The Australasian Professional Society on Alcohol and other Drugs

ASVCP-SIG

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These webinars are organised by the APSAD Smoking and Vaping Cessation Professionals (ASVCP) Special Interest Group for APSAD members, providing the opportunity to share information and knowledge through regular contact and webinars. The aim is the promotion of optimal smoking cessation practice in Australasia by trained health professionals incorporating evidence-based practice with an ongoing learning objective.

Membership of the ASVCP-SIG is open to APSAD members with an interest in Smoking and Vaping Cessation. For information contact Membership Services at This email address is being protected from spambots. You need JavaScript enabled to view it..

Coming Up in the ASVCP Webinar Series

Tuesday 4 June 2024 | 1300 (AEST)

Trends in vaping and tobacco smoking: An Australian and Aotearoa New Zealand outlook

Presenters:
Professor Hayden McRobbie, National Drug & Alcohol Research Centre, University of New South Wales, Sydney; and Regional Director, Northern National Public Health Service, Health Board New Zealand, 
Dr Ryan Courtney, Program Lead Tobacco Research Group, National Drug & Alcohol Research Centre, University of New South Wales, Sydney; Associate Professor/ National Heart Foundation Future Leader Fellow; and ASVCP Chair

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Tuesday 18 June 2024 l 1200 (AEST)

Tobacco Use in Drug and Alcohol Use Disorders: First cab off the rank or least of our problems

Presenter: Dr Adam Pastor, Deputy Director Department Addiction Medicine, St Vincent's Hospital Melbourne

This webinar will cover the epidemiology and evidence base for treatment of tobacco use disorders in people with other substance use disorders. It will also cover important clinical considerations including drug-drug interactions and considerations in prioritisation of care..

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Registration Terms and Conditions

Any persons affiliated with tobacco entities (current, in the past, or have future plans), tobacco lobbyists, either professionally or on a personal basis, will be ineligible to attend or present at any APSAD webinar or event.

APSAD’s policy is aligned with the World Health Organization’s Framework Convention on Tobacco Control, Article 5.3: There is a fundamental and irreconcilable conflict between the tobacco industry’s interest and public health policy interests. 

Registrations from such persons will be cancelled without notice. Paid registrations of such persons will not be refunded.

Disclaimer

The views expressed by presenters and speakers are not necessarily the views of APSAD, and the Society does not accept responsibility for any information, research, recommendation or advice presented.

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Watch ASVCP Webinars

Previous Recordings

April 2024 An update on the Royal Australian College of General Practitioners (RACGP) guidance for clinicians on Therapeutic Vaping

This presentation will critique recent changes to regulation on access to vaping products and discuss use of therapeutic vaping for treatment of nicotine dependence.

Presenter: Professor Nicholas Zwar, Executive Dean, Faculty of Health Sciences and Medicine, Bond University

WATCH THIS WEBINAR 

March 2024 Reducing e-cigarette use among young people in NSW - social marketing campaign

This presentation will provide an overview of the NSW social marketing campaign to reduce e-cigarette use among young people (14-24 years). The presentation will focus on research and insights for campaign development

Presenters: Kate Reakes, Manager, Cancer Prevention, Cancer Screening & Prevention, Cancer Institute NSW, and  Dr Sandra Rickards, Team Leader, Research & Evaluation, Cancer Screening & Prevention, Cancer Institute NSW

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February 2024 | Intensive tobacco treatment incorporating contingency management for women attending substance use in pregnancy antenatal services. Is it feasible?

Pregnant women who use tobacco and other psychoactive substances are a high-priority group. Typically, considerable resources are devoted to preventing other substance use, but most women will continue to smoke tobacco throughout their pregnancy and beyond. This webinar describes the feasibility of an intensive tobacco treatment incorporating contingency management, nicotine replacement therapy and behavioural counselling into treatment for women attending substance use in pregnancy antenatal services. Included are results from the pilot trial including a cost-consequence analysis, and qualitative analysis of acceptability from the client and clinician perspective.

Presenter: Dr Melissa Jackson, Clinical Trial Coordinator, Drug and Alcohol Clinical Services Research Unit, Hunter New England Local Health District, NSW

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October 2023 | Generation Vape: The explosive rise in youth vaping in Australia

Presenter: Becky Freeman, Associate Professor Becky Freeman leads a program of research focused on countering the commercial determinants of health, including tobacco, e-cigarettes, and processed food.

