Intervention Model Research Articles

Low-intensity ABA intervention for young children with ASD in Italy

ABSTRACT This study investigated the effects of a 12-hr per week education package for 7 children with autism spectrum disorders (ASD) within the context of the Italian public health system. Different from the US, the Italian public health system traditionally offers 1 to 3 hrs per week of speech, occupational, or physical therapy, and/or ABA-based activity for children with ASD. Hence, it is imperative to assess the criteria for effective ABA interventions to enable comparison with various models of care for children with ASD. We employed a treatment package based on the Comprehensive Application of Behavior Analysis to Schooling (CABAS®) model. Each participant received interventions for 4 hours a day, 3 days a week for one year. The results revealed a significant difference in the total scores and each sub-test score of both the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and the Childhood Autism Rating Scale-Second Edition (CARS-2) before and after one year of instruction. Our low-intensity intervention appears to effectively improve the participants’ various academic, verbal, and self-management skills, positively impacting their overall development. Our findings provide insights into testing the effectiveness of an alternative model of ABA intervention while also expanding the application of advanced ABA practices to enhance the developmental trajectory of young children.

Time Series Perspective on the Sustainability of the South African Food and Beverage Sector

This study aims to quantify and graphically illustrate the negative lingering effect that the COVID-19 pandemic had on the sales in South African Rands (ZAR) of the food and beverage sector using the time series seasonal autoregressive integrated moving average with exogenous components (SARIMAX) intervention model. The SARIMAX2, 1, 00, 1, 212 intervention model provided the best fit, supported by the lowest values of the model selection and error metrics (Akaike’s information criterion, Bayesian information criterion, and root mean square error). The total estimated loss of sales in the 52 months during the intervention period (March 2020 to June 2024) amounts to ZAR 130,579 million. The most affected months were April 2020 and May 2020 with estimated losses of ZAR 7719 million and ZAR 7633 million, respectively. The findings of this study align with the Statistics South Africa® statistical report based on empirical estimation without any model fitting, thus highlighting the effectiveness of the SARIMAX intervention model in quantifying the effects of the pandemic. The lingering negative impact of the COVID-19 pandemic still continues to threaten the sustainability of the South African food and beverage sector, violating the United Nations’ Sustainable Development Goal, Number 2, which is to end hunger, achieve food security, improve nutrition, and promote sustainable agriculture.

Creating a predictive model for early detection, intervention, and prevention of opioid addiction in the United States

Creating a predictive model for early detection, intervention, and prevention of opioid addiction in the United States

New Pathways for Digital Health Technology Interventions for Workplace Anxiety

This study focuses on exploring new paths of digital health technology (DHT) intervention for workplace anxiety in the context of artificial intelligence. By exhaustively analyzing the current situation and causes of workplace anxiety and combining the latest advances in current artificial intelligence and digital health technology, this study successfully constructed a DHT-based workplace anxiety intervention model. The empirical results show that the model can accurately identify, scientifically assess and effectively alleviate anxiety symptoms in the workplace, significantly improving participants' negative emotions such as irritability and exhaustion, as well as significantly enhancing their emotion regulation ability. This study not only introduces an innovative approach to the field of workplace mental health intervention, but also provides strong support for improving employee mental health and promoting sustainable development of enterprises.

Considerations for Intensifying Word-Problem Interventions for Students With MD: A Qualitative Umbrella Review of Relevant Meta-Analyses.

Word problem-solving (WPS) poses a significant challenge for many students, particularly those with mathematics difficulties (MD), hindering their overall mathematical development. To improve WPS proficiency, providing individualized and intensive interventions is critical. This umbrella review examined 11 medium- to high-quality meta-analyses to identify intervention and participant characteristics, informed by the Taxonomy of Intervention Intensity (TII) framework, that consistently moderate WPS outcomes for students with MD. Our analysis identified four characteristics with consistent moderating effects: intervention model, number of treatment sessions, group size, and academic risk area. This result suggests that these variables are potential considerations when customizing and intensifying WPS interventions to maximize their effectiveness for students with MD. We discuss the implications of these findings for practice and research and acknowledge the limitations of our review.

