Judith McCool

Adolescent perceptions of smoking imagery in film.

Smoking amongst adolescents in New Zealand continues to be a problem, with more than a one-third increase in smoking prevalence between 1992 and 1997. Favourable portrayals of smoking in the media have been cited as potential motivators of the initiation of smoking among adolescents. To date, however, its role in influencing smoking perceptions and behaviours has not received systematic analysis. A qualitative study was conducted to explore how adolescents interpret and decode smoking imagery in movies. Data was collected through focus groups. Same-gender groups of 12- and 13-year-old students were interviewed at their schools. Participants discussed their recollections of and responses to portrayals of smoking in recently viewed films, as well as their perceptions of smoking in general. Students perceived that smoking in film is both highly prevalent and recognisable, and they regarded on-screen-smoking imagery as an accurate reflection of reality. Adolescents in this study were predominantly nonchalant towards the inclusion of smoking images in film, and they perceived an unrealistically high prevalence of smoking amongst peers and adults. Their noncholant response is linked with the perception that smoking is normal and prevalent and with the broad understanding of the constructed nature of media imagery. Smoking imagery in film may play a critical role in reinforcing cultural interpretations of tobacco use, such as its role as a means of stress relief, development of self-image and as a marker of adult independence.

Tobacco Branding, Plain Packaging, Pictorial Warnings, and Symbolic Consumption

We use brand association and symbolic consumption theory to explore how plain cigarette packaging would influence the identities young adults cocreate with tobacco products. Group discussions and in-depth interviews with 86 young adult smokers and nonsmokers investigated how participants perceive tobacco branding and plain cigarette packaging with larger health warnings. We examined the transcript data using thematic analysis and explored how removing tobacco branding and replacing this with larger warnings would affect the symbolic status of tobacco brands and their social connotations. Smokers used tobacco brand imagery to define their social attributes and standing, and their connection with specific groups. Plain cigarette packaging usurped this process by undermining aspirational connotations and exposing tobacco products as toxic. Replacing tobacco branding with larger health warnings diminishes the cachet brand insignia creates, weakens the social benefits brands confer on users, and represents a potentially powerful policy measure.

The Role of the Media in Influencing Children's Nutritional Perceptions

Recently the mass media environment of children, in particular food advertising, has come under scrutiny as a contributing factor in the increasing prevalence of childhood obesity. Focus groups were used to explore how childrens appraisals of various forms of media inform their health-related perceptions about eating and nutrition. Ninety participants aged 10 to 12 years were recruited from schools throughout Auckland, New Zealand. Schools were randomly selected from among those rated with low, medium, and high socioeconomic status. Results show that the media is a key factor shaping how young people conceptualize healthy eating and healthy bodies. Mass media food messages were not seen as a credible source of health information; rather, they assist in constructing and reinforcing dominant misconceptions about food, healthy eating, and nutrition. Nutritional messages embedded in both health promotion and advertising were perceived to be conflicting and ambiguous, and might serve to undermine the trustworthiness of health promotion initiatives.

Interpretations of smoking in film by older teenagers

Research testifies that images of tobacco use in popular films are highly pervasive and typically glamorised. There are concerns that these images may promote motivations to smoke in adolescents, but little is known about how these images are interpreted by members of this age group. A qualitative study was conducted to explore how older teenagers interpret and decode smoking imagery in film. This study builds on earlier work with a younger age group (12 and 13 years) to explore how various interpretations of smoking imagery shape and support common understandings about smoking among older teenagers. Data were collected through focus groups. Eighty-eight 16 and 17 year old students were interviewed at school. Participants discussed their recollections of and responses to recently viewed films. Older teens were receptive to smoking imagery when it was used in a credible manner to portray an emotional state, sub-culture affiliation, and lifestyle. Experience as a smoker appeared to inflate the credibility of realistic smoking images, particularly those presented in gritty realism/drama film. Older teens perceived realistic images, as opposed to stereotypical images, as a salient reference to their own lives. Stereotypical images were also readily recalled and appeared to perform an important role in supporting misconceptions about smoking and contributing to popular ideologies about tobacco use. Stereotypical images presented in comedy and action genre also serve to present paradoxical and contradictory messages about tobacco use. In particular, participants recalled tobacco use in film as associated with stress and anxiety, drug use, and seduction. Film images of tobacco use in specific contexts appear to hold specific and significant meanings for older teens. Realistic images offered salient representations of the perceived reality of smoking for this group. Pervasive and credible smoking scenes in film may offer support and reassurance to older teens who currently smoke or hold ambivalent views about smoking. Consistent with younger adolescents, older teens presented a predominantly nonchalant response to smoking imagery in film, which is a powerful indicator of the pervasiveness and acceptability of smoking in general. In contrast with younger adolescent, older teens tend to draw upon their own experience with tobacco use when interpreting smoking images in film.

