (40%) than women (33%). Proportions of smokers in each stage of change were: 137 in precontemplation (36.5%), 158 in contemplation (42%) and 79 in preparation (21%). The majority of patients in preparation (67%) and contemplation (53%) were assessed as willing to further discuss their smoking, whereas only 16% of those in the contemplation stage were willing.

Discussion: Smoking rates among general practice patients were higher than in community samples. Most of the smokers were either contemplating or preparing to quit, and the majority of smokers in these groups were willing to receive advice about smoking cessation.
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March 2008

Ten-year survival outcome of the nicotine transdermal patch with cognitive behavioural therapy.

Aust N Z J Public Health 2007 Jun;31(3):282-5

School of Public Health and Community Medicine, University of New South Wales, Kensington, New South Wales 2052.

Objective: To follow-up abstainers from the end of their initial treatment over seven points to 10 years.

Methods: In the original study there were 305 smokers who were recruited in a double-blind randomised controlled trial. Those subjects who had remained continuously abstinent to seven years (n=20) were followed up to ascertain continuous smoking prevalence to 10 years. Main outcome measure was continuous abstinence.

Results: At 10 years, the active nicotine patch group showed significantly higher continuous abstinence rates that were double those of the placebo group (7.9% vs. 2.6%, respectively). The high rate of relapse declined after six months.

Conclusions: The nicotine patch leads to superior continuous abstinence over 10 years when compared with placebo. PUBLIC HEALTH IMPLICATIONS: This is the longest follow-up study of continuous smoking abstinence after cognitive behaviour treatment combined with the nicotine patch.
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http://dx.doi.org/10.1111/j.1467-842x.2007.00062.xDOI Listing
June 2007

Promoting smoking cessation among prisoners: feasibility of a multi-component intervention.

Aust N Z J Public Health 2006 Oct;30(5):474-8

School of Public Health and Community Medicine, University of New South Wales.

Objective: To conduct a pilot study to determine the feasibility and effectiveness of a multi-component smoking cessation intervention among prison inmates.

Methods: A prospective study conducted within a maximum-security prison located near Sydney, New South Wales, and housing around 330 men. Participants received a smoking cessation intervention with six-month follow-up to determine abstinence. The smoking cessation intervention consisted of two brief cognitive behavioural therapy sessions, nicotine replacement therapy, bupropion and self-help resources. Point prevalence and continuous abstinence at follow-up were verified with expired carbon monoxide measures.

Results: Thirty male inmates participated in the intervention. At six months, the biochemically validated point prevalence and continuous abstinence rates were 26% and 22% respectively. Reasons for relapse to smoking included: transfers to other prisons without notice, boredom, prolonged periods locked in cells, and stress associated with family or legal concerns. Those inmates who relapsed, or continued to smoke following the intervention, smoked less tobacco than at baseline and 95% stated they were willing to try to quit again using our intervention.

Conclusions: Prison inmates are able to quit or reduce tobacco consumption while in prison but any smoking cessation intervention in this setting needs to address prison-specific issues such as boredom, stress, transfers to other prisons, court appearances, and isolation from family and friends.

Implications: The prevalence of smoking within Australian prisons is alarmingly high. Further work into how to encourage prisoners to quit smoking is required.
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http://dx.doi.org/10.1111/j.1467-842x.2006.tb00467.xDOI Listing
October 2006

Smoking and its correlates in an Australian prisoner population.

Drug Alcohol Rev 2006 Jul;25(4):343-8

Centre for Health Research in Criminal Justice and School of Public Health, University of New South Wales, Australia.

Despite evidence of high rates of smoking among prisoners, there has been limited research that describes smoking patterns and risk factors associated with smoking in this group. This study describes inmate smokers and identifies factors associated with smoking in prison, using a survey comprising a cross-sectional random sample of inmates stratified by sex, age and Aboriginality. A total of 914 adult inmates (747 men, 167 women) were recruited from 29 New South Wales (Australia) correctional centres. Information on the prevalence of smoking, smoking history, smoking behaviours and other risk factors were collected. Of the participants, 79% were current smokers (78% men, 83% women). Younger inmates were more likely than older inmates to smoke (86% vs. 64%). Most individuals smoked between 11 and 20 cigarettes a day and a median of 50 grams per week. In the previous year, over half (52%) of current smokers had attempted to quit or reduce the amount they smoked. At the time of the survey, 58% of smokers had plans to quit; 21% within 3 months. Independent predictors of current smoking in the multivariate analysis were past use of cannabis and a history of illicit drug use. The prevalence of smoking in prison is extraordinarily high and exceeds that of the general community. Despite this, the majority of prisoners report plans to quit. Readily available smoking cessation advice, support and treatment are needed to assist those wanting to quit in this stressful environment. As the prevalence of smoking within the general community declines, assisting cessation in groups containing a disproportionate number of smokers will become increasingly important. Despite high levels of tobacco dependence, many prisoners intend to quit and health planners and custodial authorities need to encourage and support inmates who do attempt to quit.
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http://dx.doi.org/10.1080/09595230600741198DOI Listing
July 2006

The role of remote community stores in reducing the harm resulting from tobacco to Aboriginal people.

Drug Alcohol Rev 2006 May;25(3):195-9

Menzies School of Health Research, Charles Darwin University, Australia.

