Papers by Arifuzzaman Khan
Communicable diseases intelligence, Dec 21, 2021
In recent years, there have been ongoing outbreaks of mumps reported in Northern and North-Wester... more In recent years, there have been ongoing outbreaks of mumps reported in Northern and North-Western Queensland, Western Australia and the Northern Territory, Australia. We aimed to define the epidemiology of mumps outbreaks in Central Queensland, Australia between October 2017 and October 2018 and evaluate the effectiveness of an additional dose of measles, mumps, rubella (MMR) vaccine. A retrospective case control study was conducted, including outbreak investigations with laboratory-confirmed cases of mumps and subsequent comparison with matched controls. We analysed mandatory notifications from the Queensland Health Notifiable Conditions System database and immunisation information from the Queensland Health Vaccination Information and Admin System (VIVAS) and the Australian Immunisation Register. Between October 2017 and October 2018, there were 93 cases of mumps reported in Central Queensland with three distinct outbreaks: a discrete Indigenous community; a correctional facility; and a boarding school. Among all cases, 74 (79.6%) were fully vaccinated and 14 (15.1%) were partially vaccinated with MMR vaccine. Eighty-six cases (92.5%) were reported among Aboriginal and Torres Strait Islander i people. In all outbreaks, an additional dose of MMR vaccine was offered with 35.4%, 73.6% and 35.8% of the target population being immunised in the discrete Indigenous community, the correctional facility and the boarding school, respectively. Prior to this additional dose of MMR, the mumps attack rate was 31.0 (95% confidence interval [95% CI]: 24.2-39.0) per 1000 population, compared to the post-additional dose MMR attack rate of 10.6 (95% CI: 6.7-15.9) per 1000 population. An additional or booster dose of MMR should be included as an effective public health intervention strategy, particularly in communal or high-density living conditions to control mumps outbreaks in highly vaccinated populations.
Communicable Diseases Intelligence
Q fever is a notifiable disease in Australia due to its public health significance. Recent data i... more Q fever is a notifiable disease in Australia due to its public health significance. Recent data in the Wide Bay region (Queensland, Australia) suggests a rising number and changing geographical distribution of Q fever cases. This study aims to evaluate these changes through analysis of data from Queensland Health’s Notifiable Conditions System (NoCS) over a ten-year period. A comparison was made between the recent five-year period (2018–2022) and the preceding five-year period (2013–2017) with reference to incidence rates, location of cases and likely exposures. Incidence rates of Q fever showed an upward trend over time, particularly in urban areas. This highlights the need for increased clinical suspicion, improved awareness among the community and healthcare providers, and potentially broadening of vaccination recommendations in the future.
BMC Research Notes, 2008
Background: We conducted this study to estimate the correlates of current cigarette smoking among... more Background: We conducted this study to estimate the correlates of current cigarette smoking among in-school adolescents in Jamaica 2006 and compare prevalence of smoking and associated factors between 2000 and 2006. Results: In 2006, 1854 participated of whom 49.5 were males and 50.5% females. 1752 adolescents, 48.8% male and 51.2% females participated in the 2000 survey. Between 2000 and 2006, the prevalence of smoking among Jamaican school-going adolescents went up slightly from 15.2% to 16.7% but this was not statistically significant (p = 0.22). The perception that smoking is not harmful increased from 10.9% to 15.9% while parental smoking decreased from 39.4% to 35.5%. There was a decrease in the rates of adolescents exposed to tobacco adverts on billboards (p-value = 0.037) and in newspapers/magazine (p-value < 0.001). The percentage of adolescents who reported having an item with a tobacco brand logo on it increased from 13.9% to 16.4%. The perception that boys and girls who smoked had more friends increased between 2000 and 2006 (p-values = 0.016 and 0.004 respectively). Current smoking was associated with male gender (OR = 1.55; 95% CI [1.09-2.19]), having smoking parents (OR = 1.75; 95% CI [1.23-2.50]), and smoking friends (OR = 14.94; 95% CI [8.61-25.92] for most or all friends smokers and OR = 4.38; 95% CI [2.93-6.56] for some friends smokers)). Conclusion: Results from this study indicate smoking was positively associated with male gender, having smoking friends or parents. We observed a slightly non significant increase in the prevalence of smoking between 2000 and 2006 among adolescents in Jamaica. Although there was a decrease in the rates of adolescents exposed to advertisement, the percentage of those who had an item with a tobacco brand logo had increased. The possible impact of the Jamaica's ratification of the Framework Convention on Tobacco control remains to be observed.
