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Air pollution from indoor and outdoor sources constitutes a substantial health risk to young children in sub-Saharan Africa (SSA). Although some systematic reviews have assessed air pollution and children's respiratory health in SSA, none have considered both ambient and indoor exposures. This systematic review and meta-analysis assessed the effect of air pollution (ambient and indoor) on respiratory hospitalization and mortality among children under five years in SSA. We retrieved relevant articles from PubMed, Embase, Scopus, African Journals Online (AJOL), Web of Science, and medRxiv. The protocol was registered with Prospero (CRD42023470010). We used guidelines from the preferred reporting items for systematic review and meta-analysis (PRISMA-2020) to guide the systematic review process. Risk of bias was assessed using the Office of Health Assessment and Translation (OHAT) quality appraisal tool. For exposures where there were sufficient studies/data we conducted meta-analyses using random effects models and used Stata version 17 software for analysis. For the systematic review we screened 5619 titles and abstracts, reviewed 315 full texts, and included 31 articles involving 2,178,487 participants. Eleven studies examined exposure to solid fuel use in households and its association with all-cause mortality, while four studies explored the impact of passive smoking on mortality among children under five. Only two studies assessed ambient air pollution's effects on all-cause and respiratory-related mortality. Additionally, 13 studies reported varying associations between respiratory hospitalization and household tobacco smoke exposure. Meta-analyses on studies of solid fuel use and mortality and passive smoking and hospitalizations showed that children exposed to indoor solid fuels combustion had higher odds of mortality compared to non-exposed children (OR = 1.31; 95% CI: 1.16-1.47). The meta-analysis of exposure to second-hand smoke found an increased risk of respiratory hospitalization due to pneumonia, although the results were not significant (OR = 1.29; 95% CI: 0.45-3.68), and our certainty of evidence assessment indicated insufficient support to conclusively establish this association. Our review reveals that solid fuel use and ambient PM2.5 exposure were associated with increased mortality risk in children under five years in SSA. The meta-analysis showed evidence of an increased risk of under-five years mortality associated with solid fuel use in households. Associations between secondhand smoke and pneumonia hospitalization were less clear. We conclude that significant research gaps remain in understanding the impact of discrete sources of air pollution on the causation of respiratory illness in young children living in SSA. Prioritizing interventions targeting indoor sources is essential, along with further studies which use standardized and objective exposure and outcome measures to study these associations.

Objectives Peer‐to‐peer communication approaches have been previously described as the ‘power of personal referral’. Rather than relying on official channels of information, peer‐to‐peer communication may have a role in supporting changes in understanding and possibly behaviours. However, in emergency or pandemic situations, there is currently limited understanding of whether community members feel comfortable speaking about their vaccine experiences or advocating to others. This study explored the perceptions of COVID‐19 vaccinated and unvaccinated Australian adults regarding their preferences and opinions about peer‐peer communication and other vaccine communication strategies. Study Design Qualitative interview research. Methods In‐depth interviews were conducted in September 2021 with 41 members of the Australian community. Thirty‐three participants self‐identified as being vaccinated against COVID‐19, while the remainder were not vaccinated at the time or did not intend on receiving a COVID vaccine. Results Amongst those who were vaccinated, participants spoke about being willing to promote the vaccine and correct misinformation and felt empowered following their vaccination. They highlighted the importance of peer‐to‐peer communication and community messaging, expressing the need for both strategies in an immunisation promotional campaign, with a slight emphasis on the persuasive power of communication between family and friends. However, those who were unvaccinated tended to dismiss the role of community messaging, commenting on a desire not to be like one of the many who listened to the advice of others. Conclusion During emergency situations, governments and other relevant community organisations should consider harnessing peer‐to‐peer communication amongst motivated individuals as a health communication intervention. However further work is needed to understand the support that this constituent‐involving strategy requires. Patient or Public Contribution Participants were invited to participate through a series of online promotional pathways including emails and social media posts. Those who completed the expression of interest and met the study criteria were contacted and sent the full study participant information documentation. A time for a 30 min semi‐structured interview was set and provided with a $50 gift voucher at the conclusion.

