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Sheridan A, Conway R, Murphy E, Blake M, Mulcahy M, Howell F, Gordon C, Doyle F, Kavanagh PM. The impact of the introduction of tobacco product plain packaging on consumer responses in Ireland: a real-world policy evaluation stratified by socioeconomic groups. Eur J Public Health 2024; 34:970-978. [PMID: 39167744 PMCID: PMC11430915 DOI: 10.1093/eurpub/ckae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
Smoking prevalence remains high in Europe and widening socioeconomic group differences are driving health inequalities. While plain packaging policies disrupt tobacco industry tactics that sustain smoking, evidence of their equity impact is sparse. This study evaluated the implementation of plain packaging in Ireland in 2018 on consumer responses, overall and by the socioeconomic group. Consecutive nationally representative cross-sectional surveys (2018, n = 7701 and 2019, n = 7382) measured changes in 13 consumer responses among respondents who smoked across three domains: product appeal, health warnings effectiveness, and perceived harmfulness of smoking. Multiple logistic regression-derived adjusted odds ratios with 95% confidence intervals to compare responses post- versus pre-implementation adjusting for age, gender, educational level, and heaviness of smoking. A stratified analysis examined changes by socioeconomic group indexed using educational level. There were statistically significant changes in consumer responses to plain packaging policy implementation across 7/13 outcomes studied. Five changes were aligned with expected policy impacts (2/6 product appeal outcomes and 3/4 health warning effectiveness outcomes). Two responses were also observed which were not expected policy impacts (1 appeal-related and 1 perceived harm-related outcome). There was no change in five outcomes. Differences in consumer responses between educational groups were generally small, mixed in nature, and indistinguishable when interval estimates of effect were compared. Implementation of plain packaging in Ireland had intended impacts on consumer responses. Including plain packaging requirements in revising the European Union's legislative frameworks for tobacco control will help build progress towards a Tobacco-Free Europe without exacerbating smoking inequalities.
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Affiliation(s)
- Aishling Sheridan
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Robert Conway
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Edward Murphy
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Martina Blake
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | | | - Fenton Howell
- Department of Health, Tobacco and Alcohol Control Unit, Ireland
| | - Claire Gordon
- Department of Health, Tobacco and Alcohol Control Unit, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul M Kavanagh
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
- Department of Epidemiology and Public Health, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Canty R, Gartner CE, Hoek J, Hefler M. Global policy scan of commercial combustible tobacco product retailing regulations by WHO region. Tob Control 2024:tc-2023-058523. [PMID: 39059815 DOI: 10.1136/tc-2023-058523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 06/03/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND/AIMS Regulatory schemes for tobacco retailing help restrict the supply and availability of smoked tobacco products. Tobacco retailer density and the proximity of tobacco outlets to youth spaces, such as schools, are greater in more disadvantaged areas. Exposure to tobacco retailing normalises smoking and increases ease of access, thus increasing smoking uptake and undermining quitting. To inform future policy, we conducted a global scan of combustible tobacco retail regulatory schemes (We use the term schemes to refer to any kind of relevant initiative, policy, regulations or legislation that we found). METHODS All types of English language records concerning the regulation of commercial tobacco product availability were considered, including peer-reviewed journal articles, key reports and policy documents. The key features of regulatory schemes were documented. In addition, we contacted key informants in different countries and regions for advice on additional sources and undertook targeted searching in regions where we initially found little data. RESULTS/FINDINGS Although many countries have well-established and comprehensive tobacco control programmes, tobacco retail policy that actively addresses the availability of tobacco is underutilised. Many jurisdictions have implemented a minimum purchase age and restricted point-of-sale advertising and marketing. Other tobacco retailing regulations also included licensing systems with licence fees, caps on licences and restrictions on store location, type and retailer density/proximity. A very small number of jurisdictions have ended tobacco retailing altogether. CONCLUSIONS At a minimum, policy-makers should implement licensing schemes, licence caps and proximity limits and invest in robust monitoring systems and compliance enforcement. Tobacco products' ubiquity is incompatible with its status as a dangerous addictive substance and does not align with tobacco endgame goals.