Economics and Applied Informatics, 2016
This paper examines the relationship among access to improved water, sanitation and economic grow... more This paper examines the relationship among access to improved water, sanitation and economic growth in Bangladesh through co-integration and vector error correction model (VECM) over the period 1991 to 2014. Bangladesh has registered remarkable progress in achieving major Millennium Development Goals (MDG). Today nearly 87% of our total population has access to improved water sources and 60% have access to improved sanitation facilities which is contributing significantly towards human development in Bangladesh. Therefore we want to test whether access to improved water and sanitation accelerates economic growth in Bangladesh through a time series analysis. The Johansen co-integration tests indicate that there is long run association among the variables. The vector error correction model indicates that there is a long run causality running from improved sanitation facilities (% of population with access) and improved water source (% of population with access) to gross domestic produ...
Journal of Global Health Reports
Background Verbal autopsy can play a key crucial to identify significant causes of death in a dev... more Background Verbal autopsy can play a key crucial to identify significant causes of death in a developing country like Bangladesh where post-death pathological or forensic examination is not common. Single-dose Cholera Vaccination in Bangladesh (SCVB) was an individually randomized, placebo-controlled, double-blind study where verbal autopsy had been conducted for the participants who died within three months of receiving study agents This study aim was to determine the major causes of death through a verbal autopsy in a defined urban population. Methods The trial was conducted in urban slums of Dhaka among persons aged one year and older. A census was carried out bi-annually in the study area (Mirpur) including collecting death information from every household. Screening data on death was matched with the vaccination database to confirm whether the participants received the investigational products (IP) or not. The trained physician conducted a verbal autopsy usually within 7 days o...
BMJ Open, 2021
ObjectiveThis study used a programme logic model to describe the inputs, activities and outputs o... more ObjectiveThis study used a programme logic model to describe the inputs, activities and outputs of the ‘10,000 Lives’ smoking cessation initiative in Central Queensland, Australia.DesignA programme logic model provided the framework for the process evaluation of ‘10,000 Lives’. The data were collected through document review, observation and key informant interviews and subsequently analysed after coding and recoding into classified themes, inputs, activities and outputs.SettingThe prevalence of smoking is higher in the Central Queensland region of Australia compared with the national and state averages. In 2017, Central Queensland Hospital and Health Services set a target to reduce the percentage of adults who smoke from 16.7% to 9.5% in the Central Queensland region by 2030 as part of their strategic vision (‘Destination 2030’). Achieving this target is equivalent to 20,000 fewer smokers in Central Queensland, which should result in 10,000 fewer premature deaths due to smoking-rel...
PLOS ONE, 2021
Introduction Poverty is a key contributor to delayed diagnosis and limited access to early interv... more Introduction Poverty is a key contributor to delayed diagnosis and limited access to early intervention and rehabilitation for children with cerebral palsy (CP) in rural Bangladesh. 97% of families of children with CP live below the poverty line in Bangladesh. Therefore, in low-and middle-income countries (LMICs), efforts to improve outcomes for children with CP (including health-related quality of life, motor function, communication, and nutritional attainments) should also include measures to improve family economic and social capital. We propose a randomised controlled trial (RCT) to evaluate the effectiveness of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) program for ultra-poor families of children with CP in rural Bangladesh. Material and methods This will be a cluster RCT comparing three arms: (a) integrated microfinance/livelihood and community-based rehabilitation (IMCBR); (b) community-based rehabilitation (CBR) alone; and (c) care-as-us...
PLOS ONE, 2021
Background Ensuring water, sanitation, and hygiene (WASH) facilities for households remains a maj... more Background Ensuring water, sanitation, and hygiene (WASH) facilities for households remains a major public health concern in low- and middle-income countries (LMICs). This study investigated the current situation of basic WASH facilities for households in Bangladesh and drew a national coverage map. Methods We analyzed the publicly available nationally representative 2019 Multiple Indicator Cluster Survey (MICS) dataset that was carried out by the Bangladesh Bureau of Statistics (BBS) with support from the United Nations Children’s Emergency Fund (UNICEF). A total of 61,209 households (weighted) were included in the analysis. Both bivariate and multivariate analyses were employed to examine the relationships between independent variables (socio-demographic and economic status) and their distributions over outcome variables (basic water, sanitation, and hygiene). Further, the spatial distribution of WASH facilities at the household level was depicted. Results Coverage of access to ba...