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September 2023 | Unlocking options: The changing landscape of smoking cessation medications’ availability in Australia

Presenter: Deepali Gupta, is an advanced pharmacist, working across many complex clinical areas at QEII Hospital in Brisbane
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AUGUST 2023 | The teachable moment of lung cancer screening: stakeholder views and significant opportunities to offer cessation support

Presenter: Nathan Harrison PhD Candidate and Senior Research OfficerPublic Health Discipline and National Centre for Education and Training on Addiction (NCETA), College of Medicine and Public HealthFlinders University

June 2023 |Vaping Trends

Presenter Prof Ryan Courtney 
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May 2023The patient experiences of adults with Chronic Obstructive Pulmonary Disease (COPD) in Australian general practice

Study findings from four studies, conducted as part of the PhD thesis will be discussed. The studies broadly seek to describe and synthesise the experience of care for adults with COPD and focus on patients seeking care in the community, who continue to smoke. The first study was a secondary analysis of data from an online, nationwide survey. Next, a meta-ethnographic review of published qualitative studies and a mixed-methods narrative rapid review that described patient experiences during the COVID-19 pandemic. Finally, an Interpretative Phenomenological Analysis (IPA) to explore the healthcare experiences of patients with doctor diagnosed COPD in primary care.Presenter: Sanduni Madawala, Research Fellow/Research Assistant Department of General Practice Monash University

April 2023 |Why has Australia failed to implement tobacco endgame policies and what might precipitate policy adoption?

Modelling indicates that tobacco endgame policies will rapidly reduce smoking and improve health equity. Andrew’s PhD study uses applied policy research to explore themes and framing of tobacco endgame policies for Australia. Approaches include comparative policy analysis, and analysis of media articles, public health submissions and interviews with policy stakeholders. Dominant public health models and theories of the policy process inform the research designs and data analysis.

Presenter: Andrew Perusco, PhD Student/ Sir Roland Wilson Scholar Team/Department National Centre for Aboriginal and Torres Strait Islander Wellbeing Research/ NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame

March 2023 | High-dose transdermal nicotine replacement therapy: Risk of overdose or best practice?

Nicotine Replacement Therapy (NRT) has been an approved first-line smoking cessation therapy for almost 40 years. When used in recommended doses, NRT increases the odds of a person quitting smoking. However, smokers range in nicotine plasma levels and some smokers are more highly dependent than others. So for a high nicotine dependent smoker, the recommended doses may be insufficient to manage withdrawals and “ replace” the nicotine.This presentation explores the evidence around using multiple patches concurrently, and provides some practical case studies illustrating how it can be approached.

Presenters: Prof Renee Bittoun Tobacco Treatment Specialist, Consultant, Professor, Nicotine Addiction Unit, Lifestyle Medicine, Avondale University, Australia, and the Medical School, University of Notre Dame, Australia,

Andrew Mark Health Promotion Officer, Illawarra Shoalhaven Local Health District 

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February 2023 | The cardiovascular risk & benefits of smoking cessation pharmacotherapies use among cardiac patients

This webinar reports the results of three population-based cohort studies. The first provides evidence on how the three smoking cessation pharmacotherapies available in Australia (NRT, varenicline and bupropion) compare to each other in terms of cardiovascular safety. The second describes the use of these pharmacotherapies among patients who hospitalised in NSW with major cardiovascular disease. Our third study compares the effectiveness of NRT and varenicline in preventing recurrent cardiovascular events. 

Presenters: Dr Alys Havard, Senior Research Fellow, National Drug and Alcohol Research Centre and School of Population Health, UNSW Sydney

Dr Annelies Robijn, Postdoctoral Research Fellow  National Drug and Alcohol Research Centre, UNSW Sydney. 

Presentation Slides

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January 2023 |Smoking Cessation for Hospitalised Patients - Do We Have Time to Intervene?

In the first ASCP webinar of 2023  Associate Professor Ben Kwan will review the concept of hospital based smoking intervention, different approaches and model of care. Along with the role of different health professional groups within the acute care setting to aid in smoking cessation.

