Communicating the effectiveness and ineffectiveness of government policies and their impact on public support: a systematic review with meta-analysis

Adapting anti-tobacco messages to ultraprocessed foods: message framing's impact on attitudes toward the food industry

OBJECTIVE

Ultraprocessed food consumption is associated with worse health. Ultraprocessed food companies apply production and advertising tactics used for tobacco products. Anti-tobacco campaigns that have highlighted industry manipulation have reduced youth tobacco use and increased support for tobacco-related policies. This study explored whether similar messaging affected attitudes and beliefs toward the food industry, support for obesity-related policies, and weight stigma.

METHODS

Participants aged 18 to 25 years were randomized to watch presentations emphasizing the following: 1) food industry manipulation and product addictiveness; 2) food industry manipulation and product health harms; 3) individual choices and food addiction; 4) individual choices and health harms; or 5) a control. Participants completed questionnaires regarding attitudes and beliefs toward the food industry, support for obesity-related policies, and weight stigma.

RESULTS

Messages that emphasized food industry manipulation and product addictiveness were associated with increased negative attitudes toward the food industry versus control. Industry-focused messages were associated with increased negative beliefs regarding industry practices versus control. No significant effects were observed on support for obesity-related policies and weight stigma.

CONCLUSIONS

Emphasizing food industry manipulation and product addictiveness appears promising for shifting youth attitudes toward the food industry without increasing weight stigma. Further research is needed to identify messages that shift support for obesity-related policies.

"It does help but there's a limit …": Young people's perspectives on policies to manage hot food takeaways opening near schools

BACKGROUND

Local authorities (LAs) in England are increasingly using the planning system to manage the proliferation of hot food takeaway outlets ('takeaways') near schools as part of a range of policies to promote healthy weight in children. These takeaway 'management zones' include restrictions on planning permission to open new takeaways within a certain distance of schools. In this qualitative study we explore young people's perspectives of management zones.

METHODS

We purposively recruited 46 young people (aged 11-18 years) attending secondary school across two London LAs with operating management zones. We conducted semi-structured, walking group ("go-along") interviews in January-February 2023 in the local food environment close to participants' schools. We analysed data using framework analysis.

RESULTS

Participants generally viewed management zones as reasonable and uncontroversial but were not always aware that management zones were in operation. Although participants understood that management zones prevented new outlets from opening, they observed they did not seem to reduce existing provision. This was viewed positively as it did not result in the closure of local takeaways perceived as important components of the social fabric of school life. Participants believed that the potential health impact of management zones is limited by their exclusive focus on takeaways as other food retail commonly patronised by young people, such as convenience stores, are important sources of unhealthy food. Participants also identified inadequacies in the wider food environment, including the school dining environment and access to food delivery apps.

CONCLUSIONS

Our findings suggest that although young people find management zones acceptable and believe they have some positive impact on diet, they did not perceive management zones as effective as they could be. Participants articulated that the management of takeaways on their own is unlikely to reduce exposure to unhealthy foods. Widening the remit of planning policy to include outlets selling convenience foods may be important for policy optimisation.

How beliefs and policy characteristics shape the public acceptability of nutritional policies-A survey study in Germany

BACKGROUND

Despite the high prevalence of obesity in Germany, few effective political measures have been implemented to protect population health and improve the sustainability of food systems. One argument frequently raised against policy implementation is the lack of acceptability for policy measures in the German population.

AIM

We aimed to evaluate the acceptability of policy measures currently discussed in Germany's national nutrition strategy and how perceived policy characteristics and participant characteristics influence policy acceptability.

METHOD

We conducted an online survey with 2001 participants between 06.12.2023 and 05.01.2024, in which we collected data on perceived policy characteristics (acceptability, equity, societal and personal effectiveness), as well as participant values and beliefs.

RESULTS

Most policies were highly acceptable, with policies such as the introduction of free school lunches (84 % acceptability), the introduction of a ban on fast food advertising aimed at children (71 %) or a sugar tax (53 %) being acceptable to a majority of the sample. The least acceptable policy was the introduction of a tax on animal products (36 %). Logistic regression analyses showed that perceived equity and societal and personal effectiveness predicted policy acceptability. Likewise, environmental values and beliefs about state intervention of participants influenced policy acceptability.

CONCLUSION

The high acceptability observed in this study suggests an opportunity for German policymakers to implement evidence-based and acceptable nutritional strategies to improve population health.

Improving first responders' perceptions of overdose events and survivors through tailored occupational health-focused training co-facilitated by overdose survivors

BACKGROUND

First responders (law enforcement officers, emergency medical services, and firefighters) frequently interact with people who use drugs (PWUD). Based on the nature and outcomes of such encounters, these interactions have the potential either to reduce harm, or perpetuate it. Given increased funding and attention for first responder-led interventions involving PWUD, we must identify the most critical training for improving negative beliefs about these interventions and populations. In this study, we aimed to develop and evaluate a novel, evidence-based first responder training with an occupational wellness framing aiming to increase knowledge regarding and improve attitudes toward people who overdose and toward the overdose antidote, naloxone.

METHODS

We developed and evaluated the DOTS/SHIELD (Drug Overdose Trust & Safety/Safety & Health Integration in the Enforcement of Laws on Drugs) first responder training with three components: (1) matched first responder and overdose survivor trainers; (2) locally tailored substance use service information and practical referral instructions; and (3) occupational health content designed to make first responders' jobs easier and safer. We conducted pre- and post-tests at 151 Missouri-based trainings (December 2020-May 2023) to assess associated attitudinal changes among law enforcement vs. emergency medical services [EMS]/fire.

RESULTS

Among the matched sample (N = 1,003, 53.9% law enforcement), post-training attitudes toward people who overdose and toward naloxone were more positive than pre-training attitudes. On average, law enforcement held worse attitudes than EMS/fire toward people who overdose, though there were no professional differences in naloxone-related beliefs.

CONCLUSIONS

This training approach effectively combines three training components - peer trainers, practical substance use service referral information, and an occupational wellness framing - to positively influence first responders' views toward those who use drugs and toward naloxone.

The tales of two cities: use of evidence for introducing 20 miles per hour speed limits in Edinburgh and Belfast (United Kingdom)

BACKGROUND

In 2016, large-scale 20 miles per hour speed limits were introduced in the United Kingdom cities of Edinburgh and Belfast. This paper investigates the role that scientific evidence played in the policy decisions to implement lower speed limits in the two cities.

METHODS

Using a qualitative case study design, we undertook content analysis of a range of documents to explore and describe the evolution of the two schemes and the ways in which evidence informed decision-making. In total, we identified 16 documents for Edinburgh, published between 2006 and 2016, and 19 documents for Belfast, published between 2002 and 2016.

FINDINGS

In both cities, evidence on speed, collisions and casualties was important for initiating discussions on large-scale 20 mph policies. However, the narrative shifted over time to the idea that 20 mph would contribute to a wider range of aspirations, none of which were firmly grounded in evidence, but may have helped to neutralize opposing discourses.