Tobacco Prevention & Cessation, 2020
Smoking remains one of the leading risk factors contributing to the global burden of disease. Sub... more Smoking remains one of the leading risk factors contributing to the global burden of disease. Sub-optimal implementation of evidence-based tobacco control and smoking cessation practice is a major challenge despite a substantial evidence base for interventions to increase smoking cessation globally. We aim to develop an Evidence and Gap Map (EGM) to collate the existing evidence and identify the gap in research on interventions to increase smoking cessation worldwide. A conceptual framework was developed followed by the formulation of a search strategy with key search terms and search period (1970-date of search). The search will be conducted in relevant bibliographic databases (e.g. MEDLINE, Embase, SCOPUS), systematic reviews databases (e.g. Cochrane Library, Joanna Briggs systematic reviews, EPPI-Reviewer) and impact evaluation databases (e.g. 3ie Impact Evaluation repository and Cochrane tobacco addiction group specialized register) with support from a research librarian. Subsequently, two coders will screen and retrieve systematic reviews and individual impact evaluation studies. The adapted SURE (Supporting the Use of Research Evidence) checklist will be used to evaluate the quality of the included systematic reviews. A narrative synthesis from the systematic review findings and line listing of the impact evaluations will form the basis of this EGM. The EGM report will be presented in an interactive visual format. The proposed EGM will organise the pieces of evidence generated in systematic reviews and impact evaluations on smoking cessation interventions and identify the current research gaps, if any. The findings will inform evidence-based practice and future research.
Background The burden of maternal malnutrition and low birth weight (LBW) incurs enormous economi... more Background The burden of maternal malnutrition and low birth weight (LBW) incurs enormous economic costs due to their adverse consequences. Women’s empowerment is believed to be one of the key factors for attaining maternal and child health and nutritional goals. Our objective was to investigate the association of women’s empowerment with maternal malnutrition and LBW.Methods We used nationally representative data from the Bangladesh Demographic Health Survey for 2011 and 2014. We analysed 27,357 women and 9,234 mother-child pairs. A women’s empowerment index (WEI) was constructed using principal component analysis. We estimated odds ratios as the measure of association between the WEI and the outcome measures using generalized estimating equations to account for the cluster level correlation.Results The overall prevalence of maternal malnutrition was 20% and LBW was 18%. The WEI was significantly associated with both maternal malnutrition and LBW with a dose-response relationship. ...
BMC Infectious Diseases, 2019
Background: Cholera increases the risk of harmful effects on foetuses. We prospectively followed ... more Background: Cholera increases the risk of harmful effects on foetuses. We prospectively followed pregnant women unaware of their pregnancy status who received a study agent in a clinical trial evaluating the association between exposure to an oral cholera vaccine (OCV) and foetal survival. Methods: Study participants were selected from a randomized placebo-controlled trial conducted in Dhaka, Bangladesh. The vaccination campaign was conducted between January 10 and February 4, 2014. We enrolled women who were exposed to an OCV or placebo during pregnancy (Cohort 1) and women who were pregnant after the vaccination was completed (Cohort 2). Our primary endpoint was pregnancy loss (spontaneous miscarriage or stillbirth), and the secondary endpoints were preterm delivery and low birth weight. We employed a log-binomial regression to calculate the relative risk of having adverse outcomes among OCV recipients compared to that among placebo recipients. Result: There were 231 OCV and 234 placebo recipients in Cohort 1 and 277 OCV and 299 placebo recipients in Cohort 2. In Cohort 1, the incidence of pregnancy loss was 113/1000 and 115/1000 among OCV and placebo recipients, respectively. The adjusted relative risk for pregnancy loss was 0.97 (95% CI: 0.58-1.61; p = 0.91) in Cohort 1. We did not observe any variation in the risk of pregnancy loss between the two cohorts. The risks for preterm delivery and low birth weight were not significantly different between the groups in both cohorts. Conclusions: Our study provides additional evidence that exposure to an OCV during pregnancy does not increase the risk of pregnancy loss, preterm delivery, or low birth weight, suggesting that pregnant women in cholera-affected regions should not be excluded in a mass vaccination campaign. Trial registration: The study is registered at (http://clinicaltrials.gov). Identifier: NCT02027207.