Presenter A/Prof Benjamin Kwan, Senior Staff Specialist, St Vincent's Hospital, Sydney & Sutherland Hospital
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December 2022 |Let's talk about smoking Smokefree Healthcare in Mental Health Services

Mental health alcohol and other drug (MHAOD) services are well positioned to provide smoking cessation care to people experiencing mental illness however, the delivery of routine evidence-based care has not been easily achieved. This webinar will describe the practice change undertaken in Queensland to implement routine smoking cessation care across Queensland public adult MHAOD services and the partnership developed with Quitline Queensland to provide an intensive Quit program. The presentation will provide statewide outcomes, offer reflections on strengths and challenges, and provide a brief introduction to future initiatives.

Presenter: Sally Plever, is a Psychologist. She currently co-manages the Queensland Health Mental Health Clinical Collaborative (Qld MHCC), a statewide initiative for clinical service improvement in adult mental health, alcohol and other drug services

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 November 2022 | Escape the Vape: Supporting Adolescents and Young Adults Quit Vapes

The presentation will focus on clinical engagement supporting adolescents quit vapes, including assessment and management of nicotine dependence using the 5As brief intervention framework.
Presenters: Dr Bronwyn Milne and Mary Wahhab from The Children's Hospital Westmead. 

To download a copy of the presentation slides, click here

For resources for clinicians working with adolescents, click here

August 2022 |What's in a vape: Implications for the regulation of electronic cigarettes in Australia

Australian regulation of electronic cigarettes and the scheduling of nicotine for use in these devices has recently changed (October 2021). Jody's research involves the examination of the content and toxicity of electronic cigarette liquids and aerosols.

Presenter: Dr Jody Moller (Morgan), is a lab-based toxicology researcher whose research interests sit at the intersection of analytical chemistry and public health with a focus on harm reduction methods. Her current research is focused on electronic cigarettes, cannabis and pill-testing, with particular emphasis on identification and quantification of chemical constituents in samples available to Australian consumers.

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June 2022 | Indigenous excellence in reducing smoking prevalence

Presenter: Dr Raglan Maddox’s (Modewa Clan, Papua New Guinea) program of research has focused on Indigenous tobacco.

There have been significant declines reducing tobacco use. In 2018–19, 40.2% of Aboriginal and Torres Strait Islander adults were smoking daily. This reflects a 9.8% absolute decrease in prevalence since 2004–05 (50.0%) and representing almost 50,000 fewer Aboriginal and Torres Strait Islander smokers than if prevalence remained unchanged. What lessons can we take from Indigenous tobacco control since 2004-05 and where to from here?

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May 2022 | Smoke in clinician's eyes - missing foetal nicotine exposure

Presenter:Angela Ratsch is a registered nurse and midwife with a particular interest in the neonatal outcomes from exposure to tobacco and nicotine pre-conceptionally and during gestation

In Australia, the maternal use of cigarettes is recorded twice across the nine months of pregnancy, however the maternal use of NRT and/or other cigarette and nicotine alternatives such as e-cigarettes, heat-not-burn tobacco, nicotine spray, mist, lozenges, gum and patches, hookahs, and chewed tobacco products is not collected. In addition, the paternal and house-hold use of tobacco and nicotine products is not recorded, thus maternal second-hand tobacco and nicotine exposure is not captured. This knowledge vacuum results in maternal and foetal tobacco and nicotine exposure misclassification and ramifications in the estimation of adverse maternal, paternal, foetal and neonatal outcomes from tobacco and nicotine exposure.

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April 2022 | 5 risk free behavioural strategies to manage cravings quickly

Presenter: James McLennan, State-Wide Smoking Cessation Training Co-ordinator, Alcohol and Drug Service, St Vincent’s Hospital, Sydney
Do you have clients and patients struggling when they experience cravings? Are you to finding it hard to offer practical, realistic strategies that work when cravings arise?

Here we inform of:

    • Five strategies that are risk free, cheap or cost free

    • Strategies that are easy to learn and apply yet grounded in science

    • Strategies that you can easily teach even if you are time-limited

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March 2022 | An update on the Royal Australian College of General Practitioners (RACGP) guidance on the role of Nicotine Vaping Products in smoking cessationPresenter: Professor Nick Zwar, Bond University and Chair of Expert Advisory Group for the publication An update on the Royal Australian College of General Practitioners (RACGP) guidance for smoking cessation.

