Owen B. J. Carter

The effect of retail cigarette pack displays on unplanned purchases: results from immediate postpurchase interviews

Objective: To assess the influence of point-of-sale (POS) cigarette displays on unplanned purchases. Methods: Intercept interviews were conducted with customers observed purchasing cigarettes from retail outlets featuring POS cigarette displays. Measures included intention to purchase cigarettes prior to entering the store, unprompted and prompted salience of POS tobacco displays, urge to buy cigarettes as a result of seeing the POS display, brand switching and support for a ban on POS cigarette displays. Results: In total, 206 daily smokers aged 18–76 years (90 male, 116 female) were interviewed. Unplanned cigarette purchases were made by 22% of participants. POS displays influenced nearly four times as many unplanned purchases as planned purchases (47% vs 12%, p<0.01). Brand switching was reported among 5% of participants, half of whom were influenced by POS displays. Four times as many smokers were supportive of a ban on POS tobacco displays than unsupportive (49% vs 12%), and 28% agreed that such a ban would make it easier to quit. Conclusions: POS tobacco displays act as a form of advertising even in the absence of advertising materials. They stimulate unplanned cigarette purchases, play an important role in brand selection and tempt smokers trying to quit. This justifies removing POS tobacco displays from line of sight—something that very few smokers in our sample would object to.

People's perceptions of cancer survivability: implications for oncologists

Individuals typically overestimate survival for lung cancer and underestimate it for melanoma. However, reporting of results generally masks the extent of disagreement between people on survival rates. Most methods used to question individuals are of little use and are not comparable across studies. The topic of peoples perceptions of survival for various cancers is under-researched. A clearer definition is needed of survivability, as is a standard way to measure it and then present the information. We have undertaken a review of studies reporting public perceptions of cancer survival rates and compared the results, where possible, with actual survival rates. We also investigate some potential implications of peoples underestimation or overestimation of survival for screening and prevention behaviours and delineate implications for oncologists.

Impact of a point-of-sale tobacco display ban on smokers’ spontaneous purchases: comparisons from postpurchase interviews before and after the ban in Western Australia

Objective To assess the impact of the Western Australian tobacco point-of-sale display ban on spontaneous purchase behaviours. Methods Daily adult smokers (n=402) observed purchasing cigarettes were recruited via exit interviews either 2 months before or after the implementation of the display ban. Smokers were asked if they had intended to purchase cigarettes before entering the store to assess spontaneous purchase behaviours. Whether smokers had noticed the displays before their purchase and the extent to which this influenced their purchase decision was also assessed via non-prompting questions. Results When compared with before the ban, fewer smokers after the ban noticed the displays (27.1% vs 1.1%, p<0.001), fewer reported making spontaneous purchases (28.2% vs 19.8%, p<0.05) and fewer claimed the displays influenced their purchase decisions (free recall 5.0% vs 1.1%, p<0.05; cued recall 22.1% vs 3.8%, p<0.001). Before the ban, spontaneous purchasers were more likely than planned purchasers to suggest the displays influenced their purchase decisions (free recall 9.7% vs 3.2%, p<0.05; cued recall 40.0% vs 17.9%, p<0.01). After the ban, spontaneous purchasers nominating the influence of displays fell substantially (free recall 9.7% vs 5.6%, p=NS; cued recall 40.0% vs 11.1%, p<0.01) as it did for planned purchasers (free recall 3.2% vs 0.0%, p<0.05; cued recall 17.9% vs 2.1%, p<0.01). Conclusions We observed a 30% reduction in smokers making spontaneous tobacco purchases after implementation of the Western Australian tobacco display ban and between a fivefold and sixfold reduction in the proportion suggesting displays influenced their decision to purchase cigarettes. These data are consistent with previous research suggesting tobacco displays encourage spontaneous purchases and their removal corresponds to reductions in the same.

Measuring the effect of cigarette plain packaging on transaction times and selection errors in a simulation experiment

Introduction Australia has introduced legislation to force all cigarette packaging to be generic from 2012 onwards. The tobacco retail industry estimates this will result in transaction times increasing by 15–45 s per pack and is spending at least

Tobacco control practices among Aboriginal health professionals in Western Australia

A10 million of tobacco industry funds on an advertising campaigns claiming that the increased time and errors associated with plain packaging will ultimately cost small businesses

Changes in obesity, sedentary behaviours and Perth children's television viewing from 1960 to 2003.

