Christopher Barton

Background: Nicotine exposure is increasingly occurring through non-combustible products such as electronic cigarettes and nicotine pouches. Although sport participation is often considered protective against substance use, nicotine use appears to be increasingly normalised within performance-oriented sporting environments. Methods: This scoping review synthesised evidence on non-combustible nicotine use among amateur and university athletes. Following Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, the searches were conducted in Ovid MEDLINE, Web of Science, Embase, Scopus, SPORTDiscus, and CINAHL for peer-reviewed studies published from 2019 onwards that examined non-combustible nicotine use in these populations. Results: Eleven studies, predominantly cross-sectional and conducted in high-income Western countries, met the inclusion criteria. Nicotine use was more common among male athletes, younger athletes, and those participating in team and contact sports, particularly for e-cigarette use. Across studies, nicotine use was frequently characterised as socially normative and compatible with sport, influenced by peer networks, social identity, perceived harm reduction, and beliefs regarding performance enhancement, coping, and recovery. The evidence base was limited by inconsistent measurement approaches and a predominance of studies examining demographic correlates rather than behavioural drivers. Conclusions: Non-combustible nicotine use appears embedded within sport-specific social norms and performance-related beliefs, highlighting the need for theoretically informed research and sport-specific prevention strategies.

Background: Nicotine exposure is increasingly occurring through non-combustible prodcuts such as electronic cigarettes and nicotine pouches. Although sport participation is often considered protective against substance use, nicotine use appears to be increasingly normalised within performance-oriented sporting environments. Methods: This scoping review synthesised evidence on non-combustible nicotine use among amateur and university athletes. Following JBI methodology and PRISMA-ScR guidelines, the searches were conducted in Web of Science, Embase, Scopus, SPORTDiscus and CINAHL for peer-reviewed studies published from 2019 onwards that examined non-combustible nicotine use in these populations. Results: Twelve studies, predominantly cross-sectional and conducted in high-income Western countries, met the inclusion criteria. Nicotine use was more common among male athletes, younger athletes, and those participating in team and contact sports, particularly for e-cigarette use. Across studies, nicotine use was frequently characterised as socially normative and compatible with sport, influenced by peer networks, social identity, perceived harm reduction, and beliefs regarding performance enhancement, coping, and recovery. The evidence base was limited by inconsistent measurement approaches and a predominance of studies examining demographic correlates rather than behavioural drivers. Conclusions: Non-combustible nicotine use appears embedded within sport-specific social norms and performance-related beliefs, highlighting the need for theoretically informed research and sport-specific prevention strategies.

Background: There has been limited research among family physicians (FPs) in Türkiye regarding smoking cessation and few studies have examined their perceptions of e-cigarettes as smoking cessation aids. This study aimed to examine the knowledge, attitudes and beliefs of FPs in Istanbul about e-cigarettes and their potential role in smoking cessation. Methods: A cross-sectional online survey was distributed via email to a convenience sample of FPs in Istanbul. Participants were recruited from a list of family practice clinics provided by the Istanbul Provincial Health Directorate and other social media platforms. Data was collected from August until October 2022. Survey items were drawn from published literature and informed by the Theory of Planned Behaviour. Items were translated to Turkish and assessed knowledge, attitudes, beliefs, and willingness to recommend e-cigarettes as a smoking cessation aid to patients who had failed to quit using other methods. Results: We received 243 responses from male ( n = 116, 47.7%) and female ( n = 127, 52.3%) FPs with an average age of 42 ± 10 years and an average of 9 ± 6 years clinical experience. Most participants believed it was their responsibility to aid patients in getting the correct help to quit smoking ( n = 159/217, 73.3%) and that current medications are effective in helping patients quit smoking ( n = 171/217, 78.8%). Most disagreed that e-cigarettes were suitable as smoking cessation aids ( n = 169/217, 77.9%) or safer than regular cigarettes ( n = 165/214, 77.1%). Respondents were concerned e-cigarettes were a gateway to smoking ( n = 153/217, 70.5%), addictive ( n = 166/217, 76.5%) and harmful to the health of the user ( n = 162/215, 75.3%). Over half stated they were not confident in their level of knowledge about e-cigarettes ( n = 126/200, 63%), or their ability to answer patient questions ( n = 119/200, 59.5%) and talk to patients about e-cigarettes ( n = 121/199, 60.8%). More than half stated they would not recommend e-cigarettes to patients that refuse to take alternative treatments ( n = 121/197, 61.4%) or to patients that have failed to quit using other methods ( n = 118/197, 59.9%). Conclusion: Family physicians in Istanbul demonstrated poor knowledge and confidence regarding e-cigarettes and generally held negative attitudes toward their use for smoking cessation. Knowledge and beliefs about effectiveness of e-cigarettes were key factors associated with recommendation practices. These findings highlight the need for education and guidance to support FPs in responding to patient enquiries about e-cigarettes, in line with the current regulatory context in Türkiye.