Stereotyping the smoker: adolescents’ appraisals of smokers in film

Objective: To assess the relation between demographic factors and film smoking stereotypes in adolescents and the potential influence of smoker stereotypes on smoking susceptibility. Design: A cross sectional questionnaire survey of school students (n  =  3041) aged 12–13 and 16–17 years who were asked to describe the personal characteristics of female and male smokers in films. Setting: 15 primary or intermediate schools and 10 secondary schools in Auckland, New Zealand. Results: Appraisals of smokers in film were strongly influenced by age and sex with younger adolescents and males more likely to see female smokers as sexy, intelligent and healthy whereas older students and females more often appraised female smokers as stressed bored and depressed. Overall, image stereotypes (sexy, stylish) were more likely to be significantly associated with smoking susceptibility than emotional sensitivity stereotypes (stressed, depressed etc). Conclusions: Adolescents differ significantly in their appraisal of smokers in films; however, image based stereotypes, rather than emotional sensitivity stereotypes, are significantly associated with smoking susceptibility.

A cross-sectional analysis of how young adults perceive tobacco brands: implications for FCTC signatories

BackgroundThe Framework Convention on Tobacco Control calls for the elimination of tobacco advertising, promotion and sponsorship. To test whether tobacco packaging functions as advertising by communicating attractive and distinctive brand attributes, we explored how young adult smokers and non-smokers interpreted familiar and unfamiliar tobacco brands.MethodsWe conducted an on-line survey of 1035 young adult smokers and non-smokers aged 18–30. Participants evaluated eight tobacco brands using ten attributes based on brand personality scales. We used factor analysis and ANOVA to examine patterns in brand-attribute associations.ResultsYoung adults distinguished between brands on the basis of their packaging alone, associated each brand with specific attributes, and were equally able to interpret familiar and unfamiliar brands. Contrary to our expectations, non-smokers made more favourable brand-attribute associations than smokers, but both groups described Basic, a near generic brand, as ‘plain’ or ‘budget’. There were no significant gender or ethnicity differences.ConclusionsTobacco packaging uses logos, colours and imagery to create desirable connotations that promote and reinforce smoking. By functioning in the same way as advertising, on-pack branding breaches Article 13 of the FCTC and refutes tobacco companies’ claims that pack livery serves only as an indentifying device that simplifies smokers’ decision-making. Given this evidence, signatories should see plain packaging policies as a priority consistent with their FCTC obligations to eliminate all tobacco advertising and promotion.

Keeping Kids Smokefree: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to smoking among Māori and Pacific Island children in New Zealand.

Despite a concerted, sustained and comprehensive tobacco control effort, smoking is prevalent among young people in New Zealand, particularly for Māori and Pacific Island teenagers. Many took up smoking in their pre-teen years. New Zealand research has shown that daily smoking by children aged 14–15 years is strongly influenced by parental smoking. The Keeping Kids Smokefree study is investigating whether changing parental smoking behavior and attitudes via a community-partnership approach with parents, schools, and local health providers can reduce smoking initiation by 11–12 year olds. It is a quasi-experimental trial involving four schools in an urban area of high social deprivation with large numbers of Māori and Pacific Islands families. Schools were allocated to intervention or control and the intervention was developed through a process of engagement with the schools, parents of children and local healthcare organizations. This article describes the rationale, context, methodology and methods involved in establishing the study. Building Māori and Pacific Islander research capacity was a secondary objective of the study.