DISCUSSION AND CONCLUSIONS

The relationship between evidence and decision-making in Edinburgh and Belfast was neither simple nor linear. Widening of the narrative appears to have helped to frame the idea in such a way that it had broad acceptability, without which there would have been no implementation, and probably a lot more push back from vested interests and communities than there was.

National increase in the community supply of take-home naloxone associated with a mass media campaign in Scotland: a segmented time series analysis

BACKGROUND

Take-home naloxone (THN) programmes have been associated with reductions in opioid-related mortality. In response to high rates of drug-related deaths in Scotland, the Scottish Government commissioned the 'How to save a life' (HTSAL) mass media campaign to: (1) increase awareness of drug-related deaths and how to respond to an overdose, and (2) increase the supply of THN. The aim of this study was to assess the effect of the campaign on the supply of THN.

METHODS

We used an interrupted time series design to assess the effect of the HTSAL mass media campaign on the national community supply of THN. The study time period was August 2020-December 2021. We modelled two key dates: the start of the campaign (week beginning (w/b) 30th of August 2021) and after the end of the main campaign (w/b 25th of October 2021).

RESULTS

The total number of THN kits distributed in the community in Scotland during the study period was 27,064. The mean number of THN kits distributed per week (relative to the pre-campaign period), increased by 126% during the campaign and 57% post-campaign. In segmented regression analyses, the pre-campaign trend in the number of THN kits supplied was increasing by an average of 1% each week (RR=1.01, 95% CI 1.01 to 1.01, p<0.001). Once the campaign started, a significant change in level was observed, and the number of kits increased by 75% (RR=1.75, 95% CI 1.29 to 2.40, p<0.001). The trend during the campaign was stable (i.e. not increasing or decreasing) but a significant change in level was observed when the campaign ended, and the number of THN kits supplied decreased by 32% (RR=0.68, 95% CI 0.46 to 0.98, p = 0.042). The trend during the post-campaign period was stable.

CONCLUSIONS

The HTSAL campaign had a short term, but large and significant impact, on the community supply of THN in Scotland. Mass media campaigns could be combined with other interventions and strategies to maintain the increased uptake of THN outside of campaign periods.

Public acceptability of proposals to manage new takeaway food outlets near schools: cross-sectional analysis of the 2021 International Food Policy Study

Global trends indicate that takeaway food is commonly accessible in neighbourhood food environments. Local governments in England can use spatial planning to manage the opening of new takeaway outlets in 'takeaway management zones around schools' (known sometimes as 'exclusion zones'). We analysed data from the 2021 International Food Policy Study to investigate public acceptability of takeaway management zones around schools. Among adults living in Great Britain (n = 3323), 50.8% supported, 8.9% opposed, and 37.3% were neutral about the adoption of these zones. Almost three-quarters (70.4%) believed that these zones would help young people to eat better. Among 16-17 year olds (n = 354), 33.3% agreed that young people would consume takeaway food less often if there were fewer takeaways near schools. Using adjusted logistic regression, we identified multiple correlates of public support for and perceived effectiveness of takeaway management zones. Odds of support were strongest among adults reporting that there were currently too many takeaways in their neighbourhood food environment (odds ratio: 2.32; 95% confidence intervals: 1.61, 3.35). High levels of support alongside limited opposition indicate that proposals for takeaway management zones around schools would not receive substantial public disapproval. Policy makers should not, therefore, use limited public support to rationalise policy inertia.

Effect of message framing on support for a sugar-sweetened beverage tax in Australia: a cross-sectional survey analysis

Sugar-sweetened beverage (SSB) taxes are present in many countries with evidence that they are effective in decreasing purchases of SSBs. However, in Australia where SSB consumption per capita is high, and calls for an SSB tax are frequent, there is no SSB tax and policymakers have stated their lack of support for such a tax. We examined whether political party voting preference and sociodemographic factors affect individuals' support for an SSB tax, and whether message framing affects this support. A nationally representative sample of 1519 Australian adults was recruited for an online experimental survey. Three persuasive frames and one control frame were randomly provided to participants and measures of agreement towards an SSB tax were assessed. Sociodemographic factors and political party preference were also captured. Message framing had minimal effect on the level of support for the tax. However, participants who received the 'supportive of food and drink companies frame' showed the highest positive feelings towards the tax, and participants in rural areas had higher levels of support for an SSB tax when receiving the 'protecting teenagers' frame. Participants who voted for conservative (right-leaning) parties and for Labour (a centre-left party) had similar levels of support towards the tax, which was considerably lower than Greens voters. Undecided voters had the lowest levels of support for the tax, and the frames had limited impact on them. These findings highlight the potential role of message framing in shaping public support for an SSB tax in Australia, particularly in the context of voting preference and sociodemographic factors.

Impact on wine sales of removing the largest serving size by the glass: An A-B-A reversal trial in 21 pubs, bars, and restaurants in England

BACKGROUND

Interventions that alter aspects of the physical environments in which unhealthy behaviours occur have the potential to change behaviour at scale, i.e., across populations, and thereby decrease the risk of several diseases. One set of such interventions involves reducing serving sizes, which could reduce alcohol consumption. The effect of modifying the available range of serving sizes of wine in a real-world setting is unknown. We aimed to assess the impact on the volume of wine sold of removing the largest serving size by the glass from the options available in licensed premises.

METHODS AND FINDINGS

The study was conducted between September 2021 and May 2022 in 21 licensed premises in England that sold wine by the glass in serving sizes greater than 125 ml (i.e., 175 ml or 250 ml) and used an electronic point of sale till system. It used an A-B-A reversal design, set over 3 four-weekly periods. "A" represented the nonintervention periods during which standard serving sizes were served and "B" the intervention period when the largest serving size for a glass of wine was removed from the existing range in each establishment: 250 ml (18 premises) or 175 ml (3 premises). The primary outcome was the daily volume of wine sold, extracted from sales data. Twenty-one premises completed the study, 20 of which did so per protocol and were included in the primary analysis. After adjusting for prespecified covariates, the intervention resulted in -420·8 millilitres (ml) (95% confidence intervals (CIs) -681·4 to -160·2 p = 0·002) or -7·6% (95% CI -12·3%, -2·9%) less wine being sold per day. There was no evidence that sales of beer and cider or total daily revenues changed but the study was not powered to detect differences in these outcomes. The main study limitation is that we were unable to assess the sales of other alcoholic drinks apart from wine, beer, and cider, estimated to comprise approximately 30% of alcoholic drinks sold in participating premises.

CONCLUSIONS

Removing the largest serving size of wine by the glass from those available reduced the volume of wine sold. This promising intervention for decreasing alcohol consumption across populations merits consideration as part of alcohol licensing regulations.

TRIAL REGISTRATION

ISRCTN https://doi.org/10.1186/ISRCTN33169631; OSF https://osf.io/xkgdb.