Stigma is a recognised barrier to self-management and medication adherence among people living with chronic illness. In asthma, existing research has largely conceptualised stigma as situational or episodic and has rarely examined older adults, whose experiences are shaped by decades of social and medical change. This study examined how asthma-related stigma is accumulated, negotiated, and reinterpreted across the life course, and how these processes shape identity and self-management in later life. We conducted an interpretive phenomenological analysis (IPA) of repeated, in-depth interviews with six older adults (aged 57–86 years) living with asthma in Australia. Narrative analytic techniques and life history mapping were integrated to examine how experiences of stigma were structured, interpreted, and reinterpreted over time. Participants’ narratives revealed that asthma-related stigma was cumulative rather than episodic, developing through historically situated social norms. Early experiences of disbelief, exclusion, and social comparison shaped enduring patterns of concealment, particularly around visible medication use. Across adulthood, these practices became embedded within identity and social relationships. Managing the visibility of asthma, through concealment of symptoms, inhaler use, and diagnosis, emerged as the central mechanism through which stigma was negotiated, often at the expense of optimal self-management. Although improvements in medical care enabled some reframing in later life, stigma persisted in subtle forms. These findings reconceptualise asthma-related stigma as a cumulative, life-course process organised through visibility and identity management, highlighting the enduring influence of social norms on health behaviours in older adulthood.

Introduction: In October 2024, nicotine vaping products (NVPs) containing ≤ 20 mg/mL nicotine were reclassified to the Schedule 3 (‘pharmacist‐only’) category, permitting pharmacy‐based supply of unregistered therapeutic vapes for smoking cessation in Australia. This regulatory shift expanded pharmacists' roles in tobacco harm reduction, yet their preparedness and capacity to deliver counselling and product supply, specifically related to unregistered therapeutic vapes under the 2024 reforms, remain unclear. In South‐East Melbourne, where smoking and vaping rates are high, equitable access to cessation services via community pharmacy is a public health priority. This study examined the availability of therapeutic vapes in pharmacies and explored pharmacists' smoking cessation practices and support needs. Methods: A sequential mixed methods study was conducted across the South East Public Health Unit (SEPHU) catchment in Victoria. It included: (1) an audit of therapeutic vape availability in community pharmacies; (2) a survey of pharmacists' cessation practices, confidence and service provision and (3) qualitative interviews to contextualise findings. Survey and audit data were mapped using Geographic Information System (GIS) tools to examine spatial patterns in NVP availability, socioeconomic status (SES) and smoking and vaping prevalence. Interview transcripts were analysed using Braun and Clarke's 6‐step framework for thematic analysis. Data were collected between May and July 2025. Results: Of 418 community pharmacies audited in the catchment region, 174 (41.6%) reported supplying therapeutic vapes. Seventy (16.7%) pharmacists completed the survey; most ( n = 30/32, 93%) dispensed therapeutic vapes fewer than five times weekly. Availability was higher in areas of greater socioeconomic advantage. Interviews revealed barriers to supply including perceptions of limited evidence, low demand and shelf space constraints. Ethical tensions around therapeutic vape provision, commercial pressures influencing supply decisions and systemic barriers to counselling including time constraints and lack of remuneration were also identified. Conclusions: By mid‐2025, therapeutic vapes were available in fewer than half of community pharmacies in South‐East Melbourne, with access skewed towards higher socioeconomic status (SES) areas. Pharmacists faced multiple barriers to the provision of nicotine vaping products and cessation counselling, shaped by commercial determinants and systemic constraints. Further research and regional public health action are needed to support equitable, evidence‐based cessation care in community pharmacy. So What: Uneven availability of therapeutic vapes across socioeconomic areas risks reinforcing existing inequities in smoking cessation support. Targeted public health strategies are needed to improve equitable access, strengthen pharmacist capacity and ensure implementation of vaping reforms aligns with broader smoking cessation goals.