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Affiliation(s)
- Ruth Canty
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Janet Hoek
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Public Health, University of Otago, Dunedin, New Zealand
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Malone RE, McAfee T. Birthdate-based commercial tobacco sales restrictions: will 'tobacco-free generation' policies advance or delay the endgame? Tob Control 2024:tc-2024-058716. [PMID: 38897727 DOI: 10.1136/tc-2024-058716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
Endgame thinking means transitioning from merely trying to 'control' the tobacco epidemic to developing plans and measures to bring it to an end within a specific time, by changing the underlying dynamics that have created and perpetuated it for more than a century. Among the innovative policies characterised as 'endgame' policies are so-called 'tobacco-free generation' or 'smoke-free generation' policies, which prohibit sales of some or all tobacco products to individuals born on or after a particular date. Such birthdate-based sales restrictions (BSR) have intuitive appeal, largely because they do not appreciably disrupt the status quo of retail sales, which continue unchanged for all those born before the designated cut-off date. They also hold the potential for further denormalising tobacco use and sales by anticipating the long-term end of tobacco sales. In this Special Communication, we analyse BSR policies through an endgame lens and propose questions that should be discussed in jurisdictions considering them. We suggest that this policy has potential underexamined pitfalls, particularly related to equity, and that if enacted, it should include policy guardrails and be part of a package of endgame measures.
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Affiliation(s)
- Ruth E Malone
- Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco, California, USA
| | - Tim McAfee
- Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco, California, USA
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Tamil Selvan S, Yeo XX, van der Eijk Y. Which countries are ready for a tobacco endgame? A scoping review and cluster analysis. Lancet Glob Health 2024; 12:e1049-e1058. [PMID: 38762285 DOI: 10.1016/s2214-109x(24)00085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 05/20/2024]
Abstract
Various countries have set tobacco endgame targets to eliminate tobacco use by a certain year. Tobacco endgames are generally considered more feasible in countries with advanced tobacco control measures and a smoking prevalence of 15% or less. We conducted a scoping review of 563 articles sourced from news, academic literature, and grey literature to examine global tobacco endgame progress, and grouped 153 countries into clusters based on their tobacco policy implementation score and smoking prevalence to systematically identify countries that might be well positioned to succeed in a tobacco endgame. The EU, Pacific Islands, and 18 other individual countries have set tobacco endgame targets, with another seven countries described as well positioned for an endgame. These were mostly high-income countries with higher smoking prevalence. We identified 28 endgame-ready countries with advanced tobacco policies and a low smoking prevalence. Of these, only five were part of tobacco endgame movements; the remaining 23 were all low-income or middle-income countries in Africa, Latin America, or Asia. Therefore, the global tobacco endgame movement should focus more on low-income and middle-income countries with low smoking rates and advanced tobacco policies, particularly in Africa, Latin America, and Asia.
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Affiliation(s)
- Sahaana Tamil Selvan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Xue Xin Yeo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
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Ruokolainen O, Ollila H, Laatikainen T, Pätsi SM, Carreras G, Gorini G, Carnicer-Pont D, Cselkó Z, Guignard R, Karekla M, Kilibarda B, Koprivnikar H, Lambrou A, Nguyen-Thanh V, Papachristou E, Schoretsaniti S, Vasic M. Tobacco endgame measures and their adaptation in selected European countries: A narrative review synthesis. Tob Prev Cessat 2024; 10:TPC-10-18. [PMID: 38638446 PMCID: PMC11025294 DOI: 10.18332/tpc/186402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
Due to the continued detrimental effects of tobacco use, a growing number of countries are embracing the idea of tobacco endgame, meaning ending the tobacco epidemic instead of controlling it. This narrative review aims to synthesize and update the evidence from earlier scientific reviews on effective tobacco endgame measures, as well as to assess their integration to current national strategies among European countries with official tobacco endgame goals. The synthesis of the prior scientific literature found most evidence on product-focused and some evidence for supply-focused policies. Little evidence was detected for user- and institutional-focused measures. An update for the tobacco-free generation measure showed uncertainty in reducing smoking prevalence, especially for adolescents' reactions to age-restrictive laws. All the countries that established a tobacco endgame strategy have included product standards in their measures, predominantly based on European Union regulations on conventional tobacco products, yet standards above this level and considering other products were also common. Cessation measures were given strong emphasis in strategies, yet none of the countries linked these to specific endgame measures. Despite commonly mentioning vulnerable groups, such as youth and pregnant women, adoption of measures to reduce tobacco use among these groups was scarce. Lastly, the decline in tobacco use seems to be modest, implying challenges in meeting the endgame goals. To meet these goals, European countries should reinforce the implementation of known effective tobacco control measures such as tax increases. Furthermore, new innovative strategies and measures to meet the objective of an endgame should be explored.