Clinical Infectious Diseases, 2019
BackgroundTyphoid fever illnesses are responsible for more than 100 000 deaths worldwide each yea... more BackgroundTyphoid fever illnesses are responsible for more than 100 000 deaths worldwide each year. In Bangladesh, typhoid fever is endemic, with incidence rates between 292–395 per 100 000 people annually. While considerable effort has been made to improve access to clean water and sanitation services in the country, there is still a significant annual typhoid burden, which particularly affects children. A typhoid conjugate vaccine (Vi-TCV) was recently prequalified by the World Health Organization and recommended for use, and offers the potential to greatly reduce the typhoid burden in Bangladesh.MethodsThis study is a double-blind, cluster-randomized, controlled trial of Vi-TCV in a geographically defined area in Dhaka, Bangladesh. At least 32 500 children from 9 months to <16 years of age will be vaccinated and followed for 2 years to assess the effectiveness and safety of Vi-TCV in a real-world setting. All cluster residents will also be followed to measure the indirect effe...
Vaccine, 2018
The safety and immunogenicity of the second generation oral enterotoxigenic Escherichia coli (ETE... more The safety and immunogenicity of the second generation oral enterotoxigenic Escherichia coli (ETEC) vaccine ETVAX, consisting of inactivated recombinant E. coli strains over-expressing the colonization factors (CFs) CFA/I, CS3, CS5 and CS6 and the heat labile toxoid LCTBA, were evaluated in Bangladeshi volunteers. To enable analysis of antibody responses against multiple vaccine antigens for subsequent use in small sample volumes from children, a sensitive electrochemiluminescence (ECL) assay for analysis of intestine-derived antibody-secreting cell responses using the antibodies in lymphocyte secretions (ALS) assay was established using Meso Scale Discovery technology. Three groups of Bangladeshi adults (n = 15 per group) received two oral doses of ETVAX with or without double mutant LT (dmLT) adjuvant or placebo in the initial part of a randomized, double-blind, placebo-controlled, age-descending, dose-escalation trial. CF-and LTB-specific ALS and plasma IgA responses were analyzed by ECL and/or ELISA. ETVAX was safe and well tolerated in the adults. Magnitudes of IgA ALS responses determined by ECL and ELISA correlated well (r = 0.85 to 0.98 for the five primary antigens, P < 0.001) and ECL was selected as the ALS readout method. ALS IgA responses against each of the primary antigens were detected in 87-100% of vaccinees after the first and in 100% after the second vaccine dose. Plasma IgA responses against different CFs and LTB were observed in 62-93% and 100% of vaccinees, respectively. No statistically significant adjuvant effect of dmLT on antibody responses to any antigen was detected, but the overall antigenic breadth of the plasma IgA response tended to favor the adjuvanted vaccine when responses to 4 or more or 5 vaccine antigens were considered. Responses in placebo recipients were infrequent and mainly detected against single antigens. The promising results in adults supported testing ETVAX in descending age groups of children. ClinicalTrials.gov Identifier: NCT02531802.
Baseline Widal titre among healthy adult males from the greater Mymensingh division of Bangladesh
Infectious disorders drug targets, Jan 5, 2018
Widal agglutination test is arguably the most widely used laboratory investigation for diagnosis ... more Widal agglutination test is arguably the most widely used laboratory investigation for diagnosis of Typhoid, especially in developing countries where blood culture is often inaccessible. However, the interpretation of the test still remains a controversial topic particularly in the context of endemic regions such as Bangladesh, as agglutination test is often found positive in varied and higher titrations among a large percentage of healthy population. Paired Widal tests are often not feasible, hence single unpaired test has to be used for screening and diagnosis. Even specific chemotherapy is administered frequently based on single Widal test. Therefore it is very important to establish baseline value of Widal test and re-evaluate in regular intervals to ensure standard cutoff points are as accurate and updated as possible in particular demographics Objective: The study aimed at investigating the normal range of baseline titre for Anti TO, TH, AO, AH, BO agglutinins among healthy pa...