The objective of this study was to assess the potential for reducing the harm resulting from tobacco use through health promotion programmes run in community stores in remote Aboriginal communities. The Tobacco Project utilised data from 111 stakeholder interviews (72 at baseline and 71 at follow-up after 12 months) assessing presence of sales to minors, tobacco advertising, labelling and pricing. It also involved the assessment of observational data from community stores and comments obtained from 29 tobacco vendors derived from community surveys. Sales of tobacco to minors were not reported in community stores and all stores complied with requirements to display the legislated signage. However, tobacco was accessible to minors through a vending machine and through independent vendors. Only one store displayed tobacco advertising; all stores had displayed anti-tobacco health promotion posters or pamphlets. Pricing policies in two stores may have meant that food items effectively subsidised the cost of tobacco. All stores had unofficial no-smoking policies in accessible parts of the store. Remote community stores complied with existing legislation, aside from allowing access of minors to vending machines. There may still be potential for proactive tobacco education campaigns run through community stores and for a trial assessing the effect of changes in tobacco prices on tobacco consumption.
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http://dx.doi.org/10.1080/09595230600644624DOI Listing
May 2006

Evaluation of a multi-component community tobacco intervention in three remote Australian Aboriginal communities.

Aust N Z J Public Health 2006 Apr;30(2):132-6

Menzies School of Health Research, Northern Territory.

Objectives: To assess the effect of community tobacco interventions in Aboriginal communities.

Methods: The study consisted of a pre- and post-study of the effect of a multi-component tobacco intervention conducted in six Aboriginal communities in the Northern Territory (NT). The intervention included sports sponsorship, health promotion campaigns, training health professionals in the delivery of smoking cessation advice, school education about tobacco, and policy on smoke-free public places. The study was conducted in three intervention communities and three matched control communities. Surveys were used to measure changes in prevalence of tobacco use, changes in knowledge, and attitudes to cessation in intervention communities.

Results: Tobacco consumption decreased in one intervention community compared with the matched control community; the trends of consumption (as measured by tobacco ordered through points of sale) in these communities were significantly different (t = -4.5, 95% CI -33.6 - (-12.5), p < or = 0.01). Community samples in intervention communities included 920 participants. There was no significant change in the prevalence of tobacco use, although knowledge of the health effects of tobacco and readiness to quit increased.

Conclusions: Although it is difficult to demonstrate a reduction in tobacco consumption or in the prevalence of tobacco use as a result of multi-component community tobacco interventions delivered in Aboriginal communities, such interventions can increase awareness of the health effects of tobacco and increase reported readiness to cease tobacco use.
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http://dx.doi.org/10.1111/j.1467-842x.2006.tb00105.xDOI Listing
April 2006

Role of the general practitioner in smoking cessation.

Drug Alcohol Rev 2006 Jan;25(1):21-6

School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.

This paper reflects on the role of general practitioners in smoking cessation and suggests initiatives to enhance general practice as a setting for effective smoking cessation services. This paper is one of a series of reflections on key issues in smoking cessation. In this article we highlight the extent that general practitioners (GPs) have contact with the population, evidence for effectiveness of GP advice, barriers to greater involvement and suggested future directions. General practice has an extensive population reach, with the majority of smokers seeing a GP at least once per year. Although there is level 1 evidence of the effectiveness of smoking cessation advice from general practitioners, there are substantial barriers to this advice being incorporated routinely into primary care consultations. Initiatives to overcome these barriers are education in smoking cessation for GPs and other key practice staff; teaching of medical students about tobacco and cessation techniques, clinical practice guidelines; support for guideline implementation; access to pharmacotherapies; and development of referral models. We believe the way forward for the role of the GPs is to develop the practice as a primary care service for providing smoking cessation advice. This will require education relevant to the needs of a range of health professionals, provision of and support for the implementation of clinical practice guidelines, access for patients to smoking cessation pharmacotherapies and integration with other cessation services such as quitlines.
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http://dx.doi.org/10.1080/09595230500459487DOI Listing
January 2006

Television and delivery of health promotion programs to remote Aboriginal communities.

Health Promot J Austr 2005 Aug;16(2):155-8

Menzies School of Health Research, Northern Territory.

Issue Addressed: To assess the effect of anti-tobacco television advertising in comparison to other anti-tobacco interventions for Aboriginal people in remote communities in the Northern Territory.

Method: This research was carried out as part of a large study evaluating the effect of multi-component, evidence-based tobacco interventions developed in three remote communities. Community surveys (assessing changes in smoking behaviour and exposure to tobacco interventions) were used to assess exposure to and effect of television advertising, relative to other interventions over the intervention year.

Results: 351 community members were interviewed. Exposure to anti-tobacco television advertising was high among both smokers and non-smokers (86% vs. 85%, p = 0.78). However, those who recalled seeing anti-tobacco advertising were no more likely to have quit than those who had not (11 exposed (6%) vs. 3 non-exposed (10%), Fisher's Exact Test p = 0.42). Logistic regression showed that exposure to individual tobacco interventions was not associated with an increased chance of cessation during the intervention year.

Conclusion: Recall of anti-tobacco television advertising was high in these remote Aboriginal communities; more Aboriginal people recalled exposure to anti-tobacco television advertising than to any other cessation intervention. Although the overall cessation rate was low, a small number of smokers had given up as a result of seeing these television advertisements.
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http://dx.doi.org/10.1071/he05155DOI Listing
August 2005
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