This presentation will critique new changes to the regulation of nicotine as per new rescheduling of nicotine e-liquids and outline revised recommendations and practice points.

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August 2020 | An Evaluation of Online and Automated Smoking Cessation Programs

Presenter: Prof Ron Borland, Deputy Director, Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne
There is now a plethora of online smoking cessation apps and programs, most completely unevaluated and often not based on strong theoretical principles. This presentation will focus on what works and which might be available to Australian smokers. In particular, I will describe the characteristics of the QuitCoach (which I developed), the strong evidence base behind it, and the key techniques that appear to be behind its effectiveness. I will also discuss how automated resources might be used as complements to person-delivered resources, especially for smokers with more than average needs for help.
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July 2020 l The Utilisation, Effectiveness & Safety of Smoking Cessation Pharmacotherapies During Pregnancy: An Australian Population-Based Study
Presenter: Alys Havard, Senior Research Fellow, Centre for Big Data Research in Health, University of NSWThis NHMRC-funded research used linked pharmaceutical claims and administrative health data for all women who gave birth in New South Wales and Western Australia between 2004 and 2012 to examine the extent to which prescription NRT patches, bupropion and varenicline are used during pregnancy. To examine the effectiveness of these medicines during pregnancy, the smoking cessation rates associated with varenicline relative to NRT patch use was measured. The risk and benefits associated with these medicines in pregnancy was assessed by comparing the rate of adverse birth outcomes among women who used prescription NRT patches, bupropion or varenicline with the rate among women who smoked but did not receive any of these medicines.
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June 2020 l Smoking and the Course of COVID – Clear or Mud?
Presenter: Prof Matthew Peters, Respiratory Physician and Head of Respiratory Medicine at Concord HospitalProfessor Peters takes a look at the research around smoking and COVID.
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May 2020Smoking cessation care for pregnant and postpartum Indigenous Australian women: A collective approach
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Presenters: A/Prof Gillian Gould, GP & Tobacco Treatment Specialist; Tabassum Rahman, PhD candidate; Dr Parivash Eftekhari, post-doctoral researcher and pharmacist, University of Newcastle; Allison Hart, Aboriginal Research Assistant & Cultural Liaison Officer IsistaquitEffective smoking cessation care (SCC) can save unnecessary loss of lives and smoking-related life long morbidity. The urgency of quitting smoking during pregnancy cannot be emphasised enough. Therefore, we put our effort to enhance SCC for pregnant Indigenous Australian women to support them to quit smoking for themselves and their families. Our research shows that smoking by Indigenous people is often influenced by numerous contextual, immediate social surroundings and personal factors, requiring SCC to be orchestrated at multiple levels and to be comprehensive. This presentation will be from Associate Prof Gillian Gould and members of her team to present their research on multiple aspects for interventions to address some of the major barriers around SCC. Ms Tabassum Rahman will present her systematic review about how the socio-ecological model can be applied to the barriers and enablers on system, health service, community and individual levels for the topic. A/Prof Gould will present the phased development and trials about the SISTAQUIT intervention (formerly ICAN QUIT in Pregnancy) that included an online training package for health professionals providing care to pregnant and postnatal Indigenous women, patient resources and free oral nicotine replacement therapy (NRT). A successful pilot study led to the randomised controlled trial of SISTAQUIT (Supporting Indigenous Smokers To Assist Quitting) and a national roll-out of the SCC care package as iSISTAQUIT, accompanied by a social media campaign. Dr Pari Eftekhari will present her research plan to engage family members, especially partners, in smoking cessation in pregnancy. Her research will explore partners perspectives to smoking cessation in pregnancy through our qualitative research project PAPAS. We will further outline a promising individual and community-based approach using the new MAMA-Empower Health App. Our collective goal is to make smoking cessation easier, more effective and relevant for Indigenous Australian women. The team will outline ways that the ASCP SIG could become involved in this research.
February 2020 | What is new in the second edition of Supporting Smoking Cessation: A Guide for Health Professionals? 
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Presenter: Prof Nicholas Zwar, Bond University and Chair of Expert Advisory Group for the publication The second edition of this publication from the Royal Australian College of General Practitioners was released on 28 January 2020 after a long process of review and discussion. The new edition has a number of substantive changes, including the incorporation of a brief intervention three step structure (Ask, Advise, Help) and a range of changes to recommendations for use of smoking cessation pharmacotherapies. The publication also includes recommendations around the role of nicotine containing e-cigarettes in assisting smoking cessation. These recommendations have attracted considerable attention.The presentation will cover the process undertaken for producing the new edition, the key changes in recommendations and the literature review and rationale behind these recommendations.
December 2019 | What is EVALI? What we do and do not know about the vaping lung cases in the USA 
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Presenter:  Prof Billie Bonevski, UON Women in Science Chair, Faculty of Health and Medicine, University of NewcastleIn April 2019, the first case was reported of what quickly became a high number of lung damage cases that appeared to be linked to the use of e-cigarettes in the USA. By now over 2000 cases have been reported, including 34 deaths, and the condition has been given a name:  “e-cigarette or vaping product use associated lung injury” (EVALI). All cases have been reported in the US and the CDC, FDA and state health authorities have been conducting investigations into causes. The latest advice based on those investigations is that it seems that EVALI is linked to street-bought tetrahydrocannabinol (THC) vaping, with vitamin E acetate, used as a cutting agent, implicated. It appears that nicotine vaping is not associated with EVALI.