When and Why Do People Accept Public-Policy Interventions? An Integrative Public-Policy-Acceptance Framework

The successful introduction of public policies to prompt behavior change hinges on the degree to which citizens endorse the proposed policies. Although there is a large body of research on psychological determinants of public policy acceptance, these determinants have not yet been synthesized into an integrative framework that proposes hypotheses about their interplay. In this article, we develop a review-based, integrative public-policy-acceptance framework that introduces the desire for governmental support as a motivational foundation in public-policy acceptance. The framework traces the route from problem awareness to policy acceptance and, ultimately, policy compliance. We propose this relationship to be mediated by a desire for governmental support. We integrate numerous key variables assumed to qualify the relationship between problem awareness and the desire for governmental support, such as control attributions, trust, and value fit, as well as the relationship between the desire for governmental support and policy acceptance, such as perceived policy effectiveness, intrusiveness, and fairness. We exemplify the use of the proposed framework by applying it to climate policies.

Food insecurity in people living with obesity: Improving sustainable and healthier food choices in the retail food environment-the FIO Food project

At both UK and global level, dietary consumption patterns need to change to address environmental, health and inequality challenges. Despite considerable policy interventions, the prevalence of overweight and obesity in the United Kingdom has continued to rise with obesity now a leading cause of mortality and morbidity. Obesity prevalence is greater among those on lower incomes and the current UK food system, including government policy, does not effectively address this. Current behavioural approaches, without the support of structural changes in the system, may even widen the inequalities gap. Hence, using behavioural insights from those living with obesity and food insecurity, the project will explore potential avenues that can be applied in the food system to promote healthier choices in the food retail environment. The National Food Strategy report recommends that the UK food system should ensure "safe, healthy, affordable food; regardless of where people live or how much they earn". However, the association between food insecurity and the development of obesity is not well understood in relation to purchasing behaviours in the UK retail food environment, nor is the potential effectiveness of interventions that seek to prevent and reduce the impact of diet-induced health harms. The FIO Food (Food insecurity in people living with obesity - improving sustainable and healthier food choices in the retail food environment) project provides a novel and multi-disciplinary collaborative approach with co-development at the heart to address these challenges. Using four interlinked work packages, the FIO Food project will combine our knowledge of large-scale population data with an understanding of lived experiences of food shopping for people living with obesity and food insecurity, to develop solutions to support more sustainable and healthier food choices in the UK retail food environment.

Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study

BACKGROUND

There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies.

METHODS

We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding.

RESULTS

We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication.

CONCLUSIONS

Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.

Impact of Sizes of Servings, Glasses and Bottles on Alcohol Consumption: A Narrative Review

This review summarises the evidence on the impact of serving and container size on how much people drink, interventions that have the potential to reduce alcohol consumption across populations, thereby improving health. A rapid search identified 10 published reports of 15 studies and 1 review. Four studies focused on serving size, eight studies and the review on glass size, two studies on bottle size and one on both glass and bottle size. Twelve studies and the review focused on wine, one study on beer and two on both. All were conducted in England, by just two research groups. Removing the largest serving size of wine decreased wine sales by 7.6% (95% CI -12.3%, -2.9%) in a study in 21 licenced premises, reflecting findings from two prior studies in semi-naturalistic settings. Adding a serving size for beer that was a size smaller than the largest was assessed in one study in 13 licenced premises, with no evident effect. Reducing the size of wine glasses in restaurants decreased wine sales by 7.3% (95% CI -13.5%, -1.5%) in a mega-analysis of eight datasets from studies in five licensed premises. Using smaller wine glasses at home may also reduce consumption, but the evidence from just one study is less certain. No studies have assessed the impact of glass size for drinking beer. The effect of bottles smaller than the standard 750 mL on wine consumed at home was assessed in two studies: 500 mL bottles reduced consumption by 4.5% (95% CI -7.9%, -1.0%) in one study, but in another, using 375 mL bottles there was no evident effect. No studies assessed the impact of bottle or other container size for drinking beer. Reducing the size of servings, glasses and bottles could reduce wine consumption across populations. The impact of similar interventions for reducing consumption of other alcoholic drinks awaits evaluation. Further studies are also warranted to assess the generalisability of existing evidence.

Developing and implementing 20-mph speed limits in Edinburgh and Belfast: mixed-methods study

Background

Transport initiatives such as 20-mph (≈30-km/h) speed limits are anticipated to result in fewer road casualties and improve perceptions of safety, leading to increases in active travel. Lower speeds may also lead to more pleasant environments in which to live, work and play.

Objectives

The main objective was to evaluate and understand the processes and effects of developing and implementing 20-mph speed limits in Edinburgh and Belfast. The focus was on health-related outcomes (casualties and active travel) that may lead to public health improvements. An additional objective was to investigate the political and policy factors (conditions) that led to the decision to introduce the new speed limits.

Design

This was a mixed-methods study that comprised an outcome, process, policy and economic evaluation of two natural experiments.

Setting

The study was set in Edinburgh, Scotland, and Belfast, Northern Ireland, from 2000 to 2018.

Participants

The whole population of each city were participants, as well as stakeholders involved in implementation and decision-making processes.

Intervention

The intervention was the implementation of 20-mph legislation, signage, enforcement, and education and awareness-raising in Edinburgh (citywide) and Belfast (city centre).

Main outcome measures

The main outcomes measured were speed; number, type and severity of road collisions; perceptions; and liveability.

Data sources

The following data sources were used – routinely and locally collected quantitative data for speed, volume of traffic, casualties and collisions, and costs; documents and print media; surveys; interviews and focus groups; and Google Street View (Google Inc., Mountain View, CA, USA).

Results

Collisions and casualties – the overall percentage reduction in casualty rates was 39% (the overall percentage reduction in collision rates was 40%) in Edinburgh. The percentage reduction for each level of severity was 23% for fatal casualties, 33% for serious casualties and 37% for minor casualties. In Belfast there was a 2% reduction in casualties, reflecting differences in the size, reach and implementation of the two schemes. Perceptions – in Edinburgh there was an increase in two factors (support for 20 mph and rule-following after implementation) supported by the qualitative data. Liveability – for both cities, there was a small statistical increase in liveability. Speed – mean and median speeds reduced by 1.34 mph and 0.47 mph, respectively, at 12 months in Edinburgh, with no statistically significant changes in Belfast. History, political context, local policy goals, local priorities and leadership influenced decision-making and implementation in the two cities.

Limitations

There was no analysis of active travel outcomes because the available data were not suitable.

Conclusions

The pre-implementation period is important. It helps frame public and political attitudes. The scale of implementation and additional activities in the two cities had a bearing on the impacts. The citywide approach adopted by Edinburgh was effective in reducing speeds and positively affected a range of public health outcomes. The city-centre approach in Belfast (where speeds were already low) was less effective. However, the main outcome of these schemes was a reduction in road casualties at all levels of severity.

Future work

Future work should develop a statistical approach to public health interventions that incorporates variables from multiple outcomes. In this study, each outcome was analysed independently of each other. Furthermore, population measures of active travel that can be administered simply, inexpensively and at scale should be developed.

Study registration

This study is registered as ISRCTN10200526.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.

'Why would we not want to keep everybody safe?' The views of family members of people who use drugs on the implementation of drug consumption rooms in Scotland

BACKGROUND

People who use drugs in Scotland are currently experiencing disproportionately high rates of drug-related deaths. Drug consumption rooms (DCRs) are harm reduction services that offer a safe, hygienic environment where pre-obtained drugs can be consumed under supervision. The aim of this research was to explore family member perspectives on DCR implementation in Scotland in order to inform national policy.

