Samantha Marsh

Background: Smoking is common in Saudi Arabia, particularly among men. Religion plays a protective role against smoking and serves as a motivator for quitting. Faith-based interventions have shown positive effects in supporting smoking cessation among Muslims who smoke; however, few studies have tested their acceptability when delivered via mobile phone messaging. Objective: The aim of this pilot randomized controlled trial was to evaluate the feasibility and acceptability, as well as the preliminary effectiveness of an Islamic-based smoking cessation intervention delivered via WhatsApp messaging in Saudi Arabia. Methods: This study was a 2-arm randomized controlled trial involving adult Muslim smokers who used cigarettes, waterpipe, or both. Participants were recruited from the Kafa organization antismoking clinic in Saudi Arabia. Participants were randomized in a 1:1 ratio to either the intervention or control group. The intervention messages were codeveloped with religious leaders and informed by formative research with Muslim current and former smokers. The intervention group received both religious and smoking-related health messages, whereas the control group received smoking-related health messages only. The messages were manually delivered daily by trained research assistants. The intervention lasted for 21 days, during which participants received 2 messages per day, one in the morning and one in the evening. The primary outcomes were the feasibility and acceptability of the intervention. Results: A total of 34 participants were recruited, resulting in a recruitment rate of 68% (34/50). The overall retention rate was 64.7% (22/34). Both groups received 44 WhatsApp messages over 21 days. Message engagement was high, with 88.2% (15/17) of participants in the intervention group and 82.4% (14/17) in the control group, reporting that they read the daily messages. The intervention was acceptable and was perceived as helpful in supporting smoking cessation. Complete abstinence from both cigarettes and waterpipe was slightly higher in the intervention group (4/17, 23.5%) than in the control group (3/17, 17.6%). Cigarette abstinence was also modestly higher in the intervention group than in the control group (5/16, 31.3% vs 3/16, 18.8%). Among 8 waterpipe users at baseline, 2 reported waterpipe abstinence at follow-up, both in the intervention group. No statistical comparisons of smoking cessation outcomes between the groups were conducted because the study focused on feasibility and included a small sample size. These findings were descriptive and should be considered exploratory rather than evidence of intervention effectiveness. Conclusions: This Islamic faith-based intervention, delivered via WhatsApp messaging, was acceptable and may be feasible for a full-scale trial, provided that recruitment, participant retention, and follow-up data collection are improved. The pilot study provides important lessons for intervention design and implementation of a future adequately powered trial.

This article maps and prioritises the foundational developmental needs of children and adolescents: social development, cognitive growth, emotional regulation, identity formation, and moral reasoning. Early and excessive digital engagement is then examined for its potential to impact these milestones, with consequences that reverberate through wellbeing, relationships, and lifelong resilience. Arguments which frame digital engagement as an individual right with potential benefits, downplay developmental risks. Drawing on developmental rights and agency frameworks, the current review disputes the prevailing assumption that digital participation should take precedence over healthy developmental trajectories. Instead, the debate is reframed around children’s evolving capacities. It is proposed that digital entitlements are nested within age-appropriate limits and supports. Protecting the best interests of the child requires recognising the risk of addictive technology use. The rights of the child must also ensure cultivation of emotional competence and self-reliance. Overemphasis on digital expression risks elevating performative self-presentation before moral reasoning, critical thinking, and offline social skills have matured, particularly within environments shaped by algorithmic amplification, transient relationships, peer harassment, and the desire for validation. To address these risks, we advocate for a multi-layered public health response: consistent, developmentally attuned messaging; empowered parents and educators; whole-school strategies; and policy reforms that prioritise safety, accountability, and developmental alignment. By situating digital engagement within a developmental framework, this article proposes key principles on which to base the discussion of safeguarding youth wellbeing in the digital era.

Background: Rapid, cost-effective diagnosis of acute respiratory infections is now possible using multi-viral rapid-antigen point-of-care tests (MVRA-POCTs) with high sensitivity and specificity. These offer a realistic alternative to polymerase chain reaction tests in primary care. However, evidence of acceptability and clinical utility in this setting is limited. Aim: To pilot feasibility of integrating MVRA-POCTs into routine primary care, and investigate patient and clinician attitudes and behaviours. Design & setting: A prospective mixed-methods pilot study in seven New Zealand (NZ) primary care clinics during winter 2023. Method: Patients with acute respiratory symptoms received an MVRA-POCT (instead of COVID-19-only). Outcomes and acceptability were assessed via audits of electronic medical records, clinician and patient surveys, and interviews and focus groups with patients and clinic staff. Results: Swab results were recorded from a demographically diverse cohort of 1754 patients; 14% tested positive for any virus ( n = 246/1754). All clinicians and most patients surveyed positively evaluated the test. All clinicians incorporated the MVRA-POCT into practice and found it useful. In total, 63% of prescribers ( n = 26/41) reported results influenced antibiotic prescribing; 12% ( n = 5/41) supported decisions about secondary care referrals for 12% ( n = 5/41). All patient responders who tested positive ( n = 39) and most testing negative ( n = 172/180, 96%) would like the MVRA-POCT in future. Patients testing positive self-reported as more likely to follow non-pharmaceutical interventions to reduce transmission compared with those testing negative. Conclusion: MVRA-POCTs were well-accepted and readily incorporated into practice. Routine integration into primary care could potentially improve management of common respiratory illnesses and promote patient behaviour change to reduce transmission.