This presentation will provide an overview of the EVALI “outbreak”, placing it in the context of the research evidence of the safety of nicotine vaping, the communications and media reporting used to inform the public about EVALI, and the potential consequences of misinformation.September 2019 | Let's not get burnt all over again: ill effects of electronic smoking devices  
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Presenter: Dr Sukhwinder Sohal, University of Tasmania, LauncestonThe effects of e-cigarette vaping on lung pathophysiology are slowly emerging which counter the unsupported claims of the nicotine/tobacco industry that electronic cigarettes are relatively safe. A single session of e-cigarette vaping has been shown to negatively affect lung function which is accentuated in asthmatics. Vaping has now also been linked to an increase in the risk of pneumonias, and in a mouse model e-cigarette vapour exposure has been shown to induce systemic inflammation and multi-organ fibrosis. This presentation will discuss the effects of electronic devices on lung health, supported by our own lab-based studies. This is important so that Australians are better informed when it comes to the safety of these newer devices and will help accelerate research efforts and allow health agencies to take evidence based regulatory decisions. August 2019 | Harm reduction for smoking in pregnancy – mixed messages and options 
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Presenter: A/Prof Gillian Gould, and Ratika Kumar, University of NewcastleSmoking in pregnancy is a well-known risk factor for both maternal and child health in the short as well as long term. Considering the limited research in this area and the fact that more than half of the women who smoke are not able to give up smoking during pregnancy, harm minimisation (harm reduction) options are desired. Women report they receive mixed messages about quitting versus cutting down in pregnancy from their healthcare providers.