METHODS

Scotland-based family members of people who were currently or formerly using drugs were invited to take part in semi-structured interviews to share views on DCRs. An inclusive approach to 'family' was taken, and family members were recruited via local and national networks. A convenience sample of 13 family members were recruited and interviews conducted, audio-recorded, transcribed, and analysed thematically using the Structured Framework Technique.

RESULTS

Family members demonstrated varying levels of understanding regarding the existence, role, and function of DCRs. While some expressed concern that DCRs would not prevent continued drug use, all participants were in favour of DCR implementation due to a belief that DCRs could reduce harm, including saving lives, and facilitate future recovery from drug use. Participants highlighted challenges faced by people who use drugs in accessing treatment/services that could meet their needs. They identified that accessible and welcoming DCRs led by trusting and non-judgemental staff could help to meet unmet needs, including signposting to other services. Family members viewed DCRs as safe environments and highlighted how the existence of DCRs could reduce the constant worry that they had of risk of harm to their loved ones. Finally, family members emphasised the challenge of stigma associated with drug use. They believed that introduction of DCRs would help to reduce stigma and provide a signal that people who use drugs deserve safety and care.

CONCLUSIONS

Reporting the experience and views of family members makes a novel and valuable contribution to ongoing public debates surrounding DCRs. Their views can be used to inform the implementation of DCRs in Scotland but also relate well to the development of wider responses to drug-related harm and reduction of stigma experienced by people who use drugs in Scotland and beyond.

'Why would we not want to keep everybody safe?' The views of family members of people who use drugs on the implementation of drug consumption rooms in Scotland

BACKGROUND

People who use drugs in Scotland are currently experiencing disproportionately high rates of drug-related deaths. Drug consumption rooms (DCRs) are harm reduction services that offer a safe, hygienic environment where pre-obtained drugs can be consumed under supervision. The aim of this research was to explore family member perspectives on DCR implementation in Scotland in order to inform national policy.

METHODS

Scotland-based family members of people who were currently or formerly using drugs were invited to take part in semi-structured interviews to share views on DCRs. An inclusive approach to 'family' was taken, and family members were recruited via local and national networks. A convenience sample of 13 family members were recruited and interviews conducted, audio-recorded, transcribed, and analysed thematically using the Structured Framework Technique.

RESULTS

Family members demonstrated varying levels of understanding regarding the existence, role, and function of DCRs. While some expressed concern that DCRs would not prevent continued drug use, all participants were in favour of DCR implementation due to a belief that DCRs could reduce harm, including saving lives, and facilitate future recovery from drug use. Participants highlighted challenges faced by people who use drugs in accessing treatment/services that could meet their needs. They identified that accessible and welcoming DCRs led by trusting and non-judgemental staff could help to meet unmet needs, including signposting to other services. Family members viewed DCRs as safe environments and highlighted how the existence of DCRs could reduce the constant worry that they had of risk of harm to their loved ones. Finally, family members emphasised the challenge of stigma associated with drug use. They believed that introduction of DCRs would help to reduce stigma and provide a signal that people who use drugs deserve safety and care.

CONCLUSIONS

Reporting the experience and views of family members makes a novel and valuable contribution to ongoing public debates surrounding DCRs. Their views can be used to inform the implementation of DCRs in Scotland but also relate well to the development of wider responses to drug-related harm and reduction of stigma experienced by people who use drugs in Scotland and beyond.

Acceptability of policies to reduce consumption of red and processed meat: A population-based survey experiment

Policies to reduce meat consumption are needed to help achieve climate change targets, and could also improve population health. Public acceptability can affect the likelihood of policy implementation. This study estimated the acceptability of policies to reduce red and processed meat consumption, and whether acceptability differed when policies were framed as benefitting health or the environment. In an online experiment, 2215 UK adults rated the acceptability of six policies, presented in a randomised order. Prior to rating policies, participants were randomised to one of two framing conditions, with policy outcomes described either as benefitting health or the environment. Regression models examined differences in the primary outcome - policy acceptability (rated on a 7-point scale) - by framing. Labels were the most accepted policy (48% support), followed by a media campaign (45%), reduced availability (40%) and providing incentives (38%). Increasing price (27%) and banning advertising (26%) were the least accepted. A substantial proportion of participants neither supported nor opposed most policies (26-33%), although this fell to 16% for increasing price. There was no evidence that framing policy benefits from a health or environment perspective influenced acceptability (-0.06, 95%CIs: 0.18,0.07). Fewer than half of the UK sample expressed support for any of six policies to reduce meat consumption, regardless of framing measures as benefitting health or the environment. Conversely, fewer than half expressed opposition, with the exception of price, suggesting considerable scope to influence public opinion in support of meat reduction measures to meet environmental and health goals.

Public Support for Cigarette Pack Pictorial Health Warnings Among US Adults: A Cross-sectional Analysis of the 2020 Health Information National Trends Survey

INTRODUCTION

The US Food and Drug Administration issued a final rule requiring new warnings for cigarette packages and advertisements. This study examines population-level characteristics of support for-versus neutrality or opposition toward-cigarette pack warnings that use text and images to portray the negative health effects of smoking.

METHODS

We used nationally representative cross-sectional data of US adults age 18 and older from the 2020 Health Information National Trends Survey (n = 3865). Frequencies and weighted proportions were calculated for neutrality toward, opposition to, and support for pictorial warnings across sociodemographics and other predictors. Weighted, multivariable logistic regression examined predictors of being neutral or opposed versus supportive of pictorial warnings.

RESULTS

In 2020, an estimated 69.9% of US adults supported pictorial warnings, 9.1% opposed, and 20.9% neither supported nor opposed them. In fully adjusted models, current smokers had almost twice the odds of being neutral or opposed to pictorial warnings as never smokers (odds ratio [OR] = 1.99, confidence interval [CI] 1.12, 3.52). Adults 75 years and older (vs. 18-34) (OR = 0.55, CI 0.33, 0.94) and those with children under 18 in their household (vs. no children) (OR = 0.67, CI 0.46, 0.98) were less likely to be neutral or opposed.

CONCLUSIONS

In advance of the Food and Drug Administration's implementation of pictorial warnings on cigarette packages, nearly 70% of American adults support this policy. Disseminating information about the effectiveness of pictorial warnings may further strengthen support among current smokers who are less supportive than never smokers. Furthermore, framing messages around the benefits of pictorial warnings for protecting youth may increase public support.

IMPLICATIONS

While public support for pictorial warnings on cigarette packages is high in the United States, it may increase further after policy implementation and be strengthened by utilizing information campaigns that convey the evidence that pictorial warnings are an effective public health strategy.