BACKGROUND Smoking is common in Saudi Arabia, particularly among men. Religion plays a protective role against smoking and serves as a motivator for quitting. Faith-based interventions have shown positive effects in supporting smoking cessation among Muslims who smoke, but few studies have tested their acceptability when delivered via mobile phone messaging. OBJECTIVE The aim of this pilot randomized controlled trial (RCT) was to evaluate the feasibility and acceptability of an Islamic-based smoking cessation intervention delivered via WhatsApp messaging in Saudi Arabia. METHODS This study was a two-arm RCT involving adult Muslim smokers who used cigarettes, waterpipe, or both, with participants randomized in a 1:1 ratio to either the intervention or control group. The intervention messages were co-designed with religious leaders and informed by formative research with Muslim current and former smokers. The intervention group received both religious and smoking-related health messages, while the control group received smoking-related health messages only. The intervention lasted for 21 days, during which participants received two messages per day, one in the morning and one in the evening. The primary outcomes were the feasibility and acceptability of the intervention. RESULTS A total of 34 participants were recruited, Two-thirds of whom remained in the study for the full study period. Both groups received 44 messages over 21 days. Message engagement was high, with most participants reading the daily messages (88.2% in the intervention group and 82.4% in the control group). The intervention was acceptable and helpful in supporting smoking reduction or cessation. Abstinence from all tobacco products was 20.6%, with a slightly higher rate in the intervention group (23.5%) than in the control group (17.6%). Cigarette abstinence was 35.3% in the intervention group and 23.5% in the control group, while waterpipe abstinence was much higher but equal in both groups (76.5%). Among those who continued smoking, modest reductions in cigarette and waterpipe consumption were reported in both groups. CONCLUSIONS This Islamic faith-based intervention, delivered via WhatsApp messaging, was feasible and highly acceptable, showing promising effects on smoking cessation and reduction. However, these findings require verification in a larger, fully powered effectiveness trial. CLINICALTRIAL Australian and New Zealand Clinical Trials Registry Trial Registration No. ACTRN12625001413415 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=390880&showOriginal=true&isReview=true

Introduction Influenza is a major global health concern, responsible for up to 650 000 respiratory-related deaths annually. Although influenza is often perceived as mild in healthy adults, it can cause severe outcomes in high-risk groups, such as older adults, young children, pregnant women and those with underlying medical conditions. Various clinical, sociodemographic and environmental factors influence the progression to severe outcomes, whereas resilience factors, such as vaccination, may reduce risks. Despite growing research, the evidence base regarding risk and resilience is spread across many different aspects of the literature. This umbrella review will synthesise evidence from existing systematic reviews and meta-analyses to identify key risk and resilience factors associated with the progression of influenza to severe outcomes in the general population. Methods and analysis This umbrella review follows the Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will include systematic reviews and meta-analyses reporting host-related risk or resilience factors for severe influenza outcomes. Four databases (EMBASE, Scopus, Medline and CINAHL) will be searched for English-language publications. Study quality will be assessed using AMSTAR 2, and the body of evidence will be evaluated using Grading of Recommendations Assessment, Development and Evaluation. Due to heterogeneity, findings will be analysed narratively. Risk and resilience factors will be grouped into demographic, clinical, behavioural, social and psychological domains. Ethics and disseminations No ethical approval is required. The completed review will be shared through peer-reviewed journals and conference presentations. PROSPERO registration number CRD420250644475.

Introduction: Although paracetamol is the most widely used prescription and over-the-counter drug globally, it also has a higher toxicity than other common non-opioid analgesics and is a leading preventable cause of acute liver failure and liver transplants. International evidence suggests that the public may have inadequate knowledge about paracetamol; however, in Aotearoa New Zealand (NZ), paracetamol is relatively cheap and readily available in large quantities at pharmacy and non-pharmacy outlets. Aim: To identify paracetamol-associated knowledge, attitudes and beliefs of the NZ public. Methods: Using Horizon Research Limited, a NZ-based research panel, we explored paracetamol-associated knowledge, attitudes and practices using an online survey. Results: A total of 1723 respondents completed the survey. High rates of unintentional misuse of paracetamol were identified, in addition to significant knowledge gaps, particularly those related to participants’ ability to identify paracetamol-containing formulations. Participants were also supportive of introducing policies restricting the supply and sale of paracetamol, such as where paracetamol can be purchased. Discussion: There appears to be a need to increase the NZ public’s knowledge of the safe use of paracetamol. Given the current lack of policies restricting access to paracetamol, the substantial proportion of the NZ adult population exceeding paracetamol dosing guidelines, and the public’s apparent support for introducing policies, our findings may have important implications. However, research is required to understand the potential impact of tightening current regulatory policies, including restricting where you can purchase paracetamol or reducing the amount of paracetamol you can purchase at once, before they are introduced.

This study investigated women’s exposure to adverse childhood experiences (ACEs), non-partner violence (NPV), and intimate partner violence (IPV) throughout the life course. It also explored the associations between these experiences and diagnosed mental health conditions (depression, anxiety), suicidal thoughts, and suicide attempts. This cross-sectional study utilized a population-based sample of 1464 women from He Koiora Matapopore | the 2019 New Zealand Family Violence Study. Over three-quarters of women (76.9%) reported exposure to any ACEs, NPV, or IPV, and more than half (55.1%) reported multiple exposures. Compared with unexposed women, women exposed to any ACEs, any NPV, and any IPV were significantly more likely to report any diagnosed mental health condition, suicidal thoughts, and suicide attempts (adjusted odds ratios (AORs) ranged from 1.8 to 4.7). Mental health services should be equipped to assess women’s violence exposure and provide trauma-informed care. A greater focus on violence prevention and mental health promotion is also needed.