COVID-19 vaccination has significantly reduced the risk of severe disease. Yet, across many settings in Australia, there have been issues with equitable uptake, particularly for some people from ethnic minority backgrounds. To bridge this gap, training workshops were held to support the capacity of local community leaders to communicate about the COVID-19 booster vaccines and other recommended vaccines as local vaccine champions. This study aimed to explore participants' vaccine and communication knowledge and the acceptability and perceived usefulness of the Vaccine Champions Program. The training included information about eligibility for the COVID-19 booster vaccines and the rationale for their continued use, information about other vaccines recommended for adults, as well as recommended travel vaccines. Fifteen in-depth interviews were conducted from July to December 2023. Attendees of the workshop were purposefully selected to identify as leaders of multicultural communities in Sydney, with expressions of interest being offered to all attendees to participate in the evaluation of the workshop through a semi structured interview. They contributed their insights on the development and implementation of the training workshop sessions, participants' views on becoming vaccine champions, and the improvements needed for future sessions. Interviewees emphasised the importance of providing reliable information in the training to address vaccine hesitancy. They highlighted the significance of the training in boosting their confidence to promote and champion vaccination within their community, and suggested incorporating personal stories, testimonies, and interactive elements to enhance the training package. They expressed positive views on the program's continuation beyond the COVID-19 pandemic, emphasising the importance of their knowledge of vaccines remaining current with research and adapting communication approaches. Continued collaboration between community leaders and healthcare providers, ongoing training, and staying current with research are essential for ensuring the program's long-term sustainability, self-efficacy, and impact on public health outcomes.

The effectiveness of immunisation programs in reducing vaccine-preventable diseases is well-established. However, vaccine hesitancy, driven by a range of factors depending on the cultural, social and political context, threatens the attainment of high vaccination rates. The COVID-19 pandemic amplified these challenges, exposing gaps in public health communication. In response, community-led communication approaches, such as peer-to-peer communication, have been increasingly adopted.While peer-led communication strategies as a public health initiative have been used in low- and middle-income settings for years to promote vaccines, their adoption in high-income countries is relatively new. This thesis explores the role of community-driven communication interventions in addressing vaccine hesitancy among Australian adults, with a particular focus on peer-to-peer communication.Using a mixed-methods approach, the research investigated community perceptions toward vaccine-focused communication. The first study examined community sentiment about strategies used during the COVID-19 vaccine rollout, with a second study, identical in methodology, exploring the potential for community-led approaches to supplement government efforts. A third study evaluated the acceptability of vaccine communication training workshops from the perspectives of community leaders within culturally and linguistically diverse communities within Sydney. The fourth study examined the potential of individuals to engage in community-led communication about COVID-19 booster vaccines. Lastly, a scoping review synthesised the literature on peer-to-peer communication in public health.Findings highlight gaps in current public health strategies and detail the need for culturally sensitive approaches instead of ineffectively repeating existing initiatives. Peer-to-peer communication was perceived by individuals to be effective in fostering trust and navigating vaccine hesitancy, especially within diverse communities. This research stresses the broader potential of community-driven interventions beyond immunisation.Recommendations include integrating peer-to-peer communication into national immunisation programs, developing culturally appropriate materials, and training community leaders as vaccine champions. These strategies aim to enhance vaccine uptake towards herd immunity. This thesis highlights the significant potential of community-led communication approaches to address vaccine hesitancy and ensure communities receive optimised messages about vaccines.

The COVID-19 pandemic and the associated introduction of a novel vaccine has provided researchers with the opportunity to investigate how to support vaccine acceptance and reduce hesitancy using novel approaches. This study aimed to understand the perceptions of COVID-19 unvaccinated Australian adults towards the COVID-19 vaccines and the factors influencing their vaccine decision-making. We also explored their attitudes towards vaccine communication strategies and the availability and quality of resources to support decision-making and preferences during future public health emergencies. In-depth interviews were undertaken with 35 members of the Australian community who self-identified as being unvaccinated against COVID-19 from September to December 2021 and did not intend to vaccinate. Key themes that emerged focused on past experiences of vaccination, feelings of being coerced or pushed into vaccination, concerns about transparency around the development processes used for the COVID-19 vaccines, the value of getting vaccinated and issues regarding the mandates being used. Participants acknowledged that they would be open to talking to peers but held some reservations about the process. Requirements for vaccination have now been lifted in many countries. While governments should continue to strive to promote COVID-19 primary and booster vaccines going forward, this research suggests that there will be a small proportion of the community who continue to actively decline the vaccine. Further work is needed to understand the strategies that can support decision-making during pandemics amongst people who remain uncertain about the need for the vaccines or are concerned about vaccine safety. This includes innovatively exploring the role of peer-to-peer communication and the influence it may have on correcting misunderstandings and supporting confidence.