Promoting Well-Being from a Gender Perspective: A Systematic Review of Interventions Using Digital Tools and Serious Games

Gender inequalities continue to pose a significant issue across various aspects of life, adversely impacting the well-being of both females and males. These disparities often stem from the ingrained gender stereotypes passed down to young individuals through parental guidance, educational systems, and media portrayal. For this reason, within the psycho-pedagogical field, various intervention models have been developed in recent years, leveraging digital tools to combat stereotypes and enhance well-being among adolescents. The aim of this systematic review is, therefore, to identify studies employing digital tools, particularly serious games, to promote well-being from a gender perspective. The review was conducted using the PRISMA guidelines and collected articles from four databases: Scopus, the Web of Science, PubMed, and PsycInfo. The screening process culminated in the selection of 15 articles. The findings reveal a proliferation of platforms, applications, and programs aimed at promoting well-being by addressing emotional, cognitive (or mental), physical, and sexual health dimensions. Some contributions emphasize nurturing positive attributes within individuals or fostering empowerment as a precursor to well-being. Additionally, certain articles delve into the effect of the COVID-19 pandemic on the well-being of young men and women; in particular, the authors investigated the effect of using an app to improve well-being before and after the pandemic. This systematic review aims to expand the knowledge base on technology-based interventions for social change. It endeavors to empower educators and advance the creation of innovative, evidence-based digital tools that can enhance positive mental health, promote gender equality education, and foster the well-being of young people.

Approach Proposal for Energy-Efficient Retrofit of Historic Buildings with Comparative Analysis of EU Research Projects

Within the framework of the building section, the existing building stock is a research area with a high potential for energy savings, as it is a crucial energy consumption source. Studies are being carried out on many existing building stocks to prevent and reduce the increasing energy consumption and negative situations due to climate change and global warming. It is seen that parameters such as energy efficiency are considered as a whole with conservation in intervention methods, especially in European countries, since only conservation is insufficient for historical buildings, which are one of the primary sources of important existing building stock. Preserving cultural identity values and energy efficiency are the primary intervention criteria. By considering these two intervention criteria in balance and as a whole, the permanence and sustainability of the buildings for future generations is ensured. In this regard, comprehensive, large-scale, and multinational projects supported by the European Union (EU), especially in European countries, are carried out. In line with the conclusions drawn from the detailed and systematic analysis, comparison, and evaluation of the projects, the study proposed an approach and intervention model for future studies. The determined projects were examined in detail regarding purpose, scope, target, strategy, content, and project outcome outputs. Systematic inferences were made through the analysis in line with the data obtained. Comparisons and evaluations were made on approach information, objectives, analysis methods, technology and software used, active-passive and renewable energy systems, monitoring and tracking systems, and project output data obtained at the project's end to make the intervention's effects sustainable. As a result, a comprehensive approach model for energy-efficient retrofitting intervention approaches has been proposed in line with the conclusions obtained from the analysis, comparison, and evaluations of energy-efficient retrofitting of historic buildings. Thus, the approach model obtained with the study will guide the creation of intervention models for the studies to be carried out on energy-efficient retrofits in historical buildings.

Registration and characteristics of clinical trials on traditional Chinese medicine and natural medicines for endometriosis: a comprehensive analysis

ObjectiveTo investigate the characteristics of clinical trials on traditional Chinese medicine (TCM) or natural medicines for treating endometriosis, aiming to inform future clinical practice and the development of new effective drugs.MethodThe global clinical trial registration platform was searched to identify clinical trials investigating the efficacy of TCM/natural medicine in treating endometriosis. Relevant trials were selected based on stringent inclusion and exclusion criteria. Data entry was performed using Microsoft Excel, while data analysis was conducted using SPSS version 23.ResultsThe study encompassed 57 trials, of which ClinicalTrials.gov accounted for 18, ChiCTR for 3, ICRP for 15, and ChiDTR for 21 trials. The number of registrations showed a significant positive correlation with the years. Of the 57 clinical trials, 87.7% were randomized, 63.2% were blinded, 78.9% followed a parallel intervention model, and 56.1% had a sample size below 100. Regarding trial phases, 45.6% of clinical trials did not specify a phase, while Phase 3 and Phase 4 clinical trials accounted for 17.5%. Nine clinical trials involved drugs that are already on the market, including six Chinese patent medicines: Sanjie Zhentong Capsules, Honghua Ruyi Pills, Huayu Sanjie Enema Liquid, Kuntai Capsules, Wenjing Tang, and Xuefu Zhuyu Capsules. Outside China, Iran has the highest number of registrations for natural medicine treatments for endometriosis, with curcumin being the most registered natural medicine.ConclusionThe analysis reveals that clinical trials on TCM and natural remedies for endometriosis often utilize randomization; however, substantial deficiencies remain in blinding and sample size adequacy. These findings suggest that, despite growing interest in TCM and natural remedies, further methodological improvements are necessary to enhance the credibility of future studies. This research highlights the importance of rigorously designed clinical trials in verifying the safety and efficacy of these alternative therapies, which may influence future therapeutic approaches for managing endometriosis.