Tobacco Promotion in the Pacific: The Current State of Tobacco Promotion Bans and Options for Accelerating Progress

Tobacco consumption is a major contributor to the burden of chronic noncommunicable disease within the Pacific region. Low and lower-middle income countries are acutely vulnerable to exploitation by the tobacco industry as they often lack the resources and capacity to implement protective tobacco control policies. The Framework Convention on Tobacco Control, which has been signed by 14 Pacific Island Countries and Territories, was introduced in 2004 to guide the priorities for tobacco control policy implementation. Legislation, tobacco industry documents, and peer-reviewed journals were evaluated to assess the current status of tobacco advertising bans of the 8 low and lower-middle income countries within the Pacific region. Results identified that of the 8 Pacific countries reviewed, 3 had comprehensive tobacco advertising bans that prohibit tobacco advertisements in 5 to 7 forms of media, and the remaining 5 countries have weak tobacco advertising bans that provide no protection for youth against tobacco advertising. This research reveals the need for resources to support the introduction of effective policies around tobacco advertising in the low and lower-middle income countries within the Pacific region.

Human leptospirosis in The Federated States of Micronesia: a hospital-based febrile illness survey

BackgroundHuman leptospirosis is an emerging infectious disease of global significance, and is endemic to several countries in the Pacific. Zoonotic transmission dynamics combined with diagnostic challenges lead to difficulties in prevention and identification of cases. The Federated States of Micronesia (FSM) lacks surveillance data for human leptospirosis. This hospital-based serologic survey sought to estimate the burden of leptospirosis, collect information relating to associated factors, and assess the leptospirosis point-of-care rapid diagnostic test (RDT) commonly used in FSM.MethodsA four-month hospital-based survey was conducted in Pohnpei State, FSM in 2011. Patients with undifferentiated fevers presenting to hospital were referred for enrolment by physicians. Consenting participants provided paired blood specimens 10–30 days apart, and responded to interview questions regarding demographics, clinical symptoms, exposure to animals, and environmental exposure. Blood samples were subjected to immunochromatographic RDT and confirmed by microscopic agglutination test (MAT).ResultsOf 54 participants tested by MAT, 20.4% (95% confidence interval [CI] 10.1–30.6%) showed serologic evidence of acute infection. Occupation student (odds ratio [OR], 17.5; 95% CI: 1.9–161.1) and recreational gardening (OR, 8.6; 95% CI: 1.0-73.8), identified by univariate logistic regression, were associated with infection. The local rapid diagnostic test (RDT) performed with a sensitivity of 69.2 (42.3-89.3 CI) and specificity of 90.0 (81.6-95.6 CI) compared to MAT.ConclusionsThis study demonstrated a high burden of leptospirosis in Pohnpei. Further work is warranted to identify additional risk factors and opportunities to control leptospirosis in Pohnpei and other Pacific settings.

Possibilities and expectations for mHealth in the Pacific Islands: Insights from key informants

Background The increase in mobile phone use across the globe is creating mounting interest for its application in addressing health system constraints. Although still limited, there is growing evidence of success in using mobile phones for health (mHealth) in low- and middle- income countries. The promise of mHealth to address key health system issues presents a huge potential for the Pacific Island countries where mobile use has radically increased. Current projections indicate an improved information and communications technology (ICT) environment to support greater access to mobile and digital devices in the Pacific region. Objective The objective of the study was to explore key stakeholder perspectives on the potential for mHealth in the Pacific region. Methods A series of in-depth interviews were conducted either face-to-face, via Skype or by email, with a series of key informants from the Pacific Rim region. Interviews were audio-recorded and later transcribed for detailed thematic analysis. Results We found widespread support for the potential to use mobile phones as a mechanism to facilitate improved health service delivery in the region. Essential elements for the successful development and implementation of mHealth were identified by these stakeholders. These included: developing an understanding of the local context and the problems that may be usefully addressed by the addition of mHealth to existing strategies and services; consideration of local infrastructure, capability, policy, mobile literacy and engagement; learning from others, particularly other low- and middle-income countries (LMICs); the importance of building supportive environments and of evaluation to provide evidence of impact and total cost. Conclusions The rapid growth of mobile phone use in the region presents a unique juxtaposition of opportunity and promise. Though the region lags behind other LMICs in the adoption of mHealth technologies, this offers the convenience of learning from past mHealth interventions and applying these learnings to achieve scale, sustainability and success. This study deepens the understanding of the potential of mHealth for the region, and offers a baseline from which discussions can be made to examine the limitations, barriers and complexities inherent in mHealth applications.