There is growing attention around the need to improve the confidence and skills of healthcare providers to assist them in completing the complex task of communicating to vaccine hesitant parents and other individuals. While interventions have been developed and evaluated in a research setting, there is uncertainty regarding the public availability. This study aimed to examine the current landscape regarding the availability of online dialogue- based interventions which aim to support vaccination conversations. A scoping review was undertaken to identify and appraise the availability and accessibility of dialogue-based interventions. A dialogue-based intervention was defined as a strategy aiming to improve an individual’s confidence and communication skills to engage with and respond to vaccine hesitant individuals. Two approaches were utilised to identify relevant interventions and resources. Firstly, the European Centre for Disease Prevention and Control Catalogue of Interventions was assessed to identify interventions that met the definition. Secondarily, a Google search (in English only) was conducted using key words, that reflected the strategy that healthcare providers may use to identify resources. We identified a total of 31 dialogue-based interventions, of which 29 were reviewed. The interventions were all text based and instructional in nature. Twenty-two were suitable for healthcare providers, as well as non-clinical immunisation spokespersons to use. Of issue, was that in many instances it was common to find the resource located on the fifth to tenth page of search entries, and usually disguised under seemingly non-descript and nonspecific titles. Lastly, not all resources were available for free and not all could be accessed directly from the site. Findings suggest that while there have been numerous interventions developed to support healthcare providers to communicate with vaccine hesitant parents/individuals, there are fundamental issues with accessing the materials in a timely and convenient way. Having a central repository or website (which links to the interventions) would not only assistant healthcare providers to have an improved comprehension of the different interventions available but also would theoretically increase the utilisation by providers.

•COSSI is an Australian collaborative network for vaccination social science.•Researchers, policy and program workers and advocates benefit from alignment.•The collaborative model has helped Australian researchers to generate global impact.•Other countries can learn from the COSSI model and experience for local action.

Loss of Fhit expression, encoded at chromosome fragile site FRA3B, leads to increased replication stress, genome instability and accumulation of genetic alterations. We have proposed that Fhit is a genome 'caretaker' whose loss initiates genome instability in preneoplastic lesions. We have characterized allele copy number alterations and expression changes observed in Fhit-deficient cells in conjunction with alterations in cellular proliferation and exome mutations, using cells from mouse embryo fibroblasts (MEFs), mouse kidney, early and late after establishment in culture, and in response to carcinogen treatment. Fhit (-/-) MEFs escape senescence to become immortal more rapidly than Fhit (+/+) MEFs; -/- MEFs and kidney cultures show allele losses and gains, while +/+ derived cells show few genomic alterations. Striking alterations in expression of p53, p21, Mcl1 and active caspase 3 occurred in mouse kidney -/- cells during progressive tissue culture passage. To define genomic changes associated with preneoplastic changes in vivo, exome DNAs were sequenced for +/+ and -/- liver tissue after treatment of mice with the carcinogen, 7,12-dimethylbenz[a]anthracene, and for +/+ and -/- kidney cells treated in vitro with this carcinogen. The -/- exome DNAs, in comparison with +/+ DNA, showed small insertions, deletions and point mutations in more genes, some likely related to preneoplastic changes. Thus, Fhit loss provides a 'mutator' phenotype, a cellular environment in which mild genome instability permits clonal expansion, through proliferative advantage and escape from apoptosis, in response to pressures to survive.

Loss of expression of Fhit, a tumor suppressor and genome caretaker, occurs in preneoplastic lesions during development of many human cancers. Furthermore, Fhit‐deficient mouse models are exquisitely susceptible to carcinogen induction of cancers of the lung and forestomach. Due to absence of Fhit genome caretaker function, cultured cells and tissues of the constitutive Fhit knockout strain develop chromosome aneuploidy and allele copy number gains and losses and we hypothesized that Fhit‐deficient cells would also develop point mutations. On analysis of whole exome sequences of Fhit‐deficient tissues and cultured cells, we found 300 to >1000 single‐base substitutions associated with Fhit loss in the 2% of the genome included in exomes, relative to the C57Bl6 reference genome. The mutation signature is characterized by increased C>T and T>C mutations, similar to the “age at diagnosis” signature identified in human cancers. The Fhit‐deficiency mutation signature also resembles a C>T and T>C mutation signature reported for human papillary kidney cancers and a similar signature recently reported for esophageal and bladder cancers, cancers that are frequently Fhit deficient. The increase in T>C mutations in −/− exomes may be due to dNTP imbalance, particularly in thymidine triphosphate, resulting from decreased expression of thymidine kinase 1 in Fhit‐deficient cells. Fhit‐deficient kidney cells that survived in vitro dimethylbenz(a)anthracene treatment additionally showed increased T>A mutations, a signature generated by treatment with this carcinogen, suggesting that these T>A transversions may be evidence of carcinogen‐induced preneoplastic changes. Due to absence of Fhit genome caretaker function, Fhit knockout mouse cells develop aneuploidy, allele copy number losses and −/− tissues develop >1000 single‐base substitutions in the 2% of the genome included in exomes. The mutation signature is characterized by increased C>T and T>C mutations, similar to the “age at diagnosis” signature identified in human cancers. The increase in T>C mutations in −/− exomes may be due to thymidine triphosphate imbalance, resulting from decreased expression of Thymidine Kinase 1 in Fhit‐deficient cells.