In this webinar, we bring together our extensive research findings as well as world studies to provide an overview of what women are experiencing -  what the evidence is saying – and where to from here, in order to reduce the harms of smoking among pregnant women. Hear from GP research fellow and Tobacco Treatment Specialist A/Prof Gillian Gould, and Dr Ratika Kumar a dentist specialising in smoking cessation research in high-priority populations.July 2019 | Persistence of Cardiovascular Concerns of Pharmacotherapies for Smoking Cessation: Debunking the myths with the evidence 
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Presenter: Deepali Gupta, Senior Pharmacist, Preventative Team PAHDeepali will look at the evidence for cardio vascular concerns vs benefits of medications used for smoking cessation with a focus also in patients with cardiac disease. Come for an open discussion to discuss your concerns in managing smoking cessation in a patient with cardiac disease.June 2019 | Engaging Doctors: Shared Medical Appointments for smoking cessation and relapse prevention 
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Presenters: Prof Garry Egger, Professor of Lifestyle Medicine, is well known for his Gut Busters series and his world leadership in Lifestyle Medicine; A/Prof Renee Bittoun, Founding Editor-in-Chief The Journal of Smoking Cessation, Cambridge University PressShared Medical Appointments (SMAs), or group consultations are: “… a series of individual office visits (billable at individual rates) sequentially attending to each patient’s unique medical needs individually, but in a supportive group setting where all can listen, interact, and learn.” SMAs have been successfully used in chronic diseases such as Obesity and Diabetes. This presentation will describe a project that engages GPs in smoking cessation and relapse prevention using the SMA model.May 2019 | The Theory of Naturalising Non-Smoking: A Grounded Theory Study of Smoking Cessation 
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Presenter: Dr Rodrigo Ramalho, Psychiatrist and Academic at the University of Auckland Rodrigo's PhD research looked at the processes involved in smoking cessation and becoming a non-smoker using a grounded theory methodology. Informed by a critical theory perspective, his research and publications have focused on contributing to the development of a more person-centred, ground-up, and contextually sensitive health care, with an increasing emphasis on mental health and addictions. His research interests include mental health, addictions, tobacco smoking, and psycho-social aspects of illness and well-being.
April 2019 | Addiction Paper Authoring Tool Demonstration Presenter: Prof Robert West, Professor of Health Psychology, University College London, Editor-in-Chief AddictionA recording has not been providedAddiction Paper Authoring Tool (PAT), aims to assist researchers in writing research reports that contain all the required information, presented clearly and using consistent terminology, and structured in a way that makes it easy to see what was done and why what was found and what this means. It also stores the key information in a computer readable form making it much easier and quicker to use the paper in systematic reviews and meta-analyses. The first version of Addiction PAT focuses on 2-arm randomised controlled trials but it contains modules that can facilitate the writing of any research report. Behind Addiction PAT is the beginnings of an Addiction Ontology, a formal system for representing knowledge in addiction and research methods that are used to provide intelligent prompts for authors and facilitate evidence integration and theory development and use. The scope of Addiction PAT and the Addiction Ontology includes all addictions including the use of tobacco, alcohol and illicit drugs as well as behavioural addictions such as gambling.  
Robert covers examples from the smoking field, including mention of a new E-cigarette Research Ontology that Cancer Research UK has commissioned to help identify gaps in the literature and evaluate research findings using a consistent evaluative framework.March 2019 | Tackling Nicotine Together: Assessment of smoking behaviours and receipt of quit smoking support from alcohol and other drug treatment servicesThere is no recording available for this webinarPresenter: Dr Eliza Skelton, School of Medicine and Public Health, University of NewcastleEliza Skelton is a postdoctoral researcher at the University of Newcastle, Faculty of Health and Medicine. Her PhD entitled “An Investigation of an Organisational Change Approach for Smoking Cessation in the Alcohol and Other Drug Treatment Setting” is currently under review. February 2019 | First-line treatment for smokers at risk of developing COPD: The ECOS Study 
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Presenter: Tanya Badal, Research Assistant, Woolcock Institute of Medical ResearchTanya is a medicinal chemist-turned-clinical researcher for the Airways Physiology and Imaging Group at the Woolcock Institute of Medical Research and Concord Hospital. Her area of research includes respiratory physiology in both Smoking and Asthma.
January 2019 | Targeted and collective action on tobacco control leads to shifts in tobacco management and smoking cessation
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Presenter: Anke van der Sterren, Research Fellow, University of MelbourneThis webinar will discuss how a strategic and coordinated program of tobacco control activities by ACT alcohol and other drug (AOD) services—including targeted smoking cessation support to disadvantaged smokers—has led to significant changes in tobacco management policies, treatment practices, attitudes and smoking behaviours among service users, workers and AOD organisations. October 2018 | Cytisine for Smoking Cessation 
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Presenter: Dr Ryan Courtney, National Health and Medical Research Council Career Development Fellow at UNSW, National Drug and Alcohol Research CentreThis presentation will critique the current evidence related to the effectiveness and safety of cytisine for smoking cessation.September 2018 | Smoking Cessation Framework for NSW Health 
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Presenter: Gemma HemshawGemma presents the Framework for NSW Health Services in smoking cessation health care delivery. This is a collaborative initiative to support local health districts to better manage and implement smoking cessation initiatives.August 2018 | What makes an effective smoking cessation counsellor? 
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Presenter: Renee Bittoun, Founding Editor-in-Chief, Journal of Smoking Cessation, Cambridge University PressWho do you need to be to help people quit? This Webinar will cover the essential evidence-based characteristics of a successful smoking cessation counsellor or a tobacco treatment specialist.

For further details on the ASCP-SIGs, visit our webpage.DISCLAIMER
The views expressed by presenters and speakers are not necessarily the views of APSAD, and the Society does not accept responsibility for any information, research, recommendation or advice presented.