Abraham Brown

The International Alcohol Control (IAC) Study—Evaluating the Impact of Alcohol Policies

BACKGROUND This paper describes a new multicountry collaborative project to assess the impact of alcohol control policy. Longitudinal surveys of drinkers in a number of participating countries and analysis of the policy context allow for the assessment of change over time within countries and comparison between countries. The design of the study is modeled on the International Tobacco Control study and aims to assess the impact of alcohol policies in different cultural contexts on policy-related behaviors and alcohol consumption. A survey instrument and protocol for policy analysis have been developed by the initial participating countries: England, Scotland, Thailand, South Korea, and New Zealand. The first round of data collection is scheduled for 2011-2012. MEASUREMENTS The survey instrument (International Alcohol Control [IAC] survey) measures key policy relevant behaviors: place and time of purchase, amounts purchased and price paid; ease of access to alcohol purchase; alcohol marketing measures; social supply; perceptions of alcohol affordability and availability and salience of price; perceptions of enforcement; peoples experiences with specific alcohol restrictions; support for policy and consumption (typical quantity, frequency using beverage and location-specific measures). The Policy Analysis Protocol (PoLAP) assesses relevant aspects of the policy environment including regulation and implementation. RESULTS It has proved feasible to design instruments to collect detailed data on behaviors relevant to alcohol policy change and to assess the policy environment in different cultural settings. CONCLUSIONS In a policy arena in which the interest groups and stakeholders have different perceptions of appropriate policy responses to alcohol-related harm, a robust methodology to assess the impact of policy will contribute to the debate.

Tobacco marketing awareness on youth smoking susceptibility and perceived prevalence before and after an advertising ban

BACKGROUND The Tobacco Advertising and Promotion Act (TAPA) was implemented in the United Kingdom in 2003. This study is the first to assess its impact on young people, examining smoking susceptibility (intention to smoke among never smokers) and perceived prevalence across three British cross-sectional samples (aged 11-16) before and after the introduction of the ban. METHODS Three in-home surveys (n = 1078, 1121 and 1121) were conducted before (1999 and 2002) and after (2004) the implementation of the TAPA. RESULTS Significant declines in awareness of tobacco marketing and perceived prevalence occurred across the three waves. Higher levels of awareness and perceived prevalence were associated with increased susceptibility, but direct measures of susceptibility remained stable. CONCLUSIONS The TAPA is protecting young people in United Kingdom from tobacco marketing and reducing perceived prevalence, both of which are linked to susceptibility. The stability of susceptibility across the three waves is probably best explained by both the partial implementation of TAPA at the final survey point and the time such effects take to emerge. The evidence from this and previous studies is, however, that, ultimately, they will appear.

Development and evaluation of an early detection intervention for mouth cancer using a mass media approach

Background:Scotland has a high incidence of mouth cancer, but public awareness and knowledge are low compared with other cancers. The West of Scotland Cancer Awareness Project sought to increase public awareness and knowledge of mouth cancer and to encourage early detection of symptoms among an at-risk population of people aged over 40 years from lower socio-economic groups using a mass media approach. The media campaign aimed to increase peoples feelings of personal risk, while also enhancing feelings of efficacy and control. To achieve this, a testimonial approach (using real people to tell their own stories) was adopted.Methods:Campaign impact and reach was assessed using in-home interviews with a representative sample of the target population in both the campaign area and controls outside of the target area. Surveys were conducted at three stages: at baseline before the campaign was launched, and at 7 and 12 months thereafter.Results:Awareness of media coverage was higher at both follow-up points in the intervention area than in the control area, the differences largely being accounted for by television advertising. The campaign had a short-term, but not a long-term impact on awareness of the disease and intention to respond to the symptoms targeted by the campaign. Awareness of two of the symptoms featured in the campaign (ulcers and lumps) increased, post-campaign, among the intervention group.Conclusions:While the study provides evidence for the effectiveness of the self-referral model, further work is needed to assess its ability to build public capacity to respond appropriately to symptoms and to compare the cost-effectiveness of a mass media approach against alternative communication approaches and more conventional mass screening.

The effectiveness of tobacco marketing regulations on reducing smokers' exposure to advertising and promotion: findings from the International Tobacco Control (ITC) Four Country Survey.

Exposure to tobacco product marketing promotes the initiation, continuation, and reuptake of cigarette smoking and as a result the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) has called upon member Parties to enact comprehensive bans on tobacco advertising and promotion. This study examines the immediate and long term effectiveness of advertising restrictions enacted in different countries on exposure to different forms of product marketing, and examines differences in exposure across different socioeconomic status (SES) groups. Nationally representative data from the United Kingdom, Canada, Australia, and the United States, collected from adult smokers between 2002 and 2008 using the International Tobacco Control Four Country Survey (ITC-4), were used in this study (N = 21,615). In light of the specific marketing regulation changes that occurred during the course of this study period, changes in awareness of tobacco marketing via various channels were assessed for each country, and for different SES groups within countries. Tobacco marketing regulations, once implemented, were associated with significant reductions in smokers’ reported awareness of pro-smoking cues, and the observed reductions were greatest immediately following the enactment of regulations. Changes in reported awareness were generally the same across different SES groups, although some exceptions were noted. While tobacco marketing regulations have been effective in reducing exposure to certain types of product marketing there still remain gaps, especially with regard to in-store marketing and price promotions.