A Qualitative Service Evaluation of the Introduction of Single Session Therapy for Families in a Child and Adolescent Mental Health Service in England, United Kingdom.

This service evaluation details the process of introducing Single Session Therapy (SST) with families to a Child and Adolescent Mental Health Service in the United Kingdom. SST is a model of short-term psychotherapy intervention which can be applied to family contexts to provide timely mental health support. This service evaluation had two objectives: (1) Review the existing evidence base and literature for SST. (2) Evaluate the implementation of a new SST treatment pathway in CAMHS, including patient experiences and satisfaction with the service. SQUIRE Guidelines are used to report on this new knowledge of healthcare. This evaluation used qualitative methods to evaluate the impact of the new service. The team also used existing frameworks within the Trust, namely discharge data, which is collected routinely as part of service evaluation. This evaluation suggests positive support for this model, and that many families appreciate and value the opportunity to build on strengths and work toward their goals as families. This project outcome appears to support some of Talmon's (1990) findings that the most commonly attended number of sessions is one, and that of those who attended only one session, many perceived the session as useful. Waiting times for our service are extremely long. The pace and structure around goals and solutions could feel both galvanising, as some reported, but others felt it was an insufficient response to the severity of their difficulties. More high-quality research is needed before judgments can be made around the cost-effectiveness or efficacy of SST over existing approaches in the United Kingdom. While implementing SST should not be used to justify reduction in existing interventions, it offers a positive additional service for young people experiencing mental health difficulties and their families.

Commentary: Strengthening System Readiness for Health Interventions: Lessons for Implementing Interventions and Implementation Support in Low-And Middle-Income Countries.

In low- and middle-income countries (LMICs), barriers such as low system readiness, contextual mismatches, and resource limitations impede effective implementation of evidence-based interventions. This commentary offers insights into overcoming these challenges with a case study of the PRISM project, designed to reduce behavioral and psychological symptoms of dementia in older adults living in Thailand. The case highlights how combining two evidence-based models - the Reducing Disability in Alzheimer's Disease clinical intervention and the Getting To Outcomes implementation science process enhances program success. Using interviews with stakeholders across various health system levels, we identify factors critical to successful program implementation: (1) integrating interventions into policy frameworks, (2) empowering local implementers, (3) fostering collaborative learning, and (4) adapting interventions to local contexts. The case demonstrates that building system readiness through local engagement and ownership is central to scaling up health programs in LMICs. This commentary's contribution lies in its emphasis on the role of implementation science as a vehicle for translating research into practice. It presents a practical, adaptive model for embedding interventions into routine health systems, thereby offering a pathway for successfully scaling up evidence-based programs in LMICs. Such findings provide lessons for overcoming barriers to implementation in resource-limited environments.

Overcoming Reading Difficulties with Reading Fluency Strategies in the Turkish Language: Evidence from a Transparent Orthography

This study employed a single-case design with an AB structure to examine the effect of implementing a Response to Intervention (RTI) model on a fourth-grade elementary school student with reading difficulties. The participant in the study was Deniz, a fourth-grade elementary school student. The pretest measures revealed that Deniz was at the frustration level in both word recognition and reading comprehension skills. Consequently, an eight-week reading intervention program was designed to address and remediate Deniz’s reading difficulties. Through the intervention program, Deniz’s word recognition improved from the frustration level to the instructional level, and her reading comprehension progressed from the frustration level to the independent level, accompanied by a significant decrease in reading miscues.