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Affiliation(s)
- Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Salla-Maaria Pätsi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Giulia Carreras
- Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Giuseppe Gorini
- Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Dolors Carnicer-Pont
- Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Programa de Prevenció i Control del Càncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Zsuzsa Cselkó
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Romain Guignard
- Prevention and Health Promotion Department, Santé publique France, Saint-Maurice, France
| | | | - Biljana Kilibarda
- Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut’, Belgrade, Serbia
| | | | - Angeliki Lambrou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | - Viêt Nguyen-Thanh
- Prevention and Health Promotion Department, Santé publique France, Saint-Maurice, France
| | - Efstathios Papachristou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | - Sotiria Schoretsaniti
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | - Milena Vasic
- Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut’, Belgrade, Serbia
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Hefler M. Tobacco Control: a finite project with the end on the horizon. Tob Control 2023; 33:1-2. [PMID: 38149644 PMCID: PMC10803981 DOI: 10.1136/tc-2023-058514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
- Marita Hefler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia
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Rooney T, Gartner C. Tobacco Industry Pseudo-Transformation: The Role of "Vested Interests," Allies and Third Parties. Nicotine Tob Res 2023; 25:1896-1898. [PMID: 37394232 DOI: 10.1093/ntr/ntad109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/16/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Tess Rooney
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
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Cosgrave EJ, Blake M, Murphy E, Sheridan A, Doyle F, Kavanagh P. Is the public ready for a tobacco-free Ireland? A national survey of public knowledge and attitudes to tobacco endgame in Ireland. Tob Control 2023:tc-2023-057958. [PMID: 37236784 DOI: 10.1136/tc-2023-057958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
AIM Ireland will not meet the tobacco endgame goal set in its 2013 Tobacco-Free Ireland (TFI) policy of reducing smoking prevalence to less than 5% by 2025. Public opinion on tobacco endgame, a key lever to realise this goal, is uncharted in Ireland. This study aimed to measure public knowledge and attitudes to tobacco endgame. METHODS A telephone-administered cross-sectional survey of 1000 randomly dialled members of the general public was conducted in 2022. Prevalence of awareness, perceived achievability and support for the TFI goal and tobacco endgame measures was calculated and compared across tobacco product use status. Logistic regression identified factors independently associated with goal support. FINDINGS Although TFI goal awareness was low (34.0%), support was high (74.6%), although most (60.2%) believed it achievable beyond 2025. Product-focused measures were popular while support for supply-focused measures was mixed: for example, 86.1% supported nicotine content reduction while 40.3% supported user licencing. Phasing out tobacco sales was highly supported (82.8%); for most, this was contingent on support for currently addicted users. TFI goal support was independently associated with female sex (adjusted odds ratio (aOR) 1.47, 95% CI 1.05 to 2.07), higher education (aOR 1.80, 95% CI 1.21 to 2.66) and non-tobacco product use (aOR 2.67, 95% CI 1.66 to 4.30). CONCLUSIONS Despite low awareness, tobacco endgame support is strong in Ireland. Public appetite for radically reducing tobacco product appeal and availability combined with public views on endgame achievability subject to extended timelines should be used to re-invigorate tobacco endgame discussion and planning in countries at risk of failing to meet declared targets.