Survey Results on Using Nudges for Choice of Green-Energy Supplier

One of the most important climate change mitigation strategies is to exploit the potential of individual behavioral changes in order to reduce greenhouse gas (GHG) emissions, and the insights of behavioral economics are proving helpful in this regard. This contributes to improving traditional instruments, developing new ones related to choice architecture (nudges), and combining them within behavioral decarbonization intervention strategies. It is important, in terms of their effectiveness and efficiency, whether the instruments of such interventions are supported by citizens. This paper presents the results of a survey of Polish respondents’ (n = 1064) reactions to hypothetical nudges regarding the choice of a “green energy” supplier. The main research questions of the study are: how much civic support do these behavioral intervention tools have, and what is the importance of selected factors for their acceptance? The aim of the study is to present nudges as one of the strategies of pro-environmental behavioral change and to analyze selected factors of acceptance of these instruments by the Polish society. There are two main conclusions of the research: (1) Poles’ support for the green nudges analyzed is comparatively high, like in other European countries; (2) statistically significant differences in support for one of them are age and individual political party preferences.

"We want to live a little longer and our family want[s] us around": A summative content analysis of adherence to COVID-19-related guidelines using the Theoretical Domains Framework

Objective

Public adherence to COVID‐19‐related government guidance varied during the initial lockdown in the UK, but the determinants of public adherence to such guidance are unclear. We capture spontaneous reflections on adherence to UK government guidance from a representative UK sample, and use the TDF to identify key determinants of COVID‐related behaviours.

Design

The design was cross‐sectional.

Methods

Qualitative data were collected from a large sample of UK adults (N = 2,252) via an online questionnaire as part of a wider survey about the UK public’s responses to the government’s COVID‐19‐related guidance. Summative content analysis was used to identify key guideline terms in the data, followed by latent analysis to interpret the underlying meanings behind the terms using the TDF as an analytical framework.

Results

Six TDF domains were identified in the data: Environmental Context and Resources; Beliefs about Consequences; Social Influences; Memory, Attention and Decision Processes; Emotion; and Knowledge. Although the samples were motivated and capable of adhering, limitations in their environments, resources, and social support mechanisms restricted behaviour. Self‐reported adherence was sensitive to positive and negative beliefs about the effectiveness of the measures, in addition to interpretations of the terms ‘essential’ and ‘necessary’ in the guidance.

Conclusions

Despite extensive structural obstacles to adherence, the majority of the British public were able to follow government COVID‐19‐related instructions, provided they had sufficient resources, social support, and positive perceptions about the effectiveness of the measures. Ambiguities surrounding key terminology in the guidance left room for interpretation, which may have contributed to non‐adherence.

Current status and associated factors of psychological resilience among the Chinese residents during the coronavirus disease 2019 pandemic

BACKGROUND

Since December 2019, over 4,600 deaths and 84,000 confirmed cases were reported in China because of the coronavirus disease 2019 (COVID-19) pandemic. However, there is a dearth of studies on the psychological resilience in residents.

AIMS

This study aims to measure the psychological resilience of Chinese residents to reflect their psychological status as well as influencing factors during the pandemic.

METHOD

We conducted a combination of stratified sampling and snowball sampling to select survey subjects. We employed the psychological resilience and influencing factor questionnaire based on the 10-item Connor and Davidson Resilience Scale (CD-RISC10) for survey. We collected data from 3,398 residents in China between 31 January and 29 February 2020. Multivariable linear stepwise regression analysis was used to determine factors associated with psychological resilience in residents.

RESULTS

The mean score of psychological resilience among Chinese residents was 27.11 ± 8.45 (SD = 7.98). There were some factors significantly associated with psychological status among the Chinese residents during the COVID-19 outbreak. Residents with lower financial status, living in rural areas, unmarried, lacking fixed employment or retirement guarantees, and lacking knowledge of policies were more likely to report a lower level of psychological resilience.

CONCLUSION

Health service policy makers in many countries should adopt relevant measures to improve the psychological resilience of residents during the pandemic. This includes short-term aggressive treatment, strengthening health education, and improving the awareness of residents with respect to emergency health policies. In addition, the financial status, health levels, and risk management capabilities of residents should be increased over the long term.

U.S. public opinion toward policy restrictions to limit tobacco product placement and advertising at point-of-sale and on social media

The Family Smoking Prevention and Tobacco Control Act granted the U.S. Food and Drug Administration authority to regulate tobacco advertising and promotion, including at the retail level, and preserved state, tribal, and local tobacco advertising and promotion authorities. Public health experts have proposed prohibiting point-of-sale tobacco advertisements and product displays, among other tobacco advertising restrictions. We examined the prevalence and correlates of public support, opposition, and neutrality toward proposed tobacco product placement and advertising restrictions at point-of-sale and on social media utilizing the National Cancer Institute's 2020 Health Information National Trends Survey (HINTS) (N = 3865), a cross-sectional, probability-based postal survey of U.S. addresses conducted from Feb 24, 2020 to June 15, 2020 (Bethesda, MD). Frequencies and unadjusted, weighted proportions were calculated for support, neutrality, and opposition toward the three policies under study, and weighted, adjusted multivariable logistic regression was employed to examine predictors of neutrality and opposition. Tests of significance were conducted at the p < 0.05 level. Sixty-two percent of U.S. adults supported a policy prohibiting tobacco product advertising on social media; 55% supported a policy restricting the location of tobacco product advertising at point-of-sale; and nearly 50% supported a policy to keep tobacco products out of view at the checkout counter. Neutrality and opposition varied by sociodemographic characteristics including age, sex, education, rurality, and presence of children in the household. Understanding public opinion toward tobacco product placement and advertising restrictions may inform policy planning and implementation.

Public support for policies to improve population and planetary health: A population-based online experiment assessing impact of communicating evidence of multiple versus single benefits

Background

Effective interventions for reducing the consumption of products that harm population and planetary health often lack public support, impeding implementation. Communicating evidence of policies’ effectiveness can increase public support but there is uncertainty about the most effective ways of communicating this evidence. Some policies have multiple benefits such as both improving health and the environment. This study assesses whether communicating evidence of multiple versus single benefits of a policy increases its support.

Method

Participants (n = 4616) nationally representative of the British population were randomised to one of 24 groups in an online experiment with a 4 × 3 × 2 between-subjects factorial design. The messages that participants viewed differed according to the evidence they communicated (no message, effectiveness for changing behaviour, effectiveness for changing behaviour + one policy benefit, effectiveness for changing behaviour + three policy benefits), type of policy (taxation, availability) and the target behaviour (consumption of energy-dense food, alcohol, or meat). The primary outcome was policy support.

Results

In a full factorial ANOVA, there was a significant main effect of communicating evidence of effectiveness on policy support, which was similar across policies and behaviours. Communicating three benefits increased support relative to communicating one benefit (d = 0.15; p = 0.01). Communicating one benefit increased support compared to providing evidence for changing behaviour alone (d = 0.13; p = 0.004) or no message (d = 0.11 p = 0.022).

Conclusion

Communicating evidence of a policy's benefits increases support for policy action across different behaviours and policies. Presenting multiple benefits of policies enhances public support.

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Providing evidence of policies effectiveness at achieving policy goals increases public support.

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Uncertainty exists about the most effective ways of communicating this evidence.

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Evidence about multiple policy benefits increases support more than evidence for a single benefit.

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Effects are evident across behaviours and policies.