Speech perception and language comprehension in primary progressive aphasia

Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by progressive loss of speech and language. Although speech perception and language comprehension deficits are observed in individuals with PPA, these deficits have been understudied relative to production deficits. Recent work has examined receptive language processing at sublexical, lexical, and semantic levels in PPA; however, systematic investigation of these levels of processing within a single PPA cohort is lacking. The current study sought to fill this gap. Individuals with logopenic, nonfluent, and semantic variants of PPA and healthy, age-matched controls completed minimal pairs syllable discrimination, auditory lexical decision, and picture-word verification tasks to assess sublexical, lexical, and semantic processing. Distinct profiles were observed across PPA variants. Individuals with logopenic variant PPA had impaired performance on auditory lexical decision and picture-word verification tasks, with a trend toward impaired performance on the syllable discrimination task. Individuals with nonfluent and semantic variant PPA had impaired performance only on auditory lexical decision and picture-word verification. Evaluation of the types of errors made on the picture-word verification task (phonological and semantic) provided further insight into levels of deficits across the variants. Overall, the results indicate deficits in receptive processing at the lexical-phonological, lexical-semantic, and semantic levels in logopenic variant PPA, with a trend toward impaired sublexical processing. Deficits were observed at the lexical-semantic and semantic levels in semantic variant PPA, and lexical-phonological deficits were observed in nonfluent PPA, likely reflecting changes both in lexical-phonological processing as well as changes in predictive coding during perception. This study provides a more precise characterization of the linguistic profile of each PPA subtype for speech perception and language comprehension. The constellation of deficits observed in each PPA subtype holds promise for differential diagnosis and for informing models of intervention.

Strategies for Effective Occupational Stress Management in the Workplace

Effective stress management involves addressing and mitigating occupational stress among employees. Designing a successful stress management program requires identifying key factors that influence employees’ ability to manage workplace stress. This also involves selecting intervention models that can effectively target these factors. The management framework conceptualizes occupational stress as an outcome of how stressors are perceived and how employees evaluate their coping resources. Organizational strategies to control occupational stress tend to take a more proactive approach. This study examines occupational stress management at both organizational and individual levels, aiming to enhance our understanding of effective workplace coping strategies for occupational stress. The study results indicate that IT employees, at both individual and organizational levels, expect organizations to implement stress management strategies, including counseling, training and development programs, proper recognition, career advancement opportunities, effective performance management systems, open communication, and ample support from management.

Effectiveness of The Early Start Denver Model for Children with Autism: A Narrative Review and Experiences for Viet Nam

Early intervention for children with autism is crucial for their development and quality of life. Different early intervention models exist, including the Early Start Denver Model, which has scientific evidence and is included in Vietnam's Guidance Document on Diagnosis and Intervention for Children with autism spectrum disorders. Therefore, quantitative research design and descriptive statistics methodologies are used in the study to review the Denver early intervention model's effectiveness in treating children with autism worldwide and bring lessons learned for application in Vietnam. This narrative review analyses 16 scientific articles conducted in an international database. Research results show that the Early Start Denver Model is efficacious in improving core defects in children with autism, such as social skills, communication skills, and repetitive behaviors,…; using the Early Start Denver Model will improve parent-child interactions, reducing stress for parents during the parenting process. The findings also indicate lessons for applying the Early Start Denver Model for children with autism in Vietnam, considering factors like regional culture, educational facilities, and learning materials; motor skills and imitation skills should be combined with other therapies for better effectiveness.

TAX LAW AND STATE INTERVENTION IN THE ECONOMY: WAR IN UKRAINE AND CHANGE IN TAX LEGISLATION TO MAINTAIN STABILITY IN BRAZIL

The scenario of instability and hyperinflation caused by the COVID-19 pandemic and the War in Ukraine has led Brazil to a serious crisis, with widespread price increases and deregulation of economic stability. Therefore, given the increase in fuel prices, which has a systemic effect throughout the country, it became necessary to implement a model of State intervention in the economic domain in order to minimize the impacts resulting from the unfavorable situation. Given the possible solutions, Tax Law proved to be the best solution for the case, being a mechanism for distributing the burdens of the situation among different entities of the Federative Republic of Brazil. It is therefore necessary to demonstrate how Tax Law is integrated into a form of State intervention in the Economy, correlated to classic State functions, in addition to the viability of intervention through tax legislation in order to reestablish a peaceful scenario and national economic stability.

