Gordon B. Lindsay

Adolescents' attention to traditional and graphic tobacco warning labels: an eye-tracking approach.

The objective of this study was determine if the inclusion of Canadian-style graphic images would improve the degree to which adolescents attend to, and subsequently are able to recall, novel warning messages in tobacco magazine advertising. Specifically, our goal was to determine if the inclusion of graphic images would 1) increase visual attention, as measured by eye movement patterns and fixation density, and 2) improve memory for tobacco advertisements among a group of 12 to 14 year olds in the western United States. Data were collected from 32 middle school students using a head-mounted eye-tracking device that recorded viewing time, scan path patterns, fixation locations, and dwell time. Participants viewed a series of 20 magazine advertisements that included five U.S. tobacco ads with traditional Surgeon General warning messages and five U.S. tobacco ads that had been modified to include non-traditional messages and Canadian-style graphic images. Following eye tracking, participants completed unaided- and aided-recall exercises. Overall, the participants spent equal amounts of time viewing the advertisements regardless of the type of warning message. However, the warning messages that included the graphic images generated higher levels of visual attention directed specifically toward the message, based on average dwell time and fixation frequency, and were more likely to be accurately recalled than the traditional warning messages.

Psychosocial Distress and Substance Use Among Adolescents in Four Countries Philippines, China, Chile, and Namibia

The purpose of the current study was to examine the relationship between adolescent substance use and psychosocial distress indicators among 30,851 adolescents aged 11 to 16 in four countries (Philippines, China, Chile, and Namibia). Global School-Based Student Health Survey data from these countries provided information about frequency and lifetime use of alcohol, tobacco, and other drugs as well as items about early adolescents’ feelings of loneliness, worry, hopelessness, suicide, and number of close friends. Overall, there were significant relationships between adolescent substance-use behaviors and a measure of “global” psychosocial distress for both boys and girls in all four countries and for four of the five items of psychosocial distress (often lonely, often worry, sad/hopeless, and having a suicide plan). The association between substance use and psychosocial distress was also consistent in both genders and across the four countries. These results have important implications for professionals who work with adolescent populations.

Cigarette pack warning labels in Russia: how graphic should they be?

BACKGROUND Tobacco warning labels on cigarette packs have been shown to reduce cigarette consumption. The current study measures the Russian populations acceptance and preference of graphic (picture + text) tobacco warning labels. METHODS Nationally representative data were collected from 1778 participants in the Russian Federation in October 2009. A cross-sectional survey was conducted through person-to-person household interviews with respondents aged ≥ 14 years. Survey questions included standard demographic queries and three study-specific questions. Participants rated the strength of 13 cigarette warning labels according to their effectiveness to deter from smoking. Smoking status and the populations acceptance of similar warning labels was also measured. RESULTS A dose-response pattern is apparent between the degree of graphic content of cigarette warning labels and the publics perception regarding the warning labels ability to discourage smoking. Approximately 87% of all respondents thought Russian authorities should require tobacco manufacturers to place graphic warning labels on cigarette packs, while 80% of current smokers wanted their government to enact such enforcement. CONCLUSION The Russian population would strongly support government policy that would require graphic warning labels to be placed on cigarette packs in their country. In order to best deter from smoking, future cigarette warning labels in Russia should be as graphic as possible.

Patterns of smoking behavior among physicians in Yerevan, Armenia

BackgroundPhysicians can play an important role in smoking prevention and control. This study will identify smoking prevalence among physicians in Yerevan, Armenia. It will also explore how the smoking behaviors of physicians, their perceived ability to influence patient smoking behavior, and their knowledge about health outcomes related to smoking influence their interaction with patients.MethodsA cross-sectional, self-administered, anonymous survey was conducted in July, 2004, among 12 healthcare facilities in Yerevan. Analyses are based on responses from 240 physicians, representing a 70% response rate.ResultsThe percentage of current smokers was significantly higher in men than women (48.5% vs. 12.8% regular and 6.8% vs. 4.5% occasional). Among current smokers, 52.7% of men compared with 13.0% of women had previously smoked in the presence of patients. Only 35.3% felt well prepared to assist patients to quit smoking. Physicians who smoke are less likely to ask their patients about their smoking behavior or believe their example is likely to influence their patients. Level of perceived preparedness to assist patients to quit smoking was positively associated with knowledge about known health risks associated with smoking.ConclusionSmoking prevalence is high among physicians in the 12 healthcare facilities in Yerevan, and a large percentage of physician smoke in the presence of their patients. Physician smoking behavior and knowledge of smoking related health outcomes in Yerevan influences whether they counsel patients regarding smoking.