Public attitudes to, and perceived impacts of 20mph (32km/h) speed limits in Edinburgh: an exploratory study using the Speed Limits Perceptions Survey (SLiPS)

Between 2016 and 2018 a policy was implemented to increase the proportion of 20mph (32 km/h) streets in Edinburgh, UK from approximately 50% to 80%, providing the opportunity to evaluate how behaviour and public perceptions change over time. This is important as negative public responses have been reported to limit the implementation of transport policies and may reduce the effectiveness of the policy. The Speed Limits Perception Survey (SLiPS) was developed to assess changes in public perceptions from baseline to 6 and 12 months post-implementation. We collected 3,485 individual responses to the survey, 64.6% (n=2,253) of which included complete perceptions data. Using exploratory factor analysis, the following perception factors were identified: i) Detraction and resistance, ii) Support, iii) Rule following, iv) Child safety, and v) Walking safety. Following the 20mph implementation at 6-12 months: Support (ii) and Rule following (iii) had increased; Detraction and resistance (i) had decreased; and Child safety (iv) and Walking safety (v) had not changed significantly. These findings indicate that the public in Edinburgh became more positive towards the policy once it was implemented. However, more extensive policy or ongoing communication of the safety benefits of 20mph limits are needed to increase perceptions of safety that might lead to increased walking and cycling. Future research should aim to understand how those implementing speed limit interventions can positively influence public perceptions and how public perceptions about speed limits influence behaviour.

Health warning labels and alcohol selection: a randomised controlled experiment in a naturalistic shopping laboratory

BACKGROUND AND AIMS

Health warning labels (HWLs) on tobacco products reduce smoking. There is an absence of evidence concerning the impact of alcohol HWLs on selection or purchasing in naturalistic settings. Using a commercial-standard naturalistic shopping laboratory, this study aimed to estimate the impact on selection of alcoholic drinks of HWLs describing adverse health consequences of excessive alcohol consumption.

DESIGN

A between-subjects randomised experiment with three groups was conducted: group 1: image-and-text HWL; group 2: text-only HWL; group 3: no HWL.

SETTING

A commercial-standard naturalistic shopping laboratory in the United Kingdom.

PARTICIPANTS

Adults (n = 399, 55% female) over the age of 18 years, who purchased beer or wine weekly to drink at home.

INTERVENTIONS

Participants were randomised to one of three groups varying in the HWL displayed on the packaging of the alcoholic drinks: (i) image-and-text HWL (n = 135); (ii) text-only HWL (n = 129); (iii) no HWL (n = 135). Participants completed a shopping task, selecting items from a range of alcoholic and non-alcoholic drinks, and snacks.

MEASUREMENT

The primary outcome was the proportion of alcoholic drinks selected. Secondary outcomes included HWL ratings on negative emotional arousal and label acceptability.

FINDINGS

There was no clear evidence of a difference in the HWL groups for the percentage of drinks selected that were alcoholic compared to no HWL (44%): image-and-text HWL: 46% (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.82, 1.42); text-only HWL: 41% (OR = 0.87, 95% CI = 0.67, 1.14). Concordant with there being no difference between groups, there was extreme evidence in favour of the null hypothesis (Bayes factor [BF] < 0.01). Negative emotional arousal was higher (P < 0.001) and acceptability lower (P < 0.001) in the image-and-text HWL group, compared to the text-only HWL group.

CONCLUSIONS

In a naturalistic shopping laboratory, there was no evidence that health warning labels describing the adverse health consequences of excessive alcohol consumption changed selection behaviour.

Changes in Australian community perceptions of non-communicable disease prevention: a greater role for government?

Background

Monitoring trends in community opinion can identify critical opportunities to implement upstream health policies or interventions. Our study examines change and demographic modifiers of change in community perceptions of government intervention for prevention of lifestyle-related chronic disease across two time points in Australia.

Methods

Data were drawn from the 2016 (n = 2052) and 2018 (n = 2601) waves of a nationally representative cross-sectional telephone survey, ‘AUSPOPS’. Survey questions gauged perceptions of government intervention for health in general, peoples’/organizations’ role in maintaining health (e.g., parents, government) and support for specific health interventions (e.g., taxing soft drink).

Bivariate and multivariate regression models tested for change between the two surveys, adjusted for demographic characteristics. Models with interactions between survey wave and demographic variables tested for differential change. One-tailed variance ratio tests examined whether opinions had become more polarized in 2018 compared with 2016.

Results

The large, significant increase observed in the perceived size of the role that government has in maintaining people’s health was uniform across demographic subpopulations. The role for employers and private health insurers was also perceived to be larger in 2018 compared with 2016, but the degree of change varied by gender, age and/or socioeconomic status. Support for some government interventions (e.g., taxing soft drinks) increased among specific demographic subgroups whilst exhibiting no overall change. Opinion was more polarized on general attitudes to government intervention for population health in 2018 compared to 2016, despite little change in central tendency.

Conclusions

Opportunities may exist to implement government health-promoting policies (e.g., taxing soft drinks), although advocacy may be needed to address the concerns of less supportive subpopulations. Attitudes on government intervention in general may be becoming more polarized; future research examining the association of such changes with exposure to different information sources could inform communication strategies for future health policy change.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12159-9.

Prevalence and Risk Factors of Home Quarantine Strategy Implementation Among Chinese Residents During the Coronavirus Disease 2019 Pandemic

Background: Home quarantine is an important strategy to contain the mass spread of the coronavirus disease 2019 (COVID-19) pandemic. However, there are a dearth of studies on the prevalence and risk factors of home quarantine strategy implementation among residents. This study aims to assess the state of home quarantine strategy implementation among Chinese residents, which could provide a reference for quarantine policymakers around the world during the pandemic.

Method: We conducted a cross-sectional survey of 3,398 residents in China by adopting a convenience sampling strategy. We measured the prevalence and risk factors of home quarantine strategy implementation with the Center for Epidemiological Studies-Depression Scale (CES-D), 10-item Connor-Davidson Resilience Scale (CD-RISC 10), and Perceived Social Support Scale (PSSS). A multivariable model was used to determine the factors associated with home quarantine strategy implementation.

Results: A total of 2,936 (86.4%) respondents carried out home quarantine. There were some factors significantly associated with home quarantine strategy implementation among Chinese residents during the COVID-19 outbreak. Respondents who were male, lived in western and central China, were aware of the primary symptoms of COVID-19, were willing to accept recommendations on relevant protective measures, understood local quarantine measures, had better resilience, and had better social support were more likely to engage in home quarantine. Respondents who were married, were employed, were healthy, and had high depression scores were more likely to refuse to follow home quarantine guidance.

Conclusions: Gender, region, marital status, employment status, health status, awareness of the primary symptoms of COVID-19, willingness to accept recommendations on relevant protective measures, understanding of local quarantine measures, depression, psychological resilience, and perceived social support were the main factors affecting the implementation of residents' home quarantine strategy. Health service policymakers should adopt relevant measures to improve the prevalence of home quarantine strategy implementation among residents during the pandemic.

Public acceptability of the UK Soft Drinks Industry Levy: repeat cross-sectional analysis of the International Food Policy Study (2017-2019)

OBJECTIVES

To determine whether public acceptability, in terms of both support for and perceived effectiveness of, the UK Soft Drinks Industry Levy (SDIL) changed between 4 months prior to, and 8 and 20 months after, implementation.