The rapid evolution of nicotine delivery systems is reshaping substance use patterns among young adults globally. In Australia, despite strict tobacco control policies, the proliferation of disposable vapes, nicotine pouches, and other nicotine products remains a concern, particularly among young adults. National surveys provide valuable insights but lack the frequency and granularity needed to detect emerging products and behavioural shifts in young people, aged 18-25. Agile, context-specific surveillance systems are urgently required to identify evidence for actionable interventions. This protocol describes a sentinel surveillance programme to monitor vaping and emerging nicotine product use among university students aged 18-25 years in Melbourne, Australia. Semesterly cross-sectional surveys will be conducted at selected campus events and health service clinics, supported by trained Student Wellbeing Champions. Survey instruments will be updated twice yearly to capture emerging trends. A longitudinal cohort will enable twice yearly follow-up to examine behavioural trajectories and psychosocial determinants. Data will include prevalence, emerging products, attitudes, and campaign exposure using validated instruments adapted from national studies. The study introduces a novel application of sentinel surveillance within a university setting, addressing a critical gap in Australia's monitoring systems. By embedding surveillance within health promotion initiatives, the programme will generate timely, actionable evidence to inform cessation strategies, policy evaluation, and harm-reduction efforts. The approach is scalable and aligns with global priorities for adaptive nicotine control surveillance to support public health action on youth and young adult vaping.

Medical students are exposed to sensitive topics throughout their university education. Topics can be sensitive based on an individual's life experience, and common examples include domestic violence and mental health. Teaching sensitive topics risks re-traumatisation, and educators typically receive little training in balancing harm minimisation and maximising preparedness to handle distressing patient encounters. A trauma-informed medical education (TIME) approach has been proposed, aiming to optimise the learning environment, improve resilience and prepare students for practice. However, perceptions of TIME and which approaches students find effective remain incompletely understood. We conducted a descriptive, qualitative study design using semi-structured interviews with sixteen medical students from Monash University, Australia. We recruited students in their final years who had completed their general practice rotation, and interviews were recorded and transcribed verbatim. We undertook reflexive thematic analysis of transcripts using NVivo software. The overarching theme was the generation of a 'Safe Space' to learn sensitive topics. Contributing elements included sub-themes of (1) Preparedness for Teaching, (2) Teaching Techniques, and (3) Debriefing. Students reported that many TIME strategies were already in place in their teaching. The findings highlighted that trauma-informed teaching strategies were effective in promoting medical student psychological safety and well-being.

Introduction: Stigma is a common experience for individuals diagnosed with chronic obstructive pulmonary disease (COPD). It may elicit a set of emotional responses, consistent with alexithymia, that hinders conversations with healthcare providers. Alexithymia describes a set of cognitive-affective traits linked with difficulty identifying and distinguishing emotions. This study explored whether anticipated stigma in healthcare settings among patients with COPD is associated with alexithymia and whether it predicts satisfaction with care from healthcare providers. Methods: An online survey comprising validated questions was distributed between May and June 2024 to individuals who self-reported a doctor-diagnosis of COPD. Participants were recruited from advertisements on social media, online COPD support groups, and previous related studies. Correlation and multiple linear regression analyses were conducted to examine relationships between variables. Structural equation modelling (SEM) was used to explore these relationships through path analysis. Results: Respondents (n = 123) ranged in age from 33 to 90 years. Greater anticipated stigma was associated with higher levels of alexithymia (r = 0.278, p = 0.002) and lower satisfaction with care (r = −0.462, p < 0.001). In the path analysis, social support emerged as a mediating factor between alexithymia and anticipated stigma. As alexithymia increased, satisfaction with social support decreased, which was associated with higher anticipated stigma and reduced satisfaction with care from healthcare providers. Conclusion: This study helps clarify the association between alexithymia and anticipated stigma among people with COPD and how this impacts satisfaction with care. The findings signal a need to raise awareness of alexithymia and implement interventions to reduce stigma and enhance social support resources.