Teens in trouble: cigarette use and risky behaviors among private, high school students in La Paz, Bolivia

OBJECTIVE To describe the prevalence of cigarette smoking and to identify risky behaviors associated with smoking among adolescents attending high schools in a district of La Paz, Bolivia. METHODS The Youth Risk Behavior Survey was administered to a sample of 394 males and 182 females, from 13-18 years of age, at six, randomly-selected schools in District II of La Paz. Frequencies, chi-square tests, and logistic regression were employed to identify factors associated with cigarette use during the 30 days prior to the survey. RESULTS Approximately 40% of the sample (39.4% of males and 33.7% of females) had smoked cigarettes in the 30 days prior to interview. For both males and females, consumption of alcohol was the single greatest risk factor associated with cigarette use. The males and females who reported consuming at least one alcoholic beverage on three or more occasions in the previous 30 days were 22.3 and 58.5 times (95% CIs: 6.7, 74.1 and 6.8, 502.6, respectively) more likely to smoke tobacco than those who reported no alcohol consumption. Additional risk factors included having participated in a physical fight, having carried a weapon, having had sexual intercourse, and having used illicit drugs during the previous 30 days. CONCLUSIONS Because teenagers who smoke are also likely to engage in a variety of other risky behaviors, parents, school administrators, and health educators may wish to use smoking to identify at-risk individuals. Among Bolivian teenagers, interventions should focus on preventing cigarette use and associated risk behaviors.

Using "Bud World Party" attendance to predict adolescent alcohol use and beliefs about drinking.

This study explored the association between attendance at the “Bud World Party,” a family entertainment venue created by Anheuser-Busch for the 2002 Winter Olympics, and alcohol-related beliefs and current drinking behaviors for a group of 7th and 8th graders who attend a middle school in close proximity to the downtown Salt Lake City plaza where the exhibit and related events were located. Data were collected via a questionnaire administered to 283 students 30 days after the closing ceremonies. Logistic regression was used to predict recent alcohol consumption. Significant predictors were race (non-white) (OR = 3.9), religiosity (OR = .72), having a parent who drinks (OR = 4.8), the number of best friends who drink (OR = 2.5), and the interaction for “Bud World Party” attendance and gender (OR = 33.2). Post-hoc analysis of the interaction effect indicated that the relationship between “Bud World Party” attendance and recent alcohol consumption is moderated by gender. Girls who visited “Bud World Party” were more likely than the boys to have consumed alcohol in the past 30 days. In addition, the girls who visited “Bud World Party” were more likely to believe that drinking would increase their chances of popularity at school than the students who did not.

A Descriptive Analysis of Health-Related Infomercials: Implications for Health Education and Media Literacy.

Abstract Media literacy education helps individuals become discriminating consumers of health information. Informed consumers are less likely to purchase useless health products if informed of misleading and deceptive advertising methods. The purpose of this study was to conduct a content analysis of health-related TV infomercials. An instrument specifically for health-related infomercials was developed and tested. The instrument assessed product category, health problems solved, production format, persuasive techniques, implied health benefits, implied social/emotional benefits, testimonial frequency, and product acquisition information presented in the program. Four trained observers analyzed the content of 31 health-related infomercials. Health infomercials were divided into five categories of products. Frequency of use for 21 different promotional techniques varied from 93 to 10%. Analysis demonstrated that particular types of products were far more likely to utilize selected persuasive tactics. Frequency distributions for implied physical and emotional/social benefits were calculated. Health-related infomercials utilize a consistent formula of promotional techniques. Veteran health educators will recognize these techniques from long-standing consumer health recommendations on how to spot health fraud. Implications for media literacy in health education are explored.