DESIGN

Repeat cross-sectional online survey.

SETTING

The UK.

PARTICIPANTS

UK respondents to the International Food Policy Study aged 18-64 years who provided information on all variables of interest in November-December 2017 (4 months prior to SDIL implementation), 2018 (8 months after) or 2019 (20 months after; n=10 284).

OUTCOME MEASURES

Self-reported support for, and perceived effectiveness of, the SDIL.

RESULTS

The adjusted logistic regression model predicted that 70% (95% CI: 68% to 72%) of participants supported the SDIL in 2017, 68% (95% CI: 67% to 70%) in 2018 and 68% (95% CI: 66% to 70%) in 2019. There was no evidence of a difference in support in 2018 vs 2017 (OR: 0.93; 95% CI: 0.81 to 1.05); or in 2019 vs 2017 (OR: 0.90; 95% CI: 0.78 to 1.03). The adjusted logistic regression model predicted that 72% (95% CI: 70% to 74%) of participants perceived the SDIL to be effective in 2017, 67% (95% CI: 65% to 69%) in 2018 and 67% (95% CI: 64% to 69%) in 2019. There was evidence that perceived effectiveness decreased a small amount in 2018 vs 2017 (OR: 0.78; 95% CI: 0.69 to 0.88). The difference in 2019 vs 2017 was similar.

CONCLUSIONS

We found high support for the SDIL among UK adults and this did not change between 4 months before implementation and 8 or 20 months after. While perceived effectiveness remained high, there was evidence that this decreased slightly after implementation in 2018, but no further in 2019. Greater understanding of influences on public acceptability of effective structural public health interventions is required.

Sydney's 'last drinks' laws: A content analysis of news media coverage of views and arguments about a preventive health policy

INTRODUCTION

News media representation of preventive health policies can influence public discussion and political decision making, impacting policy implementation and sustainability. This study analysed news media coverage of the contested 'last drinks' alcohol laws in Sydney, Australia, to understand the arguments made by different 'actors' (stakeholders) regarding the laws and provide insights on how preventive health policies are positioned within media discourse.

METHODS

We identified print and online news media articles discussing the laws from 2014 to 2020. Content analysis was used to quantify the arguments made to justify support or opposition to the laws.

RESULTS

A total of 445 articles were included for analysis. Four hundred and thirty-five actors were identified, with industry actors mentioned most (213 times) followed by health actors (136 times). There were more quotes from opponents of the laws compared to supporters of the laws (57% vs. 25%). The proportion of media mentions reduced for supporters (34% in 2014 to 14% in 2020) while mentions increased for opponents (47% in 2014 to 73% in 2020). Supporters used arguments about crime, safety and health. Opponents of the laws focused on issues such as Sydney's 'night time economy' and negative impacts of the laws.

DISCUSSION AND CONCLUSIONS

Opponents of the laws strategically used the media to influence public debate. Opponents, including industry actors, also ignored the health impacts of alcohol and utilised campaign groups to advocate against the laws. These findings have implications for how governments and advocates communicate and build support for contested preventive health policies.

SPINE20 A global advocacy group promoting evidence-based spine care of value

PURPOSE

The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits.

METHODS

The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted.

RESULTS

The areas of immediate concern were "Aging spine," "Future of spine care," "Spinal cord injuries," "Children and adolescent spine," "Spine-related disability," "Spine Educational Standards," "Patient safety," and "Burden on economy." Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the SPINE20.org website and during the virtual inaugural meeting November 10-11, 2020 held from the G20 platform.

CONCLUSIONS

This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence.

The Acceptability of Food Policies

We propose and test a model of food policy acceptability. The model is structured in four levels: government, topic, policy, and individual. In this study, we focus on two levels that are actionable for policy-makers: the topic and policy levels. We assess nine factors using a first online survey with 600 UK nationals and replicate our results in a second survey with 588 participants. Our results suggest that three factors have a positive effect on acceptability at the topic level: awareness of the issue, the legitimacy of state intervention, and social norms. At the policy level, we report a positive effect of the policy's expected effectiveness, its appropriate targeting of consumers, and the perceived support of the majority. On the other hand, more coercive interventions and those generating inequalities are judged to be less acceptable. Additionally, we report an interaction between awareness and coerciveness on acceptability. Participants who are aware of the issue were more likely to support coercive policies. We also find evidence for a trade-off between coerciveness, effectiveness, and acceptability, as more coercive measures are considered more effective, but less acceptable by participants. Our findings offer policy-makers, nutrition experts, and advocates for healthier and more sustainable diets a new and integrated understanding of the underlying factors that determine food policy acceptability.

Convergence of stakeholders' environmental threat perceptions following mass coral bleaching of the Great Barrier Reef

Managing human use of ecosystems in an era of rapid environmental change requires an understanding of diverse stakeholders' behaviors and perceptions to enable effective prioritization of actions to mitigate multiple threats. Specifically, research examining how threat perceptions are shared or diverge among stakeholder groups and how these can evolve through time is increasingly important. We investigated environmental threat perceptions related to Australia's Great Barrier Reef and explored their associations before and after consecutive years of mass coral bleaching. We used data from surveys of commercial fishers, tourism operators, and coastal residents (n = 5254) conducted in 2013 and 2017. Threats perceived as most serious differed substantially among groups before bleaching but were strongly aligned after bleaching. Climate change became the most frequently reported threat by all stakeholder groups following the coral bleaching events, and perceptions of fishing and poor water quality as threats also ranked high. Within each of the 3 stakeholder groups, fishers, tourism operators, and coastal residents, the prioritization of these 3 threats tended to diverge in 2013, but convergence occurred after bleaching. These results indicate an emergence of areas of agreement both within and across stakeholder groups. Changes in perceptions were likely influenced by high-profile environmental-disturbance events and media representations of threats. Our results provide insights into the plasticity of environmental-threat perceptions and highlight how their convergence in response to major events may create new opportunities for strategic public engagement and increasing support for management.

Dangerous liaisons: an online experiment on the role of scientific experts and politicians in ensuring public support for anti-COVID measures

The effectiveness of public health measures to prevent COVID-19 contagion has required less vulnerable citizens to pay an individual cost in terms of personal liberty infringement to protect more vulnerable groups. However, the close relationship between scientific experts and politicians in providing information on COVID-19 measures makes it difficult to understand which communication source was more effective in increasing pro-social behaviour. Here, we present an online experiment performed in May 2020, during the first wave of the pandemic on 1131 adult residents in Lombardy, Italy, one of the world's hardest hit regions. Results showed that when scientific experts recommended anti-contagion measures, participants were more sensitive to pro-social motivations, unlike whenever these measures were recommended by politicians and scientific experts together. Our findings suggest the importance of trusted sources in public communication during a pandemic.

Are perceptions of government intervention for prevention different by gender and age? Results from the AUStralian Perceptions Of Prevention Survey (AUSPOPS)

OBJECTIVES

Understanding public opinion and community attitudes is needed to help the implementation of chronic disease prevention policies that are acceptable to the population. The AUStralian Perceptions Of Prevention Survey ('AUSPOPS') is a national survey designed to provide evidence on the views of Australians regarding government intervention for prevention. However there is limited evidence whether age and gender have modifying effects on attitudes about prevention.