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Affiliation(s)
| | - Martina Blake
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Edward Murphy
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Aishling Sheridan
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Kavanagh
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
- Department of Public Health and Epidemiology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Gartner C, Perusco A, Puljević C, Morphett K, Hefler M. International progress toward a commercial tobacco endgame is an opportunity for advancing tobacco control in Australia. Aust N Z J Public Health 2023; 47:100029. [PMID: 36963120 DOI: 10.1016/j.anzjph.2023.100029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/25/2022] [Accepted: 11/27/2022] [Indexed: 03/26/2023] Open
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10
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From the IASLC Tobacco Control Committee. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Bostic C, Bianco E, Hefler M. Progress, challenges and the need to set concrete goals in the global tobacco endgame. Rev Panam Salud Publica 2022; 46:e118. [PMID: 36211233 PMCID: PMC9534338 DOI: 10.26633/rpsp.2022.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/27/2022] [Indexed: 11/24/2022] Open
Abstract
The tobacco endgame is rapidly moving from aspirational and theoretical toward a concrete and achievable goal and, in some cases, enacted policy. Endgame policies differ from traditional tobacco control measures by explicitly aiming to permanently end, rather than simply minimize, tobacco use. The purpose of this paper is to outline recent progress made in the tobacco endgame, its relationship to existing tobacco control policies, the challenges and how endgame planning can be adapted to different tobacco control contexts. Examples of implemented policies in three cities in the United States and national policies in the Netherlands and New Zealand are outlined, as well as recent endgame planning developments in Europe. Justifications for integrating endgame targets into tobacco control policy and the need to set concrete time frames are discussed, including planning for ending the sale of tobacco products. Tobacco endgame planning must consider the jurisdiction-specific tobacco control context, including the current prevalence of tobacco use, existing policies, implementation of the World Health Organization’s Framework Convention on Tobacco Control, and public support. However, the current tobacco control context should not determine whether endgame planning should happen, but rather how and when different endgame approaches can occur. Potential challenges include legal challenges, the contested role of e-cigarettes and the tobacco industry’s attempt to co-opt the rhetoric of smoke-free policies. While acknowledging the different views regarding e-cigarettes and other products, we argue for a contractionary approach to the tobacco product market. The tobacco control community should capitalize on the growing theoretical and empirical evidence, political will and public support for the tobacco endgame, and set concrete goals for finally ending the tobacco epidemic.
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Affiliation(s)
- Chris Bostic
- ASH – Action on Smoking and Health, Washington, D.C., United States of America
| | - Eduardo Bianco
- The Annenberg Physician Training Program at the Frank Foundation, Bethel, Maine
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Stone E, Paul C. The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics. Curr Oncol 2022; 29:6325-6333. [PMID: 36135066 PMCID: PMC9497727 DOI: 10.3390/curroncol29090497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Smoking cessation represents an untapped resource for cancer therapy. Many people who smoke and have cancer (tobacco-related or otherwise) struggle to quit and as a result, jeopardise response to treatment, recovery after surgery and long-term survival. Many health care practitioners working in cancer medicine feel undertrained, unprepared and unsupported to provide effective smoking cessation therapy. Many institutions and healthcare systems do provide smoking cessation programs, guidelines and referral pathways for cancer patients, but these may be unevenly applied. The growing body of evidence, from both retrospective and prospective clinical studies, confirms the benefit of smoking cessation and will provide much needed evidence for the best and most effective interventions in cancer clinics. In addition to reducing demand, helping cancer patients quit and treating addiction, a firm commitment to developing smoke free societies may transform cancer medicine in the future. While the Framework Convention for Tobacco Control (FCTC) has dominated global tobacco control for the last two decades, many jurisdictions are starting to develop plans to make their communities tobacco free, to introduce the tobacco endgame. Characterised by downward pressure on tobacco supply, limited sales, limited access and denormalization of smoking, these policies may radically change the milieu in which people with cancer receive treatment, in which health care practitioners refine skills and which may ultimately foster dramatic improvements in cancer outcomes.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital Sydney, Darlinghurst 2010, Australia
- School of Clinical Medicine, University of New South Wales, Sydney 2052, Australia
- School of Public Health, University of Sydney, Camperdown 2006, Australia
- Correspondence:
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan 2308, Australia
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