The Contribution of Public Health and Improved Social Conditions to Increased Life Expectancy: An Analysis of Public Awareness

Background: Historical analysis of health data suggests the majority of the life expectancy increase that occurred during recent centuries was caused by improvements in public health and social determinants of health. The purpose of this study was to assess lay public perceptions regarding why life expectancy has increased. Methods: A nationally representative sample of 705 adults were surveyed to determine which factors people credit for the 40 plus year increase in life expectancy that occurred since the mid-1800s. Survey items included open-ended questions, rank ordering of possible explanations, and numeric estimates of attribution. Results: Participants in the study rarely attributed increased life expectancy to public health measures or improvements in social health determinants. In contrast, subjects believed that medical care, by far, played the predominant role and attributed medical care for causing 80% of the life expectancy increase. Conclusion: The public grossly overestimates how much of our increased life expectancy should be attributed to medical care and is largely unaware of the critical role played by public health and improved social conditions determinants. These misperceptions may hinder adequate public health funding and efforts to address important health-related social issues. Misattribution of credit may also contribute to overfunding the medical sector of the economy and impede efforts to contain health care costs.

Tobacco brand preference among Mexican adolescents.

Abstract Introduction: Advertising plays a major role in smoking behavior and forming brand preferences. Additionally, the most advertised tobacco brands have also been the most preferred. Maintaining brand loyalty in Latin America remains a priority for the tobacco industry. Objective: The purpose of this study was to explore tobacco brand preference trends from 2003 to 2006, and explore marketing and advertising factors that might be associated with these trends. Study group: Data for this study came from Mexican adolescents residing in cities that participated in the Global Youth Tobacco Survey in both 2003 and 2006 and reported smoking either Marlboro or Camel cigarettes in the past 30 days. Methods: Respondents reported the brand name of their preferred cigarette during the past 30 days. Multivariate regression analysis was used to determine differences by brand preference and exposure to tobacco marketing and advertising, which was assessed using six items. Results: In 2003, most adolescents preferred Marlboro. By 2006, older boys preferred Camel cigarettes to Marlboro, while girls’ preference for Camel was similar to their preference for Marlboro. Adolescents that preferred Camel cigarettes in 2003 also reported greater exposure to tobacco marketing and advertising. Conclusion: Findings indicate that there are ongoing shifts in youth brand preference in Mexico, and that these shifts might be related to marketing and advertising practices. There is an ongoing need for monitoring marketing and advertising practices in an effort to protect adolescents from tobacco company exploits.

Alcohol and tobacco counter-ads: stealing a page from billboard utilizing graffitists against unhealthy promotions.

The decisions made by young people are impacted by a wide variety of positive and negative influences within society.1 The influence of media on adolescents’ health practices and behaviors, including personal values, beliefs, and perceived norms cannot be overstated. Youth media consumption continues to increase.2 Media messages are carefully designed to persuade the consumer to believe or do something.3 Some of the most persuasive media messages can be found in print advertisements selling alcohol and tobacco products. These messages are carefully crafted constructions, which understandably never tell youth the whole truth regarding the use of these products. Media literacy teaching techniques focused on helping students to critically consume and create media are essential in achieving necessary school health behavioral objectives related to use of alcohol, tobacco, and other drugs. Alcohol and tobacco advertising has long been under scrutiny. Recently health promotion efforts, including The Truth Campaign, have utilized satire and spoof advertising to expose the harmful effects of tobacco and other products. Such techniques are not new. Formed in 1979, Billboard Utilizing Graffitists Against Unhealthy Promotions (BUGAUP) was a group of advocates in Australia who used spray paint at night to cleverly alter tobacco billboards and ridicule the deceptiveness of tobacco advertisements. BUGAUP’s creative vandalism helped shift public opinion regarding tobacco marketing.4 Although health education efforts today should not encourage students to use graffiti for health promotion, teaching them to ‘‘talk back’’ to deceptive and harmful media messages through the use of counter-ads is recommended.3 As advertisers have long targeted teens’ sense of youthful rebellion, this teaching