METHODS

Using results from the 2018 AUSPOPS dataset, this study examines whether the effect of age on attitudes about prevention is modified by the effect of gender. Survey questions included views about statements for government intervention and whether government had gone far enough for thirteen different preventive interventions.

RESULTS

2601 Australian residents aged 18 years or older participated in the survey (response rate 16.7%). Results showed strong support for prevention framed as a shared responsibility between governments and individuals. Interventions where >50% of respondents felt the government had not gone far enough in prevention were restricting unhealthy food advertising for children and setting salt limits on processed food. There were significant age by gender interactions in a small number (n = 4) of questions examining support for government intervention for prevention, suggesting young men were least in favour of more action by government.

CONCLUSIONS

There is general support in the Australian community for government intervention for prevention. Policymakers could capitalize on this sentiment by prioritizing policies with high levels of support across all groups, and target population subgroups on issues where acceptability appears to be heterogenous.

Impact of health warning labels on snack selection: An online experimental study

Excessive consumption of energy-dense food increases the risk of obesity, which in turn increases the risk of non-communicable diseases, including heart disease, type 2 diabetes and most non-smoking-related cancers. Health warning labels (HWLs) that communicate the adverse health consequences of excess energy consumption could reduce intake of energy-dense foods. The aim of the current study was to estimate the impact on selection of energy-dense snacks of (a) image-and-text HWLs (b) text-only HWLs and (c) calorie information. In a between-subjects, 3 (HWL: image-and-text, text-only, no label) x 2 (calorie information: present, absent), factorial experimental design, participants (N = 4134) were randomised to view a selection of energy-dense and non-energy-dense snacks with one of five label types or no label. The primary outcome was the proportion of participants selecting an energy-dense snack in a hypothetical vending machine task. The proportion of participants selecting an energy-dense snack was reduced in all label groups, relative to the no label group (no label: 59%; calories only: 54%; text-only HWL: 48%; text-only HWL with calories: 44%; image-and-text HWL: 37%; image-and-text HWL with calories: 38%). Compared to the no label group, participants were least likely to select an energy-dense snack in the image-and-text HWL group (OR = 0.46, 95%CI = 0.40, 0.54, p < 0.001). Health warning labels - particularly those including an image and text - have the potential to reduce selection of energy-dense snacks in an online setting. Their impact on selection and consumption in real-world settings awaits testing.

Communicating evidence about the environment's role in obesity and support for government policies to tackle obesity: a systematic review with meta-analysis

Public support for many policies that tackle obesity by changing environments is low. This may reflect commonly held causal beliefs about obesity, namely that it is due to failures of self-control rather than environmental influences. Several studies have sought to increase public support by changing these and similar causal beliefs, with mixed results. The current review is the first systematic synthesis of these studies. Searches of PsycInfo, Medline, Web of Science, Scopus, and Open Grey yielded 20 eligible studies (N = 8977) from 11,776 abstracts. Eligible studies were controlled experiments with an intervention group that communicated information about the environment’s role in obesity, and a measure of support for environment-based obesity policies. The protocol was prospectively registered on PROSPERO. Meta-analyses showed no evidence that communicating information about the environment’s influence on obesity changed policy support or the belief that the environment influences obesity. A likely explanation for this null effect is the ineffectiveness of interventions that were designed to change the belief that the environment influences obesity. The possibility remains, however, that the association observed between beliefs about the causes of obesity and attitudes towards obesity policies is correlational and not causal.

Communicating Evidence about the Causes of Obesity and Support for Obesity Policies: Two Population-Based Survey Experiments

Public support for numerous obesity policies is low, which is one barrier to their implementation. One reason for this low support is the tendency to ascribe obesity to failings of willpower as opposed to the environment. Correlational evidence supports this position. However, the experimental evidence is mixed. In two experimental studies, participants were randomised to receive no message, messages about the environment's influence on obesity (Study 1 & 2), or messages about the environment's influence on human behaviour (Study 1). We investigated whether communicating these messages changed support for obesity policies and beliefs about the causes of obesity. Participants were recruited from nationally representative samples in Great Britain (Study 1 & 2) and the USA (Study 2) (total n = 4391). Study 2 was designed to replicate existing research. Neither study found evidence that communicating the messages increased support for obesity policies or strengthened beliefs about the environment's role in obesity. Study 2, therefore, did not replicate two earlier experimental studies. Instead, the studies reported here suggest that people's beliefs about the causes of obesity are resistant to change in response to evidence and are, therefore, not a promising avenue to increase support for obesity policies.

Effects of messaging on public support for drug consumption rooms in scotland, UK

BACKGROUND

There is evidence to suggest that medically supervised drug consumption rooms (DCRs) may form part of responses to reduce drug-related harm. Although DCRs have been established globally, they are perceived by some to be a controversial approach in the UK, and Government has repeatedly rejected proposals to establish one in Glasgow, Scotland. As public support is an important component of policy development and enactment, we sought to investigate the effects of different types of message framing on public support for DCR.

METHODS

We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample. Participants were randomised to one of six message conditions comprising combinations of four components. All conditions included i) a basic description of a DCR, and conditions included combinations of ii) factual information; iii) pre-emptive refutation of common public concerns about DCR; and/or iv) a sympathetic narrative describing a mother whose son died from a heroin overdose. After reading each message, participants completed a bespoke measure assessing support for DCR. Data were analysed using ANCOVA.

RESULTS

Complete data were obtained from 1591 participants (50.3% Female; mean age 44.9 ± 16.1 years). Compared to reading a basic description of DCR alone, there was greater support for DCR in participants receiving the refutation (p < .001); sympathetic + factual (p < .05); and sympathetic + factual + refutation (p < .001) message conditions. Presenting factual or sympathetic messages alone were not associated with increased support.

CONCLUSION

Our findings suggest that public support for DCRs is not improved through communication of factual statements outlining potential benefits of the intervention alone. Advocates seeking to foster public support, and thus influence policy making, should also consider communication campaigns that address common concerns that the public might have about DCRs, and present the intervention in relation to potential benefits that they hold for people indirectly affected by drug-related harm.

Nutrition Policy and Individual Struggle to Eat Healthily: The Question of Public Support

The evidence for the effectiveness of nutrition policy interventions is growing. For the implementation of such interventions, social acceptability is crucial. Therefore, this study provides insight into public support for nutrition policy measures such as labelling and taxation. Further it analyses the level of acceptance in a quantitative segmentation approach. A new element to our approach is the comparison of different policy instruments, focusing on the interaction between policy acceptance and the perceived individual struggle to eat healthily. The survey was conducted in November 2017 and a total of 1035 German consumers are included in the data. The results indicate that the majority of German citizens accept nutrition policy interventions. Based on a cluster analysis, five different target groups according to the general acceptance of policy interventions and their own struggle to eat healthily are derived. The five-cluster solution reveals that both consumers who tend to eat a healthy diet as well as those who have problems with their diet support nutritional interventions. This shows that the perceived own struggle to eat healthily does not predict whether consumers accept nutrition policy interventions.