The U.S. National Tips From Former Smokers Antismoking Campaign Promoting Awareness of Smoking-Related Risks, Cessation Resources, and Cessation Behaviors

Objective. Evaluate the second flight of the U.S. Tips From Former Smokers (Tips) campaign. Method. Data were analyzed from an online consumer panel of U.S. adult smokers before (n = 1,404) and after (n = 1,401) the 2013 Tips campaign launch. Generalized estimating equation models assessed whether the Tips advertisement recall was associated with knowledge about smoking-related risks in the Tips advertisements, awareness and use of a toll-free quitline and cessation websites, and quit attempts. Results. Seventy-one percent of participants at Wave 2 reported that they recalled seeing at least one Tips advertisement. Smokers who recalled seeing a Tips advertisement were more likely to (a) show increases over baseline in knowledge of health risks such as amputation: 65% versus 34%, p < .001; blindness: 27% versus 12%, p < .001; and (b) to be aware of a quitline (41% vs. 30%, p < .001) and cessation website (28% vs. 20%, p < .001). Recall of Tips advertisements was also associated with greater likelihood of reporting having visited cessation websites (odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.27-2.06), having called a quitline (OR = 2.28, 95% CI = 1.61-3.24), and having made a quit attempt (OR = 1.18, 95% CI = 1.00-1.39), although these results were only statistically significant in the unadjusted models. Conclusions. The 2013 Tips campaign was successful in increasing knowledge of health risks and awareness of tobacco cessation resources.

Adolescents’ Perceptions of Tobacco Control Measures in the United Kingdom

Understanding youth perceptions of measures that either encourage or discourage youth smoking is critical to help inform and consolidate tobacco control policy. Twelve focus groups, comprising adolescent smokers (N = 32) and nonsmokers (N = 35) aged 11 to 16 years were conducted in Glasgow and Lothian, Scotland. Each focus group explored factors adolescents encounter in everyday life that they perceive to facilitate or impede smoking, and about smoke-free legislation, smoking in domestic situations, access to cigarettes, and health warnings. It emerged that antitobacco advertisements and smoke-free legislation were considered of value in terms of being capable of reducing smoking. Although some adolescent smokers believed that adult smokers would not stop smoking because of a smoking ban, but instead compensate by smoking more elsewhere, such as at home, most adolescents with smoking parents or relatives indicate that this has not happened. Tightening regulation on ease of access to cigarettes was considered a suitable means of reducing youth smoking, although some smokers suggested that this could be easily circumvented by having others purchase tobacco on their behalf. Despite high awareness, text-only health warnings were not considered to discourage smoking. Point-of-sale tobacco displays however were considered to encourage smoking—being cool, fun, and attractive.

Commentary on Sims et al. (2012): A timely response to the impact of smoke-free public places on the most exposed children.

.[4] provide timely evidence that smoke-free legislationdoes not displace adult smoking to the home, but ratherreduces SHS exposure among most at risk children, i.e.those with smoking parents or living in homes allow-ing smoking. These findings dispute the arguments andinform health advocates and policymakers about theunintended health benefits of protecting non-smokers,especially children exposed to second-hand smoke in thehome [5]. Given that the main source of SHS exposureamong children is domestic [6,7], the reported declinesreflect changing social norms around smoking [8],perhaps derived from voluntary family-based restrictionsby adults to promote health in children [6].Children are particularly vulnerable to SHS exposure,as even modest levels of exposure have been associatedwith respiratory abnormalities and other adverse healtheffects [9,10]. As adolescents observe smoking in thedomestic setting, they tend more towards seeing smokingas normal adult behaviour, and attribute favourableoutcome expectations over time with repeated exposure[8,11]. Research has shown that adolescent adoption ofsmoking is related to perceptions of significant others,such as parental smoking behaviour, as well as societalnorms of smoking [12,13]. In an environment where anon-smoking directive, e.g. smoke-free homes or cars, isenacted children will possibly perceive smoking as asocially unacceptable behaviour, and may be less likely totake up smoking [14]. However, despite reported declinesin SHS exposure by the authors, the high levels of chil-dren’s exposure in England (approximately half livingin homes allowing smoking and a third with smokingparents) may send an unequivocal message to youthsthat smoking is still a normative behaviour, and mightsensitize them to start smoking.Sims