The Lancet. Infectious diseases, Jan 14, 2018
A single-dose regimen of inactivated whole-cell oral cholera vaccine (OCV) is attractive because ... more A single-dose regimen of inactivated whole-cell oral cholera vaccine (OCV) is attractive because it reduces logistical challenges for vaccination and could enable more people to be vaccinated. Previously, we reported the efficacy of a single dose of an OCV vaccine during the 6 months following dosing. Herein, we report the results of 2 years of follow-up. In this placebo-controlled, double-blind trial done in Dhaka, Bangladesh, individuals aged 1 year or older with no history of receipt of OCV were randomly assigned to receive a single dose of inactivated OCV or oral placebo. The primary endpoint was a confirmed episode of non-bloody diarrhoea for which the onset was at least 7 days after dosing and a faecal culture was positive for Vibrio cholerae O1 or O139. Passive surveillance for diarrhoea was done in 13 hospitals or major clinics located in or near the study area for 2 years after the last administered dose. We assessed the protective efficacy of the OCV against culture-confir...
BMJ open, Jul 2, 2017
Invasive infections caused by Salmonella enterica serovar Typhi and Paratyphi A are estimated to ... more Invasive infections caused by Salmonella enterica serovar Typhi and Paratyphi A are estimated to account for 12-27 million febrile illness episodes worldwide annually. Determining the true burden of typhoidal Salmonellae infections is hindered by lack of population-based studies and adequate laboratory diagnostics.The Strategic Typhoid alliance across Africa and Asia study takes a systematic approach to measuring the age-stratified burden of clinical and subclinical disease caused by typhoidal Salmonellae infections at three high-incidence urban sites in Africa and Asia. We aim to explore the natural history of Salmonella transmission in endemic settings, addressing key uncertainties relating to the epidemiology of enteric fever identified through mathematical models, and enabling optimisation of vaccine strategies. Using census-defined denominator populations of ≥100 000 individuals at sites in Malawi, Bangladesh and Nepal, the primary outcome is to characterise the burden of enter...
Vaccine, Jan 16, 2016
The oral cholera vaccine (OCV), Shanchol™ has shown protective efficacy lasting up to 5 years, ho... more The oral cholera vaccine (OCV), Shanchol™ has shown protective efficacy lasting up to 5 years, however, requirement for a cold chain limits its use in resource poor settings. The study was conducted to determine the safety and immunogenicity of Shanchol in adult participants in Bangladesh when stored at elevated temperatures. The study was conducted in Mirpur, Dhaka. Four groups of healthy adult participants received two doses of Shanchol™, kept under standard storage temperature (Group A; 2-8°C) or at elevated temperatures (Group B, 25°C; Group C, 37°C; Group D, 42°C) for 14 days, respectively. Vaccine specific antibody responses were determined. 145 participants were assigned to each group. Adverse events were mild not differing among groups. Vaccine stored at elevated temperatures remained stable with cumulative LPS content within admissible limits. Vibriocidal antibody responses were observed in all groups after each dose of vaccine at day 7 and 21 compared to pre-immune levels ...
Infection and Immunity, 2001
Helicobacter pylori infection of the gastric mucosa can be found in approximately 50% of the worl... more Helicobacter pylori infection of the gastric mucosa can be found in approximately 50% of the world's population and is associated with a range of pathology, including peptic ulcer, atrophic gastritis, and gastric cancer. To explore immunization as a strategy for preventing and treating H. pylori -associated disease, we assessed the safety and immunogenicity in healthy adults of a formalin-inactivated, oral H. pylori whole-cell (HWC) vaccine, administered with or without mutant Escherichia coli heat-labile toxin (LT R192G ) as a mucosal adjuvant. In a dose-response study, 23 subjects with or without H. pylori infection were vaccinated with either 2.5 × 10 6 HWC, 2.5 × 10 8 HWC, or 2.5 × 10 10 HWC, plus 25 μg of LT R192G . Thereafter, a randomized study was conducted in which 18 H. pylori -infected subjects were assigned, in a double-blind fashion, to receive either 2.5 × 10 10 HWC plus placebo-adjuvant, placebo-vaccine plus 25 μg of LT R192G , placebo-vaccine plus placebo-adjuvan...