Barriers and facilitators for implementing ABCs for Mental Wellbeing intervention model in Finland

Abstract Background The ABCs for Mental Wellbeing study aims to improve mental health and wellbeing by adopting, implementing and evaluating a universal, community-based mental health promotion intervention model in Finland. The study gathers information and experiences of the implementation processes, identifies barriers and facilitators, and best practices for the implementation, and the feasibility and contextual adaptability of the intervention in different settings and specific target groups. Methods The implementation took place in four municipality community settings. In total, 40 participants attended the ABC activities. The study employs a mixed methods approach to look at the implementation processes: a quantitative survey before and after the implementation, and qualitative interviews with the employees implementing the model and the participants involved with the ABC activities. Results Based on qualitative analysis, the most identified facilitator is management support alongside the competencies of professionals. The observed effects of group activities aligned with the ABC model on mental wellbeing show that participants not only experienced the benefits of model-compliant activities on their mental wellbeing but also increased their awareness of factors influencing their mental wellbeing. The results of the quantitative analysis will be ready during the spring. Conclusions The study offers fresh insights into the obstacles and enablers affecting the implementation of a mental health promotion intervention model. The best practice strategies and guidelines identified are being shared both nationally and internationally and utilised to enhance future programme implementation and adaptation of these practices in various settings. Key messages • Best practice strategies and guidelines for successful implementation of mental health promotion identified. • The ABCs for Mental Wellbeing increased participants’ awareness of the factors influencing their mental wellbeing.

Development of a systematic referral model to primary care health interventions for patients with atrial fibrillation. a delphi study

Abstract Background The European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF) recommend integrated care in AF, combining medical treatment with lifestyle modifications and psychosocial management in a multi-disciplinary set-up. Research show that patients with AF can benefit from lifestyle interventions and psychosocial management, like patient education. According to World Health Organization recommendations, these health interventions are moving from hospitals to primary healthcare settings. Therefore, patients with AF should be systematically referred to these interventions. Yet, an evidence-based referral model that can support this transition is lacking. Purpose The purpose is to develop a systematic referral model for primary care health interventions for patients with AF. Methods We used the Delphi-technique with three rounds of questionnaires (figure 1). International and national clinical experts in AF across disciplines and health sectors were invited to participate. In the first round, the expert panel evaluated items that could be part of a referral model on relevance, improvability and self-reporting. In the second round, the expert panel evaluated each item as either an inclusion or exclusion criteria, important knowledge to have, or not relevant. In the third round, the expert panel evaluated the items according to data source and outcome status. A final model was drawn based on items reaching consensus. The study was reported according to the guidance on conducting and reporting Delphi studies (CREDES). Results In total, 69 of 139 invited experts accepted to participate (50%). These were mostly academics or clinicians (90%), stemming from primary sector (16%), secondary sector (35%) and research (32%). Most were medical doctors (36%) and nurses (35%). However physiotherapist, psychologists, dieticians, and other disciplines along with six patients with AF were also represented. The expert panel (60% females) had a mean age of 50 years, and 65% were from Denmark. For the final referral model (figure 2), AF symptom burden and impaired health-related quality of life, anxiety and poor medicine compliance combined with a risk factor profile were the main inclusion criteria. Furthermore, it was important to know about the patients’ mental well-being, self-management abilities and comorbidities. Conclusion Consensus was reached for a generic referral model, which can be further adjusted in the appropriate clinical context. The model includes inclusion criteria which closely correlate with guidelines for AF management focusing on reducing the patients’ symptom and risk factor burden. The referral model is expected to increase the number of patients with AF referred to primary care health interventions, which could lead to better quality of life, fewer hospital admissions and lowered health care costs in AF.