A461 million per annum and endanger 15 000 jobs. We undertook an objective experiment to test these claims. Methodology Participants (n=52) were randomly assigned to stand in front of a display of either 50 plain or coloured cigarette packets and then were read a randomly ordered list of cigarette brands. The time participants took to locate each packet was recorded and all selection errors were noted. After 50 ‘transactions’, participants repeated the entire experiment with the alternative plain/coloured packs. Afterwards, participants were asked in an open-ended manner whether plain or coloured packaging was easier to locate and why. Results The average transaction was significantly quicker for plain compared with coloured packs (2.92 vs 3.17 s; p=0.040). One or more mistakes were made by 40.4% of participants when selecting coloured packaging compared with only 17.3% for plain packaging (p=0.011). Qualitative results suggested that the colours and inconsistent location of brand names often served to distract when participants scanned for brands. Conclusion Rather than plain packaging requiring an additional 45 s per transaction, our results suggest that it will, if anything, modestly decrease transaction times and selection errors.

Impact of smoking images in magazines on the smoking attitudes and intentions of youth: an experimental investigation

Smoking among Aboriginal people is extremely widespread (50 v. 17% of the general population). Aboriginal Health Workers (AHW) are at the vanguard of tackling this problem but many themselves smoke and little is known of their knowledge, attitudes and practices regarding smoking cessation. Structured telephone interviews were conducted with 36 AHW, including 31% current smokers, 31% ex-smokers and 38% non-smokers, to assess their current smoking cessation practices and knowledge of health risks, nicotine dependence, cessation strategies and pharmacotherapies. AHW considered diabetes, alcohol use and heart disease more problematic than smoking among Aboriginal people. Fear of appearing hypocritical stopped many who smoke from discussing smoking cessation with clients but also stopped some non-smoking AHW whose colleagues or family smoked. Cultural concerns about telling others ‘what to do’ was also a major impediment. Knowledge of the health effects of smoking was good, but knowledge of appropriate advice around cessation pharmacotherapies was suboptimal. AHW trained in smoking cessation were more knowledgeable and active in smoking cessation, but most AHW had received no training, despite being keen to do so. Specific smoking cessation training is sought and appears needed by AHW, particularly in the areas of brief interventions, motivational interviewing, dependence assessment and pharmacotherapies.

Enhancing clinical research with alcohol, tobacco and cannabis problems and dependence

As with most of the developed world, there is clear evidence that Australian children are getting fatter. Measures of subcutaneous skinfold thickness suggest a steady linear increase in the fatness of Australian children since the mid 1970s.1,2 According to BMI measurements, the proportion of Australian children who were overweight increased by between 60-70% and the proportion of obese children more than tripled between 1985 and 1995.1,3 Various current estimates suggest that between 2327% of Australian children are currently overweight, including 6-9% who are obese.4-7 As bodyweight is regulated by numerous physiological mechanisms that maintain balance between energy intake and energy expenditure, obesity is considered a multifactorial condition with genetic and environmental predictors. Genetic factors are undoubtedly important predictors of childhood obesity, yet the rapid rise in the proportion of children in the total population who have become obese in the past 20 years is not satisfactorily explained by genetics alone; environmental factors that affect energy intake and energy expenditure are likely to have played a more significant role. Much debate surrounds the contribution of diet and physical inactivity to the rapid rise in childhood obesity. One of the most common assumptions used in the research literature is that the rise in childhood obesity has come about due to ‘increased’ sedentary use of modern media such as television and computers.812 While there is clear evidence that the amount of time spent watching television is positively related to BMI, the direction of this relationship remains equivocal.10,12-17 The contention that television viewing has contributed to the childhood obesity epidemic clearly presumes that the amount of sedentary time children spend watching television has increased since the medium was first introduced around half a century ago. To test this hypothesis, I examined a 1959-60 study of children’s out-of-school activities conducted in Perth, Western Australia18 that sampled an equal number of male and female school students aged 13-14 years from a representative cross-section of government and non-government schools. In 1959, a sample of 224 children completed a one-week, out-of-school activity diary before the introduction of television and one year later a second sample of 203 children completed the same activity diary, of which just under half (n=86) reported having televisions in their homes. The television viewing behaviours of these children are compared in Table 1 to 12-14 year-old children’s leisure activities in 2003 as suggested by the Australian Bureau of Statistics.19 From this comparison it is evident that the amount of sedentary time Perth children spend on modern media activities has changed little, if at all, in the intervening 43 years. Interestingly, ‘televiewing’ by children in 1960 appears to have largely replaced other sedentary behaviours in 1959. For example, listening to radio programs dropped from seven hours and 42 minutes per week in 1959 to only 54 minutes in 1960, and watching ‘pictures’ at the cinema dropped from three hours per week to only 48 minutes per week. This result suggests that children’s sedentary behaviours associated with the use of modern media is a poor explanation for increased childhood obesity in the past several decades. It also complements other research that suggests increased consumption of energy-dense foods, not physical inactivity, is chiefly responsible for the rapid increases observed in childhood obesity in the past 20 years.20