The New England journal of medicine, Jan 5, 2016
A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by ... more A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by the World Health Organization would make them more attractive for use against endemic and epidemic cholera. We conducted an efficacy trial of a single dose of the killed oral cholera vaccine Shanchol, which is currently given in a two-dose schedule, in an urban area in which cholera is highly endemic. Nonpregnant residents of Dhaka, Bangladesh, who were 1 year of age or older were randomly assigned to receive a single dose of oral cholera vaccine or oral placebo. The primary outcome was vaccine protective efficacy against culture-confirmed cholera occurring 7 to 180 days after dosing. Prespecified secondary outcomes included protective efficacy against severely dehydrating culture-confirmed cholera during the same interval, against cholera and severe cholera occurring 7 to 90 versus 91 to 180 days after dosing, and against cholera and severe cholera according to age at baseline. A total ...
The Lancet Regional Health -Western Pacific, 2021
Background: The prevalence of smoking in Central Queensland (CQ), Australia was higher than the s... more Background: The prevalence of smoking in Central Queensland (CQ), Australia was higher than the state
and national averages. A regional smoking cessation initiative (“10,000 Lives”) was launched to promote
available interventions (e.g., Quitline). We investigated the impact of “10,000 Lives” on referral to and use
of Quitline services.
Methods: We conducted an interrupted time series analysis using a segmented Poisson regression model
to measure the impact of “10,000 Lives” on monthly referrals to, and use of Quitline services (counselling
sessions and nicotine replacement therapy (NRT) dispatched by Quitline), in CQ compared to other areas
in the state (control population). The control population included all regional areas in Queensland with
a comparable smoking prevalence to CQ and similar access to Quitline’s Intensive Quit Support Program.
We calculated the changes in level and trend of outcomes in CQ relative to the change in the control
area during the post-launch period of “10,000 Lives”. The models were checked for autocorrelation and
seasonality and adjusted accordingly.
Findings: After the introduction of “10,000 Lives”, the mean monthly rate per 1,000 smoking population increased in the intervention area for each outcome; e.g., from 3.
3 to 10.
8 for referrals to Quitline,
from 1.
6 to 4.
4 for initial counselling session completed. These results were validated by the controlled
interrupted time series analysis which showed relative increases for each of these outcomes (238•5% for
monthly rate of referral to Quitline per 1,000 smoking population and 248•6% for monthly rate of initial
counselling sessions completed per 1,000 smoking population).
Interpretation: Our study demonstrates a locally coordinated health promotion initiative can promote and
boost the referral to, and use of Quitline smoking cessation services.
Funding: The research is funded by a collaborative research grant between School of Public Health at
University of Queensland and Central Queensland Public Health Unit which is awarded by the Central
Queensland Hospital and Health Service (CQHHS93907). The lead author (AK) is supported by a University
of Queensland Research Training Scholarship and a Research Higher Degree Top-up Scholarship.
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Papers by Arifuzzaman Khan
and national averages. A regional smoking cessation initiative (“10,000 Lives”) was launched to promote
available interventions (e.g., Quitline). We investigated the impact of “10,000 Lives” on referral to and use
of Quitline services.
Methods: We conducted an interrupted time series analysis using a segmented Poisson regression model
to measure the impact of “10,000 Lives” on monthly referrals to, and use of Quitline services (counselling
sessions and nicotine replacement therapy (NRT) dispatched by Quitline), in CQ compared to other areas
in the state (control population). The control population included all regional areas in Queensland with
a comparable smoking prevalence to CQ and similar access to Quitline’s Intensive Quit Support Program.
We calculated the changes in level and trend of outcomes in CQ relative to the change in the control
area during the post-launch period of “10,000 Lives”. The models were checked for autocorrelation and
seasonality and adjusted accordingly.
Findings: After the introduction of “10,000 Lives”, the mean monthly rate per 1,000 smoking population increased in the intervention area for each outcome; e.g., from 3.
3 to 10.
8 for referrals to Quitline,
from 1.
6 to 4.
4 for initial counselling session completed. These results were validated by the controlled
interrupted time series analysis which showed relative increases for each of these outcomes (238•5% for
monthly rate of referral to Quitline per 1,000 smoking population and 248•6% for monthly rate of initial
counselling sessions completed per 1,000 smoking population).
Interpretation: Our study demonstrates a locally coordinated health promotion initiative can promote and
boost the referral to, and use of Quitline smoking cessation services.
Funding: The research is funded by a collaborative research grant between School of Public Health at
University of Queensland and Central Queensland Public Health Unit which is awarded by the Central
Queensland Hospital and Health Service (CQHHS93907). The lead author (AK) is supported by a University
of Queensland Research Training Scholarship and a Research Higher Degree Top-up Scholarship.