Transferability of vaccination interventions from a community perspective: One size does not fit all

Abstract Background Removing health system barriers to childhood vaccination is an urgent matter in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. The objective of this study was to select and adapt potentially transferable evidence-based interventions for HPV and MMR vaccine uptake in partnership with the underserved communities. Methods Using a participatory approach, we assessed transferability of six pre-selected interventions with the Population, Intervention, Environment and Transfer (PIET-T) models: All countries investigated two interventions with trained community members to support vaccination as health promoters. Greece and the Netherlands included a school-based vaccination program. The Netherlands added two interventions addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention. Results We identified barriers and facilitators for successful intervention transfer in each of the target contexts. The transferability analysis showed that an intervention with health promoters is potentially transferable with adaptations in all countries. Principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost are transferable key elements in all contexts. Adaptations refer to the intervention elements that need to be tailored to specific contextual needs. School-based vaccination was nowhere transferable. Health provider training needs to be culturally sensitive and adapted to the Dutch system. The multilevel intervention in Slovakia is not fully transferable. Conclusions Participatory transferability analysis was essential for decision-making and intervention adaptation. All countries independently selected a health promoter intervention as having potential to remove the identified health system barriers in the respective context.

Heat-related risk in outdoor workers in the context of climate change: a systematic review

Abstract Background Climate change is one of the paramount challenges in the current global health setting. From an occupational health perspective, outdoor workers are amongst the most vulnerable populations to climate change and heat-related risk. A systematic review was performed, aiming to assess heat-related health outcomes in outdoor workers. Methods The research query was structured using the Population, Intervention, Comparison and Outcome (PICO) model, and including synonyms and Medical Subject Headings (MeSH) terms for the following keywords: “outdoor workers”, “climate change”, and “occupational risk”. The systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements, screening three databases (PubMed, Web of Science, and Scopus). Results After duplicate removal and title and abstract screening, the final screening by full-text resulted in 10 included studies. The included studies were performed mostly on construction (included in 5 studies, 50.0%) and agriculture (in 5 studies, 50.0%) workers. Eight studies (80.0%) had a majority of male workers, while one (10.0%) had a majority of female workers, and one study (10.0%) did not report on the gender ratio. Four of the included studies (40.0%) reported a high prevalence of heat-related symptoms, ranging from 64.0% to 90.3% of workers. Three studies (30.0%) showcased a prevalence of heat-related symptoms in less than 50% of workers (ranging from 11.6% to 47.5%). Three studies (30.0%) evaluated odds ratio, highlighting an increased odds ratio of heat-related symptoms in outdoor workers. Conclusions This systematic review highlights heat-related stress in outdoor workers as an important occupational risk. Mitigation and prevention strategies should be developed and implemented at a company, national, and supra-national level, to ensure the safety and wellbeing of outdoor workers worldwide. Key messages • A systematic review was performed to assess risks related to climate change in outdoor workers. Heat-related symptoms were reported with a high prevalence, ranging from 64.0% to 90.3% of workers. • Mitigation and prevention strategies should be developed and implemented at a company, national, and supra-national level, to ensure the safety and wellbeing of outdoor workers worldwide.

How stop smoking outreach works: a co-inquiry informed, complex intervention model

Abstract Background Across Europe, smoking prevalence is concentrating in underserved communities with high levels of deprivation. And yet, there is little research on how stop smoking services (SSS) can engage these communities. This study presents the findings of a 12-month collaboration involving an external public health research team and staff of an English SSS. Staff worked with community partners (e.g., schools) to raise awareness of the service, which included a newly introduced e-cigarette offer. Methods A complex intervention model was developed and refined through 6 facilitated co-inquiry sessions involving 13 SSS staff. Staff also completed 32 reflection forms on outreach events and rapid ethnography was conducted, by the research team, to evaluate staff’s working assumptions. This included 8 observations of outreach events and interviews with 10 SSS staff and 8 community members, from the service target groups. Data were organised into themes. Findings The model presents a picture of stop smoking outreach as challenging, unpredictable and resource intensive yet often having great impact. The themes enrich this to highlight 1) the appreciation for yet unpredictability of outreach referrals for people disconnected from health services; 2) the importance of staff adopting a person-centred approach; 3) the challenges and opportunities presented by e-cigarettes; and 4) the role of strategic community partnerships in optimising staff time on outreach. Conclusions Stop smoking outreach can generate considerable interest in SSS, particularly when delivered in combination with an e-cigarette offer. Future research should explore the economic and social return on investment in community outreach: while time consuming, referrals generated proactively may become more important for SSS as smoking concentrates in underserved communities. Key messages • Stop smoking outreach is an effective way to raise awareness and generate referrals but must be done non-judgementally and via effective community partnerships. • Staff’s careful discussion of an e-cigarette offer can change the perception of SSS without contributing to recreational normalization.