Maximizing Recall of Gruesome Images for Health Effects Advertising: An Experimental Investigation

Objective: To determine the effect of magazine incidental smoking imagery on youths’ smoking intentions. Methods: A magazine was developed incorporating photographs of smokers (Smoking Magazine). A second version of the magazine (Non-smoking Magazine) included these photographs with the tobacco paraphernalia digitally erased. Equal numbers of smokers and non-smokers aged 14–17 years (n = 357) were randomly assigned to look through one version of the magazine and then asked a series of questions. Results: Smokers made more unprompted mention of smoking imagery than non-smokers after viewing Smoking Magazine (52% vs 34%; p<0.05). Smokers viewing Smoking Magazine were more likely to report an urge to smoke (54% vs 40%; p<0.05). Female non-smokers who viewed Smoking Magazine were more likely than those who viewed Non-smoking Magazine to state a future intention to smoke (13% vs 0%; p<0.05). Female smokers were more attracted to the male models appearing in Smoking Magazine than Non-smoking Magazine (49% vs 24%; p<0.05) and the opposite was true for female non-smokers (28% vs 52%; p<0.05). Female smokers were also marginally more likely to desire looking like the female models in Smoking Magazine (64% vs 46%; p = 0.06) but no difference was observed in the non-smoking females (46% vs 46%). Male smokers and non-smokers did not differ in their responses by magazine type. Conclusions: Incidental positive smoking imagery in magazines can generate the same sorts of consumer effects attributed to advertising in general, including tobacco advertising. Sex specific results of our study may be explained by the choice of smoking images used.

Children's understanding of the selling versus persuasive intent of junk food advertising: Implications for regulation

ISSUES A strong body of evidence guides clinical responses to alcohol and tobacco dependence and there is an emerging evidence base informing responses to cannabis dependence. Nevertheless, there are still important gaps in the evidence base. APPROACH Three researchers, with backgrounds in alcohol, tobacco and cannabis research examine current clinical research and practice to identify potential future priorities for clinical research. KEY FINDINGS Clinical outcomes will be improved by research that enhances engagement and retention of a broader range of consumers, especially underrepresented and disadvantaged populations who may not respond as well to mainstream interventions. Research might focus on innovative client recruitment approaches, varying treatment intensity, use of new technology and assertive outreach. Assessment of treatment outcome will be enhanced by strategies that facilitate longer-term follow up of participants, adoption of shared measures of non-abstinent outcomes and extending the focus and outcome measures beyond drug use. Translation of research into clinical strategies will be enhanced by improving links between theory and interventions, increased attention on factors that influence treatment fidelity, designing treatment studies that are relevant to a variety of clinical settings, focussing on clinician characteristics as treatment variables and developing methodologies that address the capacity of participants to discriminate between placebo and pharmacotherapy. IMPLICATIONS A range of future research priorities have been identified that have the potential to better engage and retain clients in a range of treatment settings and enhance translation of research findings into improved treatment outcomes.